According to a Census Bureau report released last week, the City of New Orleans continues to rebuild.  The population of New Orleans fell drastically in the aftermath of Hurricane Katrina.  The good news is that New Orleans was the fastest growing city in the nation between July 1, 2006 and July 1, 2007; its population grew by 13.8 percent.  The bad news is that New Orleans may still have a long way to go.  On July 1, 2000, New Orleans had a population of 484,674.  On July 1, 2007, nearly two years after Katrina, its population was only 239,124, less than half its 2000 size.

As New Orleans continues its rebuilding process, getting an accurate census of the city in 2010 could prove critical to its future.  The data collected by the decennial census are used every year to determine the allocation of over $300 billion in federal dollars.  Census data are also used to allocate state funding for education and other programs.  But, with many areas of the City still undergoing major repairs and renovations, it may be hard to get an accurate count of those who have returned, particularly those living in temporary or shared residences. If the City is undercounted as a result, it could lose its fair share of federal and state funding.

For every community in the country, the decennial census is—or ought to be—a big deal.  That’s particularly true for New Orleans in 2010. “The Big Easy,” more than ever, needs a big count.

World Population Clock 6,709,117,382
As of 17:21 GMT (EST+5) Jul 10, 2008

Tomorrow, July 11, 2008, is World Population Day.  Last year the United Nations Population Fund (UNFPA) put the spotlight on urbanization, noting that 2008 would be the first year in which half the world's population lives in an urban setting.  This year’s theme, as announced by UNFPA, is “Family Planning: It’s a Right; Let’s Make it Real.” UN Secretary-General Ban Ki-Moon noted in a public statement released earlier this week that world leaders proclaimed more than 40 years ago that “individuals have a basic right to determine freely and responsibly the number and timing of their children.”  And although Millennium Development Goal 5 (improving maternal health) affirms this, Ban warned that the goal of providing family planning services to those who want them “shows the least progress to date.”  Ban’s public statement noted that:

The rate of death for women as they give birth remains the starkest indicator of the disparity between rich and poor, both within and among countries. We already know what needs to be done to meet the basic health needs of women throughout their life cycle, especially during the reproductive years, pregnancy and childbirth. There are three basic interventions necessary to improve maternal health: skilled attendance at the time of birth, facilities to provide emergency obstetric care and family planning.

Family planning is a fundamental component of reproductive health as it allows for determining the spacing of pregnancies. Studies show that family planning has immediate benefits for the lives and health of mothers and their infants. Ensuring basic access to family planning could reduce maternal deaths by a third and child deaths by as much as 20 per cent.

And yet the benefits of family planning remain out of reach for many, especially for those who often have the hardest time getting the information and services they need to plan their families, such as the poor, marginalized populations and young people. Demand will only increase, as more than one billion people ages 15-24 enter their reproductive years.

Ban called on donor nations to honor the commitments made at the 1994 Cairo Conference so that the maternal health goals of MDG 5 can be achieved by 2015.  The demand for contraceptives, however, is clearly growing. 

The “Family Planning Worldwide 2008 Data Sheet,” released earlier this year by the Population Reference Bureau showed the broad scope of the challenge.  In releasing the 2008 data sheet, PRB reported that:

In nearly all developing countries, the number of women of reproductive age (ages 15-49) will grow between 2005 and 2015 because of the large numbers of young people in these countries.  In addition, the demand for contraceptives is projected to grow due to couple’s desire for smaller families.  As a result, the total cost of contraceptives supplies to meet couple’s needs is projected to rise by nearly 50 percent (in today’s U.S. dollars) in countries such as Tanzania and Nepal.  The costs are certain to grow throughout the developing world, placing pressure on governments to increase their family planning budgets, raise additional donor funds, obtain better prices for commodities, and/or shift a greater share of costs to users.

Shifting costs to users, however, could force many couples to make do without modern methods of contraception. With grain and other food prices soaring to record levels in 2008, many of the world’s poorest are struggling just to feed themselves.  With an estimated 100 million people being driven deeper into poverty by the recent rise in food prices, many low-income families will not be able to pay for family planning services. As PRB noted in its report earlier this year:

Nearly everywhere, wealthier women are more likely to use modern contraceptives than poorer women.  The disparities in use between rich and poor are most pronounced in countries with low contraceptive use overall, such as in Uganda.  In countries such as Honduras, contraceptive use overall may rise, but the poor still lag behind.  The gap usually starts to close only when contraceptive use becomes widely available, such as in Colombia.

The United States and Europe have long been on different population trajectories, but a recent article by Gilles Pison of France’s National Institute of Demographic Studies (Institut national d’études démographiques) in Population and Societies takes a closer look at the differences:

The population of EU-25 is one and half times that of the United States: 463 million versus 296 million. But under the medium scenario of the United Nations projections, Europe’s population may decline to 460 million by 2050, while that of the United States will reach 402 million, 100 million more than today. Beyond that date, between 2060 and 2070, the European Union, in its 2005 configuration, may even be overtaken by the United States.

 

Pison notes that the “birth rate is much lower in the European Union than in the United States (10.5 births per 1,000 inhabit¬ants versus 14.0) and population growth much slower (4.4% versus 9.5%).   He also reports that immigration currently “accounts for 40% of population growth in the U.S. and about 100% of growth in Europe.”

Pison also looks at the differences in life expectancy.

The meaningful indicator for comparison is life expectancy at birth, which measures the risk of dying at each age. In 2005, European women lived almost one and a half years longer than their American counterparts – 82.0 years versus 80.4 – and for men the figures were 75.8 years and 75.2 years respectively. Yet in 1980, the situation was the reverse. Since then, life expectancy has in¬creased much more slowly in the United States, gaining 5.2 years for men compared with 6.0 years in Europe, and just 3.0 years for women versus 5.2 years in Europe. The American slowdown is espe¬cially marked among women, and the gap with respect to countries such as France, Spain or Italy is now more than 3 years.

In looking at the failure of the U.S .to match European gains in life expectancy, Pison conjectures that the difference may be attributable to the fact that “around 16% of the American population have no health insurance,” but he also cites the rising rate of obesity in the U.S. as another potential contributor.

