Who among us does not want to live a long, healthy, active life? Although the nations of Latin America, the Caribbean, and North America are at different stages of economic and social development, population longevity will become an irrefutable demographic reality in the Americas by the end of the first quarter of the 21st century. This will present new human development challenges and opportunities. Fortunately, effective responses to these challenges and opportunities can be created today, drawing from a body of aging-related medical, health, and social scientific knowledge representing four decades of research and supplemented by best practices and lessons learned from an international community of forward-looking public health, social service, and gerontology professionals.

The research of experts such as Drs. John Rowe and Robert Kahn of the United States clearly suggests that the "successful aging" of our people will depend upon choices policy choices by governmental leaders, programmatic choices by health and human services organizations, and lifestyle choices by each of us guided by the now vast body of public health knowledge and experience. These choices will become increasingly evident as the nations of the world launch their activities in commemoration of the United Nations' 1999 International Year of Older Persons and as we join forces to promote the concept of healthy aging during the year-long celebration of World Health Day 1999 by the World Health Organization (WHO) and Pan American Health Organization (PAHO). They are choices that can ensure that the three essential conditions for successful aging, as identified by Rowe and Kahn and promoted by WHO and PAHO, are pursued by governments, communities, and individuals. These conditions are: (1) the avoidance of disease and disability; (2) high levels of physical and mental activity; and (3) sustained engagement in society.

Awareness of the sheer demographics of longevity, as well as several specific public health, ethical, and economic considerations, have begun to give momentum to longevity-related policy, program, and lifestyle imperatives. Each of these considerations is independently potent. But they also are interdependent. Together, they present us with a multitude of challenges and opportunities for the future.

The Demographics of Aging in the Americas

In 25 years, the population of people 60 years and older in Latin America and the Caribbean will grow from more than 42 million to over 97 million. During the same period, the number of persons 60 years of age and older in the United States and Canada is expected to increase from more than 50 million in the year 2000 to more than 93 million in 2025.

The rapidity of growth in Latin America and the Caribbean is even more apparent when the percentage of persons 60 and older in 1992 is compared with the percentage projected for 2025. In 1992, older adults comprised at least 10 percent of all persons in only four countries Argentina, Barbados, Cuba, and Uruguay. By 2025, older persons will account for more than 15 percent of the population in countries such as Argentina, Brazil, Chile, and Colombia.

Several characteristics of the older population of the 21st century deserve note. First of all, it will be a heterogeneous population, with as many as three to four diverse generational cohorts. Secondly, one particular cohort the Baby Boomer generation, born between 1946 and 1964 and slated to begin to reach age 65 in 2011 is causing much of the upsurge in many countries' older population. This group is expected to reset the physical and psychosocial meanings of aging and to broaden the social, economic, political, and other roles and aspirations held by older adults in the 21st century. Finally, older women will continue to outnumber older men, requiring all of us to consider gender differentials in addressing longevity and aging issues.

Public Health Issues Related to Population Longevity

In general, the most frequent causes of mortality among older adults in the Americas are diseases of the heart, malignant tumors, cerebrovascular diseases, diabetes, influenza, pneumonia, and accidents. In the United States, most persons 65 or older have at least one chronic condition, such as arthritis, hearing or visual impairments, and diabetes. Even though many older adults with chronic illnesses are able to remain actively engaged in their communities and families, it is also true that many of these diseases and disabilities can be avoided, prevented, or delayed through interventions already proven to work. One way is through targeted public health policies, such as the adoption of public safety measures to prevent accidents and other injuries, and making immunizations for hepatitis A and B, influenza, and other preventable illnesses available to the older population and encouraging their use. Another way is through the individual, lifelong, conscientious pursuit of healthy lifestyles, based on the understanding that the earlier in life these practices begin, the more beneficial their effect in the older years.

One of the most heralded findings in aging and health research in recent years is the discovery that regular, strenuous physical exercise, including weight-bearing exercises, builds physical strength, and that challenging mental exercises are critical for maintaining high levels of mental functioning. When both are made part of the lifestyle of older persons, these individuals are better able to attain optimal physical and mental health, to remain productively engaged, and to reverse or delay declines. The ramifications of these findings and of public health efforts to date are clear: health promotion and disease prevention policies and programs can reduce health care costs, facilitate productive aging, and increase the probability of a good quality of life.

What is most needed, then, to assure a healthy aging population is an uncompromised vision by decision leaders, policy makers, program administrators, and health care professionals of the rewards that will accrue to all members of society, regardless of age, and the will to sustain a meaningful commitment to public health, social, and education programs over the long term.

