Loneliness Among Rural Elderly: Present and Future Public Health Challenges

Introduction

Population aging is one of the great challenges to be faced by modern societies at the future (Comisión Europea, 2007; European Commission, 2015; Organización Mundial de la Salud, 2015), and is already today a central issue in the development of public policies. Virtually every country in the world is experiencing an increase in the number and proportion of elderly people in its population (United Nations, 2015). In Spain, average life expectancy increased by more than 40 years between 1910 and 2010, especially from 1970. According to the National Statistics Institute (INE), the Spanish Ageing Index has gone from 37.35 to 120.46 in the last 30 years (1978-2018). This situation is due to different causes, among which the improvement in the quality of life and access to health resources, together with a significant drop in the birth rate, and also due to lower mortality in old age. (García, 2014). The impact of this aging has generated debate in recent years when public health policies are discussed. Some positions argue that it will lead to a drastic increase in public health “expenditure” (Ahn, Alonso & Herce, 2003; Hernández de Cos & Ortega, 2002). Less alarmist approaches state that investment in public health will not increase for this reason, based on the increasingly better general health of the elderly population and the decrease in the number of dependents among this age group (Pérez, 2016).

In Spain, mostly in the eminently rural regions, the demographic problem of aging must be added to the problem of migration. Since the 1960s, internal migratory movements in Spain have developed between rural areas in the centre and south of the country and urban industrial areas in the north (Silvestre, 2002). The region of Extremadura, a paradigm of population loss, was shaken by this rural exodus. Migration had a strong impact, resulting in a negative demographic balance from which it has not yet been able to recover (Cayetano, 2011). Migration has had a strong impact that has resulted in a negative demographic balance from which the region has not yet recovered.This internal mobility is part of a global trend where for the first time in history, since 2007, there is a greater concentration of population in cities than in towns. In this context, a direct consequence of the union of aging and depopulation appears: loneliness of the elderly in rural populations.

Most studies approach loneliness from medical positions with a perspective that problematizes it as a “disease”. The solutions proposed by public policies or the actions of third sector organizations seem to try to solve a health problem. Approaches that address loneliness from its social component and propose structural solutions beyond individual loneliness are minority. The authors, sociologists and anthropologists, participate in a research project (International Institute for Research and Innovation on Older People), which works on improving the quality of life of older people through the development of technological solutions. The aim of the text is to analyse the extent to which loneliness is “medicalised” from the scales of measurement and from the interventions of the public institutions that are carried out, starting from the great development of the concept in individual psychobiological terms from the medical space. This conceptualization has overshadowed the social and cultural sphere in its genesis, in the rules that configure experience and in the solutions that are proposed.