From Exclusion to Inclusion in Old Age: A Global Challenge 9781447307419

Citation preview

Edited by

AGEING AND THE LIFECOURSE

THOMAS SCHARF AND NORAH C. KEATING

From Exclusion to Inclusion in Old Age A global challenge

From Exclusion to Inclusion in Old Age A global challenge Edited by Thomas Scharf and Norah Keating

First published in Great Britain in 2012 by The Policy Press University of Bristol Fourth Floor Beacon House Queen’s Road Bristol BS8 1QU UK Tel +44 (0)117 331 4054 Fax +44 (0)117 331 4093 e-mail [email protected] www.policypress.co.uk North American office: The Policy Press c/o The University of Chicago Press 1427 East 60th Street Chicago, IL 60637, USA t: +1 773 702 7700 f: +1 773-702-9756 e:[email protected] www.press.uchicago.edu © The Policy Press British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library. Library of Congress Cataloging-in-Publication Data A catalog record for this book has been requested. ISBN 978 1 84742 772 4 paperback ISBN 978 1 84742 773 1 hardcover The right of Thomas Scharf and Norah Keating to be identified as editors of this work has been asserted by them in accordance with the 1988 Copyright, Designs and Patents Act. All rights reserved: no part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise without the prior permission of The Policy Press. The statements and opinions contained within this publication are solely those of the editors and contributors and not of The University of Bristol or The Policy Press. The University of Bristol and The Policy Press disclaim responsibility for any injury to persons or property resulting from any material published in this publication. The Policy Press works to counter discrimination on grounds of gender, race, disability, age and sexuality. Cover design by The Policy Press Front cover: image kindly supplied by www.alamy.com Printed and bound in Great Britain by TJ International, Padstow The Policy Press uses environmentally responsible print partners

To Jane Scharf and Norman Looney – critical thinkers, fine supporters and spouses extraordinaires

Contents List of tables and figures vi Acknowledgements vii Notes on contributors viii Foreword by Judith Phillips x one two

three

four

five

six seven

eight

nine ten

Social exclusion in later life: a global challenge Thomas Scharf and Norah Keating Globalisation, economic recession and social exclusion: policy challenges and responses Chris Phillipson International migration: patterns and implications for exclusion in old age Sandra Torres Social inclusion of older people in developing countries: relations and resources Peter Lloyd-Sherlock, Armando Barrientos and Julia Mase Exclusion from material resources: poverty and deprivation among older people in Europe Asghar Zaidi Social inclusion of elders in families Jim Ogg and Sylvie Renaut The impact of changing value systems on social inclusion: an Asia-Pacific perspective David R. Phillips and Kevin H.C. Cheng Age discrimination as a source of exclusion in Europe: the need for a human rights plan for older persons Astrid Stuckelberger, Dominic Abrams and Philippe Chastonay Towards inclusive built environments for older adults Atiya Mahmood and Norah Keating Revisiting social exclusion of older adults Norah Keating and Thomas Scharf

Index

1 17

33

51

71

89 109

125

145 163

171

v

From exclusion to inclusion in old age

List of tables and figures Tables 4.1 4.2 5.1

Participation in pension schemes and aggregate pension coverage, Brazil and Mexico, 2002 Satisfaction with different life domains among respondents aged 60 and over, South Africa and Brazil, 2008 Capability deprivation for older people in the EU, 2008

56 62 81

Figures 4.1 5.1 5.2

8.1

8.2

vi

Self-reported capacity to help others, South Africa and Brazil, 2008 Average capability deprivation for older persons (aged 65+) in EU countries, out of the total of five chosen aspects, 2008 Capability deprivation rate for older persons (aged 65+) in EU countries, defined as deprivation in at least three out of the total of five chosen aspects, 2008 Percentage of respondents from different countries in the European Social Survey who regard age discrimination to be a quite serious or very serious problem, 2008 Perceptions of discrimination on the basis of age and other criteria, EU, 2009

64 83 84

130

131

Acknowledgements The creation of this book has taken us on a journey across time and continents. It began with a country walk in Haslington, Cheshire, in which we agreed that a book on the social exclusion of older people could make an important contribution to our knowledge of the diversity of older adults and of those at risk of exclusion as they age. It has concluded with an intensive period of writing in Summerland, British Columbia, to do our final editing that allowed us to reflect on the theoretical and substantive contributions of authors and to write our concluding remarks.Throughout the process, our spouses, Jane Scharf and Norm Looney, have been our best supporters. They made tea, picked peaches and took us hiking up mountains to clear our brains.They also challenged us with critical questions about the broad relevance of our work and the clarity of our ideas and celebrated with us when we completed the project. Friends and colleagues have travelled with us through different phases of the journey.We greatly appreciate the perseverance, tolerance and flexibility of Emily Watt, Commissioning Editor at The Policy Press, whose support from first ideas through publication has been unfailing. Janet Fast, University of Alberta, provided a key part of the intellectual stimulus for this book. It was she who brought together a team of scholars to debate ideas of social exclusion and to conceptualise its application in understanding diversity in the lives of older persons.Authors of the chapters are at the heart of this project. They were remarkably good-humoured throughout the lengthy process of editorial comments and revisions. We are grateful for their contributions. We also appreciate Siobhan Fitzgerald’s support in helping to produce the final manuscript. This was truly a joint endeavour. As editors we met face-to-face when we could, sent files back and forth, and had many phone calls to deliberate ideas and strategies. At the end, we were editing each other’s work without ‘track changes’, reflecting a level of trust and camaraderie that is rare. While we may not sign on immediately for another intensive long-term project, we look forward to future collaboration on theoretically challenging questions about the lives of older people. Thomas Scharf and Norah Keating

vii

From exclusion to inclusion in old age

Notes on contributors Dominic Abrams is Professor of Social Psychology and Director of the Centre for the Study of Group Processes, School of Psychology, University of Kent, UK. Armando Barrientos is Professor and Director of Research, Brooks World Poverty Institute, University of Manchester, UK. Philippe Chastonay is Professor of Public Health, Institute of Social and Preventive Medicine, Medical School, University of Geneva, Switzerland. Kevin H.C. Cheng is Assistant Professor, School of Humanities and Social Sciences, Tung Wah College, Hong Kong. Norah Keating is Professor of Human Ecology and Co-director, Research on Aging, Policies and Practice, University of Alberta, Edmonton, Canada. Peter Lloyd-Sherlock is Professor of Social Policy and International Development, School of International Development, University of East Anglia, UK. Atiya Mahmood is Assistant Professor, Gerontology Department, Simon Fraser University,Vancouver, Canada. Julia Mase is a PhD Researcher, Brooks World Poverty Institute, University of Manchester, UK. Jim Ogg is a Researcher, Unité de Recherche sur le Vieillissement, Caisse Nationale d’Assurance Vieillesse, Paris, France, and a Research Fellow,The Young Foundation, London, UK. David R. Phillips is Chair Professor of Social Policy, Department of Sociology and Social Policy, Lingnan University, Hong Kong. Chris Phillipson is Professor of Applied Social Studies and Social Gerontology, Centre for Social Gerontology, Keele University, UK. Sylvie Renaut is a Researcher, Unité de Recherche sur le Vieillissement, Caisse Nationale d’Assurance Vieillesse, Paris, France. Thomas Scharf is Professor of Social Gerontology and Director, Irish Centre for Social Gerontology, National University of Ireland, Galway, Ireland.

viii

Notes on contributors

Astrid Stuckelberger is Senior Lecturer and Researcher, Institute of Social and Preventive Medicine, Medical School, University of Geneva, Switzerland. She is Chair of the NGO Committee on Ageing, United Nations, Geneva and President, Geneva International Network on Ageing. Sandra Torres is Professor of Sociology and Chair in Social Gerontology, Uppsala University, Sweden. Asghar Zaidi is Research Director, European Centre for Social Welfare Policy and Research,Vienna, Austria.

ix

From exclusion to inclusion in old age

Foreword Judith Phillips Tom Scharf and Norah Keating introduce us to the debates surrounding exclusion and inclusion in later life within a comprehensive global context.The book takes a multidimensional lifecourse perspective, addressing the drivers as well as policy and practice responses.The authors of each chapter offer us a better understanding of the concepts of inclusion and exclusion through issues such as poverty and economic recession, migration, the family, the built environment and human rights and place exclusion in a truly global context with reference to developing countries, the Asia-Pacific rim, as well as Europe. Consequently, the book advances our theoretical understanding, bringing fresh and challenging perspectives on the family and wider community which interact to foster exclusion and provides a way forward for policy discourse on how to develop inclusive communities. This book is an original contribution to the theoretical debate around exclusion/ inclusion and will be a good resource for undergraduates, postgraduates and, in particular, policy makers working with older people.

x

One

Social exclusion in later life: a global challenge Thomas Scharf and Norah Keating

Introduction Social, economic and demographic trends associated with population ageing have the collective potential to increase dramatically the exclusion of older adults from societies’ major institutions and resources. In this respect, older people are especially prone to the recent volatility in the always-cyclical economic environment that results from increasingly enmeshed world economies (Jenson, 2004).The economic decline that began in 2008 with the collapse of major financial institutions and subsequent attempts to reduce the over-indebtedness of many Western nations has fundamentally changed the context of debates relating to population ageing. In times of austerity and growing economic instability, the potential risks of exclusion for older people become even more pronounced. In many Western nations, for example, there has been a marked shift in recent years from policies that acknowledge societies’ obligations towards different generations – as reflected in the notion of an ‘intergenerational contract’ that underpins national welfare states – towards a set of policies and practices that encourage individuals to assume personal responsibility for the ‘risks’ associated with their ageing (Baars et al, 2006). In other parts of the world, fledgling social policies – for example, in the form of non-contributory pensions or social health care programmes – or aspirations to introduce social protection schemes may also be threatened by the economic downturn (International Labour Organization, 2010).The capacity of individuals, families and communities to respond to an increasing individualisation of risks is, in turn, challenged by other social changes. For example, in many industrialised nations, family histories are becoming increasingly diverse: divorce and remarriage rates are higher, families are becoming smaller, and lifelong singlehood and childlessness are more common (Vanier Institute of the Family, 2004). Caring for family members is becoming a normative midlife experience, creating a cruel paradox, especially for women, who may experience disadvantage in old age as a result of earlier efforts to prevent ageing parents from experiencing it (Jenson, 2004; Szinovacz and Davey, 2007). Similarly, mobility patterns are changing the cultural fabric of many countries, resulting in growing numbers of transnational families (Baldassar, 2007; Hwang, 2008). 1

From exclusion to inclusion in old age

Taken together, these challenges dramatically increase the inequalities that characterise later life, and potentially reduce nations’ capacity to support the type of policies and practices that would minimise the gap between the haves and the have-nots. However, growing inequalities in later life and related risks of social exclusion for older adults have been largely absent from global debates. Even in Europe, where social exclusion has been a central focus of research and public policy for some time, exclusion discourse tends to overlook the situation of older people (Atkinson et al, 2004; Burstein, 2005; Social Exclusion Unit, 2006). Exclusion is of fundamental importance in ageing societies, since it threatens societal cohesion and individual quality of life (Silver and Miller, 2003; Levitas et al, 2007). As will be argued in this book, older adults may be particularly vulnerable in this regard. Instead of a focus on the ways in which older people may experience forms of disadvantage, there has been an alarming countervailing tendency in public discourse to view demographic ageing – and, consequently, the growing proportions of older people – as a threat. Blame for many social and economic ills is attributed to population ageing, based on erroneous assumptions that older people’s use of society’s resources is disproportionate to their contribution (Richmond and Saloojee, 2005; Podnieks, 2006). Whether it is the notion of ‘greedy geezers’ in the United States (Binstock, 2010), the ‘unsustainable burden’ of pensions in France and Germany (Schmidt, 2000), or suggestions that the Baby Boomers Stole Their Children’s Future (Willetts, 2010) or that the country has ‘bankrupted its youth’ (Howker and Malik, 2010) in the United Kingdom, rhetoric about a ‘silver tsunami’ (Fox, 2001; Delafuente, 2009) and entrenched views of older adults as dependent (Street and Cossman, 2006) take the focus away from those older adults who are excluded or do not benefit from full citizenship (West, 2006; Phelan, 2008). Such perspectives pervade despite the lack of research evidence of serious intergenerational conflict and plentiful evidence of sustained solidarity (Arber and Attias-Donfut, 2000; Saraceno, 2008). Set against such a background, this book aims to make a case for adopting an exclusion focus for older adults. A range of recent research suggests that the likelihood of experiencing multiple forms of exclusion increases disproportionately with advancing age (Scharf et al, 2002, 2005a; Barnes et al, 2006; Becker and Boreham, 2009; Ferraro et al, 2009). Moreover, the risk of exclusion tends to be greater for some groups of older adults, including those who have a low socio-economic status, are female, belong to particular minority ethnic groups, have a disability or some type of chronic health condition, and live in particular geographic settings (eg a socially deprived urban community or a remote rural community). Different birth cohorts may also be vulnerable to exclusion. In the United States, and increasingly in other Western nations, the idea of cumulative advantage and disadvantage has been influential in showing the systemic nature of intra-cohort variation in terms of older adults’ differential access to key societal resources across time (Dannefer, 2003). Elsewhere in the world, cohort differences are just as important. In many sub-Saharan nations in Africa, for example, the 2

Social exclusion in later life

HIV/AIDS pandemic has placed particular burdens on older people who are not only obliged to take on care responsibilities for their children and grandchildren (Ssengonzi, 2007), but may also lack the support of their own children as their health deteriorates (Kautz et al, 2010). In China, similar issues arise as a result of the country’s one-child policy (Poston and Chengrong, 2000; Zhang and Goza, 2006). Drawing on such a research base and contributing new perspectives that can help to challenge singular and/or negative constructions around the so-called ‘burden of ageing’, this book seeks to address conceptual and empirical voids in our understanding of marginalised older adults. This requires that we determine who are the ageing adults at risk of social exclusion, discover the processes and conditions that exacerbate that risk, and identify strategies for creating societal conditions that minimise exclusion. Better understanding of the interplay of resources and social contexts that facilitate or constrain opportunities for inclusion can lead to enhanced strategies for establishing and maintaining the full citizenship of older adults. While exclusion clearly affects individuals, the book’s focus is primarily on the ways in which groups of older adults – in different national and regional contexts and with different characteristics – are prone to forms of exclusion. In the next section of this chapter, we consider the value of the linked concepts of social exclusion and inclusion as they relate to ageing and older people. We review contrasting interpretations of exclusion and inclusion in order to understand better the circumstances under which groups of older adults may be at risk of exclusion from societal resources. Our aim is to provide a conceptual orientation point for subsequent chapters. This is especially important given that the contributing authors are purposely drawn from a variety of disciplinary perspectives and focus on issues pertaining to markedly divergent national and supranational contexts. While contributors inevitably fall back on their own interpretations of the concepts of social inclusion and exclusion, they are consistent in regarding the concepts in terms of their multidimensionality, relativity and dynamism. As will be seen, they are also consistent in recognising the potential of a deepened understanding of inclusion and exclusion to inform both long-standing and emerging debates on the key challenges associated with population ageing in different national and regional contexts.

