Many nations of the Americas are confronting a defining, 21st Century dilemma: caring for the elderly amid turbulent social changes, economic uncertainties, mounting inequality and contentious politics.
“We are in a race against time. We are aging faster than the rest of the world,” Dr. Enrique Vega, a Pan-American Health Organization (PAHO) official of Cuban nationality, told a recent international gathering in San Francisco.
“Alzheimer’s disease is increasing and we don’t have prevention and treatment,” chimed in Dr. Carlos Cano Gutierrez of Colombia’s Pontifica Universidad Javeriana.
The warnings of Vega and Cano that the region is falling behind in prioritizing a historic demographic shift and its attendant consequences were shared by many attendees of last month’s 21st World Congress of Gerontology and Geriatrics. Hosted by the International Association of Gerontology and Geriatrics and the Gerontological Society of America, the event attracted about 6,000 people from more than 75 nations across the globe, according to organizers.
Once cast as a peculiar problem afflicting Europe and other more developed nations, graying is now coloring Latin American and Caribbean nations while posing critical public policy questions that loom large in the United States as well.
Dr. Carmen Garcia Peña, researcher for Mexico’s National Institute of Geriatrics, estimates that 27 countries in the Americas will have a greater proportion of older people than children under 15 by 2060. In Mexico, the percentage of the country’s people aged 60-plus will increase from approximately 10 percent in 2015 to 14.8 percent by 2030, adds Dr. Luis Miguel Gutierrez Robledo, the institute’s director.
Mexico and Latin America are representative of global trends marked by lower fertility rates and longer lives.
A 2017 article appearing in the professional journal The Gerontolgist, by Dr. Rachel Pruchno of New Jersey’s Rowan University, cites research that projects the older segment of the world’s population will nearly double to 1.6 billion people between 2025 and 2050, with the oldest layer of the population — seniors aged 80 and older — increasing from 126.5 million people to 446.6 million during the same time period.
“Increasing longevity has created havoc to retirement policies and likely will continue to do so in the future,” Pruchno writes, surveying the experiences of European, Latin American and Asian countries. “Health care systems, regardless of whether they provide universal coverage for citizens… are strained.”
Aging action in Mexico
Dr. Rebecca Wong, distinguished professor in health disparities at the University of Texas Medical Branch in Galveston, maintains that the time for decisive action on aging is now. “(Latin American) countries didn’t have time to adapt, because they had different priorities,” Wong contended in a San Francisco panel session. “Then we can say to the governments, if you don’t act, look, the costs are going to be very high.”
Wong and other experts who participated the San Francisco conference say problems awaiting solutions include establishing viable retirement systems, increased costs of health care and pharmaceuticals, coping with dementia and other age-related diseases, improving geriatric research and medical training, translating the latest scientific findings into best practices, and providing long-term care during an era of profound social transformations.
In Mexico, for instance, the traditional system of elder care performed by families is eroding in a country transformed by both internal and external migration, the massive entry of women into the workforce and shifting attitudes that favor a bigger role for the state.
Compounding the equation, one in five older Mexicans suffer “multi-dimensional poverty,” while only slightly more than one in four Mexicans aged 60-plus (26.1 percent) had a retirement pension in 2013, says Gutierrez Robledo. In such a scenario it’s not surprising to see many older Mexicans spending long days peddling goods on the street or, as Rachel Pruchno observes, “forced to work into late adulthood.”
Pioneered by politician Andres Manuel Lopez Obrador during his stint as mayor of Mexico City (2000-2005), small pensions for seniors were replicated at the national level during the administration of President Vicente Fox in 2006, when lower-income Mexicans aged 70-plus and not enrolled in Mexico’s Social Security program became eligible for a small monthly payment. The federal program currently benefits individuals above 65 years of age who are in adverse economic circumstances.
In 2017, however, the monthly pension amounts to 580 pesos, or about $35, paid in bi-monthly installments. Elderly, low-income Mexicans not covered by the IMSS and ISSSTE social security plans are likewise eligible for Seguro Popular health insurance, a universal coverage scheme also hatched by the Fox administration and continued by its successors. Additionally, impoverished older Mexicans receive food and personal supplies from some state governments.
Wong credits Seguro Popular for increasing health insurance coverage of older Mexicans from 50 percent to 85 percent, but cautions “the jury’s still out” on the quality of health care services delivered.
Though far from adequate, Mexico’s newer social programs for the elderly nevertheless signify a lurching recognition of the aging question in the country. Instituting a universal Social Security system is emerging as one of the issues in the 2018 presidential and congressional elections.
In an institutional response to the age question, the Mexican National Institute of Geriatrics was established as a unit of the Health Secretariat in 2012. According to Gutierrez Robledo, his agency currently employs 22 full-time researchers dedicated to studying and analyzing aging issues that can be useful for policymakers. What’s more, Mexico’s official scientific research funding arm, Conacyt, now considers proposals for aging studies, according to Garcia Peña.
Stirring a regional consensus
In Latin America, the International Longevity Centre-Brazil and the World Demographic Association convened government officials, academics, civil society activists and other elder advocates to a 2013 forum in Brazil that issued the Declaration of Rio, a celebration of the “longevity revolution” as well as a call for nations “to develop a culture of care that is sustainable, affordable, compassionate and universal.” Institutionally, PAHO has devoted more attention to aging concerns as the issue acquires international prominence.
Another milestone on the aging front is the 2015 Inter-American Convention on Protecting the Human Rights of Older Persons. “This is the first convention in the world to protect the rights of older persons,” says PAHO’s Enrique Vega.
An ambitious project within the Organization of American States system, the Inter-American Convention encompasses health and long-term care, sexuality, education, culture and leisure, community participation, labor rights, violence and exploitation, political engagement, property rights, palliative care, retirement income, and more.
The agreement commits signatories to initiatives ranging from national legislative measures to bilateral accords, with the purpose of turning comprehensive goals into political and social realities. With regard to social security, the Inter-American Convention pledges states to allocate, “within available resources,” a sufficient retirement income so older persons can enjoy a “dignified life.”
Costa Rica, Brazil, Chile, Bolivia and Argentina have so far signed on to the Inter-American Convention, with Peru arriving “at the end of the process,” Vega says. The United States and Canada haven’t supported the initiative but are not blocking it either, he says. “It’s doing well… we hope in the next two years, more and more countries will get around to it.”
Kent Paterson is an independent journalist who covers issues in the U.S./Mexico border region and a fellow in the 2017 Journalist in Aging Fellowship Program. Enlisting a diverse cross-section of journalists from across the United States, the program is sponsored by the Gerontological Society of America and San Francisco-based New America Media. As part of his fellowship, Kent attended the World Congress in San Francisco. This article was written with the support of New America Media, the Gerontological Soceity of America and the Silver Century Foundation.