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Ageing, Development and Social Service Delivery Systems in Latin America: Problems and Perspectives†

Published online by Cambridge University Press:  14 November 2008

Jorge I. Tapia-Videla  and
Charles J. Parrish
Jorge I. Tapia-Videla
Affiliation:
Professor, Department of Political Science, Research Scientist, Institute of Gerontology, Wayne State University, Detroit, MI, 48202, USA.
Charles J. Parrish
Affiliation:
Professor, Department of Political Science, Director, Institute of Gerontology, Wayne State University.
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Abstract

Economic development in Latin America has facilitated the broadening and improvement of governmental services in public health, social security and public administration. These improvements, particularly in public health, have precipitated changes in rates of morbidity and mortality. Many countries have also experienced a fall in birth rates during this period. The result of people living longer and having fewer children is a progressive ageing of Latin American societies. This article explores some critical questions posed by the ageing of populations in these societies. Within the context of varying patterns of national development, special emphasis is placed on the systemic potential for politico-administrative response in the area of social and health services.

Type
Research Article
Information
Ageing & Society , Volume 2 , Issue 1 , March 1982 , pp. 31 - 55
Copyright
Copyright © Cambridge University Press 1982

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References

NOTES

1 Hauser, Phillip M., ‘Introduction and overview’ in Hauser, P. M. (ed.), World Population and Development: Challenges and Prospects, Syracuse University Press, 1979, p. 1.Google Scholar

2 Except for a short section on the impact of the elderly on Japan's economic development, the articles included in the book have in general ignored the ageing of populations as a political problem in developmental terms. See, Ukita, Saburo, ‘Population and Development: The Japanese Experience’Google Scholar in Hauser, P. M. (ed.), op. cit., pp. 296–338, esp. 316–18.Google Scholar

3 Parrish, C. J. and Tapia-Videla, J. I., ‘Needs of the Costa Rican Elderly: A Preliminary Report’, Institute of Gerontology at Wayne State University, 08 1980, mimeo.Google Scholar

4 For a preliminary discussion of these issues, see the papers presented by Parrish, C. J., ‘Los ancianos que viven entre nosotros’ and by Tapia-Videla, J. I., ‘Los Ancianos, los servicios y el seguro social’ at the International Symposium on La Poblacion en la Tercera Edad, organized by CCSS/OISS/IDESPO, San José, Costa Rica, 1978.Google Scholar

5 See, among others, Kahn, Alfred J. and Kamerman, Sheila B., Social Services in International Perspective: The Emergence of the Sixth System, New Brunswick, N.J., Transaction Books, 1980Google Scholar. and Tobin, Sheldon S., Davidson, Stephen M. and Sack, Ann, Effective Social Services for Older Americans, Ann Arbor/Detroit, Institute of Gerontology, The University of Michigan/Wayne State University, 1976.Google Scholar

6 op. cit., pp. 1–19.

7 The notion of convergence runs through the specialized literature dealing with the larger question of modernization, development, population growth and changes, and the role played by social service systems. See, among others, Hauser, P. M., op. cit., passimGoogle Scholar; Teicher, Morton I., Thursz, Daniel and Vigilante, Joseph L. (eds), Reaching the Aged: Social Services in Forty-Four Countries, Beverly Hills, Cal.: Sage Publications, 1979Google Scholar, and Heclo, H., Modern Social Policies in Britain and Sweden: From Relief to Income Maintenance, New Haven and London, Yale University Press, 1974.Google Scholar

8 See, for example, Mesa-Lago, Carmelo, Social Security in Latin America: Pressure Groups, Stratification, and Inequality, Pittsburgh, Pa., University of Pittsburgh Press. 1978.Google Scholar

9 See, among others, Hauser, Phillip M., ‘Aging and World-wide Population Change’ in Binstock, Robert H. and Shanas, Ethel (eds), Handbook of Aging and the Social Sciences, New York, Van Nostrand-Reinhold Company, 1976, pp. 58–86.Google Scholar

10 It must be noted that these projections have been estimated on the basis of conservative assumptions. In the first place, it is assumed that between 1970 and the year 2000 the world will not experience any dramatic changes in either medical or health technology, or that no significant changes will alter the levels of socio-economic development. Any significant change in those areas will certainly have a dramatic impact on both the quality of life and life expectancy of older adults. See, Dirección General de Estadísticas y Censos, Evaluación del Censo de 1973 y proyección de la población par sexo y grupo de edades: 1950–2000, San José, Costa Rica, 1976.Google Scholar

