El Doctor Erdman B. Palmore, es un destacado sociólogo y gerontólogo norteamericano que en el año de 1985, se dio a la tarea de recopilar un análisis sobre el envejecimiento poblacional a nivel mundial con todas sus repercusiones a nivel político, sanitario, social y económico. Para ello invito a los más reconocidos especialistas en el área de la vejez en el mundo y saco a la luz el libro DEVELOPMENTS AND RESEARCH ON AGING, an International Handbook. Entre los autores seleccionó para escribir el capítulo de México al Dr. Joaquín González Aragón quien en aquella época fungía como Presidente de la Sociedad Mexicana de Geriatría y Gerontología. El artículo original lo escribió en inglés. Su dominio de este idioma tanto para hablarlo como para escribirlo fue decisivo para que interactuara con todos los especialistas que hicieron los demás capítulos y para su labor durante 15 años como asesor en vejez en la ONU y OMS (1979-1995).
El libro de Palmore que refleja la problemática de la vejez en los países siguientes fue consultado por presidentes, monarcas, primeros ministros y autoridades involucradas en la atención y cuidado de las personas mayores y es considerado como un clásico de su época y sirvió para implantar nuevas estrategias para los adultos mayores. El artículo del Dr. Aragón fue considerado como uno de los análisis más asertivos y detallados de la problemática mexicana con soluciones que si se hubieran implementado no estaríamos tan atrasados en Gerontología. Se presenta el artículo en su versión original para conservar su valor histórico.
Contenidos
1. Argentina – Roberto Kaplan and Edgardo A. Guglielmucci
2. Australia – Richard B. Lefroy
3. Brazil – Luiz Roberto Ramos
4. Canada – Betty Havens and Neena L. Chappell
5. China – Lian Bo Hsia
6. Costa Rica – Fernando Morales-Martinez
7. Denmark – Henning Kirk
8. Egypt – Abdel Moniem Ashour
9. France – Anne Fontaine
10. Germany – Margaret Dieck and Hans Thomae
11. Hungary – Edil Beregi
12. India – P.V. Ramamurti and D. Jamuna
13. Ireland – Davis Coakley and Ciaran Donegan
14. Israel – Jenny Brodsky and Simon Bergman
15. Italy – Gaetano Crepaldi and Stefania Maggi
16. Japan – Daisaku Maeda
17. México – Joaquin Gonzalez Aragon
18. Norway – Eva Beverfelt
19. South Africa – S. P. Cilliers
20. Sweden – Torbjorn Svensson
21. Switzerland – Jean-Pierre Michel, Astrid Stuckelberger, and Bernard Grab
22. Taiwan – Ti-Kai Lee
23. United Kingdom – Anthony M. Warnes
24. United States – Erdman B. Palmore
25. USSR Nations – Vladislav V. Bezrukov and Nina N. Sachuk
Appendix: International Directory of Gerontological and Geriatric Associations Select Bibliography index List of Contributors
17
MÉXICO
Joaquín González Aragón
Aging in México takes place in the context of development and crisis. Among the nations of Latin America, México is considered one of the most rapidly developing countries; since the 1940s it has undergone an accelerated modernization process.
In spite of industrial growth, however, agriculture is the main economic activity: in 1980 the agricultural and livestock sector represented 26 percent of the working population; the industrial sector was about 20 percent; the services sector was 24 percent of the labor force; and the rest were unemployed. These figures are indicative of one of the main problems in the country—the deficit in the food production system. Twenty years ago, México exported sugar, corn, beans, and so forth, but now the government must make great expenditures to buy basic supplies from the United States, Canada, and other countries.
Contrary to some theorical assumptions, poverty, lower salaries, illiteracy, and unemployment did not prevent an intensified rise in prices and devaluation of the peso. The oil boom was not enough to counteract the world economic crisis, with its deteriorating terms of exchange, depletion of international reserves, and above all, the overwhelming burden of foreign debt. Stabilization plans are now managing to stem inflation, which had reduced both personal income and public expenditure. The social cost of the crisis has been extremely high, because the government has been forced to undertake a painful economic adjustment process that has reduced the standard of living of the Mexican people.
In the 1990s, the prospect of a free commerce pact among the United States, Canada, and Mexico is one of our hopes to regain economic progress and to improve the welfare of Mexicans, including that of our elders.
Table 17.1
Population in México, by Age-Group, 1950-2025
YEAR
TOTAL POPULATION
POPULATION UNDER 15
%
POPULATION 15-60
%
POPULATION OVER 60
%
1950
25,743,360
10,754,460
41.7
13,669,520
52.7
1,419,685
5.6
1960
34,809,570
15,412,100
44.3
17,417,730
49.9
1,939,745
5.7
1970
48,225,230
22,286,680
46.2
23,229,320
48.3
2,709,230
5.5
1980
67,199,874
31,718,338
47.2
31,651,140
47.1
3,830,390
5.7
1990
86,823,108
32,385,970
37.3
49,315,550
56.8
5,435,790
6.0
2000
112,441,355
34,069,640
30.3
69,825,860
62.2
6,846,460
6.2
2020
145,956,000
31,380,540
21.5
99,979,860
68.5
14,614,000
10.0
2025
154,085,000
28,492.400
18.4
107,859,500
70.0
17,912,000
12.6
Source: National Bureau of Census.
