The world’s population is ageing and Europe’s population will be the world’s oldest. By 2030, a quarter of the continent’s population will be older than 65, a doubling compared to today. The population of working age will thus decrease.

There are several possible developments:

  • An increase in the number of women in the workforce
  • Social protection systems will come under heavy pressure
  • There could be a large number of poor older persons

Attention is our ability to focus on stimuli, and in the case of scenario planning and foresight, on our stimuli from our external environment. Perception is our ability to make sense of the stimuli.

There is an obvious connection as we select what events and facts we choose to pay attention to, and that will modify our perception of the present and of future trends. This is particularly true today due to the inflation of information readily available.

Black Swans is the name given by Nicholas Taleb to events that are unexpected, very difficult, if not impossible, to predict, and leading to major changes which can be catastrophic. The fall of Communism and the dissolution of the Soviet Union are said to be black swans.

According to this theory, the main reasons why certain events are not predicted are:

  • The difficulty of imagining how one single event can induce such large effects
  • The probability of such an event taking place is very small
  • Psychological bias.

There have been several psychological explanations put forward to explain why we stay unprepared in the face of extreme events.

We tend to forget events that happened in the past and the disasters they may have brought about.

We do not believe these disasters will happen to us because our optimism prevails over realism.

The steps we take may not be sufficient.

It is thus important to define early areas of vulnerability as these are not included in decision theory. In other words, unknown unknowns such as unprecedented occurrences, are never taken into consideration, but should be.

The main reasons for these risks not to be taken into account are the following:

  • They are hard to imagine
  • We do not know how to cope with them.
Charter Cities is a concept put forward by World Bank Economist Paul Romer who defends the point of view that it is neither technologies nor the inavailability of resources that will limit the growth of living standards, but the limited capacity to discover and implement new rules, in particular rules concerning land titels, patents and social norms. Hence, the need to adopt new rules. The model he referred to was China’s Special Economic Zones.

Sharing, in particular the sharing of technologies is a key idea behind the concept.

Another key idea is that charter cities could be run under a totally different system from the rest of the country. Also, the cities would be run by foreigners, like Hong Kong was, an idea that has been judged to be neocolonial, particularly as the workers, originating from the poor country would maintain the citizenship of their country and therefore would be strangers in the charter city.


Cognitive biases are set or preconceived ideas about people or institutions. Cognitive biases may be irrational but control our rational thought processes without our realizing it.

Cognitive biases can be overruled by understanding their presence and refusing to allow them to rule decisions.


Complex systems cannot be sufficiently described, predicted or managed. The components of the system are interrelated and a small change in one of the components of the system leads to a major change in the system.

Counterfactual history is the game of attempting to imagine what would have resulted had different decisions been taken by the historical actors and to understand how history, personal, corporate or history with a capital H, would have turned out if certain decisions had been made different from those that had actually been made. Thus, the importance of relative events can be analyzed.

Back in 1931, Winston Churchill imagined how different the world would have been if General Lee would have been if he would have won the battle of Gettysburg.

Counterfactual history has led to the theory of contingency history that supports the idea that history is not deterministic but that small events are determinant in the direction that history takes.


Debiasing techniques, of which there are a large variety, are used to improve decision making by limiting the impact of biases on the part of the decision-maker. It only limits the introduction of biases but can never totally eliminate them.

For managers to introduce debiasing techniques, they need to accept that biases may have been introduced in their decision paths and that they are willing to correct the biases.

The debiasing techniques can be divided into three types:

  • Cognitive, leading decision makers to change the manner of conceptualizing problems
  • Motivational, which modify incentives or punishments
  • Technological, which involve artificial intelligence.

The best known debiasing technique consists of getting decision makers to consider the opposite of their conclusions before taking a final decision and asking themselves if there is anything wrong in making that decision.

Incentives or punishments may be financial or psychological. For example, offering one’s decisions to criticism before their implementation is one way of debiasing them.

The increased complexity of situations for which decisions need to be taken have introduced artificial intelligence as a debiasing tool, in particular when calculations are involved.

The demographic burden is the ratio of the number of persons under working age and over working age per 1000 persons of working age.
When child and infant mortality rates decrease, fertility rates also fall. This drop in fertility is achieved through government policies essentially on family planning and health care for mothers, newly born and infants.

For a period of 20 to 30 years, economic growth increases. This is what is called the demographic dividend.

The changes brought about are as follows:

  • There are fewer investments specific for the young and funds can be transferred from infant and primary education to higher education thus increasing the skills of the population
  • There is a significant average life extension leading to an increase in the working age population
  • The workforce being younger, it tends to be more productive
  • Women are freed from pregnancies and child care earlier, have a better health, and can join the working population
  • Increased income serves to buy more and better food and a better fed population is more productive
  • Increased income is channeled into better education for both males and females
  • As the income from the majority of the population increases, there is less of a likelihood of social unrest
  • Part of the additional income is channeled into savings programs and can be used by corporations and government entities for investment.

However as the population ages, increased spending for the health and care of the aged is required.


A disruptive innovation creates a new value network and therefore a new market. By doing so, it disrupts an existing market. Usually the market is taken by surprise.

The usual reaction from the leaders of the markets as they were structured before is for them to abandon the market and leave a large market space to the disrupter.

Usually, the disruptive product is cheaper, more convenient and simpler.

The initial customers are those unsatisfied with the current market offer, but as the disruptive product improves, it gains a wider acceptance and eventually conquers the market. Precisely because the disruptive innovation touches customers not previously serviced by incumbents, the latter tend not to react.


Drivers are the primary forces leading to change. Some drivers, called predetermined, are predictable, while others are unpredictable and are called critical uncertainties.

The theory of epidemiologic transition states that there is a change in the distribution of deaths by cause away from communicable diseases towards non-communicable diseases.

There are large differences between countries and these differences are increasing. However, these are the major causes of mortality today.


The figures of the Foundation for AIDS Research are as follows:

  • In 2016, 36.7 million people were living with HIV.
  • In 2016, 1.8 million people became newly infected with HIV; 160,000 were under the age of 15.
  • About 4,932 people will become infected with HIV each day—about 205 every hour.
  • Since the beginning of the pandemic, 76.1 million people have contracted HIV and 35 million have died of AIDS-related illnesses, including 1 million in 2016.
  • In 2016, 19.5 million people living with HIV were accessing antiretroviral therapy.

