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The past half-century has seen enormous changes in the demographic makeup of Latin America and the Caribbean (LAC). In the 1950s, LAC had a small population of about 160 million people, less than today's population of Brazil. Two-thirds of Latin Americans lived in rural areas. Families were large and women had one of the highest fertility rates in the world, low levels of education, and few opportunities for work outside the household. Investments in health and education reached only a small fraction of the children, many of whom died before reaching age five. Since then, the size of the LAC population has tripled and the mostly rural population has been transformed into a largely urban population. There have been steep reductions in child mortality, and investments in health and education have increased, today reaching a majority of children. Fertility has been more than halved and the opportunities for women in education and for work outside the household have improved significantly. Life expectancy has grown by 22 years. Less obvious to the casual observer, but of significance for policy makers, a population with a large fraction of dependent children has evolved into a population with fewer dependents and a very large proportion of working-age adults. This overview seeks to introduce the reader to three groups of issues related to population aging in LAC. First is a group of issues related to the support of the aging and poverty in the life cycle. Second is the question of the health transition. Third is an understanding of the fiscal pressures that are likely to accompany population aging and to disentangle the role of demography from the role of policy in that process.

The past decade has brought an increasing recognition to the importance of pension systems to the economic stability of nations and the security of their aging populations. During this time, the World Bank has taken a leading role in addressing this challenge through its support for pension reforms around the world. Old-Age Income Support in the 21st Century attempts to explain current policy thinking and update the World Bank’s perspective on pension reform. The Bank has been involved in pension reforms in nearly 60 countries, and the demand for its support continues to grow. This book incorporates lessons learned from recent Bank experiences and research that have significantly increased knowledge and insight regarding how best to proceed in the future. The book has a comprehensive introduction and two main parts. Part I presents the conceptual underpinnings for the Bank’s thinking on pension systems and reforms, including structure of Bank lending in this area. Part II highlights key design and implementation issues where it signals areas of confidence and areas for further research and experience, and includes a section on regional reform experiences, including Latin American and Europe and Central Asia. This book will be of interest to Bank clients, the international community, and anyone interested in pension systems and reform.

How do private transfers differ by race and ethnicity, and do such differences explain the racial and ethnic disparity in wealth? Using the Panel Study of Income Dynamics, this study examines private transfers by race and ethnicity in the United States and explores a causal relationship between private transfers and wealth. Panel data and a family-level fixed-effect model are used to control for the endogeneity of private transfers. Private transfers in the form of financial support received and given from extended families and friends, as well as large gifts and inheritances, are examined. We find that African Americans and Hispanics (both immigrant and nonimmigrant) receive less in both types of private transfers than whites. Large gifts and inheritances, but not net financial support received, are related to wealth increases for African American and white families. Overall, we estimate that the African American shortfall in large gifts and inheritances accounts for 12 % of the white-black racial wealth gap.

Long-standing coverage gaps in Latin American pension systems have left most lower income and informal workers unprotected during old age, as are workers in small-scale agriculture and unpaid family workers. In response, over the past two decades, many Latin American countries have expanded the coverage of cash benefits for older adults by developing noncontributory pensions or increasing the flexibility of eligibility rules for contributory pensions. This article examines design features of noncontributory pensions, including eligibility, coverage, and benefit levels; identifies the main policy strategies for old-age coverage; and offers a combined assessment of coverage and adequacy across countries. To analyze the relative roles of states, markets, and families in providing economic security in old age, it also focuses on two key indicators (labor force participation and living arrangements of older persons) and explores how they vary across countries with different levels of basic old age protection.

Rapid fertility declines in Latin American and Caribbean countries since the 1960s have contributed to smaller family sizes among the current cohorts of older adults. This may have mental health implications in these societies as the family unit is highly valued as a source of social support. Utilising data from the 2000 Survey of Health, Well-being and Aging in Latin America and the Caribbean (SABE), this study examines the association between parental status, marital status and the likelihood of experiencing depressive symptoms among adults 60 years and older in seven cities within Latin America and the Caribbean (N = 9,756): Buenos Aires, Bridgetown, São Paulo, Santiago, Havana, Mexico City and Montevideo. Results from multivariate logistic regressions indicate that parental status is not significantly associated with depressive symptoms. Nonetheless, unmarried older adults, both those living alone and those living with others, are more vulnerable to experiencing depressive symptoms than their married counterparts. Marriage is especially protective for older adults in Havana and Montevideo. Older adults’ perceived income adequacy significantly moderates the relationship between marital status and depressive symptoms. Other significant covariates, such as experiencing disability and comorbidity, showed positive associations with depressive symptoms. While families may still represent a critical component for the mental health of older adults, broader investments in health across the lifespan are needed to improve individual psychological wellbeing.