Conceptualising social exclusion and inclusion According to Silver (1994), while the idea of social exclusion can be traced back to political debates occurring in France during the 1960s, the term only entered into widespread usage during Europe’s economic downturn of the 1980s. It has been suggested that the European Commission adopted the term in preference to the notion of ‘poverty’ on the grounds that Britain’s then Conservative government viewed with suspicion any attempts to identify poverty as a matter of shared European responsibility (Atkinson, 1998).The fight against social exclusion subsequently became a European Union (EU) social policy goal and, since 2000, 3

From exclusion to inclusion in old age

has led to a requirement for EU member states to submit regular updates in the form of National Strategy Reports on Social Protection and Social Inclusion on their efforts to ‘prevent the risks of exclusion’ and provide help for the ‘most vulnerable’ (European Commission, 2008; Scharf, 2010). Given its relatively recent emergence as a concept, and the politicised circumstances under which it gained momentum, it is not surprising that there continues to be a lack of clarity about the definition of social exclusion.According to Silver (1994, p 536), the vagueness of the concept initially had advantages:‘The expression is so evocative, ambiguous, multidimensional and elastic that it can be defined in many different ways … [therefore] it can serve a variety of political purposes’. In this context, the UK government adopted a working definition of social exclusion in 1997 that identified exclusion as being: ‘a shorthand term for what can happen when people or areas suffer from a combination of linked problems such as unemployment, poor skills, low incomes, poor housing, high crime environments, bad health and family breakdown’ (Social Exclusion Unit, 2001, p 11). Scientific approaches to conceptualising social exclusion typically seek to move beyond the identification of problems associated with exclusion, and refer instead to the ways in which individuals and groups are cut off from society’s major institutions. For example,Alan and Carol Walker (1997, p 8) define exclusion as being: ‘the dynamic process of being shut out, fully or partially, from any of the social, economic, political and cultural systems which determine the social integration of a person in society’. Silver’s (2007, p 15) approach refers to social exclusion as a ‘multidimensional process of progressive social rupture, detaching groups and individuals from social relations and institutions and preventing them from full participation in the normal, normatively prescribed activities of the society in which they live’. Other authors introduce elements of personal choice into their exclusion definitions, reflecting the fact that individuals might choose not to be ‘included’ within a particular society: An individual is socially excluded if (a) he or she is geographically resident in a society, (b) he or she cannot participate in the normal activities of citizens in that society, and (c) he or she would like to so participate, but is prevented from doing so by factors beyond his or her control. (Burchardt et al, 1999, p 229) There are at least three key themes that cut across the different approaches (Atkinson, 1998, p 7f). First, exclusion is perceived to be a relative concept. In this sense, judging whether a person or group is excluded only makes sense if their situation is contrasted with the general (normative) context of the society and time in which they live. Second, the notion of agency features in many understandings of exclusion, as in the approach of Burchardt et al (1999) just cited. According to Atkinson (1998, p 7), ‘exclusion implies an act, with an agent or agents’. In this context, individuals and groups may not only be excluded against their will, but may also opt to exclude themselves. Third, exclusion is seen as being dynamic, 4

Social exclusion in later life

changing over time and potentially extending its reach from one generation to the next. In relation to both individuals and groups, there is the possibility that people will move in and out of exclusion as they progress through time. Ideally, assessments of social exclusion should, therefore, reach beyond individuals’ or groups’ current status to take in a life-course and generational perspective. In addition to the three features of social exclusion definitions highlighted by Atkinson (1998), and in order to differentiate exclusion from a traditionally rather narrow, income-based view of poverty, many definitions also refer to the multidimensional nature of exclusion. While the dimensions highlighted in such definitions vary, they typically identify access to material resources and social relationships, as well as a range of cultural and civic activities, as being key determinants of inclusion or exclusion (eg Gordon et al, 2000; Burchardt et al, 2002). Drawing these ideas together, and recognising that the definition underplays the dynamic nature of exclusion, for the purposes of this book we follow Levitas et al (2007, p 25) in regarding exclusion as representing ‘the lack or denial of resources, rights, goods and services, and the inability to participate in the normal relationships and activities available to the majority of people in a society’. While considerable effort has been expended in recent years on conceptualising social exclusion, the concept of ‘social inclusion’ still remains relatively underexplored. Indeed, researchers tend to use a range of terms to describe what they view as being the antonym of exclusion. For example,Walker and Walker’s (1997) definition of exclusion, cited earlier, refers to processes that determine individuals’ ‘social integration’. And, writing about the UK experience, Ruth Levitas (2005) has been consistent in her critique of what she terms ‘the inclusive society’. Daly and Silver (2008) also note a recent change of emphasis, in policy circles at least, in favour of the term ‘social cohesion’. In their view, the changing focus suggests: first, an attempt to sound ‘positive’ instead of ‘negative’, pronouncing a goal rather than describing a problem. Second, inclusion is the implied antonym of exclusion, but in fact may connote something quite different. Inclusion calls attention to the supposed ‘opportunity’ and openness of society, beckoning outsiders in, whereas exclusion points at exclusionary mechanisms of society, its potential breakdown, disorder, or incoherence. (Daly and Silver, 2008, p 551) For the purposes of this book, and notwithstanding a lack of clarity around its definition and the need for further theoretical development, we treat ‘inclusion’ as an appropriate alternative to ‘exclusion’. In this sense, inclusion represents a valuable goal for all societies marked by growing inequalities and by processes that exclude and marginalise key social groups.

5

From exclusion to inclusion in old age

Social exclusion of older people To date, most of the debate around social inclusion and exclusion has focused on children and families, on people of working age, and on the ways in which exclusion affects the lives of individuals and groups perceived to be at the margins of society. Conceptual development has addressed younger adults whose immigrant status, tenuous attachment to the labour force or work-limiting disabilities increase their risks of, exclusion from material resources (Smith and Ley, 2008; Stewart et al, 2008; Reutter et al, 2009); and also persistent poverty in deprived urban neighbourhoods where people are disadvantaged because of their community surroundings (Marsh et al, 1999; Scharf et al, 2002; Burstein, 2005; Migration Resource Centre, 2006). Notwithstanding some notable exceptions (Scharf et al, 2000, 2002, 2005a; Craig, 2004; Ogg, 2005; Barnes et al, 2006; Moffatt and Glasgow, 2009), there continues to be relatively little work that addresses issues of exclusion and inclusion as they relate to older people. Moreover, where this work exists, its focus tends to be on ageing and older people who live in Western industrialised nations. Given the nature of the challenges posed by population ageing and the risks of exclusion faced by growing proportions of older people noted earlier, there is much to be gained by viewing broad social changes in different world regions through the lens of inclusion and exclusion. Adopting an exclusion focus implies addressing two key concerns. First, there is a need to consider the ways in which exclusion in later life might differ from exclusion at earlier stages of the life course. In particular, this involves reflecting on the dimensions of exclusion that appear to be most relevant in relation to ageing and later life. Second, there is a concern to identify the prime drivers of exclusion in later life. This, in turn, focuses attention on the potential policy responses to older adults’ exclusion and measures that might promote inclusion in ageing societies. Addressing the first of these questions, it is useful to begin by examining the potential characteristics of exclusion as it relates to ageing and older adults. Here, we can draw on Atkinson’s (1998) assessment of the common features of approaches to understanding exclusion, since this helps to identify the rich potential of an exclusion focus, as well as some major challenges, for social gerontology. For example, if exclusion is to be understood as a relative concept, a key issue emerges concerning the sources of comparison that apply to older adults. Is older people’s exclusion to be assessed in relation to the ‘normal relationships and activities available to the majority of people in a society’ (Levitas et al, 2007, p 25) or to the norms that apply to other older people, or to people belonging to the same birth cohort? This becomes especially important when one seeks older people’s own views about their material and social resources, since a tendency has been noted in some studies for older people to downplay the degree to which they acknowledge their disadvantage (eg Scharf et al, 2006).There are also under-explored issues concerning the nature of older people’s agency in relation to issues of inclusion and exclusion.While there has been considerable attention 6

Social exclusion in later life

in gerontological debates to issues around ‘structured dependency’ (Townsend, 1981), which some researchers take as implying a lack of agency on the part of older adults, rather less focus has been placed on the ways in which older people might opt to exclude themselves from ‘mainstream’ society. Equally, in terms of the dynamics of exclusion in later life, issues arise concerning the potential for older people to be lifted out of their disadvantage – either through their own actions or through state interventions of one type or another. Rather more work has been undertaken in recent years regarding the multidimensionality of exclusion in relation to ageing and older people. Researchers have begun to articulate elements of exclusion that are especially relevant to older adults, including truncated social connections, limited access to public services, persistent poverty and an inability to engage in civic activities (Evandrou, 2000; Phillipson et al, 2001; Brodie, 2002; Freedman, 2002; Arber, 2004; Burstein, 2005; Barnes et al, 2006; Martinson and Minkler, 2006; Patsios, 2006; Social Exclusion Unit, 2006; Grenier and Guberman, 2009). In this context, Scharf et al (2005a) draw on a substantial body of evidence to identify five domains of social exclusion that, they argue, reflect the unique circumstances of older people: • • •

• •

Exclusion from material resources, acknowledging the central role played by income and material security in determining individuals’ and groups’ ability to participate in society; Exclusion from social relations, reflecting the importance attributed to the ability of older adults to engage in meaningful relationships with family, friends and neighbours; Exclusion from civic activities, recognising the need for individuals to be able to be involved in wider aspects of civil society and in decision-making processes which may in turn influence their own lives; Exclusion from basic services, drawing upon the key role played by access to services in and beyond the home in terms of individuals’ ability to manage everyday life; and Neighbourhood exclusion, reflecting the contribution made by the immediate residential setting to an individual’s sense of self and, potentially, the quality of their lives. (Scharf et al, 2005a, p 78)

These domains represent a useful basis for interrogating the extent to which older adults are excluded from specific domains of societal participation (Jenson, 2004; Miliband, 2006). Under certain circumstances, the identified domains of exclusion overlap, generating particular risks for those marked by multiple forms of exclusion in later life (Scharf et al, 2005a, 2005b). The different domains of exclusion also provide a valuable orientation point for the chapters in this book, each of which addresses one or more of the dimensions of exclusion referred to here. A second concern in terms of gerontological research on social exclusion relates to the potential drivers of exclusion in later life.This, in turn, focuses attention on 7

From exclusion to inclusion in old age

potential policy and practice responses aimed at reducing the exclusion of older adults.Three key drivers, operating at different levels although closely interrelated, might contribute to exclusion. First, there are a variety of structural drivers, which operate at a broad national or supranational level. They encompass, for example, ageism, age stereotypes and age discrimination, changing social values, norms and behaviours that contribute to the marginalisation of older people, and an array of social and economic policies that engender ‘structured dependency’ in later life. A second set of ‘environmental drivers’ relates to older adults’ living environments.These include urbanisation and the separation of family generations, the changing nature of urban and rural communities that contribute to ageing in places that have become unfamiliar, and a trend towards age-segregated living in some Western nations that restricts the interaction between young and old.Third are ‘individual drivers’ of exclusion that arise from low socio-economic status earlier in the life course, disruptions to individuals’ personal and social networks, the onset of chronic ill-health and disability, or a migratory life course. Societies are challenged to respond to the different dimensions of exclusion affecting older people and to address the drivers of such exclusion. In relation to policies to reduce exclusion, Daly and Silver (2008, p 553) suggest that ‘The social policy implications of social exclusion call for multi-pronged, joined-up programs, anti-discrimination safeguards, social dialogue and stakeholder involvement in decision-making and program provision’. In terms of older people, there are a variety of potential policy responses to address the multiple domains of exclusion. Anti-poverty strategies or the introduction of non-contributory pension schemes might represent effective ways of targeting exclusion from material resources. Initiatives that seek to build new friendship relations or support people at times of relationship breakdown might respond to risks around individuals’ exclusion from social relations. Similarly, a variety of initiatives might support people at risk of exclusion from basic services (eg by ensuring access to public, private or voluntary services), from civic activities (including ensuring that older people have access to decision-making processes) or from the neighbourhood or community in which they live (such as a range of crime-reducing measures). Other policy responses are oriented towards longer-term strategies to address the causes or drivers of exclusion. Responding to structural drivers of exclusion might entail addressing negative societal attitudes and behaviours towards older adults through ensuring that their human rights are acknowledged. Changes to the living environments of older people through the creation of ‘ageing-friendly’ environments might address environmental drivers of exclusion. Addressing individual drivers of exclusion is likely to require a policy focus on adopting preventive strategies at all stages of the life course, and improved coordination of policies and programmes aimed at supporting older people’s participation in society. If social exclusion in later life is to be addressed effectively, and greater inclusion achieved, concerted action will be needed. However, there also remains a need to better understand the concepts of inclusion and exclusion, and to understand how 8

Social exclusion in later life

these ideas vary across world regions and according to the different dimensions of exclusion that have been identified. Our hope is that this book can contribute to developing this understanding and help to shape future debates around the most appropriate types of policy response to overcome the types of disadvantage that many older people experience.

Structure of the book Chapters in the book are organised to focus on issues of inclusion and exclusion that arise from the various contexts that influence the lives of older adults. Contributors – drawn from a range of disciplinary perspectives and a number of nations – address different drivers and domains of exclusion that are especially relevant in relation to ageing and older people. Global factors, such as demographic change, migration patterns, international financial arrangements and evolving human rights frameworks, combine with regional socio-economic patterns and changing social and family values to set the broad context for the differential exclusion of older people. Access to adequate material resources to facilitate participation in ‘normal’ social life, opportunities to engage in relationships that span the generations, and the accessibility of home and community environments represent important conditions for reducing the risks of exclusion faced by older people and increasing the potential to become more socially included. Set within the context of the global economic recession initiated by the collapse of major international financial institutions in 2008, Chris Phillipson assesses the ways in which processes arising from globalisation are transforming later life (Chapter Two). Despite the fact that population ageing has frequently been constructed as a global problem and issue, he argues that the ongoing reduction of expenditure on public programmes increasingly acts to transfer risks to individual older people and their families. This process creates new and distinctive forms of inequality. The chapter examines competing trends in the exclusion debate in light of such global developments, and considers four potential approaches to challenging exclusion: first, maintaining a framework for supportive ties within and between generations; second, promoting understanding of the value of public services; third, securing ‘protected social spaces’ to support vulnerable and marginal groups; and, fourth, promoting a rights-based approach to development in later life. Relating closely to the globalisation theme, the context for Sandra Torres’s contribution is the interconnection between international migration flows and the ways in which such migration is changing the demographics of ageing populations across the world and societies’ ethnic composition (Chapter Three). In examining contrasting approaches to exploring exclusion issues by social gerontologists and researchers who focus on international migration and ethnic relations, she argues that the diversity of older migrants poses a challenge to social gerontology’s theoretical and policy- and practice-oriented assumptions regarding who migrants are and what they need.While the ‘migratory life course’ is associated with specific exclusionary risks, the mechanisms of social exclusion 9

From exclusion to inclusion in old age

work differently according to where older migrants to Western industrialised nations have come from, when and why. An ethnicity and race-aware take on social exclusion is shown to challenge taken-for-granted assumptions that welldesigned policies and practices can reduce exclusion in later life. With social exclusion debates originating in Western industrialised nations, there have been few attempts, to date, to extend the exclusion lens to the situation of older people in developing nations. Peter Lloyd-Sherlock, Armando Barrientos and Julia Mase contribute to emerging debates about exclusion in non-Western nations by examining older people’s circumstances in the middle-income countries of Brazil and South Africa (Chapter Four). Framing their analysis within the context of Cowgill’s (1976) study on development and modernisation and the consequences for older people, the authors use original empirical data to provide a more subtle perspective on such general claims.While access to financial security and pensions provides insights into the material resources domain of social exclusion, older people’s perceptions of inclusion and the quality of their social relationships address its relational dimensions. The chapter emphasises the key contribution of material resources to older people’s social relations and subjective well-being in developing countries. Having adequate material resources is not only central to the well-being of people in developing nations. In Western industrialised nations, a lack of income and an inability to afford the types of goods and services that most people in a society have access to or to participate in social activities that are taken for granted typically figure strongly in attempts to operationalise the concept of social exclusion. Drawing on empirical data from EU nations, Asghar Zaidi not only highlights the degree to which older people across Europe are prone to the risk of income poverty, but also examines their capacity to afford key items of expenditure (Chapter Five). He shows the substantial variation that exists across European nations in relation to older people’s access to material resources, and, in particular, the extent to which cross-national differences exist arising from the measurement approach adopted. Jim Ogg and Sylvie Renaut explore debates around older people’s involvement in multi-generational family relationships (Chapter Six). Given that families have consistently been shown to provide the major context for the mitigation of social exclusion risks, their focus is on contemporary features of family relationships in European societies.Adopting an intergenerational perspective, they make the case that population ageing has not resulted in the weakening of family ties but signifies a changing balance between older and younger people in society. The authors’ conceptual framework reflects four key themes: the notion of intergenerational solidarity is viewed alongside the related ideas of intergenerational conflict and ambivalence; the changing dynamics in societies’ acknowledgement and support for old age as a period of the life course; the need for social inclusion as a basis for ‘a society for all ages’; and the value of fostering intergenerational family policies. In Asia-Pacific societies, demographic change and rapid socio-economic development have been linked to a generalised decline in close family relationships, 10

