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December 19, 2018

Growing up and how to reap from the demographic dividend

Listen and watch at length to any group of our politicians at one of their many press conferences or weekend funerals and you might despair for the country. In September, teachers did not work; many health workers were on a go slow; teachers were on strike claiming more pay. Kenya Vision 2030, the country’s development blueprint up to 2030, looks to transform Kenya into a middle-income country with a high quality life to all its citizens by 2030.

There are many ways to measure ‘high quality life’ such as levels of income, but one fundamental measure is whether people are healthy or not. Whether a person is healthy or not is ultimately an individual’s subjective measure. I may never have visited a doctor, eat well and still complain about this or that, whereas another person living in a terrible slum waiting to be swept away by El Niño unless the government steps in may never have complained of ill-health. But at population level, it is a little easier to measure ill health. We measure mortality, that is, various death rates; most commonly child mortality and maternal mortality. Apart from these specific population mortality measures, the overall mortality figure is also important, subject to one curious fact — in the end we all die. Recognising that some people become quite sanguine and say we should leave nature alone and not interfere when it's time for a person to die. This ignores another important fact; a lot of these deaths are caused by humans themselves, either by commission or omission, and secondly, many of these deaths are easy and inexpensive to avoid.

A look at Kenya’s demographic age structure tells you why we have so many child and maternal deaths. With an overall population of 45 million, 42 per cent are aged below 14 years, with a further 18.7 per cent aged 15-24and just 2.8 per cent aged over 65 years. In terms of absolute numbers, these add up 18.9 million, 8.4 million and 1.3 million people. Compare that with the United Kingdom total population 65 million. Those aged under 14 years make up 17.3 per cent of the population with those aged 15-24 at 12.6 per cent and over 65 years at 17.3 per cent, similar to the under 14 years. In absolute figures this adds to 11.2 million, 8.2 million and 11.4 million respectively. Therefore Kenya has about 50 per cent more under 14-year-olds than Britain and the same number of teenagers and young adults. However, the United Kingdom is 34 times richer than Kenya. The difference is that most Kenyans are not in the working bracket whereas in the United Kingdom they are.

There are two possible solutions to this problem. The first is to grow old quickly. As the developed world ages rapidly, they are investing more into why people grow old. While growing old is a fact of life, the process of aging is not well understood. At the cellular level, what is known is that almost every cell in our body divides only a certain number of times then stops dividing. So think about the liver cells or kidney cells, every day a certain number are worn out and replaced by fresh ones, but as one ages less and less of the worn out cells get replaced, so organ function begins to diminish until one day the organ as a whole and therefore the human body is not able to function. In animal experiments, certain gene pathways and particular proteins have been identified as being critical for the decision of some cells to continue dividing and for the whole animal to not age fast. A class of drugs have even been identified that it is hoped in the future may be taken to slow down the aging process. The flip side of the coin to this research on aging is that cancer is characterised by cells that refuse to stop growing. So cancer research is busy looking for ways in which cell growth can be stopped or at least slowed down, so success in anti-aging may lead to more cancer. This muddled picture suggests that for the foreseeable future advances in medicine may not help our population immediately.

The second possible solution is to invest in the current population, educate them and provide basic public health that allows them to function as healthy individuals able to generate wealth the moment they are of age. This requires some focus and purpose by those in positions of power. Economists talk of a ‘demographic dividend’, when a country has a young healthy, active population able to work. The assumption is that along the way they were taught some basics and that they have adequate health. Countries that spend many years at war end up with the problem of youth that are unemployable not only because they missed school but also because they are not healthy everyday of the month to work for a living. It becomes a vicious cycle because those that do not receive proper healthcare and education often do not promote it to the next generation. Then there is no demographic dividend, more like demographic punishment. This scenario can easily happen if we do not plan to grow up.


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