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Experts like Paul Ehrlich argue that the population of the world has long since surpassed optimal levels, though critics counter that consumption is as important as population levels.

one-third of all people – almost 4 billion – will be African.

By that year, there will be more Nigerians than Americans.

If birthrates have fallen so far, why is the population still rising fast?

In the pre-modern era, fertility rates of 4.5 to 7 children per woman were common. At that time, high mortality rates of young people kept population growth low.

The level of education in a society – of women in particular – is one of the most important predictors for the number of children families have.

People are living longer

which means that one child in 13 die before their fifth birthday.

This compares with six for every 1,000 in Europe and northern America and four for every 1,000 in Australia and New Zealand.

A consequence of falling child mortality but continuing high fertility is a “youth bulge” – a high population of young people.

But ageing populations can be a cause for celebration. It means development has taken place.

What next?

Family planning organisations are learning that to survive political shifts and budget cuts, they need to diversify their sources of funding. This means seeing family planning as not just a public health concern but also about development and a clear return on investment.

When Herbert Hoover talked about putting “a chicken in every pot,” chicken was a luxury: In 1930, whole dressed chicken retailed in the United States for $7 a pound in today’s dollars. In contrast, that Costco bird now sells for less than $2 a pound.

It’s not that Costco chickens suffer more than Walmart or Safeway birds. All are part of an industrial agricultural system that, at the expense of animal well-being, has become extremely efficient at producing cheap protein.

“They’re living on their own feces, with no fresh air and no natural light,” said Leah Garcés, the president of Mercy for Animals. “I don’t think it’s what a Costco customer expects.”

Garcés wants Costco to sign up for the “Better Chicken Commitment,” an industry promise to work toward slightly better standards for industrial agriculture. For example, each adult chicken would get at least one square foot of space, there would be some natural light and the company would avoid breeds that put on weight that the legs can’t support.

Burger King, Popeyes, Chipotle, Denny’s and some 200 other food companies have embraced the Better Chicken Commitment, but grocery chains generally have not, with the exception of Whole Foods.

Yet what struck me was that Costco completely accepts that animal welfare should be an important consideration. We may disagree about whether existing standards are adequate, but the march of moral progress on animal rights is unmistakable.

When I began writing about these issues, I never guessed that McDonald’s would commit to cage-free eggs, that California would legislate protections for mother pigs, that there would be court fights about whether an elephant has legal “personhood,” and that Pope Francis would suggest that animals go to heaven and that the Virgin Mary “grieves for the sufferings” of mistreated livestock.

I don’t pretend that there are neat solutions. We raised a flock of chickens on our family farm when I was a kid, and we managed to be neither efficient nor humane. Many birds died, and being eaten by a coyote wasn’t such a pleasant way to go, either. There’s no need for a misplaced nostalgia for traditional farming practices, just a pragmatic acknowledgment of animal suffering and trade-offs to reduce it.

We treat poultry particularly poorly because humans identify less with birds than with fellow mammals. We may empathize with a calf with big eyes, but less so with species that we dismiss as “bird brains.”

Still, the issue remains as the English philosopher Jeremy Bentham posed it in 1789: “The question is not, Can they reason?, nor Can they talk? but, Can they suffer?”

One of the book’s authors, Neil Howe, 71, has become a frequent podcast guest. A follow-up, “The Fourth Turning Is Here,” comes out this month.

The play’s author, Will Arbery, 33, said he heard about “The Fourth Turning” while researching Stephen K. Bannon, the right-wing firebrand and former adviser to President Donald J. Trump, who is a longtime fan of the book and directed a 2010 documentary based on its ideas.

He described it as “this almost fun theory about history,” but added: “And yet there’s something deeply menacing about it.”

Mr. Arbery, who said he does not subscribe to the theory, sees parallels between the fourth turning and other nonscientific beliefs. “I modeled the way that Teresa talks about the fourth turning on the way that young liberals talk about astrology,” he said.

