By Marcia Scazufca,
Scientific Researcher,
Instituto de Psiquiatria Universidade de São Paulo
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October 1, 2021, marked the 18th anniversary of the enactment of Brazil’s Statute of the Elderly, which provides specific rights for those over 60 years old. Development and enactment of the statute is a great achievement of Brazilian society. Its existence is particularly relevant for individuals who were born at a time when aging with dignity, respect, and social protection was a privilege of the few and was not considered to be an important part of the social agenda.
Particularly given that Brazil is home to over 30 million people age 60 and older,1 the 18th anniversary of the Statute of the Elderly should be a cause exclusively for pride, celebration, and discussion. However, that is not the current situation. NGOs, politicians, and the media commemorated the date while also warning about the setbacks facing Brazil’s social policies for supporting older adults. Senator Paulo Paim, who proposed the law that created the Statute of the Elderly, even noted, “We have to make [the Statute] a reality effectively. It needs to be fully implemented in every municipality in the country.“2 The pandemic has only exacerbated perennial challenges. As the pandemic continues to send lessons and messages that have long needed to be heard, it is time to ensure that the statute truly becomes a way of Brazilians’ everyday life.
System Strain: Hidden Cracks Revealed
Approximately 75 percent of older Brazilians are dependent on the Sistema Único de Saúde (SUS, the National Health Service).3 SUS was created by the 1988 Constitution to offer health services to all Brazilians free of charge. This system is also responsible for monitoring and improving the health of older adults. When the pandemic struck, its flaws became evident. The SUS could not effectively handle the crisis, nor could it monitor the pandemic on a national level. The public hospital system collapsed in several parts of the country4 because of hospital overcrowding, a lack of ICU beds, and a lack of available technicians, nurses, and doctors.5 Many previously scheduled in-person surgeries and other medical appointments were cancelled, hindering the treatment of older individuals with chronic health conditions.6 Furthermore, most of Brazil’s approximately 400,000 Community Health Workers7 did not feel adequately trained nor protected to continue working in a pandemic.8
Thus, rather than celebrate an anniversary in October 2021, the country did quite the opposite: that month it reached the milestone of 600,000 COVID-19 deaths.9 The spatial distribution of COVID-19 deaths was notably impacted by socioeconomic determinants of mortality and the lack of protections for Brazil's most vulnerable older adults. Since the onset of the pandemic, urban communities with lower household incomes, overcrowding, an inability to access work remotely, and limited access to quality health services saw a disproportionate number of deaths. In Manaus, the capital of Amazonas state, the COVID-19 mortality rate for people over 60 years old was approximately three times higher than in São Paulo, the country's wealthiest and most populous city.10 As the Thematic Group on Ageing and Public Health from Associação Brasiliera de Saúde Coletiva (ABRASCO, the Brazilian Association of Collective Health) noted, these deaths show how Brazil has never had policies that can effectively protect the wellbeing of older persons in practice.11
As deaths from COVID-19 increased among young people, public manifestations of discrimination against older adults became more frequent, despite being illegal. In March 2021, at the height of the COVID-19 crisis in Brazil (approximately 3,500 deaths per day), a popular deputy in the Parliament of the State of São Paulo tweeted, “I care about all lives! But the lives of those who have lived less concern me more. In fact, I think it is time to clearly establish rules to prioritize the use of available resources: beds, respirators, etc. It is not a decision we take lightly, but it is necessary.”12
During the pandemic, reports of physical, psychological and financial abuse of older adults have also increased. In 2019, there were about 48,500 reports of violence against older adults, which accounted for 30 percent of the complaints received by the helpline Disque 100 — a platform run by the federal government that receives reports of human rights abuses. In 2020, reports of aggression against older individuals almost doubled, and in 2021 those reports have continued to grow.13
All this comes despite the powerful contributions older individuals have made, and continue to make, to society. In Brazil, economic prejudice against older adults is not only ethically wrong, it is baseless and even in direct contrast to reality. The cohort of older Brazilians who transformed the country from a young, rural, agrarian economy to one of the biggest urban and most diversified economies in the world was born roughly midway through the last century, and it plays an important role in Brazilian society today. Around a quarter of older Brazilians are still working.14 Almost half of these individuals are also key family breadwinners who support and care for children and grandchildren.15
Older adults in Brazil deserve more respect and recognition than they have been given to date. It is their legal entitlement and their human right. The Statute of the Elderly provided hope that the nation could achieve great progress. The 20th Anniversary will arrive in 2023. To make that two-decade milestone truly meaningful, we can listen to what the pandemic told us in blaring volume. We can put the statute’s tenets into practice in everyday life.
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1 https://agenciadenoticias.ibge.gov.br/agencia-noticias/2012-agencia-de-noticias/noticias/20980-numero-de-idosos-cresce-18-em-5-anos-e-ultrapassa-30-milhoes-em-2017
2 https://pt.org.br/paim-estatuto-do-idoso-trouxe-luz-a-populacao-esquecida/
3 https://portal.fiocruz.br/noticia/estudo-aponta-que-75-dos-idosos-usam-apenas-o-sus
4 https://portal.fiocruz.br/sites/portal.fiocruz.br/files/documentos/boletim_extraordinario_2021-marco-03.pdf
5 https://www.nexojornal.com.br/expresso/2021/03/16/Como-a-precariedade-hospitalar-impulsiona-as-mortes-por-covid
6 https://www.gov.br/cnpq/pt-br/assuntos/noticias/destaque-em-cti/pesquisas-apoiadas-pelo-cnpq-estudam-a-saude-fisica-e-mental-dos-idosos-em-tempos-de-pandemia
7 https://www.camara.leg.br/noticias/766182-entidades-pedem-melhores-condicoes-de-trabalho-para-agentes-comunitarios-de-saude/
8 https://portal.fiocruz.br/sites/portal.fiocruz.br/files/documentos/os_agentes_comunitarios_de_saude_e_a_pandemia_da_covid-19_nas_favelas_do_brasil.pdf
9 https://covid.saude.gov.br/
10 https://www.scielo.br/j/csp/a/BSdNnmSRWRxf9hZsx7CWB5Q/
11 https://www.scielo.br/j/rbgg/a/pQvWz8j4JZx8B7PL984MHrQ/?lang=en#
12 https://twitter.com/janainadobrasil/status/1375883484271624192?lang=en
13 https://agenciabrasil.ebc.com.br/direitos-humanos/noticia/2021-06/aumentam-casos-de-violencia-contra-pessoas-idosas-no-brasil
14 https://www.icict.fiocruz.br/content/pesquisa-aponta-que-mais-da-metade-dos-idosos-sem-v%C3%ADnculo-empregat%C3%ADcio-perdeu-renda-durante
15 https://www.ipea.gov.br/portal/index.php?option=com_content&id=36188