Market Scan HEALTHY AGEING IN BRAZIL Rio de

Market Scan HEALTHY AGEING IN BRAZIL Rio de Janeiro & São Paulo

INDEX This is an automated Index, where you can navigate through topics independently Terms of Reference & Summary Index 03 Premises 06 Profile 07 Elderly in Brasil 09 Recent Relevant Facts in Brazil 11 The Health Care Market in Brazil 14 Scientific Production 20 General Context 22 Studies & Scientific Articles 23 Technology. : . Lines of Elderly Research 28 Technology. : . Scientific Publications 36 Social. : . Third Age Universities 38 Public Polices (PPs) 41 General Context 43 Major Areas of Federal PPs 45 International Visibility 48 State PP. : . Rio de Janeiro 49 State PP. : . São Paulo 51 State PP. : . Bills 53 Tax Deduction 54 Private Sector 55 General Context 57 Start Ups Overview 58 Investors 60 Incubators 61 Accelerators 63 Startups Highlights & Lists 64 Private Companies & Elderly Related Initiatives 82 Opportunities Future Vision with Intelligence Hub 88 101 2

TERMS OF REFERENCE Index EXECUTIVE SUMMARY Analysis of Science, Technology and Innovation opportunities in healthy ageing in Brazil for Dutch institutes and companies, besides civil society organisations. Background Healthy ageing is supposedly one of the main societal challenges of the 21 st century. Within the Netherlands there is already broad expertise in both fundamental and applied research and there is an interest to both share this and develop new expertise together with Brazilian counterparts. The Brazilian Health sector is looking forward to international partnerships and co-operation in order to provide the appropriate solutions within the Brazilian context. Cooperation between The Netherlands and Brazil in this field is at its initial stage, though recently very much increasing throughout the entire “value chain” of education-R&D-entrepreneurship, including civil society. In order to develop such collaborations effectively, the Dutch counselor for Science, Technology & Innovation and the Dutch Health sector would like to create insight in specific necessities and opportunities in healthy ageing in Brazil. Objective The main goal of this study is to present a picture of science, technology and innovation regarding Healthy Ageing in Brazil. It comprehends an initial and summarized analysis of data gathered from Intelligence Hub’s research and assessment to companies, universities, start ups and investors. More specifically, this report focuses on analyzing the main players and networks in the public and private sector, including civil society, state-of-the-art and main R&D programs, challenges and opportunities for international collaboration in healthy ageing in Brazil. Furthermore, this report focus not only on the technological aspects but also covers non-technological aspects of (social) innovation in healthy ageing, such as the technology transfer process from public parties (universities and research institutes) to the private sector and the creation of new businesses and new markets, where applicable. Results The expected result of this study is: Ø An overview of the main players in Brazil in the field of healthy ageing as defined above, for companies, (applied) research institutes and universities, and civil society. Ø An overview of the scientific knowledge (fundamental and applied) in Brazil in the field of healthy ageing plus an indication in which segments of healthy ageing Brazil has already a strong position or has the potential of obtaining a strong position. Includes a listing of main public policies impacting and steering healthy ageing in the country. 3

EXECUTIVE SUMMARY TERMS OF REFERENCE Index Ø An overview of main technological developments among leading (health) companies in Brazil and of the main challenges for further innovation & business development for these companies and for scientific knowledge in research institutes and universities. Such challenges could be technological and non-technological (social). Ø An overview of opportunities for international collaborations and of lessons learned from previous international collaborations in this field, leading to specific recommendations for actions to be taken by Holland Innovation Network Brazil.   This result should be delivered in: Ø a compact written report, in English (maximum of 30 pages including annexes), made available digitally, in Microsoft Word format; Ø a final presentation with digital slides in a videoconference setting allowing interested parties from the Netherlands to assist and interact on-line. The report will be made available to interested Dutch companies and knowledge institutes / universities, and possibly civil society, so they can develop follow-up activities. Holland Innovation Network is granted all rights to this report and presentation and is free to publish (all or parts of) its content as it sees fit. 4

SCOPE of WORK SUMMARY INDEX Index The objective is to bring an overview of Rio de Janeiro (RJ) and São Paulo (SP) States in Brazil as far as healthy ageing, within three main pillars: Scientific Works (academic and institutions), Public Policies, and Technological Developments by the private sector (through private Companies and start ups). In addition, we included a general view of Brazil and both states as far as demographics and elderly references, referred to as Profile. The last step referred as “Opportunities & Recommendations” consist of a preliminary perceptions as to how the Consulate of the Netherlands should evolve from here. A short scope version: Ø PROFILE: overview of SP and RJ states, including the main stakeholders Ø ACADEMY: summary of scientific works developed in the states - institutes and research centers, universities, government and niches institutions Ø PUBLIC POLICIES: summary of the main public policies that may or are impacting today Ø PRIVATE SECTOR: overview of major technological developments. E. g. personal health records, telemedicine, e-health / e-diagnostics and home care. Ø OPPORTUNITIES & RECOMMENDATION: opportunities for partnerships between Brasil and Netherlands (institutional and business related), as well as general recommendations; 5

PREMISES Index EXECUTIVE SUMMARY It is important to have some premises and terms commonly used in Brazil understood. Ø São Paulo State = SP Ø Rio de Janeiro State = RJ Ø Elderly = people 60 years of age and over Ø Exceptions: there a few cases and public policies that use a different age reference for “Elderly”, e. g. 65 years of age and over. Whenever that happens, there will an indication of the age in question. Ø Elderly = also referred to as “Third Age” or “Best Age” Ø “Young Elderly” = people between the ages of 60 -70 Ø Minimum Wage in Brazil: R$880/month or ~US$260/month (exchange rate by 25 of November) Ø Exchange rate reference for this report - Real (Brazilian currency) vs. Dollar: US$1 = R$3, 38 It is also important to mention that all findings descriptions are based upon the Brazilian reality (terms and expressions, the way to segment Healthy Ageing, and so). 6

PROFILE Ecosystem – Brief overview from SP and RJ states SCIENTIFIC PRODUCTION Summary of works developed in RJ/SP PUBLIC POLICIES Summary of the main impacting public policies SCOPE Healthy Ageing Brazil PRIVATE SECTOR Overview of major technological developments OPPORTUNITIE S Attention point and general recommendation s of next steps States of Rio de Janeiro & São Paulo 7

Index PROFILE Ecosystem – Brief overview from SP and RJ states PROFILE Healthy Ageing Brazil States of Rio de Janeiro & São Paulo 8

ELDERLY IN BRAZIL Index The last census conducted by Brazilian Institute of Geography and Statistics (IBGE) in 2010 indicated that Brazil has more than 20 million elderly people, representing 11% of the population. The survey takes place every ten years. PROFILE Projections indicate that by 2030 the population over sixty years of age will reach 40 million people, representing 20% of the total population of the country. Some reasons contribute to this increase in the elderly population, among the most relevant are the increase in the life quality due to new accessible technologies and the implementation of social assistance policies. These actions directly impacted on Brazilian life expectancy increase, which leaves 75 years expectancy in 2013 and, according to estimates, 81 years by 2060. In addition, the percentage of older people also increases due to the fall in fertility rate over the decades: the average number of children per Brazilian family was 6. 2 in 1960 s and fell to 1. 77 in 2013. ELDERLY in RJ and SP STATES According to the official population count of Brazil conducted by the IBGE Census in 2010, Rio de Janeiro and São Paulo together have 6. 8 million elderly people, corresponding to 33% of the population of Brazil over 60 years of age. This means that only these two states together add up to one-third of the elderly nationwide. The estimate is that in the next 15 years, that is, until 2030, the elderly population in the two states will more than double, and the total number of elderly will exceed 14 million. The State of São Paulo, the most populous state in the country, accounts for 4. 7 million elderly people, representing 12% of the state's population. The State of Rio de Janeiro has more than 2. 1 million people over 60 years of age, corresponding to 13% of its population. 9

ELDERLY IN BRAZIL Index PROFILE In the context of elderly population increase, several actors are working either together or with isolated initiatives to develop better practices and conditions for society to absorb and integrate this new population contingent. These are the stakeholders in Brazil, including both States within the scope of this report, when we talk about healthy ageing and elders. One way or another, players fall into one of these groups. Whether it is with a social and assistentialist bias or with new business in mind, government, civil society, private companies of diverse branches (entrepreneurs, investors, companies already consolidated, start ups, and so on), universities, among others, are investing in innovation, research and actions for life quality for those over 60 years of age. 10

RECENT RELEVANT FACTS IN BRAZIL TO CONSIDER Index To conclude this profile overview, we point out recent relevant facts within theme Health in Brazil. PROFILE 1. January 2015 - Law 13. 097/2015 - the market opening foreign investment in hospitals in Brazil In January of 2015, Brazil’s last president Dilma Roussef sanctioned the Law 13. 097, amending the prior Law 8. 080/1990, allowing direct or indirect participation, including control, of companies or foreign capital in health care in Brazil, more specifically hospitals. The prior Law 8. 080/1990 allowed participation of foreign companies and capital in Brazilian healthcare only in four cases: • Health plan operators; • Manufacturing and distribution of medical and hospital supplies; • Donations from international agencies linked to the UN, technical and financing entities; • Non-profit health service, maintained by a company to care for its employees and dependents, without any burden for social security. The “Opening to Foreign Investments” is not a recent topic in Brazil. Political movements towards that Opening date back to the year 2000. In addition, with the need for capitalization within this legal prohibition from 1990, some hospitals even became Anonymous Society in order to issue debentures, since these debentures would not represent participation in the capital of the issuing companies, allowing foreign investment. 11

RECENT RELEVANT FACTS IN BRAZIL TO CONSIDER Index LAW 13. 097 - OPENING TO FOREIGN CAPITAL IN THE OFFER OF HEALTH SERVICES CHAPTER XVII PROFILE FROM OPENING TO FOREIGN CAPITAL IN THE OFFER OF HEALTH SERVICES Article 142. Law 8. 080, of September 19, 1990, becomes effective with the following changes: "Art. 23. It is allowed direct or indirect participation, including control, of companies or foreign capital in health is permitted in the following cases: I - donations from international organizations linked to the United Nations, technical cooperation entities, and financing and loans cooperation entities; II - legal entities intended to install, operationalize or operate: a) general hospital, including philanthropic, specialized hospital, polyclinic, general clinic and specialized clinic; and b) family planning actions and research; III - health services maintained by companies, with no profit intention, to care of their employees and dependents, without any burden for social security; and IV - other cases foreseen in specific legislation. "(NR) "Article 53 -A. As health actions and services, health care supporting activities are those developed by human genetics laboratories, production and supply of medicines and health products, clinical analysis laboratories, pathological anatomy and diagnostic imaging and are free to the direct or indirect participation of companies or foreign capital. " 12

RECENT RELEVANT FACTS IN BRAZIL TO CONSIDER Index 2. World Investment Prospects Survey 2012 -2015 places Brazil in 5 th place among the most attractive countries for future foreign investments. PROFILE Brazil has been pointed by international organisations as an attractive country foreign investment, despite the recent economic events and the current economic situation that the country is going through. 3. Foreign investments in Brazilian health as well as consolidation movement of Brazilian players. Our research has shown foreign investments coming in as well as some consolidation movements by Brazilian players. A coupe of examples are: • 2012 - The American owned company United. Health purchased 90% of the brazilian company Amil Health Insurance for R$10 billion. The deal was approved by regulating entities (National Health Agency - ANS) and included Amil’s 22 hospitals, based on the argument that the hospitals were privately owned by Amil and used as a way to reduce costs. • 2015 - Purchase of part of D'Or São Luiz Network, Brazil's largest private healthcare group, by private equity fund manager Carlyle and the Singapore Sovereign Wealth Fund. This post-law change. o Apr/15 - Private equity fund manager Carlyle purchased 8% of D’Or Network for R$ 1. 75 billion, the first major transaction in the segment in Brazil after federal government allowed the entry of foreign capital into the hospital sector. o May/15 - Singapore's sovereign wealth fund bought 16% of D’Or for R$ 3. 3 billion. * D’Or Network operates 27 hospitals in four Brazilian states, with revenues of R$ 5. 5 billion in 2015 and earnings before interest (Ebitda) of R$ 930 million. These are a few relevant fact that we understand should be monitored: the consequences of this new law and foreign investments entering Brazil. 13

THE HEALTH CARE MARKET IN BRAZIL Index PROFILE OVERVIEW According to the Brazilian Institute of Geography and Statistics (IBGE), the final consumption of health goods and services totalled R$424 billion in 2013, equivalent to 8% of the Gross Domestic Product (GDP). Government consumption expenditures reached R$ 190 billion, or 3. 6% of GDP. In 2013, of the total final consumption of health goods and services, 77. 6% went to service consumption and 20. 6% to medicines. Expenditure on final consumption of health goods and services accounted for 18. 9% of total government final consumption and 7. 1% of total final household consumption. The health system in Brazil is made up of the public health services, who must provide service to any needy citizen, and private health organizations, who are contracted by private business organisations (health insurance is part of employment benefits) and citizens. In addition, private health organisations are also contracted by the government in order to increase service capacity within the public health system. All public health system (including the portion contracted from private companies) together form the Unified Health System (UHS), which covers hospitals, inpatients, outpatients, and the promotion of public health, and provides comprehensive healthcare. 80% of hospitals that provide services under the wing of the UHS are private. Although health care is not part of the scope of Intelligence Hub’s work, it is important to contextualize how the private health insurance market is presented and how it is inserted in the context of health and active ageing. According to the ANS - National Health Agency (regulating agency), we have the following numbers: • Medical Plan Beneficiaries: Jun/16 = R$48. 5 million, presented a decrease of 3. 3% over the same period the year before. This fall is due to the economic crisis and the cut of jobs, since 90% of the plans are provided by businesses (employment benefits). • Dental Plan Beneficiaries: Jun/16 = R$22 million, presented an increase of 1. 9% over the same period the year before. Plans are cheaper and are optional. This is a market with great business potential, considering a very low penetration rate of around 25% for health insurance and 11% for dental insurance. The ANS - National Health Agency estimates that the Brazilian private health market will reach about R$ 118. 3 billion in revenue in 2016. 14

