Foreword: Investment in Population Development — Exploring Solutions for the Dual Pressures of Low Fertility and Population Aging

In 2024, the world commemorates the 30th anniversary of the landmark 1994 International Conference on Population and Development (ICPD) in Cairo. The ICPD Programme of Action, established at the conference, prioritized individual well-being in development and committed to enhancing health, rights, and choices for all. As we mark this milestone, accelerating efforts and investments is imperative to fulfill these promises and translate them into tangible outcomes (1).

Over the past three decades, significant progress has been made in addressing population issues, but new challenges and demographic trends have emerged that require renewed focus and adaptation. The current global population stands at approximately 8.1 billion and is projected to increase to about 8.5 billion by 2030, 9.7 billion by 2050, and over 11 billion by the end of the century (2). Despite this overall growth, fertility rates are declining in many regions, particularly those experiencing the second demographic transition. This transition is characterized by societal changes such as increased female education and workforce participation, delayed marriage and childbearing, and other factors (3). Consequently, the total fertility rate (TFR) in some regions has continued to decline even after falling below the replacement level (4).

Low fertility rates are a significant concern in the Asia-Pacific region, particularly in countries such as Japan, The Republic of Korea, Singapore, and China, which have some of the world’s lowest rates. For example, China’s TFR has declined to approximately 1.3 children per woman, according to the 2020 national population census. Despite ongoing efforts to adjust population policies, changing societal attitudes and economic pressures continue to impact family planning decisions among contemporary Chinese families.

The simultaneous decline in birth rates and increase in longevity has led to a growing proportion of elderly individuals worldwide. In 2002, the global population aged 65 and above surpassed 7%, marking the world’s entry into an aging society. By 2015, less developed regions, as classified by United Nations standards, also reached this proportion. The World Population Prospects 2022 estimates that the least developed regions will similarly transition into an aging society by 2056 (2). The pace of aging is even more pronounced in China and other East Asian countries and regions. China, in particular, faces significant pressure and challenges due to population aging. As the country with the world’s largest older population, China transitioned from an aging to an aged society in the shortest timeframe (5) and experienced more severe aging in rural compared to urban areas (6). These demographic shifts have substantial implications for social security systems, healthcare infrastructure, and economic productivity. According to data from the National Bureau of Statistics of China, there were 217 million people aged 65 and above by the end of 2023, representing 15.4% of the total population (7). With the exception of Xizang Autonomous Region, all other provinces in China have already entered an aging society.

In an era of significant demographic shifts, many societies face critical challenges posed by low fertility and population aging, threatening the sustainability of economic growth and population development. As highlighted previously, China exemplifies these dual pressures, necessitating innovative and comprehensive strategies. To address these demographic challenges, China has adopted “high-quality population development” as a strategic goal. This approach prioritizes improvements in population structure, health, education, and economic well-being over simply increasing population size, aligning with the core principles of the ICPD Programme of Action. Achieving high-quality population development requires exploring the multidimensional causes of population issues. Understanding the scientific evidence of population trends and influencing factors enables policymakers to design targeted interventions tailored to the specific needs of diverse regions and populations.

This special issue of theChina CDC Weekly, dedicated to World Population Day 2024, presents a collection of papers exploring pressing issues and proposing solutions for achieving high-quality population development in the face of low fertility and population aging. This issue examines infertility patterns across the Asia-Pacific region. Additionally, it explores the scientific basis for actively addressing population aging and achieving healthy aging by considering the intersections of disease, disability, mortality, and life expectancy.

Specifically, Luo et al. examined trends and the distribution of infertility in the Asia-Pacific region from 1990 to 2021. Their study, “Trends and Distribution of Infertility — Asia Pacific Region, 1990–2021,” revealed a concerning rise in female infertility rates, partly attributed to increased incidences of polycystic ovary syndrome and maternal infections (8). In “Age, Sex, and Disease-Specific Mortality Contributions to Life Expectancy in Urban and Rural China, 1987–2021,” Talifu et al. investigated the contributions of various diseases and age groups to life expectancy changes in China over the past 35 years (9). Furthermore, Yang et al., in their study “A Multi-State Model Study of the Disability-Free Life Expectancy of Older Adults with Chronic Multimorbidity Based on CHARLS — China, 2011–2020,” provided insights into how chronic multimorbidities impact health state transition risks and life expectancy among older adults in China (10).

These studies collectively provide valuable insights into the demographic dynamics of China and the broader Asia-Pacific region. They reveal the intricate interplay of social, economic, and health factors in shaping population trends. Furthermore, the studies emphasize that addressing the challenges of low fertility and population aging requires multifaceted and context-specific solutions. As highlighted in UN Secretary-General António Guterres' message for World Population Day, the robust data sources utilized in this article underscore the importance of investing in data collection to understand problems, tailor solutions, and drive progress (11). By drawing on the latest research and insights from different regions, a more comprehensive understanding of these complex demographic challenges can be achieved, facilitating the development of effective strategies to address them. These strategies may encompass addressing immediate issues of population quantity and structural optimization, as well as fostering improved support for fertility, retirement security, natural and social environments, and healthcare systems that support sustainable demographic trends and high-quality population development.

As we commemorate World Population Day 2024 and dedicate ourselves to achieving high-quality population development, broader research and practical endeavors are warranted. These efforts contribute to fostering concerted collaboration and innovation among policymakers, researchers, and communities. Ultimately, this will help create supportive environments that enable individuals and families to thrive, navigate contemporary demographic challenges, and build a sustainable future for all.