Persons diagnosed with HIV are prone to suffer from tuberculosis, accounting for 13% of all cases worldwide.

Prevention is taking the upper hand today. In the US, the government is encouraging populations at risk to take a daily pill of a product called Truvada, as a preventive measure, replacing the use of condoms. This is expected to increase the risk of contamination by other sexually transmitted diseases such as gonorrhoea or syphilis.


Alcohol can harm all and any part of the human body as well as increasing the risks to the drinker by increasing the chances of incurring accidents and indulging in violent behavior. People other than the drinker can also be put in danger, again mostly through an accident-prone or a violent behavior. Fetus and child development are also affected. In Europe, up to 80% of crimes and 70% of violence, both intentional and unintentional, against partners or children has been associated with drunken behaviour. Alcohol consumption has also been associated with high suicide rates. Over 7% of premature deaths have been ascribed to alcohol consumption. Alcohol consumption is estimated to be responsible for 90 extra deaths per 100 000 men and 60 per 100 000 women.

The World Health Organizations estimates that the total number of deaths due to alcohol consumption if, worldwide, of 2.5 million people, or 4% of all deaths. It is a bigger killer than AIDS, violence or tuberculosis; is the world’s third largest risk factor for disease and disability (after childhood underweight and unsafe sex) and the greatest risk in mid-income level countries. Alcohol is deemed to be a causal factor in 60 types of diseases and injuries and a component cause in 200 others. Alcohol is also responsible for a number of social issues such as child neglect and absenteeism.

Men, particularly, suffer from the effects of alcoholism. For males aged 15 to 59, it is the main cause of death. 6.2% of all male deaths are attributed to alcohol against only 1.1% for women. Men with lower socioeconomic and educational levels are particularly prone to alcoholism.

Europeans are the biggest consumers, with an annual consumption of 9 liters per year, hence twice the global average. Consumption is, however, declining – in France and Italy, for instance, two countries which were the largest alcohol consumers, adult consumption has decreased by one third. It is particularly wine drinking that has been reduced. The proliferation of fast food appears to have been a contributing factor in this slowdown.

Alcohol-related deaths remain low in Western Europe while this is not the case in Eastern Europe. In Russia, particularly, binge drinking is a major problem.

Of increasing concern, particularly because this behaviour is typical of young adults, is binge drinking. While there is no agreed definition, one can say that it is the heavy consumption of alcohol in a short period of time – figures of 60 to 70 grams of alcohol in a period of two hours can be found in the literature. Up to 80 million Europeans have been reported to practice binge drinking with 25 million indicating this is a usual pattern of behaviour. Ireland and the UK are the countries that report the largest number of binge drinkers, and men outperform women by a ratio of 3 to 1. France, Germany and Italy are the countries with the lowest number of binge drinkers.


Data from the WHO:

  • Cancer is one of the leading causes of morbidity and mortality worldwide, with approximately 14 million new cases in 2012.
  • The number of new cases is expected to rise by about 70% over the next 2 decades.
  • Cancer is the second leading cause of death globally, and was responsible for 8.8 million deaths in 2015. Globally, nearly 1 in 6 deaths is due to cancer.
  • Approximately 70% of deaths from cancer occur in low- and middle-income countries.
  • Around one third of deaths from cancer are due to the 5 leading behavioral and dietary risks: high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco use, and alcohol use.
  • Tobacco use is the most important risk factor for cancer and is responsible for approximately 22% of cancer deaths..
  • Cancer causing infections, such as hepatitis and human papilloma virus (HPV), are responsible for up to 25% of cancer cases in low- and middle-income countries.
  • Late-stage presentation and inaccessible diagnosis and treatment are common. In 2015, only 35% of low-income countries reported having pathology services generally available in the public sector. More than 90% of high-income countries reported treatment services are available compared to less than 30% of low-income countries.
  • The economic impact of cancer is significant and is increasing. The total annual economic cost of cancer in 2010 was estimated at approximately US$ 1.16 trillion.
  • Only 1 in 5 low- and middle-income countries have the necessary data to drive cancer polic


As it often remains undetected, it is a cause of early mortality.

Diseases of the circulatory system

They account for 50% of deaths in Europe with men being more affected than women. The incidence varies by country, sex and age. Men are predominantly affected. High blood pressure is the main culprit. (WHO, 2012)

The use of preventive drugs has been shown to lower this incidence. A reduction in the consumption of salt and tobacco has also contributed to these improvements. (Rapsomaniki et al, 2014)

The reduction of deaths due to cardiovascular diseases has been a major contributor to longevity. (Mathers et al, 2014)

Diseases of the digestive system

These include chronic liver disease and cirrhosis as well as ulcers. They have been associated with viruses, toxins and drug use, particularly alcohol. (WHO, 2012)

Diseases of the respiratory system

These diseases affect mostly children and older persons and are due to environmental exposures. (WHO, 2012)


Cannabis is the most commonly used drug in Europe, followed by cocaine, opioids and ATS. In Western and Central Europe, 7.6% of the population is believed to be addicted to cannabis.

Britain has the worst level of drug abuse in Europe, and the second highest level of drug-related deaths, a report said Wednesday.

Overall, Britain has the highest number of addicts with 0.85 percent of the population — more than twice that of European countries such as France and Sweden (0.4 percent) or Germany and the Netherlands (0.3 percent).

The lowest rates of drug abuse are in Poland and Germany, said the study. In terms of deaths linked to drug abuse, Britain comes second only to Denmark — although both are well behind the United States and Australia. France has the lowest number of acute drug-related deaths.

Eastern and South-Eastern Europeans are bigger users of heroin with 1.2% of the adult population being addicted. Russians, who find it increasingly difficult to procure heroin, also use local substances such as desomorphine. Injections are a frequent carrier of the HIV virus. (Patten, 2008)

Crack cocaine and opiates are among the most dangerous drugs. (Centre for Social Justice, 2013)

Some authors claim that drug consumption has been reduced if one compares present consumption to that of a century ago. Thus, in spite of a sharp population increase in this interval, opium production has fallen from 30 000 metric tons to 9000, including the quantities devoted to medicinal use.

The total number of drug users is estimated to be 200 million with cannabis the most used drug, being the favourite of 165 million people.