DEMOGRAPHIC TRENDS
México, with an area of almost 2 million square kilometers, has been a country with a predominantly rural population, which in recent decades has shifted to become a predominantly urban population.
In México the absolute number of people over 60 has increased rapidly, but the percentage has been almost constant. Table 17.1 shows the evolution of the Mexican population, from 1950 with a total population of 25 million, to 1990 with 86 million. This figure is expected to double again by the year 2025.
The population under 15 is declining from 41.7 percent in 1950 to 37 percent in 1990 and to 18.4% in 2025; while the 15 to 60 years group is increasing from 52.7 percent to 56 percent and then to 70 percent over the same period of time. In contrast, the oldest population group is growing from 5.6 percent in 1950 to 6 percent in 1990, with steady increases up to 12 percent in the year 2025.
Figure 17.1 shows the expected population pyramid for the year 2000.
By the end of 1991, the annual population growth rate will be 1.9 percent (20 years ago, it was 3.5 percent). This decline is due to the decrease of the birthrate. Mortality rates were reduced from 10.6 deaths per 1,000 inhabitants, to 5.6. This reduced mortality is reflected in the life expectancy at birth, which was 30 years in 1900; 60 years in 1970; and in the year 2000 is expected to be 69.7 years. In the year 2000, the population growth rate is expected to be only 1 percent.
The population will double in 30 years from 1980. The birthrate is expected to decrease, from 30.1 per 1,000 in 1980 to 18.5 in 2010; and the mortality rate is also expected to decrease from 6.2 per 1,000 in 1980, to 5.0 in 2010.
One important variable in the demographic transition is internal migration.
Figure 17.1
Population Pyramid for the Year 2000
Regional inequalities have generated massive migration from the less-developed to more-developed regions. Because migrants tend to leave older generations behind, there are a large number of people who are neither culturally nor technically prepared to live and work in an urban environment, and who will age without the family network that they would have developed in their place of birth. Moreover, the poorer regions will experience a marked increase in the proportion of elderly people, with few in the younger generation on whom to rely.
Another important problem is the environmental deterioration in México. Erosion and desertification have affected 45 percent of the total territory, and they continue to advance. The pollution of water and its waste and the lack of treatment of the black waters are damaging the natural ecosystems. Of particular importance is the pollution of the air in the urban areas, which in spite of the efforts of both public and private sectors will have a negative effect on all ages.
Education also plays a role in the nature of aging. Present older persons had little access to education in their youth. According to the 1990 census, 39 percent of the persons over 60 were illiterate (49% of women; 30% of men). This lack of education limited their work opportunities, social roles, standard of living,, and quality of work. New generations will have the chance to achieve better levels of education, and this will be an important factor in changing the altitudes of government and institutions toward the "third age."
The most remarkable feature of the population, however, is the level of poverty. In 1990, out of a total population of 86 million, 40 million people lived within the range of poverty and 17 million lived below the line of extreme poverty. This poverty has generated a government program called "solidarity," which is investing a great deal of the public expenditure to provide elementary services to the most vulnerable and traditionally abandoned classes. Older people have higher rates of poverty.
CULTURAL VALUES AND ATTITUDES TOWARD THE ELDERLY
In México more than 90 percent of the elderly live in families, where they can maintain their status and respect. A high percentage of people over 60 are still the head of the family, among both the poor and the rich. The mother plays a dominant role in the family organization.
The family revolves around a number of rules regarding behavior among family members, especially in economic, social, and ritual aspects. This behavior is founded on continuing exchanges and is reflected in the values and beliefs about solidarity among kinfolks.
In pre-Columbian México are found the roots and cultural values of Mexico's modern families. Various research studies about the personalities and sociocultural premises of Mexicans have confirmed that the individual is not as important as the family. Mexicans feel secure as members of a family where every one tends to help each other; family members are almost always willing to help other members with problems of any kind. This family cohesion is more important in Mexican culture than the size or structure of the family (Contreras de Lehr, 1988). Philosophy about life, altitudes and values, and ideas about the duties owed each other by husband and wife, parents and children, and brothers and sisters are a heritage from our forefathers. It is important to remember that in Spanish society also the family is close-knit, so that both the culture of Spain and of pre-Colombian México combined to form strong family bonds.
In the Mexican family, there is a clearly defined hierarchy of dominance and submission. Parents have authority over children, the husband over the wife, and older siblings over the younger. The traditional role of father and mother is of absolute dominance, to be obeyed and respected by all other family members. While the father is the instrumental head of the family unit and makes all decisions regarding the family's relations with society, the mother is the expressive head, who keeps order in relations among family members and who is dedicated to the emotional well-being of the home. She is the source of tenderness and sentiment, and of much of the cultural expressions of Mexicans.
The extended family (of three generations) is typical in México regardless of social class. Each extended family is made up of a couple, their children, and their grandchildren. After the death of the grandparents, each member of the next generation becomes, in turn, the head of another extended family.
In campesino, or peasant, groups there are extended patrilineal family units, in which each nuclear family occupies a room or lodging on a single piece of land. There may be many types of domestic units and arrangements, which can vary in the same community. Each family is also an economic, social, and ritual unit.
