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21. The Future of Fertility and the Health of Men
64 Plays13 days ago
A chat with a Norwegian demographer and the director general of the Norwegian Institute of Public Health
Vegard Skirbekk is a social scientist studying how global demographic change is reshaping health, economies, and society. He is co-founder of the Centre for Fertility and Health and is a professor at the University of Oslo. He is the author of Decline and Prosper: Changing Global Birth Rates and the Advantages of Fewer Children.
Guri Rørtveit is a physician and public health researcher, and director general of the Norwegian Institute of Public Health. She is a doctor and professor of family medicine at the University of Bergen.
We discuss:
- Are we in the midst of a demographic emergency or a new phase of history we don’t yet understand?
- Why do interventions to increase fertility rarely work?
- Why Japan might do better with its old age dependency ratio compared to a country such as India.
- Will the Norwegian population disappear around the year 3200?
- We discuss some of the depopulation doomer anxieties: no more Einsteins to innovate, no more taxpayers to take care of elderly, reliance on immigration to steady population levels, etc.
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Transcript
Introduction and Demographic Issues
00:00:05
Speaker
This is the Out of the Wild podcast with Ken
00:00:18
Speaker
Vegard Skirbek is a social scientist studying how global demographic change is reshaping health, economies, and societies. He is a co-founder of the Center for Fertility and Health at the Norwegian Institute of Public Health. I'm also joined with Guri Rertveit, a physician and public health researcher, the director general of the Norwegian Institute of Public
Fertility Decline and European Demographic Emergency
00:00:43
Speaker
Health.
00:00:43
Speaker
People are getting pickier. There's less family formation. There's fewer kids being born. Vegar Jørn. expert on fertility decline, population decline. So so let's get right into it. um So some people think Europe is entering a demographic emergency.
00:01:07
Speaker
um Basically, we need to have 2.1 children per woman for the population to be stable. In a country like Norway, correct me if I'm wrong, it's closer to like 1.4 for So, you know, some people are calling this a demographic emergency.
00:01:24
Speaker
Or do you just see this as a new phase of human history we don't yet understand? That's a very big question. And us so um as you know, I've been interested in this for quite some time. And I think there's there's many dimensions to this. One being that we are not it's not correct what many people say, that if you don't have 2.1, you'll see population decline.
00:01:51
Speaker
um that even in a close population with zero migration, you could still have increases in life expectancy, that improved health. When it comes to the consequences of of low fertility, there are many consequences. It's a huge and important topic to to study. But I think many of the consequences are perhaps misunderstood. That first of all, there's a ah Much of the decline we see is due to a decline in unplanned fertility, which is something that has been explicitly wanted from policymakers. Declines in teenage fertility due to unplanned childbearing for contraceptive use. and And that is something we have seen declines in over time in many countries, including in Norway, and even stronger so in, in for example, the United States.
00:02:40
Speaker
So some of the drivers are are due to developments which have been wanted for a long time and something one should ah which probably gives benefits to certainly the children. Parents that actually are in a stable situation who want to have a children child is in most cases probably a much better situation for the children than than otherwise.
00:03:01
Speaker
And also for the parents, being in a situation where you actually want children is is better. You have, as we discussed also earlier, many challenges related to unplanned childlessness that you end up not having children, which is problematic for the individual and and a huge challenge for many who might, for instance, postpone too late. And Guri, you might be interested in this question.
Norway's Birth Rate Challenges
00:03:23
Speaker
um so as we all know nick norway is considered one of the healthiest most successful societies we've ever built um presumably with terrific support for families i'm getting guessing guessing you have very generous paternity leave um daycare and so on so why are and i'm just guessing you have lots of space too in norway so why are fewer people choosing to have children in one of the greatest places on earth?
00:03:54
Speaker
That's a ah very interesting question. And when I had my first child in 1993, that was when the very long maternal maternal leave was introduced. We could have one year with maternal or paternal leave. with 80% salary from the government, which is very generous. And I think that led to, you have to correct me now if I'm wrong, Vega, but I think that led to a little bit increase in fertility for a while, or no, I'm looking at Vega now. But anyway, it it least at least it hasn't, and I'm not sure that that was in the reason why, I think this was more about equality between the sexes that that that was introduced.
00:04:42
Speaker
um Later on, i think, and Lega knows more about the interventions to try to increase the fertility rates ah in Norway. um ah Several interventions have been tried and they don't work as well as you should think. It's to do with the to the accessibility like accessibility of kindergarten and and also, of course, economic compensation for loss of income and so on and so forth. I think you're you're more into the actual interventions that have been tried.
Global Fertility Policies
00:05:22
Speaker
Yeah, no, there's been... um ah Well, many governments have for many, many years have tried to... to have policies for affecting fertility. So on a global scale, ive worked ah quite a bit on global demography, and most policies have been focused on where the spill population policies has been focused on on the opposite, on decreasing fertility. And many of those policies have been likely fairly effective in terms of lowering fertility levels, it seems. But the other policy in terms of raising fertility, which has become more prevalent in in recent years, particularly the recent two decades, ah are often found to be ah either inefficient, and this could be different types of financial subsidies, subsidies of childcare, subsidies of... of a time off when the mother or the father stays home with the children. The housing market is something that is not so often addressed in these debates.