45% of the British population has used cannabis at one point or another of their life.

Cocaine is mostly used in North America where the 7 million consumers represent half the total number. The reverse effect is taking place in Europe where Britain and Spain are the main consuming countries.

The number of opium consumers in China has decreased from 450 million to 9.3 million.

The main production and distribution centers are  the so-called ‘Golden Triangle’ in South-East Asia (Myanmar and Laos) and the ‘Golden Crescent’ (Afghanistan and the neighboring countries). (Patten, 2008)

The financial flows from the drug trade to the legal economy are so large, that a major disruption of the drug trade would lead to an international crisis.

The value of trade in illegal drugs is estimated at five billion pounds a year, according to the study by Professor Peter Reuter of Maryland University in the US and Alex Stevens of Kent University in Britain.

New drugs are entering the market every week. (Centre for Social Justice, 2013)

Environmental factors

These include living conditions, road safety, quality of the air and water, climatic conditions, etc. in 2012, 7 million died from air pollution alone making it the world’s number one environmental risk.  WHO estimates at 1.2million the number of children that die every  year  due to polluted environments – in other words, 1 in 4 deaths of children under 5 years of age.

More specifically, the deaths occur due to air pollution,  diarrhoea, malaria, etc.

There is a relationship between air pollution and cardiovascular diseases and cancer. (WHO, 2012)

Injuries and poisoning

This is the third cause of death representing 8% of all deaths. This category includes accidents, suicides and homicides. (WHO, 2012)

There have been considerable efforts in many countries to reduce accident fatality rates. Thus, over the period 1995 to 2009, these were reduced by 50% on average in high-income countries, with a reduction in France of 52%.

This reduction has been achieved through good planning and management of resources, implementation of specific measures both regulating driving behaviour and emergency response and finally through the provision of sufficient resources.

The driver’s behaviour most responsible for accidents are speeding, drunk behavior and failure to use seat belts. (Transportation Research Board, 2010)


An increasing number of children are obese and will be carrying their obesity into adulthood. As their number increases, the increased lifespan trend may falter and even be reduced by two or three years. (Roberts, 2008)

Obesity is an independent risk factor for diabetes, cardiovascular disease and some forms of cancer. (Sulston, 2012)

Road accidents

Road traffic accidents, not Aids, cancer or any other disease, are the biggest killer of young people worldwide, experts warn.

Nearly 400,000 young people under the age of 25 are killed in road traffic crashes every year. Millions more are injured or disabled.

Most occur in low income countries, such as Africa, and are avoidable.

These include lowering speed limits, cracking down on drink-driving, promoting and enforcing the use of seat-belts, child restraints and motorcycle helmets, as well as creating safe areas for children to play.

Socioeconoimic determinants

Very important determinants of health are income level – particularly disposable income -, employment status and the attained level of education. There is an established relationship between income level and mortality due to circulatory diseases.

Low socioeconomic determinants in childhood – when children are exposed to chronic stressors – lead to inflammatory reactions, and later to cardiovascular diseases in adulthood, even if later in life there is a marked improvement in these determinants. High maternal warmth may, however, shield children from these determinants. (Waite and Plewes, 2013)

Social pressure due to population increase is leading to curtailing of funds to treat the aged and the introduction of euthanasia, and in some countries, not only for patients with terminal diseases but also as a means to control population.


Another mortality factor of growing importance is suicide which represents 2% of the deaths worldwide, a nearly 60% higher than 50 years ago, having become the second most important cause of death for the 15-35 age bracket.

It is only recently that it has been accepted that the causes of suicide have social roots in spite of the fact that the pioneering work of the French sociologist Emile Durkheim can be traced back to the end of t nineteenth century.

Nearly one million people commit suicide annually and the World Health Organization forecasts the figure to grow to 1.5 million by 2020.

In 2001, the number of suicides overtook the combined total of deaths by homicide (500 000) and war (230 000). The highest suicide rates are noticed in Eastern Europe with the lowest in Latin America, in Moslem countries and in some Asian countries. In Western Europe, suicides have overtaken deaths by car accidents. The rates of suicide are three times higher for people over 75 years of age than for the 15 – 24 age range. Men commit suicide three times more frequently than women except in China were the rate is identical for both sexes.

The number of suicide attempts is estimated by the WHO to be 10 to 20 times that of accomplished suicide, even though data is not precise. Women attempt suicide more frequently than men.

The most commonly used suicide methods are pesticides, fire arms and pharmaceuticals, in particular analgesics. (Perez M: Le suicide tue plus que les guerrres, Le Figaro, September 10, 2004)

Suicidal behaviour is a major health concern in many countries, developed and developing alike. At least a million people are estimated to die annually from suicide worldwide. Many more people, especially the young and middle-aged, attempt suicide.

Over the last few decades, while suicide rates have been reported as stable or falling in many developed countries, a rising trend of youth suicide has been observed. In 21 of the 30 countries in the World Health Organization (WHO) European region, suicide rates in males aged 15-19 rose between 1979 and 1996. For females, suicide rates rose less markedly in 18 of the 30 countries studied. Various possible explanations for these rising suicide trends – loss of social cohesion, breakdown of traditional family structure, growing economic instability and unemployment and rising prevalence of depressive disorders – have been presented.

Some worldwide analyses of suicide trends and rates in the world have been published (4-7), but very little is known worldwide about the causes of death and suicide rates among young people aged 15-19.

The purpose of this study was to present an overall picture of suicide among adolescents worldwide using available data from the WHO database, and to evaluate the role of suicide as a cause of death in the 15-19 age group.

Suicide data are still not available in many countries. In the present study, data from only 90 countries (areas) out of the world’s 192 nations were available for the 15-19 age group in the WHO Mortality Database, which is the largest database in the world on this topic. The WHO mortality statistics are commonly broken down by gender and age. However, some countries do not report deaths broken down for the 15-19 age group, and there are only 130 member states of WHO.

The reliability of suicide statistics is often questioned. Suicides are underreported for cultural and religious reasons, as well as owing to different classification and ascertainment procedures. Suicide can be masked by many other diagnostic categories of causes of death.

Unfortunately, in cases of young people, death due to suicide is often misclassified or masked by other mortality diagnoses. This makes the global picture of death by suicide even graver.

