Immigration policies might affect fertility rate changes

One out of every five dollars in the U.S. will be spent annually on health care by 2025. This staggering figure is being driven by increased access to health care, expanding treatments derived from biomedical technology and inflation. However, in the long term, the greatest driver is the aging U.S. population. Fortunately, the growing Hispanic demographic in the U.S. offsets what would otherwise be an even more formidable challenge. U.S. immigration policy should consider and embrace this opportunity.

Populations throughout Europe, China, Japan and Russia are aging far faster than in the U.S. This poses a mounting threat to quality of life and access to health care during the coming decades.

Societies age when fertility rates drop and especially if life expectancy goes up at the same time. When the average age of a population rises, there are relatively fewer young, productive adults to work and pay taxes to keep entitlement programs such as Medicare solvent. Governments, especially in countries like Japan, Germany and Singapore, will face increasing difficulties honoring their commitments to care for their nations’ elders.

Low fertility rates, if not balanced by immigration, may also result in a shrinking population. For the U.S. population to remain stable there must be 2.1 births per woman. Some developed countries like Japan and Germany currently have fertility rates as low as 1.4. Russia’s fertility rate dropped to 1.2 in 1999 and, like Singapore, it has begun to offer cash incentives for women to bear more children.

China’s fertility rate was above 6.0 in the 1950s but dropped to 1.5 as a result of the "one child" policy. In recent years, "only children" are now allowed to have two children but this is still not enough to prevent the population from shrinking which may cause a labor shortage.

In contrast, the African continent is home to the world’s highest fertility rate with Nigeria, for example, running at 5.25. Feeding, educating, employing and ensuring access to health care for youth is a massive problem for undeveloped nations with high fertility rates.

Compared to rapidly aging populations in most developed nations and the opposite problem in many undeveloped countries, the U.S. finds itself in an optimal middle zone. As a whole, the U.S. fertility rate is 2.0 but only because the lower fertility rate of 1.8 among non-Hispanic Caucasians and Asians is offset by a fertility rate of 2.4 among the Hispanic population which presently accounts for 20 percent of the U.S., according to the Pew Research Center.

Medicare costs are expected to double to nearly 8 percent of GDP by 2050 compared to today. Without a large, young Hispanic population entering the labor force as baby boomers retire, the U.S. government would be even more hard-pressed to cover these health care costs.

Among the cacophony of political proposals for immigration reform are short-sighted impressions that Hispanic immigrants will take jobs from American citizens and utilize government resources for which they should not be entitled. The truth is that, at some point, the ancestors of all U.S. citizens were also immigrants seeking fresh opportunities for themselves and their families. Yes, borders must become less porous and every effort must be employed to ensure that new immigrants can become good citizens. That includes not only adequate upfront screening and background checks but also investment that supports social integration, including quality education.

Hawaii’s fertility rate is an exceptionally stable 2.1. More importantly, our island community is a model for embracing diversity to build a strong community and healthy economy.

Ira “Kawika” Zunin, MD, MPH, MBA, is a practicing physician. He is medical director of Manakai O Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.