When these family groups migrate to the city, they have to reorganize their housing patterns and redefine their solidarity. Unmarried migrants will live alone among strangers, but if they have relatives, they will live with them. Various surveys have found that living arrangements may vary according to the economic circumstances of the community and the city. A survey carried out in 1978, showed that the majority (62 percent) of households were nuclear families, but 22 percent were extended families. The mean household size of nuclear families was 5.2, while extended and composite units were larger: 7.1 and 8.6. This study also found that extended households with more than one nuclear family occur more frequently as the age of the head increases (Díaz Guerrero, 1986). In urban areas the domestic group is a residential, biological, and consumer unit, but it is not usually a unit of production.
The usual composition of the extended family household includes grandparents, grandchildren, married son and wife, married brother and wife, unmarried brothers and sisters, and so on. The mean household size of the nuclear family is 5.4, in the extended family it is 6, and in the multiple family it is 7.9.
Moreover, according to the National Survey of Household Income and Spending of 1977, there was an average of four members per family with a head over 64 years of age. It is interesting to note that although 73 percent of the families with an elderly head are made up of one or two members, there is a considerable proportion (29 percent) of families with seven or more members in which an old man is still the head of the family.
In another survey, it was found that the majority of old people live with their families, both in urban areas (57%) and suburban areas (52%). The majority of aged men live with their wives and children, while the majority of elderly women live with their children, grandchildren, or other family members. The two surveys clearly show that the elderly are still integrated into the family structure (Alvárez Gutiérrez, 1983).
FORMAL AND INFORMAL SUPPORT NETWORKS
There are very few studies on the needs and roles of the elderly and more has to be done in order to implement programs and plans related to older persons. It has been already mentioned that budgetary restrictions and economic crises affect mainly the weakest and unprotected sectors of the population. The elderly are among the most vulnerable groups and this fact produces a negative image of old age: that old people are sick, a burden for the family, useless, nonproductive, and declining. The elderly themselves often accept these prejudices and feel inferior. This situation is less pronounced in rural areas where the elderly retain more responsibilities and higher status.
As for legislation for the elderly, the Mexican Constitution does not provide specific laws for the care and rights of the elderly, but is it recognized that there is a need for actions that benefit the elderly, especially those not covered by social security. In this matter, the participation of the elderly as a special interest group will play a decisive influence in the formulation and implementation of the laws. Some reforms are being reviewed by the Mexican congress on issues related to labor force participation, underemployment, self-employment voluntary retirement, support from relatives, state pensions, and so on.
Social assistance in México is provided by the Sistema Nacional para el Desarrollo Integral de la Familia or DIF, (National System for the Integral Development of the Family), a government agency created for the marginal groups: orphan children, the disabled, and unprotected elderly. This kind of service is provided in "asylums," a category of nursing home very common in Latin America. The new health law implements technical norms for regulation of health services and social assistance for the "third age." The agency also has developed a plan for rural and suburban areas on self-care and day-care facilities. All the states of the federation have their own social assistance programs, which are complemented by training programs.
Another main institution is the Instituto Nacional de la Senectud, or INSEN (National Institute for the Aged), a government-supported agency that aims to protect, support, orient, and care for the elderly. There exist four main programs: (1) Nursing homes and Day Care Centers, where medical and dental services are linked to social work, psychological, and behavioral care together with ocupational therapy and cultural activities; (2) Third Age Clubs with a variety of activities; (3) Cultural Centers for teaching new skills, arts, languages, music, and so forth; and (4) Training Programs in Gerontology for assistants, professionals, and the public in general. A membership card identifies more than 800,000 elderly and allows them discounts in shops, theaters, movies, transportation, and many order facilities. The institute has offices in most of the states of the Mexican federation and coordinates actions of volunteer groups, private assistance, and groups like Rotary and Lions' clubs. INSEN nevertheless recognizes that these programs are still far from being a sufficient response to the needs of this group.
The Instituto Mexicano del Seguro Social, IMSS, (Mexican Institute for Social Security) provides health care services within the framework of family medicine. Neither geriatric services nor geriatric hospitals have been considered a priority in this health care system, which covers 45 percent of the Mexican population. The cost is covered by the government, the employer, and the employee. Nevertheless, the social security system manages a program for pensioners that in recent years has had great advances, such as increases in the amount of pensions, retirement programs, training courses, preventive programs, social benefits, vacation programs, cultural, and recreational activities. These programs provide services to 200,000 elderly per year all over the country.
The social security system for state workers (ISSSTE), as well as other institutions like PEMEX (Mexican oil company) provide similar retirement and pension programs for another 7 percent of the population. These two govern-mental institutions are starting geriatric wards in their hospitals as well as geriatric speciality training programs. For the first time, they recognize the need to establish specific geriatric care to improve the quality of care and to keep the elderly integrated in their families.
The Ministry of Health pro vides health care for the remaining 53 percent of the population, mainly people of low resources in the rural areas. The aproach is designed as family care with priority for childhood and control of infectious diseases.
Geriatric care is not considered in general health care, in spite of the higher incidence of chronic diseases. Some specific clinics dedicated to elderly health care are the out-patient service and the in-patient geriatric ward of the General Hospital in México City, and the Geriatric Section of the Dr. Gustavo Baz Hospital in Tepexpan, State of México (with 120 beds for long-term care and out-patient services). Nevertheless, promising signs of increases in geriatrics programs are expected in this decade.
