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ОглавлениеMany people are afraid of aging … much of the negative attitude is generated by a set of myths about individual and population aging that are not backed and often squarely contradicted by evidence. (Axel Börsch-Supan, 2013: 3)
If you are reading this book, chances are that you have signed up for a course in ageing studies or social gerontology, which is a sub-set of gerontology – the study of human ageing. Or, perhaps, you are working with older people and would like to know more about social policy issues related to ageing. You may even be one of those people who picked up this book because you are curious. Regardless, you are sure to have some questions about ageing and older people. In our experience of teaching people about ageing, we have identified a number of questions to which students want to know the answers, but are too afraid to ask. These questions range from ‘What counts as old age anyway?’ to ‘Will I have enough money to retire, and when?’. You probably have more questions of your own that relate to your personal experience, members of your family or what you have observed from news or public debate.
Whatever your question, we can assure you of two things: you are probably not alone in asking it, and the answer will be much more interesting than you expect. We have been so inspired by the questions that students have put to us over the years that we decided to use their curiosity to shape our whole book. Each chapter is written as a response to a question posed by a student to one of us at some stage in our teaching careers. In every chapter you will find interesting questions lead to fascinating answers.
It is this constant capacity of the study of human ageing to shock, excite, inspire and even provoke fear that makes it one of the most interesting areas of scholarship in social science today. Box 1.1 sets out six shockers to whet your appetite:
Box 1.1: Some ageing factoids
•If you are female and were born in 2000 in Kensington and Chelsea (a wealthy area of London, England), your life expectancy at birth is eight years longer than a baby girl born just 200 miles north in Manchester, England, in the same year (ONS [Office for National Statistics], 2013).
•In the UK, as of April 2019, the full state pension is £167.25 per week. That’s about £8,700 per year (Department for Work and Pensions, 2019).
•Population ageing is as much to do with children as it is older people. One of the main drivers for population ageing is actually falling total fertility rates (that is, the number of children born per woman) (Harper, 2016).
•In 2016, more than 30 per cent of the homeless population of the United States (US) were over 50 years old and this is still growing (Department of Housing and Urban Development, 2016).
•According to a 2016 Government Accountability Office (GAO) report, in the US, around 50 per cent of households headed by someone 55 or older have neither a pension nor any retirement savings (Government Accountability Office, 2019).
•Extended life expectancy varies across the globe. A girl born in Swaziland today will be lucky to see her 50th birthday. This compares with a life expectancy of 87 years for a girl born in Japan (United Nations Department of Economic and Social Affairs, 2015).
To check out your own life expectancy, use the tool on the UK’s ONS website (www.ons.gov.uk).
Throughout this book, we aim to keep you interested. So, we will include lots of boxes with interesting facts, references to relevant online resources, and, crucially, difficult questions for you to think about as you learn more about ageing. In this chapter we are going to lay the groundwork by describing some of the infrastructure that you need to understand population ageing. However, we have left detailed descriptions of some key concepts, such as the ‘dependency ratio’ and ‘birth cohorts’, to later chapters. We have provided a glossary of key terms for you to check the meaning of concepts too. As social scientists we are also keen to explain how different approaches in social policy and allied health services such as social work and social care might affect older people, or indeed, whole populations who are ageing. Deciding the legal age at which someone qualifies for a state pension may seem like a simple and straightforward policy decision, for example, but it has very significant implications for the experience of ageing in that particular country. For instance, if you are required to work until you are 67 (the current age at which someone is eligible to receive the state pension in the UK) that may lead you to take a very different perspective on your work-life balance than someone who knows that they can retire at 62, such as pensioners in Greece (OECD, 2017). Retiring earlier also means that you will need to have saved a much bigger pension pot throughout a shorter working life. Likewise, if, like many middle-class people in northern and western Europe, you spend longer in education and so don’t start earning a salary until you are in your thirties, the time available to you to make adequate pension contributions is shortened. Our working lives are changing and so our pension policies must too. As you work through the book you will get down to the nuts and bolts of policy questions such as this, but first we need to talk about theories of ageing and how they help us to understand and explain population change.
Theories are vital because they help us to sort and interpret information, evidence and data. Evidence without theory is like jelly without a mould – shapeless and difficult to work with. Arguably, theories are the most important part of the infrastructure of your learning about any topic. That is why in this book, rather than separating theories of ageing into a chapter by themselves, we have grounded each chapter in the relevant theory. So, in Chapter 2 you will be introduced to basic concepts of ageism, Chapter 3 covers the dependency ratio, Chapter 6 includes feminist theories of gender and ageing, and so on. As we are interested in both the theory and policy implications of population ageing we have used practical tools to help you to understand how knowledge of ageing societies is constructed. For instance, towards the end of this chapter we will examine and deconstruct the most popular and useful method of representing an ageing population in graphical form, the population pyramid. You will see in Table 1.1 later in this chapter that we have outlined life expectancy and a human development index for populations all around the globe. These are useful measures of working out which stage of the demographic transition a society has reached. First, let us lay out a few ground rules about the theoretical approach that the book takes: critical gerontology.
An important note on the language of gerontology and ageing
For the most part, in your daily life you will notice that the language around ageing and older people tends to swing between two extremes. On the one hand there are the sensationalist newspaper headlines which suggest that our ageing population represents a ‘demographic time-bomb’. The time-bomb analogy is based on the idea of the dependency ratio, which we explore in Chapter 3. The short version is that actuaries suggest that, based on current costs of pensions and healthcare, if more people live longer and fewer children are born, then we will be left with fewer workers per retired person. They envisage pension funds then having a big gap between the expectations of members and the funds available. When this is applied to a whole population, it seems legitimate to claim that there is, indeed, a time-bomb of under-funded pensions.