THE HEALTH CARE MARKET IN BRAZIL Index Opportunity PROFILE • A market with great potential for health services provision, within three non-exclusive potential business models: 1. Investments in local health services companies; 2. Performing as a service or product provider for local health services companies; 3. Be a health service provider in Brazil – enter the market with your own operation. Example: The Intermedia Group Notre. Dame (GNDI) will go through an IPO – stock options opening, which is expected to take place in 2017. Intermédica is a local health service group established in 1968 and was bought out by the private equity fund Bain Capital in 2014 for about R$2 billion. • Considering the health care market is under penetrated and with investments made mostly by individuals, there is space to pursue business opportunities that help improve the performance of single health care system, Internet of Things (Io. T), telehealth, medical big data and electronic health / medical records. • The health market focuses on three pillars: lowering costs, improving performance, and access to information. Thus, any initiative that covers theses pillars shall have effectiveness. Some important information: • About 87% of health plan beneficiaries are up to 59 years of age and only 13% of beneficiaries are considered elderly (60 years old and up); • São Paulo and Rio de Janeiro have coverage rates of 43% and 35%, respectively. • In Brazil, 47. 5% of the final health bill is sustained by the government, against 52. 5% of the bill by the citizen. On the other hand, world average ratio is exactly the opposite: 57. 6% of health spending is sustained by governments, compared to 42. 3% paid by citizens; • Despite the difference between health spending in Brazil and the relationship with the rest of the world, WHO - World Health Organisation points out that Brazil has made some progress in recent years. In 2000, 4. 1% of the government's national budget went to health. In 2012, this rate reached 7. 9%. In the world, however, WHO data shows that, on average, governments allocate 14% of their national health budgets. In rich countries, the rate is 16. 8%. • In total, 9. 5% of the Brazilian Gross Domestic Product (GDP) was destined for health in 2012, against 7. 2% in 2000. • Official reports by the Brazilian Ministry of Health reported that the federal budget for health actions tripled between 2004 and 2014, from R$ 32. 7 billion to R$ 92. 6 billion. Sources: WHO, ANS, IBGE and MS 15

Index THE HEALTH CARE MARKET IN BRAZIL THE PHARMACEUTICAL INDUSTRY IN BRAZIL PROFILE According to data from IMS Health and Interfarma, in 2015, the value of medicines sales in Brazil was around R$ 135 billion, considering the three marketing channels - laboratories, distributors and pharmacy retail. There is a strong presence of Brazilian companies among the top 10 largest companies, indicating the strength of generic drugs. According to Interfarma, the pharmaceutical industry installed in Brazil only applies 10% of its annual research revenue (about R$ 4 billion), half of what is placed in developed countries, such as the United States, which apply 20% each year In R&D. Ranking Brazil - Pharmaceutical Industry - Top 10 RK Company Sector Control Revenue Growth Profitability 1 Pfizer Pharma USA U$ 866, 5 NA NI NI 2 Hypermarcas Pharma BR U$ 806, 7 -0, 70% U$ 143, 4 6, 50% 3 Roche Pharma SU U$ 790, 9 3, 10% U$ 73, 3 NA 4 Novartis Pharma SU U$ 735, 1 -6, 50% U$ -103, 1 -74, 60% 5 Sanofi-Aventis Pharma FR U$ 730, 7 31, 80% U$ 50, 8 NA 6 EMS Sigma Pharma BR U$ 566, 3 -5, 00% U$ 33, 4 12, 00% 7 Eurofarma Pharma BR U$ 554, 3 -2, 60% U$ 45, 7 NA 8 Aché Pharma BR U$ 470, 8 2, 70% U$ 111, 9 26, 40% 9 Laboratório Cristália Pharma BR U$ 365, 6 5, 30% U$ 90, 8 19, 30% 10 Astra. Zeneca Pharma SW U$ 330, 1 6, 00% U$ 18, 2 15, 30% 16

THE HEALTH CARE MARKET IN BRAZIL Index THE PHARMACEUTICAL INDUSTRY IN BRAZIL PROFILE Our research did not identify a specific industry focus on the elderly. What exists are lines of drugs most used by the elderly, due to more present diseases. The main offers from laboratories are linked to the most common diseases, like the ones below: Cardiovascular System • Heart failure • High blood pressure • Heart attack Respiratory System • Bronchitis • Pneumonias Digestive System • Ulcers (dural and gastric) • Cancer of the Stomach and Colon • Constipation Urinary System • Hyper prophylaxis and prostate cancer • Urinary Tract Infection Hematologic System • Anaemia • Leukaemia and lymphomas Nervous System • Dementias: Alzheimer's disease, Vascular dementia and Parkinson's • Cerebral Vascular Accident, Thrombosis and Cerebral Embolism Endocrine and Metabolic System • Diabetes mellites • Thyroid disorder • Dehydration Rheumatology and Bone System • Arthrosis • Osteoporosis • Rheumatoid arthritis • Fractures (hips, radius, humerus) The Brazilian Institute of Geography and Statistics (IBGE) 2010 census data (a 10 year period census) analysed the mortality rate in the elderly population. Considering groups of diseases, it was verified that the highest frequency of deaths is due to diseases of the circulatory system, neoplasia’s (tumours) and diseases of the respiratory system. However, the causes of death with the highest percentage increases were mental disorders (increase of 455%) and nervous system diseases (394%), pointed out as consequences of life expectancy increase (longevity) and greater elderly mobility (at cities not well prepared for such mobility increase and houses that have not been adapted to the needs of the elderly, such as the installation of safety bars in toilets, the removal of furniture that can cause falls, etc. ). Also significant was the increase of 81. 86% in deaths due to external causes (accidents, violence etc. ), which may mean that the elderly is taking advantage of the best health conditions for greater movement and urban mobility, which exposes them equally to greater risks. Deaths from falls increased by 437% for people over 60, while in traffic accidents the increase was 345%. In this context of mortality, opportunities are opened to explore active ageing in the states of SP and RJ. 17

THE HEALTH CARE MARKET IN BRAZIL Index THE PHARMACEUTICAL INDUSTRY IN BRAZIL Opportunity PROFILE In terms of diseases and mortality for the elderly, there are 3 lines to be considered for investments in studies of molecules, drugs, treatments and solutions: 1. High incidence - diseases of the regulatory systems, neoplasia / tumours and respiratory system; 2. Exponential growth - diseases of mental disorders and diseases of the nervous system; 3. External accidents - accidents, falls and run over. The direction of the investments is being channeled by all actors due to the incidence of diseases, enlargement of them and reasons for accidents. These 3 items above are catalysts. Corporate investments (large corporations and startups) can be directed at issues related to the highest elderly mortality in Brazil. However, it must be evaluated by Dutch entities and entrepreneurs, within their particular needs and interests. All public policies, business investments and civil society converge to a lesser or greater degree in this sense. This points to where government and business efforts are being channelled and presents opportunities for the Netherlands not only in identifying strategies to monetize relatioships with businesses and universities (USP, UNICAMP, UFSCAR UFRJ, UERJ and UFF – reference on chapter SCIENTIFIC PRODUCTION) as well as in the issues and challenges being posed for the active ageing in the states of São Paulo and Rio de Janeiro (High Incidence diseases, Exponential Growth Diseases and External Accidents). 18

THE HEALTH CARE MARKET IN BRAZIL Index PROFILE THE GERIATRICS MARKET IN BRAZIL According to the study “Demografia Médica no Brasil 2015” (Medical Demography in Brazil 2015, Geriatrics ranks 43 rd, with only 0. 4% of the total number of specialists. Currently, there are 1. 405 geriatricians working in Brazil. The average of the geriatrician is 45. 2 years, with an average time of formation of 21. 2 years, 47. 8% men and 52. 2% women. If we take into account the entire Brazilian population, there are only 0. 7 geriatricians for every 100. 000 people. If we use the same indicator only for the elderly population, estimated at 26. 1 million people (IBGE 2015), there are 5. 4 geriatricians for every 100. 000 elderly, which means one geriatric doctor for every 18. 505 elderly person. The same study pointed to the existence of only 461 geriatricians in the entire state of São Paulo and only 145 in Rio de Janeiro state. Given the low number of geriatricians in Brazil, the elderly are treated by specialists from other areas such as general practitioners, orthopaedists, pulmonologists, and others. Gerontology Courses - According to the Brazilian Association of Gerontology (ABG) there about 18 undergraduate courses in SP (13) and RJ (5). Sources: Medical Demography in Brazil 2015 – institutions USP, CFM, CREMESP, ABG Relevance: ü For the medical segment, taking into account the Brazilian population ageing and the lack of specialized health professionals, these numbers present an opportunity and challenge for training and attracting new doctors and specialists. 19

Index SCIENTIFIC PRODUCTION Summary of works developed in RJ/SP SCIENTIFIC PRODUCTION Healthy Ageing Brazil States of Rio de Janeiro & São Paulo 20

SCIENTIFIC PRODUCTION GLOSSARY Index TERMS & INSTITUTIONS Ø BDTD - The Brazilian Digital Library of Theses and Dissertations Ø BIREME - the Latin American and Caribbean Centre on Health Sciences Information Ø CAPES - Coordination of Improvement of Higher Level Personnel Ø CNPq - National Council for Scientific and Technological Development Ø FAPESP - Foundation for Research Support of the State of São Paulo Ø FINEP - Research and Studies Funding Agency Ø Fio. Cruz - Foundation Institute Oswaldo Cruz Ø MEC - Ministry of Education Ø NASF - Family Health Assistance Nucleus Ø RBGG - Brazilian Journal of Geriatrics and Gerontology Ø SABE - Health, Welfare and Ageing Program Ø Scielo - The Scientific Electronic Library Online Ø UERJ - University of the State of Rio de Janeiro Ø UFF - Federal University Fluminense Ø UFRJ - Federal University of Rio de Janeiro Ø UNATI - Open University of the Third Age Ø UNICAMP - State University of Campinas Ø Unifesp - Federal University of São Paulo Ø USP - University of São Paulo 21

SCIENTIFIC PRODUCTION - GENERAL CONTEXT IN BRAZIL Index ACADEMY In Brazil, there are over 2. 000 higher educational institutions, and 3 types of denomination: “Faculties” (schools of …), University Centres and Universities. According to the Census of Higher Education (MEC), there are 195 educational institutions that fit the Brazilian classification of “University”. Thus, those are the focuses of this report. Universities are spaces that concentrate necessarily three lines of academic activities: Teaching, Research or Scientific Production, and Postgraduate studies (Extensions). Therefore, scientific production in Brazil is concentrated in universities. In São Paulo, there was found 39 universities (20% of the total) and in Rio de Janeiro 17 universities (9% of the total). According to the evaluation of the Ministry of Education (MEC), the evaluation of specialists in the education market and the RUF Survey (University Ranking Folha – a publishing institution) conducted annually since 2012, the 3 best universities in Brazil are located in RJ (UFRJ – Federal University of Rio de Janeiro) and SP (USP – São Paulo University and UNICAMP – Campinas University, a city in SP). Below you can find the 3 best universities in RJ and SP in 2016, according to market and MEC evaluation. Top 3 Medicine courses in SP 1. Federal University of São Paulo (UNIFESP) 2. University of São Paulo (USP) 3. State University of Campinas (UNICAMP) Top 3 Medicine courses in RJ 1. Federal University of Rio de Janeiro (UFRJ) 2. Federal University Fluminense (UFF) 3. University of the State of Rio de Janeiro (UERJ) Sources: RUF Survey 2016 – Folha de São Paulo (newspaper and publisher from SP State) 22

STUDIES AND SCIENTIFIC ARTICLES Index ACADEMY The scientific knowledge production is important in order to can advance the understanding of the challenges of. health enrichment. In the field of scientific production, our research mapped information from SABE, SCIELO, BDTD and Elsevier • Description of those four institutions on the two following slides. We raise themes and quantity of knowledge production in the area of longevity. Knowledge Base Quantitative SABE 100 SCIELO 859 BDTD ELSEVIER 1. 269 893 The domain of knowledge produced is quite extensive and is available in the market scan study. In order for us to visualize the most cited words in the publications we use the Tag Cloud method to materialize the related key words, as shown below. The size of the words indicates its relevance 23

STUDIES AND SCIENTIFIC ARTICLES Index ACADEMY In terms of international collaboration, the research in theses four specific databases (SABE, Scielo, BDTD and Elsevier: about 3, 000 articles) showed that only 5% (just over 140 articles) of Brazilian ageing publications and all themes related had an international co-authorship. The main countries with which Brazil has published are: UK (22%), USA (20%), Spain (8%), Canada (5%) and France (5%). The others countries are Australia, Colombia and Uruguay (3% each one), Croatia and Finland (2% each one), Germany, Barbados, Bolivia, Cuba, Japan, Malaysia, Peru, Poland, Sweden and Ukraine (1% each one). The most frequent topics covered in these publications with international co-authorship concern health and disease issues (both physical and mental), social aspects, and food / nutrition. Few articles on technological innovations and scientific research have been identified. The following are some Brazilian articles with international co-authorship: UK: Ethical dimension of mental health care in the public service network USA: Suicide among the elderly Spain: Inadequate intake of nutrients in the elderly population of Brazil Canada: Health-related behavior and quality of life among the elderly Chile: Health research in Brazil: context and challenges Argentina: Age as a prognostic factor in early stage breast cancer Venezuela: Anthropometry of elderly residents in geriatric institutions Netherlands: Comparative health policies: home care for people with dementia and policies related to the care of the elderly in Brazil and the Netherlands 24

STUDIES AND SCIENTIFIC ARTICLES Index SABE. : . Health, Welfare and Ageing Program Linked to the School of Public Health of USP, carries out and publishes several studies on the life and health conditions of the elderly in São Paulo. Since 2005, almost 100 studies and surveys have been published by SABE. ACADEMY We list below some topics of relevance for the scope of this study: • • • • The influence of chronic diseases on the functional capacity of the elderly; Anthropometric Changes in the Brazilian Cohort of Older Adults; Association Between Urinary Incontinence in Elderly Patients and Caregiver Burden; Association between waist circumference value and hypertension, heart disease and diabetes, reported by the elderly; Correlates of change in self-perceived oral health among older adults; Correlates of the incidence of disability and mortality among older adult Brazilians with and without diabetes mellitus and stroke; Functional performance of the elderly in the instrumental activities of daily living; Evaluation of renal function and immune system cells in elderly individuals from SP City; Obesity and abdominal fat of elderly people with diabetes mellitus; Polypharmacy among the elderly in SP city; Falls in the elderly with chronic pain: prevalence and associated factors; Risk of Potential Drug-Drug Interactions among Brazilian Elderly; Undernutrition as a major risk factor for death among older Brazilian adults in the community-dwelling setting. BDTD. : . The Brazilian Digital Library of Theses and Dissertations Aims to gather, in a single search portal, theses and dissertations defended throughout Brazil and by Brazilians abroad. The BDTD was conceived and is maintained by the Brazilian Institute of Science and Technology Information (IBICT) within the scope of the Brazilian Digital Library Program (BDB), with the support of the Research and Studies Funding Agency (FINEP). In the BDTD library, there are 837 dissertations and 432 theses with theme related to ageing, longevity, elderly, Elderly life quality, among others correlated. In quantitative terms, the largest generators of these contents / publications in SP and RJ are: • • USP - University of SP: 188 State University Paulista: 131 Campinas University: 108 Pontifical Catholic University (SP Campus): 67 • Federal University of SP: 13 • Fiocruz: 12 • State University of RJ: 11 25

