Ageing in Portugal: regional iniquities in health and health care

Abstract

The health of the Portuguese has improved considerably in the last twenty years. Economic and social transformations that have contributed to the progressive amelioration of problems of feeding, sanitation, hygiene, housing and social conditions in general, as well as health services, have had decisive effect on this phenomenon. The spectacular regression of the indicators related to transmitted diseases, infant, perinatal (more than 50% between 1985 and 1994) and maternal mortality, and the mortality of children 1 to 4 yr old, also reflects this impact. The positive changes that took place in health indicators were reflected in the growth of life expectancy at birth (2.2 yr more for male and 2.3 more for women between 1985 and 1994) in spite of the fact that the difference in life expectancy in relation to EU countries has grown. Improvement in life expectancy, especially in the older age groups, is not normally associated with significant reductions in morbidity. In fact, increased longevity has become more generally associated with chronic illness or other disabilities requiring more medical services and other forms of personal care. This paper reviews some of the evidence for regional differences in the health status of elderly people in Portugal and considers how health services have reacted to these differences. A preliminary study of health status and patterns of utilisation of elderly people was undertaken. After 30 yr of a National Health Service (NHS) in Portugal we may ask why do inequities in health and access to health care of the elderly population persist? Proactive policies to prevent illness and promote health are still relatively underdeveloped in the Portuguese NHS, and the factors that influence health, such as housing, diet and occupational health hazards, remain largely absent from health and welfare policies. Poor accessibility to health services is the most serious barrier consumers have to face in order to get a medical appointment, and this is more relevant to the oldest part of the population. Geographical location of health care facilities unequally affects the ease of access of different groups of consumers and influences utilisation patterns. Examining the distribution of health services resources is an important way to understand the inequities of access to health and to health care.

Designing a model to minimize inequities in hemodialysis facilities distribution

“…Furthermore, Lisbon & Tagus Valley has a population of 2,808,414 and 34 hemodialysis centers, concentrating 71% of those units in four municipalities comprising only 36% of the population of that area. This focus on the cities has also been reported in other studies demonstrating geographic inequities in the Portuguese health system, such as the uneven distribution of hospitals (Oliveira and Bevan, 2003) and facilities providing care for the elderly (Santana, 2000). The multivariate analysis revealed an association with "buying power percentage" but none with "electricity consumption", which could be interpreted as correlation with welfare but not with industrialization.…”

Functional, Sensorial, Mobility and Communication Difficulties in the Portuguese Oldest Old (80+)

“…17,18 The existence of significant differences in some sociodemographic characteristics and sensorial, functional and cognitive status reinforces the heterogeneity of the older population, even in the oldest subgroup (centenarians). Gender differences on life expectancy (higher for women) are commonly cited in the literature [19][20][21] and corroborated by the preponderance of females in our study.…”

Neoliberalism and Austerity in Spain, Portugal and South Africa: The Revolution of Older Persons

“…The increasing number of older people associated with demographic ageing of the population is an emerging phenomenon across Europe and is becoming prominent in Spain and Portugal (Santana, 2000). Instituto Nacional de Estadística (INE, 2014) A c c e p t e d M a n u s c r i p t "As older persons become an ever greater proportion of the total population, they will become an even greater force to be reckoned with in societypolitically, economically and socially… The impact of population ageing on the socio-economic development of society engenders the need for continuing integration and empowerment of older persons, including the removal of barriers and obstacles which serve to exclude or discriminate against them" (Kelly, 2005: 1).…”