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A country’s health status is closely intertwined with its demographic development. Improved access to healthcare reduces mortality and the birth rate, while life expectancy rises. This can pose new challenges for the health sector, as it will need to adjust to the changing needs of the population and an ageing society.

A population’s health status has an impact, among other things, on mortality and birth rates

The population’s health significantly influences its size and age structure. In recent decades improved healthcare has contributed to a steady increase in average life expectancy and to a decrease in birth rates in developing countries. Nonetheless, couples often continue to have more children than they would like. In fact, it is estimated that 43% of all pregnancies in developing countries are unintended (Guttmacher Institute, 2017).

A key reason is lack of access to early comprehensive sexuality education and to sexual and reproductive health and rights (SRHR) services, including access to modern contraception. It is estimated that in sub-Saharan Africa one in every five women has an unmet need for family planning (UN, 2015). Since many women desire fewer children than their partners, empowerment of girls and women in this respect is of great importance. According to the Guttmacher Institute, if all women had access to contraceptives, three quarters of unintended pregnancies could be avoided. Unplanned births would thus fall worldwide from 30 million to seven million per year.

The birth rate is indirectly influenced by infant and child mortality rates. In regions where child mortality is high, women also have on average more children. It has been proven that couples are prepared to have fewer children if each individual child has a better chance of surviving. Although child mortality in low- and middle-income countries has been successfully reduced in recent years, in some of these countries the average rate is still almost 15 times higher than in Europe, North America, Australia, New Zealand and Japan (UN, 2017).

Health services must respond to changes in the population’s age structure and spatial distribution

Population dynamics should always be taken into account when planning health policy and programmes. As the population grows, so too does the need for medical infrastructure, supplies and healthcare workers. The spatial distribution of the population, e.g. between rural and rapidly growing urban areas, is another key demographic factor that influences the demand for health services and needs to be reflected in an adjustment of the offer.

The age structure of a population also influences the demand for health services. In many developing countries with a comparatively young population, child health and youth-oriented health services in areas such as sex education, HIV prevention and family planning are particularly important. As a society ages, clinical profiles change and non-communicable and chronic diseases tend to become more prevalent. Health systems must be able to respond to these changes.

Provision of medical care to refugees poses a special challenge. Displacement exposes particularly children, women and the elderly to greater health risks, with poor access to medical services.

Population data are essential for health planning and surveillance

Data on population trends and on the distribution of health risks and diseases are required to document the status of a country’s public health system, plan policy and measure results. From figures on the frequency of specific causes of death, for instance, the spread of diseases and epidemics can be recognised in time. Population data can also provide information on regional disparities in relation to needs in the health sector.

For more information on the interlinkages of health and population dynamics, please refer to Chapter 4.2 of the handbook.

How can the health sector factor in population dynamics?

To address these challenges and opportunities, stakeholders can:

  • Take population trends into account in the health sector in order to plan in function of current and longer-term needs.
  • Support the capacity of the health sector to adapt to the special needs of specific groups, e.g.:
    • Strengthen youth-oriented health services to promote awareness and acceptance of sex education and family planning. 
    • Prepare health services in advance for changes in the clinical profiles of an ageing society. 
    • Improve access to health services of good quality, particularly for girls and women, including to reduce pregnancy-related deaths. 
    • Establish and expand adequate health services for refugees, particularly for children, women and the elderly. 
    • Improve collection and analysis of data from CRVS systems and healthcare institutions to promptly identify health risks and develop a reliable data basis for health policy planning.


  • The Health Data Collaborative is a global multi-actor partnership committed to the improvement, availability and local use of health and population data.
© GIZ/Dirk Ostermeier
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