Social exclusion in later life

and especially the reciprocal family responsibilities known as filial piety. David R. Phillips and Kevin H.C. Cheng focus on population ageing on the one hand, and on value systems, social norms and traditions within filial piety on the other (Chapter Seven).They show how traditional values are changing in the Asia-Pacific region and the degree to which such changes vary across societies, posing new risks of exclusion for some older people. In some settings, changing interpretations of filial piety have led to a growing acceptance that personal care no longer needs to be provided solely by family members, and that filial contributions can also be fulfilled by providing cash or access to services provided by non-kin. Elsewhere, the quality of institutional care provision has become a key indicator of children’s enduring filial commitment to ageing parents. In addressing age discrimination, a major driver of exclusion in later life, Astrid Stuckelberger, Dominic Abrams and Philippe Chastonay examine steps being taken in Europe and through the United Nations to create a ‘society for all ages’ (Chapter Eight). Following a review of core processes of discrimination and exclusion based on old age, such as ageism, stigmatisation and stereotyping, the authors highlight the extent to which European citizens perceive ageism and age discrimination to be problematic. In terms of legislative responses to age discrimination, the EU has led the way internationally in outlawing different forms of discrimination in the workplace. However, loopholes in the legislative framework need to be filled if the risks of employment-related exclusion are to be minimised. Moreover, despite a range of UN initiatives in recent years, the authors suggest that relatively little progress has been made.As a result, many older people around the world are continuing to experience disadvantage. The built environment, encompassing people’s homes and the immediate neighbourhoods and communities that surround the home, represents a further important context for older people’s inclusion or exclusion. Atiya Mahmood and Norah Keating reflect on the centrality of place in the lives of older people (Chapter Nine).They conceptualise the built environment within the context of exclusion debates, focusing in particular on the ways in which the idea of ‘ageing in place’ is challenged by exclusion discourse. Several major policy and practice interventions that aim to enhance the built environment and thereby potentially reduce the risks of exclusion facing older people are reviewed. While universal design, visitability and age-friendly city initiatives are judged to be valuable in addressing different dimensions of the physical environment, there is a role for research to review in more critical fashion the process and outcomes of such programmes. Taken together, the contributors to this book examine a broad range of perspectives on social inclusion and exclusion in later life. In a concluding chapter, Norah Keating and Thomas Scharf synthesise the key arguments raised by contributing authors, and identify a number of cross-cutting issues that merit closer reflection by researchers (Chapter Ten). In a forward-looking piece, they highlight a number of challenges that lie ahead in relation to the risks of exclusion faced by ageing adults around the world. Responding to such challenges, with 11

From exclusion to inclusion in old age

the goal of promoting greater inclusion in later life, should represent a goal for policymakers, practitioners and the research community. References Arber, S. (2004) ‘Gender, marital status, and ageing: linking material, health, and social resources’, Journal of Aging Studies, vol 18, no 1, pp 91–109. Arber, S. and Attias-Donfut, C. (eds) (2000) The myth of generational conflict: The family and state in ageing societies. London: Routledge. Atkinson, A.B. (1998) ‘Social exclusion, poverty and unemployment’, in A.B. Atkinson and J. Hills (eds) Exclusion, employment and opportunity. CASEpaper 4, Centre for Analysis of Social Exclusion, London: London School of Economics, pp 1–20. Atkinson, A.B., Marlier, E. and Nolan, B. (2004) ‘Indicators and targets for social inclusion in the European Union’, Journal of Common Market Studies, vol 42, no 1, pp 47–75. Baars, J., Dannefer, D., Phillipson, C. and Walker, A. (2006) Aging, globalization and inequality. Amityville, NY: Baywood Press. Baldassar, L. (2007) ‘Transnational families and aged care: the mobility of care and the migrancy of ageing’, Journal of Ethnic and Migration Studies, vol 33, no 2, pp 275–97. Barnes, M., Blom, A., Cox, K., Lessof, C. and Walker, A. (2006) The social exclusion of older people: evidence from the first wave of the English Longitudinal Study of Ageing (ELSA). Final report. London: Office of the Deputy Prime Minister. Becker, E. and Boreham, R. (2009) Understanding the risks of social exclusion across the life course: Older age. London: Cabinet Office, Social Exclusion Task Force. Available at: http://webarchive.nationalarchives.gov.uk/+/http://www. cabinetoffice.gov.uk/social_exclusion_task_force/life-course.aspx (accessed 11 August 2011). Binstock, R.H. (2010) ‘From compassionate ageism to intergenerational conflict’, The Gerontologist, vol 50, no 5, pp 574–85. Brodie, J. (2002) ‘Citizenship and solidarity: reflections on the Canadian way’, Citizenship Studies, vol 6, no 4, pp 377–94. Burchardt, T., Le Grand, J. and Piachaud, D. (1999) ‘Social exclusion in Britain 1991–1995’, Social Policy and Administration, vol 33, no 3, pp 227–44. Burchardt, T., Le Grand, J. and Piachaud, D. (2002) ‘Degrees of exclusion: developing a dynamic, multidimensional measure’, in J. Hills, J. Le Grand and D. Piachaud (eds) Understanding social exclusion. Oxford: Oxford University Press, pp 30–43. Burstein, M. (2005) Combating the social exclusion of at risk groups. Ottawa, ON: Policy Research Initiative. Available at: http://policyresearch.gc.ca/doclib/ DP_PEX_Burstein_200511_e.pdf (accessed 11 August 2011). Cowgill, D. (1976) ‘Aging and modernization: a revision of the theory’, in J. Gubrium (ed) Late life: communities and environmental policy. Springfield, Ill: Charles C. Thomas. 12

Social exclusion in later life

Craig, G. (2004) ‘Citizenship, exclusion and older people’, Journal of Social Policy, vol 33, no 1, pp 95–114. Daly, M. and Silver, H. (2008) ‘Social exclusion and social capital: a comparison and critique’, Theory and Society, vol 37, no 6, pp 537–66. Dannefer, D. (2003) ‘Cumulative advantage/disadvantage and the life course: cross-fertilizing age and social science theory’, Journals of Gerontology B: Social Sciences, vol 58, no 6, pp S327–37. Delafuente, J.C. (2009) ‘The silver tsunami is coming: will pharmacy be swept away with the tide?’, American Journal of Pharmaceutical Education, vol 73, no 1,Article 1. Available at: http://www.britannica.com/bps/additionalcontent/18/37131226/ The-Silver-Tsunami-is-Coming-Will-Pharmacy-Be-Swept-Away-with-theTide (accessed 10 August 2011). European Commission (2008) Joint report on social protection and social inclusion 2008: social inclusion, pensions, healthcare and long-term care. Brussels: European Commission. Available at: http://www.ec.europa.eu/social/BlobServlet?docId =2386&langId=en (accessed 10 August 2011). Evandrou, M. (2000) ‘Social inequalities in later life: the socio-economic position of older people from ethnic minority groups in Britain’, Population Trends, vol 101, pp 11–18. Ferraro, K.F., Shippee, T.P. and Schafer, M.H. (2009) ‘Cumulative inequality theory for research on aging and the life course’, in L.V. Bengtson, D. Gans, N.M. Putney and M. Silverstein (eds) Handbook of theories of aging (2nd edn). New York: Springer, pp 413–33. Fox, S. (2001) Wired seniors. Washington, DC: Pew Internet and American Life Project. Available at: http://www.pewinternet.org/Reports/2001/WiredSeniors/Summary-of-Findings.aspx (accessed 11 August 2011). Freedman, M. (2002) ‘Civic windfall? Realizing the promise in an aging America’, Generations, vol 26, no 2, pp 86–9. Gordon, G., Adelman, L., Ashworth, K. et al (2000) Poverty and social exclusion in Britain.York: Joseph Rowntree Foundation. Grenier, A. and Guberman, N. (2009) ‘Creating and sustaining disadvantage: the relevance of a social exclusion framework’, Health and Social Care in the Community, vol 17, no 2, pp 116–24. Howker, E. and Malik, S. (2010) Jilted generation: how Britain has bankrupted its youth. London: Icon Books. Hwang, E. (2008) ‘Exploring aging-in-place among Chinese and Korean seniors in British Columbia, Canada’, Ageing International, vol 32, no 3, pp 205–18. International Labour Organization (2010) World social security report 2010/11: providing coverage in times of crisis and beyond. Geneva: International Labour Organization. Available at: www.ilo.org/public/english/protection/secsoc/ downloads/policy/wssr.pdf (accessed 11 August 2011). Jenson, J. (2004) Canada’s new social risks: directions for a new social architecture. CPRN Research Report F 43. Ottawa, ON: Canadian Policy Research Networks.

13

From exclusion to inclusion in old age

Kautz, T., Bendavid, E., Bhattacharya, J. and Miller, G. (2010) ‘AIDS and declining support for dependent elderly people in Africa: retrospective analysis using demographic and health surveys’, British Medical Journal, vol 340, c2841, doi:10.1136/bmj.c2841. Levitas, R. (2005) The inclusive society? Social exclusion and New Labour (2nd edn). Basingstoke: Macmillan. Levitas, R., Pantazis, C., Fahmy, E., Gordon, D., Lloyd, E. and Patsios, D. (2007) The multi-dimensional analysis of social exclusion. London: Social Exclusion Unit, Cabinet Office. Available at: http://citeseerx.ist.psu.edu/viewdoc/download?d oi=10.1.1.127.339&rep=rep1&type=pdf (accessed 11 August 2011). Marsh, A., Gordon, D., Pantazis, C. and Heslop, P. (1999) Home sweet home? The impact of poor housing on health. Bristol: Policy Press. Martinson, M. and Minkler, M. (2006) ‘Civic engagement and older adults: a critical perspective’, The Gerontologist, vol 46, no 3, pp 318–24. Migration Resource Centre (2006) Seeking asylum: a report on the living conditions of asylum seekers in London. London: Migration Resource Centre. Miliband, D. (2006) Social exclusion: the next steps forward. London: Office of the Deputy Prime Minister. Available at: http://www.revolving-doors.org.uk/ documents/david-miliband-social-exclusion-speech/ (accessed 11 August 2011). Moffatt, S. and Glasgow, N. (2009) ‘How useful is the concept of social exclusion when applied to rural older people in the United Kingdom and the United States?’, Regional Studies, vol 43, no 10, pp 1291–303. Ogg, J. (2005) ‘Social exclusion and insecurity among older Europeans: the influence of welfare regimes’, Ageing and Society, vol 25, pp 69–90. Patsios, D. (2006) ‘Pensioners, poverty and social exclusion’, in C. Pantazis, D. Gordon and R. Levitas (eds) Poverty and social exclusion in Britain: the millennium survey. Bristol: Policy Press, pp 431–58. Phelan, A. (2008) ‘Elder abuse, ageism, human rights and citizenship: implications for nursing discourse’, Nursing Inquiry, vol 15, no 4, pp 320–9. Phillipson, C., Bernard, M., Phillips, J. and Ogg, J. (2001) Family and community life of older people. London: Routledge. Podnieks, E. (2006) ‘Social inclusion: an interplay of the determinants of health – new insights into elder abuse’, Journal of Gerontological Social Work, vol 46, nos 3–4, pp 57–79. Poston, D.L. and Chengrong, C.D. (2000) ‘The current and projected distribution of the elderly and eldercare in the People’s Republic of China’, Journal of Family Issues, vol 21, pp 714–32. Reutter, L., Stewart, M.J.,Veenstra, G., Love, R., Raphael, D. and Makwarimba, E. (2009) ‘Who do they think we are, anyway? Perceptions of and responses to poverty stigma’, Qualitative Health Research, vol 19, pp 297–311. Richmond, T. and Saloojee, A. (eds) (2005) Social inclusion: a Canadian perspective. Halifax, NS: Fernwood Publishing. Saraceno, C. (ed) (2008) Families, ageing and social policy: intergenerational solidarity in European welfare states. Cheltenham: Edward Elgar. 14

Social exclusion in later life

Scharf,T. (2010) ‘Social policies for ageing societies: perspectives from Europe’, in C. Phillipson and D. Dannefer (eds) The Sage handbook of social gerontology. New York/London: Sage, pp 497–512. Scharf,T., Phillipson, C., Kingston, P. and Smith,A.E. (2000) ‘Social exclusion and ageing’, Education and Ageing, vol 16, no 3, pp 303–20. Scharf,T., Phillipson, C., Smith,A.E. and Kingston, P. (2002) Growing older in socially deprived areas: social exclusion in later life. London: Help the Aged. Scharf,T., Phillipson, C. and Smith, A.E. (2005a) ‘Social exclusion of older people in deprived urban communities of England’, European Journal of Ageing, vol 2, no 2, pp 76–87. Scharf,T., Phillipson, C. and Smith,A.E. (2005b) Multiple exclusion and quality of life amongst excluded older people in disadvantaged neighbourhoods. London: Stationery Office, Social Exclusion Unit, Office of the Deputy Prime Minister. Scharf, T., Bartlam, B., Hislop, J., Bernard, M., Dunning, A. and Sim, J. (2006) Necessities of life: older people’s experiences of poverty. London: Help the Aged. Schmidt,V.A. (2000) ‘Values and discourse in the politics of adjustment’, in F.W. Scharpf and V.A. Schmidt (eds) Welfare and work in the open economy. Vol. 1: from vulnerability to competitiveness. Oxford: Oxford University Press, pp 229–309. Silver, H. (1994) ‘Social exclusion and social solidarity: three paradigms’, International Labour Review, vol 133, nos 5–6, pp 531–78. Silver, H. (2007) Social exclusion: comparative analysis of Europe and Middle East youth. Working paper of the Middle East Youth Initiative, No. 1, Dubai: Wolfensohn Center for Development. Silver, H. and Miller, S. (2003) ‘Social exclusion: the European approach to social disadvantage’, Indicators, vol 2, no 1, pp 1–17. Smith, H. and Ley, D. (2008) ‘Even in Canada? The multiscalar construction and experience of concentrated immigrant poverty in gateway cities’, Annals of the Association of American Geographers, vol 98, no 3, pp 686–713. Social Exclusion Unit (2001) Preventing social exclusion. Social Exclusion Unit, London: Stationery Office. Available at: http://dera.ioe.ac.uk/5218/1/ preventing.pdf (accessed 30 March 2012). Social Exclusion Unit (2006) A sure start to later life: ending inequalities for older people. London: Office of the Deputy Prime Minister. Available at: http://www. cpa.org.uk/cpa/seu_final_report.pdf (accessed 11 August 2011). Ssengonzi, R. (2007) ‘The plight of older persons as caregivers to people infected/ affected by HIV/AIDS: evidence from Uganda’, Journal of Cross-Cultural Gerontology, vol 22, no 4, pp 339–53. Stewart, M., Reutter, L., Makwarimba, E.,Veenstra, G., Love, R. and Raphael, D. (2008) ‘Left out: perspectives on social exclusion and inclusion across income groups’, Health Sociology Review, vol 17, pp 78–94. Street, D. and Cossman, J.S. (2006) ‘Greatest generation or greedy geezers? Social spending preferences and the elderly’, Social Problems, vol 53, no 1, pp 75–96. Szinovacz, M.E. and Davey,A. (2007) ‘Changes in adult child caregiver networks’, The Gerontologist, vol 47, no 3, pp 280–95. 15

From exclusion to inclusion in old age

Townsend, P. (1981) ‘The structured dependency of the elderly: the creation of policy in the twentieth century’, Ageing and Society, vol 1, no 1, pp 5–28. Vanier Institute of the Family (2004) Profiling Canada’s families III. Ottawa:Vanier Institute of the Family. Walker, A. and Walker, C. (eds) (1997) Britain divided: the growth of social exclusion in the 1980s and 1990s. London: Child Poverty Action Group. West, E. (2006) ‘Mediating citizenship through the lens of consumerism: frames in the American Medicare reform debates of 2003–2004’, Social Semiotics, vol 16, no 2, pp 243–61. Available at: http://works.bepress.com/emily_west/7 (accessed 11 August 2011). Willetts, D. (2010) The pinch: how the baby boomers stole their children’s future – and how they can give it back. London: Atlantic Books. Zhang, Y.T. and Goza, F.W. (2006) ‘Who will care for the elderly in China? A review of the problems caused by China’s one-child policy and their potential solutions’, Journal of Aging Studies, vol 20, no 2, pp 151–64.