Pison’s article does not address the implications of Europe’s low fertility rates and concerns about a “birth dearth,” but a New York Times Magazine cover story (“Childless Europe”) this past weekend asked the question, “What happens to a continent when it stops making babies?” The article provides some interesting perspectives, but no clear answer to the question: 

Those inclined to see the glass as half-full include some people who are closest to the numbers. James W. Vaupel, founding director of the Max Planck Institute for Demographic Research in Rostock, Germany, looking in particular at Germany’s demographic status, is downright sunny on the future. He, too, says that the shrinking and graying of European societies is inevitable, but he suggests that “on balance, the future will probably be better than the past. People will probably live longer, healthier lives. Continued economic growth, even if at a slower pace than in the past, will further raise standards of living.”

But Russo Shorto, the author of the article, also asked Carl Haub of the Population Reference Bureau for his perspective:

Haub wasn’t buying it. “Maybe tinkering with the retirement age and making other economic adjustments is good,” he said. “But you can’t go on forever with a total fertility rate of 1.2. If you compare the size of the 0-to-4 and 29-to-34 age groups in Spain and Italy right now, you see the younger is almost half the size of the older. You can’t keep going with a completely upside-down age distribution, with the pyramid standing on its point. You can’t have a country where everybody lives in a nursing home.”

When opinion leaders and policymakers talk about world population growth, they generally rely upon the “medium variant” projection issued by the UN’s Population Division.  In the UN’s 2006 Revision the “medium variant” shows global population growth rising to 9.2 billion by 2050.  That projection assumes however, that total fertility in all countries will converge eventually toward a level of 1.85 children per woman, though many countries will not reach that level by 2050. 

If fertility rates do not fall as fast as projected by the UN’s medium variant, world population (currently 6.7 billion) could exceed the projected 9.2 billion mark for 2050.  Earlier this month, the Census Bureau released the latest revision of its International Data Base (IDB).  Based on updated projections for 34 nations, the latest Census Bureau projection shows global population rising to 9.5 billion by 2050. 

The difference between the UN and Census Bureau’s projection for 2050 (9.2 billion vs. 9.5 billion) may not seem that large, but it’s important to remember that population growth has momentum.  Virtually everyone agrees that global population will, at some point in the 21st Century, stabilize and begin to decline.  But, when?  And at what level?

The latest Census Bureau report indicates that the rate of global population growth, currently about 1.2 percent per year, will decline in the next 42 years. Global population, however, will still be increasing by 0.5 percent a year by 2050.  That means that world population, currently growing by about 79 million people a year, would still be growing by close to 50 million people a year in 2050.

The Census Bureau's latest global population projection received virtually no coverage in the press.  But, as the debate grows about the role that population growth plays in climate change, the food crisis, and resource depletion, you can expect more attention will be paid to these projections—and their underlying assumptions.  Stay tuned.

A report (“International Energy Outlook 2008”) released this week by the Energy Information Agency (EIA) raises some provocative questions regarding the world’s energy future.  With global population, currently 6.7 billion, projected to reach 8.3 billion by 2030, how will the world’s demand for energy be met?  And at what price?

The EIA's report outlines two scenarios.  Under the “reference case” scenario, where current laws and policies remain unchanged, world energy consumption “driven by robust economic growth and expanding populations in the world’s developing countries.” is projected to grow by 50 percent between 2005 and 2030.

But the reference case assumes that world oil prices will decline to around $70 per barrel in 2015, then rise steadily to $113 per barrel in 2030 ($70 per barrel in inflation-adjusted 2006 dollars).

The report, however, includes an alternative “high price case,” in which world oil prices in 2030—at $186 per barrel in nominal terms—are nearly 65 percent higher than projected in the reference case.

So which price scenario is more likely? The EIA concedes “that world oil prices are on a path that more closely resembles the projection in the high price case than in the reference case.” 

Under the “high price” scenario, world consumption of oil and other liquid fuels “totals only 99.3 million barrels per day in 2030, 13 million barrels per day lower than in the reference case.”

This revised “high price” estimate represents a major revision in EIA thinking. Just six months ago, the EIA was projecting that global oil production would rise to 113 million barrels a day by 2030.  As current production levels are somewhere between 85 and 87 million barrels a day, acceptance of the “high price case” suggests that projected increases in liquid fuel production could be nearly 50 percent lower than anticipated just last year.

The EIA report says that the “composition of supply differs substantially between the reference and high price cases.”  Higher oil prices, in other words, would spur development of bio-fuels and other energy alternatives.

So how would the “high price” scenario affect total energy consumption?  Given the wide disparity in oil prices between the “reference case” and the “high price” scenario, one might expect that the higher prices would boost energy conservation and sharply reduce total energy consumption.  Not according to this report. 

In the “reference case,” the world’s total energy consumption rises at an annual rate of 1.6 percent a year between 2005 and 2030. In the “high price” scenario, total energy consumption still rises at 1.5 percent a year. 

The EIA report appears to indicate that even in the developing world, higher oil prices will not dampen demand for energy.  In the “high price” scenario total energy consumption in Africa increases at an annual rate of 1.9 percent a year between 2005 and 2030, only slightly lower than the rate of 2.0 percent a year in the “reference case” scenario.  In Central and South America (excluding Brazil), total energy consumption under the “high price” energy scenario rises at 1.5 percent a year, only slightly less than the 1.7 percent a year increase that occurs in the “reference case.”

It would be comforting to believe that world energy needs—particularly the needs of the developing world—will be met whether or not the price of oil goes to $186 a barrel by 2030.  But if global oil production is going to peak at less than 100 million barrels—and a growing number of experts believe that it will peak well below that level—the impact on developing world could be severe.  Higher oil prices will translate into higher prices for other forms of energy, including coal and natural gas.  In the developed world, higher energy prices means it costs more to drive your car and air condition your home.  In much of the developing world, energy needs are more basic. Higher energy prices mean that it costs more to fertilize fields and harvest and transport crops to market. 

How rising energy prices will affect poor countries with rapidly growing populations is a matter of enormous concern.  This is an area that needs further research. The EIA report may not be the last word.

With the flooding in the Midwest and corn and oil prices soaring to record levels, it would be easy to overlook the issue of water shortages. Easy, perhaps, but short-sighted.  Of all the population-related challenges that policymakers face in the 21st Century, water is perhaps the greatest.

Warning of a global water crisis, Peter Brabeck-Letmathe, the chairman of Nestle SA, the world largest food country, told the World Economic Forum on East Asia on Monday that, “We will run out of water before we run out of oil.” He noted that, “three parts of the world no longer send water into the sea.”  Yesterday, the National Oceanic and Atmospheric Administration released a report on climate change that there is growing scientific evidence suggesting that droughts and excessive heat in the U.S. and the world "are likely to become more commonplace as humans continue to increase the atmospheric concentrations of heat-trapping greenhouse gases."

