A doctor colleague once told me that if I wanted to get a taste of what he called “a short course in street geriatrics,” I should go “to an ATM on retirement payday with a notebook” and write down the conversations, take photos of faces, measure time with a stopwatch. “With that you have enough to give lectures for a week about the inadaptability of the environment to the needs of the elderly,” he told me. It seems like a joke, but it is something serious.
It is not my intention with this text to give recipes on what to do to approach (not “face”) the issue of aging and old age in Cuba. I’m just presenting some ideas.
The “typical” older person does not exist
People over 80 years of age can have mental capacities like those of someone aged 50. The physical and social environment in which each person lives determines, more than age, the opportunities, habits, and lifestyles, needs and expectations of human beings. In general, the family, the social environment, urbanization, technology, including the Internet, and major social events, such as the recent pandemic, influence older people’s needs and emotional and rational response to daily life.
Meeting these needs in Cuba becomes increasingly difficult, if we consider phenomena such as emigration, inflation and fatigue due to a prolonged crisis situation.
The failure or partial success of many proposals at the local or national level for the situation of Cuba’s aging population derives from the fact that decision-makers determine “what is best for older people,” without having heard their opinions. Not considering the heterogeneity of elderly people, nor their opinions, when drawing up public policies, reduces the effectiveness of interventions.
Designing policies on old age and aging requires first finding out what older people value, to take steps in the direction of those values. Too many times measures are implemented for older people without having asked them what they want for their lives, assuming that the proposal we define will be the best for them. This means, in other words, that as decision-makers we must move towards “doing with,” instead of “doing for.”
Although you cannot create as many policies, plans or interventions as there are different opinions, it is possible to develop enough flexibility for these programs to adapt to local conditions and needs.
Many older people carry out daily activities independently, although we know that the older they get, the greater the likelihood of disability. In Cuba, according to the 2017 National Population Aging Survey, concerning life as a couple, from 75 years of age, 43% of men have at least one limitation to maintaining a full life, and women reach almost 53%.1
On the other hand, and at the same time, in Cuba, older adults are politically active citizens: they constituted more than 40% of the voters in the municipal elections of People’s Power held in November 2022, which is also a sign of two concomitant phenomena: the gradual aging of the Cuban population and the massive emigration of young people. Truly representing the citizen interests of older adults should lead local governments to commit to meeting their needs in municipalities and neighborhoods, first, and then on a national scale.
In and out of some common places
I argued earlier that there is no such thing as a “typical older person.” The same goes for problems attributed to old age.
It is assumed, for example, that social life reduces with age. However, there are thousands of examples of older people who are more intellectually active when they retire because they are no longer tied to a working life. Of course, many are not like that. But defining policies towards healthy aging requires freeing oneself from ageism, which is usually extremely subtle, involuntary and unnoticed.
Ageism or age discrimination refers to the stereotypes resulting from how people think, the prejudices they feel, and the discrimination manifested in behavior towards people based on their age.
Ageism, often derived from ignorance, begins in childhood and is reinforced over time. Children quickly internalize the stereotypes and prejudices that their reference figures have towards their elders. This implemented attitude reduces the quality of life of the elderly, increases their social isolation and loneliness and can also intensify the risk of violence and abuse against them; it also contributes to the poverty and economic insecurity of people in old age and to the economic impoverishment of countries. Some studies measure the cost of ageism to a country in hundreds of millions of dollars.
As is known, in Latin America and the Caribbean, our country is the oldest. The year 2022 closed with 22.3% of its inhabitants at least 60 years old. For some time now, there are fewer children than older people: barely 1,000 for every 1,428 older people. And the total population of Cubans continues to decline slowly: from 11,113,215 in 2021 we went down to 11,089,511.2
The evidence shows that in many societies older people are a resource for their families, communities and economies when living environments are welcoming and facilitating. A 2019 report from the American Association of Retired Persons (AARP) states that those over 50 contributed $8.3 billion to the U.S. economy and created $745 billion in added value through unpaid activities, such as volunteering and family care.3
While low birth rates, emigration, and life extension reduce the percentage of the workforce of working age, the cost of education may fall, perhaps offsetting some of the growth in costs for retirement pensions. Japan has begun to close schools due to the decrease in children enrolled and is converting them into community social interest centers. Changes like these have already begun in Cuba and more are coming soon.
Getting out of the labyrinth?
According to the UN Decade of Healthy Aging (2020-2030), which Cuba subscribes to, the way of thinking, feeling and acting with respect to age and aging should change; communities should promote the capabilities of the elderly, and pay attention to patients with chronic diseases.
It is about developing and maintaining the functional capacity that makes well-being possible, defined as “being and doing what is important for each person, based on their physical and mental capabilities and their material, social and political environment in constant interaction.”
At a time when many countries are demanding national legislation and programs, in Cuba we have a legal body that covers the responsibility of children towards their parents: the Family Code. Implementing it and converting it into policies and decisions, adjusted to different types of families, remains a challenge, as families and culture change in response to incentives.