As for nongovernmental agencies, since the beginning of the century, private assistance has undertaken the major task of caring for the elderly poor. The government recognizes these institutions as nonprofit private agencies to perform social assistance. They are declared of "public interest" and are tax exempt. There is a law for institutions of private assistance that considers the Junta de Asistencia Privada (Council on Private Assistance) to be a decentralized organization under the jurisdiction of the Ministry of Health.
These nonprofit organizations provide important and effective services that complement the coverage that the state provides. At the end of 1988, there were 171 agencies operating 236 elderly care institutions.
The range of services includes nursing homes, dispensaries, out-patient and in-patient medical service, mental health care, physical and social rehabilitation, social work, day-care centers and so on. Nevertheless, the number of institutions is small relative to the tremendous need for this type of service in a developing country. There is an attempt to increase their number in the near future, depending on future economic improvement.
The public and private sectors have combined in the Solidaridad program, which views the elderly as a group that needs special attention from both sectors. A new concept has been developed that the elderly are a group with rights and duties that must be incorporated into national development.
Volunteer groups are another important informal support network linked to the private institutions. They are playing a very important role in disseminating gerontological information, creating awareness of the magnitude of the problem, fighting ageism, and changing altitudes toward more positive views of those in the third age. The groups provide considerable support to understanding aging and direct support to the existing programs, some of which are DIVE (old age dignification); VEMEA (old age in México research and action); VOGENE (northeastern gerontological volunteers); The Society of Spanish Beneficence of the Spanish Hospital; and FAVE (foundation for the elderly).
The academic-scientific organizations are also contributing to these advances in gerontology. The first was the Sociedad de Geriatría y Gerontología de México, founded in May 1977, when it was recognized that a new organization for gerontology was needed. A group of professionals made a commitment to update the country on the modern research and programs that developed nations have instituted to face the aging of their populations. This organization opened a new era in México and has become a model for the creation of other similar organizations that are working for the development of gerontology in biology, psychology, geriatric medicine, and sociology.
One example of the influence of scientific organizations was the launching of a Program for Self-care and Health Promotion among the elderly by the Sociedad de Geriatría at the Fourth National Congress of Gerontology in 1984. This program followed the guidelines of the World Health Organization. In 1986 and 1987 the National System for Integral Development of the Family (DIF) organized two workshops with experts from abroad to prepare local experts to disseminate this program in México. Let's Learn About Healthy Aging, the only self-care manual in Spanish, provided the background material (J. Gonzáles Aragón, 1985).
As a result, more man 30 self-care programs were implemented; but the most important fact was that the main institutions (IMSS, ISSSTE, etc.) became aware of the WHO guidelines and in 1989 started major programs in self-care and health promotion. These were directed to the entire population with the goal of "health for all in the year 2000." In one state, Jalisco, in 1990, there were organized 104 centers of extension of knowledge, 595 community committees, 5 brigades of social security, and 13 of preventive medicine, all linked to the formal network of 160 family medicine units and 4 welfare centers.
GROWTH AND DEVELOPMENT OF GERONTOLOGY
From the beginning of this century, the care of the elderly was in the preindustrial stage. The asylum was the only geriatric institution; it was churchsponsored as a shelter for the unprotected, even if they were considered as "deposits of waste" who received little sympathy from most old people and the rest of society. Now there is a tendency to restructure the whole concept to make the asylum one of the main available resources.
In 1950 new interest in gerontology was developed by Dr. Manuel Payno, who was one of the pioneers in the field in México and abroad. At that time great interest was created among professionals, and the culmination of this movement was the First Pan American Congress of Gerontology held in México City in 1956, with attendance by scientists from all over the world. After the congress, there was no other gerontological activity for 20 years. Dr. Payno's group never worked again, even though they continued to produce sporadic publications. While other Latin American countries developed important achievements in gerontology, México was deprived of any academic or educational activity.
In 1976 the government of the state of México held a geriatric meeting in the city of Toluca to gather all professionals interested in the field to discuss the future. One result of this meeting was the foundation in May 1977 of the Sociedad de Geriatría y Gerontología de México, which became a member of the International Association of Gerontology the following year. The programs of this society have encouraged the development of gerontology.
In the last 14 years, more than 7,000 student volunteers and professionals of several disciplines have been trained through the intensive educational activities of the society all over the country. Numerous internationally reknown gerontologists have lectured in symposia, workshops, and the seven national congresses. The most relevant activity that represented México to the world scientific community was the Fourteenth World Congress of Gerontology of the International Association of Gerontology (IAG), held in Acapulco, México, in June 1989. For the first time, a developing country became the center of gerontological attention, and the congress attracted 3,000 gerontologists who shared the same interest in the multidisciplinary aspects of gerontology. This congress was sponsored by the government of México, and many official institutions participated in the program.
As a result, a great impetus to public and private plans was achieved. After the Congress, Dr. Samuel Bravo Williams became President and Dr. Joaquín González Aragón became Secretary General of the International Association of Gerontology for the period 1989-1993.
