FROM THE DIRECTOR
Longevity and the quality of life: a new challenge for public health in the Americas
Mirta Roses Periago
Director, Pan American Sanitary Bureau, Washington D. C., United States of America
More people in the Americas now live longer than was true at any other time in our history. Nevertheless, further reducing premature deaths among adults and older adults will require major efforts, parallel to global efforts to meet the Millennium Development Goals and to together plan a future in which everyone can enjoy good health and quality of life.
At the beginning of the 21st century the Region of the Americas had some 2 228 900 people who were 90 years of age or older, and 90 400 of them were centenarians. By the middle of the century, these figures will have climbed to nearly 13 903 000 and 689 000, respectively. At the beginning of this century nonagenarians represented a population group who managed to survive in spite of high infant mortality and major epidemics of infectious diseases. These survivorsselected by their genetic characteristics and their living conditionsrepresent extraordinary cases of active aging to a very advanced age. One example is Elizabeth "Ma Pampo" Israel of Dominica, who died in 2003 at the age of 127. However, the people who will be nonagenarians between 2025 and 2050 will not have been selected on account of their genetic gifts and their living conditions, but rather will have benefited from the public health achievements in the Americas. The centenarians of the future will have survived because they have had access to vaccines, antibiotics, potable water, and a network of community services. The centenarians of 2025 are already known: they are people who in 2000 turned 75 and to whom we dedicate this issue of the Re-vista Panamericana de Salud Pública/Pan American Health Journal of Public Health. This special issue of the Revista/Journal allows us to analyze the health situation of this population group and to think about the responsibility that all of us share in seeing that the greater life expectancy of these people does not become a problem or a burden for their families and society. Public health priorities and societal commitments to older persons and to ourselves should include actions aimed at preventing premature disability in old age and at preventing and adequately treating the chronic diseases in the group most at risk, that is, persons who are 60 or older. This entails promoting healthy lifestyles: not smoking, eating well, and staying physically, mentally, and socially active throughout life.
In April 2002, representatives of the governments of 159 countries met in Madrid, Spain, for the United Nations' Second World Assembly on Ageing. There they adopted the International Plan of Action on Ageing, which calls for steps to change attitudes, policies, and practices related to successful aging. Promoting health and well-being in old age is one of the three priority areas of the Plan. The World Health Organization (WHO) has put forth its Policy Framework on Active Ageing, which points out that among the determinants of good health in old age is access to health care services that are adapted to the needs of older adults. The WHO initiative for age-friendly primary health care establishes general principles for responding appropriately to the health problems of elderly persons. In this issue of the Revista/Journal we present, together with some research studies on the health and well-being of older adults, reports on initiatives that WHO and other agencies of the United Nations system and of the Inter-American System are carrying out, in a coordinated manner, in order to move ahead with the commitments made in Madrid. Guaranteeing a life of quality to long-living persons is a new challenge for the Americas that will continue to grow in importance within the context of international cooperation and in the national agendas of the majority of countries over the next decade. We individuals who have already reached 50 years of age could live to 100. Therefore, it is imperative for us to think about the quality of life that we want to have in old age, and to take steps designed to protect our health and well-being in the future.