Ageing with attitude
Human beings are living longer and longer.
At the same time, prejudice against older people is getting stronger.
Where will this lead us? Nikki van der Gaag explores
the paradox and suggests a way forward.
'Will you still need me, will you still feed me/When I'm 64?' The Beatles' song may be old itself, but it lies at the heart of what most of us fear about ageing - not death, but neglect; not the added years but lack of love, lack of respect.
We wake up on the morning of our 60th or 65th birthdays, and suddenly we are 'old age pensioners' and 'senior citizens'. We don't feel any different from the day or the month or the year before, but we are now officially 'old'. Suddenly we are no longer part of the workforce, no longer 'productive'.
And many people, both young and old, feed this feeling of uselessness by saying, 'I've done my bit, I deserve a rest'. So they 'rest'. And the myth of old people as 'past it' is perpetuated from generation to generation.
It is a dangerous myth, not just for our own self-respect as we grow older, but also for a world with an ever-growing population and shrinking resources. If the 'old' do not participate in society, it is society's loss as well as their own.
'Ageing', says Alex Kalache, Head of the Programme on Ageing at the London School of Hygiene and Tropical Medicine, 'is the number one problem in the world. And if it is not addressed now, there will be serious consequences.' 1
It is the 'number one problem' firstly because the numbers of people over 60 - and particularly those over 80 - are growing fast. In 1959 there were 200 million people over 60 in the world, who accounted for eight per cent of the total population. By 2025 there will be 1.2 billion - 14 per cent of the total. Contrary to popular myth, by early next century three-quarters of these will live in the Third World. 2
And it is in developing countries that the growth is greatest and the problems are most acute. Their elderly populations are growing at many times the rate of those in the North. For example, over the next 50 years the numbers of those over 60 in Britain will increase by 23 per cent and by 100 per cent in the US - but by 201 per cent in Bangladesh and 300 per cent in Brazil.3
Where Britain and the US, Australia and Canada have had 100 years to deal with increased longevity, China or Brazil have only 20 or 30 years to deal with the same rate of growth - and fewer resources with which to do so. And even countries which have had an older population for longer are struggling for positive ways of responding.
They are not helped by the fact that 'age' is a relative concept. Each one of us will know people in their sixties who regard themselves as 'old' - and are therefore seen as 'old' by everyone else. We will also know and people in their seventies, eighties or even nineties who remain very much part of society and who are mentally if not physically agile.
'Old' also varies from country to country and place to place. The Vilcabamba Valley in Ecuador, for example, is known locally as the Valle de la Ancianidad (Valley of Old Age) or the Isla de Imunidad (Island of Immunity). It is one of three places in the world where many people live to be over 100 - the others are in the Georgian Republic and in Pakistan. No-one really knows why, but a number of factors have been suggested, including the altitude, a mainly vegetable diet with little fat, reasonable work conditions, comparatively little stress, the beneficial effects of the huilco tree which recycles air - and the relative isolation of the valley.
Further down in South America, in Potosi in Bolivia, life expectancy is at the other extreme - people don't expect to live beyond their 40th birthday. Mining is the main occupation. The miners and their families suffer from harsh conditions, poverty, overwork, accidents, silicosis and other forms of lung poisoning.4
In Vilcabamba, you may not be considered 'old' until you are 90. In Potosi, you might be 'old' at 30.
So if we can't even really generalize about the meaning of 'old', can we say that there is an 'ageing crisis'? Under current conditions and in the light of today's population predictions, I think the answer must be 'yes'. As more and more people live longer and their numbers increase both in actual numbers and relative to the general population, there will be fewer people to care for them if and when they need it. The dependency ratio, as it is called, is also affected by the increasing financial pressures put on families, particularly in the Third World. More and more women everywhere are working. Because women form the vast majority of carers, this also affects the numbers of people able to support elderly members of the family. As governments squeeze pensions and health systems in an attempt to keep taxes low or to conform to the 'structural adjustment' policies imposed by the International Monetary Fund, it is old people who are likely to suffer most.