Seven hundred million people today live in countries experiencing water stress or scarcity.  By 2035, the World Bank projects that 3 billion people, more than one third of the world’s population, will be affected by severe water stress.  With many countries sharing water supplies, experts warn that disputes over water in the Middle East and elsewhere could lead to international conflict. 

The FAO reports that most countries in the Near East and North Africa suffer from acute water scarcity.  So do countries like China, India, Mexico, Pakistan, and South Africa. Population growth, urbanization, and climate change pose an enormous challenge to these areas and other. According to the FAO, one in five people in the developing world presently lacks access to the daily twenty litres of water deemed necessary for human survival. 

Water is particularly is particularly critical to food production (and production of biofuels).  Global population is expected to reach 8.1 billion by 2030. If the farmers of the world needs to produce 50% more food by 2030 as the U.N. Secretary General recently indicated, the FAO indicates that 14 percent more freshwater will need to be withdrawn for agricultural purposes in the next 30 years.

But under a “business as usual” scenario the International Food Policy Research Institute projects, by 2025, that: 

• Water scarcity will cause annual global losses of 350 million metric tons of food production-slightly more than the entire current U.S. grain crop.
• Consumption of water for all nonirrigation uses will rise dramatically, by 62 percent.
• Household water use will increase by 71 percent, of which more than 90 percent will be in developing countries, but many households will remain unconnected to piped water.
• Industrial water demand will increase significantly in developing countries and, by 2025, a major shift will occur: industrial water demand in the developing world will exceed the demand in developed countries.
• Water scarcity will cause substantial shifts in where the world's food is grown. Developing countries will dramatically increase their reliance on food imports. In sub-Saharan Africa, grain imports will more than triple. Poor countries, unable to finance imports, will experience increased hunger and malnutrition.

The U.S. is also impacted by water shortages.  Indeed, the fastest growing regions of the United States (the West, the Southwest, and the Southeast) are all struggling with water problems. 

Earlier this month, Gov. Schwarzenegger declared an official statewide drought, the first such declaration since 1991.  A recent New York Times story (“Water-Starved California Slows”) reports that building projects in California are being curtailed for the first time because developers are unable, as required by state law, to secure a 20-year water supply as a condition of building. The article reports that:

An eight-year drought in the Colorado River basin has greatly impinged on water supply to Southern California. Of the roughly 1.25 million acre-feet of water that the region normally imports from that river toward the 4.5 million acre-feet it uses each year, 500,000 has been lost to drought, said Jeff Kightlinger, the general manager of the Metropolitan Water District of Southern California.

California’s population, currently 37 million, is projected to grow to 45 million by 2020 and to 60 million by 2050, but water restrictions could make that more difficult.  It could also make it more challenging for farmers. California’s breadbasket, the Central Valley, is also the fastest growing part of the state.  Concerns are mounting that farmers in the Central Valley will have to curtail irrigation (and production) due to the drought and increased demands of residential water users.

Food and fuel prices may grab all the headlines, but policymakers—here and abroad—should not take their eyes off the water problem.  Next month, the Population Resource Center will be hosting a policy roundtable on Capitol Hill looking at how projected population growth rates in the West and the Southwest are posing a growing challenge to water resource managers in the region.

At a time when concerns are mounting regarding food, fuel and the economy, a little good news is always welcome.  The CDC’s National Center for Health Statistics (NCHS) gave us some of welcome news this past week.  NCHS released preliminary data on deaths for 2006 indicating that age-adjusted death rates in the United States fell significantly between 2005 and 2006, while life expectancy hit another record high.  NCHS reported that:  

The 2006 age-adjusted death rate fell to 776.4 deaths per 100,000 population from 799 deaths per 100,000 in 2005. In addition, death rates for 8 of the 10 leading causes of death in the United States all dropped significantly in 2006, including a very sharp drop in mortality from influenza and pneumonia. 

The report also found:

Life expectancy at birth hit a new record high in 2006 of 78.1 years, a 0.3 increase from 2005. Record high life expectancy was recorded for both white males and black males (76 years and 70 years, respectively) as well as for white females and black females (81 years and 76.9 years). The preliminary number of deaths in the United States in 2006 was 2,425,900, a 22,117 decrease from the 2005 total. With a rapidly growing older population, declines in the number of deaths (as opposed to death rates) are unusual, and the 2006 decline is likely the result of more mild influenza mortality in 2006 compared with 2005. 

It appears that progress is being made on a number of health fronts:  

Between 2005 and 2006, the largest decline in age-adjusted death rates occurred for influenza and pneumonia, with a 12.8 percent decline. Other declines were observed for chronic lower respiratory diseases (6.5 percent), stroke (6.4 percent), heart disease (5.5 percent), diabetes (5.3 percent), hypertension (5 percent), chronic liver disease and cirrhosis (3.3 percent), suicide (2.8 percent), septicemia or blood poisoning (2.7 percent), cancer (1.6 percent) and accidents (1.5 percent). There were an estimated 12,045 deaths from HIV/AIDS in 2006, and age-adjusted death rates from the disease declined 4.8% from 2005. 

Despite the progress in these areas, the U.S. still ranks 29th in life expectancy among the United Nations' member nations.   Nations, like Japan, Sweden, Australia and Switzerland still lead us by 3-4 years, and most countries in Europe lead us by 2-3 years.  The U.S. is also plagued by large disparities in life expectancy.  As reported in an earlier PRC blog (April 30, 2008), two recent studies reveal disturbing disparities between the life expectancy whites and blacks.  And the life expectancy of lower socio-economic groups still lags far behind higher socio-economic groups.  One study also reported that not all Americans are living longer; life expectancy in some areas of the country is actually declining.

The NCHS report also showed that the  “infant mortality rate for 2006 was 6.7 infant deaths per 1,000 live births, a 2.3 percent decline from the 2005 rate of 6.9.” But despite the progress in reducing infant mortality, a less encouraging report on children was issued this past week by the Annie E. Casey Foundation.  Its Kids Count report found that in 2005, 8.2 percent of U.S. babies were born at low birth weight, the lowest level since 1968.   In various press reports, Laura Beavers, coordinator of the Kids Count project, is quoted as saying the increase in low birth weights was due, in part, to a rise in multiple births and a growing number of premature births.  The foundation report also found significant health disparities: the increase in low-weight birth was significantly higher for blacks (13.6%) than for white (7.3%) or Hispanics (6.9%). 

