Health and Healthcare Systems

COVID-19 is only adding to the woes of older people in Brazil

Senior citizens dance at a party at "Instituto Da Melhor Idade, Estacao Vida", at Agua Branca park in Sao Paulo, Brazil November 11, 2017. Picture taken November 11, 2017.

A society that is cavalier about its older population is one that is cavalier about its social memory Image: REUTERS/Nacho Doce

Alexandre Kalache
President, International Longevity Centre-Brazil
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Brazil

This article is part of: Centre for Health and Healthcare
  • Structural disadvantages in Brazil become amplified for its poorer, older population - and the pandemic is only making this worse.
  • Ageism in normal times produces negative health outcomes. Today, these are even more pronounced.
  • To become truly resilient to this virus and its impacts, Brazil must better recognise the value and dignity of people at every stage of their lives.

Brazil is a global epicentre of the COVID-19 pandemic. As of 25 October, 156,000 Brazilians have died from this disease. Using the International Classification of Diseases (ICD) model, the coronavirus is now the top cause of death in the country.

Many of the victims are younger people prematurely aged by diseases which have poverty as their root, but most are drawn from the 31 million Brazilians over the age of 60. Despite a weak testing regime and a considerably smaller population, the number of confirmed cases in Brazil is only surpassed by the US and India. None of the factors that have led to this grim third-place distinction are unique to Brazil; it is their perverse synergy, however, that has produced this unenviable outcome.

COVID-19 landed on very fertile ground in Brazil. For decades, the country has consistently ranked among the 10 most unequal societies in the world. According to the World Bank, almost half of the Brazilian population either live in poverty (defined as less than US$5.50 per day) or are vulnerable to falling into poverty. After some improvement in the first 10 years of the century, income inequality has worsened in Brazil since 2016. In the four years prior to COVID-19, 6.3 million Brazilians – equivalent to the entire population of Switzerland – joined the ranks of the poor. With the onset of the pandemic, the World Bank anticipates another 7.2 million new Brazilian poor in 2020.

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Almost 50% of the population lack access to a proper sewerage system and 33 million have only an irregular water supply. Cramped, multi-generational households, over-burdened public transport and precarious employment are the unavoidable reality for tens of millions. Low educational levels have compromised health literacy. Unsurprisingly, the proportion of Brazilians of all ages living with NCDs and disabilities is high.

These structural disadvantages, which frame the lives of so many younger Brazilians, inevitably produce an amplified effect in later life – a cumulative inequality that has greatly compounded the vulnerability of older Brazilians on multiple fronts. Race, gender and sexuality are powerful contributing factors. Older age for many Brazilians arrives on top of a life history of health, food and welfare insecurity. COVID-19 has not forged inequalities in Brazil – it has simply brought them into the open.

Total number of coronavirus cases in Brazil
Total number of coronavirus cases in Brazil Image: Worldometer

Still reeling from a 2015-16 recession and further contractions in 2019, the Brazilian economy was struggling even before the pandemic. Many of the nation's 26 states were insolvent, and several municipalities were financially unsustainable. Health and education budgets had been slashed and federal legislation in 2017 froze all social expenditure for 20 years. In the meantime, the number of billionaires kept increasing. The capacity of the Brazilian National Health Service (SUS), on which 83% of older adults rely (that proportion is even higher for Afro-Brazilians), was already significantly eroded.

It has been said that COVID-19 is a health crisis that has morphed into an economic and a social crisis. In Brazil it might be more accurate to say that an economic and social crisis has morphed into a health crisis. Furthermore, it is not the first time that this has happened, and it is unlikely to be the last. Despite the obfuscations of some political leaders, health, the economy and society are not divisible silos. Nor are youth and older age. We do not become less of a person as we age. We become more of the same person. In common with some other countries, two false and particularly virulent dichotomies have emerged in coronavirus-ravaged Brazil. The first is that there is a choice to be made between health and the economy. The second is that there is a choice to be made between the young and the old.

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It is political actions and inactions – both historic and current – that have brought us to this point. The key public health tool is trust – trust in institutions, trust in the message and trust in your fellow citizens to do the right thing. Brazil may be rich in commodities, but trust is in noticeably short supply. Confidence in public and political bodies is low. Dogma has left little space for scientific due diligence. Opportunities to deliver coordinated public health instruction have been squandered. There is a resistance to transparency and accountability. Federal authorities have consistently downplayed the coronavirus; aggressively championed a business-as-usual model; and so, minimised the governmental responsibility to protect the lives of older Brazilians. The countrywide Councils of Older Persons, which once gave impressive voice to millions of older persons through a vast national web of peer selection, has been effectively decommissioned. The government's 'Age-Friendly Brazil' scheme is widely mocked. Millions in public finances have been siphoned off through corruption; this has been alleged to be the reason why only one of the seven camp hospitals constructed in Rio in response to COVID-19 has ever functioned. Individualism continues to proliferate at a time when the only solutions are collective. Mounting evidence suggests an increased incidence of elder abuse (including financial abuse) throughout the country.

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Ageism in normal times produces measurable negative health outcomes. In times of crisis, the repercussions are even more pronounced. A society that is cavalier about its older population is a society that is cavalier about its social memory and its human resources. Older people may be more vulnerable in times of crisis, yet, they are also more resilient, they can see the light at the end of the tunnel. Multiple studies reveal their critical role in post-crisis societal recovery. For Brazil and other countries to achieve resiliency in the face of the coronavirus, they must learn to fully respect the dignity, value and full citizenship of people at every stage of life.

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