The International Association of Gerontology (IAG) had been founded in Liége, Belgium, in 1950 as a multidisciplinary organization. Since then it has sponsored thirteen international meetings all in developed nations. The IAG has selected México to be the host of the Fourteenth World Congress because by the year 2000, 60 percent of the world's elders will live in lesser-developed nations.
This unprecedented growth of the aged population will reach every village of the planet. We will have to learn from one another how to preserve those ancient values that have supported our elders over the centuries in environments not complicated by modernization, industrialization, and migration. But we will also have to develop the technology, the social systems, clinical procedures, and public policies that will make aging for the "Old in a New World" less stressful and more satisfying for the millions of us who will be tomorrow's elders. Developed and less-developed nations will need to help each other.
The most relevant aspects of the 1989 congress in México was the recurrent theme of the need for developed nations to provide technical advice and financial support for plans and programs for the elderly in less-developed countries. Emphasis was on the need to increase services for the elderly. Although the majority of sessions were devoted to reports on advances in the scientific understanding of aging, the call for political action to solve the problems of the aged was loud and clear. The voices of science within the IAG were overshadowed by the interest in resolving common service problems through political action.
The Mexican Society continues intensive activity through workshops, courses, lectures, a Program of Geriatric Continuing Education, a monthly bulletin, the Mexican Journal of Gerontology (quarterly), the biennial National Congress and the annual National Convention of Nursing Homes and Institutions for Care of the Elderly.
The educational activities have provided the framework for some universities and institutes to develop specialization programs to meet the need for professionals in the field. The National Institute for the Aged (INSEN) was the first to implement a post-graduate degree in Geriatrics and Gerontology in 1982. Two types of geriatricians were trained, one focused on Internal Medicine and the other on general practice. The project lasted two years. Now they provide short courses in nursing, psychology, social work, preparation for retirement, and legal protection for the elderly.
The Instituto Politécnico Nacional (National Polytechnic Institute) awards a master's degree in geriatric sciences. It trained researchers and docents and developed national geriatric resources. This program has already produced four generations of new professionals.
The Universidad Nacional Autónoma de México (National Autonomous University of México) attempted to establish a post-graduate degee in geriatrics recently. Approval has been delayed, but it will start in the near future. Some other universities have included geriatrics at the pregraduate and post-graduate levels (Chihuahua, México, Guadalajara). Periodic courses, workshops, lectures, and seminars are held at the local and regional levels in different states of the republic. It is not possible to count accurately the number of scholars in gerontology, but the field of aging is increasing in México.
Since 1977, the Board of Public Education has implemented the career of geriatric technician as a health service provider trained for elderly care. The nursing schools of several universities have also started training programs in geriatrics. The López Mateos Hospital started geriatric speciality programs in 1986, along with creating geriatric wards. During their first two years, students are assigned to the internal medicine ward and in the last two years to geriatric medicine.
The General Hospital of México developed six-month speciality programs in 1985. The Program of Continuing Geriatric Education of the Sociedad de Geriatria provides a monthly course in different subjects of geriatric specialties. This program is aimed at general practitioners and physicians of different specialities. The Universidad Iberoamericana (Iberia-American University) implemented in 1990 a Diploma in Gerontology that prepares experts in socioeconomic problems, legal aspects, community services, housing, and social integration.
Training programs in aging are spreading all over the country with two main purposes: (1) to provide knowledge and skills in geriatrics and gerontology to all health professionals regardless of their specialty; and (2) to form new generations of young scholars in geriatrics and gerontology who will provide the future leaders and organizers for the care of the elderly.
Table 17.2
Labor Force Engaged in Agriculture
TOTAL
POPULATION
OVER 60
MEN
POPULATION WOMEN
1950
58%
95%
13%
1960
52%
72%
17%
1970
41%
80%
12%
1980
36%
85%
12%
LABOR FORCE, RETIREMENT, AND PENSIONS
According to the 1990 census, 46 percent of those over 60 were in the labor force (74% of males and 20% of females). In the rural areas, the economically active population is mainly masculine because the different activities of the peasant women in old age are not registered in the census. Elderly women in both urban and rural areas are extremely vulnerable and strictly dependent on the economic support of the family or friends, especially if they are widowed or single. Children represent the main security for most women, who are seldom in any pension program.
Table 17.2 shows the changes in the engagement of the labor force in agricultural activities, from 58 percent of the total population in 1950 to 36 percent in 1980. On the other hand, the involvement of the elderly did not have important variations. These figures are an eloquent demonstration of urbanization, industrialization, and better educational opportunities for the young, who will also have more opportunities for pensions. They also reflect the tremendous crisis in the food production system, which is becoming the responsibility of the elderly who are in a precarious economic situation and who lack any chance for pensions or for gerontological programs. Those over 60 years are increasingly concentrated in the informal sector (self-employed, nonprofessional workers).
For those 15 to 29 years old, the formal sector (employees, wage laborers, professionals) is four times as large as the informal sector, and for those 30 to 50, the formal sector is twice as large as the informal. The elderly are for the most part self-employed, and the number in the private sector or in government is dropping. This change is due to the particular conditions of the economy and chronic unemployment. The IMSS, ISSSTE, and PEMEX have instituted old-age retirement programs for those 65 years of age or those who have worked for a period of 25 years.