STUDIES AND SCIENTIFIC ARTICLES Index ACADEMY Scielo. : . The Scientific Electronic Library Online It is an electronic library covering a selected collection of Brazilian scientific journals. The library is an integral part of a project being developed by FAPESP - Foundation for Research Support of the State of São Paulo, in partnership with BIREME - the Latin American and Caribbean Centre on Health Sciences Information. Since 2002, the Project is also supported by CNPq - National Council for Scientific and Technological Development. The Project foresees the development of a common methodology for the preparation, storage, dissemination and evaluation of scientific literature in electronic format. Scielo's basis has 859 publications with theme longevity, with several approaches, among which the object of this study are those related to: • • • Public health (35) Multidisciplinary and applied psychology (23) Policies and health services (22) Sociology (19) Geriatrics and gerontology (13) Nursing (12), Cardiac and vascular system (7), Orthopaedics (7) General medicine (4) Psychiatry (4) Anthropology (3) Clinical neurology (2) • • • Intensive medicine (2) Pharmacology (2) Rehabilitation (2) Rheumatology (1) Health sciences and services (1) Nutrition and dietetics (1) Ophthalmology (1) Respiratory system (1) Biomedical sciences (1) Urban studies (1) Urology and nephrology (1) Elsevier World-leading provider of information solutions that enhance the performance of science, health, and technology professionals, empowering them to make better decisions, deliver better care, and sometimes make ground-breaking discoveries that advance the boundaries of knowledge and human progress. In the Elsevier publications database, there are 893 articles and research published with theme ageing & Brazil. 26

STUDIES AND SCIENTIFIC ARTICLES Index ACADEMY CENTRAL THEMES OF ACTIVES AGEING IN SP AND RJ STATES Research and analysis showed some important topics or domains of knowledge in SP and RJ when it comes to healthy ageing. Thus, when considering potential investments in technology, these topics should be considered and investigated. These are the most comprehensive issues that we face in our survey. They appear quite as much in the sphere of government, studies, companies, society and startups. 1. Information sharing: • Physician-patient digital communication (closing-up); • Integration of medical information – disease history, medicines used (prescribed and non-prescribed), and so on; 2. Monitoring and accompaniment needs systems; 3. Remote assistance in the social interaction of the elderly, and in physical and cognitive exercises (e. g. games); 4. Physical accessibility (public and home infrastructure); 5. Domótica = home automation concept (“Domus” + “Robotics” = robotics at home); 6. Formal training of professionals that deal directly with the elderly (including the ability to recognize and support elderly with more serious illnesses); 7. Society preparation to deal with relatives, friends and neighbors who are elderly and with more serious illnesses (e. g. dementia, Parkinson's, and so on). 27

ACADEMY STUDIES AND SCIENTIFIC ARTICLES Index In Brazil, the performance of universities and research institutions in theme of Ageing is essentially within two spheres: Technological and Social. However, in the Technological sphere, investments in innovation, scientific research and practical studies are still small in the face of the Brazilian reality (elderly population size and needs). Institutions to be highlighted are The University of São Paulo (USP), in São Paulo, and Fiocruz, in Rio de Janeiro. Fiocruz: linked to the Ministry of Health, it’s the most prominent institution of science and technology in health in Latin America, promotes health and social development, generates and disseminates scientific and technological knowledge. On the other hand, actions aimed at promoting elderly socialization, knowledge expansion, intergenerationality, and the maintenance of an active life are quite expressive, mainly due to the own effort of the “Open Universities of the Third Age”, a type of concept implemented by several higher education institutions in Brazil. Elderly related activities within universities and educational institutions take place in two scenarios: 28

Academy / TECHNOLOGY LINES OF ELDERLY RESEARCH IN BRAZIL Index With a scenario of broad ageing process of the Brazilian population, the production of studies and publication of academic articles on the subject has become exponential in recent years. The scientific researches and technological innovations of Brazilian public universities suffer from the lack of resources for investments. In many cases, they are moving forward through partnerships with private companies and universities in other countries, such as the Netherlands and USP. While Groningen has strong performance in technological research, and the Netherlands wants to create more structured long-term partnerships than the current ones (more bilateral between researchers), Brazil has a series of financial restrictions for investment in state-of-the -art research In public universities. These are a few themes of the most relevant research lines of these 3 most relevant institutions. 29

Academy / TECHNOLOGY LINES OF ELDERLY RESEARCH IN BRAZIL Index Below we will briefly discuss some of the most relevant research lines of renowned institutions in Rio de Janeiro and São Paulo on the ageing processes of human population and its impacts on society. Physical weaknesses The study aims to evaluate the effects of strength training and the intake of protein and amino acid on the skeletal muscle. The study, conducted in partnership with the School of Physical Education and Sport (EEFE) of USP – University of São Paulo, aims to seek effective strategies to combat the physical weaknesses common to ageing through the combination of exercise and nutrition. Mental Weaknesses A group of researchers from the Department of Pharmacology at the Institute of Biomedical Sciences (ICB) at USP is a pioneer in showing the involvement of DVL-2 protein in the ageing process. The decrease of this protein in the cell favours the vulnerability of the neurons and contributes to the maintenance of the chronic inflammation of the nervous system. The socalled neuroinflammation, so common in the elderly, appears to be a major factor in the emergence of neurodegenerative diseases, such as Alzheimer's and Parkinson's. Foods that prevent ageing A research by the School of Pharmaceutical Sciences (FCF) of USP has identified that substances present in black soybeans are better than yellow soybeans to prevent ageing. Black soybeans have the same nutritional qualities as yellow beans, but have double antioxidant activity and help prevent cell degeneration. Design thinking for the elderly Accessibility, proper orientation plates, increased traffic light times, driver education, bus collectors and attendants at various service counters, well paved sidewalks, mobility in the city and understanding how we can improve our Capacity of autonomy as we age. These are all factors incorporated into the Ambience and Ageing research project. "At the moment when all the environmental stimuli are perceived, from those that are within the private space to those that are present in the great collective spaces, it is considered that these impacts can favour or disfavour the healthy ageing. In order to find solutions capable of mitigating the effects of urban life on the daily life of the elderly, the study takes into account the environment and its effects on the elderly - and how the practice of strategic design can intervene in this situation. 30

LINES OF ELDERLY RESEARCH IN BRAZIL Index Academy / TECHNOLOGY Biomarkers Research carried out at the Institute of Biomedical Sciences (ICB) and the School of Pharmaceutical Sciences (FCF) of USP aims to show that there are ways to peripherally evaluate (e. g. by blood tests) what occurs in the central nervous system. The researchers were able to identify three compounds present in the blood associated with brain aging and that may in the future open the way for early identification through blood tests, diseases such as Alzheimer's and dementias. The researchers studied three compounds present in the body whose levels vary with aging: cyclic guanine monophosphate (cyclic GMP), nitric oxide synthase (NOS) and thiobarbituric acid reactive substances (TBARS). Neuroimaging, Neuro nano biotechnology and Neurostimulation Aimed at research and therapeutic applications in neurosciences focused on the study of ageing, the research line emphasizes the investigation of mechanisms of neurological disease and prognoses through functional neuroimaging, new molecular imaging techniques, electrophysiology, Neurostimulation, identification of genetic factors associated with the appearance and evolution of several neurological diseases, besides the possibilities of therapeutic applications of new pharmacological agents, brain implants and possibilities of use of stem cells and applications of nanobiotechnology 31

LINES OF ELDERLY RESEARCH IN BRAZIL Index Academy / TECHNOLOGY ALBERT EINSTEIN ISRAELI HOSPITAL (São Paulo) The institution invests in research in the most diverse segments of medicine. We highlight three important sectors related to human ageing: Cardiology, Neurology and Orthopaedics / Rheumatology. Cardiology The research lines of the NAPEC - Nucleus of Support to Cardiovascular Research guide the scientific production in the cardiology department of the Albert Einstein Israeli Hospital, and are based on the institutional theme of ageing. In addition to behavioural cardiology, the other lines of research in activity are: • Economic Analysis in Cardiology • Cardiac Arrhythmias • Atherosclerosis / Vascular Calcification • Behavioural Cardiology • Exercise Cardiology • Cardio-oncology • Peripheral Vascular Disease • Cardiac insufficiency • Cardiovascular intervention • Cardiovascular Prevention Responsible: Dr. Marcelo Katz, Coordinator of the Nucleus of Cardiovascular Research Support E-mail: mkatz@einstein. br Tel: +55 (11) 2151. 9408 32

LINES OF ELDERLY RESEARCH IN BRAZIL Index Academy / TECHNOLOGY ALBERT EINSTEIN ISRAELI HOSPITAL (São Paulo) NEUROLOGY Created in 2004, the Einstein Integrated Neurology Program monitors and supervises good Neuroscience practices within the Brazilian Israeli Society Albert Einstein. The objective is to ensure excellence in diagnosis, promotion of the best treatments, qualified rehabilitation and prevention and education of patients. The Program also adopts a policy of continuous interaction between neurologists, neurosurgeons, clinicians, psychiatrists and neuro-radiologists. Main areas of activity: • Stroke • Alzheimer's and other dementias • Sleep disorders • Neuromuscular diseases • Epilepsy • Multiple sclerosis and demyelinating diseases • Neurooncological • Parkinson's and other movement disorders Some productions and researches of Neurology: • Dural arteriovenous fistula and cerebral venous thrombosis. • Brazilian consensus on guidelines for diagnosis and treatment for restless legs syndrome. • Physiological Effects of Mind and Body Symptomatic Cerebral Vasospasm and Delayed Cerebral Ischemia Following Trans sphenoidal Resection of a Craniopharyngioma. • Temporopolar blurring in temporal lobe epilepsy with hippocampal sclerosis and longterm prognosis after epilepsy surgery. • Interference of blood pressure control within 24 h in acute ischemic stroke. Systematic review and meta-analysis. Responsible: Dra Gisele Sampaio Silva, Medical manager Tel: +55 (11) 2151. 3555 33

LINES OF ELDERLY RESEARCH IN BRAZIL Index Academy / TECHNOLOGY ALBERT EINSTEIN ISRAELI HOSPITAL (São Paulo) ORTHOPEDICS / RHEUMATOLOGY The research lines of the orthopaedic team seek the development of studies related to the locomotor system, culminating with the scientific production. The main lines of research are: Cell Therapy - Experimental Research The projects under development in the field of experimental research analyse the cellular and molecular mechanisms involved in diseases of the locomotor system. Our studies explore alternative therapies such as the use of mesenchymal stem cells, active biomolecules, synthetic frameworks and blood biomarkers. The results obtained will contribute to the elucidation of innovative alternative therapies. The projects in this area are carried out in partnership with the IIEP (Israeli Institute of Education and Research). Managed Protocols of the Orthopaedic Program The objectives of the projects related to this area of research aim to establish data that allow to create guidelines for the best treatment of the patients. This aims not only at research, but mainly at improving medical practice. Evidence-based Orthopaedics and Rheumatology Evidence-based orthopaedics and rheumatology assist in patient care planning based on publications of adequate quality and with low risk of bias. Although more reliable estimates of the effect of an intervention come from studies with an adequate level of evidence, there a number of challenges to the adequacy of this philosophy in orthopaedics and rheumatology. Bone tumours: Early diagnosis by imaging Line of research that studies the treatment of bone and cartilage tumours, such as complications of surgeries, local recurrences, rehabilitation of patients and evaluation of the quality of life of patients with tumours and skeletal metastases. Responsible: Dr Mario Ferretti Filho, Medical Manager Tel: +55 (11) 2151. 4586 34

LINES OF ELDERLY RESEARCH IN BRAZIL Index Academy / TECHNOLOGY FIOCRUZ (Rio de Janeiro) Mapping of Successful State and Municipal Experiences for Elderly Ageing and Health Fiocruz created the mapping program of successful experiences in the area of ageing and health of the elderly. This is an initiative that since 2013 has included the annual agenda of the Health Coordination of the Elderly Person (COSAPI / DAPES / SAS) of the Ministry of Health, in partnership with the Institute of Communication and Scientific and Technological Information in Health (ICICT / Fiocruz). Its objective is to knowledge and give visibility of municipalities and states good practices in the field of health of the elderly. Consequently, it is hoped to encourage managers to promote strategies and actions that contribute to qualify care for the elderly in the Unified Health System. Since 2013, every year, about 100 projects and initiatives take part in the mapping. Here are some of the most relevant themes of 2016: • Literacy for the elderly: tool in the construction of the health process • Characterization of the socio-demographic and health profile of the elderly assisted by the NASF (Family Health Assistance Nucleus) and actions developed to assist them in basic care. • Early detection of chronic kidney disease in the elderly • Friend of the Elderly Hospital • Comprehensive Health Care for the Elderly - Preventive Strategies and Health Promotion • Dental care for the elderly • Self-caribbean: theories and practices of good aging. • Avoiding falls of the elderly in areas of disordered occupation • Intra-family violence to the elderly 35

LINES OF ELDERLY RESEARCH IN BRAZIL Index Academy / TECHNOLOGY FIOCRUZ (Rio de Janeiro) Post-graduation Fiocruz The institution created the mapping program of successful experiences in the area of ageing and health of the elderly. Stricto Sensu post-graduation teaching at Fiocruz is offered through 32 programs recognized by CAPES, in the academic (22 programs) and professional (10 programs) modalities. In addition to these courses, Fiocruz associates with other institutions to offer five postgraduate programs. Some relevant postgraduate courses in health: • Biodiversity and health • Cellular and molecular biology • Biosciences and biotechnology in health • Bioethics and collective health • Biotechnology in Health and Investigative Medicine • Health Sciences • Epidemiology in Public Health • Research and Development in the Pharmaceutical Industry • Public Health Policies • Immunobiological Technology Publications and research Fiocruz In Fiocruz online library, there are more than 50 articles, researches and publications with the ageing theme. Among these, we can highlight: • Sociology of ageing • Ageing and health of the elderly • Endocrinology of ageing • Health-disease process in ageing • Immunology of ageing • Productive and healthy ageing • The contemporary elderly and the process of biological, psychological and social ageing 36