The aims of this study were to assess factors associated with catastrophic healthcare expenditure (CHE) and the burden of out-of-pocket (OOP) payments for specific healthcare services in Peru. We used data from 30,966 households that participated in the 2016 National Household Survey (Encuesta Nacional de Hogares, ENAHO). Participants reported household characteristics and expenditure on ten healthcare services. CHE was defined as healthcare spending equal to or higher than 40% of the household's capacity to pay. The associations of various household characteristics and OOP payments for specific healthcare services with CHE were assessed in logistic regression models. Poorer, rural and smaller households as well as those with older adults and individuals with chronic conditions had greater odds of facing CHE. According to the estimates from the adjusted regression model, healthcare services could be grouped into three groups. Medical tests, surgery and medication were in the first group with odds ratios (ORs) between 6.43 and 4.72. Hospitalisation, outpatient, dental and eye care were in the second group with ORs between 2.61 and 1.46. Child care, maternity care and other healthcare services (such as contraceptives, rehabilitation, etc.) were in the third group with non-significant ORs. Many Peruvian households are forced to finance their healthcare through OOP payments, burdening their finances to the extent of affecting their living standards.

The aim of this study is to provide cross-cultural empirical support that endorses the scientific nature of Quality of Life (QoL), which a review of definitions reveals as a nomothetic and multidimensional concept (personal and environmental circumstances), made up of a set of subjective and objective indicators. Although this is commonly accepted, many instruments and authors reduce it to subjective and personal conditions. Bearing in mind the aim described, multi-group Structural Equation Modelling analysis was applied to two representative samples made up of 1217 participants aged over 60 from Mexico and Spain, recruited both at random (through the random route procedure), who completed the CUBRECAVI (Brief Questionnaire of Quality of Life). In this model two third-order latent variables are considered for QoL: personal and external factors, both made up of objective and subjective indicators. As predicted, the results permit us to state that the structural model is invariant across the two countries—that is, although the QoL construct has the same structure in the two countries, the importance of the indicators (factor loadings) and the relationships between them are not equivalent.

Similar to other developing countries, population aging in Mexico has accelerated, raising concerns that economic disparities will widen even more. We use data from the Mexican Health and Aging Study for 2001 and 2012 to derive measures of economic security—income and its sources, and wealth and its components—and describe how they changed over time and varied across key characteristics. The database is unique for a developing country: longitudinal and spanning a relatively long time period, and nationally representative of older persons (n = 12,400; ages 50+). We conduct descriptive analysis for the full sample, and for sub-samples defined by \"safety net\" indicators, health status, and demographic characteristics. Given that this time period included crucial economic and social changes in Mexico, we derive period results, measuring differences across time in two cross sections; and longitudinal results, capturing changes among individuals as they age. In-depth examination of income and wealth identifies important contributors to old-age economic security in Mexico; we confirm several expected patterns and provide first evidence about others. Older adults with low income and asset values in Mexico have less diverse income sources and asset types; real incomes of older persons decreased substantially, and their income and asset portfolios became less diverse over the period. With older age, Mexicans relied more heavily on transfers and family help, and less on earnings. Overall, limited safety net options and worse health conditions were associated with less robust and deteriorating economic profiles.

Poor early conditions have been associated with increasing risks of some chronic diseases during adulthood. Since chronic illnesses are known to be important risk factors for disability, poor early conditions should predict disability at older ages. In addition, recent literature suggests that poor early conditions may affect the risk of disability even in the absence of chronic illnesses. We aimed to evaluate the magnitude of differentials in the risk of being disabled according to early conditions experienced by elderly populations in Latin America and the Caribbean, and to identify the group of chronic illnesses responsible for it. We find that poor early conditions exert a strong influence on disability later in life in two ways: by increasing the risk of suffering disability-related chronic illnesses and by increasing the risks of suffering disabilities by those with chronic illnesses.

Objective In Canada, recent immigrant households experience more food insecurity than the general population, but limited information is available about the personal, cultural, and social factors that contribute to this vulnerability. This study focused on recent Latin American (LA) immigrants to explore their perceived barriers in acquiring safe, nutritious, and culturally-appropriate food. Design A cross-sectional mixed-method design was applied to collect information from a convenience sample of 70 adult Spanish/Portuguese speakers who had arrived in Toronto within the last five years. Face-to-face interviews were conducted with primary household caregivers to obtain responses about barriers to acquiring food for their households; data were analyzed using a thematic analysis technique. Results Four main categories of barriers were identified: limited financial resources; language difficulty; cultural food preferences; and poor knowledge of available community-based food resources and services. Inadequate income was the main impediment in accessing adequate food, and was related to affordability of food items, accessibility of food outlets and transportation cost, and limited time for grocery shopping due to work conditions. Language barriers affected participants’ ability to obtain well-paid employment and their awareness about and access to available community-based food resources. Cultural barriers were related to food preferences and limited access to culturally-appropriate foods and resources. Conclusion The main barrier to food security among our sample of LA newcomers to Toronto is limited financial resources, highlighting the need for policies and strategies that could improve their financial power to purchase sufficient, nutritious, and culturally-acceptable food. Linguistic barriers and limited information among newcomers suggest the need to provide linguistically- and culturally-appropriate information related to community-based food programs and resources, as well as accessible subsidized English language programs, in the community and at workplaces. Participatory community-based food programs can augment, in a socially acceptable manner, food resources and reduce the social stigma attached to food charity. Finally, it is crucial to monitor and evaluate existing social and community-based services for their accessibility, cultural appropriateness and diversity, and effectiveness.