In 2009, the U.S. Congress passed a five-year, $7.5 billion aid package for a country it had all but abandoned just 10 years earlier. Indeed, if one word can summarize the U.S. relationship with Pakistan, “volatile” might be it. Since the September 11 attacks, the U.S. has appropriated nearly $61 billion in aid to Pakistan – more than twice what it received since independence in 1947.

Though some remaining funds may still be disbursed, the latest round of aid came to a close last September amid growing dissatisfaction on both sides. The Department of State billed the 2009 Enhanced Partnership with Pakistan Act (or Kerry-Lugar-Berman Act, also known as KLB) as an “innovative approach” to aid because of its attention to Pakistani priorities, its support of visible infrastructure projects, its focus on areas most susceptible to violent extremism, and its whole-of-government coordination.

But optimism quickly fell by the wayside. Widespread allegations of corruption dogged aid recipients and the slow distribution of funds spurred regular complaints in Pakistan. By 2011, failure seemed so certain that the Wilson Center hosted a bilateral working group to salvage KLB. The next year, the International Crisis Group issued a damning report openly criticizing KLB for putting visibility ahead of actual aid.

For all its shortcomings, though, KLB got one thing right: it looked at aid with a longer-term view and recognized that success depended on the ability to address multiple issues in tandem.

That perspective is sorely needed. By 2050, Pakistan will be the world’s sixth-most populous country and home to 271 million people, more than Canada and Mexico combined. The amount of water available per person will decrease by 60 percent, well below the UN’s threshold for water scarcity. By 2050, its economy will need to create jobs four times faster than the current rate in order to employ more than 100 million young people.

If, in the wake of KLB, U.S. lawmakers revert to short-term thinking, they will make it more difficult for Pakistan to tear down the systemic and seemingly intractable barriers holding back progress. Climate change, gender inequality, and population dynamics are shaping Pakistan’s future in ways that will endure for decades; ignoring them now lays the foundation for a precarious future. For U.S. interests – to say nothing of the basic rights of Pakistanis – this is an ill-informed gamble.

Looming Environmental Change

Last fall, Pakistan suffered historic flooding in Punjab – or rather, it might have once been considered historic, but is sadly becoming routine. Similar floods also struck in 2010, 2011, 2012, and 2013. The financial costs have been staggering: the 2010 floods, by far the worst, cost the country $9.7 billion. Altogether, the government estimates at least 3,776 people have been killed and more than 38 million affected by flooding.

It’s an irony of climate change that a country with barely enough water for drinking and irrigation suffers from such inundations. The country’s geography – mountains and glaciers to the north, the Indus River running down its middle, and the jet stream hanging overhead – makes it particularly sensitive to changing weather patterns. In the summer months, the jet stream unleashes monsoons across South Asia, accounting for 80 percent of annual rainfall over a four-month period. In Pakistan, monsoon season and snow melt account for 86 percent of the Indus River’s flow from April through September. Unfortunately, both sources are becoming less predictable. Warmer and drier winters mean less snow is melting, and it melts earlier in the season, while monsoons and other tropical storm systems are expected to get stronger and harder to predict.

Poor infrastructure and outdated water management systems exacerbate these climate stresses. Nationwide, 53 percent of Pakistanis – 97 million people – lack access to improved sanitation. In Karachi, Pakistan’s largest city, more than a third of city water is lost to pipe leaks and theft. By some estimates, more than 30,000 die from water-related diseases every year. The Indus, which supplies 90 percent of Pakistan’s irrigation water and 23 percent of its electricity, is managed by a 55-year-old treaty with Pakistan’s archrival, India. While the treaty has survived three wars between the two countries, it is the subject of recurring tensions, as water is also a critical concern in India.

Nearly half Pakistan’s workforce is employed in agriculture. In Sindh and Punjab, the two most populous provinces, agriculture is the predominant livelihood. As climate changes – drier winters, hotter summers, and more extreme monsoon seasons – make farming more unpredictable, already poor and food insecure Pakistanis have few options available other than to migrate in search of new livelihoods.

A recent USAID-sponsored study finds that as climate change corrodes traditional ways of life in some developing countries, grievances and frustrations can increase the risk of conflict, especially where the government is perceived as failing in its responsibilities to forecast and prepare for such risks.

Unfortunately, Pakistan’s government has been slow to embrace decisive action on climate risks. In August 2012, Georgia Tech researchers reportedly shared models with government officials showing the potential for extreme flooding in Sindh. The advanced warning was ignored, they say, and within two weeks the floods hit, killing more than 400 people.

The following spring, the government launched its National Climate Change Policy. But by June, the Ministry of Climate Change was demoted to a division and its budget reduced to just $350,000. “The paltry allocation for the Climate Change Division indicates that the government is dismissive about the grave challenges of climate change, despite highlighting its far-reaching impacts on the economy,” former UN Environment Program Deputy Executive Director Shafqat Kakakhel, himself Pakistani, told the Climate News Network last summer. This January, the government promoted the division back up to a ministry, but a budget increase has yet to follow.