The Will to Succeed

Throughout the Americas, individuals and communities are generating a new momentum at the same time they provide models of exemplary commitment and creativity. HelpAge International is a London-based global network of not-for-profit organizations that works to improve the quality of life of older persons, particularly the disadvantaged. Valerie Mealla, its regional representative for Latin America, describes one such example of personal commitment:

Dr. José Aguilar, a rheumatologist working with a small multidisciplinary health team in a marginal district in Peru, struggles out of bed on Sunday mornings at 4 in the morning, not to take his family off on a weekend picnic, but to begin organizing the regular community campaigns aimed at the early detection of disability.

Among the many community-based initiatives, we can cite the partnership of the cities of Lerdo, Mexico, and Las Cruces, New Mexico (United States). Teenagers from Lerdo are working alongside their peers in four Las Cruces sites, where they are gaining valuable experience in how to run meals programs and develop cultural activities for elders in their own communities.

In their own small way, these efforts are contributing to a new public agenda on aging for the countries of this Hemisphere. To successfully implement such an agenda, however, primary health care professionals will need to be familiar with the special physical and mental health changes typically related to aging, and, similarly, gerontologists and geriatricians must be prepared to play a more active role in policy development and program implementation and management.

Ethical Considerations Related to Population Longevity

The United Nations has identified five major goals for older persons of all nations: independence, participation, care, self-fulfillment, and dignity, and a theme, "Toward a Society for All Ages," for the International Year of Older Persons. In doing so, the U.N. is acknowledging the need for intergenerational equity and reciprocity, as reflected in policies, processes, and programs that facilitate activities of daily living for everyone, regardless of age, and that avoid the marginalization of older persons.

"Aging should be seen as an achievement, not a burden," says Denise Eldemire of the University of the West Indies' Department of Community Health and Psychiatry in Kingston, Jamaica. In this country, the thrust is to build activities for older people into existing programs, instead of creating new or special ones for them. "A cornerstone of this new policy is that older persons be regarded as important participants in the development process and not simply as persons in need of support services," Eldemire notes.

Political Approaches to Ethical Considerations

Other countries as well are revamping their social agendas to reflect a growing awareness of the potential contribution the older population can make to socioeconomic development. In Chile, for example, the Government's new social policy is to effect a "cultural change" in how Chileans view the aging process and the value of older persons to society, according to Dr. Juana Silva Opazo, director of Chile's National Geriatrics Institute. Political clout is provided by First Lady Marta Larraechea de Frei, who has assumed a high-profile personal commitment to public health and aging issues. She chairs the National Commission on Aging, whose work is guided by five principles: active aging, educational programs on healthy aging involving the participation of all age groups, a recognition of the diverse needs of older adults, social participation at the community level, and a strengthening of the Government's leadership role in streamlining the work of public and private enterprises dedicated to promoting this cultural change.

Meanwhile, in Uruguay, where the population aging trend is already well underway, theMinistry of Health has spearheaded healthy aging initiatives with a variety of public and private institutions. In 1998, the National Institute for Solidarity with Older Persons was created with the mandate to develop a countrywide network of community senior centers that will serve as focal points for health promotion and education activities.

As the ramifications of population longevity begin to surface in country after country throughout the Americas, the need to transform social attitudes will become even more pronounced. What may be considered "ethical considerations" today will sooner or later become pragmatic and economic imperatives in order to maintain continuity in family and community relations. In all likelihood, intergenerational programs will be needed that involve older adults in child care, in guiding and educating the young and middle-aged to help support those who need long-term care, and in countless other activities that will hold together the very social fabric that defines our collective sense of well-being.

Economic Considerations Related to Population Longevity

The demographics of longevity are sure to generate multidimensional policy and program challenges. Particularly where poverty and basic development issues have not been resolved, it may seem inconceivable that attention should be given to the health and well-being of older persons. Yet, beyond arguing from a strict social ethics perspective, the tremendous opportunities presented to the nations of the Americas by population longevity must be reiterated. By applying what we already know about our aging society we can approach the challenges of the next century rationally rather than recklessly. We will then likely be able to contain health care costs, legitimize new productive roles and functions for older persons, increase the pool of human resources required for economic and social development, encourage the creation and growth of new markets and services, and better provide for all persons in our nations, regardless of age.

But everyone must work together to create promise out of longer life. By charting an informed course, we can create positive social and economic development that translates a longer, healthier, more active life into greater contributions that benefit us all.