Youth and the elderly / by Alexandre Kalache

A common feature that surfaced in the articles received for this wel-come issue of World Health about Youth is the respect and affection for their elders shown by the contributors - young people representing different and widely separated cultures of the world . It is particu- larly noteworthy as they had not been specifically asked to write about this. It came spontaneously, an expression of their inner feel- ings, at a time when so much is said about the difficulties of " the generation gap,'' something which is based on little evidence and many preconceived ideas: that young people do not care; that the disruptions of family life imposed by modern ways of liv- ing have caused an irretrievable loss of old values; or that the elderly and young are both lack- ing in mutual channels of commu- nication. So it is refreshing to hear the young expressing their con- cern , particularly when this comes naturally and without being solicited . Paradoxically , while the population of young people in the world has dramat- ically increased both in absolute numbers and relative to the rest of the population, especially in developing countries, the numbers of people surviving to old age is also rising sharply. The aging of populations is the most enduring revolution of our time . To reach old age used to be a privilege of the few until as recently as the end of the last century, even in the wealthiest countries of the world. This has now become the ordinary experi- ence of an overwhelming ma- jority of populations in the entire industrialised world, and also in many countries in Latin America and Asia. African countries are still lagging behind, but even there a lowering of mortality rates is starting to be reflected in sub- stantial increases in life expectancy. Inevitably, they will follow the universal trend. In fact, since the 1980s most of the world's elderly have lived in developing countries, and by the · beginning of the 21st century they will make up three-quarters of the total elderly population. In the next few decades we will see a rapid increase in the proportion of old people in the world's popu- lation. As recently as 1975 there were only 3.8 per cent of people aged 65 and over in developing countries. By the year 2025 the Youth and the elderly by Alexandre Kalache Or Kalache is a Senior Research Fellow with the London School of Hygiene and Tropical Medicine and has been acting as a consultant for the WHO Global Programme on the Health of the Elderly. % OF YOUNG PEOPLE IN A POPULATION Pakistan 10 0 % 0 10 Brazil 10 10 England proportion will have doubled to 7.5 per cent, and a new doubling, to 15 per cent, is expected in the following 25 years . A combination of factors known as the demographic transition has brought about this trend , but basically lowered mortality fol - lowed by decreased ferti lity has inevitably resulted in an "aging" population. The demographic transition has now been completed in the industrialised world and , a t varied stages, is progressing in virtually all other countries . But there are significant differences here. Aging of the populations of countries such as France , Hungary or the United Kingdom took place when most people had achieved high living standards ; survival into old age reflected better nutrition, sanitation , hous- ing , healthier working environ- ments and so on. There was little impact of medical technology on their "aging". Mass immunization or other effective means of treating infectious diseases (the major premature killers) were not yet available ; nor were the powerful artificial means of birth control. By and large, most of these came only after the Second World War. So it was a relatively more gradual process than the one now taking place in the developing world. Those coun- tries were reasonably well off and equipped with material resources to meet the needs and demands of an increasingly large number of old people. Aging of populations in the Third World now has a different dimension. People may still live in absolute poverty, and even in appalling conditions in slums or the remote countryside. But even then they can survive. A gastro- enteritis which only a few decades ago would inevitably lead to death can now be success- . fully treated with antibiotics. And many diseases can be '' artifi- cially" prevented in spite of the environment where people live. Well then, what does this have to do with Youth and the Elderly? A great deal, I would say. We are going through a unique period, an unprecedented experience in the history of man- kind. For the next few decades - a very short period of time con- sidering that for thousands of years life expectancy was around 35 years - people will have on average longer lives. That means that, for this period, we will have WORLD HEALTH 3/89 large numbers of young cohabit- ing side by side with increasing numbers of elderly people. A tremendous opportunity; a live laboratory to foster new approaches , to discover new dimensions , to experiment with imaginative, creative schemes. We will all have to learn a lot in order to accommodate the emerging demographic revolu- tion; a revolution which will affect all of us in our lifetimes . There will be no place for nostalgia and no time for complacency. Were the "golden days" as enlightened as they seem now? The evidence emerg- ing from carefully conducted studies on historical demography shows that the comforts of a good old age only prevailed in the last century for the fortunate minority, rich enough to buy services .. and affection. The lot of most people was not one of privilege. Instead , they were constantly faced with neglect and destitution. Today we cannot afford simply to raise our arms and praise old values. Positive action is what is lacking. We need to look for good examples and for successful ini- tiatives . If life in extended families is no longer feasible, and if the real ity of modern living has imposed or is imposing limita- tions on that idealised social struc- ture , then that does not mean that all is bad or wrong. On a personal note, all I can say is that I was fortunate enough to have been brought up within the context of an extended family , surrounded by elderly relatives. There are often (but not always) love, time and care to be shared with us - the privileged children of successful immigrants from Southern Europe and the Middle East thriving in an emerging, promising country. But the Brazil of my childhood is no longer the Brazil of today or tomorrow. It is no longer a rural country with a traditional culture, but rather a country full of competing, contra- dicting priorities , of urgent prob- lems requiring solutions. It is a country that in the space of one generation has seen its urban population grow from 25 to lOO million people, increasing from one-third to three-quarters of its total population. Would it be reasonable to expect the same ways of living, the same family structure, the same pace of society? Most certainly not. Neither reasonable nor fair. The children of this generation are WORLD HEALTH 3/89 inevitably experiencing a differ- ent childhood from mine. Neither better nor worse but different. They are children of their time. And in every society, good values are there to be explored . It will require imagination and boldness to foster and forge a new enlightened world where old and young can positively share their experiences. And there is much reason for hope and opti- mism . The concerns fr eely expressed by young people writing in this issue are living proof of that. It will not be by longing for the past that we achieve such a world . We need hard data., fresh evidence, objec- tive measures. A lot can be achieved - if we are willing to do it now. • The new demograpluc profile of the world makes it imperative that good communications be established between the older and younger generations. Photo WHO/F. Dupuy