Demographic Trends Reflect Poor Health, Gender Inequity

Pakistan’s demographic trends could exacerbate climate-related tensions. Population is on course to grow 47 percent in the next 35 years, from 185 million people today to 271 million by 2050.

Such rapid growth creates an age structure that is disproportionately young. Fifty-six percent of Pakistanis are under 25 years old today; in fact, there are nearly as many Pakistanis under 25 as there are Americans under 25 (about 105 million), even though the United States has almost twice as many people in total. Meanwhile, Pakistan’s economy is creating about 700,000 new jobs every year. In the U.S., more than twice as many jobs were created last year, even as many Americans, especially young people, felt stuck in an endless recession.

As demonstrated by political demographers like Richard Cincotta, Jack Goldstone, and Henrik Urdal, growing numbers of unemployed youth do not bode well for Pakistan’s stability. But if policymakers make the right investments, youth could become an asset, fostering a “demographic dividend” wherein slower population growth propels the country into a new era of economic growth. According to models from the Wittgenstein Center for Demography and Global Human Capital, investments in human capital, like schools and health care, could bend Pakistan’s population trajectory from 271 million people by 2050 to 248 million.

Improving the health system and tearing down entrenched gender norms are important first steps. Pakistan’s public health system is among the most underfunded in South Asia, as evidenced by a bevy of bleak indicators: The region’s highest infant mortality rate; an average life expectancy of 67 years (second lowest to Afghanistan’s 61); and the third highest rate of undernourishment (behind Afghanistan and Sri Lanka).

Women have an added burden. Only a quarter of Pakistani women report using modern methods of contraception, about half the regional average. This low rate of contraceptive prevalence contributes to a total fertility rate of 3.8 children per women, second only to Afghanistan’s 5.4. One-fifth of married women have an unmet need for family planning, wanting to control their fertility but lacking contraception.

Gender inequality plays a major role in these poor health outcomes. Last year, Pakistan ranked second to last in the world on women’s equality, according to the Global Gender Gap Report, an annual assessment from the World Economic Forum, Harvard, and the University of California-Berkeley. In a 2012 World Health Organization survey, 84 percent of women interviewed reported experiencing some kind of violence. Such violence starts early and takes many forms, from the Taliban’s high-profile shooting of teenager Malala Yousafzai and the fact that one-quarter of girls aged 13 to 16 are forced into early marriage, to the 60 percent of men who admit they abuse their wives.

Avoiding a Dark Future

Weak governance undergirds all of these problems. Pakistan’s federal government is consistently ranked among the world’s most corrupt, while its provincial governments – in addition to suffering from varying degrees of corruption themselves – lack resources and capacity. A 2010 constitutional amendment decentralizing broad swathes of power has only exacerbated the challenge of implementing essential public policies.

Such internal discord has left a void often filled by others – the Taliban, Al Qaeda, and the international community. But how can complex environmental and social problems be addressed when governance is minimally effective at best, violence runs rampant, and the international community is locked into their own priorities? Where does Pakistan go from here? And what role should the United States play?

As combat operations in Afghanistan scale down, “the United States will have less need to be so fixated on the war there, and by extension on relations with Pakistan,” says the Wilson Center’s Michael Kugelman. “Instead, Washington will now have more strategic space and capital to invest more in the relationship with India. So this suggests a downgrading of the relationship with Pakistan, which will weaken the rationale for maintaining a robust U.S. assistance program.”

At the same time, the perception that Pakistan is a security threat is undoubtedly growing, says Kugelman. President Obama’s budget proposal for 2016 includes $804 million in civilian and military assistance, maintaining the country’s customary spot near the top of aid recipients. But with the expiration of the Kerry-Lugar-Berman Act there’s no overarching framework guiding the relationship forward.

As long as American aid continues, it ought to be better. Despite criticisms, KLB’s attempt to coordinate U.S. aid in the service of a broader, more cohesive vision was a step in the right direction. But instead of focusing on infrastructure and high visibility projects, the next aid package should focus on Pakistan’s people.

Population, health, and environment issues are too often afterthoughts when it comes to our foreign policy towards countries we consider to be a security threat, but they have a tremendous effect on the daily lives of millions. Every year, the monsoon season is a powerful reminder of how much the environment matters. And although population, health, and the gender issues that surround them don’t always get that same visibility, they are just as important. In 2012, the U.S. underscored this by issuing a strategy to combat gender-based violence premised on the fundamental role that gender equality, including access to sexual and reproductive healthcare, plays in development and security.

An aid strategy for Pakistan that similarly links security to development challenges, invests in health and education, and builds resilience to climate change could be a powerful way to address core issues that affect stability and show the United States is not a cynical partner focused only on immediate security needs.

The prediction of an overcrowded, thirsty, and hungry Pakistan in 2050 is by no means a certainty. But if Pakistan and its biggest partners don’t change how they approach development, today’s challenges could become tomorrow’s catastrophes.