The mean suicide rate of 7.4/100,000 (10.5 for males and 4.1 for females) may be perceived as a reasonable estimate for the 15-19 age group and used as a basis for evaluating suicide rates among adolescents in different local communities.

In the calculation of suicide rates, the numbers of suicides in two large countries with more than 1,000 suicides in the 15-19 age group (Russia, with 2,883 cases in 2002 and USA with 1,616 in 2000) accounted for 37.3% of the total, thus heavily influencing the mean rate.

Interestingly, these two countries’ suicide rates were markedly different. The Russian rate was 23.6/100,000, more than 3 times the mean (7.4), whereas that in the USA was 8.0, fairly close to the mean. Sri Lanka had an extraordinarily high suicide rate in the 15-19 age group: at 46.5/100,000, it was more than six times the mean rate. Unfortunately, data for recent years are not available for Sri Lanka.

Suicide rates for young people in the 15-19 age group are, as for other age groups, higher in males than in females. Young males’ overall suicide rate was 2.6 times that of females. Exceptions were found in a number of non-European countries, like Sri Lanka, El Salvador, Cuba, Ecuador and China, where suicide rates for females 15-19 years old exceeded those of males in the same age group. This fact urgently calls for further investigations.

Data from the latest 35-year period (1965-1999) show a marked difference in suicide rates between European and non-European countries. The high rates in non-European countries call for more attention. One reason for the lower suicide rates in European countries (although suicide rates in this region also vary widely from one country to another), beside cultural and psychosocial factors, may possibly be the physicians’ awareness of the importance of adequately treating people with psychiatric disorders, psychosocial problems and harmful stress. However, this does not apply to the whole European region, since countries in transition show very high suicide rates, both for adults and for young people.

The fact that suicide rates are higher in males than in females has long been widely recognised. However, this study shows that suicide as a cause of death in the 15-19 age group is very similar in both sexes: 9.5% in males and 8.2% in females.

Suicide is one of the leading causes of death among young persons of both sexes. It is the leading cause of death in this age group after transport and other accidents and assault for males, and after transport and other accidents and neoplasms for females. (Wasserman D, Cheng Q and Jiang G: Global suicide rates among young people aged 15-19, World Psychiatry, 4, 2, pp 114-120, 2005)


Statistics show that approximately 50% of all smokers will die of a smoking-related pathology.

Annual tobacco-induced deaths are estimated to be of 6 million people per year. Included in this figure are the 600 000 who are passive smokers. (WHO, 2011)

95% of all lung cancer deaths occur in smokers. This, in spite of all the warnings given to smokers. These warnings seem to be taken more seriously the higher the status of the smoker. A possible explanation is that the higher the social status, the more oriented towards the future and therefore the need to remain alive and in good health.

In the 1950s smoking was prevalent whatever the social class. The fist anti-tobacco campaigns had a bigger effect on the middle class than on the lower-income class. Lower classes became more sensitive to higher taxes on cigarettes. (Marmot, 2004)

Nevertheless, large graphic health warnings on tobacco packaging as well as mass media campaigns, particularly on television, reduce tobacco use by inducing smokers to quit and youngsters not to start smoking.

Providing assistance in quitting smoking habits is also an important measure.

While smokers seem to be indifferent to the dreadful images on the packages, banning of tobacco advertising, and promotion generally, also yields positive results. A complete ban would result in a 7% decrease in consumption.

These measures must be accompanied by tax increases on tobacco products. This is possibly the most effective means of reducing consumption by younger people. Each 10% increase in retail prices leads to a 4 – 8% reduction in consumption. (WHO, 2011)

Nevertheless, in certain countries, price increases has simply led consumers to smoke cheaper cigarettes.

While twice as many men smoke as women, the latter are catching up quickly.

Nations at advanced stages of cigarette diffusion, where women have had a longer time to catch-up with the earlier adoption of men, showed convergence in female and male smoking-attributed mortality, whereas nations at the early stages, where women have not adopted smoking in large numbers, showed divergence in female and male smoking-attributed mortality.

This argument about the source of national differences views cigarette use and smoking mortality as a type of epidemic or diffusion process that rises slowly at first, accelerates to a peak, begins to abate, and falls to levels below the peak. The pattern of change occurs among both men and women, but, because men adopt cigarettes in large numbers earlier than women, the male changes precede the female changes by a decade or two. With men affected by the epidemic first, the sex differential initially grows. Later, as smoking mortality among men peaks and begins rising among women, the differential stops growing. Still later, as smoking mortality declines among men, it grows among women (just as it had earlier among men). Therefore, the differential begins to narrow. The lag in the process for women means, in short, that the more advanced the stage of the epidemic (i.e., the earlier the diffusion process begins and the farther it proceeds), the closer the smoking mortality rates of men and women.

The harm of cigarette use on male and female mortality emerges most clearly in the traditionally high rates of lung cancer mortality among men and the movement toward convergence between men and women in recent decades. With around 90 percent of lung cancer deaths stemming from cigarette use, the trends in this form of death directly reflect trends in smoking. However, identifying the full harm of cigarette use and the whole influence it has on the sex differential in mortality requires attention to causes of death other than lung cancer. According to estimates of the U.S. Surgeon General, only 28 percent of tobacco-related deaths involve lung cancer. The risks of lung cancer mortality among current smokers ages 35 and over relative to nonsmokers are 22.4 times higher for men and 11.9 times higher for women. In addition, the relative risks of mortality to smokers from bronchitis and emphysema are 9.7 (males 35+) and 10.5 (females 35+), from cerebrovascular disease are 3.7 (males 35-69) and 4.8 (females 35-69), and from ischemic heart disease are 2.8 (males 35-69) and 3.0 (females 35-69). Similarly, in a 40-year study of British doctors, smoking raised the rate of death from lung cancer by a factor of 14.9, but also raised the rate of death from other cancers by 1.5, respiratory diseases by 2.9, ischemic heart disease by 1.6, and all causes combined by 1.8.

