Investments in health and mortality reduction to address population decline

Gietel-Basten, S., Pothisiri, W., & Scherbov, S. ORCID: https://orcid.org/0000-0002-0881-1073 (2026). Investments in health and mortality reduction to address population decline. Bulletin of the World Health Organization 104 (02) 94-102. 10.2471/BLT.25.293627.

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Abstract

Faced with significant population decline, many governments have turned to pronatalist policies to boost birth rates, even though such approaches are frequently ineffective and potentially infringe on reproductive rights. This study demonstrates that a more effective and immediate policy alternative exists: reducing preventable and treatable mortality. Using United Nations data, we modelled population projections to 2050 in 28 countries and territories, comparing a baseline scenario against two benchmarks: an immediate increase to replacement-level fertility and the reduction of national mortality rates to match the rate of Japan. Our findings show that investing in health is a more effective way to reduce population decline than raising fertility, particularly for countries in eastern and south-eastern Europe. For countries in the World Health Organization European Region that are most affected by population decline, achieving Japanese mortality levels would almost halve population loss, greatly outperforming the reduced decline expected with a replacement fertility approach. We consider that reducing mortality should be a central pillar of a demographic strategy. This approach offers faster demographic returns, aligns with human rights and healthy ageing goals, and provides a stronger return on prior societal investments in education and health. We recommend that policy-makers therefore move towards strengthening health systems, disease prevention and public health interventions. At the same time, they should integrate these measures with broader institutional reforms for a more sustainable response to population change that protects human rights.

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