The book’s outlook on the near future has made it appealing to macro traders and crypto enthusiasts, and it is frequently cited on the podcasts “Macro Voices,” “Wealthion” and “On the Margin.”

In the new book, he describes what a coming civil war or geopolitical conflict might look like — though he shies away from casting himself as a modern-day Nostradamus.

“The Fourth Turning” captured a mood of decline in recent American life. “I remember feeling safe in the ’90s, and then as soon as 9/11 hit, the world went topsy-turvy,” he said. “Every time my cohort got to the point where we were optimistic, another crisis happened. When I read the book, I was like, ‘That makes sense.’”

“The Fourth Turning” was conceived during a period of relative calm. In the late 1980s, Mr. Howe, a Washington, D.C., policy analyst, teamed with William Strauss, a founder of the political satire troupe the Capitol Steps.

Their first book, “Generations,” told a story of American history through generational profiles going back to the 1600s. The book was said to have influenced Bill Clinton to choose a fellow baby boomer, Al Gore, as his running mate

when the 2008 financial crisis hit at almost exactly the point when the start of the fourth turning was predicted, it seemed to many that the authors might have been onto something. Recent events — the pandemic, the storming of the Capitol — have seemingly provided more evidence for the book’s fans.

Historically, a fourth turning crisis has always translated into a civil war, a war of great nations, or both, according to the book. Either is possible over the next decade, Mr. Howe said. But he is a doomsayer with an optimistic streak: Each fourth turning, in his telling, kicks off a renaissance in civic life.

“I’ve read ‘The Fourth Turning,’ and indeed found it useful from a macroeconomic investing perspective,” Lyn Alden, 35, an investment analyst, wrote in an email. “History doesn’t repeat, but it kind of gives us a loose framework to work with.”

“This big tidal shift is arriving,” Mr. Howe said. “But if you’re asking me which wave is going to knock down the lighthouse, I can’t do that. I can just tell you that this is the time period. It gives you a good idea of what to watch for.”

Life brings an accumulation of unremitting stress, especially for those subjected to inequity — and not just from immediate and chronic threats. Even the anticipation of those menaces causes persistent damage.

The body produces too much cortisol and other stress hormones, straining to bring itself back to normal. Eventually, the body’s machinery malfunctions.

The constant strain — the chronic sources of stress — resets what is “normal,” and the body begins to change.

t is the repeated triggering of this process year after year — the persistence of striving to overcome barriers — that leads to poor health.

Blood pressure remains high. Inflammation turns chronic. In the arteries, plaque forms, causing the linings of blood vessels to thicken and stiffen. That forces the heart to work harder. It doesn’t stop there. Other organs begin to fail.

, that people’s varied life experiences affect their health by wearing down their bodies. And second, she said: “People are not just passive victims of these horrible exposures. They withstand them. They struggle against them. These are people who weather storms.”

It isn’t just living in an unequal society that makes people sick. It’s the day-in, day-out effort of trying to be equal that wears bodies down.

Weathering doesn’t start in middle age.

It begins in the womb. Cortisol released into a pregnant person’s bloodstream crosses the placenta, which helps explain why a disproportionate number of babies born to parents who live in impoverished communities or who experience the constant scorn of discrimination are preterm and too small.

The argument weathering is trying to make is these are things we can change, but we have to understand them in their complexity,” Geronimus said. “This has to be a societal project, not the new app on your phone that will remind you to take deep breaths when you’re feeling stress.”

The girls who came to us had many comorbidities: depression, anxiety, ADHD, eating disorders, obesity. Many were diagnosed with autism, or had autism-like symptoms. A report last year on a British pediatric transgender center found that about one-third of the patients referred there were on the autism spectrum.

This concerned me, but didn’t feel I was in the position to sound some kind of alarm back then. There was a team of about eight of us, and only one other person brought up the kinds of questions I had. Anyone who raised doubts ran the risk of being called a transphobe. 