00:06:20
Speaker
And that is something that has made the ah life, I would say, a lot tougher for younger couples. But it has become a lot more expensive in the last three decades. in in norway You mentioned the early 90s being a case for having children. Back then housing was very, very affordable in Norway and that is certainly not the case now. So some of the ah some of the highest increases in the entire world has been found in terms of relative increases in in Norwegian cities over the last few decades. and that is
00:06:52
Speaker
likely i reason why many people postpone or choose to even forego childbearing altogether because they they argue that the they cannot afford actually So that's kind of like a non radical fix. And let's say we've maxed out all like the the things we could possibly do. Most generous paternity leave payments for having kids, ah more housing. Do you think that would affect things so much to kind of get it up to kind of that around that 2.1? Or do do we need to be thinking more imaginatively and and and radically about the situation?
Adjusting to Aging Societies
00:07:30
Speaker
I do think it would help some to have more children, but also think it's very hard. First all, many of these policies are extremely difficult implement in reality, such as policies that might increase in housing supply. But I think the consequence is something one should have to tackle in any case, because we do face lower fertility than what used to be the case. Although the decreases like the 1.4 figure you mentioned is that's a period measure. There's other ways of measuring fertility. Fertility hasn't declined to such low levels yet. If you look at core fertility, that is actual number of children woman has at the age of 40 or 45, which is still somewhat higher. One can still see a certain upswing in a slight increase in fertility as women who have postponed try to recuperate.
00:08:17
Speaker
and So we don't know how what Pretilt will end up with. But in any case, we do have to adjust to to some extent to um to an older society and to um that families have fewer children on average than what used to be the case. But that might be possible to do. And some countries have, demographically speaking, at more advanced stages than Norway. For example, Japan has gone from, go back to 1950, found that Japan had a median age of around 20. In 2026, it has a median age of 50. Japan, according to the UN median variant projections, will reach a median age of 53 before so actually declining again. So being the oldest major economy of the world, Japan has already gone through that transformation and there's not so much left.
00:09:00
Speaker
How can How did they cope? How are they managing? Did so society collapse? Probably not. so Did it see many challenges? Certainly it did. And it has probably not done enough, for example, in in terms of increasing female-level participation, um making um its populations more productive, doing institutional changes that would help society cope better with the inevitable aging. But no, society is not going collapse due to failure or fertility. See, I come at this from, I'm thinking about it in two different ways. The one is like, I think this is ah a great thing. And there's a lot of doomerism out there. I mean, like we have like 8 billion people on this planet. It's going to get up to above 10 billion at some point.
00:09:46
Speaker
Is it that big of a deal if we're having, you know, 1.4 kids per woman versus, you know three kids per woman? I think this is like a break for people.
00:09:58
Speaker
habitat ecosystems environment air water but on the other hand i'm just like how is it ever going to get back up to kind of like replacement level because if society keeps moving in this direction where more availability for conscious contraception higher education for everybody All the good things we like about living in an enlightened society. If those old things keep improving, like why would we ever want to have three or four or five kids in the house again?
00:10:30
Speaker
Do you think about, do you ever think about it like that? in my case at least, our children has been a blessing. um And I think most people who have children feel that that's a blessing, at least if you're able to provide for them.
00:10:42
Speaker
Myself, I have two children. ah How many children you want to have is, ah his of course, an individual question. and And I think it should remain so for a long time. um So I don't know. i would say that it's important.
00:10:59
Speaker
it's so it's so It's such an important part of life. And also I want to emphasize that I really acknowledge that people do not want children. As long as that is a choice people are making, that is absolutely fine, of course, and it should be respected by society. Every every choice should be respected and not a forced choice because of, for example, socioeconomic disparity.
Health Investments and Dependency Ratios
00:11:27
Speaker
I also think one of the key issues to how to deal with low fertility, inevitable low fertility, because this is some development we had. We had low replacement fertility since the nineteen seventy s This is not a sudden development, um but it's gone to much lower levels in recent years.
00:11:42
Speaker
But we should invest in health. We should help people to maintain health to a much older age. And that will make social economic systems, labor markets, pension systems much more sustainable over time. um And when it comes to more the the global issue, how, um yes, we we passed 8 billion people three years back and we have ah we have seen rapid population growth. Last last century, we saw populations growth from around 1,5 billion to
00:12:13
Speaker
to around 6 billion people. ah This century we are likely to see the populations grow from 6 to maybe, um we we used to think 10 billion, but now it's been down adjusted a bit. So many demographers assume it will be 9 point something million. And that is good or bad for environmental reasons. Still, i I think many environmental researchers certainly agree with what you state, that it's it might be beneficial for the planet, but it's also a return to what society used to be like.
00:12:46
Speaker
and And I think one issue which is often discussed is ah other dependency ratios. This old age dependency ratios will become um inflated it will be much harder to deal with a with with sustaining our social and economic systems.
00:13:04
Speaker
ah It certainly will be harder but it's also it might also there and be a back to normal. So low population size might be back to a situation we had earlier. Dependency ratios given that you have fewer children to take care of might also represent that back to normal. And if you do manage to increase health, which has been the case for many countries,
00:13:20
Speaker
um say India has ah has ah the oldest population of any major economy. We had a published in The Lancet where we found that if you're just for health, the dependency ratio in India might be worse off than the situation in Japan because ah poor health occurs so much earlier in India than in Japan. Japan has invested much more health and maintaining health to an older age, while this is unfortunately not been the case in a population level in countries such as India. There might be similar situation to India many parts of the world because of poor public health and poor investments in health and education for large major population population.
