Are we living longer or merely surviving?It has been clear for some time that living beyond the age of 60 is not necessarily a social or health triumph. Albeit lagging, among other fronts of social development, Brazil has been experiencing the aging process since the late 1960s. Data from the latest Demographic Census reveals that life expectancy of Brazilians in 2022 was 79 years for women and 72 for men1. However, this raises the question: are we living longer or merely surviving?
This questioning emerges amid the health status associated with Brazilian older adults, most notably in the contexts of social vulnerability, which have given rise to care needs that the health systems has been unable to fully meet. No health system, even those of a universal nature, such as the Brazilian National Health System (SUS), would be able to cope with this level of demand while maintaining excellent response capacity. When aging is synonymous with disease and disability, especially given the absence or shortcomings of health promotion policies, living beyond the age of 60 years translates to health needs which tend to be both specialized and complex2.
Against this backdrop, health systems struggle to guarantee effective access to health services by the older population. This situation leads to significant inequalities in service use and access, intensifying demands among the population strata that most rely on this care. Hence, barriers to accessing health services are important markers of social inequalities, representing a violation of the right to health of this population
Of these different barriers, the race question is of particular concern. Older individuals who self-identify as black encounter greater difficulty accessing health services for perceived need compared to individuals who are white. This association occurs irrespective of education or holding a private health plan, important predictors of health service use and access, highlighting the extent to which racial issues are structural and warrant attention in this discussion3.
With regard to health plans, it is important to emphasize the level of concern over this facilitator of access to health services, especially in the Brazilian milieu. From the moment that holding a health plan ensures, even if partially, better access to health services, at least two guiding principles of the SUS are violated: universality and equity. The same applies for other factors facilitating access to health, such as income, itself a determinant of whether older adults hold health plans3.
Despite all this debate which, sometimes goes beyond the journals and feeds into health administration agendas, we are far from addressing the multitude of demands arising from the aging of the Brazilian population. The experience of European and Asian countries, which underwent the process of population aging some time ago, tells us that the solution lies in promoting health over the life span, with a focus on active aging. Although simple, the solution calls for reworking of the prevailing healthcare model and for more effective health promotion policies targeting all phases of life.
Remodeling healthcare in Brazil requires overcoming a host of challenges ranging from the geography of the country, underfunding of the SUS, and political will (including the issue of ageism), which transcend administration agendas. After all this reflection, perhaps we can more confidently answer the opening question of this editorial: are we living longer or merely surviving?
References
- 1 BRASIL. Ministério do Planejamento e Orçamento. Tábuas Completas de Mortalidade para o Brasil - 2022. Instituto Brasileiro de Geografia e Estatística. Rio de Janeiro, RJ, 2023.
- 2 GBD 2019 AGEING COLLABORATORS et al. Global, regional, and national burden of diseases and injuries for adults 70 years and older: systematic analysis for the Global Burden of Disease 2019 Study. BMJ, v. 376, 2022.
- 3 OLIVEIRA, Elaine Cristina Tôrres et al. Difficulties in accessing health services among the elderly in the city of São Paulo-Brazil. Plos one, v. 17, n. 5, p. e0268519, 2022.
