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1、Report ofrica and the Caribbean foron Ageingtional Planelusion and rights oltecoersonsUnited NationsAgeing in Latin America and the CaribbeanFifth RegionalIntergovernmental Conference09eing and the Rightsof Older Personsin Latin America and the CaribbeanSantiago, 13-15 December2022ContentsAgeing in

2、Latin America and the Caribbean: inclusion and rights of older personsFigure 1.13 Latin America and the Caribbean (5 countries): distribution of the older population by age group, sex and place of residence33Latin America and the Caribbean (5 countries): femininity index of the older population, by

3、age group and area of residence, 2017-2020 35Figure 1.14 Latin America and the Caribbean (5 countries): distribution of the older population by age group, sex and place of residence36Latin America and the Caribbean (5 countries): older Indigenous population, by age group, sex and place of residence3

4、6Figure 1.15 Latin America and the Caribbean (50 countries and territories): life expectancy at birth, by subregion, 1950-206039Latin America and the Caribbean (50 countries and territories): life expectancy at birth, by sex and subregion, 1950-206039Figure 1.16 Latin America and the Caribbean (50 c

5、ountries and territories): total fertility rate, by subregion, 1950-206041Figure 111.1 Latin America (13 countries): persons aged 65 and over receiving contributory and non-contributory pensions, by sex, area of residence and income quintile, 2019 and 202062Figure 111.2 Latin America (13 countries):

6、 persons aged 65 and over receiving contributory and non-contributory pensions, by country, 202062The Caribbean (11 countries): average monthly value of national insurance system contributory pensions and national poverty and extreme poverty lines64Figure 111.3 Latin America (12 countries): monthly

7、per capita amounts of non-contributory pensions relative to the income deficit of the poor population, 201764Figure III.5 Latin America and the Caribbean (26 countries): number of emergency cash and in-kind transfers introduced in response to COVID-19 whose target population includes older persons,

8、March 2020 to October 202167Figure III.6 Latin America and the Caribbean (18 countries): employment rates, persons of both sexes aged 60 and over, by age group, 2000-202071Figure III.7 Latin America and the Caribbean (18 countries): employment rates, men aged 60 and over, by age group, 2000-202071Fi

9、gure III.8 Latin America and the Caribbean (18 countries): employment rates, women aged 60 and over, by age group, 2000-2020 72Figure III.9 Latin America and the Caribbean (14 countries): employment rates for men aged 60 and over and for men aged 65 and over with inadequate pensions, 2020 72Figure 1

10、11.10 Latin America and the Caribbean (14 countries): employment rates of women aged 60 and over and of women aged 65 and over with inadequate pensions, 202073Figure 111.11 Latin America (17 countries): illiteracy rate of the population aged 60 and over, by sex and geographical area, 2000-202076Figu

11、re 111.12 Latin America (16 countries): illiteracy rates in the population aged 60 and over, by sex, latest reference period77Figure 111.13 Latin America (10 countries): persons aged 55 and who have access to and use the Internet and computers, by age group, around 201880Figure 111.14 Latin America

12、(18 countries): main social networks used, by age group, 2020 81Figure 111.15 Latin America (18 countries):a main web and mobile applications used, by age group, 2020. 81Figure IV.1 Latin America and the Caribbean (35 countries and territories): deaths from non-communicable diseases among persons ag

13、ed 60 and over, by sex and age group, 2015 and 201991Figure IV.2 Latin America and the Caribbean (35 countries and territories): differences between women and men in the proportion of deaths due to non-communicable diseases, 2015 and 201992Figure IV.3 Latin America and the Caribbean (31 countries):

14、probability of a person aged 30 dying before the age of 70 from cardiovascular disease, cancer, diabetes mellitus or chronic respiratory disease, 2015 and 201993Chapter IVEconomic Commission for Latin America and the Caribbean (ECLAC)Box IV. 1Older persons, human mobility and healthAs a follow-up on

15、 the social determinants of health and the inequalities that affect the health conditions of older persons, the report A claim to dignity: ageing on the move. Regional assessment on the situation and needs of older persons on the move in the Americas (Bustamante and others, 2021) conducted a first r

16、egional assessment on the intersection between old age and human mobility, whose objective was to present an overview of the situation and needs of older persons on the move (whether in or outside their own countries) in Latin America and the Caribbean. The analysis, which involved 865 older persons