The Kids Count report, which looked at ten broad indicators of child well-being [child death rate, teen death rate, teen birthrate, high school dropout rate, teens not in school and not working, infant mortality rate, low-birth weight babies, children living with jobless or underemployed parents, children in poverty, and children in single-parent families], gave a somewhat mixed review of the overall picture for children.  The report noted that:  

Some dimensions of well-being improved, some worsened, and some showed little change. However, the overriding picture that these 10 indicators present is one of little change since 2000.  At the national level, 5 of the 10 indicators of child well-being showed that conditions improved since 2000, while child well-being worsened on 4 indicators and stayed the same on 1 indicator. It should be noted, however, that many of these changes were very small and may be random fluctuations in the data. The three areas where measures have worsened (in addition to low-birth weight babies) are: children living in families where no parent has full time year round employment, children in poverty, and children in single parent families.  

The Annie E. Casey Foundation’s report emphasized that progress on improving child well-being has stalled in recent years:  

The portrait of change in child well-being since 2000 stands in stark contrast to the period just prior to 2000. Between 1996 and 2000, 8 of the 10 key indicators used in KIDS COUNT improved, and several improved dramatically. The improvement was experienced by every major racial group and in nearly all of the states.

Pre- and post-2000 trends are clearly illustrated by changes in the rate of child poverty since the mid-1990s. Between 1994 and 2000, the child poverty rate fell by 30 percent. This was the largest decrease in child poverty since the 1960s. Since 2000, however, improvements have stalled. In fact, the child poverty rate has increased by 6 percent, meaning 1 million more children in poverty in 2006 than in 2000.

While the financing of health care is likely to be a hotly debated issue in the upcoming president, too little attention is likely to be paid to one of the greatest challenges we face related to an aging, still growing America: a shortage of trained medical personnel.

Two months ago, the Institute of Medicine released a report (“Retooling for an Aging America: Building the Health Care Workforce”) that raised alarm about a growing shortage of doctors and nurses certified in geriatrics. At present, there are only 7,100 geriatricians (physicians) in the United States - one per every 2,500 older Americans - and less than 1 percent of registered nurses are certified in geriatrics.  The study, which was conducted by IOM’s ad hoc Committee on the Future Health Care Workforce for Older Americans, looked at the health care needs of Americans over 65 years of age. 

The IOM report notes that:

The number of older adults in the United States will almost double between 2005 and 2030, and the nation is not prepared to meet their social and health care needs. The baby boomer generation starts to turn 65 in 2011, which will create multiple challenges for the health care system. For one, the majority of older adults suffer from at least one chronic condition and rely on health care services far more than other segments of the population. Additionally, this generation of older adults will be the most diverse the nation has ever seen….. Another problem is the dramatic shortage of all types of health care workers, especially those in long-term care settings. Finally, the overall health care workforce is inadequately trained to care for older adults.

The report's conclusion warns that:

The impending crisis, which has been foreseen for decades, is now upon us.  The nation needs to act now to prepare the health care workforce to meet the care needs of older adults.  If current reimbursement policies and workforce trends continue, the nation will continue to fail to ensure that every older American is able to receive high-quality care.  The dramatically rising number of older Americans, along with changes in their demographic characteristics, health needs, and settings of care will necessitate transformations related to the education, training, recruitment, and retention of the health care workforce serving older adults.

But it’s not just the lack of geriatricians and nurses certified in geriatrics that should concern policymakers.  Many of the states that are ‘aging’ rapidly are also growing rapidly.  For example, the population of the country’s most populous state, California, is projected to grow from 33.9 million in 2000 to 46.4 million by 2030.  During that same time period, the percentage of Californians aged 65 and over is expected to increase from 10 percent to 17.5 percent.  That means that the number of Californians between 2000 and 2030 will increase by just over one-third and the number of Californians over the age of 65 will jump by nearly two-thirds.

States that are aging and growing face a double challenge. Arizona, the second fastest growing state in 2007, is another one of those ‘aging and growing’ states.  A study just completed by the Arizona Healthcare Workforce Data Center concluded that Arizona will need an additional 49,000 registered nurses over the next nine years to keep pace with Arizona's projected population growth.  And Arizona, the report indicates, already has a shortage of registered nurses, just 681 registered nurses per 100,000 people compared with the national average of 825 registered nurses per 100,000.

The problem in Arizona is not necessarily a lack of people interested in nursing; it’s a lack of teachers and classroom space according to a story that appear in the Arizona Republic.  And Arizona is not alone in this challenge.

The new IOM report indicates that by 2030 America will need an additional 3.5 million health care providers just to “maintain the current ratio of providers to the total poplation.”  That number is a very conservative estimate. As the IOM report stresses, that number does not take into account that older Americans require more health care services and that, as America ages, the ratio of providers to the total population should rise and so should the ratio of geriatricians to other health care specialties.

As important as it is to provide health care coverage to the more than 40 million Americans who lack health insurance coverage, let’s hope that policymakers at all levels will also give more attention to the future of America’s healthcare workforce.

Last week, on the eve of this week's high-level conference on world food security in Rome, the UN's Food and Agriculture Organization (FAO) and the Organization of Economic Cooperation and Development released a report (Agricultural Outlook 2008-2017) on the food crisis that concluded that grain prices may recede from their record highs, but warned that there are "...permanent factors underpinning prices that will work to keep them at higher average levels than in the past."

One of those "permanent factors" is population. The report noted that:

Population dynamics are important determinants of the future global economic environment, directly affecting demand for agricultural commodities. Population growth over the next decade will decline relative to the last 10 years to an average of 1.1% annually to reach approximately 7.4 billion in 2017. The fastest population growth is expected in Africa (annual average above 2%), whereas in Europe, population is expected to essentially stabilise over the coming decade.

Population growth is most pronounced in what the FAO classifies as the Low-Income Food-Deficit Countries (LIFDCs). The danger, of course, is that the rapidly growing LIFDCs will not be able to feed their populations if food prices remain high. In the past year, food riots have broken out in more than a dozen LIFDCs and more riots are anticipated unless grain prices retreat from their record highs.