Critical gerontologists have always critiqued this kind of actuarial reasoning for three important reasons. First, we argue that the predictions do not allow for any change of policy. In fact, if pension policies were adjusted to allow for greater life expectancy, through policies such as making larger employer contributions or workers retiring later, then the gap between savings and expectations should never arise. Second, critical gerontologists recognise that by applying actuarial assumptions to a whole swathe of the population, it is easy for the public to come to the mistaken assumption that older people, as a group, are dependent, a burden in some sense. It would not be acceptable to apply this reasoning to other groups. For instance, can you imagine actuaries saying that all pregnant women and their babies represent a ‘maternity benefit time-bomb’? This seems ridiculously sexist and short-sighted. If so, then why should it be perfectly acceptable to apply such a reductionist moniker to pensioners as a group? Third, critical gerontologists are very conscious of the role of language in perpetuating myths and stereotypes about old age. We are aware not just of the structures which confine older people to homogenous categories, but also the processes that maintain and support those structures. So, critical gerontologists take great trouble to analyse policies for older people in a way that reveals potential benefits but also the potential of the policy to be oppressive. A good example of this kind of reasoning can be viewed in the work of Bülow and Söderqvist (2014) in critiquing ‘successful ageing’. In their historical overview of ‘successful ageing’ (a concept introduced through Rowe and Kahn’s 1984 paper, ‘Human ageing: usual and successful’) the authors identify how the language of success, central to the discourse of ‘Reaganomics’ in the US in the 1980s, managed to shift responsibility for well-being in old age away from society or the state, instead placing it on the individual. The door was then left open for neoliberalism, that ideology of the individual, to claim that those who avoided poverty and ill health in old age were ageing ‘successfully’. Critical gerontologists are more concerned with where this leaves the many millions of older people who become frail, ill or poor through no fault of their own, a theme that we develop in some detail in Chapter 4.
Bülow and Söderqvist (2014) make a convincing case for recognising that language is not neutral, particularly when it is being used to evaluate the performance of a particular segment of the population. Their critique applies to other related concepts which built on the successful ageing ideology, such as active ageing, healthy ageing or ageing well. At its heart, the critique of these neoliberal approaches to analysing old age has its roots in the broader claim by critical gerontologists such as Meredith Minkler that to understand human ageing we must see beyond the physiological and particularly the biomedical which tends to reduce old age to ‘a series of downward sloping lines’ (Minkler, cited in Bülow and Söderqvist, 2014: 146). So, language is important because it links back to ideology as well as to conceptual schema and theoretical approaches. The overall impact is that language serves to empower or imprison depending on the kind of ideology or approach it is describing. As you read through this book, take note of when we use terminology such as ‘pension time-bomb’ or ‘economic burden’ to describe a policy response to a particular question facing our ageing societies. We will use quotation marks to indicate that the term being used needs critical interpretation by you as a reader, and by your whole class in discussions and debates.
Ageist language, whether hostile or paternalistic, is the tool used to empower or imprison people in stereotypes of old age. It is an important goal of our book that students learn about the impact of their own words, and how to devise fair and clear language to describe ageing and older people through their study and work. There are some clear examples of the impact of language and particularly how a lack of nuanced understanding of the diversity of older people’s lives and experiences has resulted in the use of age as a means of controlling the spread of COVID-19 in 2020 (Carney, 2020). The use and misuse of language in the formation of stereotypes is developed in Chapter 2. The issue of language as a means of empowerment or oppression has come to the fore in recent years with the rise of populist and divisive politics in the Western world. There are many reasons for this, most of which are beyond the scope of this book. However, there is one aspect of this shift which is an important conceptual theme running through this book – the prevalence of neoliberal ideology in government, politics, and society for the past three decades.
A note on neoliberalism and Right versus Left politics
Neoliberalism is an ideology, best understood as the marketisation and commodification of every aspect of our lives, from our social media data to our education and healthcare. It began with a backlash against the economic instability of the 1970s, which saw the UK economy dominated by industrial unrest and the US by repeated economic crises. The antidote to this instability was presented as the free market. This neoliberal ideology was institutionalised in US and UK politics through the leadership of Ronald Reagan in the US and Margaret Thatcher in the UK. Thatcher and Reagan worked hard to liberalise and deregulate markets so that the state had less control over the national economy. The purpose of this liberalisation was to free up the market to provide goods and services in a manner which was more efficient and effective than the state could provide. In the UK, Thatcher claimed that the state had no responsibility for individual welfare, setting out to remove state control from as many aspects of life as possible. State-run utilities and transport networks were privatised and those living in free, local government-owned ‘council housing’ were encouraged to buy their homes under the ‘Right to Buy’ scheme. While Thatcher’s premiership ended in 1990, her legacy is still visible in every general election held in the UK since, including the New Labour government of Tony Blair which held office from 1997 to 2008. Even Labour, the traditional party of the Left with strong socialist and social justice ideals at its core, opted to embrace neoliberal ideology in order to be elected. Thatcher and Reagan’s regimes left a legacy, shifting politics in the UK and the US firmly to the more conservative and free-market Right-wing of the spectrum. This shift has been solidified in elections of Donald Trump in the US and Boris Johnson in the UK. However, the importance of collectivist solutions to major problems has been thrown into sharp relief since the COVID-19 pandemic emerged. Suddenly politicians who won votes on the basis of promises to retract state-run public services are utterly dependent on the state institutions they have spent years depleting, such as the National Health Service (NHS) in the UK. These conditions beg the question whether a post-COVID consensus, like the post-war consensus of 1945, could emerge once the pandemic has passed, or whether the experience of the pandemic will make politics even more divisive and individualistic.
