*Presented at the annual symposium sponsored by the University Steering Committee for Science, Technology, and Society, Penn State University, April 28, 1977.


Should the more developed nations, particularly the United States, adopt an explicit policy of triage in regard to the less developed nations? Should assistance in meeting food needs be denied those nations which lack resources or motivation to reduce their rates of population growth? Which is the greater immorality: to refuse to feed starving children in Bangladesh or the African Sahel; or to feed the children so that they might survive to become parents themselves, producing more children to starve? Do we, in fact, face such issues now and for the future? I offer comments on these questions drawing partly upon the perspectives of Thomas Malthus and Karl Marx and partly upon data now available on world food and population trends.

Triage is a term based on the French word for sorting. Its most general usage is in the agricultural processing industry. Berries, for example, are sorted by size, mechanically, in a process known as triage. In recent years, following publication of a book by William and Paul Paddock entitled Famine 1975, the term has been applied to a strategy for avoiding overpopulation. Use of the term by the Paddocks was derived from a practice said to have been followed in field hospitals by the French military in World War I. The flood of casualties into the hospital during a battle was too great for all to receive treatment. Thus the wounded were sorted. Those needing little attention were treated briefly and returned to the lines. Those more seriously wounded but likely to survive were given as much attention as could be provided. Those likely to die whatever the treatment were given nothing, except minimum treatment to ease their pain. Such sorting occurs now in emergency situations in which limited resources must be used discriminantly to help those who can benefit from them and denied those who cannot.

The thesis presented by the Paddocks, and by others writing in the same vein, is based on the observation that, over several decades of the recent past, death control -- in the form of improved medical care and nutrition -- without birth control has produced dramatic increases in population growth in parts of the world least likely to be able to produce enough food to meet population needs. While the more developed countries have moved toward zero population growth and have experienced steady increases in per capita food production, the less developed countries have been growing in population at accelerated rates, straining their own capacities for food production and requiring increased imports of food from the more developed nations. The consequences of such growth for the world food situation are, in the Paddock's view, alarming. Two-thirds of the four billion people in the world are in the less developed countries. Doubling time for the world population is currently about 35 years (meaning that the present annual rate of growth - about two percent - the total population would reach eight billion in 35 years and 16 billion in 35 more), down from about 1200 years in 1650. In some of the less developed countries doubling time is down to 20 years. By the end of this century at least three-fourth, rather than two-thirds, of the population is likely to be in the less developed countries, meaning that doubling time for the world will be reduced even more. Whether food production can be doubled even once is in serious doubt. Certainly it cannot be doubled indefinitely. Thus, argue the Paddocks, the security of the world is threatened and drastic action is needed to alter the trends. Specifically, triage as a policy would deny food aid and agricultural assistance to nations which could not be expected to become self-reliant in providing food, either through production or trade, to meet population demand.

Major international problems in the early 1970's - crop failures in Asia leading to imports and the consequent price increases for food in the United States, the Arab oil embargo and further price increases, hostilities and threats of war in many parts of the world, etc. - have been viewed by many as the first signs of an imminent world-wide famine. A more recent proposal by William Paddock is for a moratorium on research programs designed to increase food production in countries with either an accelerating population growth rate or one above the world average (Paddock, 1975).

Are these observations valid? Is there a need for triage? What would be the consequences of the adoption of such a policy? Some insight might be gained by considering the prophesies of Malthus and Marx in light of such data as we have.