Last week's FAO/OECD forecast predicted that food prices:

....over the medium term will average substantially above the levels that prevailed in the past 10 years. When the average for 2008 to 2017 is compared with that over 1998 to 2007, beef and pork prices may be some 20% higher; raw and white sugar around 30%; wheat, maize and skim milk powder 40 to 60%; butter and oilseeds more than 60% and vegetable oils over 80%. Over the Outlook period, prices will resume their decline in real terms, albeit at a slower rate. However, the impact of various supply and demand factors on prices will differ across commodities.

....prices may also be more volatile than in the past: stock levels are not expected to be replenished substantially over the Outlook; demand is becoming less sensitive to price changes at the farm level as the commodity share in the final food bill falls and as industrial demand grows; weather conditions and agricultural product supply may become more variable with climate change; and speculative non-commercial investment funds enter or leave agricultural futures markets as profit opportunities dictate.

As sobering at that assessment is, it assumes that the price of oil will fall substantially in the years ahead:

The world oil price assumption underlying this year’s Agricultural Outlook is based on that published in the OECD Economic Outlook n° 82 (December 2007). It assumes prices to slowly increase over the outlook period from USD 90 per barrel in 2008 to USD 104 per barrel by 2017.

In light of the recent spike in oil prices, how realistic is that December 2007 forecast? Long-term futures contracts for delivery oil in 2015 are presently running at about $140 per barrel, substantially above the assumption used in last week's FAO/OECD report. An analyst for Goldman Sachs said last week that oil prices could average $200 a barrel next year. Higher energy prices will translate into higher than anticipated prices for fertilizer and will, likewise, boost the cost of cultivating and transporting crops. Higher energy prices will also boost the growing demand for biofuels and lead to further diversion of croplands to fuel production.

For the foreseeable future, it appears that global food security may be less than secure. Let's see what comes out of the food summit that convened today in Rome.

For decades now, economists and demographers have studied the economic boost (often called the “demographic dividend”) that can occur when a nation’s fertility rate falls and the youth dependency rate declines. 

The term “demographic dividend” is never used, but the final report ("The Growth Report: Strategies for Sustained Growth and Inclusive Development") of the Commission on Growth and Development gives us another perspective on the relationship between population change and economic development.

The Commission, an independent group of policy makers, business leaders and scholars, supported by the World Bank, the Hewlett Foundation, and the governments of Australia, Netherlands, Sweden, and the United Kingdom, released its report in late May.

The Commission examined 13 economies that since 1950 have grown at an average rate of seven percent a year or more for 25 years or longer.  At that rate, an economy nearly doubles in size every decade.   The 13 “economic miracles” were: Botswana, Brazil, China, Hong Kong (China), Indonesia, Japan, the Republic of Korea, Malaysia, Malta, Oman, Singapore, Taiwan (China), and Thailand.  The report identified several factors that accounted for these strong economic performances, including high rates of savings and investments and reliance on market mechanisms. 

While the report did not highlight possible demographic factors, all of these countries underwent a significant demographic transition in the last half century.  The total fertility rate in all but two of the countries (Botswana and Oman) is below 3.0 today  Most of them have a total fertility rate today that is below the “replacement rate” needed to maintain population growth.

The Commission did not directly address the possible role of family planning in helping to achieve sustained economic growth, but the report did talk about birth rates and the importance of educating girls:

The education of girls provides one strong test of a government’s commitment to equality of opportunity. Many formidable obstacles stop girls completing their schooling: family financial pressure, lack of safety, even things as basic as inadequate toilet facilities. But if these obstacles can be overcome, the payoff is very high. Educated women have fewer, healthier children, and they have them at older ages. Their children are then more successful in school, largely because they benefit from their mother’s education. Educating girls and integrating them into the labor force is thus one way to break an intergenerational cycle of poverty.

After evaluating these and other reasons for the success of these 13 “economic miracles,” the Commission looked at future economic growth prospects and again touched on demographic factors. 

With respect to the growth prospects of economies with aging populations, the Commission offered a cautiously upbeat appraisal:

Aging societies account for about 70 percent of global GDP, large enough to be significant. As their populations gray, must their economic growth slow? According to simple arithmetic, if the number of working-age adults stagnates or falls, and the number of retirees increases, this must surely squeeze income per head. There are fewer people to earn the income, but no fewer people to divide it among.

But this gloomy projection assumes that the definition of “working-age” remains the same as it does today. That is unlikely to be true. In many countries and regions (including most of Europe, North America, Japan, and China), the graying of the population threatens the solvency of the country’s pension arrangements. As a result, reforms are needed to extend the working life in these countries, or to give people a different set of choices with respect to retirement, income, and consumption before and after retirement.

The current fixed retirement ages cannot survive. Thus the reforms needed to restore the fiscal viability of many national pension systems will also change the length and pattern of working lives. If these reforms are undertaken gradually, as we expect, then the research suggests there is no compelling reason to expect a major slowdown in global growth.

The Commission, however, raised a few warning flags about the growth prospects of countries with younger demographic profiles: 

Aging is mostly a problem for the richer countries but does include China. Many of the world’s least developed countries have the opposite problem. Populations are young, and in countries ravaged by diseases like HIV/AIDs, the “anti-aging effect” is dramatic.

As a result, some countries have millions of young people leaving school and entering job markets that cannot absorb them. Moreover, as new entrants to the labor force, youth are often at a disadvantage to more experienced workers. The result is a worrying youth unemployment problem. It is a predicament that goes well beyond economics, posing a moral challenge and a security risk. And it is very widespread.

In some areas, even very high growth rates will not be quick enough to absorb the forecast labor supply. The numbers are striking. From now until 2050, the world is projected to add 3 billion people. Only 100 million will be in rich countries. One billion will be in fast-developing countries, like India and China. The remainder, which is to say two-thirds of the world’s population increase, will be added in countries that do not yet have a solid track record of growth. Thus, the supply of labor is not where the jobs are being created.

This demographic problem cannot be solved by individual countries alone. The solution will have to span national boundaries. For many countries, it is clear to us, migration for purposes of work is the only potential solution. Workers will have to move from countries where labor is abundant to countries where it is scarce. Migration for work needs international supervision to prevent abuses in the treatment of mobile labor.

Unfortunately, many of the papers written for the Commission were completed before the latest round of commodity price shocks. The report, however, did allude to the challenge posed by rising commodity prices:

One big question remains. Do these rising prices mark the beginning of a period in which natural resources, broadly defined, impose new limits on global growth? It is possible. Growth, both globally and in developing countries, may be somewhat slower than the pace set in the recent past. But it is not possible to know in advance how tight the new limits might be.