16

Two

Globalisation, economic recession and social exclusion: policy challenges and responses Chris Phillipson

Introduction The focus of this chapter is on the challenge to policies aimed at removing social exclusion, faced with a context of economic recession and continued pressures from global economic and social change. As the editors note in Chapter One of this book, issues concerning the marginalisation of older people have tended to be pushed aside in a public discourse that has focused on demographic change as a major contributory factor – if not cause – of current economic ills. By the same token, the extent to which the global economic crisis will increase financial and related problems experienced by particular groups of older people has also been neglected in the public sphere. Much has been made of the rise of mass unemployment, the expansion of poverty and the experience of insecurity in the workplace. However, connections are rarely made between different groups across the life course, with much of the discussion highlighting problems faced by people in the early and middle stages of working life (International Monetary Fund and International Labour Organization, 2010). The purpose of this chapter, then, is to highlight problems and concerns facing older people given a context of global economic recession. The neglect of older people in debates about social exclusion is compounded by the limited discussion about their vulnerability given severe reductions in public expenditure. Moreover, this tendency has itself been supported by arguments in the various fora covered by global social policy, these focusing on the need to curtail age-related expenditures such as pensions and health care (Cottarelli and Schaechter, 2010). Following this, the chapter has four aims. First, it will summarise the implications of the economic crisis for understanding issues relating to social exclusion. Second, it will place the recession in the context of wider forces associated with globalisation and global social policy. Third, it will assess new forms of exclusion arising from the economic recession. Finally, it will consider new responses and approaches to challenging social exclusion in old age.

17

From exclusion to inclusion in old age

Economic crisis and social exclusion Social and policy issues relating to older people have been fundamentally transformed by the economic crisis of 2008 and its aftermath. At one level, responses to the recession might be presented as a temporary disturbance in levels of support for vulnerable groups.An alternative reading, however, sees the present state of economic emergency as one likely to ‘become permanent’ (Žižek, 2010) and, therefore, to raise long-term questions about the viability of measures to combat social exclusion. In historical terms, we appear to have reached a very distant point from the ideas and sentiments that led to the birth of the modern welfare state. Judt (2005, pp 76-77), in his history of post-war Europe, observes that: the chief basis of support for state-funded welfare and social services provision lay in the popular sense that these corresponded to the proper task of government. The post-war state across Europe was a ‘social’ state, with implicit (and often constitutionally explicit) responsibility for the wellbeing of its citizens. (see also Hennessy, 2006) The retreat from what came to be known as the ‘classic welfare state’ came well before 2008 of course, with its origins in the recession of the 1970s and the subsequent rise of neo-liberal policies (Judt, 2010). But 2008 might be said to represent a turning point for ideas about responses to poverty and exclusion: first, with the return of a strong pro-market, anti-welfare state agenda; and, second, the location of this within global institutions emphasising demographic change as representing a social and economic crisis for the 21st century (see below). The present reconstruction of social policy is entirely compatible with the ‘shock tactics’ launched by capitalism in response to any crisis affecting social and political systems. Klein (2007) develops this argument in her analysis of what she terms ‘disaster capitalism’ – the process of re-engineering societies that have undergone traumas and dislocations of various kinds. These can be natural disasters (eg Hurricane Katrina), terrorist attacks (eg 11 September 2001) or, indeed, economic breakdowns such as that following the bursting of the credit bubble in 2008. Klein (2007, p 6) quotes Milton Friedman, guru of neo-liberal capitalism, as arguing that: only a crisis – actual or perceived – produces real change. When that crisis occurs, the actions that are taken depend on the ideas that are lying around. That, I believe, is our [ie the neo-liberal perspective’s] basic function: to develop alternatives to existing policies, to keep them alive and available until the political impossible becomes the political inevitable. What many European governments (notably that in the UK) have now presented as ‘inevitable’ is the contraction of the state and the public sphere in particular, 18

Globalisation, economic recession and social exclusion

with the corresponding expansion of private and so-called ‘third sector’ services. Such a process has been captured by Harvey’s (2010) conception of ‘accumulation by dispossession’, a process whereby existing forms of association, organisation, identity and creativity are forcibly channelled into the private domain so that value can be siphoned off or extracted anew. Harvey goes on to argue that: the reversion of common property rights won through years of hard class struggle (the right to a state pension, to welfare, to national health care) to the private domain has been one of the most egregious of all policies of dispossession pursued in the name of neo-liberal orthodoxy. (Cited in Coburn, 2010, p 60; see also Harvey, 2010) This process of ‘dispossession’ is being vastly accelerated in the context of plans to reduce remnants of the ‘classic welfare state’.This is most obviously the case in examples such as the National Health Service (NHS) in the UK, where proposed reform ‘opens the door to the comprehensive privatisation of health care’ (Milne, 2010), a development in line with moves across a number of European countries (for a review, see Coburn, 2010). It is further illustrated by long-term changes affecting pensions with the shift from occupational (defined benefit) schemes to personal (defined contribution) schemes. Blackburn (2006, p 4) summarises this process as one in which individuals and institutions are now being ‘weaned from the teat of public finance and [learning] how to be “responsible risk takers” … rejecting the old forms of dependence of which the old age pension was a prime example’ (see, further, Phillipson, 2009). ‘Dispossession’ is further highlighted in the rise of mass unemployment, reaching in 2010 ‘over 210 million people across the globe … an increase of more than 30 million since 2007 … three-quarters of this increase in the “advanced” economies’ (International Monetary Fund and International Labour Organization, 2010, p 4). All of these developments might be said to be opening up new forms of exclusion for vulnerable groups, with older people among those most seriously affected. Chapter One of this book reviewed the various ways in which exclusion has affected the lives of older people. We can now see economic recession introducing new exclusionary strands, but with these additionally influenced by broader structural and political processes associated with globalisation. The next section of this chapter reviews some of the key developments behind globalisation and the links that can be made with the changes arising from the 2008 crisis.

Globalisation and economic crisis Debates around the impact of globalisation on ageing have been extensive both within the social gerontology literature (see, eg, Baars et al, 2006; Dannefer and Phillipson, 2010) and in studies of social welfare (Mishra, 1999;Yeates, 2001; George and Wilding, 2002). One argument emerging from within gerontology concerns the extent to which globalisation has itself become an influential factor in the 19

From exclusion to inclusion in old age

construction of old age, notably in the design of policies aimed at regulating and managing population ageing.Although the impact of globalisation remains ‘highly contested’ (Diamond, 2010), there seems no question that an interdependent world such as that associated with more fluid labour markets and transnational forms of governance creates distinctive pressures and influences across the life course. Much work has still to be done in working out more precisely what these might be and the relative influences on the particular policies of national and global actors. Yeates (2001, p 2) suggests, for example, that the relationship between globalisation and social policy is best conceived as ‘dialectical’ or ‘reciprocal’ and that, ‘far from states, welfare states and populations passively “receiving” [and] adapting to globalisation … they are active participants in its development’ (see, further, Diamond, 2010). This may be especially the case in the context of the present economic recession where the role of nation states in managing the crisis, over and against global bodies, appears to have been enhanced (Gray, 2010). On the other hand, the impact of global bodies at the ideological level, notably in respect of policies towards issues such as pensions and retirement (Vincent, 2006; Phillipson, 2009), remains influential. A key aspect of this has been the move from debates that focused on ageing as a burden for national economies, to those that presented population ageing as a worldwide social problem. The World Bank’s (1994) report Averting the Old Age Crisis was a crucial document in this regard, but other contributions have included those from the Central Intelligence Agency (2001) and documents such as The Global Retirement Crisis, produced by the Washington-based Center for Strategic and International Studies (Jackson, 2002).There is insufficient space in this chapter to deal with the particular arguments raised by these papers (see, however, the discussion in Vincent, 2006), but the general point concerns what amounts to a politicisation of ageing generated by the intensification of global ties. The above development has been driven by a number of factors: the growth of neo-liberalism is one obvious dimension, this propagating hostility towards collective provision by the state or, at the very least, a view that private provision is inherently superior to that provided by the public sector (Yeates, 2001;Walker and Deacon, 2003). Politicisation has also arisen from the way in which globalisation fosters awareness about the relative economic position of one nation state compared with another. George and Wilding (2002: 58) make the point here that:‘Globalization has created an economic and political climate in which national states become more conscious of the taxes they levy and their potential economic implications. Neo-liberal ideology feeds and justifies these concerns’. Finally, the ideological debate has been promoted through key supranational bodies such as the Organisation of Economic Co-operation and Development (OECD) and World Trade Organisation (WTO), along with transnational corporations (notably pharmaceutical companies), all of which contributed to a distinctive worldview about the framing of policies for old age. The processes associated with globalisation have assisted the development of a new approach to ageing societies, based around what Ferge (1997) refers to as the ‘individualization of the social’. On the one side, ageing is presented as 20

Globalisation, economic recession and social exclusion

a global problem and concern; on the other side, the focus has moved towards individualising the various risks attached to growing old. In this context,Young (1999, p 7, author’s emphasis) has interpreted such developments as part of a wider shift from an: inclusive to an exclusive society. That is from a society whose accent was on assimilation and incorporation to one that separates and excludes. This erosion of the inclusive world … involved processes of disaggregation both in the sphere of community (the rise of individualism) and the sphere of work (transformation of … labour markets). Both processes are the result of market forces and their transformation by the human actors involved. Such changes received some acknowledgement in the policy debate on social exclusion that emerged in European social policy in the 1980s and 1990s. Notwithstanding overlaps between the concepts of poverty and social exclusion (Bhalla and Lapeyre, 1997), the exclusion discourse sought to extend the poverty debate in important ways. In particular, social exclusion was regarded as a useful means of highlighting the social costs that can arise when individuals, families and communities become disengaged from the wider society (see, further, Chapter One). Other definitions highlighted the multidimensionality of exclusion, suggesting that people can become excluded when particular institutional systems break down, leading to the loss of support for vulnerable groups (Atkinson and Davoudi, 2000; Scharf et al, 2004, 2005).Yet, despite the systemic implications of this last point, links between exclusion and wider social and economic changes were underplayed in the policy discourse. From a sociological perspective, however, writers such as Bauman (1998) presented the ‘human consequences’ of globalisation in terms of new forms of exclusion and segregation, especially affecting those in deprived and peripheral communities. Also, Sennett (2006) linked aspects of globalisation – for example, the rise of flexible labour markets – to the ‘erosion of social capitalism’, with older workers increasingly disadvantaged within corporations that emphasised low-wage and low-skill work environments. Failure to integrate the various changes associated with globalisation could be said to have limited the scope of debates and interventions around social exclusion. Moreover, certainly during the 1990s and early 2000s, these rested upon a set of assumptions that the welfare state would continue and that the goal of policy was to reincorporate excluded groups back into its main institutions. Against this, the dismantling of the welfare state – as part of an accelerated process of deregulation and privatisation – is setting new challenges for the exclusion debate. Indeed, we can now see that the combination of globalisation and recession is itself creating new forms of marginalisation and associated threats to the welfare of older people. The next section of this chapter provides examples of some of the changes involved.

21

From exclusion to inclusion in old age

Social exclusion and economic recession The argument developed thus far is that a combination of globalisation and economic recession is generating new challenges to the living standards of older people. Although such a statement might be taken as self-evident, in reality there remains limited discussion of the impact of expenditure cuts on the lives of older people. Some elements of the picture await full documentation and will not be discussed here.This is most obviously the case in relation to private pensions, with the consequences arising from the near collapse of many funds following 2008 yet to be fully unravelled. But other elements are becoming clearer, notably those relating to ideologies about demographic change, the provision of services and the changing balance of power between public and private sector provision. All these elements, it will be argued, are increasing the exclusionary processes affecting older people and will require the development of alternative perspectives within social gerontology and social policy. Such processes can be illustrated by the rise of exclusionary discourses on the one side, and that of exclusionary services on the other. On the first of these, older people are increasingly caught up in a discourse emphasising the costs and problems arising from support for older people. Leys (2010, p 15) notes, for example, the extent to which in the current climate the ‘public discourse [about] publicly-provided health care is not articulated with “poverty”,“housing”,“industrial pollution”, or “inner-city deprivation”, but with “cost”, “taxation”, “bureaucracy”, “welfare” [and the] “nanny” state’. In this way, services that directly benefit older people are invariably subject to questioning about their legitimacy and value. This process is intensified through the various ‘panics’ about the costs linked with demographic change. In the UK, to take one example, pension provision for public sector workers (eg teachers, nurses and local government workers) has been subject to numerous attacks on grounds of ‘soaring costs’ and ‘unaffordability’ (see, eg, Daily Mail, 2009; MailOnline, 2009). Yet a government-sponsored report (Independent Public Service Pension Commission, 2010) found that in reality, on a day-to-day basis, some of the largest public sector schemes (such as those covering the NHS) were actually in surplus; that the total cost of public sector pensions was projected to remain flat at around 1.5% of Gross Domestic Product for the next decade, dropping to 1.1% by 2059–60; and that although the liability for pensions has been placed at around £993bn, this will actually be spread over some 70–80 years (see, further, Office for Budget Responsibility, 2011). A further strand in the exclusionary discourse concerns changes affecting work and retirement. Here, the closing down of opportunities for retirement is itself producing new forms of exclusion. Governments across many industrialised countries are moving to create an automatic link between gains in longevity and pension age. This policy introduces new class- and gender-based forms of exclusion. In the first place, the policy takes as self-evident the desirability of working additional years, this is viewed as acceptable given increased life expectancy and necessary as a means of reducing the cost of pensions. But such 22

Globalisation, economic recession and social exclusion

a measure (now adopted by other European countries) is especially unfair on working-class groups whose lower life expectancy means that they will draw their pension for a significantly shorter period in comparison with those from professional and managerial groups. An additional concern is that increasing numbers of workers will be forced to remain in employment despite major health problems, with many experiencing downward mobility with an increase in low-paid, part-time working. In reality, many workers may find higher state pension ages an unfair exchange between guaranteed retirement benefits on the one side, and insecure employment on the other. Certainly, there is no evidence for an expansion in appropriate forms of paid work for most older employees, with very little ‘flexible’ employment available that properly takes account of the health and social changes affecting people in their 60s and 70s (Phillipson, 2009). The policy is especially unfair for women who are bearing the brunt of the changes. Over a 10-year period, women’s pension age in the UK will rise by six years, compared with just one year for men. One calculation suggests that a 45-year-old woman turning 60 in 2025 will miss out on nearly £47,000 as a result of the changes, based on the 2010 basic state pension rising by 2.5% per year (Jones and Inman, 2010). In relation to exclusionary services, exclusion from traditional sources of care may be another consequence of economic recession and cuts in public spending. Horton and Reed (2010a) examined the consequences for different households of planned reductions in spending in the UK of £99bn, set against increases in taxes of £29bn.They took a two- and four-year time horizon, viewing projections for the years 2012/13 and 2014/15. Results from this research show significant losses for all households but especially for children and older people (and very elderly people in particular). They make the point that: because pensioner households tend to have lower incomes than other household types, the value of these losses from cuts tend to be quite high as a proportion of … household income. If pensioners had to replace the services lost, by purchasing services out of their own income, it is clear that the welfare impacts would be very severe indeed. (Horton and Reed, 2010a, p 1) This last point is especially apparent in the case of social care. Reduced spending in this area has been a feature for some time, as reflected in a tightening in the eligibility rules and restrictions in the packages of support that maintain people at home. With substantial reductions in the financial help provided by local authorities in England as part of the planned cuts in public expenditure, withdrawal of support from large groups of older people would appear inevitable. Forder and Fernández (2010) modelled the impact of the first two years of likely spending cuts over the years 2011/12 and 2012/13. The impact of their ‘reduced budget’ scenario was measured against a comparator where eligibility thresholds and the financial means test in the current social care system remained unchanged. 23