But this need not be. As Simone de Beauvoir said: 'The meaning or lack of meaning that old age takes on in any given society puts that whole society to the test.'
If so, governments and international agencies have failed that test - neither seriously addressing the issue nor seeing the need to invest major resources in it. For example, one of the main reasons that people in Africa or Asia or South America cite for having large numbers of children is to 'provide security' in old age. If people knew that they could remain independent and yet be supported in their old age, then they would not feel the need to have so many children. Nor would they fear the isolation from society that arises from not having children. And yet, time after time, support for old people is ignored in discussions on population.
As it is 'old' people - both in the North and the South - have been increasingly isolated from the rest of society in retirement homes which were seen as the model of how to deal with old age. People's need for health care increases as they grow older, and the seriously-disabled minority need special care and attention. But many people who do not have serious physical or mental disabilities have nonetheless been shut away in unsuitable homes, cut off from the rest of the world.
Today a growing number of governments are promoting another model which ostensibly helps people to live more independently: 'care in the community', as it is often known. What it usually means is 'care in the family' and in most cases it does not spring from a philosophical belief that families care best for their own but rather from the need to find a cheap solution to the problem of caring for the old.
In Muslim countries, putting the aged into old people's homes has always been anathema. King Hassan II has said that: 'If an old-age home were built in Morocco, I believe it would mean the country no longer existed. Moreover, I would be the first to burn it, in an act of auto-da-fé.'5
This is all very well, but it puts the burden of caring very much back into the family - usually the women. While families can in some cases provide the support needed, the breakdown of the extended family and the squeezing of household resources have often led to neglect of, rather than succour for the elderly. When resources are stretched, the old are likely to be the ones who go without.
It is precisely for this reason that in most of the world, 'old' people continue to work until they die. They have no choice. They need to earn an income - of sorts - or they don't eat. In Malawi, for example, a recent survey showed that 85 per cent of men over 65 were still part of the 'labour force'. In Liberia it was 70 per cent and in Guatemala, 63 per cent.6 Indeed, people may even have to work harder as they get older, taking on the manual labour that younger people do not want to do. Many have to uproot themselves - old women who outlive their husbands are forced to leave their villages to seek work in the cities. In most Third World countries, older people figure as part of the huge informal economy, selling vegetables on the streets or recycling garbage.
PAUL SCHATZBERGER /
In almost every culture, financial indpendence gives older people more respect from others and consequently more dignity. Yet 'old' people are not considered to be officially productive because they are not usually earning an official wage.
All over the world older people, particularly women, are looking after grandchildren so that their daughters or sons can work. In parts of Africa particularly stricken by the aids epidemic, the young and sexually active have nearly all died, leaving the oldest generation to care for the youngest. And in Asia migration to the cities produces the same result.
Unpaid childcare, housework and people-maintenance is the work that makes the world go round. But in a world increasingly based on a cash economy this kind of work is not regarded as 'real work' and the size of their pay packet has become the only measure of a person's worth.
This is illustrated in a classic manner by the World Bank's recent report entitled: Averting the Old Age crisis: policies to protect the old and promote growth. This report pretty much ignored the informal economy and advocated a 'three-pillar approach' to financing the old which is based entirely on pensions. But even according to the World Bank, an estimated 60 per cent of the world's labour force and 70 per cent of old people, are part of the informal economy - they have no pension plan and are unlikely to be able to save.
Kasturi Sen, a specialist on ageing and policy issues, has quite a different strategy. She calls it the 'life-cycle approach'. The circumstances that people find themselves in when they are older, she says, is simply a continuation of the situation that they have been in throughout their lives. If you are poor, overworked and in ill-health when you are young, these conditions are likely to be the same or worse when you are old.
She argues that in order to improve the quality of peoples' lives - and especially the lives of women, who in most societies live longer - policies should aim at improving education in earlier life, helping people to move in and out of the labour market, and enabling women to take out financial credit and buy land. Better nutrition and access to contraception would improve health. These things, she says, would do more than anything else to 'reduce the possibilities of acute vulnerability in later stages of life'.7
In other words, the 'problem' of the elderly is something which concerns us not only in old age but in youth and middle age as well.