Innovative Solutions for Fertility Decline
00:13:55
Speaker
So the dependency ratio, that's a big issue for kind of the fertility decline doomers. They're worried there's going to be a ton of old people and not a lot of young workers to take care of them, to you know put revenue into the tax base, stuff like that. But as you're saying, that would eventually level out, right? Like that would only be an issue for a generation or two until you know things kind of leveled out.
00:14:23
Speaker
That's correct. It will be a partly temporary phenomenon because you have very large cohorts which are going older and and ah for those years when they are in recipients of Social Security or pensions, it will be difficult. but But this will not be a permanent situation. So they will die out. And you will have, again, somewhat more beneficial dependency ratios. But it also depends how long these courts will work, to which ages will they be active members, and ah from which ages will they be active members of society, of the economy, and from which ages will they be dependent on others. And and um and that is the ah crucial issue for for sustainability of social security systems, example.
00:15:12
Speaker
and And that feels very short sighted to me is to be so worried about this dependency ratio being kind of, you know, not favorable to a generation or two. It's just like, but do we really want, you know, 9.8 billion people on this planet? Can't we kind of work through this transition into kind of leveling out the the population? I did some math or rather i had AI do some math for me. And I looked at Norway's current fertility rate and population, which I believe is between five and six million people.
00:15:45
Speaker
And I was just like, if it if it's just 1.4 children per woman, when does the Norwegian population disappear? And it gave me the year 3200 around them, which seems awfully soon.
00:16:00
Speaker
But that just kind of says like, eventually, and that's without migration. That's with no migration coming in from year year. eventually something needs to change. Are there any kind of like radical or really progressive ideas to kind of change this in, in the long run? Like in the U S I've heard things of like a GI i bill for women where, you know, they could have kids in their twenties, but,
00:16:29
Speaker
once they kind of get over that parenting phase, they can get like free education or they can get like early access to social security funds early on. And then that just means they have to work deeper into life, deeper into their seventies, anything kind of radical or imaginative that hasn't been tested out that kind of you've noticed.
00:16:49
Speaker
i think it's um many radical solutions might tip over and become personalistic or authoritarian or so we have to be really really careful about how we what what kind of plants we're making in this and this within this
Cultural and Economic Fertility Factors
00:17:12
Speaker
field.
00:17:12
Speaker
And I also think it's important to be ah be realistic because I think you're right. I think most of us think that having a reduced population on the earth is not a big catastrophe, but that those couple of generations might lead to such an instability that that might be a reason for this being a catastrophe still. So because because of the dependency ratio and and other kinds of, leading to other kinds of instability. this is This is an unprecedented situation that we have. So we don't really know how to deal with it. And we have to, ah
00:17:54
Speaker
Really we have to to work with research strategies to figure out what works, what does not work, and what are the side effects when we try out more or less radical intervention. There's a lot talk of how how things might change over time. And there are certain mechanisms which might alter fertility trajectories, for example, the prospect of continued low fertility. ah For example, there are ah there are cultural groups, religious groups, which have sustained high fertility, even as overall fertility declines over time.
00:18:32
Speaker
If this continues, they might constitute a large proportion of the population and overall fertility might again increase somewhat because of their higher proportion in the population.
00:18:43
Speaker
ah There could also be ah consequences related to to labor to sorry to housing markets, that there are, given that populations might shrink in some places, some cities even, you might see stabilization or even a decrease in housing prices, which in turn could make it easier for younger people to establish themselves.
00:19:04
Speaker
and to to find housing and also to form families, which might make at least the economic calculation easier. The world has to add adapt to to lower fertility. It's ah it's certainly a um a development which takes place in more and more parts of the world. And we should try to figure out where on earth and in which context, in which cultures, which communities have we managed best. And we should see ah what we can take, copy perhaps from from these communities and societies and try to see if they can implement it elsewhere
00:19:35
Speaker
There's a lot of good that's coming from this ecological good. We're getting what we always wanted. Higher education, autonomy, gender equality, child survival.
00:19:47
Speaker
Why do you think societies, i don't think there's any society kind of really celebrating um low fertility or a lower population these days. Even China's trying to stop what they've what they've done with the one-child policy. So why does why are societies struggling to celebrate something that is in many ways a success story?
Societal Reluctance and Fertility Rates
00:20:10
Speaker
But they don't see it as, there are many reasons. so One reason being fear of the decline, the cultural, political, military power and influence in the world. Absolutely, but also in relative terms. Facing facing decreases is something which is hard to to celebrate as something positive. And it's different from, it's unprecedented. So it's different from what we have used to, have experienced with. So it's uncharted territory. We don't know where we're going. there are There are societies celebrating fertility decline, but typically when it goes from very high levels to to very very low levels, no, towards replacement levels, I mean, um then there's certainly many countries in the world though that still encourage decreases in in childbearing patterns.
00:20:58
Speaker
Just wait, just wait a couple of years. Then they're going to be like, we got to get it back up again, but is which is seems like what's happening in China. But of course, in in some ah you mentioned Europe. Europe is in one situation. You had fairly low fertility in Europe for quite a number of years.