Academy / TECHNOLOGY: SCIENTIFIC PUBLICATION - AGEING IN BRAZIL Index The State University if Rio de Janeiro (UERJ), through the “Open University of the Third Age” (UNATI), publishes the Brazilian Journal of Geriatrics and Gerontology (BJGG), a journal specialized in scientific production with the objective of contributing to the deepening discussions on of issues relevant to human ageing. The journal is published every two months in Portuguese, English and Spanish, and it’s available online in the electronic address: http: //www. rbgg. com. br/ Attention point: this is a publication that should be monitored continuously. 37

Academy / TECHNOLOGY: SCIENTIFIC PUBLICATION - AGEING IN BRAZIL Index The SABE Program (Health, Welfare and Ageing), linked to the School of Public Health of USP, carries out and publishes several studies on the life and health conditions of the elderly in São Paulo. Since 2005, almost 100 studies and surveys have been published by SABE. We list below some topics of relevance for the scope of this study: • The influence of chronic diseases on the functional capacity of the elderly • Anthropometric changes in the Brazilian cohort of older adults • Association Between Urinary Incontinence in Elderly Patients and Caregiver Burden • Association between waist circumference value and hypertension, heart disease and diabetes, reported by the elderly • Correlates of change in self-perceived oral health among older adults • Correlates of the incidence of disability and mortality among older adult Brazilians with and without diabetes mellitus and stroke • Functional performance of the elderly in the instrumental activities of daily living • Evaluation of renal function and immune system cells in elderly individuals from São Paulo City • Obesity and abdominal fat of elderly people with diabetes mellitus • Polypharmacy among the elderly in the city of São Paulo • Falls in the elderly with chronic pain: prevalence and associated factors • Risk of potential drug-drug interactions among Brazilian elderly • Undernutrition as a major risk factor for death among older Brazilian adults in the community-dwelling setting Free translation: SABE - Health, Welfare and Ageing 38

SOCIAL INTEGRATION : THIRD AGE UNIVERSITIES Index Academy / SOCIAL GENERAL CONTEXT Education until recently was directed exclusively to the younger population, because it was believed that the human being would develop initially in childhood (First Age), during the adult phase (Second Age) would reach its maximum of development and, in old age (Third Age), development would no longer occur. However, today we know that this is not true. Human beings develop throughout the entire life and, despite the changes linked to ageing, the third age can be lived with advances and achievements. In this context, in France, in 1973, Pierre Vellas, a university professor, confirmed that the educational opportunities offered to the elderly were almost non-existent. Thus, he decided to open the University of Toulouse’s doors to all elderly, without distinction of income or schooling, offering programs with intellectual, physical, cultural, artistic and leisure activities particularly adapted. Removing the elderly from isolation, providing them with health, energy and interest in life and changing their image before society were, from the beginning, the objectives of the program. From this local initiative on, the program has spread all over the world in such a way that today millions of elderly people from different countries, from different continents, participate in a series of intellectual and cultural activities that contribute to active ageing and, consequently, for a successful ageing process. In Brazil, the first initiative to offer education to mature and elderly adults took place in the 1970 s, where the first Open Schools for the Third Age of SESC (Social Service of Commerce) were established in São Paulo. In 1982, the Federal University of Santa Catarina (a State in the south region of Brazil) became the first institution of higher education in the country to join the movement “Open University to the Third Age”. Currently, Brazil has more than 200 programs nationwide in public and private institutions. In general, the main objectives of these programs and academic institutions are: 1. To promote studies, debates, research and assistance to the elderly population; 2. Advise government agencies in the formulation of specific public policies for the age group over 60; 3. Contribute to raising the levels of physical and mental health of the elderly, using the resources and alternatives existing in the University; 4. To promote courses and workshops for the elderly, aiming at updating their knowledge and integrating them into contemporary society. 39

Academy / SOCIAL INTEGRATION : THIRD AGE UNIVERSITIES Index The courses programs directed to the elderly are quite broad and sometimes the focus is on cultural activities, mental development, general learning and socialization. There are currently over 50 different types of courses and workshops available. The most popular are theater workshops, art therapy, handicrafts, singing, chromotherapy, body and movement workshops, dances, gymnastics and yoga, geriatrics, gerontology and aging, food and nutrition, environment and health, elderly rights, entrepreneurship Social, computer science, foreign languages, photography, games (chess, for example), narrative and memory, among others. RIO DE JANEIRO. : . Lines of Elderly Social Integration Activities The main teaching institutions in RJ that have the program university for the elderly are as follow. • Has a nucleus connected to Pedro Ernesto Public Hospital (UERJ Medical School) - Elderly Care Nucleus (NAI); • Provide comprehensive care for the elderly; • Produce social responses to address the issues of Brazilian population ageing. • Brings together professionals of geriatrics and gerontology, social service, law, economics; • No link with the Medicine School; • Only cultural extension courses; • No link with the Medicine School. The only Un. ATI with close ties to a medical school it’s the State University of Rio (Un. ATI of UERJ). It has a Nucleus of Elderly Attention at the Pedro Ernesto Hospital. It’s director is specialized in gerontology and geriatrics, which may translate into greater chances of approximation by foreign institutions focused in the medicine and health aspects. The remaining Un. ATIs have no connection with medical schools. 40

SOCIAL INTEGRATION : THIRD AGE UNIVERSITIES Index SÃO PAULO. : . Lines of Elderly Social Integration Activities Academy / SOCIAL The main teaching institutions in SP that have the program university for the elderly are as follow. • It’s part of the Pro-rectory of culture and extension; • No link with the Medicine School. • University extension project, linked to the Community Social Integration Program; • Activities are developed in the different university units of UNESP (interior of SP State); • Has no link with Medical School. • Coordinated by the Social Services School, emphasizing the social aspect 41

Index PUBLIC POLICIES Summary of the main impacting public policies PUBLIC POLICIES Healthy Ageing Brazil States of Rio de Janeiro & São Paulo 42

PUBLIC POLICY GLOSSARY Index TERMS & INSTITUTIONS Ø BPC - Continuous Care Benefit Ø Help. Age International - international NGO (non-governmental organisation) that helps older people claim their rights, challenge discrimination, and overcome poverty, so that they can lead dignified, secure, active and healthy lives. Organisations from Canada, Colombia, Kenya, India and the United Kingdom set up the NGO in 1983 to provide a network to support older people worldwide. Help. Age International has offices in London and Brussels. Ø IBPT - Brazilian Institute of Planning and Taxation Ø Law 12. 213: in force since January 2011, created the National Citizenship Fund authorized the deduction of income tax by individuals and legal entities that donate to the municipal, state and national funds towards specific public policies. Ø RJ = Rio de Janeiro State Ø SP = São Paulo State 43

PUBLIC POLICIES (PP) – GENERAL CONTEXT Index The Federal Government in Brazil defines the Public Policies, which are considered great guidelines. In turn, even though States and Municipalities/Counties have an autonomous political administration, all must develop and implement public policies initiatives in order to fulfil or attend those federal policies, using those guide lined federal policies. In summary, states and municipalities do not create large public policies, but are responsible for implementing many policies defined by the Federal Government. PUBLIC POLICES Overview In order to better understand the Brazilian Public Policies (PP) for the elderly population, it is important to the aware of the relationship between the administrative spheres or levels in Brazil and how they are interconnected - federal, state and municipal or county governments. Considering Brazil has 26 states + the Federal District (capital), and 5570 municipalities or counties within those states, there lots of players or individual decisions between these many counties Historically, Brazilian public policies have had a welfare or assistance (aid) nature. This practice is no different in the context of the ageing and health. Thus, investments in scientific research to improve elderly life quality are in second plan, in the background. Disease prevention based on the development of state-of-the-art technology is not a focus on Federal Government initiatives. The focus of care with the elderly focuses on the creation of public policies that seek the implementation and fulfilment of social assistance actions. 44

PUBLIC POLICIES (PP) – GENERAL CONTEXT Index Considering Federal Public Policies, there can be consider three attention points: PUBLIC POLICES Overview As far as Healthy Ageing and Elderly, most policies are defined within the Federal sphere, but in most cases the responsibility for implementation and management is transferred to the states and municipalities. In that scenario, many of these policies are created, but are not implemented due to lack of goals, deadlines and dedicated financial resources by the lower administrative spheres – States and, specially, Municipalities. 1. Lack of Sinergy among ministries and entities that lead to energy and financial expenditure; 2. Poor application of PP by states and counties; 3. Budget limitation my most counties. There is a lack of structure to enforce laws and implement such policies in practice. The difficulty is in implementing what is defined by these policies. Regions where elderly reside and public services function, especially in the richer municipalities, the situation is more favorable. But where public service network is working precariously or does not exist, the elderly suffer from this lack of resources. 45

Major Areas of Federal PPs PUBLIC POLICIES (PP) – GENERAL CONTEXT Index Before going specifically into the laws implemented in Brazil for the treatment and care of the elderly population, it is necessary to recognize that there were created two sets of assistance actions of extreme relevance and that they are the guidelines and the basis of several later policies: The Elderly Statute and the Pact for Life. The Elderly Statute, created in 2003, is a set of Federal Government guidelines designed to regulate the rights granted to the elderly. These guidelines deal with three main points in essence: 1. health care; 2. minimum wage assistance for every elderly person on the poverty line; and 3. criminalization of elder abuse. The Pact for Life, created in 2006, deals with a set of commitments related to health, but is not exclusively designed for the elderly. A special chapter has been assigned to 1. Elderly health. In addition to the elderly, the Pact for Life also prioritized other issues such as: 2. Cervical and breast cancer; 3. Infant and maternal mortality; 4. Emerging diseases and endemics, with emphasis on dengue, leprosy, tuberculosis, malaria and influenza; 5. Health promotion; and 6. strengthening basic health care. At the Federal level, we can categorize, even if freely, public policies in the following major areas: Financial Assistance, Transportation, Health, Housing, and Education. There are still Other Policies that are more dispersed and do not fit into these groups. In each of these categories, there a group of social policies aimed at assisting the elderly population, aiming at ensuring life quality and inclusion in society. Some of the policies attend to more than one group, but this is an attempt to organize those policies created by different Ministries and federal entities, many without synergy among themselves and/or overlapping one another. 46

PUBLIC POLICIES (PP) – GENERAL CONTEXT Index Major Areas of Federal PPs The following federal policies for the elderly stand out at the federal level. FINANCIAL AID – currently, the government created the BPC: • Continuous Care Benefit (BPC): guarantee of a minimum monthly wage to the elderly of 65 and over who proves that they do not have the means to guarantee their own livelihood or do not have it provided by their family. TRANSPORTATION – resumes into: • Collective transportation system: guarantees the elderly with equal or less than two minimum wages monthly, two free seats in each vehicle / bus, railroad train or vessel within the conventional interstate passenger service. HOUSING – comes down to two initiatives: • Program My Home, My Life: financing of low-income housing for the poor - guaranteed housing for the elderly within the program; • Accessibility Projects: initiative to support the implementation and adaptation of urban infrastructure, to provide accessibility to people with mobility and disability restrictions. EDUCATION – in general, covers these two goals: • Program "Literate Brazil" (PBA): literacy of young, adults and elderly people; • Course "Elderly Care": addition to the National Catalogue of Technical Courses. 47

Major Areas of Federal PPs PUBLIC POLICIES (PP) – GENERAL CONTEXT Index HEALTH – below is a list of programs and actions that touch upon disease prevention, medication, basic health, physic and mental health, living: • Violence prevention against the elderly and humanized care for the elderly victim of violence; • Fall Prevention: purpose of reducing hospitalizations from femur fracture; • Programs "Popular Pharmacy" and "Health has no Price": free and / or discounted drug distribution programs for the general population; • Program "National Immunization": vaccination against influenza for the elderly; • Basic Health Unit (UBS) - home visits for registration and monitoring of population, with priority for the elderly; • Program "Health Academy": implementation of health academies, also known as "Third Age Academies"; • National Food and Nutrition Policy (PNAN) - aimed at eating habits and healthy lifestyles for the elderly; • Program "Better at Home": multi professional and humanized care at home, aimed at people in need of motor rehabilitation, elderly, chronic patients without aggravation or in a post-surgical situation. Attention Points: Ø Health PPs themselves cover primary care, prevention, as well as welfare/assistance profile of Brazilian policies. However, researches indicate that states and municipalities do not implement them adequately or that it’s not applied to satisfaction. Ø Different municipalities within the states of SP and RJ have very distinct budgets. Thus, when we move outside Rio de Janeiro and São Paulo city / municipalities, budgets worsen, the PPs applicability worsen. OTHER POLICIES – include: • Program "Healthy Living": to democratize leisure and recreational sports, prioritizing the protagonism of the ageing person; • Program "Travel More Better Age" / Affordable Tourism: promote social inclusion of the elderly, retirees and pensioners, providing the opportunity to travel and carry out tourism; • Digital Inclusion: implementation of telecentres, free public access, with computers connected to the internet. 48

International Visibility FEDERAL PUBLIC POLICIES – International Visibility Index Brazil ranked 31 st position of countries that offer better life quality and well-being to people over 60, according to the Global Age. Watch Index 2013 of the non-governmental organization Help. Age International, which advocates for the rights of the elderly. Global Age. Watch Index ranks over 200 countries by how well their ageing populations are faring. It is based on those four domains or key enablers of elders well-being: income, health, capabilities, and enabling environments. The Income domain considers: pension coverage, old age poverty rate, relative welfare and GNI per capita. The indicators of Health are: life expectancy at 60, healthy life expectancy at 60 and relative psychological/mental wellbeing. Employment of older people and education attainment are considered in Capability. And finally, Enabling environment considers social connections, physical safety, civic freedom and access to public transportation. By Global Age. Watch Index 2015, Brazil dropped down to the 56 th position. Brazilian ranking in the Global Age. Watch Index of each key area Income considers: pension coverage, old age poverty rate, relative welfare and GNI per capita. Health considers: life expectancy at 60, healthy life expectancy at 60 and relative psychological/mental wellbeing. Capability considers: Employment of older people and Education attainment. Enabling Environment considers: social connections, physical safety, civic freedom and access to public transportation. Attention Point: In addition of this worsening condition, our research indicates that this Index does not evaluates other variables that may improve elderly life, such as scientific research and technological advances, . Thus, Brazil could be in a even worst position. 49