That is a big question, too big in fact to receive so little attention in this report.  The 13 economic success stories profiled by the Commission’s report occurred, for the most part, during a time of rapidly expanding oil production and sharp increases in agricultural production.  If global oil output stagnates and/or global food production fails to keep up with the world’s growing appetite for food, “economic miracles” may be a lot harder to come by in the future.

With the price of oil breaking new records amid projections that oil could soon reach $200 a barrel, it’s not surprising that the national security community is concerned about the rising price of food and fuel and its impact on political stability. More surprising perhaps, the connection is also being drawn to population.

In the past year, riots over food and energy prices have broken out in more than a dozen countries, most recently in South Africa.  Foreign policy experts are concerned that the rising cost of food and fuel could destabilize conditions in current-day hotspots like Somalia, Afghanistan, and Pakistan, and in potential hotspots like Egypt, Jordan, and the Philippines.

In the short-term, emergency food shipments by the U.N.’s World Food Programme can help defuse the food crisis, but there is a growing concern in the foreign policy community that population growth in countries already struggling to feed themselves could lead to chronic unrest as the food crisis worsens. 

Earlier this year the U.N.’s Food and Agriculture Organization (FAO), listed 36 nations as “Countries in Crisis Requiring External Assistance.” The population of these 36 nations, currently 1.1 billion, is expected to rise to 1.5 billion by 2025 and 2.0 billion by 2050.
 
Three weeks ago, in a speech delivered at Kansas State University, CIA Director General Michael V. Hayden warned that:

Today, there are 6.7 billion people sharing the planet. By mid-century—by mid-century, the best estimates point to a world population of more than 9 billion. That’s a 40 to 45 percent increase—striking enough—but most of that growth is almost certain to occur in countries least able to sustain it, and that will create a situation that will likely fuel instability and extremism—not just in those areas, but beyond them as well.

There are many poor, fragile states where governance is actually difficult today, where populations will grow rapidly: Afghanistan, Liberia, Niger, the Democratic Republic of the Congo. That group—the population is expected to triple by mid-century. The number of people in Ethiopia, Nigeria, and Yemen is likely to more than double. Furthermore—just beyond the raw numbers—all those countries will therefore have, as a result of this, a large concentration of young people. If their basic freedoms and basic needs—food, housing, education, employment—are not met, they could be easily attracted to violence, civil unrest, and extremism.

And through the fact of global migration, this impact of rapid population growth in Africa or Southeast Asia and elsewhere is not going to be confined to those places. It will be felt in the developed world as well. Millions of young people from fast-growing, poorly developed countries will emigrate—legally and illegally—in search of economic opportunity, security, or political freedom.

Last week, an article written by Lee Hudson Teslik at the Council on Foreign Relations also warned about the threat posed by population pressures:

"The wars of the twenty-first century will be fought over parking spaces." So writes Suketu Mehta in his recent portrait of Mumbai, a city pushing the limits of overpopulation, struggling with sewage overflows, and clawing for limited electricity, water, and gas supplies. The wars Mehta predicts in fact are well under way. Easily missed in the clamor over the spiking prices of oil, natural gas, coal, iron, aluminum, copper, and a long list of other commodities (WSJ)—not to mention shortages of wheat, rice, flour, and other basic foodstuffs—is that population pressures weigh on the availability of all these goods.

Like the CIA Director’s speech, Teslik’s article expresses concern about global population growth projections:

Currently, some 6.6 billion humans inhabit the Earth. By 2050, experts say that number will likely hit 9 billion. The rate of global population growth has abated in recent years, and some regions, mostly in the developed world, even fear population decline (Foreign Affairs). But global population growth remains a long-term dilemma for producers of food, energy, and raw materials. At current levels, there are almost two-and-a-half times as many people in the world as there were in 1950, when global population sat around 2.5 billion. The world has largely been able to make up for this growth through increased efficiency, and by finding new sources for materials. Substantial gains have been made against global hunger...though international targets for hunger reduction remain unmet….

….Projections from the International Food Policy Research Institute show the world's need for food rising significantly in the first two decades of the twenty-first century. The prominent academic Jared Diamond says demand problems could be exacerbated as consumption rates rise in the developing world, as seems likely. Improvements in agricultural efficiency may continue, but at some point they will be limited by physical factors. One acre, however efficiently it is cultivated, can only grow so much food.

Emerging security concerns about population trends are not limited to population growth.  As Gen. Hayden noted in his Kansas speech, in some areas of the world a shrinking population poses security concerns:

Another example of demographics: Russia, which faces a different kind of demographic stress. In the next four decades, we expect Russia—the population of Russia—to shrink by 32 million people. That means Russia will lose about a quarter of its population. To sustain its economy, Russia increasingly will have to look elsewhere for workers. Now some of them—some of them will be immigrant Russians coming from the former Soviet states, what the Russians call the near abroad. But there aren’t enough of them to make up that population loss. Others will be Chinese and non-Russians from the Caucasus, Central Asia and elsewhere, potentially aggravating Russia’s already uneasy racial and religious tensions.

Population trends, of course, have always played a role in world events, but as Gen. Hayden emphasized in his speech, they may take center stage in the 21st Century.

The recent calamities in Myanmar and China are stark reminders that—despite advances in the detection and mitigation of natural disasters—many people in the world still live in harm’s way.

The threats posed by tsunamis, earthquakes and other natural disasters are as old as the world, but the world is constantly changing.  Despite declining fertility rates, global population continues to rise and it’s rising fastest in some of the more disaster-prone areas of the world. 

The cyclone that devastated Myanmar may or may not be related to climate change, but climate change is expected to intensify cyclones and typhoons in South Asia.  The fourth assessment report of the UN’s Intergovernmental Panel on Climate Change (IPCC), released late last year, noted that: 

Recent studies indicate that the frequency and intensity of tropical cyclones originating in the Pacific have increased over the last few decades (Fan and Li, 2005). In contrast, cyclones originating from the Bay of Bengal and Arabian Sea have been noted to decrease since 1970 but the intensity has increased (Lal, 2001). In both cases, the damage caused by intense cyclones has risen significantly in the affected countries, particularly India, China, Philippines, Japan, Vietnam and Cambodia, Iran and Tibetan Plateau (PAGASA, 2001; ABI,2005; GCOS, 2005a, b).

The IPCC report predicted that: 

Countries in temperate and tropical Asia are likely to have increased exposure to extreme events, including forest die back and increased fire risk, typhoons and tropical storms, floods and landslides, and severe vector-borne diseases.