00:21:13
Speaker
ah Historical fertility in Europe was not not that high. You had the, due to the European marriage part pattern, where people married quite late, the state celibate on average before marriage. They ended up with fairly low fertility, with perhaps so four or five children average, ah of which half, two-thirds survived to reach adulthood. So you had two and half, three children surviving at its peak in in European countries.
00:21:41
Speaker
So you had fairly low population growth. But if you go to places all the parts of the world where you see historical meaning, historical meaning going back to the nineteen sixty s and not so long back, yeah you find that fertility was at much, much higher level ah in a situation where mortality was lower.
Regional Fertility Challenges and Norway's Economy
00:21:59
Speaker
So you might have had the four, five, six surviving children, twice as many as children as as what you had in Europe. And at the same, and in recent years, you've seen a much more rapid decline in fertility and a much more rapid increase in life expectancy.
00:22:12
Speaker
So for example, in China, you mentioned that China had the low fertility, China has below one child using but the total fertility rate measure in 2025.
00:22:23
Speaker
um But it does how ah has also gone from a situation where it had much, much higher fertility than was ever observed in in Europe in terms of surviving children, which means that population aging is going to be much more extreme in China, going from five children to to one child rather from two and a half to one and a half time and child, in which is the case in Europe. So you have much more extreme challenges in in other parts of the world, which which is it's really going to put a strain on, uh, on, uh, institutions and social systems.
00:22:56
Speaker
This is this question. probably getting into trouble, so please feel free to dodge it. Um, but what's, what's like, um, Norway's ideal population is, is your 5.5 or 5.8. Is that a good population to kind of stick with, or is there any conversation around that?
00:23:16
Speaker
there i and I'm not aware of the conversation around the actual number. We are more into the dependency ratio. Gotcha. And what about worldwide population, Vegard? I'm sure you've kind of tapped into some studies that look at the sustainability of of the world and its resources. are are there any kind of consensus numbers about what kind of a stable human population is Well, actually, I do get this question quite And I try to refuse to answer because it's hard to say. And I don't have a definite answer. Of course, yeah. And things really change with technology. I mean, just think about agricultural technology. I mean, that could support a lot of people. sorry.
00:23:58
Speaker
ah No, but but there is actually the Norwegian situation is very special because we have the oil fund. We have a very large capital reservoir, which... which was discussed in a recent government paper discussing long-term consequences of aging population decline. And because of this oil fund, which is absolute, with a larger population, you will have fewer, less capital per capita. So in some some ways Norway is in a very different and special situation because a lower population would ah could mean increased economic welfare. But this is, course, not the the situation for most countries in the world, which lacks such a fund. The development of of dealing with low fertility with increased life expectancy is something which is quite expensive. You have to make unpopular political choices.
00:24:47
Speaker
I've been dealing with politicians in many years, and for for many years and i do find that it's it's, of course, hard for them. But it's also... somewhat unforgivable not to deal with it because it's foreseen, it's easily understood that this is going to happen and not ah and and many are um too short-sighted and they should have dealt with this many, many years ago, but they keep postponing necessary reforms for too
Community Effects of Low Fertility in Norway
00:25:08
Speaker
late. Huge debates in Norway regarding schools and were how if if we can keep up schools, for example, in the district, but also actually in the in the middle of Oslo, the capital, because there are less children that can populate the schools now. and And schools is not just about education of children. It's also, at least in Norway, it's ah its ah it's a local community around it.
00:25:35
Speaker
it's a cultural center in many ways and so that's a big issue and of course if you if you remove the school from a local community you will have families moving away and and that's a huge problem so as i said earlier this is creating quite a lot of instability, but it's it's still a major issue for a country, which is, as you said, and that not very densely populated. We need the population to be, we need the districts to be the to be populated. This is ah is a huge political debate in Norway.
00:26:16
Speaker
And I'm sure, yeah, it's a political debate in so many countries, because there's a lot of countries such as Spain, we talked about relying on kind of migration to immigration coming into the country to kind of maintain population levels. What's the kind of the dialogue and in Norway about that? Are there a lot of immigrants
Immigration and Population Maintenance
00:26:36
Speaker
coming in? And is that a strategy to kind of keep the population steady?
00:26:41
Speaker
it's um it's an important very important question it's not a strategy we have have had more
00:26:50
Speaker
immigrants coming over the over the years, and not the least from Syria, Afghanistan in 2015-16, and now from Ukraine. But yeah ah some of the immigration populations do not have the um educational level that needed ah that is needed to to take part in the workforce in Norway, and that is a big issue and and and a big problem.
00:27:17
Speaker
So we see that when it comes to social disparity in Norway, quite a lot has to do with immigrant populations, unfortunately. we have With that, we have to deal with, and and that can be done, of course, over some time.
00:27:35
Speaker
And that's a big concern from a lot of the fertility decline doomers is that, you know, culture is fragile, cultural is cultural sensitive and just bringing in a lot of immigrants, you know, it could kind of degrade some of the wonderful things about a country you're living in.
Innovation, Education, and Global Development
00:27:53
Speaker
Another one is kind of like an innovation collapse fear. And Vagor, I'm sure you've come across something like this.