From exclusion to inclusion in old age

The results suggested that by 2012, local authorities would be able to support at home only around half the number of people assisted in 2010. Crucially, the researchers note that this reduction will be offset to some degree by an increase in the number of private users of social care with a projected increase in 2012/13 of around 300,000 of those paying for care, compared with the 490,000 fall in state-supported recipients. The conclusion from this is instructive: The modelling suggests that a reduction in public support would prompt more people to pay privately for care and/or seek informal care. However, the substitution from public to private expenditure is limited because of the limited financial resources available to individuals with needs, who cannot always afford the high costs of care.As a result, the overall (state and private) expenditure is lower when the level of public funding is reduced.There are also equity consequences – with more private funding required, the rich would do better and the poor would be the biggest losers. (Forder and Fernández, 2010, p 8) As this last argument suggests, the development of new exclusionary forces has disproportionate effects across different age, class and gender groups. There is mounting evidence that women – across all age groups – have been hit especially hard by reductions in public expenditure. Lone parents and single pensioners (most of whom are women) appear to have suffered worse in the 2010 Spending Review, with the latter losing services equivalent to around 11% of their income (Trades Union Congress, 2010). Alongside the raising of the pension age, women will be especially affected by the cuts to employment in the public sector, where around two thirds of workers are women.Threats to health and social care will also have a disproportionate impact on informal carers, the majority of whom are, once again, women. These developments confirm Estes’s (2006, p 88) analysis of the extent to which: ‘older women [are] highly vulnerable to state welfare policies that are subject to politically charged, uncertain, and partisan conflicts, which may result in erratic, radical, and regressive policies with regard to the treatment of women’. Social exclusion is, then, re-emerging as a major issue for different groups of older people, notably: those with the lowest incomes, that is, those most reliant upon public services; those most involved in care tasks in the home and community; those (such as first-generation migrants) who have failed to build rights to pensions and related support; and those (especially the poor and very frail) most affected by a discourse focused around the burden of old age. Major issues will need to be faced in responding to these new forms of social exclusion. The next section of this chapter sets out a context for considering these and identifies four areas where responses might be developed.

24

Globalisation, economic recession and social exclusion

Challenging social exclusion: new goals for gerontology and social policy A key conclusion of this chapter is that globalisation combined with economic recession is creating – for industrial societies at least – a major new phase in the history of ageing (see, further, Walker, 2006). The first phase of development occurred in the two decades following the end of the Second World War. A key element here concerned the way in which, in most capitalist societies, growing old was transformed by the social and economic institutions associated with the welfare state and mandatory retirement. Both were instrumental in shaping the dominant discourse around which old age and its associated images and identities were framed (Phillipson, 1998).A supporting theme was the reordering of the life course into distinctive stages associated with education, work and retirement, with the transition to retirement becoming an important element in the development of a new identity separate from that associated with work and paid employment (Best, 1980). The transformation in welfare from the 1980s began, however, a second phase of development, albeit one with a number of tensions and contradictions. On the one side, the institutions supporting old age became weakened through economic recession and mass unemployment, with a developing sense of ageing as a ‘burden’ and ‘problem’ for society (Vincent, 1999). On the other side, arguments emerged suggesting that the extended period of retirement associated with ‘early exit’ from work could lead to more expansive lifestyles, an approach associated with the idea of a ‘third age’ of personal development and liberation (Laslett, 1989; Gilleard and Higgs, 2005). An underlying theme, however, in both of the above phases concerned the continued responsibility of the state – at least in the European context – in providing support to older people. Old age was largely taken for granted as a time in which public institutions would play a dominant role in the provision of care; a period of life in which it was governments – whether at central or local level – who had primary accountability for ensuring the security and quality of life for the most vulnerable in society. In contrast, the latest period in the development of old age appears underpinned by a new ‘moral narrative’, to use the phrase of Tony Judt (2010): one represented by a shift from the state to the market, or from ageing managed within ‘private’ rather than ‘public’ spaces. This new phase is by definition more open and less constrained by the traditional institutions supporting older people; equally, it is a more unequal old age – with new opportunities for inclusion on the one side, but varieties of exclusion on the other (Cann and Dean, 2009). What kind of responses need to be made to these developments? Moreover, what options do we have for achieving a more secure old age given the economic and social transformations sketched out in this chapter? A starting point must come from some kind of rethinking of the role of the state in supporting older people. Here, it is important to challenge the idea that the state can progressively withdraw from being a major partner in supporting older people. Of course, 25

From exclusion to inclusion in old age

the state has not ‘withered away’ in key areas of responsibility. Judt (2010, p 199) makes the point that: Having reduced the scale of public ownership and intervention over the course of the past thirty years, we now find ourselves embracing de facto state action on a scale last seen in the Depression. The reaction against unrestrained financial markets – and the grotesquely disproportionate gains of a few contrasted with the losses of so many – has obliged the state to step in everywhere. But, as Judt goes on to argue, the outstanding point remains that having spent much of the 1990s and 2000s rejecting state/public intervention, the case for why it is needed must be rethought: We have freed ourselves of the mid-20th century assumption – never universal but certainly widespread – that the state is likely to be the best solution to any given problem.We now need to liberate ourselves from the opposite notion: that the state is – by definition and always – the worst available option. (Judt, 2010, p 202, author’s emphasis) In redefining or ‘rethinking’ the state in the context of exclusion, four areas for discussion might be suggested: • first, maintaining a framework for supportive ties within and between generations; • second, promoting understanding of the value of public services; • third, securing ‘protected spaces’ to support vulnerable and marginal groups; and • fourth, promoting a rights-based approach to development in later life. On the first of these, there is evidence of a return to arguments promoting the theme of ‘intergenerational conflict’, which are characteristic of those that emerged in the ‘workers’ versus ‘pensioners’ debate in the 1980s (Johnson et al, 1989).The new form of this in the UK (and elsewhere) focuses on the idea of the ‘baby boomer’ cohort (those born during the mid-1940s to mid-1950s) as a resourcerich group, controlling a level of assets and resources substantially in excess of younger cohorts (see, eg, Howker and Malik, 2010;Willetts, 2010). Leaving aside empirical evidence challenging this view (Evandrou and Falkingham, 2006), the key issue is the extent to which debates around intergenerational ‘fairness’ and ‘justice’ actually obscure important issues about inequalities and divisions within different cohorts – whether baby boomers or younger or older cohorts. Thus, attacks on baby boomers are a problem not just because they undermine important ideas about the value of ‘interdependency’ between generations, but also because they deflect attention from the continuing problems of poverty and inequality affecting all cohorts – not least of the hugely diverse cohort now entering old 26

Globalisation, economic recession and social exclusion

age.The danger is that the idea of ‘intergenerational conflict’ itself becomes a new strand in the exclusion debate, justifying the restriction of resources to one group (older people) on the basis of competing claims from another group (children and young people). The second area of discussion concerns the issue of why the state is viewed as a problem. Here, there is compelling evidence from the UK – replicated elsewhere no doubt – of a deep well of misunderstanding about the value of public spending and the benefits it provides. In a sense, this was the major problem for the welfare state as it matured: once its initial moral vision was lost and it became perceived as part of the problem – poor services, unjust treatment, unequal care – the transaction between the public (in terms of the payment of taxes) and benefits (in respect of the delivery of services) was lost. Hedges (2005) makes the point from his research that while ‘many people are sharply aware of the tax system draining money from them … they don’t have equivalent awareness of all the ways in which money flows back … through benefits and services’ (cited in Horton and Reed, 2010b, p 12). Horton and Reed (2010b, p 12) suggest that two important consequences arise from this: first, that people underestimate the value of the services received from public expenditure; and, second, that public expenditure is itself often ‘invisible’, resulting in a ‘broader sense of disconnection in how people think about paying taxes and receiving public services’. Of course, this has made it much easier for neo-liberal governments to reduce public expenditure – precisely on the grounds of costs and efficiency for taxpayers. Yet, because it is the poor who most benefit from these services – and the elderly poor in particular – the task of ‘reconnecting’ taxes with services has never been more important or timely given the reductions in public spending across European countries. Third, the case might also be made for reconnecting to the original vision of a welfare state with responsibility for promoting the well-being of all its citizens. The tendency for capitalism to convert ‘public services into commodities’ (Navarro, 1976) has been vastly accelerated over the past decade, with increasing penetration of multinational corporations into the health and social care system. The evidence suggests that this process has had the greatest effect on the poorest older people, with community services for low-income groups most vulnerable to underfunding and potential closure (Hermann, 2010). Deppe (2009, p 36) draws a wider argument from this about the importance of what he calls ‘protected social spaces, which are orientated to the common welfare and which cannot be trusted to the blind power of the market’. He argues that: We have to respect and sustain areas in which communication and co-operation is not commercialised, where services do not have the character of commodities. Such protected sectors extend from the way vulnerable groups are dealt with … to social goals such as solidarity and equity and vulnerable communication structures – especially those which are based on confidence like the … worker–patient

27

From exclusion to inclusion in old age

relationship. Indeed, these protected social spaces form the basis for a humane social model. Developing such spaces will be especially important given the need to protect people with Alzheimer’s and other forms of dementia and those with major physical disabilities from the dangers of abusive relationships both in the community and in institutional settings. The need to embed care relationships within spaces that emphasise solidarity over market forces is an important task for gerontologists and others to address. In this context, a fourth avenue for challenging exclusion must come from the adoption of the type of human rights perspective developed in the later writings of Peter Townsend (2007) and also articulated in Chapter Eight of this book. Townsend highlighted the importance of measures such as the European Convention on Human Rights and the Universal Declaration of Human Rights as offering a means of challenging the ‘structured dependency’ of older people. Use of such frameworks may become essential given the rise of care organisations operating across national borders and the drive to deregulate and privatise hitherto public services.Townsend argued that problems relating to dependency persisted as a major issue affecting older people, with these problems set to grow in many parts of the world. At the same time, he concluded that: Human rights instruments offer hope of breaking down blanket discrimination and of using resources more appropriately, and more generously, according to severity of need. But investment in human rights is not only a moral and quasi-legal salvation from things that are going depressingly wrong. Used best, human rights offer a framework of thought and planning [for] the 21st Century that enables society to take a fresh, and more hopeful, direction. (Townsend, 2007, p 43)

Conclusion The argument of this chapter has been that economic recession, linked with global economic and social change, has created the basis for new forms of exclusion. Older people are especially vulnerable to these, affected as they are by discourses that present them as a burden on society and by changes to those public services that have a disproportionate effect on the quality of everyday life.The stakes are now high in terms of the future of social policies for older people. As John Gray (2010, p 5) has observed: ‘A roll-back of the state of the magnitude [planned] will leave people more exposed to the turbulence of world markets than they have been for generations. Inevitably, they will seek protection’.Yet the nature of such support will inevitably be different than that which shaped the lives of older people in the second half of the 20th century.Then, it was a relatively modest welfare state that provided a ‘moral narrative’ for growing old; then, it was the promise of retirement that underpinned the aspirations of many – at least in industrial countries; then, it was the idea of a compact between generations, which was presented as a new 28

Globalisation, economic recession and social exclusion

form of ‘bonding’ for society. Analysis now suggests a more unequal and divided old age, with prosperity for some matched by deep poverty for others – all of this complicated by the greater spread of incomes within different cohorts and added threats introduced by global risks and insecurities. But, at the very least, all of the above should be seen as a challenge to develop new forms of analysis and policy alternatives. Social policy is now faced with a different type of ageing underpinned by changing institutional forces and responses. These are transforming the landscape around which the social construction of ageing has traditionally been built. Social gerontology has been slow to respond to the changes facing older people – notably those most affected by policies that undermine traditional sources of support. Developing new ways of analysing and responding to the challenge of social exclusion in old age is likely to remain at centre stage in analytical and policy debate for some years ahead. References Atkinson, R. and Davoudi, S. (2000) ‘The concept of exclusion in the European Union: context, development and possibilities’, Journal of Common Market Studies, vol 38, no 3, pp 427–48. Baars, J., Dannefer, D., Phillipson, C. and Walker,A. (eds) (2006) Aging, globalization and inequality: the new critical gerontology. Amityville, NY: Baywood. Bauman, Z. (1998) The human costs of globalization. Cambridge: Polity Press. Best, F. (1980) Flexible life scheduling. New York, NY: Praeger. Bhalla, A. and Lapeyre, F. (1997) ‘Social exclusion: towards an analytical and operational framework’, Development and Change, vol 28, pp 13–43. Blackburn, R. (2006) Age shock: how finance is failing us. London:Verso. Cann, P. and Dean, M. (2009) Unequal ageing: the untold story of exclusion in old age. Bristol: Policy Press. Central Intelligence Agency (2001) Long term global demographic trends: reshaping the geo-political landscape. Available at: https://www.cia.gov/library/ reports/general-reports-1/Demo_Trends_For_Web.pdf (accessed 30 March 2012). Coburn, D. (2010) ‘Inequality and health’, in L. Panitch and C. Leys (eds) Morbid symptoms: health under capitalism. The Socialist Register 2010. London: Merlin Press, pp 39–58. Cottarelli, C. and Schaechter, A. (2010) Long-term trends in public finances in the G-7 economies. Geneva: International Monetary Fund. Daily Mail (2009) ‘Gold-plated pension schemes threatened by £100bn deficit’, 22 December.Available at: http://www.dailymail.co.uk/news/article-1237566/ Black-hole-200-pension-schemespasses-100bn-time.html Dannefer, D. and Phillipson, C. (eds) (2010) Handbook of social gerontology. London: Sage. Deppe, H-U (2010) ‘The nature of health care: commodification versus solidarity’, in L. Panitch and C. Leys (eds) Morbid symptoms: health under capitalism.The Socialist Register 2010. London: Merlin Press, pp 29–38. 29

From exclusion to inclusion in old age

Diamond, P. (2010) How globalisation is changing patterns of marginalisation and inclusion. York: Joseph Rowntree Foundation. Estes, C. (2006) ‘Critical feminist perspectives, aging and social policy’, in J. Baars, D. Dannefer, C. Phillipson and A.Walker (eds) Aging, globalization and inequality: the new critical gerontology. Amityville, NY: Baywood, pp 81–102. Evandrou, M. and Falkingham, J. (2006) ‘Will the baby-boomers be better off than their parents in retirement’, in J.Vincent, C. Phillipson and M. Downs (eds) The futures of old age. London: Sage, pp 85–98. Ferge, Z. (1997) ‘The changed welfare paradigm: the individualization of the social’, Social Policy and Social Administration, vol 31, no 1, pp 20–44. Forder, J. and Fernández, J.-L. (2010) The impact of a tightening fiscal situation on social care for older people. PSSRU Discussion Paper 2723. Available at: www.pssru.ac.uk/pdf/dp2723.pdf George,V. and Wilding, P. (2002) Globalization and human welfare. London: Palgrave. Gilleard, C. and Higgs, P. (2005) Contexts of ageing. Cambridge: Polity Press. Gray, J. (2010) ‘Progressive, like the 1980s’, London Review of Books, vol 32, no 20, pp 3–7. Harvey, D. (2010) The enigma of capital. London: Profile Books. Hedges, A. (2005) Perceptions of redistribution: report on exploratory qualitative research. CASE Paper 96. London: London School of Economics. Hennessy, P. (2006) Having it so good: Britain in the fifties. London: Allen Lane. Hermann, C. (2010) ‘The marketisation of health care in Europe’, in L. Panitch and C. Leys (eds) Morbid symptoms: health under capitalism. The Socialist Register 2010. London: Merlin Press, pp 125–44. Horton, T. and Reed, H. (2010a) How the government’s planned cuts will affect older people. London: Age UK. Horton, T. and Reed, H. (2010b) Where the money goes: how we benefit from public services. London: Trades Union Congress. Howker, E. and Malik, S. (2010) Jilted generation: how Britain has bankrupted its youth. London: Icon. Independent Public Service Pensions Commission (2010) Interim report. London: Pensions Commission. International Monetary Fund and International Labour Organization (2010) The challenges of growth, employment and social cohesion. Geneva: IMF/ILO. Jackson, R. (2002) The global retirement crisis.Washington, DC: Citigroup/ Center for Strategic and International Studies. Johnson, P., Conrad, C. and Thomson, D. (eds) (1989) Workers versus pensioners: intergenerational justice in an ageing world. Manchester: University of Manchester Press. Jones, R. and Inman, P. (2010) ‘Disappointment for fiftysomethings’, The Guardian Money, 23 October, p 8. Judt, T. (2005) Postwar: a history of Europe since 1945. London: Heinemann. Judt,T. (2010) Ill fares the land: a treatise on our present discontents. London:Allen Lane. Klein, N. (2007) The shock doctrine. London: Allen Lane. 30