11 See, among others, Goldman, Ralph and Rockstein, Morris (eds), The Physiology and Pathology of Human Aging, New York: Academic Press, Inc., 1975Google Scholar; Institute of Medicine, The Elderly and Functional Dependency, Washington, D.C.: National Academy of Sciences, 1977Google Scholar, and Kart, Cary S. and Metress, E. S., Aging and Health: Biologic and Social Perspectives, Menlo Park, Ca., Addison Wesley Publishing Co., 1978.Google Scholar

12 United Nations Demographic Yearbook, 1977.

13 The Costa Rican social security system, one of the most progressive in the hemisphere, has been experiencing major financial and economic problems in its attempts to meet its legal mandate: to cover the total population of the country under a growing panoply of rights and entitlements. See, among others, Rosenberg, Mark B., ‘Social Security Policy Making in Costa Rica: A Research Report’ in Latin American Research Review, XIV, 1, 1979), pp. 116–33.Google Scholar

14 The trends observable in countries like Costa Rica and Venezuela, for example, have followed what can be described as a universal pattern of development. There is reason to believe that this pattern will affect the region in a similar fashion.

15 Studies on the general question of poverty in Latin America have become increasingly popular. See, among others, OFIPLAN, La dimensión de la pobreza: Estudios de la pobreza rural en Costa Rica, San José, C.R., OFIPLAN, 1981Google Scholar; Cortazar, R., Necesidades Basicas y Extrema Pobreza, Santiago: CIEPLAN, 1977Google Scholar, ILPES, La pobreza critica en America Latina: Ensayos sobre diagnosticos, explicación y políticas, Santiago: ILPES, 1976, 3 vols.Google Scholar, and Kaminsky, M., ‘La pobreza en America Latina: Análisis cuantitativo, comparativo multivariante con indicadores sinteticos alternatives: Brasil, Chile, Costa Rica, Mexico’, Buenos Aires: CIDES/CIENES, 1979, Preliminary report.Google Scholar

16 Acuña, Olda M. and Denton, C., La Familia en Costa Rica, San José, C.R., Imprenta Nacional, 1979.Google Scholar

17 The results of this particular research project have been reported in both Spanish and English. See, IDESPO, Problemes y necesidades que enfrenta la población costarricense mayor de 60 anos, San José, C.R., IDESPO, 1980Google Scholar, and Parrish, Charles J. and Tapia-Videla, Jorge I., ‘Needs of the Costa Rican Elderly: A Preliminary Report’, op. cit.Google Scholar

18 See, among others, Golant, Stephen M. and McCaslin, Rosemary, ‘A Functional Classification of Services for Older People’, Journal of Gerontological Social Work, 13, 3, 1979, pp. 187–209CrossRefGoogle Scholar; Tobin, S. S., Davidson, S. M. and Sack, A., op. cit.Google Scholar, and Teicher, M. I., Thurz, D. and Vigilante, J. L., op. cit.Google Scholar

19 Golant, S. M. and McCaslin, R., op. cit., p. 188.Google Scholar

20 See, for example, ibid.

21 Tobin, S. S. and Lieberman, M. A., Last Home for the Aged: Critical Implications of Institutionalization, San Francisco, CA, Joseph Zass, 1976, p. 226Google Scholar; and Golant, S. M. and McCaslin, R., op. cit., pp. 200–1.Google Scholar

22 United Nations, Reunión Técnica sobre la Tercera Edad: América Latina, San José, Costa Rica, 2–5 12 1980Google Scholar. (Mimeo) Preliminary report.

23 For specialists like Kahn, R. L. and Kamerman, S. B., an effective system of personal social services requires that there be a base system that addresses the income, health care and housing needs of the elderly. See, Not for the Poor Alone: European Social Services, Philadelphia, Temple University Press, 1975. Along the same lines, see their Social Services in International Perspective, op. cit.

24 ‘For the Elderly: An Overview of Services in Industrially Developed and Developing Countries’ in Tiecher, M. I., Reaching the Aged, op. cit., pp. 149–72.Google Scholar

25 Activities supporting the planning of the United Nations Year of the Elderly (1982) have been an important factor bringing the elderly into the forum.

26 United Nations Demographic Yearbook, 1975.

27 The institution of the asilos or hogar de ancianos is rooted in the colonial past. It clearly shows its origins as an expression of private/public charity. In many countries of the area, the asilos are the only alternatives open to the impaired elderly who lack family or community supports. Non-professional, voluntary personnel are usually responsible for functions and services. No systematic study has been done about the the institution of the asilo or about the institutionalized elderly.