Throughout this book, we make reference to Right wing and Left wing governments. In general, Left means a government which is more socialist or social democratic, such as those parties associated with workers’ rights, women’s rights and protecting minorities. This would be the Democrats in the US, the social democratic governments of Sweden and Denmark or the Labour Party in the UK. It is worth noting that there is still a lot of diversity within this, with Swedish socialists being decidedly more collectivist than the US Democrats, who are more liberal than socialist. On the other end of the political spectrum we see parties of the Right, or Right-wing governments. These governments tend to subscribe to ideologies such as free-market liberalism, or more commonly, neoliberalism. Examples of Right-wing governments include the US under Donald Trump and the UK under Boris Johnson. Further to the Right on the political spectrum are governments such as those of Jair Bolsonaro in Brazil or Viktor Orban in Hungary. In these cases governments may set out to erode equality or human rights, such as the policy of Orban to ban gender studies from universities in Hungary (Redden, 2019). While you will need to read on to Chapter 3 to engage with a worked example of neoliberalism, it is worth taking some time to read its full definition in Box 1.2.
Box 1.2: Defining neoliberalism
Neoliberalism is one of those awkward phrases that is widely used but, perhaps through such over-use, has lost some of its analytical weight. In his article, ‘What is Neoliberalism?’, Kean Birch (2017) outlines many of these issues, but also provides a handy definition of the concept and its uses: ‘Neoliberalism is regularly used in popular debate around the world to define the last 40 years. It is used to refer to an economic system in which the “free” market is extended to every part of our public and personal worlds … Neoliberalism is generally associated with policies like cutting trade tariffs and barriers. Its influence has liberalised the international movement of capital, and limited the power of trade unions. It has broken up state enterprises, sold off public assets and generally opened up our lives to the dominance of market thinking’ (Birch, 2017: 1). In short, neoliberalism refers to the monetisation and marketisation of many aspects of human life.
Deciding what to include in a textbook is always difficult. It is important to be as comprehensive as possible, but restrictions in space and time mean that no book is truly so. Given these limitations, we chose broad themes. The result is nine chapters, each of which addresses a core area of social gerontology. In each chapter, we lean on seminal work to scope out the field, then update this with current publications and try wherever possible to include worked examples to illustrate how the policy plays out for older people and their families in real life. As stated in the Preface, much of the writing for this book took place in 2018–19. The COVID-19 pandemic is unfolding as we make our final changes to the proofs of the book and so only minor comments can be made on the implications of the pandemic for ageing societies. One thing we can say with some surety is that the pandemic throws a harsh light on the need for society and government to take greater account of the age and health profile of their population when planning where to spend public money.
In this first chapter we demonstrate how making the transition to an older population means that we will need to rethink many of the basic tenets of the welfare state. We outline how thinking and research on ageing populations are constantly developing, and how issues which seemed insurmountable in the past (for instance, gender inequality in life expectancy), have now been replaced with alternative challenges, such as the prevalence of dementia, or the need to improve standards of care in residential settings. We use a number of tools such as population pyramids to demonstrate this complexity and provide readers with an overview of population ageing around the globe. We conclude that the problem is not ageing itself, it is that we use age to structure social, economic, and political life in a way that is neither efficient nor effective (Carney and Gray, 2015).
Chapter 2, ‘The ageist zeitgeist’, takes up the baton of this problematic approach to thinking about chronological age by addressing the challenge of combating ageism – one of the most pervasive and harmful forms of discrimination. We explain how attitudes and behaviours are interlinked and how socio-cultural norms reinforce what is and is not acceptable behaviour.
One of the ways in which ageism perpetuates is through the use of age as a structural barrier to accessing employment and education. We explore some of these issues in Chapter 3, ‘Retirement, active ageing and working longer’. By asking whether retirement is becoming a thing of the past, we examine alternatives such as extended working lives and opportunities for new careers in business or trade. We conclude that active ageing, the core policy in this area for ageing societies since the 1990s, is problematic when it is operationalised within the context of high levels of inequality. As levels of inequality continue to increase, active ageing has become maligned in some circles, and is now often regarded as merely an aspiration for well-off older people rather than a workable policy for ageing societies.
As Chapter 3 reports, most people have little say about when they retire. Quite often retirement is the result of redundancy or ill health. For these reasons, in Chapter 4 we take up the theme of care for older people. We note that most carers of older people are spouses or older adult offspring, who are aged 60 or over themselves. While we note the physiological changes that accompany normal ageing, we frame this as just one of many stages of possible dependency experienced across the lifecourse, from birth to death (Fineman, 2005).
Rights are taken up again in Chapter 5 when we discuss ‘Diversity among the ageing population’. Chronological age is a pretty spurious basis on which to place people into one group or ‘minority’ and so it is hardly surprising that diversity among older people is significant. In this chapter, rather than offering a superficial overview of everything from gender to racial discrimination, we choose to focus on LGBTQI* rights as a means of exploring the process of ageing through a period when gay men’s lives transformed from being criminalised to gaining equal rights.
As gender discrimination shapes every aspect of ageing across the lifecourse, we have dedicated Chapter 6 to examining how age and gender intersect to produce different experiences of ageing for men and women. We address important questions such as gender differences in old age and how policies affect older women. We finish with a section on masculinity and ageing, concluding that there are particular challenges for men in old age.