Globalisation, economic recession and social exclusion

Laslett, P. (1989) A fresh map of life: the emergence of the third age. London:Weidenfeld and Nicolson. Leys, C. (2010) ‘Health, health care and capitalism’, in L. Panitch and C. Leys (eds) Morbid symptoms: health under capitalism.The Socialist Register 2010. London: Merlin Press, pp 1–28. MailOnline (2009) ‘Millions of public sector workers face losing final salary “gold-plated pensions”’, 27 August. Available at: http://www.dailymail.co.uk/ news/article-1209147/Gold-plated-pensions-public-sector-workers-warned. html (accessed 30 March 2012). Milne, S. (2010) ‘We cannot allow the end of the NHS in all but name’, The Guardian, 15 July, p 29. Mishra, R. (1999) Globalization and the welfare state. Cheltenham: Edward Elgar. Navarro,V. (1976) Medicine under capitalism. New York, NY: Praeger. Office for Budget Responsibility (2011) Fiscal sustainability report. London: The Stationery Office. Phillipson, C. (1998) Reconstructing old age. London: Sage. Phillipson, C. (2009) ‘Pensions in crisis: aging and inequality in a global age’, in L. Rogne, C. Estes, B. Grossman, B. Hollister and E. Solway (eds) Social insurance and social justice. New York, NY: Springer, pp 319–40. Scharf,T., Phillipson, C. and Smith,A. (2004) ‘Poverty and social exclusion: growing old in urban neighbourhoods’, in A.Walker and C. Hennessy (eds) Growing older: quality of life in old age. Maidenhead: Open University Press, pp 81–106. Scharf,T., Phillipson, C. and Smith, A.E. (2005) ‘Social exclusion of older people in deprived urban communities of England’, European Journal of Ageing, vol 2, no 2, pp 76–87. Sennett, R. (2006) The culture of the new capitalism. New Haven, CT:Yale University Press. Thomson, D. (1989) ‘The welfare state and generational conflict: winners and losers’, in P. Johnson, C. Conrad and D. Thomson (eds) Workers versus pensioners: intergenerational justice in an ageing world. Manchester: University of Manchester Press. Townsend, P. (2007) ‘Using human rights to defeat ageism: dealing with policyinduced “structured dependency”’, in M. Bernard and T. Scharf (eds) Critical perspectives on ageing societies. Bristol: Policy Press, pp 27–44. Trades Union Congress (2010) ‘Spending review will hit the poorest 15 times harder than the rich’, Available at: http://www.tuc.org.uk/economy/tuc18705-f0.cfm Vincent, J. (1999) Politics, power and old age. Buckingham: Open University Press. Vincent, J. (2006) ‘Globalization and critical theory: political economy of world population issues’, in J. Baars, D. Dannefer, C. Phillipson and A. Walker (eds) Aging, globalization and inequality: the new critical gerontology. Amityville, NY: Baywood, pp 245–72.

31

From exclusion to inclusion in old age

Walker, A. (2006) ‘Re-examining the political economy of aging: understanding the structure/agency tension’, in J. Baars, D. Dannefer, C. Phillipson and A.Walker (eds) Aging, globalization and inequality: the new critical gerontology. Amityville, NY: Baywood, pp 59–80. Walker, A. and Deacon, B. (2003) ‘Economic globalization and policies on aging’, Journal of Societal and Social Policy, vol 2, no 2, pp 1–18. Willetts, D. (2010) The pinch: how the baby boomers took their children’s future – and how they can give it back. London: Atlantic Books. World Bank (1994) Averting the old age crisis. Oxford: Oxford University Press. Yeates, N. (2001) Globalisation and social policy. London: Sage. Young, J. (1999) The exclusive society. London: Sage. Žižek, S. (2010) ‘A permanent economic emergency’, New Left Review, vol 64, pp 85–95.

32

Three

International migration: patterns and implications for exclusion in old age Sandra Torres

Introduction The globalisation of international migration flows is changing the demographics of ageing populations across the world and the ethnic composition of most societies (Castles and Miller, 1998). Even if some regions of the world are more affected than others, few societies are entirely exempted from this phenomenon. With specific respect to Europe, Muus (2001) has argued that the globalisation of international migration has transformed the European Union into a de facto region of immigration. This is why Warnes et al (2004) have proposed that this phenomenon is as important to the study of ageing and old age as population ageing itself. As is also suggested in Chapter Two, globalisation is transforming the very boundaries we regard as relevant to the experience of ageing (Phillipson, 2009). The feminisation and differentiation that characterise current migration flows are two features of particular interest to migration researchers (Castles and Miller, 1998). It was once the case that most migrants were men and that most of those who migrated across national borders had relatively disadvantaged backgrounds (at least if compared to people in the receiving countries; migration research has since shown that, compared to those left behind in the sending countries, migrants are often relatively privileged). Nowadays, neither the gender nor the background of migrants can be taken for granted. For example, women now play a central role in almost all forms of migration flows. With respect to the differentiation of migration flows to Europe, King (2002) has argued that the globalisation of international migration challenges us to consider migration in new ways since the pervasive assumption that all migrants are poor and uneducated no longer holds true – and probably never did hold true. It is for these reasons that migration researchers have urged other social scientists to acknowledge that the globalisation of international migration should not be reduced to the upswing in migration flows with which it is typically associated (Castles, 2000; Faist, 2000). The challenges that this phenomenon poses are actually far greater. What is actually at stake is our very understanding of what culture is (Tomlinson,

33

From exclusion to inclusion in old age

1999), who migrants and refugees are (Castles, 2000; Richmond, 2002), and how inequality and the so-called ‘periphery’ are to be addressed (Beck, 2000). Within this context, it has previously been argued that globalisation is challenging social-gerontological notions of who the older migrants are and how their needs can be catered for (Torres, 2006a). The migratory life course is in fact a profuse yet relatively unexplored source of information about how the process of ageing is experienced and can be understood (Torres, 2006a, 2008). In other words, the diversity of older migrants brought about by the globalisation of international migration is challenging social gerontology’s theoretical and policy- and practice-oriented assumptions about this group of older people. As a consequence, this chapter seeks to address the sources of this diversity in order to extract what it conveys as far as social exclusion is concerned.The chapter will show that there are specific exclusionary risks associated with the migratory life course, even if – as is bound to be the case – the mechanisms of social exclusion work differently according to when, why and where older people with migratory life courses have come from. The chapter is organised into four main sections. First, the debate on social exclusion that has been carried out within the social sciences in general and within social gerontology in particular will be addressed in order to clarify the conceptualisation of social exclusion from which the chapter departs. Building on this, the second section summarises the debate on social exclusion as it has been articulated within the field of international migration and ethnic relations. This highlights the central issues that are being discussed from an ethnicity- and race-aware perspective. Third, some of the key issues associated with the ethnogerontological literature on older migrants – specifically migrants to Western industrialised nations – are discussed in order to highlight what that specific literature says about the characteristics of these migrants, where they have come from and why, as well as what they need as they approach old age. Finally, the chapter addresses the ways in which this literature can inform debates around social exclusion in later life. In this respect, the chapter’s broad aim is to contribute to social-gerontological understandings of social exclusion in two key ways. First, it seeks to highlight the specific risks that are associated with the migratory life course. Second, it aims to make the point that social gerontology’s knowledge of, and solutions to, social exclusion – such as, for example, the taken-for-granted assumption that well-designed policies and practices can reduce exclusion in later life – are open to question when one understands the issues that an ethnicity- and race-aware take on social exclusion brings to the fore.

Social exclusion: a gerontological glimpse at the socialscientific debate O’Brien and Penna (2008, p 1) have argued that in the late 20th and early 21st century, ‘the notion of social exclusion has found its way into the lexicon of all major global governance institutions and has become something of a trope around 34

International migration

which is pegged justifications for various reforms’. This is the case despite the fact that social exclusion is a contested term (Silver, 1994; Levitas, 1998) and one that is extremely difficult to study empirically. Drawing the line between social exclusion, inequality, marginalisation, disadvantage and the more easily identifiable chronic poverty is not an easy task. According to Silver (2007), this is why social exclusion researchers often fall back on poverty indicators when studying the phenomenon of exclusion. Although arguing that social exclusion – defined as a ‘dynamic process of progressive multidimensional rupturing of the “social bond” at the individual and collective levels’ (Silver, 2007, p 1) – is a term that attempts to transcend the narrow focus on material resources that is at the heart of the poverty discourse, Silver (2007, p 18) suggests that exclusion researchers’ tendency to use poverty indicators ‘gives credence to the claims that exclusion is just a new label of old wine bottles’. Her argument is that social exclusion encompasses a more comprehensive and complex conceptualisation of social disadvantage than chronic poverty. It links economic dimensions of disadvantage to its relational aspects in ways that are often ignored in poverty debates (Bhalla and Lapeyre, 1997). In suggesting that the term social exclusion draws attention to the social costs associated with disengagement from society, Scharf et al (2005) have therefore argued that the study of disadvantage in old age might benefit from a deeper understanding of the exclusion debate. The social-gerontological theory of disengagement can be understood as being implicitly central to the way in which some conceptualisations of social exclusion are constructed. For example, disengagement can be interpreted as one of the potential outcomes arising from prolonged social exclusion.The fact that current social exclusion debates depart from Durkheim’s functionalist social theory is obvious against this backdrop. Just like Durkheim – who was concerned with the transition from agrarian to industrial society and the ensuing social dislocation – contemporary European social policies interpret social exclusion as being the potentially disastrous outcome arising from persistent inequalities. However, the dimensions that determine what constitutes social disengagement vary across time and space. Social exclusion is, after all, a multidimensional and context-dependent term, which is used to draw attention to the lack of resources, rights, goods and services that can isolate people from the mainstream of society. The term is also used to bring into focus the inability to participate in the normal relationships and activities that are available to most people. While some theorists of social exclusion focus on the outcome that the lack of resources in question can pose, others argue that social exclusion represents a structural process of social isolation (eg Silver, 2007). Irrespective of which stand one takes, the value of the social exclusion discourse is that it draws attention to the array of activities, relationships and resources that are needed in order for people to have an acceptable level of social participation and a certain degree of power over their situation (Room, 1995). In this context, Berghman’s (1997) definition of social exclusion – as the non-realisation of citizenship rights – emphasises the elements of normal relationships and activities 35

From exclusion to inclusion in old age

that are important to the realisation of these rights with reference to the four societal systems where inclusion takes place: the democratic and legal system, which enables civic integration; the labour market, which underpins economic integration; the welfare system, which is key to social integration; and the system of social networks of affiliation to which the family and community belong since these make interpersonal integration possible. Approached in a different way, Burchardt et al (1999) have focused on five types of activity that can combat social exclusion: production activity (which pertains both to economically valued and socially valued activities); consumption activity (which refers to one’s ability to consume the types of goods and services considered ‘normal’ in society); savings activity (which encompasses the accumulation of savings, pension entitlements or property ownership); political activity (which corresponds with the collective efforts people make in order to improve their immediate or wider environment); and social activity (which entails engagement in significant social interaction through one’s networks of affiliations as well as identification with a cultural group or community). Casting a critical social-gerontological lens on these activities suggests that both the process of ageing and the social position represented by old age can engender specific exclusion-related risks. The three risks associated with production, consumption and savings activity are most pertinent to the discussion here. To the extent that ageing brings about retirement from paid work, production activity – especially the type that is economically valued – is closely related to the ageing process. A decline in production activity might also be associated with a decline in consumption activity, especially among those who have been unable to accumulate sufficient wealth earlier in life through savings activity. Savings activity itself inevitably declines following withdrawal from the labour market.As argued in Chapter One, therefore, the key domains of social exclusion in old age differ from those affecting other age groups. Moreover, such exclusion does not happen in isolation but in interaction with the contexts within which people live. This chapter argues, first, that the process of international migration can potentially increase the risk of exclusion and, second, that there are specific conditions of exclusion that are central to understanding the manner in which the social position of old age intersects with the social position associated with a migratory background. The reason for this is that the process of migration, and the migratory life course that ensues, brings about a rupture in migrants’ sociocultural, socio-economic and socio-legal contexts. Against this background, the next section focuses on the social exclusion debate within research on international migration and ethnic relations. Developing an understanding of social exclusion that is migration-aware – as well as being ethnicity- and race-aware – would be difficult if this debate were disregarded.