Index STATE PPs STATE PUBLIC POLICIES Now looking into SP and RJ states, both should follow the Federal guidelines, but poorer counties have more difficulty to implement welfare type of policies under their responsibility. Both States have large amounts of counties: SP – 645 and RJ – 92. RIO DE JANEIRO STATE These are PPs by RJ State gathered in group in the same manner as we did with the Federal Policies. We used to total of 10 groups, representing a wide variety of policies. 1. HEALTH • Creation of the Medical, Social and Elderly Care Census in the RJ State; • Creation of the Elderly Immunization program; • Creation of the Rio State (Fluminense) Geriatrics and Gerontology Institute; • Implementation of Geriatric Diaper Production Program to be distributed free of charge. 2. ELDERLY CARE AND ASSISTANCE • Creation of the special police department for elderly attendance; • Foundation of the Public Defender's Office for the Elderly; • Obligatory assistance care for elderly (60+) in public calamity or epidemic situation. 3. EDUCATION • Implementation of educational content aimed at the ageing process, as well as the respect and appreciation for elderly in the state education network; • Inclusion of "Elderly Rights" in the school curriculum; • Institution of the program of elderly participation in educational and laborious activities called Third Youth. 50

STATE PUBLIC POLICIES Index RIO DE JANEIRO STATE PPs 4. FINANCIAL AID & FEE EXEMPTION • Granting subsidy to low-income individuals or families who are responsible for elderly people in need of special care; • Payment exemption for use of public toilets for people over 65 years of age; • Payment fees exemption for national driver's license renewal for those over 65 years of age. 5. CULTURE ACCESS & TOURISM • Guarantee to the elderly free admission to museums and cultural spaces owned by the State of Rio de Janeiro, sports stadiums and gyms to citizens over 65 years of age; • Discount on price of cinema entrance to citizens over 65 years of age; • Establishment of State Policy to encourage elderly tourism. 6. SOCIALIZATION • Assignment of recreation areas in state schools, on weekends, to elderly groups for use as a leisure area; • Authorization by the State Government to establish agreements with city hall to create "coexistence / cohabitation centres for the third age“. 7. HOUSING & NURSING • Regulation of the preferential allocation of ground-floor apartments in the buildings built by state housing programs; • Establishment of the Substitute Home program of the elderly; • Creation of home-like type of houses designed to accommodate the needy elderly. 8. EMPLOYMENT • Granting of tax incentives for private companies that hire people over 50 years of age. 9. ACCESSIBILITY • Obligation of all undertakings / enterprises of tourist interest in the municipalities of RJ state to maintain adaptations and accessibility for the elderly and people with disabilities; • Wheelchair availability for elderly care in banking branches, supermarkets, concert halls and bus stations. 10. TRANSPORTATION • Gratuity in interstate collective transportation. 51

STATE PUBLIC POLICIES Index SÃO PAULO STATE PPs These are the most recent and relevant PPs by SP State gathered in the same groups as RJ. Overall themes between RJ and SP are very similar, as well as the PPs themselves. 1. HEALTH • Establishment of the Paulista Institute of Geriatrics and Gerontology; • Obligation of all State health units to post in places visible to the general public notice about the elderly right to have an accompanying person at the time of hospitalization. 2. ELDERLY CARE AND ASSISTANCE • Handling priority of administrative processes in which people with age equal or superior to 60 years appear like party or intervener; • Creation of the Elderly Assistance program; • State Administration entities are obliged to establish priority in the elderly care or attendance. 3. EDUCATION • Promotion of policies to eradicate illiteracy, to give access to educational technologies and recreational, cultural and sporting activities • Educational Program Directed to the Elderly, in order to attend those who did not have the opportunity to be literate. • Implementation of programs that value and share elderly knowledge and experience, and the inclusion themes like ageing and old age in schools. 4. FINANCIAL AID & FEE EXEMPTION • Payment fee exemption for the issuance of Identity Card or duplicate to elderly over 65 years old if male, and 60 years old if a female. 5. CULTURE ACCESS & TOURISM • Cinemas, theatres, museums, circuses, parks and other public leisure and entertainment centres must grant a 50% discount on the normal ticket price to the people over 65 years old. 6. SOCIALIZATION • Institution of the Elderly State Fund, in order to secure their social rights and create conditions to promote their autonomy, integration and effective participation in society. 52

STATE PUBLIC POLICIES Index SÃO PAULO STATE 7. HUSING & NURSING STATE PPs • Implementation of the State Housing Program for the Elderly (PEMI) in order to provide government housing to people over 65 years of age; • Institution of the "Seal Elderly Friend", designed to evaluate the quality of the services provided by entities that attend the elderly in the modalities of nursing homes, asylums, social centres, home-like nursing homes and sheltered workshops. 8. ACCESSBILITY • Installation of seats for the elderly, pregnant women and people with disabilities in the intercity public bus terminals, subway and train stations. 9. TRANSPORTATION • Gratuity to people equal or over 60 years of age at passenger public transportation. 53

PUBLIC POLICIES - BILLS Index Since 2008, there has been 619 propositions in the Congress (House of Representatives) that deal with theme "Elderly", within the most different subjects. Of those, 348 propositions became Bills (PL - Law Projects). In turn, of 348, 238 bills are in processing, thus, are being analysed in order to follow for voting. The remaining amount was either suspended or dropped. BILLS The most relevant Bills in the Congress can be divided into the following categories: Observation: the remaining bills do not have direct relation with the scope of work in this report. E. g. 1 a bill for “no use of handcuff on elderly upon imprisonment“; e. g. 2: a bill for “a formal national celebration date for the elderly caregiver”; e. g. 3: a bill for “regulation of the profession of psych pedagogue for elderly; and so on. 54

TAX DEDUCTION Index PUBLIC POLICES According to the Brazilian Institute of Planning and Taxation (IBPT), Brazil is one of the countries with the highest taxes collection. The tax burden in Brazil represents 35. 42% of Gross Domestic Product (GDP). It is not the highest in the world, however the return on welfare to its citizens is much lower than that offered in other European countries that have a rate larger. Sources: IBPT In the case of the elderly, this may be an opportunity. The challenge in the case of the law is that generally companies to enjoy the tax waiver must have established office in the country. Ø The recommendation would be to check with law firms as foreign companies that are not yet present in Brazil could use the law of the elderly for investments. Tax waiver as a development engine. The Elderly Funds are a reserve of money to be used to promote and defend the rights of the elderly. For the Elderly Fund, the company can deduct up to 1% of the amount of its due income tax, applicable on the amount due at the rate of 15%, and the deduction is not allowed on the additional tax of 10%, which it also needs pay. And the amount donated cannot be considered operational expenditure. Governmental Fund for the Elderly • Investments using the government law. • Law 12. 213: in force since January 2011, created the National Citizenship Fund authorized the deduction of income tax by individuals and legal entities that donate to the respective municipal, state and national funds. • The Fund is intended to finance programs and actions that ensure the rights of the elderly, as well as create conditions to promote autonomy, integration and effective participation in society. • It can be use to sponsor and / or foster Accelerators or Incubators (of start ups) operating in the health, e-health, biotechnology and ageing processes 55

Index PRIVATE SECTOR Overview of major technological developments PRIVATE SECTOR Healthy Ageing Brazil States of Rio de Janeiro & São Paulo 56

PRIVATE SECTOR GLOSSARY Index EXECUTIVE SUMMARY TERMS & INSTITUTIONS Ø ANS - Brazilian health agency Ø Exame - leading business magazine Ø SEBRAE - Brazilian Service of Support to Micro and Small Enterprises 57

PRIVATE SECTOR – GENERAL CONTEXT Index Overview OVERALL CHARACTERISTICS IN BRAZIL Contrary to the Brazilian governmental logic upon elderly practices and care, whose main focus is that of welfare and assistance, and less as an investor in scientific research and technology, the private sector has been assuming this role - although from the commercial point of view - and presents itself in this scenario as an important innovation vector in the offering of products and services focused on elderly life quality. Considering that startups have simpler structures, agile nature and innovative essence, they may be more likely to succeed in this scenario and already add a considerable volume of actions directed to the elderly population. On the other hand, established companies present programs more directed to social actions and social integration of the elderly. Given the great dynamics of this technologic and innovative market, it is difficult to quantify and determine the total number of start ups operating in Brazil in segments that act directly or indirectly in the quest for the better elderly population life quality. We did a survey of the ecosystem where start ups are involved. These numbers identify the number of entities in each group that act directly or indirectly in the health and elderly care, whether in technology, health, medicine, special care and even in integration and socialization. Our survey of the ecosystem where start ups are involved included: • Investor – companies that present themselves as financial accelerators of these start up businesses; • Incubators – ecosystems and/or companies where start ups, in the figure of it’s founders, can have mentoring and infrastructure in order to develop ideas and in fact put up a start up; • Accelerator – ecosystems and/or companies that usually help start ups to gain traction within their target market; • Start Ups – people that started a company or that have ideas to turn them into products or services. As a result, we identified the most relevant initiatives in each companies’ nature that act directly or indirectly in the health and elderly care, whether in technology, health, medicine, special care and even in integration and socialization. • 02 Investors focused on health and/or elders • 04 Incubators • 11 Accelerators • 57 start ups • 53 start ups focused on Health, Medicine and Special Care (08 elderly exclusive) • 04 work the Elderly Socialization and Integration 58

PRIVATE SECTOR – START UPS Index START UPS According to information from Brazil's leading business magazine Exame, the health sector in Brazil fell in the interests of investors. Almost 40% of the R$18. 5 billion invested by private equity funds in Brazil in 2015 went to the health sector. RELEVANT INFORMATION • Other relevant information from a SEBRAE survey, Side / B Startups 2015, the health sector is at the height of the trend among startups, with the third most attractive business vertical for investors, behind only education and technology. • In a report by Fundacity Investments, a platform that connects start ups to investors around the world, 77% of Brazilian Accelerators companies are interested in investing in business in this sector. The emergence of start ups in the health sector is a worldwide phenomenon. The health start up segment is very recent in Brazil. It is an ecosystem in formation. According to private equity funds, such as Repoint, the number of such companies tripled in 2015 - there are slightly more than 100 health related start ups in Brazil. According to Start Up + Health, it is estimated that there are 7. 500 companies in the health market worldwide, most of them established from 2013 on in the United States and Europe. It is impossible for an organization to hold 100% of the knowledge it needs to advance technology and serve its patient well. Knowing what is being developed by other companies is an interesting alternative. In the state of RJ and SP, we have identified 57 start ups within our scope of work, being 8 in RJ and other 48 in the state of SP. According to Rafael Campos, CFO of Berrini Venture, specialist Accelerator in the health segment, there are 4 segments that health start ups in Brazil are investing in: 1. Clinics - 34% clinics and doctors' offices. 2. B 2 C - 28% patients and final consumers. 3. Hospitals - 14% referral hospitals. 4. Public sector - 10% government and public agencies. Sources: Survey Berrini Venture 59

PRIVATE SECTOR – START UPS Index START UPS OPPORTUNITY Ø As the ecosystem of start ups linked to health is relatively new in Brazil, the opportunity presented is that there is a greater or lesser presence in this system of all important actors (government, universities, technology studies centres, investors and established companies). Therefore, its natural profile is to be a network link between the opportunities, needs and challenges that the Brazilian health market presents. Ø Being close to this young ecosystem and actively participating with resources or guidelines is a critical success factor so that the Netherlands can build lasting partnerships and relationships with stakeholders in this segment. In Brazil, we identified 1 venture capital company focused on accelerating health start ups, there is still an equity crowdfunding and 6 business Incubators and 12 business Accelerators. In dealing with opportunities, we will prioritize the most promising ones for the Netherlands. Important issues for considering investments in the health sector. Four basic points of the investment health market should be taken into account. 1. Non-cyclical - The health market feels less like oscillations. Economic conjunctures, that is, in the case of an economic crisis. The crisis takes longer to reach the health sector and it recovers faster than other sectors such as retail, for example. So it is a more stable market over time from the macroeconomic point of view. 2. Hospital – In Brazil, 67% of healthcare costs are in hospitals (World Bank). When we work considering that health is about 9 to 10% of GDP, where 6. 600 hospitals in Brazil account for 7% of GDP by turning in there. 3. Costs - Medical readjustments of health plans in 2015 were around 16. 2% (ANS). 4. Role of the employer - 63% of the health plans are paid by companies (World Bank). In Brazil this index reaches close to 90%. When you make a link between items 3 and 4, you have a chain of events, that is, the health plan becomes more expensive, the company pays more and, with that, your profit gets smaller. At that time, the company will pass its cost on to its final product, so this will somehow explode in the consumer or the worker in some way. The opportunity is clearly in these items (costs, performance and final consumer) and the market, government, universities and civil society recognize this. Soon there will be a need for innovation and to bring new ways of being more productive, which goes beyond the question of innovation and the doctor and start ups to beat in issues of the entire sector. 60

PRIVATE SECTOR Index INVESTORS AN OVERVIEW OF INVESTING COMPANIES Name: Acelera Partners Main activity: Investment holding that focuses on identifying start ups based on state-of-the-art technology, providing capital, management, infrastructure and access to markets and potential clients. Website: http: //acelerapartners. com. br/ Name: Broota Main activity: It is an online collective investment platform that unites investors, mentors and entrepreneurs. Website: https: //www. broota. com. br/ 61

PRIVATE SECTOR Index AN OVERVIEW OF INCUBATOR COMPANIES INCUBATORS Name: Biotechnology Polo of Rio de Janeiro Main activity: The Bio. Rio incubator focuses on biotechnology, and has 17 incubated companies. Website: http: //www. biorio. org. br/ Some companies in this Incubator: Company of industry and trade of biomaterials of bone grafts. Brazilian Network of Tuberculosis Research Name: Cietec Main activity: It an incubator linked to USP/São Paulo University. Companies allowed to participate include segments such as electronics, biotechnology, medicine, environment, information technology. It has 139 incubated companies. Website: http: //www. cietec. org. br/ Some companies in this Incubator: Immunogenic is dedicated to research and innovation in diagnostics in the areas of Clinical Immunology, Allergology and Genetics. Post-traumatic recovery equipment, 100% natural, that uses only the attributes of thermal cure. Research and Development company whose main focus is to generate specialized human cells from induced stem cells. The company already has heart cells in its portfolio and is developing skin and liver cells. 62

PRIVATE SECTOR Index AN OVERVIEW OF INCUBATOR COMPANIES INCUBATORS Name: Incamp Main activity: To create and develop innovative technology-based companies, training them both managerially and technologically, through the interaction of Unicamp-company-network of partners and contributing to the strengthening of the Regional Innovation System. . Website: http: //www. inova. unicamp. br/incamp/sobre/ Some companies in this Incubator: Cybox Technology is a technology-based company with operations in mobile robotics projects and smart cities ANS Pharma, founded by researchers and graduate students of Unicamp, conducts research and development of new drugs, medicines and medical equipment. Company specialized in the treatment of chronic ulcers, severe burns and vitiligo with the use of autologous cell therapy. Name: Supera Main activity: Innovation environment that promotes the transfer of knowledge in different types of activities. It is responsible for attracting and retaining technology companies, with emphasis on the sectors of Health, Biotechnology, Information Technology and Bioenergy. Website: http: //www. superaparque. com. br/ Some companies in this Incubator: Development of molecular diagnostics focused on oncology. Specialized in the use and analysis of gene expression profiles for the diagnostic routine of cancer patients. Oxbone is a technology-based company focused on the research, development and commercialization of new bone materials and substitutes. They work in the fields of biomaterials and nanotechnology. 63