Given the declining contribution of smoking mortality to the relative mortality rates overall, the contribution of trends in non-smoking mortality becomes critical. Having risen steadily over the past two to three decades, the sex differential in non-smoking mortality will likely continue to rise in the near future, perhaps at a slower rate. If so, the sex differential for all causes will, on average, also rise. This prediction depends on the assumed continuation of increases in the female advantage in causes of death unrelated to smoking, and past patterns obviously do not guarantee the same in the future. If instead, the past growth in the female advantage in non-smoking mortality is assumed to immediately cease or even reverse direction, it would lead to different predictions: The total sex differential would show no growth or decline.

Will relative trends in male and female non-smoking mortality change in the future? On one hand, a reversal in past growth of the female advantage as yet seems unlikely. Despite movement toward equality in other areas of social life, norms of male and female health behavior remain sufficiently distinct to continue favoring women. Moreover, female longevity (at least among non-smokers) has not yet come close to a ceiling that would slow future growth, allow male longevity to catch up, and reduce the sex differential. As a result, deaths from suicide, homicide, accidental injury, cancer, COPD, stroke, and heart disease that have little direct relationship to smoking do not indicate convergence between men and women. On the other hand, reductions in the use of tobacco by men may reflect a broader and growing concern with good health that may soon bring rewards in other areas of health. Such trends may narrow the gap in non-smoking mortality between men and women. (Pampel F: Forecasting sex differences in mortality in high income nations : the contribution of smoking, Demographic Research, Volume 13, Article 18, Pages 455 – 484, November 2005)

There is a strong price elasticity and price increases of cigarettes could be used to curb smoking. (WHO, 2012)

In France, smoking is the preventable disease causing the greatest number of deaths – 70’000 which represents eighteen times more than road accidents. 59’000 of these deaths are masculine. It is thus 22% of the male deaths and 11% of the female. 60% of these deaths are cancer-related.

One third of all deaths of men between 35 and 69 years of age are related to smoking.

The health costs are of 12 billion Euros. The total cost of smoking (direct and indirect costs) amounts to 47 billion Euros, or 3% of GDP.

Every third Frenchman smokes and since 2005 tobacco sales are no longer decreasing. In fact, there has been an increase in smoking in women and younger persons.

Taxes related to tobacco represent approximately 15 billion Euros. Another important financial issue is the revenue of the owners of newspapers come tobacco kiosks.

It has been suggested by a number of state-affiliated bodies that the costs of anti-smoking cures, under the supervision of doctors or pharmacists, should be financed, at least partially, by the state. (Cour des comptes, 2012)

One of the best ways to reduce smoking has been shown to be banning smoking at home or in the city.

The decrease, essentially by men, of smoking habits has led to an extension of longevity. (Mathers et al, 2014)


Tuberculosis, abbreviated TB, is a treatable bacterial disease. Today, however, we have multi-drug resistant tuberculosis essentially in the BRIC countries with the notable exception of Brazil due to easy access to health care and to the poverty alleviation programs in that country. (Olson et al, 2014)

Russia and Eastern Europe, in particular, are countries with a large number of drug-resistant cases. The high incidence of HIV renders those individuals more susceptible to TB infections.

Due to the high cost of treating these cases, they are often left untreated and contamination then spreads through the population. Treatment costs of multi-drug resistant TB are of the order of USD 10’000 and therefore out of reach of the majority of the population. (Stratfor, 08.09.14)



Assisted suicide

European governments are increasingly passing laws decriminalizing assisted suicide. Switzerland has probably the most liberal law, allowing persons who are neither ill nor even residing in the country, to have access to assisted suicide without even requiring the authorization of a medical doctor.In Belgium, the law condones assisted suicide even for children if they are terminally ill and there is no chance of medical relief. In the Netherlands, the law applies to anyone over 12 years of age who have unbearable suffering and no chance of relief. (The Economist, July 19, 2014)


Several studies have shown that men and women having completed only the minimum mandatory education had a higher mortality that men or women having completed their doctoral thesis. These studies have shown that there is a gradient of mortality directly associated with the number of years spent studying. (Marmot, 2004)


Environmental scanning is the study of the environment of the corporation to extract information that could be relevant to determine trends. The information can include events, ideas, comments, and any type of information that could be felt to be relevant.


The Total Fertility Rate (TFR) in the world has dropped by nearly 50% since 1955, from 5 to 2.5 children per woman, and is forecast to be between 1.8 and 2.2 by 2050.

A UN report states that perhaps for the first time in human history, couples can have a long term relationship without having children. Thanks to birth control methods, and the disconnection between sexuality and reproduction, childbearing in developed countries is the result of a planning decision in at least 50% of the births, and is essentially a decision heavily influenced by women, women and their partners, and more rarely by men.

There are a large number of factors affecting birth rates, and we shall cover the main ones in this note.

Children as caretakers of their parents

In predominantly rural societies, particularly in the absence of retirement plans, children would be caretakers of their parents. As increasingly countries have introduced pension plans, this driver of natality has lost its importance.

The impact of age

Age of the mother is a major factor. Child brides were necessary in early society as the period during which they were fertile was longer and this allowed them to carry aa large number of children. Conversely, women marrying at an older age will not be able to carry many children.

In several developed countries, the average age of women at their first birth is now over thirty. There are several factors that explain this delay: longer studies, the decision of women to have children only once they have well established themselves in life, with a stable job and companion. Women who undertake long periods of study will also delay their first pregnancy and will bear only one child.  Further, the availability of a variety of contraceptive means has nearly eliminated teenage unwanted pregnancies.

Felicity and birth

It has generally been believed that happiness in life has led to women have a larger number of children, in particular if the relationship between partners, and particularly married partners, is a happy one.

Particularly unhappy relationships, such as those leading to depression, are conductive to low fertility if only because anti-depressants reduce libido and fertility.

The cost of parenthood

Some couples take a rational view and consider direct costs and opportunity costs in deciding to have a family. Policies such as ‘speed premium’ – a material encouragement to have a second child in a maximal set period from the birth of the first child – and financial incentives generally, have thus been found to encourage fertility, but only marginally so. In general, monetary aids have not been determinant in increasing fertility rates.

The impact of social infrastructure

As increasingly women have entered the workforce, the task of caring for the children has been passed on to the state.

The availability of material support and social services, such as affordable childcare, flexible working times, or the possibility of parental leave, has a determining effect, particularly for working women with a lower income. Couples who truly want children may move to areas where such services are available.

It appears that the fertility gap is essentially due to the absence of these services.

The impact of education

Education levels of women are also an important factor determining birth rates.