In Chapter 7, we move from the discussion of age discrimination to solidarity between generations, one of the most valuable forms of social solidarity in ageing societies. The chapter elaborates on some core concepts, such as ‘generation’ and ‘birth cohort’, explaining how each is related but distinct. The chapter goes on to discuss how some governments, who wish to remove socio-economic rights supported through the welfare state, have attempted to erode solidarity between generations by promoting regressive politics of generational equity which have little foundation in researched evidence.
The fact that public discourse about ageing has been ‘ceded to political activists, pundits and journalists, leading often to exaggerated or garbled interpretation’ (Teitelbaum, 2015: S87) is explored in Chapter 8, ‘Politics of ageing’. By asking why older people vote and younger people protest, we investigate how political participation changes across the lifecourse. We conclude that narrowing the gap between public perception of what it means to live in an ageing society and research evidence about population ageing is going to be key in making a peaceful transition to a new, older, electorate.
In Chapter 9, we take up the challenge of ageism, naïve media interpretation and low levels of public understanding of ageing through the lens of cultural gerontology. We explore how the cultural turn has expanded and enhanced our understanding of what it means to live a long life. Through themes of embodiment and identity, and by exploring cultural critiques of the biomedical model, we show how a deeper and more culturally connected understanding of ageing can enrich this stage of the human lifecourse for everyone.
Chapter 10, the final substantive chapter of the book, pulls together all of the core concepts and information from each chapter under broad headings and themes such as political economy of ageing, and post-structuralism. In this chapter, we also lay out a range of possible research questions and areas for further research, which students may decide to pursue at postgraduate level. We conclude with some critical questions for graduates around how they can have a positive influence on ageing societies.
Chapter 11 is dedicated to helping you consolidate what you have learned. We do this through a series of multiple-choice questions. You can dip into this chapter as soon as you have finished working on a particular topic, or you can wait until you have finished the whole book and use these exercises to test your level of knowledge with an end of term quiz. Either way, you will be surprised by how much you now know about human ageing and the policy challenges it poses for ageing societies.
An online resource of questions and exercises is also available at https://policy.bristoluniversitypress.co.uk/critical-questions-for-ageing-societies/online-resources
As this is a textbook, we worked hard to make it a useful and easy-to-read introduction for anyone interested in the social implications of ageing. To this end, we have added an extensive glossary of key terms which we hope will accelerate your education on ageing.
Let’s begin by addressing the first question that students ask in class; why are there more older people around now than in the past? Or, to put it more directly, what is population ageing?
Population ageing refers to the general trend across the globe whereby the average age of the human population is increasing. This means that a higher proportion of the population is aged 50 years or more. We tend to take 50 as the marker of the very beginning of old age because it is the point at which life scientists recognise that human beings are beyond reproductive age. This capacity of human beings to live beyond reproductive age has been recognised as significant by all the major international organisations. In fact, the implications of population ageing have been recognised as being so pervasive, enduring and significant that, in 2002, the United Nations launched the Madrid International Plan on Ageing. The World Health Organization (WHO) has led a major international ‘age-friendly’ initiative in more than 46 countries around the world (WHO, nd). The European Union (EU) has recognised it as a ‘grand societal challenge’ for researchers under the Horizon 2020 programme of research (European Union, 2019). Most countries in Europe have some form of active ageing strategy (see United Nations Economic Commission for Europe, 2018). For policy makers, population ageing is a major challenge, as it requires changes in how resources are allocated between groups.
The process of population ageing is not a static or linear process; in fact, it has been constantly changing since it gained international recognition at the turn of the century. For instance, the human race passed a major milestone in 2015 when, for the first time in human history, the number of people aged over 60 was larger than the number of babies born. So, population ageing refers to the fact that people are living longer, women are giving birth to fewer children (hence the higher average age), and people are moving around the globe so much that it is affecting the population balance. Let’s look at these three conditions that contribute to population ageing in more detail.
•Fertility: The number of children being born per woman (referred to as the ‘total fertility rate’) has been decreasing around the globe and specifically in western and northern Europe, North America and East Asia.
•Delayed mortality: Populations of these same regions have experienced significant increases in life expectancy over the past century. One hundred years ago a woman born in northern or western Europe could have expected to live to be about 50. Today, she will most likely be over 80 at time of death. Her children can expect to live to be over 100 years old. This is an increase of over 30 years in one century. It is helpful to think of this in simple, global terms, provided by leading critical gerontologist, Chris Phillipson. So, in 1900 1 per cent of the world’s population was aged 65 or over. By 2000 it was 7 per cent (Phillipson, 2013). This does not allow for regional variation. In some countries, such as Japan and Italy, more than 20 per cent of the population is aged 65 or over. Table 1.1 illustrates these regional differences.
•Migration: The third driver of population change is migration. This does not seem as obvious a cause of population change as extended life expectancy and falling fertility. However, people’s decisions to stay in or leave a certain country can have a major impact on the population balance. For instance, one of the main ways that older populations in western Europe can maintain their demographic balance is to ‘import’ younger people from eastern European countries such as Poland which have traditionally have high levels of emigration. The result is that the population in Poland is now ageing quickly as older people are left behind following the exodus of young people to pursue higher wages and better prospects in richer countries of the European Union (World Bank, 2012).