The old-age and pension programs are integrated with those of disability and death. Benefit levels granted by pension systems are not determined by the retirees' needs but rather are linked to working income levels.
In some cases, pensions are complemented by family allowances. Membership in the pension program is not mandatory for the self-employed or "independent" workers. Nevertheless, the amounts of pensions are not increased sufficiently to keep up with inflation, and pensioners lose purchasing power every year (Mesa Lago, 1989).
To clarify the meaning of retirement, it is useful to point out that the right to retire from work is one of humanity's achievements, which becomes possible thanks to technological progress and the allocation of part of the surplus in productivity towards freeing older persons from the need to work for a living. But what was meant as a privilege, has become a way of penalizing our elderly, because retirement pensions are generally equivalent only to a small fraction of salaries, while survivor annuities and widow's benefits are even less. Pensions in México limit opportunities for a new work, because if workers start a new job, the pension is reduced in proportion to the new salary. On the other hand, the federal work law expressly forbids underemployment—that is, hiring a person for fewer than eight hours or less than two days a week. Furthermore retired people are defined as economically dependent and thus considered to be a burden for society and to have lost their social identity.
A prospective survey of the pensions of the Mexican Institute for Social Security (IMSS) from 1944-2025 reflects the concept of retirement from the legal aspect. There is emphasis on the fact that the number of pensioners is growing so fast that soon pensioners will surpass the number of contributors, thereby jeopardizing the economic situation of the institute.
Table 17.3 shows the issues related to pension by disability, old age, forced retirement by age, and death. It summarizes the requirements, limitations, and amount of pension stipulated according to the social security law (Soto Pérez, 1989).
Table 17.4 presents the number of insured workers and pensioners of the IMSS from 1950 to 1990, with estimates until the year 2025. The insured to pensioners ratio has been constantly decreasing from 83 in 1950 to 7 in 1990. In 2015 and after, this ratio will be 3 to 1.
The contractual wage relationship has been the axis along which social security has been constructed, and this has limited its expansion. The cooperation of employers, employees, and government has generated the idea that such programs are self-financed and independent from other fiscal policies. A result is that only certain privileged sectors obtained benefits from the system. This system is not universal nor equitable and has resulted in institutions stratified by privileges.
Table 17.3
Social Security Pensión Policies
CONCEPT
Eligible Individuals
Requirements
Limitations
Amount of Pensión
Disability
Affiliated workers and employees
150 weeks
Lifelong
35% of average of the last 250 weeks of contributions plus premiums
Oíd Age
500 weeks and 65 years
Forced retirement by age
500 weeks and 60 years
Widowhood
wife or concubina of worker
150 weeks
Life long or until new marriage
90% of the pensión of household
Orphans
sons or daughters of workers
Until 16 or 25 1f a student
20 to 30% of pensión of parent
Voluntary Retirement
Pensioner
W11l1ngness
2 years
Widow
New marriage
3 years
Orphan
End of pensión
3 months
Funeral expenses
Pensioner
B111 of expenses
2 months
It is not surprising that state employees enjoy best services and coverage. They are starting to mobilize in formal organizations both of a general nature and of retirees only. The most important is the Movimiento Unificador de Pensionados or MUNJP, (Unification of Pensioners Movement), which unites a number of local and regional organizations, mainly of pensioners, through social security. Such organizations have a key role to play in proposing and in ensuring necessary reforms for the elderly.
The organizations are growing rapidly and exerting more influence every day. The elders' movement has at minimum a watchdog role: to ensure that the legislative mandates for their benefit are implemented, respected, and carried out. A prominent leader of pensioners is Eduardo Alonso Escarcega, a former social security employee who is actively engaged in a movement to provide pensions to all Mexicans.
In 1985 there were only 1,250,000 ex-workers receiving pensions, while around four million were not. Six national conventions of MUNJP have been organized since 1980 with important achievements in pensions and social protest. In 1989 for the first time in México, pensions to social security retirees became tied to the wage increases. The retirees are demanding, for example, that pension payments maintain their real value; that adequate health services must be created; that the retirees need to be treated by trained professionals and that their rights must be outlined.
Table 17.4
Historical and Projected Variability between Insured Workers and Pensioners
YEAR
INSURED WORKERS
PENSIONERS
WORKERS TO PENSIONERS RATIO
1950
373,644
4518
83
1955
582,570
21,073
28
1960
1 ,200,708
48,715
25
1965
2,209,915
105,042
21
1970
3,120,763
217,625
14
1975
4,305,532
326,912
13
1980
6,368,936
536,006
12
1985
8,132,189
840,715
10
1990
9,318,177
1 ,305,332
7
1995
11,612,143
1,902,492
6
2000
14,470,842
2,658,488
5
2005
16,773,696
3,571,949
5
2010
18,519,516
4,644,076
4
2015
20,447,041
5,878,371
3
2020
22,575,186
7,279,613
3
2025
24,924,829
8,838,134
3
Nevertheless, the elderly are not a homogeneous social group, but rather an age-category whose internal stratification reflects the social inequalities that characterize younger cohorts today. In fact, our elderly have some basic common needs and interests, but should not be considered as opposed to other age cohorts. They should be considered by the rest of society to be an age-group that all can reasonably expect to join.
