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King in a maverick style

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7215.942 (Published 09 October 1999) Cite this as: BMJ 1999;319:942

The world population has just reached 6 billion. Kamran Abbasi profiles Maurice King, who is advocating a one child world

Maurice King is a visionary or a madman—depending on how you take him. Certainly he is an enigma. To promote debate about world population, which he says is being stifled by vested interests, he has coined a new phrase: benign uproar. Benign uproar is good, believes King, far better than the alternatives of slaughter and starvation. Radical thoughts burst freely from him and may seem unpalatable at first. But he is a man of conviction, misguided or otherwise.

In 1993, after he had safely fathered two children, King hit on the idea of a one child world: “I had been to a meeting in Paris and was writing something. When the words first appeared on my computer screen they seemed daft. I cannot now remember what sparked off the idea. Then the idea seemed more and more reasonable and was incorporated in several papers in 1994, notably a handout at the Cairo conference” (see glossary, p 1000).

Born in 1927 in Ceylon (now Sri Lanka), King studied at Trinity Hall, Cambridge, and then St Thomas's Hospital, London. Initially, he worked as a pathologist, moving to Africa in 1956. While in Rhodesia (now Zimbabwe), he displayed his willingness to fight injustice. He objected to not being allowed to train black Africans; his employers did not renew his contract, and he left.

In 1962, he started at Makerere College in Kampala, Uganda, and, as he puts it, “jumped out of the Petri dish into the community.” David Bradley, professor of tropical hygiene at the London School of Hygiene and Tropical Medicine and a colleague in Uganda, recalls: “He volunteered to look after a remote mission hospital while the doctor took a fortnight's holiday, and he was struck by the absence of literature to prepare him for it. So he organised a conference, took all the papers from it, and began to integrate them into a coherent whole. After 18 months of meticulously detailed work combined with profound intuitive leaps, there resulted Medical Care in Developing Countries, the bible of the primary health care movement.” The book has sold over 50000 copies.

King formed many of his ideas on demography in those early days in Africa (“they were apt to come as I was going round a particular roundabout on my way home on my scooter”), though they had yet to develop into one cohesive vision. By 1985 he was teaching public health medicine at Leeds University, having spent most of his time in Africa working on various projects for the World Health Organisation, and was focusing his intellectual energies on primary health care. His other great cause at the time was nuclear disarmament, which he espoused with his usual passion.

In 1988, he was invited to give a lecture to the Royal Society of Medicine on the health of Africa. His interest in demography was ignited, and since then he has been one step ahead of the debate, championing ideas that have initially provoked outrage and then become gradually more widely accepted. This was the case with “entrapment,” then the hardinian taboo, and is again now with his concept of the lockstep (see glossary).

In 1990 he courted controversy with an article in the Lancet. King posed the dilemma that an extra mouth to feed meant less for someone else in an entrapped community. The message was, he says, “public health measures for child survival don't necessarily have to be put into practice, merely because they are possible.” Much to his angst, he was accused of advocating infanticide. He readily admits, though, that his ideas were not fully formed: “At that time I was still ‘tabooed’ over thinking radically about fertility. I had not yet faced up to one child families. I failed to realise that measures to increase child survival don't have much effect on population growth.”

A conversation with King is heavy with terms like two wisdoms, the Hardinian taboo, policing the lockstep, disentrapment, and benign uproar. He is consumed by the need to address the population crisis, and the “overpowering evil” of the US State Department, which, in concert with other agencies like the United Nations, the World Bank, and the Roman Catholic Church, is actively, and often covertly, preventing population issues being discussed fully. In the case of the United States, he believes that the motivation is to prevent attention being focused on its over-consumption of fuel.

When King makes these claims, however, he distances himself from other demographers. Even Charles Elliott, master of Trinity Hall, Cambridge, longstanding friend, and coauthor on a previous BMJ article on the Hardinian taboo (BMJ 1997;315:1441-3), has decided not to sign up to King's current offering (see pp 998-1001).

“He's become unduly excited about the role of the CIA and there is a touch of paranoia about it. I think Maurice weakens his case by getting into this ‘metapolitical’ analysis,” says Elliott. “You can believe it, but that is different from making a watertight case.”

Elliott believes that King's ideas are visionary but sometimes lack evidence: “Most professional demographers say he's off the wall. I don't think he is. He identifies the processes in action, but the fieldwork has often not been done.”

Malcolm Potts, professor at the school of public health at the University of California, describes well the dilemma that King poses: “There are people who think him extreme or even evil. I think he presents us with difficult problems many people do not want to face. We might come to different conclusions, but I don't think we can escape the issues he presents. My experience is that Maurice King wants to start a debate, not single-handedly establish a policy. The obligation of people who disagree with him is not to condemn him, but to review the facts and suggest alternatives if they exist.”

At face value, King is obsessed with imposing a one child world and is paranoid about the role of the United States. A closer analysis reveals a deep affection for Africa, and a missionary zeal—bordering on the manic—to surmount the problems of overpopulation. Few innovators get it right every time. But King is a visionary with a touch of creative madness. That means it's time for benign uproar.

Graphic“There are people who think him [King] extreme or even evil. I think he presents us with difficult problems many people do not want to face”


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Maurice King: a man of conviction