There are so many interesting points to note about this representation of life expectancy around the globe in Table 1.1. You will see that we use the Human Development Index (HDI) to show not just how long people live, but also the quality of life they are likely to enjoy. The HDI was put forward by leading social scientists such as Amartya Sen, who claim that there must be a strong connection between the means and the ends of human development (Anand and Sen, 1994). Therefore, the HDI is a measure of whether a country’s economic progress, measured by Gross Domestic Product (GDP), is accompanied by a society which allows each individual human being to develop their achievements, freedoms and capabilities. The HDI measure is a score between zero and one, offering a useful shorthand for understanding whether human beings are thriving in a specific country. Countries with a score nearer to zero are more likely to have high levels of infant mortality, low levels of access to basic education, and higher maternal mortality rates (for example, Ethiopia and Sierra Leone). On the other hand, countries with low infant mortality, higher levels of tertiary education and literacy in the population will score closer to 1 (for example, Japan and Switzerland). By including HDI in our table of life expectancies, we hope to open your eyes to the possibility that countries with the oldest populations, both in terms of life expectancy and percentage of the population aged 65 or over, often offer the best opportunities for human development.
Table 1.1: Life expectancy in selected countries
| Region | Country | Life expectancy at birth | Human Development Index | % Population aged 65 or over |
| Europe | Switzerland | 83.6 | 0.944 | 18.6 |
| Italy | 82.2 | 0.880 | 23.3 | |
| France | 82.0 | 0.901 | 20.1 | |
| United Kingdom | 81.2 | 0.922 | 18.7 | |
| Germany | 80.5 | 0.936 | 21.7 | |
| Poland | 76.7 | 0.865 | 17.3 | |
| Russia | 70.1 | 0.816 | 14.6 | |
| North America | Canada | 82.5 | 0.926 | 17.4 |
| Cuba | 79.9 | 0.777 | 15.2 | |
| United States | 78.5 | 0.924 | 15.8 | |
| Mexico | 77.3 | 0.774 | 7.1 | |
| Jamaica | 76.1 | 0.732 | 9.9 | |
| Haiti | 63.0 | 0.498 | 4.9 | |
| South America | Chile | 79.7 | 0.843 | 11.5 |
| Argentina | 76.7 | 0.825 | 11.3 | |
| Brazil | 75.7 | 0.759 | 8.8 | |
| Colombia | 74.6 | 0.747 | 8.0 | |
| Bolivia | 69.5 | 0.693 | 6.8 | |
| Guyana | 66.8 | 0.654 | 5.4 | |
| Oceania | Australia | 82.5 | 0.939 | 15.7 |
| New Zealand | 81.7 | 0.917 | 15.6 | |
| Vanuatu | 72.3 | 0.603 | 4.5 | |
| Fiji | 70.4 | 0.741 | 6.4 | |
| Micronesia | 69.3 | 0.627 | 5.1 | |
| Papua New Guinea | 65.7 | 0.544 | 3.9 | |
| Asia | Japan | 84.1 | 0.909 | 27.5 |
| Singapore | 82.9 | 0.932 | 13.6 | |
| China | 76.4 | 0.752 | 11.2 | |
| India | 68.8 | 0.640 | 6.2 | |
| Afghanistan | 64.0 | 0.498 | 2.6 | |
| Middle East | Israel | 82.6 | 0.903 | 12 |
| United Arab Emirates | 77.4 | 0.863 | 1.2 | |
| Iran | 76.2 | 0.798 | 5.7 | |
| Turkey | 76.0 | 0.791 | 8.4 | |
| Syria | 71.0 | 0.536 | 4.5 | |
| Yemen | 65.2 | 0.452 | 2.9 | |
| Africa | Algeria | 76.3 | 0.754 | 6.4 |
| Egypt | 71.7 | 0.696 | 5.2 | |
| Ethiopia | 65.9 | 0.463 | 3.5 | |
| South Africa | 63.4 | 0.699 | 5.5 | |
| Democratic Republic of the Congo | 60.0 | 0.457 | 3.0 | |
| Sierra Leone | 52.2 | 0.419 | 2.5 |
Sources: http://hdr.undp.orgorenorcountries (HDI); https://data.worldbank.orgorindicat//sp.dyn.le00.in (Life expectancy); https://data.worldbank.orgorindicat//SP.POP.65UP.TO.ZS?view=map (% of over 65s)
As you read through the book, no doubt you will refer back to this table to check life expectancies, and to wonder why certain issues such as gender inequality, diversity, or lack of adequate care might produce a lower life expectancy or a smaller population of over 65s.
Box 1.3: When does old age begin?
Alert readers will, by now, have noticed that we are referring to older people inconsistently. Sometimes we refer those who are 50 years or over as older people, at other times it is over 60 or over 65. People aged 80 or over are often referred to as if they belong to a separate category. The question of when old age begins depends on which population you are referring to. In Sub-Saharan Africa, old age begins in your thirties, or not at all, as a relatively high proportion of the population never makes it to adulthood, never mind old age. The answer to the question of when old age begins also depends on who you ask. Life scientists who study senescence (the biological decline associated with old age) will say that old age begins once a human being has moved beyond their reproductive years. So, for much of the wealthy industrialised world, this is aged 50 or over. For policy makers, age tends to be used as a means by which it is decided whether someone qualifies for a benefit. The most important benefit for older people is the state pension. It is so important in the UK context that retired or older people are generally referred to as ‘pensioners’. As the pension age has (up until very recently) been set at 65, for policy scholars in UK and European countries more generally, 65 is the age at which old age begins.