NEED ASSESSMENT SURVEYS
In 1982, the Minister of Health and Welfare had received requests for funding in order to develop some rather elaborate and sophisticated programs for the elderly. It was difficult to know which, if any, of these programs were needed. It was decided to do a broad range needs-assessment survey.
In looking at the distribution of the elderly throughout the country's 31 states plus the capital, it was interesting to note that over 70 percent of the elderly were concentrated in 11 states plus the capital. Utilizing 10 criteria, four states were selected to be studied. Separate samples were designed from each of the four states' urban and semiurban areas. Rural areas were not studied because the government believed a survey might give rural people false expectations. The government realized the limitations of human, economic, and physical resources, and therefore wanted to keep the focus of the study on gathering descriptive data that could later be used to plan and implement appropriate programs.
Given that México is a developing nation and has marked contrast between the haves and have-nots, it was realized that the implementation of effective programs to improve the social, economic, and cultural well-being of the elderly must include all people, from children to the elderly themselves. In designing the questionnaire, a thorough study was done of existing needs-assessment surveys. It was realized, however, that none of the existing instruments could be used as is, because it is not possible to obtain reliable data from a culturally inappropriate survey tool. The design of an effective questionnaire that can produce reliable and desirable data is much more than a simple translation and requires several pretests. Every step of this study, from the selection and the four states, through sample size and design, the interviewing of 2,025 elderly (over 60) to the processing of the results and cross-checking was done with careful attention to satisfy the requirements for statistical validity. Every effort was also made to ensure that the research would be methodologically sound.
Although the survey was supported by a grant from the national council of science and technology, it was decided not to tell interviewees that the study was being conducted by the government department of health and welfare because it was thought that this might bias the results (Alvárez Gutiérrez, 1982).
Some selected results of the survey are discussed here:
1. Health: Twenty-five percent presented respiratory problems; 75 percent had cardiovascular problems; 46 percent lacked dental pieces; 50 percent had osteomuscular pain; 50 percent had visual deficits; 73 percent had auditory problems; 90 percent were independent in their home; and 85 percent could walk in the street. Fifty percent of accidents happened in the street, 45 percent at home, and 4 percent at work; 70 percent requested medical attention and social services; 50 percent said they had better health than others of their age.
2. Social satisfaction: Ninety-three percent were satisfied with their social status; 56 percent considered themselves up-to-date on social and political events; and 61 percent expressed a positive attitude toward the future.
3. Employment and income: Fifty-three percent of males and 12 percent of females have an activity that ensures adequate income; 20 percent of males and 7 percent of females were pensioners; 6 percent of males and 60 percent of females never worked. In urban areas, 15 percent were self-employed, and 13 percent were business employees. In suburban areas, 43 percent were in agriculture, and 74 percent of the working women were engaged in domestic activities.
4. Education: Thirty-five percent of males and 45 percent of females in urban areas, and 60 percent of males and 66 percent of females in suburban areas were illiterate. Elementary school was completed by 17 percent of males and 15 percent of females in urban areas, and by 7 percent of males and 5 percent of females in suburban areas. Superior studies, including university degrees, were completed by 9 percent of males and 2 percent of females in urban areas and 2 percent of males and 1 percent of females in suburban areas.
5. Family: Ninety-eight percent of males and 91 percent of females lived with their families. When questioned about use of free time, 44 percent expressed willingness to learn something; 50 percent would like to teach their skills to others; and 48 percent offered themselves as volunteers.
6. Miscellaneous results: The majority of men, even into their 80s, still work.
Slightly over half of urban elderly had drinking water within their homes as compared to only 40 percent of semi-urban elderly; 24 percent of urban elderly and 35 percent semi-urban elderly had no toilets or outhouses.
The majority of elderly consulted a private physician when needing medical attention rather than going to medical clinics provided to them by the state, free of charge or on a sliding-fee scale. The reasons varied from not trusting the clinic, feeling that medical staff had no interest in or preparation for how to work with geriatric patients, to long waiting periods in order to see a doctor.
Those who wished to be involved in recreational or educational activities said they would prefer to do so with other members of their own family or with people of all ages; therefore senior citizens' centers were not needed.
In terms of life satisfaction, it was surprising that over 94 percent in both areas reported that they were satisfied with their lives and had a positive outlook toward their future.
The negative stereotypes toward elderly found in some countries were absent in this study.
Over 60 percent of the elderly in both areas felt their families and society treated them the same or better than when they were younger.
7. Needs of the elderly: The study identified priority needs in the following order:
Medical attention including that of the doctor, nutritionist, optometrist, opthamologist, and dentist;
Recreational activity centers for all ages;
Community education about the aging process;
Volunteer programs for elders to serve others; and
Alternative housing.
The fact that subjective and objective data coincided, indicates that the elderly had an accurate self-assessment. One important implication of the findings is that health care professionals need to be trained to work with older people.
An epidemiological survey on centenarians was carried out in 1989 with the purpose of stimulating gerontological research. This survey was conducted by the Mexican Gerontological Society (Bravo Williams, 1990). The instrument was a questionnaire with five chapters and 46 issues selected by the interviewers as relevant. It was meant to be a multidisciplinary and multipurpose study with samples from the 30 states and the Federal District. Considering that the National Census Bureau reported for 1989 that there were 18,378 centenarians, a sample of 1,095 elderly over 90 were interviewed. A main problem was the uncertainty about their real age because many of them lacked birth certificates. From the total sample, only 142 were over 100 and fulfilled the requirements for evaluation. The average age of the centenarians was 105 years.