Educated women have more to lose, materially, than less educated women, in financial loss and slower career advancement due to childbirth. They also tend to be more independent and therefore less likely to want to form a family. The values of these women also move to search for quality rather than quantity in their offspring.

Women with higher education are usually older when they have their first child and this, of course, limits the total number of children they will have unless they decide to accelerate their subsequent child-bearing.

Conversely, women with a low level of education seek the financial backing of a husband and are therefore more prone to motherhood.

There is a negative relationship between literacy and birth rates. The most probablyereason is that highly educated women want their offspring to be, in turn, well-educated and that means a more reduced number of children.

 Some studies have shown that fertility is associated with the type of employment held by women. Women employed in professions associated with childcare tend to have larger families.

Job stability and the ability of women to exercise their rights and their autonomy is also an important element.

The impact of religion

Religious family have higher birth rates than families that do not practise religious ceremonies.

The domestic division of labor

The domestic division of labor is also a factor influencing fertility.  However, research has led to contradictory results in this respect.

The division of labor does not seem to concern only the split of the domestic tasks, but also whether the woman compounds paid work outside the house with work inside the house, in which case she does not favour having children.

Personal views of mothers on the possible effect of their absence on the development of their children is also an important factor.

The impact of child mortality

The sharp decrease in child mortality is a contributing factor to reduced fertility and opens the way to the demographic transition.

The economic impact

There is a relationship between an increase in GDP and fertility which could be due to increases in public health and nutrition, both of which decrease mortality. In the twentieth century, it is the richest segments of society that reduce the number of children they beget. Social mobility, which allows a decrease in inequalities, is also acquired through a limitation in the number of children.

In the period 1950 to 2007, world GDP per capita increased on average by 2.1%. In that same period, there was a considerable drop in infant mortality, from 140 to 44 per 1000 births and the average life expectancy at birth increased from 43 to 66 years.

It has been suggested that the baby boom of the 1950s was due essentially to the increase in men’s wages, while the decline in child birth of the 1960s was caused by the increase in the wages and income of women. Women tend to have children in periods of unemployment, which would make childbearing countercyclical.

This is known as the substitution effect. It would apply specifically for first births and would depend on the expected duration of the unemployment period and on the level of education of the women since higher educated women tend to have access to more important financial resources allowing them to maintain a certain living standard during their unemployment period unless their husbands are also unemployed.

The general view is that as men’s unemployment reduces the available household income, it reduces the likelihood of men becoming fathers. This is known as the income effect. Women also see the husband as an unlikely father in these conditions.

Traditionally, the cost and burden of raising children was split among the members of a family. However, as families are increasingly nuclear, the parents are the only persons directly involved in raising the family.

An increase in revenue has two contradictory effects. On the one hand, it raises the demand for children while on the other hand it increases the price of the time spent with the children. Either effect can dominate depending on the specific situation.

In developing countries, child labor contributes to the income of the family and therefore additional children represent additional income.

After the crisis of 2009, there was a drop in fertility in 24 European countries, with a time lag. The drop was more pronounced among the immigrant population.

Today, because of the economic recession, the impact of this factor on birth can be again studied and we can indeed see that the birth rates have decreased in most, though not all, European countries. This is particularly true for first births and whatever the age of the parents with the exception of the 40 – 44 age group. On the contrary, the younger the age of the parents, the more sensitive is the impact of the crisis.

Possible explanations include:

  • the fact that it is easier for younger couples to postpone having children
  • younger couples are harder hit by unemployment.

Women over 40, on the other hand, were more reluctant to have a second or third child.

Unemployment of young people forces them to continue to live with their parents and therefore delays the creation of a family.

In Northern Europe, women’s unemployment has led them to have their children earlier, while the reverse has been the case in other European countries, and France in particular.

In conclusion, it is safe to say that uncertainty on the labor market has been found to have a clear negative impact on fertility.

Union instability

Union instability has been deemed to contribute to fertility inasmuch as women want to have children from their new partner after a divorce or separation.

When hit by unemployment, married couples tend to delay family formation, while cohabiting couples adopt an exactly opposite behaviour.

The family norm or social identity

Women are likely to follow the family norm which today, in Europe, is of a family with two children.

There is the possibility that the couple is satisfying the desires of their parents or, alternatively, that one of the members of the couple – the woman – wants to have the reassurance that the other member of the couple attaches value to her decision to become a mother. The desire to have a child takes second role.

There is the desire, by the parents of the fertile woman, to have or not to have a child – in other words, the woman is conceived as a result of a strong desire of her parents, or at least of her mother, to have a child. On the other hand, if the woman or feels this was an accidental act, she may be reluctant to become a mother.

Today’s the social norm is ambiguous. On one hand, women are expected to have children, but when they do so, they lose social value in that they are pushed back into house chores. When their salary is vital for the wellbeing of the family, they have to manage everything and become a superwoman.

The support of the parents is in many cases not available as it used to be a generation ago.

In the countries of Southern Europe there are rigid expectations: women should be married and not work as long as the children are young, 30% of the children are born outside wedlock and TFR is 1.4. This compares with 50% in more liberal societies such as France, Norway and Sweden where TFR is of 1.8 or above. In the latter countries as well, over 80% of the women between 24 and 54 were employed while in the former, the employment rate hovers around 70%.

Today many women in emerging countries use as role models the women they see in soap operas, and these are independent, in full control of their bodies, and none or extremely few have children. The number of hours women watch television has thus become a reliable predictor of the number of children they will have.

Economies of scale

Having two children relatively close to each other creates economies of scale, particularly if they are of the same sex, whether in the fact that clothes and toys can be reused or in that a working woman can take parental leave to take care of  two children simultaneously.


Water pollution has also been found to affect male fertility due to the content in testosterone-blocking chemicals. They reach water through sewage.

Fertilizers, organic solvents and lead modify the functions of sperm. Phthalates are also responsible for diminished sperm counts and testicular damage. Increased temperature, such as that due to long sitting stints, are also responsible for lower sperm count. Stress is also a cause of reduced sperm count.

The loss of independence

Parenthood translates into loss of independence and of control over one’s own life. It also leads to the realization that one’s youth is finished. In today’s society where leisure and games have become easily available, such a commitment may be unwanted.