The municipal autonomy provided for in the new Constitution could allow some opportunities. Let’s say that the municipality asked an enterprising owner of a cafeteria or restaurant to fix the sidewalk three meters to the right and left of his entrance, put up night lighting all night in front of the establishment, and a couple of benches, following urban planning regulations, with the comfort requirements for older people. On the other hand, a certain tax exemption would be granted, in the same way as if this same entrepreneur contributed to feeding a dining room belonging to the municipality’s Family Care System.
Likewise, we should think about tax incentives for those who produce goods and services for the elderly, such as care services, for example. Involving the private sector more in these responsibilities will lead us towards a desirable social and solidarity economy.
Flexible responses to aging-related needs and preferences require concerted and sustained policies that promote social inclusion. Say, for example, placing public announcements with larger letters, or painting dividers in the middle of two-way avenues so that people can cross them in two steps.
A politically effective response could be the creation of an Association of Older People that gives voice to their different needs, and facilitates the formulation of laws, policies and regulations, in addition to serving as an interlocutor for the government, as occurs with farmers, artists and writers, some religious communities, the disabled, and other segments of the population that do not reach one-fifth of the total population.
The existence of this association gains more meaning when we understand that the lack of social and citizen empowerment is at the root of many disadvantages suffered by the elderly, ranging from long waiting lines in banks, grocery stores, clinics, digital exclusion, to the issue of “vulnerability” that has been talked about so much since the pandemic, and that became worse with the Special Period.
This vulnerable state is not only one of physical fragility but also of lack of motivation and social marginalization.
Indeed, the daily life of older people must be conceived as integrated into the community, and not apart from it, so that policies can ensure that older adults are builders of the socialist model that is projected. Whether the elderly live healthily or not will affect our health system, retirement schemes, the demand for long-term care and the lives of society as a whole.
Population aging presents great economic challenges but also offers opportunities to create a long-term sustainable model.
A current of economic thought called “happiness economics,” oriented to people’s subjective well-being, has as its premise that material wealth is not per se an absolute indicator of well-being. This current is based on the fact that factors such as health, education, the environment, equality, social relationships and participation in community activities are key to well-being. It also proposes designing public policies and business strategies that can improve life, through measures such as the promotion of mental health, the creation of satisfactory jobs and the development of friendlier and more sustainable urban environments.
Among the strategies to achieve this prominence of the elderly in the design of a future worthy of being called socialist, it is required, for example, to promote an active and healthy lifestyle throughout the course of life, which helps prevent and control disease and dependency towards the final years of existence, with the consequent increase in healthy life expectancy and decrease in health costs. Aging is not expensive, what is expensive is disability and dependency.
Older people can be a valuable source of experience and knowledge that can be used to benefit the community and the economy. Let’s say, for example, in the creation of mentoring and training programs for young people and adults in certain professional or trade sectors, and opportunities and work modalities for seniors who wish to continue working after retiring from formal employment.
Promoting entrepreneurship and economic participation among older people can help create employment and generate income, as well as develop innovative solutions to the problem of care, which incorporate the use of technology and care focused on the home rather than in institutions, which would reduce costs and improve the quality of care.
Promoting post-retirement rehiring is a way to complement the low levels of retiree pensions. It must be facilitated and promoted, instead of maintaining obstacles, as some organizations and institutions do, contrary to the spirit and letter of Decree Law 36, amending Law 105 of Social Security. Said legal body establishes, among other things, that subsidies and pensions can reach up to 90% of the worker’s average salary, as well as that pensioners returned to active work can accumulate salary and pensions.
Ultimately, the job changes brought about by technological innovations will contribute to increased production with fewer people, not to mention the accelerated impacts of artificial intelligence at work.
The investment we make today in aging and old age will establish how today’s young people will age. It is a challenge today, but it offers the space to create a more inclusive and supportive society in the future. Learning from the wisdom and experience of older people, as well as building our tradition of care and respect for the elderly, would make it possible not only to promote a culture of active and healthy aging but also a new meaning of life as a collective, affected by the prolonged social crisis that began with the Special Period.
Different ways of moving through life have already begun: the classic linear trajectory of learning, working, and retiring will not be the one of the visible future. There are already new patterns of paid work, free time for informal learning, leisure and recreation, intergenerational partnerships, opportunities for mentoring and engagement, and so much more.
Achieving this is not limited to formulating an “Aging Task.” Just as it happens with emigration, the low birth rate, the participation of young people, and other issues, it is about stopping seeing the issue as a problem, to conceive it as an opportunity towards a horizon of a truly inclusive and diverse society for all, and policies that guarantee it.
1 ONEI-CEPDE. National Population Aging Survey 2017 (ENEP2017). Havana: National Office of Statistics and Information; 2019. [accessed 05/23/2020]. Available at: http://www.onei.gob.cu/sites/default/files/0.enep-2017_documento_completo.pdf
2 ONEI-CEPDE: Indicadores demográficos de Cuba y sus territorios. 2022 [accessed 06/18/2023] Available at: http://www.onei.gob.cu/node/13815
3 AARP 2019: Investing in the purchasing power of older adults. [accessed 07/21/2023]. Available here.