FINAL COMMENTS*
Ana Amélia Camarano
Instituto de Pesquisa Econômica Aplicada (IPEA)
Several chapters in this book have shown that prolonging life or lives is one of the most important social conquests of the twentieth Century. Actually, reaching 100 years of age is not a privilege of this generation. There is evidence to show that people have died at ripe old ages such as a man at 115 [see Wilmoth (1997)] and a woman at 122 [see Robine and Allard, apud Wilmoth (1997)].
What is new is the increase in life expectancy at birth, which results in more people reaching more advanced ages. For example, in 1980, out of 100 Brazilian children of the female gender, 22 lived to celebrate their eightieth birthday. In 2000, this number has doubled. The fall in mortality rates for all ages has been the most important determinant of this.
This was the effect of the “success” achieved by economic and social policies that have resulted in generalized improvements in living conditions, especially with regard to health. It has been observed since the latter part of the 1950s that the Brazilian population has been experiencing greater access, though unequally, to preventive and curative medical services, to advanced medical technology, to potable water, to sewage and sanitation, to schooling, etc.
The perspectives that can be foreseen for the medium term are continued reduction in mortality for all ages and, especially, for the more advanced ages. It is very likely that there will be a high growth rate of elderly people living longer in the near future. This is the continuation of population ageing. Nowadays, this subject is the focus of national and international conferences, government planning, public and private policymaking, and it constantly appears in the media. It has gained a place on the national and international agenda.
Aside from the certainty in gains in years of life, another reason that has contributed to the growing importance of this issue is the uncertainty in health
* This chapter was translated from Portuguese to English by Barbara Melo and reviewed by Ana Amélia Camarano.
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ANA AMÉLIA CAMARANO conditions that elderly people will face. This is so not only in terms of health, but also in terms of income, of familial support, etc. The question raised here is the one that closed the introduction to this book: “Well beyond 60 years of age, but how?” Another way of putting it is to ask if the new elderly Brazilians or elderly people in the future will be able to continue to enjoy the relative improved living conditions that the elderly of today have.
Negative points of view associate the increase in life expectancy to an increase in the time period in which elderly people would spend with mental disorders and chronic illnesses. The concern comes from the fact that this would place pressures on the finances of the health system and would raise the burden on families. This point of view has been the core of the discourse of various researchers in health conditions who have come to call it the bankruptcy of success.
It is understood here that it is a static point of view that ignores advances in medical science, improvements in access to preventive and curative medical services, changes in the life style of the population, the expansion in Social Security coverage, modifications in production processes, etc. It ignores as well the fact that even survival to the age of 60 is dramatically increasing; there are many persons who do not reach that age. Those that do should have a high degree of selectivity. Though a rather European and North American phenomenon, the rise and expansion of a group of elderly individuals not characterized by failing health, by pauperisation or by exclusion from various sectors of social life has been observed in Brazil.
While recognizing improvements in the health condition of the elderly population, another issue that has been present in the debate over ageing is the association of elderly people to the lack of productivity as they are excluded from the workplace, i.e., they are “consumers,” not “producers”. This leads to the thinking that even if ageing is desirable from the point of view of the individual, the increase in the elderly population would become a burden for the young population and the cost of supporting them can threaten the future of the nations.
1
Indeed, the Brazilian debate on population ageing continues to be strongly focused on Social Security expenditures, on fiscal adjustments and on the distribution of public expenditures. It was strongly influenced by a document put out by the World Bank in 1994 and re-evaluated in 2004, though still within the same focus [see World Bank (2004)]. Elderly people have been considered the greatest beneficiaries of public expenditures. As Goldani has stressed in this book, in Brazil, as well as in other countries, the conflict between generations over the
1. For an alarmist view of population ageing, consult: World Bank (1994) and Petersen (1999), apud Lloyd-Sherlock (2002).
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573 distribution of resources, whether real or perceived or invented, has become one of the core issues in political discussions and, also, in popular thinking owing to the media. This can be exemplified by the relative improved economic situation of elderly people in relation to the non-elderly group.
2
This discussion is quite biased, as well, by demographic determinism. A change in age distribution in itself is neither good nor bad. Ageing does not drop into an empty social space. Caring for a healthy elderly population is different from caring for a sick one. Health paradigms or institutional models are other important determinants in health costs. Ageing, therefore, can be seen as a problem or as a social conquest depending on how the society opts to deal with it.
The challenge raised here is in finding ways to commemorate this great social conquest, i.e., the fact that more and more people are experiencing a prolonged life span. To a large extent, the United Nations has given the answer: “Add quality of life to added years”. Now it is necessary to find out how.
The starting point for thinking about the proposed question is to take into account the heterogeneity of the elderly population. It begins by assuming that this age group has experienced differentiated life trajectories that will affect their living conditions in the final phase of their lives. These trajectories are strongly affected by ongoing social, regional and racial inequalities. Social policies, as well as myths, stereotypes and prejudices related to the elderly population can either reinforce such inequalities or weaken them.