Family planning

The availability of contraceptives at affordable costs would favors smaller families.

Planned behaviour

According to the theory of planned behaviour (TPB), there are three considerations that lead to the intention of having or not having a child. They are:

  • Behavioural beliefs – i.e. the perceived positive or negative consequences of having a child. They lead to the formation of an attitude towards pregnancy.
  • The perceived expectations and behaviors of important referent individuals or groups and the willingness of the future parents to accept that reaction.
  • Control beliefs – i.e. perceived presence of factors that can influence a person’s ability to have a child.

Gender equity

The theory of gender equity states that the lack of gender equity in social institutions is responsible for very low fertility. Women then have to choose between their roles as mothers and their careers. To allow for higher fertility therefore, countries must allow women to be able to combine work and family.

It implies that employers accept the fact that women, at one stage of their career, may want to work part-time while working full time later on in life when their children have grown. It also implies that social transfers are sufficiently high so that they can replace the resulting decrease in income.


The perception that through procreation, immortality is ensured – or at least continuity of the family line.


Urban fertility is lower than rural fertility and urbanization may well be the most important driver of lower fertility.

Indeed, almost all the factors summarized above are in favor of lower fertility. In the case where urbanization is fed by migration, migrants tend to be individual achievers that are often reluctant to create families.


In our analyses and recommendations we take the following geopolitical consideraations into account:


  • Local, regional and national political instability
  • The impact of great power rivalry
  • Perceptions of possible reactions of leadership.
Malthus’ theory is based on three postulates or assumptions :

1 – Food is a vital necessity

2 – People will continue to reproduce and population will grow geometrically and double every 25 years.

3 – The law of diminishing returns applies to agriculture and grows arithmetically.

Population increase cannot be met with a corresponding increase in food production and therefore famines may ensue.

To avoid this, Malthus suggested the use of positive checks and preventive checks.

Positive checks are essentially misery, famine, natural disasters and war.

Preventive checks consist in a variety of methods to prevent high fertility rates and includes celibacy and late marriage.

There are several flaws in the theory:

  • Population has not expanded geometrically and food production has increased massively, in particular due to technological improvements
  • New geographic areas have opened and have proved to be large food suppliers
  • Population increases may lead to a demographic dividend
  • Population increase has been due mostly to the extension of life rather than to an increase in birth rates
  • Increase in family income reduces fertility as the cost of bringing up children in a more expensive social environment increases
  • Efficient family planning methods were developed as preventive checks.

Megatrends are slow-forming major changes that can be economic, environmental, political, social or technological. They influence a large number of activities, perceptions and processes and may last over large periods.


While in our global age there is a near total connectedness, it is extremely difficult, if not impossible to trace the relationship between the various steps of a chain of connected events. It is then said that the causal relationships are opaque. The world and the risks it carries are reckoned to be unintelligible.


Life is a collection of risks. While their analysis carries a major importance, it remains, to a large extent, a subjective exercise, one in which perception plays a key role.

Risk is the child of uncertainty, as all future is.

Common errors in perceiving the extent of risk are numerous:

  • The belief that the future is a continuous of the past tends to blot out new types of risks
  • Neglecting the effect of the occurrence of a risk. High-probability risks may have only a reduced effect while low-probability risks may have very large effects
  • The perception of risk is influenced by the social and cultural context
  • The risk-propensity of the decision-maker, with over-confidence being a dangerous attitude
  • Lack of information.

System mapping is a tool that was originally used in systems thinking to map complexity by seeing and understanding how the various parts of a system are connected to make up a system. The parts are linked by information, people and resources.

Every system is part of a larger system and it is therefore important to also include parts of the larger system. For instance, the car industry is part of the transport sector and of the energy sector.

Its use in foresight allows one to see the entire system clearly and identify the drivers.

The Anthropocene describes our present time, starting with the Industrial Revolution, when human action has altered a large number of natural processes through agriculture, global warming, urbanization, etc. These changes in the biosphere have led to habitat loss, invasion of new species, among numerous others.
Evolution of species, whether bacterial, plant or animal, diverged from the American and the Eurasian continent. Thus, the New Continent did not have the germs responsible for a large number of infectious diseases such as chickenpox, influenza and malaria among others. The transfer of animals and plants from both sides of the Atlantic, as well as the germs, has been called the most important event in modern history.

The spread of diseases brought by the Europeans explains the collapse of the Amerindian population and the import of African slaves to replace them as they were immunized from these diseases.

Epidemiologic transition is when causes of death change from infectious diseases to chronic degenerative diseases. This change means that people die at an older age.

The theory was formulated by Abdel Omran in 1971.

The theory states there are three stages:

  • The age of pestilence and famine
  • The age of receding pandemics
  • The age of chronic diseases.

The age of pestilence and famine took place one thousand years ago with the development of the agricultural society. The result is that infections became more common due to the accumulation of waste, contact with animals and contagion from one person to another. Major pandemics are cholera, influenza, plague, small pox and typhus. There was also a lack of food and water. It is the age of pestilence and famine. This situation prevails still in some developing countries.

In the second age pandemics recede. Medical treatment is still at its early stage but there are a number of improvements such as drinkable water, sewage treatment, more available food, increased pre- and post-natal care. Antibiotics and vaccination made their appearance eliminating death from certain infectious diseases.

Industrialization and lifestyle changes are a cause of pollution leading to allergies, autoimmune disorders and sexually transmitted diseases. Consequently, there is a sharp increase in population.

In the age of chronic diseases, the main causes of death are cancer, cardiovascular diseases and diabetes. There are law levels of fertility and mortality, and therefore there is no population growth.

These ages take place at different times in each country.

Nevertheless, certain pandemics still appear and cause major diseases and mortality.

The fertility gap is the difference between the number of children desired and the actual number of children born.
The Great Divergence is the divergence in living standards and economic power between Europe and Asia. The date at which it started is also open to interpretation, with authors situating it anywhere from the 16th to the 19th century. Prior to these dates, regions of China and India were more prosperous than Europe.

Scholars do not agree on the underlying  causes behind this phenomenon and it appears to be a multi-factorial causality.