PRIVATE SECTOR Index ACCELERATORS AN OVERVIEW OF ACCELERATOR COMPANIES Accelerator dedicated to work with high potential health start ups, in order to solve the main health system challenges. http: //berriniventures. com/ Performs in segments such as Clean Energy, Aerospace Solutions, Automation Systems, Water and Forests, Intelligent Cities, Education and Creative Economy, Genetics, Biotechnology and Nanotechnology. http: //criabiz. com. br Holding of Investments. Accelerator for digital business. http: //www. baita. ac Search for social impact business. Focus sectors: Education, Housing, Health and Financial Services. http: //www. artemisia. org. br Accelerator and Seed Fund for Digital Business in Brazil. http: //21212. com Comprehensive ecosystem for the high-impact entrepreneur, who counts on solutions for each of the maturity stages of the startup. http: //goace. vc/ Accelerator of startups that aims to bring innovative solutions to the corporate market. http: //gemaventures. com/ Focused on internationalization and acceleration of companies and IT startups, with a special connection between Brazil and Silicon Valley. http: //outsourcebrazil. com. br/ It's a multi-thematic accelerator. That is, each program has a different theme. For each program a theme is chosen based on consumer, business and technology trends. Every 6 months, choose mentors, create detailed programs and accelerate startups in a personalized way. https: //www. linkedin. com/company/papaya-ventures? trk=company_logo It acts in the stimulation to foment the enterprises of the sectors of the Creative Economy, Healthcare, Agribusiness. Preferably they have product or service innovation. http: //www. syndreams. com. br/ Wayra is a digital business accelerator, supported by Telefónica http: //wayra. co/en/ 64

PRIVATE SECTOR Index START UP SCENARIO – Elderly related (Health or Socialization) START UPS Start Ups by Groups (Line of Work) Biotech 1 2 Caretakers 4 Clinic Digital Infrastructure 1 Cognitive Exercising 6 Collaboration & Communication 3 Diagnosis (DICOM, Mollecular, Retinography) 1 Elderly Employment 1 Elderly Marketplace 2 Health Professional Profile 1 Health Systems Development 2 Home Care & Rehabilitation 1 Location 3 Management - Hospital Shifts 3 Management - Medical History 2 Management (Bed Ocupation & Exams) 3 Medical/Diagnostic Content 1 Mobility 7 3 1 Prescription Public Health Service Search Engine 3 1 2 1 Monitoring Scheduling Social Telemedicine Virtual Reality Traning 65

PRIVATE SECTOR Index START UPS HIGHLIGHT – Related to Health or Socialization Name: Be Close Home Monitor Segment: Monitoring & Accessibility Description: Non-intrusive wellness solution monitors daily activity with small sensors at home, which communicate with the Alarm. com central, allowing: • Tracking a person’s routine from your computer or smartphone; Receive real-time notifications of what's happening at home, as well as status updates via your smartphone using the Alarm. com application. Website: http: //www. homemonitor. com. br/ • Name: Virtual Care Segment: Health Monitoring / Wearables Description: Virtual. Care is a system for monitoring/accompanying the health status of the elderly based on behavioral analysis using wearables. Connected with the elderly and their family members, accompanying 24 -hour, day-to-day behavior, predicting an occurrence of alertness to health and wellbeing before it manifests in a disease. Website: http: //marcosallesm. wixsite. com/saudeonnet/virtualcare 66

PRIVATE SECTOR Index START UPS HIGHLIGHT – Related to Health or Socialization START UPS Name: Acto Segment: Remote Assistance / Wearables Description: A terminal is installed in the user's home and user wears a bracelet or pendant with an "alert" button. In case of emergency, the user will press the alarm button and immediately a hands-free call will be opened with the Call Center The attendants will inform the user’s contacts (pre-set by the user) about the occurrence so that they can take the necessary measures. If need be the company transfers the call to the Medical Call Center and this decides the need to send the ambulance. Website: www. meuacto. com. br Name: Iris Senior Segment: Remote Assistance / Wearables Description: A terminal is installed in the user's home and user wears a bracelet or pendant with an "alert" button. In case of emergency, the user will press the alarm button and immediately a hands-free call will be opened with the Call Center The attendants will inform the user’s contacts (pre-set by the user) about the occurrence so that they can take the necessary measures. If need be the company transfers the call to the Medical Call Center and this decides the need to send the ambulance. Website: http: //www. irissenior. com. br Free translation: A button that saves lives 67

PRIVATE SECTOR Index START UPS HIGHLIGHT – Related to Health or Socialization Name: Daruni Healthcare Segment: Marketplace Description: Marketplace for life quality and for the Elderly. It has an online store, a news portal, a job portal and provides, in addition to products and services, experience and a better quality of life for the public of the Third Age. Website: http: //www. terceiraidade. com/ Name: Neuro. Forma Segment: Neuro Activities Description: Online platform of exercises scientifically designed to stimulate key brain functions and increase cognitive performance. A multidisciplinary team that seeks technological and innovative neuroscience solutions to promote Health, Well-Being, Education, among other areas of applied sciences. Website: http: //neuroforma. com. br/ Free translation: Your brain also needs exercise 68

PRIVATE SECTOR Index START UPS HIGHLIGHT – Related to Health or Socialization START UPS Name: Cuide me Segment: Caretakers Platform Description: Cuide. me is an online platform that offers trained and well-evaluated caregivers for the elderly care. Website: http: //cuideme. weebly. com/ Name: Be fine Segment: Services Platform Description: Be. Fine offers a range of services to the elderly, link Monitoring and accompaniment, Healthy eating aid, Physical activities, Personal care, Regular Visits, Domestic tasks , Health Alerts (medicine hours) Website: http: //www. sejabefine. com. br 69

PRIVATE SECTOR Index START UPS HIGHLIGHT – Related to Health or Socialization Name: Maturi. Jobs START UPS Segment: Elderly Job Placement Description: Platform where people over 50 find alternatives and opportunities to stay active, working and sharing their experiences. The public has access to the platform in order to searches for available positions, and partner companies can publicize opportunities. Website: http: //www. maturijobs. com Name: Mundo Prateado (Free translation: Silver World) Segment: Social Description: The Silver World Movement keeps alive a network of people committed to building and assuring the growing population that surpasses 60 years a more dignified and active life. Mission: to inspire seniors, family and friends to approach maturity in a productive and creative way. Objective: to find solutions that facilitate the everyday life of the elderly and their families, inspiring people and companies to act collaboratively. Website: http: //mundoprateado. com/ 70

PRIVATE SECTOR Index START UPS HIGHLIGHT – Related to Health or Socialization Name: Portal do Envelhecimento (Free translation: Portal of Ageing) Segment: Content Portal Description: The Ageing Portal has the mission to transfer qualified information about old age and ageing, allowing democratic access to knowledge about this phase of life. This social mission has guided the production of credible content, becoming reference in Brazil. Website: http: //www. portaldoenvelhecimento. com/ Name: Olhe – Observatório da Longevidade (Free translation: Longevity Observatory) Segment: Social Business Description: These are professional with interdisciplinary training on human ageing - professionals, researchers and teachers, masters and doctors, who have come together to define strategies to place longevity on public and private agendas. The Observatory also develops researches, subsidizing studies and contributing to policy, technologies and services formulation for longevity. The main Olhe programs are: Caring is Living (caregivers course), Condominium Friend of the Elderly, Permanent and Continuing Education in Gerontology Website: http: //mundoprateado. com/ 71

PRIVATE SECTOR Index OTHER HEALTH START UPS LIST of ADDITIONAL START UPS GENOTYPING - SP Target: Biotechnology. Genetic Analysis. Brazilian biotechnology company founded in 2008. In 2013, the company expanded its operations to the molecular diagnostics sector, pioneering the use of state-of-the-art sequencing for genetic analysis. http: //www. genotypingsaude. com. br i. Clinic - SP Target: Clinic Digital Infrastructure Scan and organize clinic and office information easily and intuitively, making them more productive and smarter. Health software company, revolutionizing clinic management and improving the way they handle your information. https: //iclinic. com. br Medicina Direta – SP (Free translation: Direct Medicine) Target: Clinic Digital Infrastructure Provides Digital Infrastructure for Clinics www. medicinadireta. com. br Pro Radis - SP Target: Clinic Digital Infrastructure Provides Management Clinics and laboratories. Develops software specialized in the management and operation of radiology clinics and laboratories www. proradis. com. br Vitta - SP Target: Clinic Digital Infrastructure Develop tools that help doctors better manage their office. Main products: Vitta Payments, Vitta Management and Vitta Clinic. Web. https: //vitta. me 72

PRIVATE SECTOR Index OTHER HEALTH START UPS LIST of ADDITIONAL START UPS Hy. Doc – SP (Ribeirão Preto City) Target: Collaboration – Doctors Medical communication web platform that enables the medical specialist to assist the general practitioner in the diagnosis of patients anywhere through the smartphone. Sending of exams, chats, images, voice and video conference. http: //www. hydoc. com. br Avelã - SP Target: Collaboration & Communication Application that allows the healthcare professional to relate to patients, in addition to organizing the agenda in a simpler and more efficient way. http: //avela. me/ Clever Care – SP (Ribeirão Preto City) Target: Collaboration & Communication It is a computer system that allows the control, management and orientation of patients who need continuous medical follow-up. The system allows for communication with the patient in a personalized and active way, providing a closer care, which can be performed in two ways, one initiated by the system or initiated by the patient. ] http: //www. clevercare. com. br/ Dr Cuco - SP Target: Collaboration & Communication Dr CUCO offers solutions to improve the patient's medical treatment experience. Connecting doctors, patients and other players in the health area through technology. www. drcuco. com. br Medicinia - SP Target: Collaboration & Communication Medicinia is a multi-channel platform (desktop, mobile applications, SMS, etc. ) that counts on usability and health safety technologies. www. medicinia. com. br 73

PRIVATE SECTOR Index OTHER HEALTH START UPS LIST of ADDITIONAL START UPS Meplis – RJ Target: Collaboration & Communication Platform that connects people, health professionals and organizations in a collaborative community to share knowledge and care information, long-term behavioural change or improved professional development. https: //meplis. com/pt/ Navegatium - SP Target: Diagnosis Application that allows the healthcare professional to relate to patients, in addition to organizing the agenda in a simpler and more efficient way. http: //navegatium. com/home/naveg 073/public_html/pt-br/ Onkos – SP (Ribeirão Preto City) Target: Diagnosis Development of a molecular classifier, based on mi. RNA profiling technique, to classify indeterminate thyroid nodules in order to avoid patients with benign nodules undergoing unnecessary surgeries. http: //onkos. com. br Phelcom – SP (Ribeirão Preto City) Target: Diagnosis Develops innovative equipment and solutions for the medical field, joining expertise in optics, electronics and computing. In the area of Internet of Things (Io. T) Healthcare, Phelcom is developing the SRC, Smart Retinal Camera, a high resolution handheld retinography equipment integrated with smartphones and telemedicine systems. www. phelcom. br 74

PRIVATE SECTOR Index OTHER HEALTH START UPS LIST of ADDITIONAL START UPS Doctor Found - SP Target: Health Professional Profile Platform of presentation of health professionals to the search engines and future clients. Doctor Found is the solution to connect the healthcare professional to the online universe, this is done by creating your professional profile. https: //doctorfound. com Respire Life - RJ Target: Health Professional Profile Collaborative platform for holistic health services and wellness focused on prevention. Customize the experience of each user according to your need. The system is focused on health monitoring and the incentive to change habits through a customized dashboard, which provides content and services in accordance with its objectives. www. respirelife. com Kidopi – SP (Ribeirão Preto City) Target: Health Systems Development Focus on the development of hospital management systems, computerization of clinics and clinics, regulation of emergency and emergency procedures, medical images and research support. http: //kidopi. com. br Grupo Reabilitar - SP Target: Home Rehabilitation Start up of the health sector, focusing on physical therapy and home speech therapy. http: //www. gruporeabilitar. com. br/ 75

PRIVATE SECTOR Index OTHER HEALTH START UPS LIST of ADDITIONAL START UPS CONNECT HEALTH Target: Development of technological applications for health. Home care first product. Start up focused on technology solutions for the health market. Platforms, applications, customized to your business to optimize routines and processes. • GE Health. Care Support - Hackathon Health http: //www. connecthealth. com. br Connect Health Product – HEALTHMOB Optimized and intelligent platform for Home Care companies and service providers to manage the health information of their patients. http: //www. connecthealth. com. br/portfolio/Health. Mob-Home. Care/ MEMED (SP) Target: Medical Prescription Exclusive platform for physicians, 100% free, with updated information of medicines available for prescription in the Brazilian market. Accessing Memed, the doctor finds all the package inserts and information of more than 20, 000 medicines, constantly updated as they enter and leave the market. In addition, Memed has a prescribing tool where the doctor can enter the drug’s name they want to prescribe and print the prescription directly from the computer screen into the hands of their patients. https: //mmed. com Portal Telemedicina - SP Target: Telemedicine Solution that offers health institutions online medical report services by specialists in the 24 x 7 model. www. portaltelemedicina. com. br Brasil Telemedicina – SP (Campinas) Target: Telemedicine Provides services of medical, psychological, nutritional and emission of reports, at a distance. http: //brasiltelemedicina. com. br/ 76

PRIVATE SECTOR Index OTHER HEALTH START UPS LIST of ADDITIONAL START UPS Hospital + – SP (Mogi das Cruzes City) Target: Collaboration – Doctors Medical communication web platform that enables the medical specialist to assist the general practitioner in the diagnosis of patients anywhere through the smartphone. Sending of exams, chats, images, voice and video conference. https: //guia. hospital. plus Mais Leitos – SP (Free translation: More Beds) Target: Management - Bed Occupation Created to help the multi professional team in the follow-up of the patient, from their hospitalization to their discharge. It allows the clinical staff to have a global view and a map of the patients' location, making it easier to identify problems and solve problems quickly. http: //www. maisleitos. com. br/ Med Cloud – SP Target: Management - Exams All-In-One platform for diagnostics management. http: //www. medcloud. com. br/ Doctor ID - SP (Campinas City) Target: Management - Hospital Shifts Provides Management Clinics and laboratories. Automated online tool associated with a bank of medical professionals available to cover shifts. It manages on-call schools, makes it possible to advertise vacancies, presents reports based on its unique system of management of scales, enhances communication with those applied to smartphones, among others. www. doctorid. com. br IPlantão – SP (Campinas City) Target: Management - Hospital Shifts Web-based management software for scales in health facilities, in addition to the bank of professionals and vacancies. It allows, for example, access to the database of registered professionals, manage the schedules of shifts and generate administrative and financial reports www. iplantao. com. br 77