In order to better understand how the Brazilian population is experiencing the final phase of life and to think of future perspectives, the Amarthya Sen theoretical perspective [apud Lloyd-Sherlock (2002)] has been adopted. It considers that this depends on: z
basic capacities (those which people were born with); z capacities acquired throughout life; and z environmental conditions in the last phase of life; therein included familial arrangements and public policies.
The somewhat better economic situation of the elderly population as compared to the non-elderly has been well documented in this book. Though on uneven conditions, today elderly people have benefited from the reduction not only in maternal mortality, but also in middle-age mortality, and in adult and
2. For more information, see Camarano (2002) and Beltrão, Camarano and Mello (2004).
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ANA AMÉLIA CAMARANO advanced age mortality. They have been the great beneficiaries of by pass heart surgery. They have survived high mortality rates of infectious-contagious diseases in early childhood. They experienced at their prime a period of economic growth, of stable and formal work. They were also beneficiaries of government financing for housing. On the other hand, this was the period in Brazilian economy in which social inequalities have been stressed and poverty has gained room on the public agenda. From the familial point of view, intimate relations were also more stable; once married they remained so. Fertility rates were high and the main role of women was to care for family dependents. Men continued to be the main providers of the family.
The family represented by women continues to be the main care-giver for elderly members with no autonomy to deal with daily activities. Their caring allows males that cannot deal with such activities to remain heads of their households. On the other hand, if women have no income of their own, their economic survival depends on their husbands’ income. Still, the majority of elderly women who cannot manage their daily activities, probably widows, look to their children for aid by way of co-residence. Although they need help, they bring income to the family budget, derived from pensions of deceased spouses. In other words, they receive and provide help. In sum, the family continues to play an important role in providing support for vulnerable segments. In fact, it is a twoway system of intergeneration transfer and it is mediated by social policies.
Nevertheless, in Sen’s words, family is a space for “conflicting cooperation” as these relationships are based on power. In addition, one does not know whether the forms of help, as co-residence, for instance, reflect preferences or not.
Some of the public policies that are currently being designed for this age group have contributed to reduce inequalities that have marked the lives of these individuals while others have reinforced them. As was mentioned in various chapters in this book, the 1988 Constitution established a number of benefits for the group that is living the last phase of life today. It could be mentioned, for example, the increase in rural social security coverage, the establishment of a minimum value for benefits
(one minimum wage). This applies to the rural and urban social security and social assistance benefits. Also, for the rural social security, the beneficiary unit was changed from the head of household to the individual. All these have had a great impact in reducing not only rural poverty, but also income inequalities in rural areas and have offered an incentive to small subsistence production units. These have also affected familial arrangements and have resulted in greater empowerment of elderly people.
Changes in rural social security have been widely recognized as a modern social protection policy for the rural population.
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On the other hand, both the private and public urban social security systems present various distortions. One of them is retirement according to working time or contribution time. As demonstrated in this book by Oliveira et al, in 1998,
91% of retired males had begun to receive benefits according to working time or time of contribution before the age of 60. Due to the increase in life expectancy, these retirees will spend a long time receiving benefits and will be “putting pressure” on a system that has been on stand-by alert since 1994.
It is difficult to believe that the traditional way of financing Social Security will be sufficient to deal effectively with the elderly population of the future within the context of rising informalisation of the economy. Two reforms were made, one in 1998 and another in 2003, focused on delaying the retirement age and on linking the benefit to the contribution.
In the case of retirement benefits from the private sector, Oliveira et al showed some results of the “reform” with regard to delaying retirement age. On the other hand, linking eligibility to benefits to the contribution itself means not taking into account transformations in the labour market. While the labour market tendency is one of growing flexibility that of the Social Security policy is one of
“rigidity”. This will certainly bring about difficulties in retiring for the 40 million
Brazilians that were either engaged in informal work or were unemployed in 2002.
Besides, it will not sort out the matter of how to finance Social Security.
Another social security policy that has contributed to reducing or even changing the direction of gender relationships is the one related to women. In general, for the elderly of today, those who worked and/or contributed were entitled to retirement pensions. Those who did not fulfil these conditions were eligible for the Social
Assistance benefit from the age of 65 onwards, as of the beginning of 2004. Since the 1988 Constitution, elderly rural women were made eligible for the benefit regardless of whether the heads of household were receiving it or not. This benefit is theoretically linked to work and, thus, contributory. Nevertheless, some research work has already shown that a great part of the 60-79 female cohort currently receiving benefits did not work when they were 40 to 59 years old nor did they contribute to
Social Security [Camarano (2003)]. This is more evident among rural women and it may be associated to the difficulty in measuring female work in rural areas.