South Asia is not the only part of the world that is affected by rising oceans and increased storm activity. The Organization for Economic Cooperation and Development (OECD) released a study last December that estimated the exposure of 136 of the world’s largest port cities to coastal flooding. The study concluded that the number of people in these 136 cities (each with a population of one million or higher) that are currently exposed to a 1 in 100-year coastal flood event will more than triple by 2070.  At present, about 40 million people are at risk.  By 2070, the number will rise to about 150 million due to the “combined effects of climate change (sea-level rise and increased storminess), subsidence, population growth and urbanization.”

The OECD report also found that “asset exposure could grow even more dramatically,” reaching $35 trillion by the 2070s, “more than ten times current levels and rising to roughly 9% of projected global GDP.”The report concluded that even if cities adopt high levels of protection in the future, “the large exposure in terms of population and assets is likely to translate into regular city-scale disasters across the global scale.”  The report went on to say that, “The policy implications of this report are clear: the benefits of climate change policies – both global mitigation and local adaptation at the city-scale – are potentially great.”

Population change, particularly increasing urbanization, may also be exposing more people to the threat of earthquakes.  This year marks the first time in history that half of the world’s population lives in an urban environment. While urbanization entails some potential benefits, it also heightens certain risks. GeoHazards International, a nonprofit research group seeking to reduce suffering due to natural disasters, issued a statement (“Trends in Global Urban Earthquake Risk: A Call to the International Earth Science and Earthquake Engineering Communities”) a few years back, that warned:

Urban earthquake risk in poor countries is large and rapidly growing. Fifty years ago, the population of the world’s largest earthquake-threatened cities was equally divided between rich and poor countries. Today, there are five times as many people in poor as in rich earthquake-threatened cities. Fifty years ago, the earthquake resistance of buildings in rich countries was better than that of buildings in poor countries, and since then it has steadily improved, while that in poor countries has steadily worsened. Data of the U.S. Office of Foreign Disaster Assistance indicate that the average number of deaths resulting from fatal earthquakes in rich countries decreased by about a factor of 10 between the first half of the 20th century and the last half. This improvement in seismic safety is presumably the result of, among other things, better building and land-use codes and better enforcement of those codes. By contrast, there are indications that earthquakes in developing countries will increase their lethality in the future.

The 2004 statement went on to note:

The future does not look better. In the next 20 years, the world’s population will increase by 2 billion. Of that 2 billion, only 50 million will be added to industrialized countries, the rest to developing countries. Because of internal migration, from the countryside to cities, the urban population of developing countries will increase by itself by 2 billion people over this period. Imagine that in the next 20 years the combined population of today’s India and China will be added to such cities as Algiers, Cairo, Istanbul,Ankara, Aleppo, Teheran, Tabriz, Mashed, Kabul, Quetta, Rawalapindi, Delhi, Calcutta, Dhaka,Yangon, Manila, Jakarta, Mexico City, Guatemala City, Bogotá, Quito, and Lima. Recall that the 8th World Conference on Earthquake Engineering occurred only 20 years ago. In that same amount of time, 2 billion people will appear in some of the world’s poorest cities and will need places to live, learn, and work. Given the lack of resources and the urgency to build, the quality of construction will, unless something changes quickly, continue to decline.

As these and other statements suggest, various population trends—including population growth, urbanization, and the growing number of people living in coastal regions—pose a significant challenge to governments and international institutions seeking to mitigate the death toll resulting from large natural disasters.  That’s why understanding these demographic trends—their magnitude and their implications—becomes ever more important to policymakers around the world.

The African Development Bank (AfDB) is hosting its annual meeting this week in Maputo, Mozambique.  The Ministerial Round Table Discussions is the key event of the Annual Meetings Seminars, taking place a day before the formal opening of the Bank Group Annual Meetings. The theme of this year’s plenary session is “Fostering Shared Growth: Urbanization, Inequalities and Poverty in Africa.”   

As concerns mount about the impact of rising food prices on Africa’s poor, particularly its urban poor, AfDB reported today that: 

Strong urban economies form the base of the wealth of many nations. Yet over the last half century, Africa has experienced rapid urban growth, even as long-term economic growth has remained stagnant, and even declined in some decades. It is estimated that the continent’s cities and towns will absorb another 12-13 million people in 2008, with the urban population outpacing rural population from about 2035. While inequalities between cities and the countryside appear to be narrowing, the differences between the rich and the poor are becoming more conspicuous as unhealthy, overcrowded slums grow. More than 250 million people—or around 60% of the urban population—live precariously in these settlements, and, if present trends continue, the number of slum dwellers will grow to over 350 million by 2020.

The AfDB also reported that:

In his speech at the plenary session, AfDB President, Donald Kaberuka, highlighted the difference between urban and rural poverty, explaining that while majority of Africans living below the poverty datum were rural dwellers, the living conditions of the urban poor were dire and remained a major challenge to development and urbanization, as demonstrated by recent food riots in some African cities and beyond.

 “Our determination to fight poverty everywhere must be, and is an inclusive one. It targets all those who are part of the “bottom million” and these include the urban poor,” Mr. Kaberuka said, noting that internal migration to urban areas would increase rather than decrease.

This week's AfDB meeting comes on the heels of another conference held in Austria last week on "Forging a Uniquely African Green Revolution." In addressing the conference,   Kofi Annan, former Secretary-General of United Nations (UN) expressed concern over the impact of the ‘world food crisis’ on Africa.  He warned that the unfolding food crisis:

.....may roll-back the progress that has been achieved by African countries in the last decade.The solution to the food crisis in Africa today is to stimulate a domestic supply response to raise food production. If ever there was a time for an African Green Revolution, it is now. The time for talk is over. We must implement immediate solutions for today’s crisis, and do so in the context of a long-term concerted effort to transform smallholder agriculture, to increase productivity and sustainability, and end poverty and hunger.

As the global food crisis intensifies, so will the debate over its origins. Several factors account for the emerging international food crisis, including rising energy prices, a drought in Australia, and the conversion of cropland to biomass production. More recently, hoarding of grains and financial speculation in grain commodity prices have exacerbated the rise in food commodity prices. But policymakers should not overlook the role that population growth and other demographic trends play in increasing the world's appetite for food.

A drop in oil prices or a good harvest in Australia might offer some short-term relief from skyrocketing food prices, but demographic trends are slow to change and likely to make high food prices a concern for years and possibly decades to come.