Myths and facts about population ageing
One of the great things about studying population ageing is that, while it is a relatively new phenomenon, the scale and size of the ‘longevity revolution’ (Butler, 2004) means that there have been major investments in research in the area. From the perspective of social scientists, the most important studies are longitudinal. Longitudinal studies are long-term programmes in which researchers find a group of people who are willing to be poked, prodded, questioned and analysed, not just once in a lifetime, but once every two to five years. Longitudinal studies are viewed as the gold standard in research on ageing populations because they allow you to see if there are major changes in a population over time. There are numerous such studies around the globe, and some are specifically designed to investigate population ageing. These studies recruit participants aged 50 or over and follow their progress for as long as they live. In the US, there is the Health and Retirement Study (HRS). The comparable study in Europe is called the Survey of Health, Ageing and Retirement in Europe or SHARE (www.share-project.org/). There are many country-level studies in Europe too, including The Irish Longitudinal Study of Ageing (TILDA) (https://tilda.tcd.ie/), the Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA) (https://www.qub.ac.uk/sites/NICOLA/) and the English Longitudinal Study of Ageing (ELSA) (https://www.elsa-project.ac.uk/).
The architects of these studies had the foresight to design them to be comparable. This means that researchers can compare the physiological, financial and socio-economic status of older people in a number of different regional and national contexts around the world. Comparative longitudinal data is invaluable if we are to start adapting and changing our policies to adjust for an older population. So far, findings from these studies are revealing that older people are a more diverse and complex section of the population than envisaged. The stage of life known as ‘old age’ is proving to be more productive, and have a more varied experience, than previous generations could have imagined.
At the time these studies were launched (SHARE began in 2004, the HRS in 1992) researchers rather naively believed that adapting to an older population merely meant that we needed to find out more about that older population. Once we had the facts, it was thought that we could then use good quality social scientific evidence of the needs of the over 50s and adjust social spending accordingly. As with most things in social policy (and life) it turned out to be a tad more complicated than that. We will begin to discuss these issues by answering a common question asked by students: ‘Why is population ageing a big deal?’
Why is population ageing a big deal?
There are a number of reasons why policy makers and politicians are anxious about population ageing. Basically, any change in the demographic balance of a state’s population impacts on family structure, the labour market, the organisation of social welfare, the supply and demand of goods and services, and pretty much every aspect of resource allocation in society. In democracies which operate on the basis of ‘one person, one vote’, a changing demographic profile could also cause big shifts in voting patterns. We will deal with these issues in Chapter 8, which focuses on the politics of ageing. For now, let’s concentrate on what having an older population might mean for the political economy, or the financing and resource allocation decisions that produce the ‘welfare state’ – the social contract between state and citizens which provides publicly funded supports and services to citizens, including pensions, healthcare and education. In truth, ageing is only the latest in a series of incremental but seismic changes to the global population since death rates started to decrease, followed by a logical decrease in fertility rates. The overall process is referred to as the ‘demographic transition’ and is said to occur in four stages (Harper, 2016; 1); see Box 1.4.
Box 1.4: The four stages of the demographic transition
•Stage 1: ‘Life is nasty, brutish and short’ (Hobbes, 1651). High death rates from famine, disease, lack of hygiene and malnutrition, accompanied by high fertility rates. This was the situation in England up until about 1780.
•Stage 2: A rapidly expanding population because of improvements in public health, and a reduction in deaths from communicable disease, but fertility rates are still high. However, child mortality rates are also still relatively high. Examples include 21st-century Sudan and 19th-century UK.
•Stage 3: Mortality rates stay low, but fertility rates now also begin to drop. This is where we begin to see the ageing of the population. This was the situation in Europe or the US in the 20th century, or present-day Uruguay.
•Stage 4: By stage four, the fortunes of the European population have completely turned around from the time of Hobbes: life is now healthy, peaceful and long. Death rates and fertility rates are both low but the population is relatively stable, albeit at a high level. This is the stage we have reached in Canada, the US, and western Europe in the 21st century.
Source: Harper, 2016
The main point to note from Box 1.4 is that reaching stage 4 of the demographic transition is where we begin to see important implications for the welfare state. That said, the recent COVID-19 pandemic has given some of countries with the oldest populations in the world, such as Italy and Japan, a bitter taste of the past, when infectious diseases were widespread killers of vulnerable groups. However, if, as expected, a vaccine for COVID-19 is found and we return to low death rates from communicable and infectious disease, then we are likely to continue to have larger numbers of older people. Making the transition to an older population means that we will have to rethink some basic elements of the social contract that underpins the welfare state. One of the major points of contention is the ‘dependency ratio’ (the ratio of people of working age to those not of working age). Traditionally, working age in the UK is taken to mean those aged between 16 and 64 years. In Chapter 3, we will discuss why calculating a dependency ratio can be problematic.
At the beginning of the third stage of the demographic transition, it was thought that having more people aged 50 or over would have a major, negative impact on the public purse. Some people even thought that the onset of population ageing might lead to a ‘demographic time-bomb’ (itself a troubling phrase) whereby a disproportionate number of older people would demand healthcare and pensions, at the expense of younger populations. In some quarters, this deficit hypothesis still prevails. It is now recognised that the assumptions underpinning such a phrase are essentially ageist, as they work on the basis that being older automatically implies dependence and need rather than independence and productivity. However, more recently it has been noted that the ‘baby boomers’ of the early 21st century (those born between around 1946–64) have not been replaced. So, the increase in the proportion of over 60s in societies that experienced a strong baby boom will begin to reduce after 2030 or 2040 (Reher, 2015). Even so, demographers such as Reher (2015) argue that countries which experienced a strong post-war baby boom, such as the UK, the US and many western European countries, should prepare for a ‘tidal wave’ of growth in the number of cases of certain chronic or degenerative illnesses typical of persons of advanced age. Note that ‘tidal wave’ holds similarly negative connotations as ‘time-bomb’ and reflect the negative associations with older cohorts.