28 Ageism seems to be a universal phenomenon. As such it has been extensively commented on and criticized in the literature on social gerontology. See, for example, Hendricks, Jon and Hendricks, C. D., Aging in Mass Society: Myths and Realities, Cambridge, Ma., Winthrop Publishers, Inc., 1977, pp. 14–16.Google Scholar

29 See, for example, Rosenberg, Mark B., ‘Social Security Policy making in Costa Rica…’, op. cit.Google Scholar; Mesa-Lago, Carmelo, Social security in Latin America, op. cit.Google Scholar, and Parrish, Charles J. and Tapia-Videla, J. I., ‘Welfare Policy and Administration in Chile’, Journal of Comparative Administration, 1, 4, 1970, pp. 455–76.CrossRefGoogle Scholar

30 The implicit assumption in many works dealing with the larger problem of poverty in Latin America stresses the importance of solving global questions. Eventually, through the workings of a spillover effect, the problems of the elderly would be solved - or at least taken care of Finally it must be noted that only exceptionally are the elderly recognized for what they are, namely, the fastest growing group of poor people in the area.

31 With the exception of Costa Rica, there are few countries in the region in which one can find a widely shared concern about the need to promote research and training activities in the area of geriatrics and gerontology. See, for examples, the activities of IDESPO at the National University of Costa Rica, the workings of the Costa Rican Commission for Aging, and the recently established National System for the Assistance to the Family (SINAF).

32 For a general discussion of the problem in the context of human health resources in Latin America, see, Navarro, Vicente, ‘The Underdevelopment of Health or the Health of Underdevelopment: An Analysis of the Distribution of Human Health Resources in Latin America’, International Journal of Health Services, 4, 1, 1974, pp. 5–27.CrossRefGoogle ScholarPubMed

33 For more detailed descriptions of these functions see, Tapia-Videla, J. I., ‘Understanding organizations and Environments: A Comparative Perspective’, Public Administration Review, 36, 6, 1976, pp. 631–6.CrossRefGoogle Scholar

34 This problem has been described and discussed extensively in the literature dealing with economic planning and development administration. See, for example, United Nations, Development Administration: Current Approaches and Trends in Public Administration for National Development, New York, 1976.Google Scholar

35 Tapia-Videla, J. I. and Parrish, C. J., Clases sociales y la politica de seguridad social en Chile, Santiago, Insora, 1970.Google Scholar

36 For general information on social security systems in the area, see, among others, U.S. Department of Health and Human Services. Social Security Programs Throughout the World, 1979, Washington, D.C., Social Security Administration, 1980Google Scholar, Research Report N.54, and the work by Mesa-Lago, Carmelo, Social Security in Latin America, op. cit.Google Scholar

37 A notable example being the Costa Rican case. In 1961, a constitutional amendment mandated the universalization of coverage within a period of ten years. Universalization of social insurance programs (health and pension) has proceeded at a rapid pace for the last two years. There are increasing fears that the system will not be able to cope with the increasing costs of social insurance programs as the State faces growing financial and economic constraints. See, for example, Rosenberg, M. B., ‘Social Security Policy Making in Costa Rica…’, op. cit.Google Scholar

38 Fisher, Paul, ‘Social Security and Development Planning: Some Issues’ in Kassalow, E. M. (ed.), The Role of Social Security in Economic Development, Washington D.C., U.S. Government Printing Office, 1968, p. 246.Google Scholar

39 See, for example, the excellent discussion offered by Zchock, Dieter K., ‘Health Care Financing in Central America and the Andean Region: A Workshop Report’, Latin American Research Review, 15, 3, 1980, p. 150.Google Scholar

40 Zchock, D. K., op. cit., p. 151Google Scholar. Bolivia, in this sense presents a dramatic example of health care problems and deficiencies. See, op. cit. pp. 159–60.

41 Tapia-Videla, J. I. and Quiros-Varela, Luis, El subsistema politico de la seguridad social en Chile. Serie de Documentos de Trabajo, Instituto de Ciencias Políticas U.C., Santiago, Universidad Catolica de Chile, 1974.Google Scholar

42 What follows is based on materials previously cited and/or on experience of the authors in their field work on aging in Latin America. Special credit is given to the work by Montgomery, J. D. on the administrative consequences of rapid population growth. Figure 3 is adapted from ‘Planning to Cope: Administrative consequences of Rapid Population Growth’ in Ilchman, Warren F., Laswell, Harold D., Montgomery, John D. and Weiner, Myron (eds), Policy Sciences and Population, Lexington, Mass., Lexington Books, 1975, p. 112.Google Scholar