Aging with dignity requires changes in the healthcare system – 02/26/2024 – Shireen Mahdi

We ourselves have or know people who have health problems that require constant care. These are things like hypertension, diabetes, high cholesterol, back pain, anxiety and depression, among many others. These are called chronic or non-communicable diseases. They represent almost 64% of years of life lost due to disability and around 74% of deaths globally. In Brazil, these proportions are even higher: around 71% and 76%, respectively.

Although these numbers are impressive in themselves, they hide an even greater challenge: the fact that many people – and, in the case of the elderly, the majority – have more than one chronic illness at the same time. This is what public health experts call multimorbidity. It is estimated that, worldwide, around two-thirds of people over 65 years of age have at least two concomitant chronic conditions.

In Brazil, data from the 2019 National Health Survey reveal that, among the elderly, 56.5% have multimorbidity. This challenge becomes even more urgent because the Brazilian population is aging very quickly. The number of elderly people increases by around 1 million people per year and it is estimated that, in 2050, almost a third of Brazilians will be 60 years old or over.

People with multimorbidity are more likely to face prolonged hospitalizations, the need for multiple medications, and an increased risk of postoperative complications. All of this leads to higher costs for the Unified Health System (SUS). Between 2000 and 2015, 53% of SUS spending was concentrated on 15% of patients who had two or more comorbidities.

The big problem is that, in general, health systems, public and private, are not structured to deal with people with multimorbidity. Health care is organized in a fragmented manner, considering each disease individually. Thus, the patient is referred to a professional to take care of their diabetes; another to treat hypertension; another for depression, etc.

The Ministry of Health, the National Council of Health Secretaries and the National Council of Municipal Health Secretaries are aware of these challenges and are developing interesting initiatives.

The Ministry of Health, for example, is reformulating the specialized care policy to integrate it with primary care, which ensures coherence between the different levels of care, minimizes the burden on the patient and the risk of them circulating between different services health care unnecessary. It has also been improving the elderly person’s booklet to incorporate the multidimensional perspective of the person, the family and their rights.

In addition to such efforts, the health system needs to look at the person as a whole and have quality primary care, organized to identify, treat and monitor these patients. The healthcare system must also be able to conduct an appropriate review of medication use to address rational drug use and drug interaction issues. It requires a well-structured referral system, capable of referring patients to services capable of adequately and comprehensively dealing with the most complex patients; and a management and information system equipped to capture the use of health services and the flow of patients in the system.

As noted in a recent World Bank event, Brazil would also benefit from exchanges with other Latin American countries, such as Chile, Colombia and Uruguay. International experience shows that aging and multimorbidity require a health system prepared to support the population throughout life. Building it requires cultural change and comprehensive policies, sooner rather than later.

_{This article was written in collaboration with my colleagues Roberto Iunes (Senior Health Economist at the World Bank) and Ana Maria Lara Salinas (Migration and Health Consultant)}

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