Ecuador, Haiti, Nicaragua and Paraguay, for instance, have public health spending below 50%, high out-of-pocket spending and a very low proportion of older persons. Given that the pace of population ageing in these countries will be very rapid, and that they must also face the epidemiological backlog amidst widespread poverty, the lack of health protection will definitely worsen unless measures are introduced to strengthen the public system. Inequity, on the other hand, stems from having to make out-of-pocket payments to access health services or buy medications (Titelman, 2000).