Perhaps the solution is for policies to be tweaked to serve an older demographic profile? Such an approach is preferable to blaming a growing minority of the population for simply living too long. This thesis is gaining traction in gerontology. For instance, Carney and Gray (2015) argue that the problem is not the age of the population itself, but rather how age is used to structure social, political and economic life. We will discuss these issues in more detail in Chapter 2 on ageism and again in Chapters 6, 7 and 8 on gender, solidarity between generations, and the politics of ageing, respectively.
Population ageing in the context of population change
For now, the main point to note is that population ageing is the result of the interaction of a number of drivers including declining mortality rates, decreased fertility rates and migration. The impact of migration should not be underestimated. It has been argued (Carney, 2017) that the issue of falling numbers of ‘working age population’ (aged 20–64) could be solved by opening up to inward migration. However, this approach may lead to new imbalances. For instance, countries such as Poland have a population that is ageing rapidly due to the exodus of young, educated people to more economically healthy member states of the EU, such as Ireland and the UK, since 2004. Conversely, in countries where immigration is a politically contentious issue, the link could be made between relaxing immigration laws and increasing the number of younger people in the population. Of course, gerontologists would also argue that there are many other means of increasing productivity, such as providing opportunities for older people to gain further education, to remain independent and to enjoy encore careers into their eighties and nineties. This philosophy of ‘active ageing’ has been the official policy of major international organisations and supranational institutions such as the WHO and the EU since the late 1990s. While this approach is not without its critics (Bülow and Söderqvist, 2014;), active ageing is useful for helping us to challenge notions of old age as a period of dependency (Foster and Walker, 2015). In fact, many older people are independent and active throughout their lives. Related to this is the issue of access to education, which tends to be focused on the early decades of the lifecourse. However, looked at from the perspective of long-term demographic change there are two compelling reasons which suggest that education should be lifelong. First, there is a ‘positive correlation between education and the likelihood of a long and healthy life’ (Reher, 2015: S66). Second, access to education allows ageing societies to improve their capacity to adapt to challenging circumstances (Coleman et al, 2015: S4). Taken together, changes to any or all of these policy areas – particularly education and migration – could have a major impact on the rate at which a population is ageing.
It is generally recognised within social gerontology that ageing is a gendered experience, and that women suffer particular discrimination and disadvantage in old age. This is, perhaps, why there is a whole journal (the Journal of Women & Aging) dedicated to the analysis of women’s ageing. In more recent years, scholars such as Laura Hurd Clarke have identified gender issues arising for older men, though this work is less abundant (Hurd Clarke and Lefkowich, 2018). The absence of a gender analysis is problematic for lots of reasons, not least that it tends to cause scholars to be blindsided in their analysis of the causes and consequences of demographic ageing. For instance, in his otherwise robust account of the role of baby booms and baby busts in the ageing of the developed world, Reher (2015: S57) cannot account for the abrupt decline in fertility rates from the 1970s onwards. Other scholars have identified an important role for women’s fertility choices in precipitating this change. The 1970s saw the advent of the second wave women’s movement in the very countries that experienced a sudden dip in their fertility rates, leading Carney (2017: 2) to conclude that ‘gender relations can and do shape demographic trends’.
State, citizen and age relations
The welfare state was designed on the basis that people would live for a relatively short period after retiring. Prussian Chancellor, Bismarck, who is largely credited with introducing the first pension in 1889, was working on the basis that most people would be dead long before qualifying for a state pension (von Herbay, 2014). At that time, life expectancy was 68 and the state pension age was 70. Even up until the time welfare states were established following World War II, life expectancy was much lower than it is today. Moreover, people tended to die suddenly of critical illnesses, such as heart attack or stroke. Fast forward to the 21st century and our population is not just older, it is entirely different in terms of physical health, socio-economic status and the older person’s expectations of retirement. For example, the male breadwinner model which was a cornerstone of the welfare state allowed the state to delegate large amounts of unremunerated work to women. Thanks to the work of campaigning second wave feminists from the 1960s onwards, this set of norms is no longer acceptable and more women are in employment. This change in the employment status of women has a positive impact on the dependency ratio (Spijker and MacInnes, 2013) but raises major questions about who will provide care to current and future generations of older people.
Extended life expectancy means that we are now living for up to 30 years after retirement. In countries with established health and welfare systems, people are less likely to die suddenly of heart attacks and other cardiovascular diseases. Nowadays, people have much higher survival rates across a range of illnesses, from cancer to pulmonary disease and stroke. Nevertheless, we are more likely to live with a chronic condition such as type 2 diabetes or dementia. Of course, our trusty longitudinal studies have captured all these changes. However, it is proving very difficult to translate this complexity into public understanding of what it actually means to be older. Health is just one area of change, and there are also major challenges in terms of our expectations of wealth, how we have organised housing, and experiences of loneliness and social isolation, as well as more recent problems such as the digital divide. The big question for ageing societies is that a changing demographic balance will require a reallocation of resources. There is no point in building lots of schools if there are not enough children to take up places. At the same time, we need to start investing in lifelong learning and training programmes if delayed retirement is to become a workable policy solution to increased longevity. Crucially, we need to convince voters and taxpayers that this demographic change justifies a change in resource allocation away from early years and towards older people’s services. Unfortunately, this task has been further complicated by the fact that some pundits have decided to use older people as a means to justify the retraction of the welfare state, with disastrous consequences. For instance, the systematic underfunding of social care for older people in the UK has long been a campaigning subject of critical gerontologists, an issue that has been thrown into sharp relief by the thousands of unnecessary deaths in care homes during the COVID-19 pandemic (Phillipson, 2020).