I certainly saw this at the center. One of my jobs was to do intake for new patients and their families. When I started there were probably 10 such calls a month. When I left there were 50, and about 70 percent of the new patients were girls. Sometimes clusters of girls arrived from the same high school. 

There are no reliable studies showing this. Indeed, the experiences of many of the center’s patients prove how false these assertions are. 

The doctors privately recognized these false self-diagnoses as a manifestation of social contagion. They even acknowledged that suicide has an element of social contagion. But when I said the clusters of girls streaming into our service looked as if their gender issues might be a manifestation of social contagion, the doctors said gender identity reflected something innate.

To begin transitioning, the girls needed a letter of support from a therapist—usually one we recommended—who they had to see only once or twice for the green light. To make it more efficient for the therapists, we offered them a template for how to write a letter in support of transition. The next stop was a single visit to the endocrinologist for a testosterone prescription. 

When a female takes testosterone, the profound and permanent effects of the hormone can be seen in a matter of months. Voices drop, beards sprout, body fat is redistributed. Sexual interest explodes, aggression increases, and mood can be unpredictable. Our patients were told about some side effects, including sterility. But after working at the center, I came to believe that teenagers are simply not capable of fully grasping what it means to make the decision to become infertile while still a minor.

Many encounters with patients emphasized to me how little these young people understood the profound impacts changing gender would have on their bodies and minds. But the center downplayed the negative consequences, and emphasized the need for transition. As the center’s website said, “Left untreated, gender dysphoria has any number of consequences, from self-harm to suicide. But when you take away the gender dysphoria by allowing a child to be who he or she is, we’re noticing that goes away. The studies we have show these kids often wind up functioning psychosocially as well as or better than their peers.” 

Frequently, our patients declared they had disorders that no one believed they had. We had patients who said they had Tourette syndrome (but they didn’t); that they had tic disorders (but they didn’t); that they had multiple personalities (but they didn’t).

Here’s an example. On Friday, May 1, 2020, a colleague emailed me about a 15-year-old male patient: “Oh dear. I am concerned that [the patient] does not understand what Bicalutamide does.” I responded: “I don’t think that we start anything honestly right now.”

Bicalutamide is a medication used to treat metastatic prostate cancer, and one of its side effects is that it feminizes the bodies of men who take it, including the appearance of breasts. The center prescribed this cancer drug as a puberty blocker and feminizing agent for boys. As with most cancer drugs, bicalutamide has a long list of side effects, and this patient experienced one of them: liver toxicity. He was sent to another unit of the hospital for evaluation and immediately taken off the drug. Afterward, his mother sent an electronic message to the Transgender Center saying that we were lucky her family was not the type to sue.

How little patients understood what they were getting into was illustrated by a call we received at the center in 2020 from a 17-year-old biological female patient who was on testosterone. She said she was bleeding from the vagina. In less than an hour she had soaked through an extra heavy pad, her jeans, and a towel she had wrapped around her waist. The nurse at the center told her to go to the emergency room right away.

when there was a dispute between the parents, it seemed the center always took the side of the affirming parent.

Other girls were disturbed by the effects of testosterone on their clitoris, which enlarges and grows into what looks like a microphallus, or a tiny penis. I counseled one patient whose enlarged clitoris now extended below her vulva, and it chafed and rubbed painfully in her jeans. I advised her to get the kind of compression undergarments worn by biological men who dress to pass as female. At the end of the call I thought to myself, “Wow, we hurt this kid.”

There are rare conditions in which babies are born with atypical genitalia—cases that call for sophisticated care and compassion. But clinics like the one where I worked are creating a whole cohort of kids with atypical genitals—and most of these teens haven’t even had sex yet. They had no idea who they were going to be as adults. Yet all it took for them to permanently transform themselves was one or two short conversations with a therapist.

