It occurs in stage 5 of the demographic transition model as death rates exceed birth rates. This results in a smaller workforce that has to support an ageing population which drains resources.

It occurs in stage 2 of the demographic transition model when birth rates are very high and death rates fall, meaning that more money is invested into healthcare.

It occurs in stage 4 of the demographic transition model when the workforce begins to decline and there are more elderly dependents who need greater levels of healthcare.