towards people aged 60 and over around the year 2050. Changes in the age composition of populations represent the most important social and economic challenges” health (ECLAC, 2005A, p.104). On the other hand, the reduction in fertility has positive effects in the short and medium term, mainly due to the stabilization health of the target population of maternal and child health care.

Thus, the dependency rate decreases

• as the birth rate decreases, however, as the older adult health population increases, the weight of dependents shifts from under 15 to over 60. and, consequently, the dependency ratio rises again, this time generating other demands for health care and economic security. In all countries of the region, the proportion and absolute number of people aged 60 and over will increase steadily over the coming decades. Currently Argentina, Cuba and
• Uruguay health are in advanced stages of aging with percentages of older people above 10%. The proportion of people over the age of 60 will triple between the year 2000 and 2050; thus, by the latter date, one in four Latin Americans will be an older adult. Given the longer life expectancy of women, who live on average 6.5 years longer than men, the larger population will be mainly female. ECLAC-Social health

Policies Series No. 114 11 A. Old and new problems of health in The Latin american region faces a double challenge as a result of the great social-economic changes and health demographic trends; on the one hand, it must address the traditional problems of health as communicable diseases and infections, maternal and child mortality, and on the other hand, must deal with the new problems arising out of development, and of gradual changes, and sometimes rapid, in the profiles of morbidity: the increase of chronic-degenerative, senile and mental health,

and HIV and AIDS, among others. In addition, the change in the profile of mortality by cause and the distribution of deaths by age is reflected in the percentage decrease in deaths from communicable diseases (infectious, parasitic and respiratory) and perinatal diseases, leading to a relative health predominance of deaths from chronic and degenerative diseases (circulatory system and malignant tumors), as well as external causes (caused by violence, accidents and trauma). This is influenced by the greater decrease in mortality from the first group of causes, which mainly affect children, as well as the change in the age structure of the population, which leads to an increase in deaths of older

mortality rates by cause and sex

(rates per 100,000 population) total men women communicable diseases adjusted estimated adjusted estimated adjusted estimated adjusted Latin America and the Caribbean 64.9 78.0 91.0 73.4 56.7 66.1 Latin America 65.0 78.2 91.3 73.6 56.8 66.4 92.4 107.3 96.7 120.9 88.5 96.7 Latin America 92.4 107.3 96.7 121.0 88.6 96.8 health circulatory diseases Latin America and the Caribbean 175.1 203, 1 181,6 227,7 169,2 182,1 Latin America 174,3 202,4 180,9 227,0 168,4 181,3 Diseases due to external causes in Latin America and the Caribbean Of 74.1 75,5 121,3 122,8 26,7 29,2 Latin America 74,6 76,0 122,0 123,5 26,8 29,4 Source: Pan american Health Organization (PAHO) (2005). Health situation in the Americas. Basic health indicators http://www.paho.org/spanish/dd/ais/IB-folleto-2005.pdf health policies and programs in Latin

• America. Problems and proposals 12 the epidemiological profile is also being modified by actions taken to reduce maternal and infant mortality and by the emergence of new problems that strain health systems, such as HIV AIDS (see boxes 1 and 2) Box 1 reducing maternal mortality in BOLIVIA, CHILE, CUBA and HONDURAS
• Source: United Nations (2005) Millennium Development Goals. A look from Latin America and the Caribbean, Chapter V the right to health and the Millennium Development Goals. LG.2331, Santiago de Chile. health The reduction of maternal mortality is an example of progress towards goal 5 of the Millennium Development Goals. This reduction is observed in countries

with different levels of social and economic health

• development such as Bolivia, Chile, health Cuba and Honduras. Between 1993 and 2003, Bolivia had reduced maternal mortality by 41 per cent, from 390 maternal deaths per 100,000 live births to 235. Chile currently has the second lowest maternal mortality rate in Latin America and the Caribbean, at 17 maternal deaths per 100,000 live births. Honduras has made significant progress in reducing maternal mortality, which fell by 38
• per cent between 1990 and 1997, from 182 to 108 maternal deaths per 100,000 live births. health In the case of Cuba, the situation has been similarly enhanced health by a health policy that has the permanent support of the political authorities. The continuous improvement of the coverage and quality and empowerment of women are central elements of the Cuban health system that aimed to reduce maternal

motherhood, in health particular, individual training and access for all women to education and health services with a capacity to respond. The experience gained in all these cases demonstrates the essential role of the authorities and the importance of sustainable, far-reaching and cross-sectoral public policies, health which contribute in particular to the strengthening of health systems and services. ECLAC – Social Policies series No 114 13 Box 2 the spread of HIV/AIDS in Latin America and the Caribbean Source: United Nations (2005) Millennium Development Goals. A look from Latin America and the Caribbean LG.2331, Santiago de health Chile and joint United Nations Programme