Being put on powerful doses of testosterone or estrogen—enough to try to trick your body into mimicking the opposite sex—-affects the rest of the body. I doubt that any parent who's ever consented to give their kid testosterone (a lifelong treatment) knows that they’re also possibly signing their kid up for blood pressure medication, cholesterol medication, and perhaps sleep apnea and diabetes. 

Besides teenage girls, another new group was referred to us: young people from the inpatient psychiatric unit, or the emergency department, of St. Louis Children’s Hospital. The mental health of these kids was deeply concerning—there were diagnoses like schizophrenia, PTSD, bipolar disorder, and more. Often they were already on a fistful of pharmaceuticals.

no matter how much suffering or pain a child had endured, or how little treatment and love they had received, our doctors viewed gender transition—even with all the expense and hardship it entailed—as the solution.

Another disturbing aspect of the center was its lack of regard for the rights of parents—and the extent to which doctors saw themselves as more informed decision-makers over the fate of these children.

We found out later this girl had had intercourse, and because testosterone thins the vaginal tissues, her vaginal canal had ripped open. She had to be sedated and given surgery to repair the damage. She wasn’t the only vaginal laceration case we heard about.

During the four years I worked at the clinic as a case manager—I was responsible for patient intake and oversight—around a thousand distressed young people came through our doors. The majority of them received hormone prescriptions that can have life-altering consequences—including sterility. 

I left the clinic in November of last year because I could no longer participate in what was happening there. By the time I departed, I was certain that the way the American medical system is treating these patients is the opposite of the promise we make to “do no harm.” Instead, we are permanently harming the vulnerable patients in our care.

Today I am speaking out. I am doing so knowing how toxic the public conversation is around this highly contentious issue—and the ways that my testimony might be misused. I am doing so knowing that I am putting myself at serious personal and professional risk.

Almost everyone in my life advised me to keep my head down. But I cannot in good conscience do so. Because what is happening to scores of children is far more important than my comfort. And what is happening to them is morally and medically appalling.

For almost four years, I worked at The Washington University School of Medicine Division of Infectious Diseases with teens and young adults who were HIV positive. Many of them were trans or otherwise gender nonconforming, and I could relate: Through childhood and adolescence, I did a lot of gender questioning myself. I’m now married to a transman, and together we are raising my two biological children from a previous marriage and three foster children we hope to adopt. 

The center’s working assumption was that the earlier you treat kids with gender dysphoria, the more anguish you can prevent later on. This premise was shared by the center’s doctors and therapists. Given their expertise, I assumed that abundant evidence backed this consensus. 

All that led me to a job in 2018 as a case manager at The Washington University Transgender Center at St. Louis Children's Hospital, which had been established a year earlier. 

What happened in 2012, when the oldest Gen-Z babies were in their middle teens? That was the year Facebook acquired Instagram and young people flocked to the latter site. It was also “the beginning of the selfie era.”

Mr. Haidt’s research, confirmed by that of others, shows that depression rates started to rise “all of a sudden” around 2013, “especially for teen girls,” but “it’s only Gen Z, not the older generations.” If you’d stopped collecting data in 2011, he says, you’d see little change from previous years. “By 2015 it’s an epidemic.” (His data are available in an open-source document.)

Mr. Haidt imagines “literally launching our children into outer space” and letting their bodies grow there: “They would come out deformed and broken. Their limbs wouldn’t be right. You can’t physically grow up in outer space. Human bodies can’t do that.” Yet “we basically do that to them socially. We launched them into outer space around the year 2012,” he says, “and then we expect that they will grow up normally without having normal human experiences.”

He calls this phenomenon “compare and despair” and says: “It seems social because you’re communicating with people. But it’s performative. You don’t actually get social relationships. You get weak, fake social links.”

That meant the first social-media generation was one of “weakened kids” who “hadn’t practiced the skills of adulthood in a low-stakes environment” with other children. They were deprived of “the normal toughening, the normal strengthening, the normal anti-fragility.

Now, their childhood “is largely just through the phone. They no longer even hang out together.” Teenagers even drive less than earlier generations did.