This is also one of the key messages of activist groups on ageing issues like the Gray Panthers. Started in the US in 1970 to oppose the war in Vietnam, they have become a worldwide network active on health care, housing, discrimination and work. Maggie Kuhn, one of the founders, is now in her eighties, but as feisty as ever. She spoke to Betty Friedan about the importance of old and young working together: 'Our philosophy was using gray power with the young for issues on the cutting edge of social change. I think we've established the fact that old age is a triumph. What we've done is establish the intergenerational bond necessary for real social change, the continuity of life. The old and the young need each other. We're opposed to the segregation of old people... Older people have so much to give to society...'8
The recognition that older people have valuable contributions to make is slowly permeating the thinking of development activists. Mark Gorman of HelpAge International recognizes that in recent years there has been 'a growing focus on the involvement of older people as active participants in development'.9
In Colombia, older people who are part of Pro Vida (For Life) have set up the city's first recycling scheme. In Kenya, a group of middle-aged women got together to tackle the problem of earning income in their later years. They set up schemes for clean water and a successful poultry-keeping project. They called themselves Itambya Yaa Aka Kichakasimba (women of Kichakasimba take a step ahead).10
In Argentina old people have been leading a militant grassroots campaign since the pension cuts of 1992. They held a 24-hour-a-day vigil in the Plaza de Mayo in Buenos Aires, enduring great cold and hardship until they were finally expelled by the police two months later. After that they began a vigil and protest every Thursday outside Parliament. Occasionally they stopped traffic, occupied government buildings and even scuffled with police and government officials in the streets of the capital.
On many occasions protesters were arrested but sometimes armed riot police withdrew before them, unable to frighten and unwilling to club down these dignified grandmothers. On 2 March 1994 thousands of elderly people converged on the centre of the capital to mark 100 weeks of these dramatic protests.6
Finally the Argentinian Government realized that they could not discredit the protesters. They raised pensions for the oldest, agreed to pay some of the money owed to the poorest and promised a reform of the pension system. But they failed to restore the cuts. So the old people took to the law. As of today, 350,000 court cases have been lodged with the High Court. Around 100,000 have already been won and the 'old people's' protest threatens to throw the whole economic policy of the Argentinian Government off course.
We too can push for change in policy and in attitudes - including our own. We can plan for our old age like the women of Kichakasimba. And we can work together, young, middle-aged and old, to ensure that everyone has enough to provide them with a satisfying and dignified life.
1999 will be the International Year of Ageing. Let us use the four years between now and then to take up the challenge of David Pitt, a non-retired 'retired person' who volunteers here at the New Internationalist:
'Let us direct our energies against those responsible for the poverty... and for declining health services. Let us also do what we can to support those living in other countries where care for the aged is a matter of gross neglect. Let us band together and be wilful and cantankerous and obstreperous. Above all, let us never apologize for growing old.'
1 Quotes from Alex Kalache taken from an interview by Nikki van der Gaag.
2 MSJ Pathy (Ed.) 'Ageing in Developing Countries' by Alex Kalache in Principles and Practices of Geriatric Medicine, John Wiley 1991.
3 Kasturi Sen Ageing - Debates on demographic transition and social policy, Zed Press 1994.
4 Ken Tout Ageing in Developing Countries, Oxford University Press 1989.
5 Jeannine Jacquemin Elderly Women and the Family Soroptomist International.
6 Suzanne S Paul and James A Paul Humanity Comes of Age, WCC Publications 1994.
7 Kasturi Sen Women in later life: health, security and poverty, International Health Exchange, April 1994.
8 Betty Friedan The Fountain of Age, Vintage 1993.
9 Mark Gorman from a discussion with Nikki van der Gaag
10 United Nations The World Aging Situation 1991.
©Copyright: New Internationalist 1995