Aside from receiving retirement pensions, widowed women have the right to receive a survivor’s pension upon the death of their husbands. Since the 1988
Constitution, this is equal to the husband’s last wage/benefit. Also, these women are allowed to work. This has led to a change in gender relationship with regard to income. Non-elderly women are poorer than non-elderly men and the inverse is
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ANA AMÉLIA CAMARANO true in the last phase of life [Camarano (2002)]. Men can also accumulate the two benefits and keep working, but few become widowers.
Based on the proposed model by Sen and on the near certainty of prolonged life for a large segment of Brazilians, the question raised is how will these additional years be lived?
The new elderly people or those entering the 60 and over age bracket from
2010 onwards are the baby boomers (born under a high fertility regime) and those who experienced dramatic reduction in childhood mortality. The women got great gains in schooling and entered the labour market en masse . They made the revolution inside the family by getting married, getting divorced, remarrying or not marrying again, and by having fewer children. The condition of not marrying and not having children also became a choice.
The instability in family relationships has also affected the men. Though they remarry at a greater rate than do the women, they maintain less ties of affection with their children if divorced. The increase in the number of relationships may result in a greater fragility in these.
The labour market has also changed. Part of this generation is already experiencing the effects of its flexibility and the “rigidity” of Social Security policy, which will affect their retirement benefits in the near future. Among the males aged 40 to 69 in 2002, 82.2% worked and 50.3% contributed to Social Security.
The comparable proportions for females were 43.1% and 25.2%. Although the proportion of contributors is low, it is difficult to know how long these people have been contributing. In addition, it is difficult to expect that they will be able to contribute for 30 years (in the case of women) and 35 years (in the case of men) towards retirement by contributory time or 15 years towards retirement by age, as required by the Constitutional Amendment 20. These numbers do not include the unemployed.
The outlook as to the likelihood of retirement for elderly people in the next
20 years is not a promising one and gets even worse for the generations that are now 20 to 40 years of age. It is very unlikely that social assistance will be able to generate income for this high proportion of the population, today unemployed and informally employed, when they lose their working capacity.
In addition, the transition to adult life is being affected by difficulties in the labour market and in family relationships. The result has been that young adults have been spending more time in the home of elderly parents, reliant on their income. How this relationship will unfold in the near future is a great interrogation
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577 mark. What kind of help will future young people be able to rely on in their transition to adult life?
On the other hand, the future elderly generation is also experiencing great advances in medicine, cosmetology, hormone drugs and over-valorisation of youth.
Elderly people will become political actors more and more, increasing their political representation in government, in the legislative branch, in organised society, etc.
This increases the heterogeneity of the elderly group. On the one hand, a proportion of the elderly population wants to turn youth into the negation of death while the other suffers in its approach to death, requiring health care and emotional nurturing. The family will no longer be the same, with fewer children. Multiple marriages weaken family ties with relation to fathers and mothers-in-law. Women are fully integrated in the labour market, as they are providers as well as care-givers.
They can give to the elderly relatives more financial resources, though less time and attention. The poor family, especially the woman, needs help in caring for dependents. In other words, policies must help her to decide whether to care for dependents or engage in the labour market in order to guarantee economic survival.
Heath policies should take the entire life cycle into account in order to assure not only that more people reach the last phase of life but also that they are healthy when they get there. Among such policies, one should highlight the promotion of health, universal access to public health services throughout life and, as a consequence, the consideration of the impact of environmental, economic, social and educational factors, among others, on health conditions. For the final phase of life, a public health system must be able to assure the ways and means by which people may live out this phase of their lives in dignity and with minimal suffering when they decide the right moment has come to end it. This is what Debora
Diniz discusses in her chapter.
Though it is recognized here that elderly people have specific requirements, differentiated both by age and gender, in order to reach “a society for all ages”, as proposed by the United Nations, a policy geared to the elderly population should be inserted into a sustainable development policy aimed at increasing the wellbeing of the whole population. Elderly people do not live in isolation and their well-being is closely linked to that of the society as a whole.
It is believed that the ultimate target of any public policy is the well-being of the population. Financial equilibrium is necessary in order for this to occur in a sustainable way. In the case of Brazil, the concern over fiscal adjustments has been held as the main aim of public policies, i.e., the means is being privileged in detriment of the end.
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BIBLIOGRAPHY
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CAMARANO, A. A. Brazilian population ageing: differences in well-being by rural and urban areas .
Rio de Janeiro: IPEA, 2002 (Texto para Discussão, 878).
__________. Mulher idosa: suporte familiar ou agente de mudança? Revista Estudos Avançados ,
São Paulo: USP, v. 17, n. 49, 2003.
LLOYD-SHERLOCK, P. Ageing, development and social protection: a research agenda . Madrid:
UNRISD Meeting on Ageing, Development and Social Protection, 2002.
WILMOTH, J. In search of limits. Between Zeus and the Salmon: the biodemography of longevity.
Washington, D.C.: National Academy Press, 1997.
WORLD BANK. Averting the old age crisis: policies to protect the old and promote growth . Washington,
D.C., 1994.
—————. Keeping the promise of old age income security in Latin America . Washington, D.C.,
2004.
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