Mr. Haidt especially worries about girls. By 2020 more than 25% of female teenagers had “a major depression.” The comparable number for boys was just under 9%.

The comparable numbers for millennials at the same age registered at half the Gen-Z rate: about 13% for girls and 5% for boys. “Kids are on their devices all the time,”

Most girls, by contrast, are drawn to “visual platforms,” Instagram and TikTok in particular. “Those are about display and performance. You post your perfect life, and then you flip through the photos of other girls who have a more perfect life, and you feel depressed.

Mr. Haidt says he has no antipathy toward the young, and he calls millennials “amazing.”

“Social media is incompatible with liberal democracy because it has moved conversation, and interaction, into the center of the Colosseum. We’re not there to talk to each other. We’re there to perform” before spectators who “want blood.”

To illustrate his point about Gen Z, Mr. Haidt challenges people to name young people today who are “really changing the world, who are doing big things that have an impact beyond their closed ecosystem.”

He can think of only two, neither of them American: Greta Thunberg, 19, the Swedish climate militant, and Malala Yousafzai, 25, the Pakistani advocate for female education

I’m predicting that they will be less effective, less impactful, than previous generations.” Why? “You should always keep your eye on whether people are in ‘discover mode’ or ‘defend mode.’ ” In the former mode, you seize opportunities to be creative. In the latter, “you’re not creative, you’re not future-thinking, you’re focused on threats in the present.”

University students who matriculated starting in 2014 or so have arrived on campus in defend mode: “Here they are in the safest, most welcoming, most inclusive, most antiracist places on the planet, but many of them were acting like they were entering some sort of dystopian, threatening, immoral world.”

56% of liberal women 18 to 29 responded affirmatively to the question: Has a doctor or other healthcare provider ever told you that you have a mental health condition? “Some of that,” Mr. Haidt says, “has to be just self-presentational,” meaning imagined.

This new ideology . . . valorizes victimhood. And if your sub-community motivates you to say you have an anxiety disorder, how is this going to affect you for the rest of your life?” He answers his own question: “You’re not going to take chances, you’re going to ask for accommodations, you’re going to play it safe, you’re not going to swing for the fences, you’re not going to start your own company.”

Whereas millennial women are doing well, “Gen-Z women, because they’re so anxious, are going to be less successful than Gen-Z men—and that’s saying a lot, because Gen-Z men are messed up, too.”

The problem, he says, is distinct to the U.S. and other English-speaking developed countries: “You don’t find it as much in Europe, and hardly at all in Asia.” Ideas that are “nurtured around American issues of race and gender spread instantly to the U.K. and Canada. But they don’t necessarily spread to France and Germany, China and Japan.”

something I hear from a lot of managers, that it’s very difficult to supervise their Gen-Z employees, that it’s very difficult to give them feedback.” That makes it hard for them to advance professionally by learning to do their jobs better.

“this could severely damage American capitalism.” When managers are “afraid to speak up honestly because they’ll be shamed on Twitter or Slack, then that organization becomes stupid.” Mr. Haidt says he’s “seen a lot of this, beginning in American universities in 2015. They all got stupid in the same way. They all implemented policies that backfire.”

Mr. Haidt, who describes himself as “a classical liberal like John Stuart Mill,” also laments the impact of social media on political discourse

Social media and selfies hit a generation that had led an overprotected childhood, in which the age at which children were allowed outside on their own by parents had risen from the norm of previous generations, 7 or 8, to between 10 and 12.

Is there a solution? “I’d raise the age of Internet adulthood to 16,” he says—“and enforce it.”

By contrast, “life went onto phone-based apps 10 years ago, and the protections we have for children are zero, absolutely zero.” The damage to Generation Z from social media “so vastly exceeds the damage from Covid that we’re going to have to act.”

Gen Z, he says, “is not in denial. They recognize that this app-based life is really bad for them.” He reports that they wish they had childhoods more like those of their parents, in which they could play outside and have adventur