36

International migration

Social exclusion: the perspective of researchers within the field of international migration and ethnic relations As noted earlier, exclusion debates to date have largely focused on distinguishing this term from other related concepts, such as chronic poverty, to emphasise that economic disadvantage is just one of the dimensions that characterise those who live on the margins of society. This debate tends to take for granted that economic integration is an important aspect of social inclusion. However, material deprivation does not, in and by itself, necessarily lead to social exclusion. This point has been made most convincingly by researchers in the field of development studies. Bell (2002, p 45) argues, for example, that ‘in late-developing countries, the vast majority of people are already excluded from formal labor markets and are never in their lives likely to benefit from state welfare or formal social security’, yet they are not necessarily excluded in relation to other domains of exclusion (see also Chapter Four). Across Europe, while immigrants have higher rates of poverty than majority ethnic groups (Gordon, 1995), the causes of their economic disadvantage are complex. International migration and ethnic relations researchers seek explanations, for example, in the language barriers that migrants face and in the fact that they often arrive in their host societies with either incompatible educational credentials or non-transferrable job skills. Loury (1999) and Quadagno (2000) have argued that racial/ethnic hostility also plays a key role in relation to the poverty of many migrants to Western industrialised societies. At the core of exclusion debates in international migration and ethnic relations research – and drawing on the approach of Burchardt et al (1999) – is an understanding that the social position associated with being a migrant can heighten the risk of social exclusion in relation to production, consumption and savings activities. Inevitably, the extent to which people with migrant backgrounds can engage in political activity is almost always contingent upon the citizenship rights that they are accorded in their host societies. However, the formal entitlement of citizenship rights does not guarantee that individuals will be in a position to use them to their advantage. Migrants often lack the kind of social resources that are needed to be able to exercise fully their citizenship rights (Valtonen, 2001), thus challenging their ability to engage in political activity. In a similar vein, the extent to which migrants can engage in social activities that correspond to the mainstream of their host society is typically mediated by the degree to which they have succeeded in adapting to prevailing social norms and values. Successful adaptation requires constant engagement with members of the host society, leading international migration and ethnic relations researchers to emphasise that ‘an important part of racial inequality arises from the way that geographic and social segregation along racial lines makes an individual’s opportunities to acquire skills depend on skills attainments by others in the same group’ (Loury, 1999, p 234; see also Phillips, 2009). Irrespective of which dimension of social exclusion one focuses on, it is often taken for granted that the very process of leaving behind one societal setting for 37

From exclusion to inclusion in old age

another entails the risk of being relegated to a disadvantageous position when one first migrates. From the perspective of research on international migration and ethnic relations, it is argued that one of the major flaws of welfare state theorists’ conceptualisations of inequality is that race or ethnicity are often acknowledged as dimensions of the stratification process but are seldom theoretically addressed (Quadagno, 2000). Such research also questions the relative effectiveness of policies designed to increase the integration of marginalised and disadvantaged segments of the migrant population (Loury, 1999; Bell, 2002; O’Brien and Penna, 1996, 2008). To this effect it has been argued that: there is at least a prima facie case for seeing ‘integrative’ institutions of Europe as locked into processes of discrimination and marginalization. When questions of gender, race, class and colonialism are applied to the institutions of the political and economic subsystems, it becomes clear that these institutions are infused with cultural and historical identities, statuses and expectations. Exclusion, it can be argued, is not a by-product of system malfunction, it is woven into the fabric of those institutions – the labour market and the welfare state – that are offered as the means to resolve the problem of exclusion. (O’Brien and Penna, 2008, p 89) The debate on social exclusion in the realm of research on international migration and ethnic relations is characterised by a degree of well-founded scepticism. Some researchers in this field have convincingly argued that the policies and institutions that claim a desire to combat the deprivation of marginalised migrants lack the type of race-awareness that is needed in order to address the social exclusion of ethnic and racial ‘Others’. It is for these reasons that those engaged in this debate often ask themselves:‘inclusion to what, on whose terms, and in whose interests?’ (Bell, 2002, p 50). In summary, researchers in the field of international migration and ethnic relations take for granted that the social exclusion affecting migrants arises not only from socio-cultural power differentials that affect the way in which racial ‘Others’ are regarded, but also from the social resources that they can access as a result.They also make the point that exclusionary processes cannot be understood if one fails to acknowledge that the intersections of different social positions (such as gender, class, age and ethnicity) are relevant to the way in which disadvantage and marginalisation operate (Anthias, 1998).After all, ethnicity and race constitute ‘particularly salient constructions of difference and identity on the one hand, and hierarchization and unequal resource allocation modes on the other’ (Anthias, 2001, p 368).

38

International migration

Older migrants: diversity in international migration patterns and outcomes Having reviewed the main features of the ongoing debate on social exclusion within the social sciences in general and within the field of international migration and ethnic relations in particular, we now move on to address the state of knowledge regarding older migrants to Western industrialised nations. The departure point for this element of the discussion is recognition of the fact that all older migrants are not created equal. People who migrate from one country to another not only have different legal statuses – depending, for example, on whether one is a labour migrant, asylum seeker, refugee or student – but also migrate for different reasons and at different stages of the life course, and have different socio-cultural backgrounds. With particular regard to older migrants in Europe, Warnes et al (2004, pp 310–11) point out that the category of older migrants includes people ‘who are among the most deprived and excluded in our societies … and others who are in the vanguard of innovative, developmental and positive approaches to later life’. Despite this heterogeneity, Warnes et al (2004) identify at least two distinctive subgroups within the broad category of older migrants: those who migrated early in life and have aged as migrants; and those who migrated in old age.The former are often assumed to have migrated for reasons of either political and/or religious persecution (as in the case of refugees) or to pursue work-related opportunities (as in the case of labour migrants) (see, eg, Lewinter et al, 1996; Torres, 2001, 2004; Attias-Donfut and Wolff, 2005; Attias-Donfut et al, 2005a, 2005b; Bolzman et al, 2006). The migration decision of the latter is assumed to be motivated either by amenity-seeking reasons – such as better retirement conditions – or for familyreunification purposes (Williams et al, 1997; Warnes et al, 1999; Dwyer, 2000, 2001; King et al, 2000; Gustafson, 2001;Warnes, 2001;Torres, 2002; Casado-Diaz et al, 2004; Illes, 2005; Torres, 2006b). The ethnic, cultural and religious backgrounds of older migrants are also important when their past, present and future situation is being discussed. This applies because affinity between culture of origin and host culture has been found to be conducive to post-migration adaptation (Berry, 1980). It is also bound to play a role in relation to older people’s risk of social exclusion. As a result,Warnes and colleagues’ (2004) typology of older migrants in Europe pays attention both to migrants’ country of origin and/or the affinity between the socio-cultural background of their home and host countries (see also Blakemore, 1999;Warnes, 2003). This typology distinguishes between migrants with or without European backgrounds, between early-in-life and late-in-life migration, and – given that the ageing experience is gendered – between female and male migrants (Wray, 2003; Attias-Donfut and Delcroix, 2005; Afshar et al, 2008). Reflecting these distinctions, four subgroups of older migrants in Europe can be identified (Warnes et al, 2004): European international labour migrants (EILM); non-European labour migrants (NELM); family-oriented international retirement migrants 39

From exclusion to inclusion in old age

(FIRM); and amenity-seeking international retirement migrants (AIRM). The fourfold typology was created to raise awareness about the two older migrant populations that are increasing most rapidly in Europe (ie labour migrants and amenity-seeking retirement migrants who typically migrate permanently or seasonally from Northern to Southern European countries). It also proposes that the care expectations and needs of these different types of migrants differ as a result of their socio-cultural backgrounds. Equally, the typology suggests that older migrants’ social support networks differ because they migrated at different stages of the life course. Although useful – as will be illustrated later – the typology developed by Warnes and colleagues (2004) has its limitations. In particular, since its point of departure is the groups that form the basis of the international literature on older migrants, it fails to address the needs of refugees – a group largely ignored in the literature. In this context, Dwyer and Papadimitriou (2006) argue that refugees should be treated as a distinct category in research on older people’s financial well-being. Thus, although their argument could be questioned if one departs from the wider gerontological debate on social exclusion that urges us to regard social exclusion in a much broader sense and one not solely focused on financial well-being (Scharf et al, 2001, 2005), Dwyer and Papadimitriou’s (2006) identification of refugees as a separate category is appropriate if one departs from the international migration and ethnic relations debate on social exclusion. From the latter perspective, the circumstances of people with migratory life courses are best addressed irrespective of their age since it is their migration status – rather than their status as an older person – that this literature deems to be most important. This example is useful in showing that the intersection of old age and migrant background can be understood in one way when one applies the gerontological lens and in an another way when one applies the international migration and ethnic relations perspective. This undoubtedly complicates gerontological understandings of social exclusion, whose primary point of departure is old age as a social position and not necessarily all of the other social positions that we inhabit (such as social class, gender and ethnicity). It is for this reason that this chapter seeks to problematise social gerontology’s understanding of social exclusion by arguing that the intersection of old age and a migratory life course means different things depending on migrants’ different characteristics. Any debate on social exclusion that specifically addresses older migrants should, therefore, address not only the diversity of older migrants, but also the fact that the other social positions that older people inhabit relate closely to their potential social exclusion or inclusion. With respect to social positions, research suggests that low education, rural backgrounds, relatively poor language skills, interrupted employment biographies and incomplete residence histories are more characteristic of older European and non-European international labour migrants (ie EILM and NELM) than they are of amenity-seeking international retirement migrants (AIRM). It is because of this that the migratory life course brought about through international labour migration is regarded as having the potential to compromise welfare eligibility in 40

International migration

old age (Dwyer and Papadimitriou, 2006). In this respect, when comparing the two groups of international labour migrants (EILM and NELM), Warnes et al (2004) identify older Chinese people who have worked in low-cost restaurants and within the catering trade as one of Western Europe’s most vulnerable groups of older people. Such elders not only have relatively weak family resources, but have also lived relatively segregated lives. In France, as also noted in Chapter Six, Gallou (2005) has argued that the most vulnerable group is constituted of older migrant workers living in workers’ hostels. In other words, both of these groups have had a migratory life course and are living under conditions that pose a heightened risk of social exclusion. In contrast, research on amenity-seeking international retirement migrants (AIRM) suggests that their backgrounds are characterised by comparative affluence and a relatively high level of education (in addition to well-developed financial management skills) (Warnes et al, 1999; see also Casado-Diaz et al, 2004). Nevertheless, considerable differences exist when one examines the sociodemographic characteristics of older British retirement migrants living in Tuscany in Italy, Malta, the Costa del Sol in Spain and the Algarve region of Portugal. Despite such differences, this group of older migrants differs from others in that most of them ‘are property owners, have occupational pensions and have worked and lived in the larger cities of northwest Europe’ (Warnes et al, 2004, p 312). However, research also shows that both amenity-seeking and family-reunification international retirement migrants (ie AIRM and FIRM) have compromised welfare eligibility – not only because they have migrated late in life, but also because their well-being in old age is conditioned by the level of health insurance coverage that they were able to accumulate when they were economically active. Their vulnerability is augmented by the fact that their rights are conditioned by what socio-legal experts refer to as ‘the secondary legislative measures in EU law … [which] serve to severely limit any right to residence and social security benefits should the need arise’ (Dwyer and Papadimitriou, 2006, p 1309). Even when these types of older migrants have citizenship within an EU member state, they can still be denied the right to claim means-tested benefits, which represent an important safety net for older people on low incomes. In other words, the welfare eligibility of older people who migrated for amenity-seeking and familyreunification purposes is compromised by the differentiated rights that exist across Europe.Their rights are shaped not only by citizenship and welfare policy for EU citizens, but also by their migration history, socio-legal status, past relationship to the labour market and location within particular EU member states (Dwyer, 2000, 2001;Ackers and Dwyer, 2002, 2004). Dwyer and Papadimitriou (2006) also show that the ways in which the EU perceives migration and how member states construct their notion of national citizenship has an impact on older migrants’ welfare eligibility. This is especially the case for third-country nationals – that is, people who are neither from the EU country in which they currently live or stay, nor from another EU member state.

41

From exclusion to inclusion in old age

Researchers on older migrants in the US have noted that a substantial proportion of older migrants live on welfare benefits (Hu, 1998; Binstock and Jean-Baptiste, 1999; Yoo, 2001, 2002; Angel, 2003). This state of affairs also has the potential to bring about social exclusion. The issue of welfare eligibility is, therefore, yet another one of the issues that must be carefully considered when addressing older migrants’ risk of social exclusion. In sum, the list of potential sources of social exclusion is long. Any discussion of the potential risks of exclusion faced by older migrants needs to take into account not only people’s different migration motives and the nature of their socio-legal status, but also the socio-economic positions that these could give rise to once they settle in their new host country.

Social exclusion in old age: the migratory life course as a lens The previous section has suggested that although we can use the when and why of older migrants’ decisions to migrate as a way to differentiate between them, there is still too much variation within these groups to be able to speak of older migrants in generalised terms. The heterogeneity of this group is considerable, which is why it is difficult to refer to older migrants in terms of general sociodemographic characteristics. After all, these encompass a broad array of situations, motives of migration, countries of origin, ethnicities, social classes, educational and financial backgrounds, socio-legal statuses, and citizenship and social security rights.With regard to this diversity and what it signifies for the attention previously paid to demographics, Warnes (2006, p 217) has argued that: Over the next three decades, if we are to understand the material, social and welfare circumstances of older people, it will increasingly be necessary to have knowledge of their biographies or individual life courses, for neither their country of residence nor their birth dates or last occupation will be as reliable predictors of their social and experiential positions as they were in the recent past. For this reason, among others, it has been suggested that the interesting thing about older migrants is not necessarily where they come from, but rather that they have a life course that is characterised by disruption and discontinuity as opposed to one marked by the continuity that many social gerontologists assume to be necessary for a good old age (Torres, 2004, 2006a, 2008). In this respect, Phillipson (2002, p 8) has proposed that the type of discontinuity that older migrants experience has ‘implications for adjustment in middle and late life and may require some re-thinking and re-assessment of theoretical models in gerontology which often assume a measure of linear development through the life course’. Migrating to a foreign country means leaving behind the socio-cultural contexts that have previously given one’s life meaning. Consequently, migration researchers frequently argue that policymakers and practitioners need to become aware of the challenges that the process of migration can pose for migrants, their families and 42

International migration

the societies that host them. The migration process – especially when it entails migrating to a country that differs greatly from one’s country of origin – has, after all, been found to bring about a culture shock, a sense of bewilderment and high psychological stress (Evans, 1987) due to acculturative demands (Berry, 1980) as well as potential strains arising from role losses. This process also means that one lives in between cultures. Migrants are often exposed to multiple, and sometimes contradictory, cultural values and attitudes. For all of these reasons, it has previously been argued that the uniqueness of the migratory life course represents a valuable source of information about understandings of ageing and old age (Torres, 2004, 2006a, 2008). With respect to the type of life disruption that the migration process brings about and to those who migrate late in life – as noted earlier in relation to amenity-seeking and family reunification migrants – Angel and Angel (1992, p 483) have argued that: Migration can seriously affect an older person’s well-being because it severs that individual’s ties to familiar social networks and the institutions that have sustained him or her throughout the life course.… Older migrants have less time to rebuild their social networks than do younger migrants; consequently, their networks may remain truncated, perhaps indefinitely. This is one of the many reasons why migrants are often assumed to inhabit disadvantageous social positions. Although this might be the case, it should also be acknowledged that the research presented in the previous section suggests that the risks of social exclusion in old age for people with a migrant background are, in fact, rather difficult to assess.Very little research has actually addressed the social exclusion of older migrants per se. Nevertheless, it is evident that being a migrant – especially if the process of migration entails moving to a country that differs greatly from one’s country of origin – entails having experienced socioeconomic and cultural disruption during the life course. Such disruption has the potential to render people vulnerable to social exclusion in later life since disadvantages tend to accumulate over the life course and aggregate in old age.

