Runaway immigration, crumbling NHS, economic disaster: there's just one underlying cause

Telegraph

13-05-2025

This week, the Telegraph will be publishing a series of essays from experts on the demographic crisis facing much of the world, with falling birth rates and ageing populations seen across many regions. A list of published articles can be found below this one
You hardly need look far these days to see articles in the press or postings on social media or hear opinion formers in broadcasts and podcasts expressing despair over the state of the nation. Discussions of the causes of our current national malaise are varied and often tangled, but I believe they have at root a single factor. As Bill Clinton might have said: it's the demography, stupid.
For more than half a century, the UK has had below-replacement fertility, meaning that the average couple has had fewer than around 2.1 children. This is hardly particular to the UK. There is not a country across Europe where there have been enough births in the past decades. And the problem goes well beyond Europe. Many know that Japanese and Chinese women have barely more than one child each, but how many know that women in Jamaica and Thailand are having fewer children than in Britain or that, if it were a state, Puerto Rica would have a lower fertility rate than any US state? This is a truly global issue but it cannot be solved globally. Each country will have to sort it out for itself. So for now, let's focus on the UK.
If I had ten minutes with Keir Starmer and Rachel Reeves, I would try to persuade them that the root of our ills is demographic. The reason they are struggling with tight labour markets, endless demand for immigration and a populist backlash, sluggish growth, lack of innovation, spiralling government spending, withering tax receipts and mounting deficits, with the fear of the bond markets calling a halt at any moment, making the country like an impecunious Victorian family ever awaiting the arrival of the bailiffs – all of this can be traced to our birth problem. Let me give you just a few examples to illustrate this.
One: In the middle of the last century, there were five-and-a-half people of working age – say twenty to sixty-five – to every one older than that in the UK. When I was born in 1964, there were more than four and a half. Today, there are barely three. By the middle of this century there will be two. Think what that means for the balance of the economy, for the availability of workers versus the need for care, for the relationship between the payers of tax and receivers of benefits.
Two: There is a very sharp peak of entrepreneurship around the age of thirty and a very sharp peak of innovation around the age of forty. It is clear that societies with burgeoning numbers of such age groups have a real and significant advantage when it comes to exactly what is required for an economy to grow. So some kind of sweet spot might come when the median age in a society is around thirty-five, which is where it was in the UK pretty consistently from 1950 to the mid-1990s, since when it has been rising. By the end of this century, it will be nearer to fifty. And over the same period, the share of thirty-somethings in the population will have fallen from almost 15 per cent to barely 10 per cent.
Three: The average person aged over eighty-five requires around seven times the amount of healthcare spend compared to someone in their twenties, thirties or forties. This may not be so alarming until you realise just how dramatically the number of people aged of eighty-five had ballooned seven-fold since 1950, and more than five-fold as a share of the population. Their share will grow a further three-to-four fold by the end of the century. When you understand on the one hand the vastly greater spend the old require and the vastly greater share of the population they are becoming, you will understand why the NHS seems like a black hole, taking ever more of the national spend and seeming to provide an ever-diminishing service.
Four: Mass immigration and ethnic change are being driven by a labour shortage due to our longstanding low birth rate. A spad to a senior minister told me: 'You won't believe the daily pressure we are under from business to allow in immigrants for labour'. And every business person or state employee I meet tells me how hard it is to get workers, this despite our sluggish economy. When I joined the workforce in the 1980s and the last baby boomers were entering the workforce, we had far more new entries to the labour market than retirees leaving it. No longer. So we have demographically-driven labour shortage being met by immigration. Bear in mind that nothing correlates with a vote for Trump or Brexit or I suspect Reform – or the AfD or the National Rally – as strongly as a concern about immigration.
You simply cannot understand the dramatic and ubiquitous rise of national populism across Europe and the US without understanding the rise of immigration and rapid ethnic change. And you cannot understand the immigration and rapid ethnic change without understanding demography. California went from being over 75 per cent non-Hispanic white in 1970 to under 40 per cent in 2012. London was 87 per cent White British in 1971: by 2021, it was 36 per cent. You may think these numbers are something to celebrate, or you may think that it is impolite even to talk about them. But they do have a political impact, and if you want to understand the politics of the US or Britain or anywhere else in the developed world which has experienced recent high levels of immigration, you cannot ignore them.
So if you are Keir Starmer or Rachel Reeves – or indeed Kemi Badenoch – trying to figure out why the economy is not growing or why the public debt is ballooning or why however much money you throw at the national health service, the service experienced by individuals keeps deteriorating – or why your polling in the last local elections was so dire and Reform seems to be streets ahead in the polls and we may be looking at a Reform government and a potential parliamentary wipe out for both of the main parties – take a close and careful look at the demography which underlies all this.
As to what we can do about it – that is another subject. And one it is high time politicians engaged with.