By Mary-Genevieve Moisan
Intern
AARP Policy, Research, and International
In January of 2023, I traveled to Oaxaca de Juárez, Mexico for two weeks. As part of my Masters in Global Public Health program, I had the opportunity to learn from public health and other healthcare professionals about the many factors that influence health in Oaxaca, and Mexico overall. From my time as an intern at AARP, I entered the experience with a focus on learning more about the city’s approach to aging, and what life in Oaxaca is like for older adults.
Located in southern Mexico, Oaxaca is known for having some of the country’s best food, gorgeous beaches, and a fascinating history. But, as I learned from spending two weeks in the state’s capital city, Oaxaca de Juárez, there are many more aspects of Oaxaca that make it not only a great place to visit, but to live and age.
At first glance, Oaxaca de Juárez may not seem like the epitome of an age-friendly city. High-reaching mountains surround the valley and can make travel out of the downtown area difficult, especially as public transportation is largely inaccessible for those in wheelchairs or with limited balance or standing capacity. The city is set on an incline, and some neighborhoods seem to be entirely made up of countless flights of stone steps. Downtown, there is an extensive network of walking streets and sidewalks, but cobblestone and uneven cement may cause even the most sure-footed pedestrian to stumble. That said, some churches and museums do have wheelchair ramps, and for those who choose to rent a vehicle, handicap parking spots abound around Oaxaca de Juárez. For older adults with full mobility or an adventurous spirit, Oaxaca may be a paradise.
The weather alone is a major draw. January in Oaxaca is the coldest time of year, with most days ranging from 75 to 80 degrees, sunny, and with a gentle breeze. While the temperatures do climb in the spring, they tend to peak between March and May at around 90 degrees, and humidity stays low. Rainy season runs from June-November, though average precipitation is typically under 30 inches a year, significantly less stormy than other popular tropical retirement locales.
The scenery makes it easy to justify getting out and about, and an active social calendar is something that characterizes life in Oaxaca. Community is central, and the friendly, patient nature of residents makes it easy to get involved, no matter one’s level of Spanish proficiency. There is always something to do in Oaxaca, from shopping in bustling markets to helping celebrate weddings with spontaneous street parades. There are also delightful cultural events year-round (think a radish-carving festival). Restaurants with a range of cuisines abound, and Oaxaca is known for its production of hundreds of types of Mezcal, a strong alcohol made from agave plants that are grown all over the state.
History and art lovers are also sure to be impressed, as Oaxaca boasts countless galleries, artist’s workshops (particularly for weaving and pottery), museums, churches, and other historic sites. For the nature lover, the botanical gardens in the capital city (Jardin Etnobotanico de Oaxaca) offer a fascinating look at some local flora. For active types, both public parks and hikes with dramatic views are in plentiful supply around the city.
Although older adults make up a relatively small portion of the population (as of 2020 individuals age 65+ make up about 10.2% of the population) taking a walk down the street is enough to see that people of all ages live and thrive in Oaxaca. The compact nature of Oaxaca’s neighborhoods allows most people to live within walking distance of family, friends, shops, a post office, library, hair salon, and more. Strong cultural values of family and community mean that older adults are respected and included in all aspects of society as important social figures. They are featured on bulletin boards and in advertisements and can be seen out and about at all hours of the day, selling in the markets, strolling with friends in the local parks, participating in group fitness classes, or walking arm-in-arm with grandchildren along the streets.
A final healthy feature of Oaxaca that adds to its age-friendly environment is the healthcare system. As one of Mexico’s 32 states, almost every resident of all 570 Oaxacan municipalities has access to some form of health insurance.
The Mexican healthcare insurance system has three main branches. Individuals who are part of the formal labor sector receive one of two types of coverage depending on if they are employed by the private sector or public sector. The coverage is funded through the Mexican government, the employer, and small employee contributions, and extends to retired individuals. A second insurance option is to pay out-of-pocket for private coverage, which gives one access to a different set of healthcare centers and providers. Finally, there is national health insurance, which covers everyone else. In Oaxaca, this includes the large percentage of the population that works in the informal sector, such as street vendors. Healthcare delivery for those with public insurance occurs at the local, state, and national level. For routine check-ups, vaccinations, and other primary level health needs, patients go to the local Centro De Salud (health center) in their community. For more intensive or specialist care needs, patients receive services to secondary or tertiary care hospitals. Many Mexican healthcare providers work for multiple systems at once, splitting their hours between a private and public setting.
Disparities in the quality of health care delivery between the three systems have been noted. Care is said to take longer for those with public health insurance, and many facilities are under-resourced. Lack of access to healthcare remains an issue, especially among rural populations. As one of the states with the greatest ethnic diversity in Mexico (Oaxaca is home to individuals from 16 different indigenous groups), a particular challenge is persistent health disparities faced by indigenous and Afro-indigenous individuals. Power imbalances, financial inequities, poor treatment in the healthcare system, and differing access to health resources remain a powerful legacy of Spanish conquest in the 16th century. However, recent years have seen growing pushback and calls-to-action for changes that would improve treatment of indigenous persons in healthcare and increase opportunities for health. One such recent movement has called for incorporating traditional health practices into medical care, which will hopefully inspire a shift towards greater respect of ancient healing practices.
An age-friendly community is characterized by opportunities for older residents to fully participate in life. Despite the cobblestones, Oaxaca de Juárez achieves just this. Older residents age in an incredible hub of language, history, art, and food, all under blue skies and a colorful cityscape. Residents of Oaxaca enjoy further opportunities for healthy aging through public health insurance systems, and a culture of community that values older adults. For travelers seeking an experience in Mexico outside the walls of a resort, or expats looking for a destination retirement, Oaxaca de Juárez is definitely worth a visit.