Aging of the Brazilian population and challenges for the health sector



Maria Cecília de Souza Minayo

Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil. maminayo@terra.com.br



The demographic revolution is one of the most important changes Brazil has experienced in the last 100 years. Average life expectancy in Brazil was only 33.5 years in the early 20th century. According to the Brazilian Institute of Geography and Statistics (IBGE), by 2009 it reached 73 years (76.5 for women and 69 for men). The proportion of elderly increased from 9.1% in 1999 to 11.3% in 2009, with a current contingent of 22 million, thus surpassing the elderly population in such European countries as France, England, and Italy according to U.N. estimates. Increasing life expectancy has been most impressive among individuals over 80 years of age. From 1997 to 2007, the population 60-69 years of age grew by 21.6%, while the over-80 group increased by a full 47.8%.

As a result, Brazil's crude mortality rate decreased from 6.60‰ in 1997 to 6.23‰ in 2009, according to the IBGE. And while the proportion of elderly in the overall population has increased, the number of children has decreased. Under-five children now represent only 7.2% of the Brazilian population, while the 0-9-year contingent shrank from 30.2 million in 2007 to 29.4 million in 2009. Such changes have implications throughout the life cycle and in the country's age profile, calling for adequate policies and new forms of social organization, in keeping with contemporary society. For example, if Brazil now has fewer children, more quality investment is needed in their education; the time span that defines youth needs to be extended, as occurs in various European countries today due to competitive demands in the work market; and retirement age will have to be postponed, to the extent that the number of individuals over 70, 80, 90, and even 100 years of age is increasing.

In fact, the very concept of aging has also aged, given that more and more rites of passage that mark aging have become obsolete. Currently, the majority of Brazilian elderly cannot be treated as disposable, since they are present in the country's socioeconomic, political, and cultural development: more than 85% of Brazilian elders are still active and independent, even when living with health problems; 87% of elderly men are heads of families, and more than half contribute to the household income from their earnings. It is beautiful to see how the fighting generation of the 1960s gives a new meaning to aging, making it more productive and pleasurable.

However, a small share of Brazilian elders lack an income of their own and are unable to meet their basic needs, in addition to suffering from serious health problems and physical and mental dependency. Some gerontologists have expressed concern, especially with the population over 80 years of age, when the incidence of illnesses generally increases and independence declines. Some even claim that it is difficult to promote life with dignity in this age segment, among other reasons because treatment for elderly individuals demands three times more financial resources and personal care.

Data show that the Brazilian demographic revolution is both a milestone and a responsibility for public administrators and society. It is crucial to invest in promoting independent and healthy living in this social group, as well as to adequately care for its needs. This "new age of the old" requires planning, logistics, training for caregivers, and especially sensitivity to realize that the elderly population has come to stay and that it will continue to grow at least until the 2050s.

Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Rio de Janeiro - RJ - Brazil
E-mail: cadernos@ensp.fiocruz.br