The lack of public understanding of the complex range of issues that arise from an ageing population goes well beyond politics; indeed, it affects every aspect of life, business and community. A major challenge for gerontologists (and a good reason for writing this book) is to help people to understand the implications of ageing for themselves, their families, communities and societies. We are not alone in seeing this gap. In fact, this book contributes to a growing literature which seeks to directly address the gap between public understanding of ageing and its actual, observable implications. Such is the lack of public understanding of what it means to have an older population that Axel Börsch-Supan (the architect of SHARE) felt compelled to write an article aiming to ‘demystify popular fallacies’ about our ageing population. In that article, Börsch-Supan (2013) outlines a number of myths that have endured, despite ample evidence to the contrary provided by SHARE and other longitudinal studies. None of the statements in Box 1.5 is supported by research evidence.
Box 1.5: Common myths about ageing populations
•To make a peaceable and successful transition to an older population policy makers need to plan for changes to the lives and behaviours of older people only.
•Older workers are less productive than younger people.
•Retirement is bliss.
•Keeping older people in the workforce leads to higher youth unemployment.
•Older societies have more intergenerational conflict.
Source: Börsch-Supan, 2013
Börsch-Supan (2013) is not alone in expressing frustration with the misinformation and half-truths that are peddled as ‘facts’ in relation to population ageing. As social scientists, you will be interested to hear that some of those most sceptical of the ‘demographic time-bomb’ hypothesis are hard data enthusiasts. For instance, Spijker and MacInnes (2013) have described population ageing as the ‘time-bomb that isn’t’. Scepticism also comes from demographers such as Teitelbaum (2015) who argue that public debate on population ageing, one of the most significant and impressive developments in human history, has been reduced to a series of crises for the public purse framed in ideological terms (see Willetts, 2010, or Howker and Malik, 2010, as examples of this kind of ideological writing). Teitelbaum (2015: S87) traces the difficulty in producing reliable public information about demographic ageing to its complexity, which had led many pundits to fall for the ‘seductive temptation of long range demographic projections, demographic dystopias and garbled demography’.
One of the most important ways of countering this trend is to communicate (and interpret) factual evidence about population ageing in formats that can be understood by a general audience. Population pyramids are a great way to do this as they allow demographers and gerontologists to sketch a graph of how populations in different countries, regions or time periods are ageing.
Every academic discipline has its signature device that draws in new scholars and keeps those already engaged interested for years, decades, and even lifetimes. Geographers have maps, economists have supply and demand curves, historians have archives and demographers have population pyramids. As demography is the study of the changing structure of human populations, the use of population pyramids has filtered into general use by gerontologists (scholars of ageing). Indeed, population pyramids are so integral to understanding and explaining population change that we have provided the tools for you to create your own population pyramid at the end of this chapter.
What are population pyramids?
Population pyramids are a simple graphical device for demonstrating how many people are alive at a particular period of time in a certain location. A basic population pyramid like the one shown in Figure 1.1 has the number of people on the horizontal x-axis and age cohorts on the vertical y-axis.
Pyramids are generally colour-coded into male and female divisions. There are some websites which allow you to surf different population pyramids by country and region (see https://populationpyramid.net). If you play around with these you will find some fascinating (and sometimes alarming) differences between the gender and age balance of different populations around the globe. For instance, a population pyramid from the US in 1950 will show a high birth rate, as indicated by the wide base on the x-axis. If you change the year to 2010 you will see major changes at the top and the base of the pyramid. Now there are some 60,000 people living in the US reaching the age of 100 or more. In 1950, the highest age bracket recorded on the pyramid was 80+. This means that while some of those living in the US might have survived up to 100 and beyond at that time, they were so few in number that they could not be recorded meaningfully on the pyramid.
Figure 1.1: An illustrative population pyramid
Population pyramids are also really useful for helping us to understand why some countries can be viewed as ‘old’ countries while other countries still report themselves as having ‘relatively young populations’. Once you have mastered the art of deciphering population pyramids you will be able to check out these facts for yourself. Population pyramids also help us to understand the relationships between different birth cohorts, the overall balance of the population and the ratio of young people to old people. These figures are important as they are used by policy analysts and economists to calculate something called ‘the dependency ratio’, which we will explain in more detail in Chapter 3. For now, take some time to learn how to read a population pyramid, create your own population pyramid, and compare and contrast population pyramids across the globe.
Of course, population pyramids are only one way of demonstrating what a population structure looks like. There are many other methodologies available to researchers of ageing societies. For instance, evolutionary biologists (scientists who study the development of the human race) have a hypothesis that humans have evolved to live beyond the age of sexual reproduction because our ancestors worked out a way to make themselves useful. The detail of the theory is that grandmothers found ways of helping their adult daughters to take care of their offspring (Hawkes, 2003). This adaptation meant that there was a purpose for older members of the tribe and humans began to live longer. Of course, as scholars of ageing we are interested in human ageing in the present day. In particular, we are fascinated in the implications that having an older population may have for social policy. We are also interested in how the experience of ageing may differ from country to country and from region to region. All of these issues will be explored in subsequent chapters.
In this chapter we have tried to whet your appetite for investigating what it means to live in an ageing world. We have introduced some of the most important elements of research infrastructure, tools and methodologies that researchers use to explore and understand population ageing. To do this, we have given detailed examples and instructions on how to construct and interpret a population pyramid. We have explained the main drivers of population ageing and how they produce a higher average age in the population. We have made some important detours into critical thinking by asking you to consider when old age begins and to begin to tackle the perennial problem of differentiating myths from facts about our ageing world.
So, we hope by now you are convinced by the United Nations (2002) claim that population ageing is worth studying because it is ‘pervasive, enduring’ and has ‘profound implications’.
Creating a population pyramid. See Appendix 1 for detailed instructions.