Some important findings of this survey include: 60 percent were between 100 and 104; 36 percent were between 104 and 109; and 4 percent were between 109 and 130 years. There was a ratio of 2 women to 1 man. This fact reinforces the theory that women are more resistant and have better chances for longevity. In level of education, it was found that 72 percent were illiterate, 25 percent studied up to three years of elementary school, 2 percent studied in secondary school, and 2 percent were graduates. These results reflect the limited educational opportunities at the beginning of the century.
Ninety-five percent of women were occupied in home activities, 25 percent of men in agriculture, and the rest did not have any work, except for minor manual activities. A remarkable fact is that 4 percent earned their living from their work.
Regarding housing, 48 percent live in rural settlements, 34 percent in suburban housing, and 28 percent in urban facilities; 98 percent lived with their families.
Another surprising finding was that 40 percent were self-sufficient for daily living activities and had a fairly good health status and social role. Fifty percent had various types of disabilities that produced a certain degree of dependence. Only 3.5 percent were completely disabled. This survey is continuing toward a longitudinal phase in order to collect further information on biological, psycho-logical, geriatric, and social aspects of centenarians.
Gerontological research is very important to a country because it can contribute to the planning and provision of services by finding key areas needing attention. Without such a study, limited resources could be wasted.
Once a reliable data base has been established, a wealth of futher information and cross-tabulations can be obtained and utilized by various interested groups. Thus far, the government has not implemented a public health program based on the results of these studies. However, the Mexican gerontological and geriatric society and several large national organizations have utilized information from the results as well as utilized the questionnaire in doing other studies.
CONCLUSIONS
The inadequacy of the present systems for dealing with the demographic reality of the coming decade is somewhat overwhelming and intimidating. When it comes to concrete actions that are equitable, economically feasible, and adequate to the overall framework of the country, the usual reaction is either defeatist or utopian. However the difficulty of visualizing a convincing scenario for reaching a solution to these problems may be due in part to our lack of information on the concrete needs and perspectives of elders. It is impossible to imagine an optimal connection between government resources and the needs of the elderly, unless those needs, as well as the capabilities of the elderly themselves, are known with some degree of precision. It is necessary to study the biological, behavioral, and social conditions within which individuals age, shape, and construct their own old age. We must also take into account the facts that most of us will be old and that we will become so in an adverse social environment. The manner in which we age, in México or in any other country, however, will depend partly on ourselves.
In the last fourteen years, a dialogue has been established between our scientific-academic organizations, the public in general, and the government, concerning the importance of systems of care for the aged population.
We are all agreed that these resources need further development. The National Institute of Aging and several other programs have begun in the past few years, but the most important achievements have been the change in official and private policies, the new generations of gerontologists whom we encouraged and trained, and the recognition of geriatrics as a medical speciality. This has been the result of long years of heavy work. We believe that the awareness of the needs of future generations of elderly and the need for more adequate policies will play an important role in the twenty-first century. New solutions will have to be proposed by generations more prepared in all aspects.
INFORMATION SOURCES
The National Gerontological Information Center of the Sociedad de Geriatría y Gerontología de México (Av. Prolongación División del Norte 4273, C.P. 14350, Col. Prado Coapa, México D.F.) has gathered and stored more than 2,000 international and national papers on aging; a data bank with 5,000 names and addresses of gerontologists; the Latin American Reference Index; and a library with more than 800 books, journals, and selected bibliographies in the field of aging.
The Sistema Nacional para el Desarrollo Integral de la Familia [DIF] (Emiliano Zapata No. 340, Colonia Portales, México D.F.) and the Instituto Nacional de la Senectud [INSEN] (Avenida Concepción Beístegui No. 13, Colonia del Valle C.P. 03100, México D.F.) have developed an information network on aging and stored and produced selected bibliographic materials. The abstraéis of conferences, symposia, and workshops for social attention of the elderly are rich in information collected from public and private sources.
REFERENCES
Alvárez Gutiérrez, Ramón. (1983). Survey assessment needs of the elderly. Mexican Journal of Public Health 11:2-21-75.
Bravo Williams, Samuel. (1990). Epidemiologic survey of centenarians in México. Seventh National Congress of Gerontology and Geriatrics, México City.
Contreras de Lehr, Esther. (1988). Aging in México. Kellog International Program on Health and Aging, México City.
Díaz Guerrero, R. (1986). Women and historie socio-cultural premises of Mexican family. Latin American Journal of Psychology 6:85-109.
González Aragón, Joaquín. (1985). Let's Learn AboutHealthy Aging. México City: Costa Amic.
González, Eleuterio. (1991). Diagnosis of Health in México. México City, Trillas.
Mesa Lago, C. (1989). The development of Social Security in Latin America. ECLAC, Santiago, Chile document 43:1-30.
Ruiz Pérez, Leobardo (Ed.). (1988). Achievements in the social care of the elderly. National System for the Development of the Family, México City.
Soto Pérez, Carlos. (1989). Pensions: 1944-2025. Social Questions. Journal of Social Security 15:89-95.
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