The World Bank reports that over the last forty years demand for food in developing countries has increased more than threefold. It also estimates that global food demand will double by 2030 as world population increases by an additional two billion people. It's not possible to grasp the implications of the current food crisis without understanding the demographic factors that underlie these trends in food consumption.

The first and most obvious demographic dimension to the food crisis is global population growth, which rose by 1.2 percent last year, increasing the number of people on the planet by over 70 million people. That's more than the population of France (61.7 million). Between 2007 and 2050, global population is projected to climb from 6.6 billion to 9.3 billion, an increase of 40 percent and roughly equivalent to the current populations of India and China combined.

The second demographic dimension is the population growth rate of the countries that are most vulnerable to food inflation. Many of the fastest growing countries in the world—including Niger, Somalia and the Democratic Republic of the Congo—are severely impacted by the food crisis. The UN's Farm and Agriculture Organization (FAO) maintains a list of "countries in crisis" that require external food assistance. In February, there were 36 nations on the list. The population of those countries is presently 1.1 billion. In just 17 years (2025), their projected population will reach 1.5 billion, and by 2050 an estimated 2.0 billion.

The third demographic trend is a rapidly growing middle class. The World Bank estimates that the size of the middle class in developing nations will triple by 2030, rising from 400 million in 2007 to 1.2 billion. Homi Kharas, a Brookings Institution scholar, earlier this year projected even faster growth. According to Kharas over half of the world (52%) will be middle class by 2020, compared to 30 percent today. China, according to his projections, will have the world's largest middle class and the size of India's middle class will be 10 times larger than today's.

A growing middle class is translating into a larger appetite for food. As incomes rise, diets tend to change. People tend to eat more meat, fruits and vegetables, and fewer grains. Consumption of meat, in particular, puts added stress on global food production. That's because, it takes 7-8 pounds of grain to produce a pound of beef and about 3-4 pounds of grain to produce a pound of pork.

In recent years, meat consumption has been increasing significantly faster than global population. Between 1991 and 2005 meat consumption rose at an annual rate of 6.2 percent a year in China, and 3.1 percent in seven other Southeast Asian nations. Globally, meat production is projected to double by 2020 due to increased incomes, population growth, and rising per capita global consumption of meat.

The forth demographic dimension is growing urbanization. This year, for the first time in history, half of the world's population lives in urban areas, including smaller cities and towns. An estimated 3.3 billion people now live in urban environments and by 2030 that number is expected to climb to 5 billion. The urban population of Africa and Asia will double between 2000 and 2030 and many of these urban dwellers will be poor.

The urban poor—because they are not growing their own food—are severely impacted by the spike in food prices. The World Food Programme and other international agencies warn that rising food prices will force many people to reduce their consumption of meat and other sources of protein, and that the poorest of the poor—those living on less than a dollar a day—will be forced to reduce their total caloric intake.

Understanding these four demographic challenges is essential to averting famine and losing ground in the battle against hunger and malnutrition. Robert Zoellick, president of the World Bank, estimates that the current food crisis has already pushed 100 million people deeper into poverty. If food and energy prices continue to rise, that number could climb sharply in the years ahead.

In the weeks and months ahead, the world may see some temporary relief from rising food commodity prices as speculation eases and higher food prices encourage farmers to expand production. Wheat prices are already in decline. Rice prices may soon follow. The real challenge, however, lies ahead. Can farmers, particularly in developing countries, overcome climate change, water scarcity, and rising production costs in time to meet the demands of a growing population and a rising middle class. That's the big question.

Americans as a whole may be living longer, but two recent studies reveal growing and disturbing disparities in longevity.  In fact, not all Americans are living longer; life expectancy in some areas of the country is actually declining.

Two weeks ago, the Congressional Budget Office released a report (“Growing Disparities in Life Expectancy”) that found:

Though the gaps in life expectancy between men and women and between whites and blacks have narrowed somewhat, differences by income and educational attainment have been growing. The close relationship between socioeconomic status and mortality—the flip side of longevity—has been long observed and is well documented.5 Individuals with higher lifetime earnings or more education experience lower mortality rates than those with lower lifetime earnings or less education. But in recent decades, socioeconomic status has become an even more important indicator of life expectancy, whether measured at birth or at age 65. 

•  
  • In 1980, life expectancy at birth was 2.8 years more for the highest socioeconomic group than for the lowest. By 2000, that gap had risen to 4.5 years. The 1.7-year increase in the gap amounts to more than half of the increase in overall average life
    Expectancy at birth between 1980 and 2000.
  • In 1980, the difference in life expectancy at age 65 between the highest and lowest socioeconomic groups was 0.3 years. By 2000, the difference had grown to 1.6 years. That increase in the gap equals more than 80 percent of the increase in overall average
    Life expectancy at age 65 over that period.

Changes in life expectancy between 1990 and 2000 show a similar pattern among people with different levels of educational attainment. The gap in life expectancy at age 25 between individuals with a high school education or less and individuals with any college education increased by about 30 percent over that period. The gap widened because of increases in life expectancy for the better-educated group; life expectancy for those with less education did not increase over that period. The growing differentials by level of educational attainment have occurred for both men and women and for both blacks and whites.

A second study (“The Reversal of Fortunes: Trends in County Mortality and Cross-County Mortality Disparities in the United States”) published in the Journal PLoS Medicine, found that rising mortality from lung cancer, diabetes, and chronic pulmonary disease is beginning to offset some of the progress made in reducing mortality from cardiovascular disease. The study found “overall life expectancy in the U.S. increased more than seven years for men and more than six years for women between 1960 and 2000,” but that, “These gains are not reaching many parts of the country; rather, the life expectancy of a significant segment of the population is actually declining or at best stagnating.”

The report by researchers at the Harvard School of Public Health ( HSPH ) and the University of Washington found that, “4% of the male population and 19% of the female population experienced either decline or stagnation in mortality beginning in the 1980s.”

The study looked at geographical disparities in longevity at the county level and found a significant number of counties where longevity had declined.  The report found that “The majority of the counties that had the worst downward swings in life expectancy were in the Deep South, along the Mississippi River, and in Appalachia, extending into the southern portion of the Midwest and into Texas.”

A number of factors may account for these differences in life expectancy, including smoking, obesity, and disparities in health care treatment, but whatever the causes, the reports suggest that we have long a way to go in reducing health care gaps in America.