PRIVATE SECTOR Index OTHER HEALTH START UPS LIST of ADDITIONAL START UPS Pega Plantão – SP Target: Management - Hospital Shifts Application for Scale Management, Medical Scales, Medical Applications. https: //www. pegaplantao. com. br Dr. Recomenda – SP (Free translation: Dr. Recommends) Target: Management - Medical History Dr. Recomenda is multi-channel platform (website and mobile app) for self-management of medical records, that increases the adherence of the major chronic diseases through unique algorithm that enables automated follow up according to Medical Guidelines. www. doutorrecomenda. com. br Saúde Controle – SP (Free translation: Control Health) Target: Management - Medical History Online platform that stores all health information in one place. http: //saudecontrole. com. br/ PEB Med - RJ Target: Medical/Diagnostic Content App and Portal with up-to-date medical content to aid in clinical decision making. www. pebmed. com. br Saúde Advisor – SP (Free translation: Health Advisor) Target: Medical/Diagnostic Content Portal on hospitals, clinics, laboratories and health posts. Find information, ratings, reviews and comments. www. saudeadvisor. com. br 78

PRIVATE SECTOR Index OTHER HEALTH START UPS LIST of ADDITIONAL START UPS TV Doutor – SP (Campinas City) (Free translation: TV Doctor) Target: Medical/Diagnostic Content A closed digital signal transmission network (Digital Out - Of - Home) with strong online presence on You. Tube, Facebook and Twitter. It offers quality production with aesthetics and content, in care points such as Hospitals, Clinics, Analysis and Examination Laboratories segregated by geo-referencing, medical specialties and other characteristics. http: //tvdoutor. com. br/ Parknet- SP Target: Mobility Mobile application that provides the location of more than three thousand places reserved for people with disabilities and senior citizens of the city of São Paulo, with the possibility of tracing routes to the desired parking place. http: //parknet. com. br/produtos. html#pnet_acessivel Cuidador Digital– SP (Free translation: Digital Caretaker) Target: Monitoring With Digital Caregiver you just have to push a button to notify the people you choose and they will receive a call. platform that stores all health information in one place. www. cuidador. digital Sen. Fio - RJ Target: Monitoring Development of automatic solutions for the health segment in wireless monitoring for decision making. www. senfio. com. br 79

PRIVATE SECTOR Index OTHER HEALTH START UPS LIST of ADDITIONAL START UPS Epistemic - SP Target: Monitoring Device that works from two non-intrusive detectors that are discreetly located in the user's head. These detectors send constant signals to the device, which analyses possible occurrences of short-term attacks. If the system identifies the seizure approach, the device automatically sends an alert to the patient and a caregiver. www. epistemic. com. br Tele. Help – SP Target: Monitoring Teleassistance, as its name implies, means telephone assistance. It is a telephone answering service, which in the case of Tele. Help, works through a panel connected to the telephone line and a personal emergency button. When the customer is in a situation where he needs help, he presses his button and requests immediate assistance from the 24 -hour Call Centre, who performs all the service on the panel's hands-free system or by telephone. www. telehelp. com. br 360 Saúde – SP (Free translation: 360 Health) Target: Prescription This is a smartphone application and a system that works in the cloud. The central idea is the replacement of handwritten medical prescriptions with standardized electronic prescriptions accessible to patients and pharmacies. https: //www. linkedin. com/company/360 -sa%C 3%BAde? trk=company_logo Insulin. App - SP Target: Prescription An application that facilitates doctors to prescribe insulin simply and quickly, and to manage their patients' glycaemic control from admission to hospital discharge. http: //www. insulinapp. com. br 80

PRIVATE SECTOR Index OTHER HEALTH START UPS LIST of ADDITIONAL START UPS Saútil - SP Target: Public Health Service Search Engine Search engine created to help the population find information about the public health network and we do not provide any medical care service (such as consultations, diagnoses, indication of treatments, medications and / or vaccines). www. sautil. com. br Beep Saúde – SP (Free translation: Beep Health) Target: Scheduling App where the patient chooses the doctor and the location of the consultation. List of nearest doctors available for home visits or immediate office care. www. beepssaude. com. br Boa Consulta – SP (Free translation: Good Consultation) Target: Scheduling App to schedule medical appointments http: //www. boaconsulta. com Hippo Drs – SP (Ribeirão Preto City) Target: Scheduling Online platform that connects patients with physicians. https: //hippodrs. com. br/ Med. Room - SP Target: Virtual Reality Training Med. Room is a simulator of health training in virtual reality. www. medroom. com. br 81

PRIVATE SECTOR Index OTHER HEALTH START UPS LIST of ADDITIONAL START UPS Portal Telemedicina - SP Target: Telemedicine Solution that offers health institutions online medical report services by specialists in the 24 x 7 model. www. portaltelemedicina. com. br Brasil Telemedicina – SP (Campinas) Target: Telemedicine Provides services of medical, psychological, nutritional and emission of reports, at a distance. http: //brasiltelemedicina. com. br/ 82

PRIVATE SECTOR Index PRIVATE COMPANIES Large and medium-sized companies in Brazil usually have an Socio-environmental Responsibility (RSA) area, which acts as an incentive, support and special care agent in regards to sensitive issues of society. The choice of action target is free and usually happens according to the company’s profile. Usually all actions are focused on fiscal incentives public policies*. That is, the private sector ends up replicating the Brazilian Government’s assistance model, in fact actually acting as an agent for implementing creative actions. * Brazilian companies have been using a tax exemption law resource to implement social action programs for the most diverse target publics. Some companies chose the elderly as their social platform. Law 12. 213: in place since Jan 2011, it established the National Senior Citizen Fund, and has authorized income tax deduction by individuals and corporations that donate to their respective county, state and national funds. The Fund is intended to finance programs and actions that ensure elderly rights, in addition to creating conditions to promote autonomy, integration and effective participation in society. We have listed the main companies that elected to carry out activities focused on elderly care and attention. The following are some actions developed by companies that have shown social relevance for the elderly in Brazil. The companies come from different segments, including insurance, energy, banking, nutrition, pharmaceutical, agriculture. 83

PRIVATE SECTOR Index PRIVATE COMPANIES LIST of COMPANIES and ITS ELDERLY RELATED INITIATIVES MONGERAL AEGON Business segment and overview: Life Insurance & Private Pension - the Aegon Group is active in the insurance market in more than 20 countries, has more than 180 years of experience in the Brazilian market, and share a commitment to the cause of longevity. Call to Action: Instituto Longevidade Longevity Institute Overview: non-profit organization that points out ways for Brazilians to live longer and better. This means preparing the country to face longevity’s socio-economic impacts and also fostering conditions for opportunities to be created in this new scenario. Observations: • The Aegon Monger Longevity Institute is associated with other Longevity Institutes worldwide: the Transamerica Institute and the Aegon Centre for Longevity and Retirement. The three Institutes have in common the support of the Aegon Group. • The Brazilian initiative is led by Mongeral Aegon. BRADESCO SEGUROS Business segment and overview: Insurance, within one of the largest banking institutions in Brazil Overview: develops and supports three initiatives: ü “Doorman Friend of the Elderly” Program - free of charge and idealized with the objective of preparing this professional to solve daily problems, contributing to the security, autonomy, mobility and independence of the elderly living in large urban centres. Over 1, 000 doorman trained in 2015; ü Longevity Prize - awards divided into three categories: Journalism, Longevity Research and Life Stories ü Longevity Circuit - created with the goal of encouraging the practice of physical activity, and thus provide a healthier life. 84

PRIVATE SECTOR Index PRIVATE COMPANIES LIST of COMPANIES and ITS ELDERLY RELATED INITIATIVES SANTANDER Business segment and overview: Banking Overview: Banco Santander (Santander Bank) directs financial resources to the Elderly Funds (1% of income tax due) and offers training and remote support to the Municipal Councils of the Elderly, in partnership with two consultancies specialized in theme: Prattein and Interage. Program objectives are to contribute to the improvement of elderly life quality, to disseminate the Statute of the Elderly and to strengthen the Councils and the Municipal Funds of the Rights of the Elderly. CPFL ENERGY Business segment and overview: Energy Overview: CPFL develops and supports two initiatives focused on the elderly theme • Develops the model of the Program for Elderly Support Councils: ü Municipal Council for the Elderly Rights (CMI) is responsible formulating, deliberating and controlling actions to implement the elderly rights policies, as well as managing the Fund for the Elderly Rights. • Support for the “City for All Ages” Program ü Program based on the active ageing concept. The objective is to make the participating city an easier, more comfortable and safer place of cohabitation for the elderly. 85

PRIVATE SECTOR Index PRIVATE COMPANIES LIST of COMPANIES and ITS ELDERLY RELATED INITIATIVES MONSANTO Business segment and overview: Agriculture and Biotechnology Overview: ü Monsanto directs financial resources to the Elderly Funds (1% of income tax due) to the Municipal Council of the Elderly in Barretos City (SP). ü The law allows corporations to donate up to 1% of income tax due to trust funds created to strengthen public policy of elderly protection. These grants, at the discretion of peer councils, are applied in projects presented by social support network institutions. The donation percentage is authorized by the Law 10. 741 / 2003, which establishes the Statute of the Elderly. ü The company does the same with the Child and Adolescent Fund. Free translation: Funds for Children, Adolescents and Elderly UNIMED Business segment and overview: Health Insurance Overview: ü The initiative aims to promote the life quality and well-being of people over 55 years old, from Campinas City and Region (São Paulo State), Cooperative clients or not. The activities aim to contribute to make the elderly feel integrated within society. ü The Program focuses on health promotion and life quality, develops activities aimed at disease prevention, cultural promotion, education and socialization, performed through weekly meetings that bring together more than 250 elderly. The activities offered are: lectures and Preventive Medicine campaigns, presentation of artistic groups, choral, cinema session, dances, adapted gymnastics and stretching classes, choreographic dance, crafts classes, Portuguese recycling, biodance, emotional health, workshops of memory, stories and fashion and beauty. 86

PRIVATE SECTOR Index PRIVATE COMPANIES LIST of COMPANIES and ITS ELDERLY RELATED INITIATIVES NESTLÉ HEALTH SCIENCE Business segment and overview: Nutrition Overview: • A separate company from the traditional Nestle. • Nestlé Health Science invests in an awareness program on the importance of nutrition and active living for healthy ageing. DANONE Business segment and overview: Nutrition Overview: • Danone supports the Care for Life program of the Longevity Observatory (Olhe) • The program began in 2011 and its main purpose is to provide training for elderly caregivers for the marketplace. 87

PRIVATE SECTOR Index PRIVATE COMPANIES LIST of COMPANIES and ITS ELDERLY RELATED INITIATIVES PFIZER Business segment and overview: Pharmaceutical Call to Action: supports the 'Shameless Ageing Program' Overview: ü The program has a social and inclusive character, and carry forward ideas, projects and stories of elderly who are not ashamed to be what they are, to socialize, to flirt, who are not ashamed to change direction, to make new discoveries. ü The “Shameless Ageing” program shows that ageing does not mean seclusion, isolation and deprivation. Free translation: 88

Index OPPORTUNITIES Healthy Ageing Brazil OPPORTUNITIE S Attention point and general recommendation s of next steps States of Rio de Janeiro & São Paulo 89

OPPORTUNITIES Index PARTNERSHIP OPPORTUNITIES OVERVIEW During this month of work for the Netherlands and its representatives and business partners and academics, the following information was collected in this market scan. We mapped more than 619 draft laws, 57 start ups, 12 accelerators, 6 incubators, 56 universities, 18 gerontology courses and several scientific articles, as well as the identification of people involved in these activities. The final approach is focused on relating to the partners in the Netherlands only the most adherent initiatives, and because of their positioning, infrastructure and results achieved, they present greater potential for partnerships. The other information will be forwarded in a database. In terms of opportunities for the Netherlands a path that can be followed is the search for partnerships with innovation centres, accelerators and business incubators. These 3 axes serve as poles of attraction and development and somehow manage to engage all relevant actors so that ideas and initiatives related to active aging and related innovations leave the paper and get to the market through established programs of mentoring, entrepreneurs, funding and partnerships with government agents and large companies that want to innovate and fail to realize innovation with the agility needed by their large structures. Taking into account that the state of SP has 645 municipalities and Rio de Janeiro has 92 municipalities the great opportunities of partnerships related to scientific and business production for the health segment are concentrated in the capital. São Paulo is an exception where we identify interesting poles in Campinas (Incanp), Ribeirão Preto (Supera Parque) and São Carlos (Ufscar). 90

OPPORTUNITIES Index VENTURE CAPITAL BUSINESS OPPORTUNITIES IN VENTURE CAPITAL BERRINI VENTURES – SP It is an accelerator dedicated to working with high potential health start ups to address health system challenges. Invested Start ups: Vitta; Hazel; Hospital Catalogue Why it may be relevant to the Netherlands: Ø It is promising because it is unique in the health segment and has renowned sponsors and companies already accelerated. Ø Sponsors: Pfizer, Sabin Lab, Samaritan Hospital, Qualicorp, Unit. Care and Live Healthcare Media. Types of Opportunities: 1. Business Partnerships 2. Investments in start ups 3. Access to technological development Contact: hello@berriniventures. com Responsible: CEO - Fernando Cembranelli / fernando@berriniventures. com Address: Professor José Lannes Square, 40 - Berrini Building 500 - 17 th floor Brooklin Novo - São Paulo - SP 91