00:28:01
Speaker
the Elon Musk's and Silicon Valley people of the world, they're worried that there's just not going to be enough Einsteins out there to, you know, be innovating and inventing stuff. do you Do you think that depends on population size? Or do you think smaller societies can remain really creative and entrepreneurial and dynamic? much more of the global production takes place in low fertility countries. Of course, there's been more low fertility countries over time, but also productivity in these countries have actually increased massively, as I'll also show in the climate prosper,
00:28:36
Speaker
book you referred to earlier. The world is so different than it was a few decades ago. You only need a few innovators a few places on the planet and technology systems, new process of of service and goods production can be adapted globally ah very quickly. And this is quite different from what used to be the case. So whether global population decline or a decrease in number of children should have ah an impact when you at the same time it can invest more in the children you do have. We do know that the illiteracy for quality of schooling is a massive problem in many parts of the world and and that is certainly something that can be addressed in order to increase
00:29:16
Speaker
increase entrepreneurship and and improve ah innovation and economic growth in spite of population decline. But I think the verdict is still out there. We don't know yet. But until now, it's so hard to say that this has occurred because we still see very high productivity in low fertility cultures.
00:29:35
Speaker
Just a couple more quick questions here. um When is it time to to panic? Because we're all pretty relaxed about this. Like, yeah, we're kind of tinkering with it the fertility is little bit down, but it's not time to panic.
00:29:47
Speaker
When are we like, this is an actual problem and we ah we need to do something about it, hopefully nothing totalitarian, but when shall we become alarmed about fertility decline?
00:30:00
Speaker
Having all populations in the world have good opportunities to develop and grow will be good for everybody. um That means um that would be less...
00:30:16
Speaker
and unwanted and migration, which is a huge huge problem and challenge for the world as such now. And that would also imply ah better education of people where they live.
00:30:31
Speaker
And that might also result in when people want to migrate, they would be able to take part of the in the workforce and so on. So um really working hard to make all populations in the world have um good opportunities would be a very good place to start, I think.
00:30:52
Speaker
You know, you guys spend so much of your time looking at research and working in your various fields. I'm just wondering if this has affected any kind of personal decisions you've made, whether that's about family, aging, what makes a meaningful life? You ever looking at the numbers and just makes you change how you live?
00:31:13
Speaker
I have two grandchildren and it worries me that we might leave this world to them in a worse state than it was when when I was little. That does not that does not to do with the the growth of the population or the decline of the population, but it's more to do with climate change, antimicrobial resistance, wars and so on and so forth. so Yeah, I'm worried, as most people are these
Balancing Global Risks and Health Concerns
00:31:43
Speaker
days. And I hope but that we will see yeah that this is a transitional time and that we will have more peaceful times and in not too long.
00:31:53
Speaker
What about you, Vega? Are you worried? ah Well, I used to work at the Climate Change Research Institute for 10 years. And ah ah back then, i remember, we as researchers were worried, but most of the population were were were not. so So I feel the the world has sort of adapted to what was common knowledge in a small group but back then.
00:32:16
Speaker
um ah with the focusing on global risks, including risks of conflict, of climate change, of resource scarcity and pollution and so forth. But but I think there's... ah um um ah you I'm not sure if it's... an effective strategy to worry. I'd rather spend my energy to try to come up with the good solutions and better adaptations to to challenges for you we face. So I actually feel in some ways that the global discussions become more honest in recent years and and hence challenges might be um more realistic to to try to to deal with.
00:32:58
Speaker
Okay. A little bit of worry, a little bit of hope.
Men's Health Issues and Societal Norms
00:33:01
Speaker
Let's talk about some of the problems that are particularly affecting men in Norway now.
00:33:09
Speaker
So I think yeah um there are many issues facing facing men, but some of the key ones are, i wouldn't say specifically um important only for Norway, but important for much of the much of the world really. And some of them relates to to health.
00:33:27
Speaker
ah One issue is that men have higher mortality, they have higher age specific mortality. than women ah men die often of avoidable disease at any given age.
00:33:40
Speaker
And in spite of this, there's ah a lower use of healthcare services among men. And this has been the case for many, many years. And although this has been known for a long time, um there has been few at least effective interventions that have changed this this discrepancy in in health and healthcare care use.
00:34:00
Speaker
Let me jump in there because I just published a podcast today with ah American author Sebastian Younger of the The Perfect Storm. And he wrote a book recently about a pancreatic aneurysm he had. He was basically bleeding from the inside. And for years, he was having these abdominal pains, but he just never went to get this checked. And he almost died on the on the hospital bed there. So that's just ah an illustration of men not going to the doctors when they probably should. Do we know why this is the case? Why do women um ah care more about their bodies or listen to their bodies more more than men do
00:34:42
Speaker
That's a very interesting question and I've been asking myself that for ah decades when I've been working as a GP during many, many years. um I think there are many reasons for that and I don't think we know all of them and probably Vega can explain some of it but um at least we know for sure that some of the huge um benefits from using healthcare is that we can see that the The number of deaths related to cancer and also to heart disease have been reduced and dramatically over the last 20, 30 years.
00:35:20
Speaker
Some of that relates to much less smoking, which is a really important risk factor for heart disease and cancer. But some of it also relates to the the important work that has been done in the healthcare care services. So that means that when men are disproportionately less users of healthcare, and they're also disproportionately more ah inclined to have the risk factors for what we call NCDs, non-communicable diseases, such as heart disease, cancer, and so on,
00:35:57
Speaker
and That means that, yeah, that's ah actually a perfect storm, as I said, which was probably not the reason why he used that expression. But ah that means that men are...