17、, caregivers and service providers, focused on five countries: Colombia, Ecuador, El Salvador, Honduras and Peru.The study shows that older persons on the move face a number of constraints on access to social rights and services that exacerbate the health inequalities they experience at their place

18、of arrival. It reveals a number of vulnerabilities specific to older persons on the move, most notably: difficulties in obtaining documentation; poor social protection and financial problems (more than half this older population on the move receives no income and others receive only an inadequate in

19、come); limited access to work, informality, substandard working conditions and labour exploitation; nutrition that is inadequate in quality and quantity, with one fifth of survey respondents being unable to eat three meals a day; and, in the cases of Colombia, Honduras and Peru, problems of overcrow

20、ding in the dwellings where they live.Among the most important data on health conditions, care and access to health services, the older population surveyed reported suffering from hypertension (42%), mental illness (34%), gastrointestinal conditions (21%), heart disease (16%), diabetes (15%), respir

21、atory diseases (14%) and cancer (4%). It was found that 42% of older persons had not received treatment for these conditions for a variety of reasons, including missed appointments, lack of documentation, lack of resources to pay for medicines, fear of going to health centres because of the risk of

22、infection during the coronavirus disease (COVID-19) pandemic, mobility issues and long distances to health centres.Around 30% of the older persons surveyed did not use health services when they needed them, even before the pandemic. This was due to a lack of financial resources to pay for consultati

23、ons, treatment and medicines (more than a fifth of those who used health services had had to pay). Furthermore, 27% of those interviewed reported having no access to any health services, a situation that worsened during the pandemic, and 98% reported having at least one illness or disability.Source:

24、 Economic Commission for Latin America and the Caribbean (ECLAC), on the basis of M. Bustamante and others, A claim to dignity: ageing on the move.Regional assessment on the situation and needs of older persons on the move in the Americas, Bogota, HelpAge International, 2021; and M. Bustamante, “Un

25、reclamo de dignidad: la vejez en situacion de movilidad humana,l Boletin Envejecimiento y Desarrollo, No. 19, Santiago, ECLAC, December 2021.Inequalities in older persons5 health accumulate over their lives because of exposure to risks and environmental and social barriers that result in differences

26、 in health conditions (PAHO, 2017a), in healthy life expectancy at birth and in healthy life expectancy at age 60 and beyond.Estimates from The Global Burden of Disease Study (IHME, 2022), which considers the epidemiological profile of older persons and the different non-communicable disease burdens

27、, show that healthy life expectancy at age 65 in the Americas (including Canada and the United States) increased by 1.4 years over the three decades from 1990 to 2019, from 12.2 years in 1990 to 13.6 years in 2019. By contrast, in the same population group, the percentage of years of life spent in p

28、oor health remained about the same, rising from 28.8% in 1990 to 29% in 2019. Life expectancy at age 65 in the Americas increased by 2.1 years to 19.2 years in 2019 (Martinez and others, 2021, p. 2).96Healthy life expectancy at birth in the countries of the region varies. While healthy life expectan

29、cy is above 60 years in most countries, the highest values are found in Peru and Colombia, with over 69 years, and the lowest in Haiti and Guyana, with 55.4 and 58.4 years, respectively. Healthy life expectancy decreases with age. In the 60 to 64 age group, the highest healthy life expectancy is fou

30、nd in Peru and Colombia (19.3 years) and the lowest in Guyana and Haiti. For the 70 to 74 and 80 to 85 age groups, the extremes are Colombia (15.9 and 7.7 years, respectively) and Haiti (10.4 and 4.6 years, respectively). At the oldest ages (95 and over), lastly, Colombias value is highest at 3 year

31、s of healthy life expectancy and Guatemalas is lowest at 1.3 years. Although higher life expectancy at birth might be expected to correlate closely with higher life expectancy at older ages, countries do not always rank in the same positions on the two indicators (see figure IV.6).Ageing in Latin Am

32、erica and the Caribbean: inclusion and rights of older personsChapter IVChapter IVFigure IV.6Latin America and the Caribbean (33 countries): healthy life expectancy at birth from age 60 onward, by age group, 2019(Years)aSaint Vince nt and theob agar bu daN St ev at is eof )25242322212019181716151413

