European governments worried about population decline often focus on policies to encourage people to have more children. However, a new study reveals that this popular strategy is often less effective and more ethically problematic than a simpler, immediate alternative: large-scale investment in public health to reduce preventable deaths.
The research, conducted by an international team of demographers including IIASA Distinguished Emeritus Research Scholar Sergei Scherbov, analyzed population trends across 80 low-fertility countries. Among them, the researchers identified 28 countries – mostly in Eastern and South-Eastern Europe – where dramatically reducing mortality, especially premature mortality, would slow population decline more effectively than raising birth rates.
The top 10 countries projected to see the greatest relative population decline by 2050 are all in Europe, with nations like Bulgaria, Ukraine, Latvia, and Russia showing the highest potential for impact.
For the first time, researchers compared two ambitious population strategies:
- Instant replacement fertility: assuming a country’s birth rate immediately jumps to 2.1 children per woman (the “replacement” level), the goal of many pronatalist policies.
- Japanese mortality levels: assuming a country’s health systems improve instantly to match Japan’s world-leading low mortality rates.
The results show a stark difference. For the 13 European countries facing a projected population decline of 5% or more by 2050, the findings are clear:
- The total population of these countries is currently projected to fall by 33.8 million people by 2050 without intervention.
- If they achieved the (highly unlikely) jump to replacement fertility, the population loss would slow down, reducing the total decline to 14.1 million.
- Crucially, if they reduced their mortality rates to match Japan’s, the total population decline would shrink to only 1.7 million.
“In the countries most affected by population decline, which are predominantly in Eastern and South-Eastern Europe, achieving Japanese mortality levels would reduce the predicted population loss from 33.8 million to just 1.7 million people,” says Stuart Gietel-Basten, study coauthor from The Hong Kong University of Science and Technology. “This far outperforms the benefits expected from pushing for more births. It’s an empirical demonstration that saving the lives of people already here is the most powerful demographic tool available.”
The authors argue that focusing on lowering mortality offers multiple advantages over pronatalist policies, which often fail to achieve long-term fertility increases and can sometimes infringe on reproductive rights by limiting access to sexual and reproductive health services.
The researchers recommend that policymakers shift their focus to strengthening health systems, improving disease prevention, and implementing public health interventions – especially those targeting high male mortality from issues like alcohol abuse and poor diet in Eastern Europe.
The analysis concludes that reducing preventable and treatable mortality should be the central pillar of any demographic strategy, offering a more effective, immediate, and human-rights-aligned response to concerns over population decline.
“Governments have already made massive investments in citizens’ education and health,” says Scherbov. “When people die prematurely from preventable diseases, that societal investment is lost. Saving those lives means maximizing the return on investment in our existing population, allowing them to continue contributing to the economy and society for longer.”
“While our study focused specifically on Europe, the imperative to invest in human life and health is a universal lesson for all nations facing a future of demographic change,” concludes coauthor, Wiraporn Pothisiri, from the College of Population Studies, Chulalongkorn University, Bangkok, Thailand.
Reference
Gietel-Basten, S., Pothisiri, W., & Scherbov, S. (2025). Investments in health and mortality reduction to address population decline. Bulletin of the World Health Organization; Type: Policy & practice. Article ID: BLT.25.293627 [pure.iiasa.ac.at/21298]
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