00:36:08
Speaker
subject to more de disease and and then also have this, we also see this life expectancy gap that Vegard knows a lot about and how that differs among different countries and still you can see the same quality of the gap almost in all countries. Isn't that great Vegard? Vegard, are you a typical man? Are you not going to the doctor as much as you need to go to?
00:36:35
Speaker
Probably not just as much, but I guess I've become more aware of this in recent years. um But I would like to add that there's there is a um common understanding that there is, at least among researchers, that it's largely socially explained.
00:36:48
Speaker
Guri mentioned smoking, which is really important in explaining sex differences in mortality. But there are also other major interventions that might have been fairly uncontroversial, at least when we look at them now, such as introduction of seatbelts, alcohol restrictions while driving cars, which disproportionately benefited men.
00:37:08
Speaker
Even in Norway, you had the more than half a thousand deaths per year at its peak from traffic deaths, which was so disproportionately male. Most of those deaths were men.
00:37:21
Speaker
And that has now been reduced to a fraction, to perhaps a hundred or less annually. ah And it's largely due to new regulations, better quality of safety regulations, seatbelt restrictions, alcohol restrictions while driving, which suggests that there are many things one can probably do to improve men's health, which which's um are on the table. and And there are many other examples of of interventions that to be possible. so What is on the table? What are a couple interesting interventions to improve men's health?
00:37:58
Speaker
Well, I think, first of all, I think it's important to understand why there are differences in life expectancy between men and women. So both men and women have experienced increases in life expectancy over quite some time, but the gap between men and women persists.
00:38:10
Speaker
And a key reason for this is is lifestyle related. some people Some researchers would argue that it's it it's partially biological, that you have ah um women have um two X chromosomes. X chromosome is much larger than a Y chromosome, which might give certain health benefits. you do have ah men have ah Many men have a high testosterone levels, and that might relate to risky health behaviors.
00:38:36
Speaker
um There are certain causes of death, certain diseases which primarily occur among men or or only occur among men, such as prostate cancer. ah But in spite of this, what we observe is that there are um there are huge differences across across countries. If you go from, for example, Norway to Latvia, I find that the difference between men and women in life expectancy is more than 10 years.
00:39:00
Speaker
If you go to Iceland, you find that it it can be a three years or or less, according to some estimates, which suggests that there it's it's mainly social.
00:39:11
Speaker
And also within't within a country such as Norway, we do have a universal healthcare system. you do have It's not an economic issue. You do find that the the differences are large. In some municipalities, you find that the difference between men and women in life expectancy is very small or gone. while in other ah municipalities you find that it's it's seven years or more.
00:39:35
Speaker
um So there are huge differences even within a fairly homogeneous population and within the same healthcare system. I think it's important to notice that um the non-communicable diseases that we're talking about, which is the main reason at least in Norway and comparable countries, is ah has a lot to do with the social disparities in in terms of risk factors, so that the non-communicable diseases are also disproportionately immense problem, at least at younger age. different The social disparity is...
00:40:16
Speaker
um is a bigger problem for men somehow, because women also live in in relative poverty, even in Norway, but ah men are more prone to, for example, smoke if they are in the lower socioeconomic levels than women are. So there are some ah characteristics for ah men that that means that they are more prone to have these disadvantages risk factors when they're socially disadvantaged.
00:40:53
Speaker
Gotcha. And I'm wondering why both of your attentions are are being drawn in this way. Is this just a matter of looking at the numbers and saying, oh, you know, men on a whole are beginning to suffer or have been suffering more under these certain categories? Or is there something kind of personal or intellectual about your your thinking being drawn in this direction?
00:41:14
Speaker
There is of course a link between for instance household wealth, household income and how long you live. But what we have found in in a publication is that the a relationship is strong for women, even in a country like Norway, but it's much stronger among men that the the difference in life expectancy between the highest and lowest income percentile is 40% roughly higher for men than for women. So this thing that the social context matters for for both the men and women, but even more so for men.
00:41:44
Speaker
And there's also- So when you're on the bottom of the economic ladder and you're a male, you're particularly screwed. that what you're saying? Exactly. And the same might go for education. The same might go for also other factors which are um ah which are not so often discussed, including fertility-related factors. that Male childlessness is much higher than female childlessness.
00:42:10
Speaker
It's ah roughly at twice as high in in Norway for for men and for women. at forty five And you do have a... ah ah The consequences in terms of health are strong for both sexes. Those who are childless tend to have somewhat worse health.
00:42:30
Speaker
But ah some evidence suggests that the effects might be and stronger for men than for women. So again, this context might have strong effects for contextual factors. Socioeconomic factors might have strong effects for both both the men and women, but the relatively strong effects for men.
00:42:47
Speaker
Can I just add that when you're asking why we're interested in this, one reason is also I think because we have the all these registries. That means we have all the national health registries gathered within the Norwegian Institute of Public Health, which means that we are able to really go into depth to see what is going on in the population when it comes to, for example, fertility, but also when it comes to non-communicable diseases, risk factors and so on. and and to and to research that and then give that out to the world together with the the other Nordic countries. we are really in We have a gold mine in that sense.
00:43:29
Speaker
And I think that is one of the reasons why we're particularly interested in these kinds of questions is because we are actually able to to look at this very very thought thoroughly in Norway and in the the other Nordic countries.