33、1211W987654321 o H ealthylifeexpectanc yatbi-e hHealthy life expectancy at birth Ages 60-64 Ages 70-74 Ages 80-84 Ages 95 and overSource: Economic Commission for Latin America and the Caribbean (ECLAC), on the basis of Institute for Health Metrics and Evaluation (IHME), “Results，The Global Burden of

34、 Disease Study 2019, Global Burden of Disease Collaborative Network online https:/vizhub.healthdata.Org/gbd-results/https:/vizhub.healthdata.org/gbd-results/ accessed in October 2022.B. Challenges for health-care systemsThe historical weaknesses of the regions health-care systems became manifest dur

35、ing the COVID-19 pandemic, which exposed chronic underfunding, involving very low public spending on health and high levels of private, mainly out-of-pocket spending. These systems are fragmented and segmented, which creates coordination difficulties and efficiency problems and thence inequalities t

36、hat compromise universal access, quality and financing (ECLAC/ PAHO, 2020; ECLAC, 2022a)4Prior to the pandemic, health-care systems faced major challenges because of the need to adapt to demographic changes that are affecting the countries of the region to varying degrees and requiring them to recal

37、ibrate their responses to epidemiological changes manifested in the increase of non-communicable diseases (even while communicable diseases must continue to be tackled). In addition, constant technological advances in medicines, inputs and equipment require more and more human and financial resource

38、s.In many countries of the region, health-care systems had to face the pandemic without adequate equipment (ECLAC/PAHO, 2020), relying heavily on imports of medicines and vaccines and experiencing shortages of supplies such as oxygen, something that was especially critical in the Caribbean.A charact

39、eristic of health systems in the region is that they include three subsystems: uone with low standards for people of low socioeconomic status, a more responsive one for formal workers, who belong to the middle-income strata, and a third, usually private sector subsystem for those of higher socioecon

40、omic status (Cid and Marinho, 2022, p. 24).97In the Caribbean, moreover, the economic cost of reduced tourism and inadequate levels of social protection resulted in many individuals and households experiencing financial hardship, which also impacts health (Quashie and Jones, 2022).Chapter IVEconomic

41、 Commission for Latin America and the Caribbean (ECLAC)In a crisis situation, the rights-based approach to health (see box IV.2) is crucial to strengthening healthcare systems and ensuring that they are equipped to address the needs of the general population and an ageing population in particular.Bo

42、x IV.2The right to healthThe right to health has been fully recognized as a human right in international instruments such as the Universal Declaration of Human Rights (1948), article 25 of which states that “everyone has the right to a standard of living adequate for the health and well-being of him

43、self and of his family, including food, clothing, housing and medical care and necessary social services” (United Nations, 1948). Subsequently, the Declaration of Alma-Ata (1978), a fundamental document for the consolidation of health as a right, stated that “governments have a responsibility for th

44、e health of their people which can be fulfilled only by the provision of adequate health and social measures. A main social target of governments, international organizations and the whole world community in the coming decades should be the attainment by all peoples of the world by the year 2000 of

45、a level of health that will permit them to lead a socially and economically productive life” (WHO/UNICEF, 1978).The conceptualization of health as a human right underwent a major modification and expansion with the discussion and publication of general comment No. 14 (2000) of the Committee on Econo

46、mic, Social and Cultural Rights of the United Nations on article 12 of the ICESCR (2000), interpreting the right to health:.as an inclusive right extending not only to timely and appropriate health care but also to the underlying determinants of health, such as access to safe and potable water and a

47、dequate sanitation, an adequate supply of safe food, nutrition and housing, healthy occupational and environmental conditions, and access to health-related education and information, including on sexual and reproductive health. A further important aspect is the participation of the population in all

48、 health-related decision-making at the community, national and international levels (United Nations. 2000).It is on the basis of this definition that the right to health can be said to depend on the presence of other satisfiers that, in combination, determine health conditions. This is therefore a c

49、omplex right, closely linked to the fulfilment of other human rights, which must be regarded as true social determinants of health (Lopez Arellano, Lopez Moreno and Moreno Altamirano, 2015).General comment No. 14: the right to healthGoods Services1. Availability Programmes PersonnelInterrelated and essential elements2. Accessibility3. Acceptability4. QualityAll available resources must be usable without discrimi