Demographic panic is not new. On Christmas Day in 1085, William the Conqueror, intending to discover how much tax he was due, set out to chronicle England’s demographic landscape, a project which resulted in the Domesday Book. This was an early example of an enduring fascination: changes in the demographic makeup of the population would intrigue and agitate British kings, queens, politicians, policymakers and academics for centuries. For much of the 18th century, it was common knowledge that national power and prestige depended on population size; Protestants even campaigned against Catholic abstinence, highlighting the limit this practice placed on population growth.
But none of these protagonists had to deal with historically low fertility, life expectancy rising by 16 minutes every hour and ever increasing expectations on public services – coupled with rapid medical advances leading to an almost daily influx of eye-wateringly expensive healthcare treatments. The demographic challenge is a juggernaut heading our way, particularly if you are in charge of the NHS.
ippr’s Population Politics report earlier this year showed that, because Britons are living longer, having children later in life and more often remaining childless, the UK is facing a demographic ‘fork in the road’. Britain’s ageing population means that taxation will have to rise to keep public spending at current levels; the view over the approaching horizon is one of rapidly increasing pressure on state spending, potentially exceeding 2.7 per cent of GDP. Pension commitments are important, but much of this extra spending will be on public services, particularly elderly care and healthcare. So can we afford it? And will there be enough skilled workers to provide the health and nursing care we will need?
The short answer is no – unless we respond now. The experiences of Italy and Japan, where politicians are almost tearing their hair out in desperation at an ageing population (and even starting up state-run dating agencies), should stop us being sanguine about population. There are two basic options: increase migration and/or raise fertility. Both raise substantial political and policy challenges.
Migration is the more difficult issue. But it is far from a panacea for an ageing society: even doubling or tripling immigration levels would do little to offset the impacts that ageing will have on the size of the workforce and would almost certainly lead to political pandemonium, however desperate the demographic need. This is not to say that migration is a demographic distraction. For example, ippr research last year showed that migrants contribute 12 per cent more to the public purse than native-born Britons; similarly, an amnesty for illegal migrant workers would raise at least £1bn in tax.
Crucially, skilled migrants will become increasingly important for staffing public services – raising taxation to fund healthcare is useless without skilled staff. Overseas-qualified doctors accounted for half of new doctors recruited to NHS hospitals between 1993 and 2003. The political challenge is to make the case for skilled and timely immigration, linked to public service needs. The government’s recent adoption of a points-based system for immigration has the potential to be a step in the right direction. Making clear links between public services, migration and demography is paramount.
Yet without tackling a low birth rate – the underlying cause of Britain’s ageing population – increased migration, even of skilled workers, will be too little, too late.
Until recently, fertility was taboo for British progressives, wary of ‘nanny state’ accusations of advocating ‘breeding for Britain’. This is in stark contrast to most other developed nations: in France, pro-natalism is a response to existential angst over national identity, and there is a customary concern with populating La Republique. Elsewhere, geopolitical and economic considerations drive attention to both the mix and magnitude of the population, a response typical of net immigration countries such as Australia and Canada. England (in particular) has always been an anomaly. Yet the last few months have seen a fundamental shift in the politics of population in Britain.
We have begun to rightly acknowledge that ageing populations are partly a result of people’s frustrated aspirations – and that this matters at least as much as public spending implications. The growing recognition of the ‘baby gap’ between the number of children Britons want and the number they actually have (which currently stands at over 90,000 a year) and the underlying causes (which largely stem from difficulties in balancing work and family life) has prompted renewed public and political appetite for a progressive response. Labour’s parental leave and childcare reforms appear to be working: fertility has now risen every year since 2001. The challenge is to make this link more explicit: cementing the current approach into a new, progressive common sense of the age. Swedish social minister Berit Andnor is openly ‘proud’ of increasing fertility rates. British politicians should be too.