00:43:45
Speaker
Gotcha. and I'm kind of wondering if we kind of look at the the history of research, like I'm coming from more of an American and and British perspective here and the same in Norway, but there was vast inequalities between men and women for a very long time. You know, men had all the higher positions, they had wages, were benefited from a multitude of different sort of laws and and things that kind of equaled out. And I think we're beginning to kind of, so so I think there was kind of a hangover. It took us longer to kind of look at men's issues because of that historical dynamic. Is it, is there something similar happening in Norway there?
00:44:28
Speaker
I think that is ah is very true. And seen from my perspective, I would say that it's equally important that men are in good health as women and it's ah and and the other way around. So it doesn't so it's not like it's ah this is not a no-sum game.
00:44:48
Speaker
So as long as we can increase the health, the the public health for both sexes, that would be the most optimal way of of addressing public health issues, I think, in ah in a country.
00:45:03
Speaker
I think you're right. Partly, we talked earlier about why men don't call to the doctor, there are many reasons for that. But it's also the sort of the male um norms which still prevail often that one should sort of toughen up, one shouldn't complain so much, one shouldn't ask others is for help, one should stand in it on on one's own, one shouldn't ask for anyone else's support, which are counterproductive and can be destructive for one's own health and one's surroundings if um if one continues to follow those norms. And I think it's ah it's especially important now when you have ah you have many lifestyle related diseases, conditions you can probably do quite a bit about.
00:45:45
Speaker
and if you and And also ah many of which might be dependent on having an early discovery, such as for example, being able to identify cancer at an early stage, ah being central for for the the likelihood of of survival, for instance.
00:46:02
Speaker
We could mention that we have in Norway we have in place we have three cancer screening programs and one of them is for and colon colonic colon cancer.
Male Loneliness and Societal Impacts
00:46:13
Speaker
and That came in place only three years ago or so, but disproportionately less men than women are taking this test. I'm not surprised.
00:46:27
Speaker
And even though they're more prone to have colon cancer. so Let's move on to so ah more of a social health problem. So, you know, we have issues like male loneliness, male friendlessness, involuntary childlessness. These are structural trends that are likely to intensify over the next quarter century.
00:46:51
Speaker
What kind of society do we get if large numbers of men remain socially disconnected and why should people who aren't married men care about that well i think it has a number of negative consequences uh and i think it's crucial that one tries to uh address these issues first of all i think these trends are highly foreseeable you talked earlier about um historically being the case which certainly is true that men had many of them top-high positions in society, higher income.
00:47:23
Speaker
this They might still have top-income positions, but but the average man is probably not so much better off than the average woman. um And if you look at the some changes, it's not so new.
00:47:36
Speaker
For instance, in Norway, the last year there were more men than women in tertiary education was in 1983. So this is not a sudden development. It has been around for quite a long time. and And in spite of this, there has been a very slow recognition that um that there is a male disadvantage in many socioeconomic developments in in how men cope.
00:48:02
Speaker
um and what it meant to succeed in society. And also that there is, ah for biological reasons, there are more men than women, more males than females born in a pre-demographic transition setting where you had high mortality, You would have probably higher male mortality at younger ages, leading to more of equity in the number of females and males at reproductive ages.
Gender Dynamics in Education and Society
00:48:29
Speaker
But in contemporary societies where most of them these males do grow up, you would find that large shares would end up not having, not being able to find a partner.
00:48:42
Speaker
And this is something that disproportionately, of course, affects men because you have yeah more men in big reproductive ages. and i'm I'm absolutely convinced that the best society is where both women and men have the best health that we can achieve. So I'm um' ah sure that that having men alienated and i said and friendless friendlessness and all all these issues that can come with, specifically with with lower socioeconomic status, is not is not beneficial for women, or quite the ah opposite. And we can see some consequences in terms of of the incel movement, where men become very, very, very,
00:49:36
Speaker
Yeah, um unfriendly towards women, and that has never been a good thing for women. I just wanted to um mention also a personal thing, that because you mentioned 1983 was the last year when when the men were dominating higher education in Norway. Was that so, Rega? Because I started studying medicine in 1984, and that's the that was the first year men.
00:50:01
Speaker
where we were more women than men in that and that class. That means that we were, I think it was 51 versus 50. So it was equal. So it was absolutely good. But we we were told all the time that this was not good by our teachers.
00:50:21
Speaker
So this this this was going to be a catastrophe for the medical profession. So you have that, you have that we have that story with us. so It's been, um it's been, ah we have been traveling quite far.
00:50:35
Speaker
And I think that's a good thing. But we definitely have to take care of the young boys and men. It doesn't sound like it was a catastrophe after all. um i don't know if you're familiar with the ah British American writer, Richard Reeves, he wrote a book called of Of Boys and Men. And One of the things he talks about is men just have slower brain development than girls. So, you know, a seven-year-old boy is at a disadvantage against up against a seven-year-old girl of the same age, academically speaking. And one of his ideas is he calls it redshirting, where like an eight-year-old boy would then be paired with a seven-year-old girl. They'd be kind of starting out in class together.
00:51:23
Speaker
Has any of this been explored at all to kind of level the playing field um academically to kind of give boys that confidence and momentum going into their secondary education?
00:51:36
Speaker
There are biological sex differences and and testing boys and girls at the same chronological age when we know that on average they have different maturation stages. they're they're less Boys might be less developed simply at a given age. It takes a bit more time. it' It's likely giving and a disadvantage to the boys.
