Conducting research on the health and living conditions

of the elderly populations in the emerging economies of Latin America and the Caribbean

Maria Victoria Zunzunegui

Professeur titulaire, Université de MontréalAxe Santé Mondiale

Centre de recherche de CHUM

Outline

• Background on:– two research experiences funded by the

Interamerican Development Bank – one research project funded by the Canadian

Institutes of Health Research• Brief summary of research results• Evaluation of impact of research on health and

social policy ?• Knowledge transfer ?• Sustainable global health partnerships ?

Background on Latin America and Caribbean aging

• Life expectancies are high (often over 70 or 75)• Aging in poverty and social/economic crisis• Little social protection, important family roles• Lifecourse trajectories:– early infection and prevalent chronic malnutrition in

childhood, – little education and unstable manual informal work in

adulthood, – few and insufficient pensions in old age.

The countries and cities where we have conducted research projects

JamaicaCuba

Trinidad & Tobago,

Surinam and Guyana

Barbados

Bahamas

Brasil

UruguayArgentina

Chile

Mexico

ESTUDIO DEL ADULTO MAYOR EN ARGENTINA, CHILE Y URUGUAYSITUACIÓN Y ESTRATEGIAS (2000-2002)

•Federación Internacional de la Vejez Oficina Regional para América Latina y El Caribe•Escuela Andaluza de Salud Pública•Instituto de Nutrición y Tecnología de los Alimentos. Universidad de Chile•Centro de Estudios de Población. Argentina.•Ministerio de Salud Pública del Uruguay•Fundación ISALUD de Argentina•Instituto Nacional de Geriatría de Chile•Centro de Investigaciones Económicas de Uruguay•Instituto Español de Comercio Exterior•Organización Panamericana de la Salud/OPS/PAHO

Banco Interamericano

de Desarrollo

Caribbean Health Research Council University of West Indies, Mona CampusUniversité de MontréalSponsored by the Interamerican Development Bank

Research team:MV ZunzuneguiBE Alvarado-LlanoP CloosD Eldemire-ShearerD Simeon

RESEARCH RESULTS

Research products:ESTUDIO DEL ADULTO MAYOR EN ARGENTINA, CHILE Y URUGUAY

SITUACIÓN Y ESTRATEGIAS (2000-2002)

• Book « Mas vale por viejo », Interamerican Development Bank, 2002

• Country reports• Three regional seminars in 2000 in Buenos

Aires, Santiago and Montevideo• Workshop in Washington on Aging in Latin

America and the Caribbean, 2002

Research products:Caribbean Aging Study

• Country reports for:– Jamaica, Bahamas, Barbados, Guyana, Suriname,

and Trinidad and Tobago

• Regional seminar in Port of Spain, Trinidad • Final report to funding agency (IADB)• Research paper in revision on Ageing and

Society

10

Research products Health differences in later life: A study of gender and social

exclusion as determinants of health and functioning in the urban elderly populations of Latin America and the Caribbean

• Scientific articles:– Journal Aging and Health (2)– Journals of Gerontology (2)– Aging and Mental Health (1)– Aging (1)– Social Science and Medicine (1)– Preventive Medicine (1)

• Presentation in Congress (10)

Evaluation of impact of research on health and social policy ?

• What is the impact of « our » research?• No structured evaluation of research impact• Need to carry out qualitative and quantitative analyses of

these efforts• EX: Brazil has taken important steps to face population

aging- Impact of many kinds of research or political opportunity? Effect Lula

• Chile has the worst health outcomes in the amidst of privatisation of health care and pensions.

• ECLAC/CELADE papers on the need for social protection as a human right issue

• Recognition by World Bank of errors in structural adjustment policies

Knowledge transfer ?• Publications: Enter Gender & Health & Aging (only one

article can be retrieved from PubMed)• Courses:– Example: Course on social Gerontology, Manizales

(Colombia), May 2009• Research Training– Pilot project on stress biomarkers: development of

measurement instruments (March 2009)• Research exchange– Short stays: Failure, lack of understanding, research as a

luxury, need to make a living among practitioners– Sabbatical periods (one-to –one basis)

PUBMED: Aging & Latin America (2 out of 8 retrieved on May 4 2009)• 1: Alvarado BE, Zunzunegui MV, Béland F, Bamvita JM. Life course social and health conditions linked to frailty in Latin

American older men and women. J Gerontol A Biol Sci Med Sci. 2008 Dec;63(12):1399-406. PubMed PMID: 19126855.

• 2: Zunzunegui MV, Alvarado BE, Béland F, Vissandjee B. Explaining health differences between men and women in later life: a cross-city comparison in Latin America and the Caribbean. Soc Sci Med. 2009 Jan;68(2):235-42. Epub 2008 Nov 25. PubMed PMID: 19036488.

• 3: Couture MC, Nguyen CT, Alvarado BE, Velasquez LD, Zunzunegui MV. Inequalities in breast and cervical cancer screening among urban Mexican women. Prev Med. 2008 Nov;47(5):471-6. Epub 2008 Jul 15. PubMed PMID: 18675296.

• 4: Sicotte M, Alvarado BE, León EM, Zunzunegui MV. Social networks and depressive symptoms among elderly women and men in Havana, Cuba. Aging Ment Health. 2008 Mar;12(2):193-201. PubMed PMID: 18389399.

• 5: Nguyen CT, Couture MC, Alvarado BE, Zunzunegui MV. Life course socioeconomic disadvantage and cognitive function among the elderly population of seven capitals in Latin America and the Caribbean. J Aging Health. 2008

• Apr;20(3):347-62. PubMed PMID: 18332188.

• 6: Guerra RO, Alvarado BE, Zunzunegui MV. Life course, gender and ethnic inequalities in functional disability in a Brazilian urban elderly population. Aging Clin Exp Res. 2008 Feb;20(1):53-61. PubMed PMID: 18283229.

• 7: Alvarado BE, Guerra RO, Zunzunegui MV. Gender differences in lower extremity function in Latin American elders: seeking explanations from a life-course perspective. J Aging Health. 2007 Dec;19(6):1004-24. PubMed PMID: 18165293.

• 8: Alvarado BE, Zunzunegui MV, Béland F, Sicotte M, Tellechea L. Social and gender inequalities in depressive symptoms among urban older adults of latin america and the Caribbean. J Gerontol B Psychol Sci Soc Sci. 2007 Jul;62(4):S226-36. PubMed PMID: 17673536.

Sustainable global health partnerships?

• Limited sucess in the above projects• Change of leadership in International

Development Bank• Some contatcs remain, mainly personal

contacts, in most places: Brazil, Argentina, Cuba, Mexico, Uruguay, Trinidad and Jamaica.

• How to go from individual exchange to long term partnerships?- MONEY and INSTITUTIONAL AGREEMENTS

Questions

• How to establish long term confidence relationships?– Recognize the long term nature of enterprises– Patience– Seize opportunities when available– Sincere collaboration among researchers of the

wealthy countries instead of fierce competition for scarce resources

• Are these suggestions possible?