Revisiting health, economy, and people

The COVID-19 pandemic has brought health and economy to the fore, assuming paramount attention from the public. However, the concern seems less about the number of people and their social status. Yet, the Philippines has had the highest COVID caseload vis-á-vis population in this part of Asia and its economy the slowest to recover. Apart from the slow response, a major reason for the country’s difficulty in managing the health-cum-economy crisis is its large population, the largest in Association of South East Asian Nations (Asean) vis-á-vis land area, coupled with the highest poverty incidence.

This “elephant in the room” is hardly raised or simply eschewed in local discourse. Which seems a carryover of the general silence when the family planning (FP) program, launched in 1970, was jettisoned in the late 1970s by then President Ferdinand Marcos Sr. for political expediency due to adamant opposition from the Catholic Church hierarchy and “pro-life” groups.

It is instructive to view the Philippines in the context of the Asean originals (excepting sui generis Singapore). The Philippines’ population was 37 million in 1970 that surged to 110 million by 2020 while Thailand’s also at 37 million climbed to only 70 million. Malaysia’s at 11 million tripled to 33 million, and Indonesia’s at 115 million rose to 274 million over the five decades.

Our country’s population growth has arguably been the most unbridled in Asean (including the rest). The Philippines’ ratio of people to land area (proxy for resource base) was 122 in 1970 that rose to 367 in 2020; correspondingly, Thailand’s 72 went up to 136, Malaysia’s from 33 to 100, and Indonesia’s from 60 to 143. As regard gross national income per capita, the values over the five decades were: $220 and $3,430 (Philippines); $210 and $7,050 (Thailand); $370 and $10,580 (Malaysia); and $80 and $3,870 (Indonesia). These, in turn, are reflected in respective poverty rates (in percent): 13 and 23.7 (Philippines), 13 and 8.8 (Thailand), 50 and 8.4 (Malaysia), and 13 and 9.8 (Indonesia).

Evidently, the Philippines’ demographic burden has weighed heavily on economic growth, people’s income, and welfare; in turn, the constrained economy has lacked the capacity to effectively fend off hunger and health crises or emergencies affecting a large segment of people. And with inadequate investments, internal tax, export revenues, and job opportunities, the economy has been hard put to advance to self-sustaining inclusive growth. Thus, from being at the top in the 1960s, our country has been the persistent laggard in Asean and has fallen to the bottom of the pile.

Meanwhile, population has grown by more than 1.6 million people annually even though its annual growth rate has been slowly dropping to 1.63 percent in 2015-2020. Quite a substantial addition of people arrayed against the economy’s unsteady growth and inadequate health system capacity unequally distributed across provinces. The next fastest population growth in Asean (pre-2020) was Laos’ 1.43 percent with only 7.4 million people. The Philippines’ growth during the 2020-2021 pandemic apparently dipped sharply, which may favorably result in a “displacement effect” as slower growth displaces the faster rise.

Relatedly, it is estimated that in 2015-2019 annual pregnancies in the Philippines totaled 3.8 million, of which 1.9 million (50 percent) were unintended and 973,000 (51 percent) ended in abortion (Guttmacher Institute, Philippines country profile, 2022). These numbers suggest that there is ample room for a comprehensive FP program with effective information, education, and communication toward attaining replacement fertility (2.1 children per woman). This has long been achieved by our Asean neighbors which firmly sustained their FP programs: Thailand in 1990, Vietnam in 2006, and Malaysia in 2013. By contrast, the Philippines’ failed program suggests that the country can follow suit in 2025-2030 with a resolute population policy, or even better yet a strong public-private partnership for the purpose.

The development economics literature tells us that among various policy options, the population program is deemed the most cost-effective—“big bang per buck”—along with international trade and international migration. The difference, though, is that population policy is within a country’s direct control while international trade and migration require international conventions. To illustrate the program’s cost-effectiveness, with a budget of just P2 billion yearly for six years maximum, the issue of unintended, mistimed, and unwanted pregnancies can be averted, thereby enabling the country to achieve replacement fertility before 2030. Unfortunately, during the previous six years, the President’s passion for the population issue was not matched by the requisite budget.

With the Philippines’ population continuing to surge, a unique phenomenon in Asean, the country seems to be breaching its carrying capacity. This is evinced by a number of socioeconomic indicators, e.g., COVID impact, child stunting, learning poverty, underemployment, abject poverty, inequality, food and fuel shortages, urban congestion, and lack of parks or open spaces for mental and physical well-being.

The government-cum-society must double down and address the demographic burden—the “elephant in the room”—enabling the economy to move to a sustained higher growth trajectory for all people to benefit. This is the critical agendum of low cost for the new administration.

Ernesto M. Pernia, Ph.D. is professor emeritus of economics, University of the Philippines, and former socioeconomic planning secretary.