By Elton Alisson, in Porto Seguro (Bahia) | Agência FAPESP
– In recent decades, the Brazilian population has aged rapidly and is
expected to include 31.8 million people over the age of 60 by 2025. This
will have a direct impact on healthcare and social security. In
particular, care for the elderly will have to change.
The above assessment was presented by researchers during a
round-table session on demographics and aging in developing countries
held as part of the 68th Annual Meeting of the Brazilian Society for the
Advancement Science (SBPC). The meeting took place on July 3-9 at the
Porto Seguro campus of the Federal University of Southern Bahia (UFSB).
“From 2 million in 1950, the number of Brazilians over 60 had jumped
to 6.2 million in 1965. By the turn of the century, it reached 13.9
million. In 2025, it will reach 31.8 million and will be one of the six
largest in the world,” said Luiz Roberto Ramos, a professor at the
Federal University of São Paulo’s Medical School (EPM-UNIFESP), during
the event.
Ramos was the principal investigator in a
FAPESP-funded research project on the effectiveness of health promotion actions for the elderly.
He said the Brazilian population is aging much faster than the
European population, for example. Mortality and fertility rates were
both high in Europe until 1800, and this combination kept the population
young. The situation changed between 1800 and 1900, during the
Industrial Revolution, mainly due to a rise in life expectancy. “It took
a hundred years for the European mortality rate to fall,” Ramos noted.
The fertility rate only began to fall in Europe between 1900 and
1950, he added. It is expected to hold steady in the decades ahead,
leading to a rise in the proportion of older people.
In Brazil, on the other hand, mortality fell between 1950 and 1980,
while fertility began declining in 1970 and is now well under 2.0
children per woman of childbearing age, less than the replacement rate.
Population growth is set to stall by 2050.
“The demographic transition that took 180 years in Europe will take half as long in Brazil,” Ramos said.
The rise in the proportion of elderly Brazilians, which is growing
much faster than that of any other age groups and has caused the overall
aging of the population, must change the public health system’s
priorities, according to Ramos.
Until 1950, when Brazil’s fertility and mortality rates were high,
40% of deaths were caused by infectious diseases and only slightly more
than 10% were due to cardiovascular diseases.
Cases of infectious disease trended down between 1950 and 1970, when
Brazil’s epidemiological transition began, and they now account for only
5% of all deaths compared to 40% for cardiovascular diseases.
“Under the old public health paradigm in Brazil, the population at
risk was made up of children, the priority was treatment of infectious
diseases; preventive measures – symbolized by vaccination – were
effective, and treatments were simple, definitive and cheap. It was the
famous case of one antibiotic per week,” Ramos said.
“Under the new paradigm, the population at risk is made up of older
people, the priority is treatment of chronic noncommunicable diseases
that cause disability, preventive measures are relatively ineffective,
and treatments are complex, chronic and expensive.”
Moreover, the Brazilian health system is not equipped to address this new situation, according to Ramos.
A survey of the profession’s evolution since 1910 by the Federal
Medical Council shows that 38% of Brazilian physicians were
pediatricians, gynecologists or anesthesiologists in 2010. Geriatrics
ranked forty-first among medical specialties, according to the report.
“We have a long way to go before our health system has enough
professionals who specialize in caring for all these older people,”
Ramos said.
Care for the elderly
Ana Amélia Camarano, a researcher at the Institute for Applied
Economic Research (IPEA), a government think tank, presented statistics
showing that the over-eighties are currently the fastest growing age
group in Brazil. This age group is set to grow at an even faster rate
owing to the baby boom in 1950–60, when fertility rates were still high.
“This age group benefited from the fall in infant, child and adult
mortality in the past few decades in Brazil and more recently from the
fall in old-age mortality due to advances in medicine,” Camarano said.
Now, however, rising numbers of over-eighties will require not only
more care but also more time for care, she added, estimating that the
size of the elderly cohort that requires more care may grow between 30%
and 50% by 2020 in Brazil.
“We have to ask ourselves whether families are ready to care for
relatives of an advanced age,” she said. “Families should be prepared
for this.”
Older Brazilian men and women require long-term care for 4.2 years
and 4.7 years on average, respectively. Men die earlier than women in
Brazil. “So, aging is a gender issue,” Camarano said. “Many older women
are prime carers for their husbands, who die first. Who will take care
of these women?”
Another concern, she went on, is the social security system. The
birth rate is falling, and the workforce is contracting as a result.
“How many people will have jobs and pay the social security
contributions that will keep these older people in pensions or
benefits?” she asked.
Impact on social security
Brazil’s 1988 Constitution uncoupled old age from poverty by
introducing a universal social security network that guarantees a basic
income for the elderly, Camarano noted. Today, 82% of Brazilians aged 65
and over receive social security benefits.
However, because of aging, the over-65 age group will comprise
approximately 20% of the population in 2050, and the social security
system will have to spend proportionately more. The deficit, which is
already substantial, will therefore become even larger, said Bernardo
Lanza Queiroz, a professor at the Federal University of Minas Gerais
(UFMG).
“Approximately 12% of public spending in Brazil goes toward the
elderly even today,” Queiroz said, adding that the large numbers of
Brazilians who apply for a retirement pension at a relatively early age
exacerbate the problem.
In the early 1990s, when universal social security was implemented,
most people over 65 were in paid employment, compared with only 20% now.
The guaranteed right to an old-age pension is itself partly responsible
for the decrease, according to Queiroz.
“A very large percentage of Brazilians receive pensions or other
social security benefits in proportion to the number of over-65s,” he
said. “In 2010, 1.6 people received retirement benefits for every person
aged 65 or over. From this ratio, you can infer that people are
retiring relatively early.”
Retirement at a relatively young age would not be a problem if the
social security system were in sound financial health – and in any event
is perfectly legal, Queiroz noted.
“The law was framed in that way for a good reason, which was to
enable the poor to get a retirement pension after working for 30 years,”
he explained. “However, exactly the opposite has happened: people with
higher levels of schooling and better-paid jobs have traditionally taken
more advantage of the opportunity to retire after contributing for 30
years.”
The longer it takes to reform social security, the steeper will be
the cost to the nation and to ordinary citizens, according to Queiroz,
who presented data showing that Brazil has four people receiving
pensions for every ten people who pay social security contributions.
If nothing changes between now and 2050 in terms of employment and
years paying contributions, for example, there will be 1.2 people
receiving benefits per person paying contributions. “The math just won’t
add up,” he stressed.
