During the 2002 Second World Assembly on Aging in Madrid, participants agreed that one of contemporary society’s greatest challenges is improving the lives of older people in developing countries, where the vast majority of the aging population live. Nevertheless, 10-plus years later, we are still questioning why older people remain invisible in our societies.
Populations in Latin America and the Caribbean (LAC) have been aging rapidly, and the speed of population aging will increase exponentially in the coming years. This demographic shift means that by around 2050, 24 percent of the LAC population—some 200 million people—will be ages 60 and over. Beyond indicating demographic maturity, this aging demographic also results from social advances and progress in healthcare. Around 81 percent of people born in the region will live at least to the age of 60, while 42 percent will live past 80. In 2025, there will be 15 million people ages 80 or over. It is clear that the aging population is one of the biggest challenges that LAC societies must face this century.
As an example of LAC “longevity democratization,” in 2006, the so-called geriatric life expectancy—or life expectancy of people at 60 years old—was 19 years for men and 23 years for women. This is similar to the geriatric life expectancy in developed countries. Greater longevity, however, has not been accompanied by comparable improvements in well-being, health, and quality of life.
Aging in LAC countries remains a burden. Despite the recent improvements in the region’s economic situation, there are many differences between countries, and the economic resources dedicated to older people remain very limited. Studies show that almost 50 percent of older people do not have the financial means to meet their daily needs, and one-third have neither a pension nor a paying job. Their education level is lower than that of the general population, and they have very high illiteracy rates, especially in rural areas.
Almost 80 percent of United States residents ages 65 and over claim to be in good health. In LAC countries, however, less than 50 percent of people ages 60 and over describe their health as “good.” Furthermore, LAC women say that they are in poorer health than men. Various studies show a reduction in the prevalence of disability in this age group in the United States and Canada; however, in Latin America and the Caribbean, 20 percent of the group members’ basic functional capacity has been affected, necessitating long-term care in their homes or in institutions.
The implications of these statistics for present and future public health in the region are many, but unfortunately the region’s health systems still lack a comprehensive vision of health for older people. Knowledge about the health care needs of older people is not uniform, and most health systems in the region do not have adequate indicators that allow for proper impact monitoring and analysis. Coverage; continuity of care; and geographical, physical, economic, and cultural access to health services without discrimination is lacking, and those people who do have access still do not receive adequate services.
In LAC societies, family members, especially women (90 percent), care for older relatives. However, their capacity to do so is changing; 60 percent of caregivers say that “it’s too much” for them, and more than 80 percent indicate financial difficulty in providing care. Expectations that families and other informal caregivers alone could fill this gap are unrealistic. The rapid demographic transition and factors such as the transformation of the family, women’s participation in the labor market, migration, and urbanization is affecting the availability of household resources to provide the care needed by older adults.
In 2009, the 49th Pan American Health Organization Directing Council approved the “Plan of Action on the Health of Older Persons, Including Active and Healthy Aging,” emphasizing that the exponential shift toward a new demographic and epidemiological situation means that countries must not only rapidly adapt, but also anticipate new contexts, and that only adequate social and health investment can produce healthy and active longevity with benefits for all.
The commitments outlined in the Plan of Action fall into four main strategic areas: 1) endorse the health of older people through public policy; 2) expand the suitability of health systems to meet the challenges of an aging population; 3) increase human resources training necessary to meet this challenge; and 4) develop the capacity to generate the information needed to undertake and evaluate action to improve the health of the older population.
Improving health conditions and reducing disability and dependence in the older population requires shared commitment and responsibility. To ensure healthy and active aging, it will be important to develop strong health promotion and prevention programs with a life course approach. Better intersectorial work among health and social protection systems, using a human rights approach, will be needed to guarantee better development opportunities, for example through the establishment of safe and age-friendly environments.
Primary care-based health systems in the region must be developed with better community and family approaches to preventing dependence while also promoting better ways to care for older people. Health systems must also provide their workers with the training they need to meet the health care needs of this population group.
This approach to aging will demand the efficiency, effectiveness, and quality of health systems and services. Tackling this challenge will also require academic and research institutions to play an active role in the production of new knowledge and scientific evidence to inform decision-making. Appropriate information mechanisms and products will facilitate monitoring, evaluation, and supervision, as well as the adaptation of plans and strategies.
The success of this Plan of Action will depend on the mobilization of political, social, and economic backing necessary for the adoption of effective public policies related to health and aging. It will require the active participation of stakeholders, donors, private sector, and civil society. Older people have yet to be recognized as independent contributors to LAC society, but this can change with improved efforts in the areas of aging and health. •
about the author
Dr. Vega is a specialist in geriatric medicine who has served as the Regional Advisor in Aging and Health at PAHO/WHO since January 2006. Before joining PAHO/WHO, he was the National Director of Older Persons Care at the Ministry of Health of the Republic of Cuba; Deputy Director for the Research Center on Longevity, Aging, and Health in Havana; Professor of Geriatrics, Gerontology, and Public Health at the Medical University of Havana; and a former Secretary General of the Latin American Committee of the International Association of Gerontology and Geriatrics.