Among these:

  • The colonization of the American continent and the creation of wealth through the labor of slaves that worked on huge tracts of land that grew enormous quantities of food items. Europe manpower was thus able to concentrate on working in industry. Further, the colonies were captive export markets for European producers.
  • The colonization and deindustrialization of India
  • The development of new technologies
  • The use of coal as the major energy source, a more efficient energy source than wood and allowing for major progress in transport. Coal extraction was easier in Europe than in China, which also has extensive deposits. The Chinese coal mines were also substantially more distant from the industrial centers than the European extraction sites
  • Innovation which was encouraged in Europe but not in Asia, perhaps due to cultural factors that valued experience more than experimentation
  • Rapid change in hegemons
  • Europe’s economic environment with high wages, cheap capital and very cheap energy allowed investments in technology
  • Cultural differences with European culture favoring change and progress while Asian, and particularly Chinese, culture emphasized respect for tradition.
The Singularity
Published on Monday, August 16, 01999  •  18 years, 2 months ago
Written by Stewart Brand for The Long Now Foundation

The metaphor of the Singularity comes from astrophysics. What makes it so compelling to futurists and trend-watchers? Like any effective metaphor, it hides distracting elements (such as how good something is supposed to be for you) and reveals properties that are hidden but essential. The Singularity metaphor answers the question, « What happens if our technology just keeps accelerating? »

Above a certain critical mass, an expiring giant star collapses not just to a super-dense neutron star but to something whose mass and density is so great that its intense gravitation makes the escape velocity of anything from the object greater than the speed of light. It becomes what is called a black hole. The region where light and everything else disappears from our universe into the black hole is termed the « event horizon. » The beyond-dense anomaly in the center of the black hole is called a singularity. « At this singularity, » writes Cambridge mathematician Stephen Hawking, « the laws of science and our ability to predict the future would break down. »

The man who applied the metaphor to human events is science fiction writer and mathematician Vernor Vinge. His 1991 novel Across Realtime joins three stories he wrote in 1984-86 around a central mystery. The mystery is, what happened to everybody? While the characters in the stories were temporarily isolated out of time in devices called « bobbles, » civilization and the rest of humanity disappeared from Earth. Reconstructing events leading up to the disappearance, the characters realized that technology advance was radically self-accelerating at the time. Innovations that used to take years were being made in months and then days. Then the record stopped. Vinge’s characters called the event the Singularity-« a place where extrapolation breaks down and new models must be applied. And those new models are beyond our intelligence. »

In the metaphor, radical progress is not progress, but the end of the world as we know it. In a 1985 afterword to the stories, Vinge predicted that the Singularity would happen in reality, in the lifetime of his readers.

A good many people, including Clock designer Danny Hillis, have adopted Vinge’s term as a shorthand way of referring to impending technology acceleration and convergence. They all note that the future becomes drastically unpredictable beyond the Singularity. Among some enthusiasts there is even a consensus date for what they call the « techno-rapture »-2035 CE, give or take a few years.

Opinions vary as to what would be the Singularity’s leading mechanism. Proponents of nanotechnology (molecular engineering) are sure that the turning point will be « the assembler breakthrough »-when ultra-tiny, ultra-fast nanomachines capable of self-replication are devised. Others expect that it’s the convergence of computer technology, biotechnology, and nanotechnology, each accelerating the other, that would fuse into a new order of life. Vinge himself sees the tipping point as the moment when machine intelligence, or machine-enhanced intelligence, surpasses normal human intelligence and takes over its own further progress. Another possibility is some emergent property of the all-embracing Internet, which Vinge proposes might « suddenly awaken. »

Any such occurrence would indeed transform our world. Whether or not it will actually occur, the mere prospect of a technological Singularity changes behavior. People already refer to the near future in terms of months instead of years, and to the distant future in terms of years instead of decades or centuries. What may happen decades from now-beyond the imagined event horizon-is treated as not just unknown, but unknowable. Under such conditions, speed becomes glorified. Haste switches from a vice to a virtue; behavior that might once have been called reckless and irresponsible becomes « swift and decisive action. »

One reason the metaphor resonates is that it offers insight about the distortion we all feel from the pace of events these years. As one falls into a black hole, the fierce gravitational field of the singularity pulls the traveler into a long thin shape, like taffy. The more the accelerating future pulls at us, the more parts of us resist. The result is a kind of dismemberment.

Society itself could be dismembered, as some people ride the breaking wave of every-newer technology over the event horizon into invisibility, while others lag behind, feeling the powerful gravitational force of still-accelerating technology, but no longer able to see it. Thus the world would be comprehensible only to those near the leading edges of technology.

The Singularity is a frightening prospect for humanity. I assume that we will somehow dodge it or finesse it in reality, and one way to do that is to warn about it early and begin to build in correctives.

Published in The Clock of the Long Now.

Gender equity theory postulates that in every society there is an acceptable type of relationship between husband and wife. In other words, there is a set division of labor and responsibilities. A high level of gender equity means that labor and responsibilities are equally, or fairly equally divided, while low level signifies that there is an imbalance in both these matters.

In developed countries, low levels of gender equity are believed to lead to low fertility, while the contrary is the case in developing countries, the main cause being a change in lifestyle.

The theory, due to Icek Ajen, explains the deliberate behavior of people and the ability to change that behavior. It stipulates that human behavior is guided by three types of considerations:

  • Behavioral beliefs about the likely consequences of the behavior
  • Normative beliefs about the expectations of others
  • Control beliefs about the presence of factors that may facilitate or impede performance of the behavior.

The combination of these three considerations lead to a behavioral intention.

Unknown unknowns are unidentified risks which therefore are not taken into account in strategic planning. Good scenario planning should assist in trying to identify them and convert them into known unknowns.

Uranization is the movement of population from rural to urban areas. The two drivers are the possibility of producing more food with a smaller amount of manpower and the fact that urban centers offer a larger number of employment possibilities as well as a concentration of social services.

Inhabitants of urban areas have a very different culture from those of rural areas.


Visioning entails getting a group to project themselves mentally into the future. This exercise can be done with the use of keywords, drawings, pictures or with the assistance of a guide. It is mostly carried out at the beginning of a planning process.


Wildcards are improbable happenings but have a huge effect when they do happen.


There are many definitions of what are weak signals. Perhaps the best is that they are trends just starting to emerge.

Weak signals are detected through the analysis of information. It thus requires a high level of alertness. However, personal biases may lead us to ignore them and practice tunnel vision.