Portugal, the fifth most aged country in the world, faces the challenges associated with reducing the total number of residents and the fact that it has a triple aged age structure. The number of young people has been decreasing, the number of elderly people has been increasing, the number of adults leaving the labor market exceeds what they enter. One in five residents is over 65 years of age and the percentage of those over 75 is increasing.
Aging does not mean greater expenditure on health
We have never lived so long. The numbers worry and explain the negative connotation that persists in relation to the way we look at the consequences of the aging phenomenon, forgetting that it reflects undeniable achievements in terms of well-being and development. We also forget that it is possible to live longer and with more health, a factor that can reduce the weight of the sector in the budgets of the State and families, the latter being called upon to contribute more and more. In a recessive context of the active force, which today contributes the most to the system, it is discussed the increase that the changes observed in the age groups may have in health and social protection costs.
It is imperative that an aging society registers greater demand for support for long-term care, professional services and medicines, creating increased pressure on the system. The increase in health spending coincided with the increase in life expectancy and aging, but it remains to be seen whether there is a causal effect between the two vectors of the equation and, if any, of what expenditure, allocation of specific services and equipment programming. we talk. Investment today can represent savings tomorrow. Changing the educational profile of older people is unlikely to be decisive in the national management of health expenditure, although it can lead to a reduction in consumption and a more effective individual management of the health-disease binomial.
The relationship between demographic aging and health is not linear and much less consensual. The authors are divided on the economic impact of the phenomenon and the necessary adjustments in terms of support for the individual and families. The expenses involve direct and indirect costs and vary with the health status of the population considered, which explains the added value of prevention and training. Associated with new technological resources available to users, it will be able to create a more flexible and cheaper health system. Two ideas to keep in mind: the costs of aging in society can be offset by increasing the likelihood of aging healthy and in the future we will be older and with better habits and information; a large part of health expenditure occurs in the last two years of life (theory of red herring) so the expected increase in life will postpone health care costs, allowing time for research advances to reduce the average degree of dependency and make access to care simpler, cheaper and more effective.
What health do we have, want and can we have?
Understanding the global picture of the health sector implies separating financial and sustainability issues and problems in their delivery. We must talk about the health we have, in individual terms and in the care delivery system, but do not forget that needs will change. In a context where material and human resources are always scarce, it is necessary to understand today what are the priorities to be taken in terms of political decision-making and building a comprehensive and articulated system between the multiple players, but thinking about the future. It will be necessary to adjust the health system to guarantee the quality of services and the ease and equity of access, which makes it necessary to articulate today the joint involvement of financing entities, service providers and citizens.
Much will have to change. More than significant investments, the impact of aging requires the reallocation of funds and investment in specialized services and resources due to the change in the profile of morbidity. We want socially fair, appropriate, sustainable and regionally adjusted quality services, regardless of economic and political circumstances, tailored to individual needs and that guarantee a common platform for prevention, access and treatment, regardless of age, income, place of residence. A policy designed based on the real specificities of the population, the characteristics of the territory and the epidemiological profile, the effective legislative implementation, based on transparency and the assumption of responsibilities by institutions and professionals, will contribute to the economic and financial sustainability of the system and to guarantee all the desired health and quality of life standards.
While it is recognized that citizens are increasingly able to take an active role in their health, certain functions will necessarily have to be carried out by professionals. Health services are no longer able to respond with the desired effectiveness in terms of proximity, which overburdens centralized services and there is much to do in the sphere of continuous, palliative and rehabilitation care, which will be increasingly necessary and complex, involving work explained by the increase in the variety and complexity of pathologies. However, it is necessary to avoid the easy discourse that “everything is going wrong in the Kingdom of health” and remember what goes well, even if it can be improved. It is good to know that we continue to be a country where we live for many years. It remains to ensure that we do it with the best possible quality. To this end, it is necessary to create new dynamics of interconnection and train non-traditional actors. The health guarantee involves politicians, funders, service providers, families and also each one of us.
Health education: is it necessary to change attitudes and behaviors?
In the real world, in profound change and where the welfare state is weakened, the right to health continues to have to be defended. But it is necessary to combat the logic that it is up to the State to guarantee all health care. The right to health is not just the result of the proper functioning of the health system, defined and supported to a large extent by the State. It must be more ambitious and reflect the intrinsic capacity of society as a whole to come together around a common objective. It is about guaranteeing health and support in the disease to all, not only in the reactive logic of providing services, but creating conditions so that everyone can access the treatments necessary to be in good health and avoid risky behaviors and, therefore, the disease. We cannot underestimate or eliminate traditional forms of community solidarity and, above all, the role of the family, which, however, may in certain cases need support to play its role.
From the comprehensive approach to the Portuguese situation, three lines of strategic action are suggested. The first two involve reorganizing the health system (controlling the factors that generate excessive demand for health care or at prices that are too high) and changing consumption behaviors (ensuring that all care provided is effectively essential for the treatment requested) . The third, not least, is to educate for health, changing, namely, collective and individual risky behaviors. The notion that we are living in an era of change must be accompanied by the necessary information to ensure that we know what to change and how. Such an objective implies health education, and it is this investment that truly allows the transition from a logic of quantity of life to a logic of quality of life.
It is true that everyone will tend to be more qualified in terms of school education, with greater access and capacity to process information, with different habits and daily lifestyles (also a consequence of better information) and with levels of income that tend to be higher than the current ones. But none of these aspects can positively influence morbidity levels if there is no effort upstream to transmit better habits, behaviors and information.
In the near future the Portuguese will be different and better able to help their health, if an effort is made to educate in matters of individual and collective health. It is necessary to train economically productive, politically and socially participative and proactive citizens, which entails rights as well as duties, which can largely contain the answer to alleviate the so feared pressure on the national health system generated by the aging of the age pyramid.
Facing the challenges posed by aging implies identifying the particularities of individual aging and finding holistic supportive responses, which should be offered alongside the traditional provision of health care. But until you get there a lot will have to change and that change goes through each and every one of us.
Teresa Rodrigues signs this text as the author of the essay “Aging and Health Policies”, published by the Francisco Manuel dos Santos Foundation.