Alexandre Kalache - “We Can No Longer Afford Receiving All the Care and Not Providing Any”

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Nov 04, 2015
by Heather Jaber
Alexandre Kalache - “We Can No Longer Afford Receiving All the Care and Not Providing Any”

Alexandre Kalache, co-chair of the Salzburg Global session Aging Societies: Advancing Innovation and Equity and president of the International Longevity Centre (ILC) in Brazil, discussed rapid demographic shifts in Brazil and bottom-up approaches to aging societies

“I was brought up in a maternity that today is a geriatric hospital,” says Alexandre Kalache, touching on the rapid demographic shift of Brazil in the past few decades. “I have a great chance of ending up where I first started — this is how fast the whole thing is.”

Kalache, co-chair of the Salzburg Global session Aging Societies: Advancing Innovation and Equity and president of the International Longevity Centre (ILC) in Brazil, was born in a country which faces a rapidly aging society. “Brazil is going to double the proportion of older people in 20 years,” he said. “This is stunning. We do not have models — we cannot look and say, ‘Let us copy how Denmark or Japan or France has done.’”

The country’s rapid rate of aging and relative level of poverty mean that creative solutions are required to deal with demographic shifts. “It’s over-simplified to say you provide good health and social services. It’s much more than that,” says Kalache, who was director of the Department Aging and Life Course in the World Health Organisation from 1994 to 2008.

“The main obstacle is discrimination, the stereotypes,” he says. “The belief that older people don't have anything to add or to contribute…is deep-rooted. But before recently, it wouldn't be very apparent because the proportion of older people in any society was very small.”

Kalache touched on studies he conducted with medical students in the UK to try and measure attitudes towards aging before and after they began working in geriatrics for one month. The results showed that exposing medical students to geriatric patients was counterproductive. 

“In focus groups, they would always say the same. ‘Are you surprised? We are young. We came to medicine because we are interested in life, not death.’” Their lack of familiarity with their own older relatives also contributed to their difficulty in understanding the geriatric patients.

The answer, says Kalache, is not to put medical students in contact with older geriatric patients, but instead with older people. Rather than viewing older people as patients, they would then build relationships with the individuals and thus have greater familiarity with their needs. Kalache reflects that his own experience growing up taking care of his grandmother who suffered from cancer has helped shape his view of aging.

One of the potential solutions to dealing with aging societies in impoverished areas following this logic of familiarity. In the favelas in Brazil, the approach suggests targeting community members who are familiar in a given community to act as informal care-takers and liaise with primary health care in the area. These care-givers, primarily women who would have previously expected to find work as nannies, would connect with a handful of older people and would be trained by primary health centers. The care-recipients’ families could pool their resources together to compensate for their time. In this way, there is potential to provide economic relief in the way of job opportunities, affordable care for impoverished communities, and a system of trust and familiarity. 

This type of approach may be more impactful than top-down policy, says Kalache. “It was not something somebody cooked up with introspection and meditation. It was something we found out by asking older people, ‘What is it like getting older in our community?’”

In focus groups done in Copacabana, Rio de Janeiro, Kalache explains, older people commonly expressed feeling closer to their doormen than their own families, at least in terms of day-to-day contact. Thus, care-giving by familiar community members may bring about more of a lasting impact.

“I remember an older woman saying: ‘Every evening I go to bed I pray for my porter not to die before me,’” says Kalache of one focus group participant. “'Because he is getting older and if he dies before me, I’m lost.’” 

Thus, adds Kalache, it is not enough to say that you offer good medical care — a holistic approach to aging encompasses much more than this. “We can no longer afford receiving all the care and not providing any.”


Alexandre Kalache was co-chair at Aging Societies: Advancing Innovation and Equity, which is part of the multi-year series Designing a Social Compact for the 21st Century. The session is being hosted in partnership with Wirtschaftskammer Österreich and is sponsored by TIAA-CREF Financial Services and Tsao Foundation. More information on the session can be found here: www.salzburgglobal.org/go/540. For more information on Designing a Social Compact for the 21st Century, please visit: socialcompact.salzburgglobal.org