OPPORTUNITIES Index BUSINESS OPPORTUNITIES in BUSINESS INCUBATORS SUPERA PARK - Ribeirão Preto, SP The Supera Park of Innovation and Technology of Ribeirão Preto is the result of a partnership between Fipase - Foundation Institute for Advanced Health, University of São Paulo (USP), City Hall of Ribeirão Preto and Secretariat of Development of the State of São Paulo. Installed in the USP's local Campus, the Park houses the Business Incubator Supervision, the Overpass Technology Centre, the Association of Local Productive Arrangement (APL) of Health, the Industrial Pole of Software (PISO), as well as the Overcome Business Centre. Incubated Start ups: Hy. Doc; Onkos; Phelcom. Why it may be relevant to the Netherlands: Ø It was voted the best in Brazil in the National Award for Innovative Entrepreneurship, conducted by Anprotec - National Association of Entities Promoting Innovative Enterprises. Ø Highlight for the sectors of Health, Biotechnology, Information Technology and Bioenergy. Ø Supera Park´s International Office has both support programs for companies that wish to expand their business and gain global relationships, as well as support programs foreign companies that want to establish themselves in Brazil. Types of Opportunities: 1. 2. 3. 4. 5. Business Partnerships Investments in startups Access to technological development Scientific and academic production International Academic Cooperation Contact: parque@fipase. org. br / +55 (16) 3315 -4730 I International Office: international@fipase. org. br / +55 (16) 3315 -9900 Responsible: • CEO - Antonio Adilton Oliveira Carneiro / adilton@usp. br • Technical director - Osvaldo de Freitas / ofreitas@fcfrp. usp. br Address: Av. Dra. Nadir Águiar, 1805 - Jardim Dr. Paulo Gomes Romeo, Ribeirão Preto - SP 92

OPPORTUNITIES Index BUSINESS OPPORTUNITIES in BUSINESS INCUBATORS BIO RIO - RJ The Bio-Rio incubator was created in 1988 and is headquartered in the state of Rio de Janeiro. Biotechnology has 19 incubated companies. The selection process is continuous, that is, it occurs continuously, according to the time determined by it. Incubated Start ups: Ossecon, Rede TB, Stratego Why it may be relevant to the Netherlands: Ø BIO-RIO is one of the biggest poles of biotechnology in the country. The pole is consolidated. It has approximate billing of companies: US$383 Mi/year Ø 20 companies installed in the Technology Park Ø 19 companies installed in the Business Incubator Types of Opportunities: 1. Business Partnerships 2. Investments in startups 3. Access to technological development 4. Scientific and academic production 5. International Academic Cooperation Contact: +55 (21) 3525 -2400 I biorio@biorio. org. br Responsible: • Secretary General - Gilberto Freitas • Information Manager - Katia Aguiar - kaguiar@biorio. org. br Address: Av. Carlos Chagas Filho, n ° 791 - Cidade Universitária - Ilha do Fundão, Rio de Janeiro / RJ – Brazil 93

OPPORTUNITIES Index BUSINESS OPPORTUNITIES in BUSINESS INCUBATORS CIETEC - SP It an incubator linked to USP/São Paulo University. Companies allowed to participate include segments such as electronics, biotechnology, medicine, environment, information technology. Incubated Start ups: Immunogenic, Flexi Medical, Pluricell Why it may be relevant to the Netherlands: Ø It has 139 incubated companies. Ø Cietec is the managing entity of the Technological Base Incubator of São Paulo - USP / Ipen, the largest incubator centre for technology-based companies in Latin America. Types of Opportunities: 1. Business Partnerships 2. Investments in startups 3. Access to technological development 4. Scientific and academic production 5. International Academic Cooperation Contact: +55 (11) 3039 -8300 Responsible: • CEO - Claudio Rodrigues / +55 (11) 3133 -8938 • Executive Director - Sergio Wigberto Risola / +55 (11) 3039 -8300 Address: Av. Prof. Lineu Prestes, 2242 - Vila Universitaria, São Paulo - SP 94

OPPORTUNITIES Index BUSINESS OPPORTUNITIES in BUSINESS INCUBATORS INCAMP – INOVA UNICAMP INNOVTION AGENCY - Campinas SP To create and develop innovative technology-based companies, training them both managerially and technologically, through the interaction of Unicamp-company-network of partners and contributing to the strengthening of the Regional Innovation System. Incubated Start ups: Cybox Technology, Insitu, ANS Pharma Why it may be relevant to the Netherlands: Ø Incubator of Technological-based Companies of Unicamp (Incamp). Ø It is a showcase of the projects that are in the process of maturation, having as a difference the fact of being inside one of the most renowned universities, nationally and internationally. Types of Opportunities: 1. Business Partnerships 2. Investments in startups 3. Access to technological development 4. Scientific and academic production 5. International Academic Cooperation Contact: +55 (19) 3521 -5203 I incamp@unicamp. br Responsible: • Executive Director - Milton Mori / +55 (19) 3788 -3963 • Director of the Science and Technology Park - Eduardo Gurgel / +55 (19) 3521 -5014 • Director of Partnerships - Iara Ferreira / +55 (19) 3521 -5207 Address: Cidade Universitária Zeferino Vaz - Barão Geraldo, Campinas - SP 95

OPPORTUNITIES Index BUSINESS OPPORTUNITIES in BUSINESS ACCELERATORS ACCELERATROS ARTEMISIA – SP Search for social impact businesses that have participated in the Accelerator. Focus sectors: Education, Housing, Health and Financial Services. Founded in 2004 by Potencia Ventures, an ARTEMISIA currently has an office in São Paulo. Accelerated Start ups: Kidopi, Saútil, Semfio, Meplis and Med. Cloud. Why it may be relevant to the Netherlands: Ø Investments in 21 companies in the health sector. Ø Focus on business with social impact. In health, it seeks projects that bring improvement to the SUS (Health Unic System) Types of Opportunities: 1. Business Partnerships 2. Investments in startups 3. Access to technological development Contact: artemisia@artemisia. org. br I +55 (11) 3812 -4303 I +55 (11) 98996 -7253 Responsible: • Executive Director - Maure Pessanha / maure@artemisia. org. br • Partnerships - Flora Bracco / bracco@artemisia. org. br / fbracco@amglobal. com Address: Alameda dos Maracatins, 186, Indianópolis, SP 96

OPPORTUNITIES Index BUSINESS OPPORTUNITIES in BUSINESS ACCELERATORS ACCELERATROS 21212 – RJ Accelerator and Seed Fund for Digital Business in Brazil. Through seed acceleration program, provides to startups with seed capital, mentorship, technology, office space and the legal and business expertise necessary to establish a strong foundation and move their business forward rapidly. Accelerated Start ups: Peb. Med, Memed Why it may be relevant to the Netherlands: Ø Sponsors like IBM and Movile. Created by entrepreneurs with over 20 years of experience in the digital market (founders and / or members of companies like the Brazilian Movile, and the Americans Complex Media and Sling Media). Types of Opportunities: 1. Business Partnerships 2. Investments in startups 3. Access to technological development Contact: +55 (21) 3496 -7856 / social@21212. com Responsible: Founders - Marcelo Sales, Frederico Lacerda Address: R. Voluntários da Pátria - Botafogo, Rio de Janeiro - RJ 97

OPPORTUNITIES Index BUSINESS OPPORTUNITIES in BUSINESS ACCELERATORS ACCELERATROS ACELERA PARTNERS - SP & RJ Investment holding that focuses on identifying start ups based on state-of-the-art technology, providing capital, management, infrastructure and access to markets and potential clients. Accelerated Start ups : Dr. Recomenda, Navegatium Why it may be relevant to the Netherlands: Ø Partners include Microsoft, Qualcomm, Performa Investimentos, AGE-Rio (Development Agency of the State of Rio de Janeiro), TOTVS and others. Was born to bring together major partners into a single network that provides an end to end start up development ecosystem by offering an accelerator network, a post accelerator network and a micro VC investment fund. Types of Opportunities: 1. Business Partnerships 2. Investments in startups 3. Access to technological development Contact: startup@acelerapartners. com Responsible: CEO - Daniel Ibri / daniel@acelerapartners. com Addresses: • SP- Av. das Nações Unidas, 12495 17 th floor – São Paulo, SP • RJ - Rua Visconde de Inhaúma, 83 10 th floor – Centro – Rio de Janeiro, RJ 98

OPPORTUNITIES Index ACADEMY OPPORTUNITIES – RESEARCH AND STUDIES PARTNERSHIPS According to surveys by SIR World Report, which evaluates scientific productions, three São Paulo institutions - University of São Paulo (USP), State University of Campinas (Unicamp) and Stated University Paulista (Unesp) - lead the ranking of Brazilian universities that have published the most scientific articles. In addition to the international and national evaluations of these institutions (USP, UNESP and UNICAMP), we identified interesting production at UFSCAR, Albert Einstein Israeli Hospital, UFRJ – Federal University of Rio, UERJ – State University of Rio, and UFF – Federal University Fluminense. Internationalization is one of the common guidelines in these organizations, so strengthening or establishing partnerships with these institutions seems quite a natural way to partner up. The following is the relevant contact information: USP (SP) - Agency for National and Internat’l Academic Cooperation (Aucani) Its objective is to establish strategies for the relationship between USP, university institutions, public agencies and society, in order to support academic cooperation in teaching, research, culture and university extension, at the national and international levels. Contact: international. info@usp. br Responsible: CEO - Raul Machado Neto / +55 (11) 3091 -2249 / aucani@usp. br Types of opportunities: 1. International Academic Cooperation 2. Scientific and academic production 3. Business Partnerships UNICAMP (SP) - Executive Vice-Rector of International Relations Created in 1984, is responsible for assisting the State University of Campinas (Unicamp) to strengthen its international presence. In order to reach this goal, it has made efforts to internationalize the campuses, encouraging and managing student exchange programs and visiting researchers and assisting the units in the elaboration of international cooperation agreements. Contact: eliete. silva@reitoria. unicamp. br Responsible: • Vice-Rector - Raul Machado Neto / +55 (19) 3521 -4702 • International Partnerships: Angélica Cristina Torresin / +55 (19) 3521 -4701 angelica. torresin@reitoria. unicamp. br Type of opportunity: 1. International Academic Cooperation 2. Scientific and academic production 3. Business Partnerships 99

OPPORTUNITIES Index ACADEMY OPPORTUNITIES – RESEARCH AND STUDIES PARTNERSHIPS The following is the relevant contact information: ACADEMY UFSCAR (SP) - General Secretariat of International Relations (SRInter) Proposes and develops UFSCar's international relations policy through the promotion of cooperation and exchange, scientific and academic between UFSCar and foreign institutions. Contact: natalia-srinter@ufscar. br / marcelo-srinter@ufscar. br Responsible: • Secretary General - Maria Estela Antonioli Pisani Canevarolo / estela-srinter@ufscar. br • Mobility for International Relations - Maria Cristina Mozaner Nitzsche / cristina-srinter@ufscar. br Types of Opportunities: 1. International Academic Cooperation 2. Scientific and academic production 3. Business Partnerships UNESP (SP) - External Relations Office (Arex) To advise the Rectorate in its relations with other public and private entities, to assist the Pro-Rectorates and University Units in the area of international cooperation and to promote cultural and scientific exchange with foreign institutions. Contact: reginacl@reitoria. unesp. br Responsible: § Chief Adviser - José Celso Freire Junior / +55 (11) 5627 0439 / arex@reitoria. unesp. br § Support Advisor for Cooperation - Carlos Vergani / +55 (11) 5627 0564 / vergani@reitoria. unesp. br Types of Opportunities: 1. International Academic Cooperation 2. Scientific and academic production 3. Business Partnerships 100

OPPORTUNITIES Index ACADEMY OPPORTUNITIES – RESEARCH AND STUDIES PARTNERSHIPS The following is the relevant contact information: ACADEMY UFRJ (RJ) - International Relations Office (DRI) Establishes dialogue with academic institutions - such as universities and research institutes - and government agencies - such as embassies, consulates and international agencies Contact: acordosarrobareitoria. ufrj. br / +55 (21) 3938 -1609 Responsible: • Director - Vitor Alevato do Amaral / + 55 (21) 3938 -1618 / vitoramaralarrobareitoria. ufrj. br • Chief Academic Agreements International - Paulo Henrique Guerra / +55 (21) 39381733 / acordosarrobareitoria. ufrj. br Types of Opportunities: 1. International Academic Cooperation 2. Scientific and academic production 3. Business Partnerships UERJ (RJ) - International Cooperation Board Works with diplomatic representatives and international organizations in order to promote programs of cooperation and exchange of teachers, researchers and students of UERJ. Contact: dci@sr 2. uerj. br / +55 (21) 2334 -0797 / +55 (21) 2334 -2188 Responsible: • Director of International Cooperation - Cristina Russi Guimarães Furtado • International Agreements - Cláudia Cavalcanti and Marcos Paulo Braga do Nascimento Type of opportunity: 1. International Academic Cooperation 2. Scientific and academic production 3. Business Partnerships UFF (RJ) - Superintendence of International Relations (SRI) It acts by developing and stimulating internationalization policies for the Fluminense Federal University. Contact: sri@id. uff. br / conveniosri@id. uff. br / +55 (21) 3674 -7901 Responsible: • Superintendent of International Relations - Livia Maria de Freitas Reis / sri@id. uff. br • Coordinator of Projects and Mobility (Deputy Director) - Adriana Maciel / sri@id. uff. br • Coordinator of Academic Cooperation - Andrea Brito Latgé / sri@id. uff. br Types of Opportunities: 1. International Academic Cooperation 2. Scientific and academic production 3. Business Partnerships 101

OPPORTUNITIES Index INTELLIGENCE HUB FUTURE VISION WITH INTELLIGENCE HUB SUPPORT The competitive intelligence function should be a constant and systematic activity. Considering the constant evolving market, in order for the Netherlands and its partners enjoy up-to-date, detailed and deep information, it would be interesting to have a Brazilian market intelligence partner who has local knowledge to support in business decisions. Throughout one month of working on this project/report, we can see a number of opportunities that were outside our scope of work and that could bring interesting insights to the Netherlands and its partners. Here are some points of interest: 1. Monitor continuously relevant topics, issuing Early Warnings as per the Netherlands and partners interest. A few topics could include: Ø Foreign companies and capital entering health market in Brazil; Ø Bills in processing stage related to health; Ø Technological developments. 2. Develop profiles, as well as approach companies and specific start ups, detailing more deeply their actions and activities; 3. Explore other geographic areas, especially the South Region - Santa Catarina State (SC) and Porto Alegre City (in Rio Grande do Sul State - RS), Northeast Region and Minas Gerais State (MG): Ø Considering there are indications of potential business outside of the RJ-SP axis. An example is the partnership between public and private sector – the Brazilian Diagnostic Network (RBD) and the state government of Bahia will create 12 diagnostic and imaging centres throughout the state (total investment R$1 billion). This is the first public-private diagnostic partnership in Brazil. RBD is composed of Philips Healthcare of Brazil (Dutch company), Alliar (one of the largest diagnostic medicine companies in Brazil) and FIDI (Foundation Institute of Research and Imaging Diagnostic Study is the largest diagnostic imaging service provider for the SUS – United Health System; present in 46 hospitals in SP). 102

Information, Knowledge and Methodologies to increase your competitiveness Market Scan Report on Healthy Ageing in the Brazilian States of São Paulo and Rio de Janeiro Dec 2016 www. intelligencehub. com. br 103