"You health experts are just too efficient; you create more problems than you solve." It is time to challenge statements such as this which result from tacit acceptance of the syllogism that since population growth tends to neutralize other development efforts, and since health programs contribute to population growth, reduction of the health component of international aid is therefore a logical step in promoting economic development.
Health programs, which once represented a major effort in American technical assistance, are now being quietly downgraded or phased out in most countries, except those that are obviously underpopulated, such as Ethiopia. Instead of challenging such decisions, most international health workers react with a puzzled sense of embarrassment. Why should they be apologetic for doing a good job? The humanitarian urge to improve the health of the world's needy people is so much a part of our total value system that it is disillusioning to find that good results have boomeranged.
It is demographic nonsense to think that the population problem can be postponed by maintaining high death rates. In underdeveloped countries, if high birth rates had not been biologically adjusted to the high death rates, the population would have faced extinction. As part of the development process the death rate is bound to fall and recent studies of demographic trends in Western countries show convincingly that health and medical services can claim regrettably little credit for this improvement. In eighteenth-century England mortality rates began to fall long before sanitation improved; the sanitary revolution occurred only after the cholera epidemics of the mid-nineteenth century. The mortality decline was probably due to better economic conditions permitting better nutrition and generally better living conditions. The birth rate also fell spontaneously but only after a lag period of one or more centuries during which the population soared.
The first reason, then, for doing something about the death rate is that with modernization it will come down anyway and equivalent population growth will occur. A characteristic of the development
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