00:51:56
Speaker
So yes, it's certainly something that should be should be addressed to much greater extent and redshirting could be one um ah one policy intervention. um but But I think this relates to actually much greater discussion that one should take into account that the ah there are differences between men and women, and and we should try to make the best of it.
00:52:19
Speaker
um And for example, you have higher shares of boys who are less able to sit still in class during certain ages, ah ah different risk-taking behaviors between boys and girls. And one should rather try to, where possible, try to translate that into something positive to to say that some boys might have to or should perhaps go into to work earlier, to have years off, ah to do something else than sitting still at the school and rather to to try to adjust society to adapt for for such differences as much as possible.
00:52:54
Speaker
And the same goes for adults as well. If there's a different risk taking structure, one should try to adapt society. So this type of risk taking comes out as something positive, as entrepreneurship, as firm creation, as patent making, as something beneficial for society.
00:53:11
Speaker
Just recently, there was a driver's school for for young people. who There was a teacher who suggested that males shouldn't be able to have their and driver's license until they were 20, I think it was.
00:53:29
Speaker
In Norway, it's 18 for both men and women, of course. and That of course met a lot of resistance, particularly among boys, but also, but that is based on those kinds of suggestions are based on looking at statistics, seeing that young boys are much more prone to be to being in car accidents when they are young and young drivers.
00:53:54
Speaker
I'm not sure if that would be postponed anymore, if or if it would it would if it would be postponed, or if it would would be cut by um um increasing the age of of boys taking the driver's license. but so So in this case, it's boys who would only, they'd have to wait until they're 20 and girls would get it when they're 18? Is that right? Yeah, exactly.
00:54:17
Speaker
I can see how that could be troubling. A lot of this stuff, um it could be very emotional. Yeah, absolutely. so But then again, it's it's interesting to to discuss this. as we It's only a little bit more than 100 years since women got their...
00:54:36
Speaker
um rights to to vote in Norway. Think how far we have come in terms of giving the same um possibilities. And now we're sitting here discussing whether we should differentiate between the sexes again. It's a very interesting and very intriguing discussion.
00:54:53
Speaker
It is. and I don't know what it's Like in Norway, but kind of from my British American context, especially in kind of like online discourse or maybe academic, um the university discourse.
00:55:07
Speaker
There's almost been a slight leeriness and aversion to talking about basic kind of sex discourses. differences. And I don't know exactly why that is. it's It's just kind of hard to say boys are good at this and girls are good at that. And there any kind of difference is usually um pointed towards like cultural, environmental stuff, like you're being shaped by the media or you're being shaped by your education to have this toxic masculinity or aggression or competitiveness or
Biological Differences and Fertility Decisions
00:55:42
Speaker
something like that. And I think you're right. And I think the reason for that is that ah when we when somebody points at differences between the sexes, it's no the the common way to do that has been to say that women should be
00:56:00
Speaker
staying in the kitchen, or that that should be the consequence somehow. So women are very um aware of this discussion. We know that the rights can be taken away from us any at any time.
00:56:13
Speaker
not Not as much in Norway, but in many many places that actually happens. and And so I think that is the background why it's difficult to discuss biological reasons and or differences. Because and I'm quite keen on discussing, for example,
00:56:30
Speaker
um There are biological differences when it comes to the possibility to have children. And as you mentioned, Beggar, the fertility rates are going down in most of the Western world. And women need know that we are not equal to men when it comes to this question.
00:56:53
Speaker
And so if you want to have two or even three children, that means that you cannot choose living like a man and wait until you're, long as you want to you have to. You have to think about this. And men, men their partners have to to be part of that discussion and they have to also take part in that.
00:57:15
Speaker
Let me just finish with one
Cultural Recommendations and Conclusion
00:57:16
Speaker
last question. i usually ask the guests at the end of of each episode, just for something they're enjoying in the culture, um one of those bleak Norwegian TV shows, ah movies, books, anything you're enjoying in the culture right now?
00:57:34
Speaker
i want to see on a cinema, and not in Norwegian, but a Spanish movie, Searot. Have you heard about that?
00:57:46
Speaker
And that was a different experience and very, very yeah yeah interesting and moving. So I can recommend recommend that.
00:57:58
Speaker
Okay, I'll put that in the show notes. Vegard, you got anything? Well, yeah this ah um if you ask the average Norwegian, including myself, about what's big in the news these days, among positive things, it would be that we have a Norwegian football team to just ah beat one of the Voodoo Glimp beat Inter in in soccer in the Champions League. And that is a major issue here, which is certainly something that... provides a lot of entertainment and positive attitude something that is really needed in these types so that is something i would um i would recommend following norwegian soccer perhaps even not only winter winter sports as i started with but also summer sports maybe the future will be
00:58:37
Speaker
but will The future is Norwegian. yeah you're just going to dominate all the Olympics. Yeah, congratulations on that victory. Congratulations on me for us winning the U.S. men's ice hockey team, which was a thrilling show. But anyways, thank you so much, both of you, for coming on, Buri and Vegard. It's been so nice chatting with you and and learning from you. So thank you and farewell.
00:59:03
Speaker
Thank you so much for inviting us. Thank you.
00:59:24
Speaker
This was the Out of the Wild podcast, original music by Duncan Barrett. For more episodes, subscribe to my sub stack.