Conclusion The issues raised in this chapter offer some explanation for the tendency of social exclusion debates to take for granted that older migrants are – almost by definition – a vulnerable group.This relates in particular to migrants’ ability to participate in activities associated with socio-economic well-being – the domains of production, consumption and savings activity identified by Burchardt et al (1999). However, the research addressed in this chapter problematises this taken-for-granted assumption. There are some older migrants, such as affluent amenity-seeking migrants with high education and well-developed financial management skills, who do not have 43

From exclusion to inclusion in old age

the odds stacked as highly against them as others, such as labour migrants from non-European backgrounds with low education and poor language skills.When discussing older migrants’ risks of social exclusion, it is therefore helpful to bear in mind that while some older migrants have had migratory life courses that could bring about exclusion, some have not. In this respect, it tends to be people who have migrated with low education, from rural backgrounds, with poor language skills, interrupted employment biographies, incomplete residence histories and inadequate levels of health insurance coverage who fare least well. Also worth emphasising is that most of the research conducted to date has focused on the material aspects of exclusion affecting older migrants as opposed to the social aspects. Moreover, while this chapter has begun to address some of the potential sources of social exclusion for this group of older people, their own take on the issue remains largely unexplored. In concluding, it is helpful to draw attention to White’s (2006) argument that the large number of migrants who are either old already or who are approaching old age is too large for elderly care planners and providers to overlook the fact that the ethnic composition of the ageing population is rapidly changing across Europe. White (2006, p 1297) suggests that failure ‘to plan for the specific needs of a population subgroup can constitute a form of social exclusion’. This reemphasises the point made in relation to debate on social exclusion within the field of international migration and ethnic relations research. The claim is that social policy and welfare institutions are largely incapable of combatting the deprivation of marginalised migrants. Such scepticism is based on the fact that ethnicity and race are crucial if we are to understand sufficiently the challenges that socially excluded racial/ethnic ‘Others’ face. As a result, it seems appropriate to end this chapter with Dwyer and Papadimitriou’s (2006, p 1316) view that in a Europe where: notions of need and entitlement have become secondary to issues of claim and contribution … and where Member States are looking to do less for their own citizens, we should not be surprised if they choose to downplay or ignore the needs of those who are deemed to be ‘outsiders’. Any discussion of the risks of social exclusion faced by older migrants must, therefore, keep in mind that different lenses entail different points of departure; while the social-gerontological lens stresses the augmentation of risks that old age could bring about, the international migration and ethnic relations lens stresses the disadvantages associated with being an ethnic and racial ‘Other’. In other words, social gerontology highlights age as the dominant social position and identifies the migratory life course as a potential source of risk augmentation, but international migration and ethnic relations research emphasises ethnicity as the social position of importance and focuses more on the structural conditions that determine whether ethnic ‘Otherness’ is associated with exclusion or not. 44

International migration

Also worth noting is that the former seems to take for granted that appropriate social policy interventions can reduce social exclusion, whereas the latter seems much more sceptical. In sum, a social-gerontological agenda for social exclusion must understand the limits of both of these approaches and will be best served by acknowledging the diversity of older migrants and the heterogeneity of the odds that are stacked against them. References Ackers, L. and Dwyer, P. (2002) Senior citizenship? Retirement, migration and welfare in the European Union. Bristol: Policy Press. Ackers, L. and Dwyer, P. (2004) ‘Fixed laws, fluid lives: the citizenship status of post-retirement migrants in the European Union’, Ageing and Society, vol 24, no 3, pp 451–75. Afshar, H., Franks, M., Maynard, M. and Wray, S. (2008) Women in later life: exploring race and ethnicity. Maidenhead: Open University Press. Angel, J.L. (2003) ‘Devolution and the social welfare of elderly immigrants: who will bear the burden?’, Public Administration Review, vol 63, no 1, pp 79–89. Angel, J.L. and Angel, R.J. (1992) ‘Age at migration, social connections, and wellbeing among elderly Hispanics’, Journal of Aging and Health, vol 4, no 4, pp 480–99. Anthias, F. (1998) ‘Rethinking social divisions: some notes towards a theoretical framework’, The Sociological Review, vol 46, no 3, pp 505–35. Anthias, F. (2001) ‘The material and the symbolic in theorizing social stratification: issues of gender, ethnicity and class’, British Journal of Sociology, vol 52, no 3, pp 367–90. Attias-Donfut, C. and Wolff, F.-C. (2005) ‘Transmigration et choix de vie à la retraite’ [‘Transmigration and life choices after retirement’], Retraite et Société, no 44, pp 79–105. Attias-Donfut, C., Tessuier, P. and Wolff, F.-C. (2005a) ‘Les immigrés au temps de la retraite’ [‘Immigrants at retirement’], Retraite et Société, no 44, pp 11–47. Attias-Donfut, C., Gallou, R. and Tessier, P. (2005b) ‘The demographic of immigrants: aged 45 to 70’, in Retraite et Société (Best of 2005 Immigrants’ Ageing). Paris: Caisse Nationale d’Assurance Vieillesse. Balla, A. and Lapeyre, F. (1997) ‘Social exclusion: towards an analytical and operational framework’, Development and Change, vol 28, no 3, pp 413–33. Beck, U. (2000) What is globalization? Cambridge: Polity Press. Bell, J. (2002) ‘Globalization and social exclusion in cities: framing the debate with lessons from Africa and Asia’, Environment and Urbanization, vol 14, no 1, pp 41–51. Berghman, J. (1997) ‘The resurgence of poverty and the struggle against exclusion: a new challenge for social security’, International Social Security Review, vol 50, no 1, pp 3–21. Berry, J.W. (1980) ‘Acculturation as varieties of adaptation’, in A.M. Padilla (ed) Acculturation: theory, models and some new findings. Colorado: Westview Press.

45

From exclusion to inclusion in old age

Binstock, R.H. and Jean-Baptiste, R. (1999) ‘Elderly immigrants and the sage of welfare reform’, Journal of Immigrant Health, vol 1, no 1, pp 31–40. Blakemore, K. (1999) ‘International migration in later life: social care and policy implications’, Ageing and Society, vol 19, no 6, pp 761–74. Bolzman, C., Poncioni-Derigo, R., Vial, M. and Fibbi, R. (2004) ‘Older labor migrants’ well-being in Europe: the case of Switzerland’, Ageing and Society, vol 24, no 3, pp 411–29. Bolzman, C., Fibbi, R. and Vial, M. (2006) ‘What to do after retirement? Elderly migrants and the question of return’, Journal of Ethnic and Migration Studies, vol 32, no 8, pp 1359–75. Burchardt, T., Le Grand, J. and Piachaud, D. (1999) ‘Social exclusion in Britain 1991–1995’, Social Policy and Administration, vol 33, no 3, pp 227–44. Casado-Diaz, M.A., Kaiser, C. and Warnes, A.M. (2004) ‘Northern European retired residents in nine Southern European areas: characteristics, motivations and adjustment’, Ageing and Society, vol 24, no 3, pp 353–82. Castles, S. (2000) Ethnicity and globalization: from migrant worker to transnational citizen. London: Sage. Castles, S. and Miller, M.J. (1998) The age of migration: international population movements in the modern world. London: McMillan. Dwyer, P. (2000) ‘Movements to some purpose? An exploration of international retirement migration in the European Union’, Education and Ageing, vol 15, no 3, pp 353–77. Dwyer, P. (2001) ‘Retired EU migrants, healthcare rights and European social citizenship’, Journal of Social Welfare and Family Law, vol 2, no 3, pp 311–27. Dwyer, P. and Papadimitriou, D. (2006) ‘The social security rights of older international migrants in the European Union’, Journal of Ethnic and Migration Studies, vol 32, no 8, pp 1301–19. Evans, J. (1987) ‘Introduction: migration and health’, International Migration Review, vol 21, no 3, pp v–xiv. Faist, T. (2000) The volume and dynamics of international migration and transnational social spaces. Oxford: Oxford University Press. Gallou, R. (2005) ‘Les immigrés isolés : la spécificité des résidants en foyer’ [‘Lone migrants: the specific case of immigrants living in workers’ hostels’], Retraite et Société, no 44, pp 106–47. Gordon, I. (1995) ‘The impact of economic change on minorities and migrants in Western Europe’, in K. McFate, R. Lawson and W.J.Wilson (eds) Poverty, inequality and the future of social policy. New York: Russell Sage Foundation, pp 489–520. Gustafson, P. (2001) ‘Retirement migration and transnational lifestyles’, Ageing and Society, vol 21, no 4, pp 371–94. Hu, W.-Y. (1998) ‘Elderly immigrants in welfare’, Journal of Human Resources, vol 33, no 3, pp 711–41. Illes, S. (2005) ‘Elderly immigration to Hungary’, Migration Letters, vol 2, no 2, pp 164–9.

46

International migration

King, R. (2002) ‘Toward a new map of European migration’, International Journal of Population Geography, vol 8, no 2, pp 89–106. King, R., Warnes, A.M. and Williams, A.M. (2000) Sunset lives: British retirement migration to the Mediterranean. Oxford: Berg. Levitas, R. (1998) The inclusive society? Social exclusion and New Labour. Basingstoke: Macmillan. Lewinter, M., Kesmez, S.S. and Gezgin K. (1996) ‘The social situation of elderly Turkish immigrants in Copenhagen, Denmark’, Journal of Cross-cultural Gerontology, vol 11, no 2, pp 115–29. Loury, G.C. (1999) ‘Social exclusion and the ethnic groups: the challenge to economics’, Annual World Bank Conference on Development Economics, Washington. Muus, P. (2001) ‘International migration and the European Union: trends and consequences’, European Journal of Criminal Policy and Research, vol 9, no 1, pp 31–49. O’Brien, M. and Penna, S. (1996) ‘Postmodern theory and politics: perspectives on citizenship and social justice’, Innovation:The European Journal of Social Science, vol 9, pp 185–203. O’Brien, M. and Penna, S. (2008) ‘Social exclusion in Europe: some conceptual issues’, International Journal of Social Welfare, vol 17, no 1, pp 84–92. Phillips, D. (2009) ‘Minority ethnic segregation, integration and citizenship: a European perspective’, Journal of Ethnic and Migration Studies, vol 36, no 2, pp 209–25. Phillipson, C.R. (2002) ‘Transnational communities, migration and changing identities in later life’, Paper to 34th European Behavioural and Social Science Research Section, Symposium on Ageing and Diversity, 29-32 August, Bergen, Norway. Phillipson, C.R. (2009) ‘Reconstructing theories of ageing: the impact of globalization on critical gerontology’, in V.L. Bengtson and N. Putney (eds) Handbook of theories of aging (2nd edn). NewYork: Springer Publishing Company, pp 615–28. Quadagno, J. (2000) ‘Another face of inequality: racial and ethnic exclusion in the welfare state’, Social Politics, vol 7, no 2, pp 229–37. Richmond,A.H. (2002) ‘Globalization: implications for immigrants and refugees’, Ethnic and Racial Studies, vol 25, no 5, pp 707–27. Room, G. (ed) (1995) Beyond the threshold: the measurement and analysis of social exclusion. Bristol: Policy Press. Scharf, T., Phillipson, C., Kingston, P. and Smith, A.E. (2001) ‘Social exclusion and older people: exploring the connections’, Education and Ageing, vol 16, no 3, pp 303–19. Scharf,T., Phillipson, C. and Smith, A.E. (2005) ‘Social exclusion of older people in deprived urban communities of England’, European Journal of Ageing, vol 2, no 2, pp 76–87.

47

From exclusion to inclusion in old age

Silver, H. (1994) ‘Social exclusion and social solidarity: three paradigms’, International Labour Review, vol 133, pp 531–78. Silver, H. (2007) ‘The process of social exclusion: the dynamics of an evolving concept’, Chronic Poverty Research Centre, Working Paper 95. Tomlinson, J. (1999) Globalization and culture. Chicago: University of Chicago Press. Torres, S. (2001) ‘Understandings of successful aging in the context of migration: the case of Iranian immigrants to Sweden’, Ageing and Society, vol 19, no 1, pp 33–51. Torres, S. (2002) ‘Att invandra till Sverige på äldre da’r: anpassningsmöjligheter för ‘sent-i-livet’ invandrarna’ [‘Post-migration adaptation in light of late in life migration: the case of those that migrate to Sweden as elders’], Socialvetenskaplig Tidskrift, vol 4, no 2, pp 339–57. Torres, S. (2004) ‘Making sense of the construct of successful aging: the migrant experience’, in S.-O. Daatland and S. Biggs (eds) Aging and diversity: multiple pathways and cultural migrations. Bristol: Policy Press. Torres, S. (2006a) ‘Culture, migration, inequality and “periphery” in a globalized world: challenges to ethno- and anthropogerontology’, in J. Baars, D. Dannefer, C. Phillipson and A.Walker (eds) Aging, globalization and inequality: the new critical gerontology. Amityville, NY: Baywood Publishing. Torres, S. (2006b) ‘Elderly immigrants in Sweden:“Otherness” under construction’, Journal of Ethnic and Migration Studies, vol 32, no 8, pp 1341–58. Torres, S. (2008) ‘L’ère des migrations: définition et importance pour la gérontologie sociale en Europe’ [‘The age of migration: what does it mean and why should European social gerontologists care?’], Retraite et Société, no 55, pp 15–37.. Valtonen, K. (2001) ‘Immigration integration in the welfare state: social work’s growing arena’, European Journal of Social Work, vol 4, no 3, pp 247–62. Warnes, A.M. (2001) ‘The international dispersal of pensioners from affluent countries’, International Journal of Population Geography, vol 7, no 6, pp 373–88. Warnes, A.M. (2003) ‘Older international migrants in Europe: groups, kinship networks and needs for support and care’, paper presented at the seminar ‘Moving and caring: the impact of migration on kinship and care’, University of Leeds, 18–19 September. Warnes, A.M. (2006) ‘The future life course, migration and old age’, in J.Vincent, C. Phillipson and M. Downs (eds) The futures of old age. London: Sage, pp 208–17. Warnes, A.M., King, R.,Williams, A.M. and Patterson, G. (1999) ‘The well-being of British expatriate retirees in Southern Europe’, Ageing and Society, vol 19, no 6, pp 717–40. Warnes, A.M., Friedrich, K., Kellaher, L. and Torres, S. (2004) ‘The diversity and welfare of older migrants in Europe’, Ageing and Society, vol 24, no 3, pp 307–26. White, P. (2006) ‘Migrant populations approaching old age: prospects in Europe’, Journal of Aging and Migration Studies, vol 32, no 8, pp 1283–300. Williams,A.M., King, R. and Warnes,A.M. (1997) ‘A place in the sun: international retirement migration from Northern to Southern Europe’, European Urban and Regional Studies, vol 4, no 2, pp 115–34. 48

International migration

Wray, S. (2003) ‘Women growing older: agency, ethnicity and culture’, Sociology, vol 37, no 3, pp 511–27. Yoo, G. (2001) ‘Shaping public perceptions of immigrants on welfare: the role of editorial pages of major US newspapers’, International Journal of Sociology and Social Policy, vol 21, no 7, pp 47–62. Yoo, G. (2002) ‘Constructing deservingness: federal welfare reform, supplemental security income and elderly immigrants’, Journal of Aging and Social Policy, vol 13, no 4, pp 17–34.

49

Four

Social inclusion of older people in developing countries: relations and resources Peter Lloyd-Sherlock, Armando Barrientos and Julia Mase

Introduction Development studies offers a specific set of perspectives on poverty, deprivation and welfare, which take particular account of conditions of generalised scarcity, limited access to salaried labour and weak formal sector institutions (Gough and Wood, 2004). While a great deal of the literature about development focuses on resources and resource deficits, the relational dimensions of development and underdevelopment are increasingly under the spotlight. New theoretical frameworks, such as Amartya Sen’s (1999) work on capabilities, functionings and entitlements, discussed in more detail in Chapter Five, have found fertile ways of combining attention on resources and relations. These, more comprehensive, approaches demonstrate that poverty and deprivation cannot be reduced to deficits in material resources alone, but must also take account of other dimensions of social exclusion. While these approaches have generated some valuable insights, they have rarely been applied specifically to older people (Lloyd-Sherlock, 2002). This chapter aims to contribute to this emerging literature by examining the role of material resources and social relations in shaping the social inclusion and exclusion of older people in Latin America and South Africa. The multifaceted nature of poverty and exclusion, and the diverse range of social and economic conditions in developing countries, suggest the need to set the boundaries of this chapter’s discussion with care. Our focus is on two dimensions of social exclusion that affect people in later life: access to financial security and pensions; and older people’s perceptions of inclusion and the quality of their social relationships. While the former provides insights into the material resources domain of social exclusion, the latter highlights relational dimensions of the exclusion construct (Scharf et al, 2005). In exploring issues relating to perceived social relations and financial security in two middle-income countries, Brazil and South Africa, we are able to take advantage of a unique data set. Our analysis draws on a survey of around 1000 households with older people in Brazil and South Africa, conducted in 2008/09 as part of a research project on ‘Ageing, well-being and development’.1 In addition 51

From exclusion to inclusion in old age

to the survey, a qualitative component involved in-depth interviews with people living in households that were also part of the household survey. The project’s main aim has been to explore the well-being of older people and their households in the two countries. It also seeks to investigate changes in well-being since 2002 when a first wave of data was collected as part of the study. The study sampled both urban and rural households with members aged 55 and over in the Western and Eastern Cape in South Africa, and in Metropolitan Rio de Janeiro and Ilhéus in Brazil.The survey captured information on the demographic, socio-economic, livelihood and social participation dimensions of well-being. It also included a supplement collecting information from every older person in the sample households. In the following discussion, we draw on the survey data to explore older people’s perceptions of their inclusion within their families, communities and societies, and on the in-depth interviews to examine their well-being and financial inclusion. However, the justification for focusing on Brazil and South Africa is not limited to data availability alone. In fact, both nations have developed innovative social policies as a means of addressing equity objectives and increasingly provide a model and a benchmark for other countries in their respective regions (Barrientos, 2008). Both are also large countries, with strong and comprehensive institutions, by developing-country standards, supporting older people. In each country, pension provision, and especially non-contributory pension provision, has been effective in reducing old-age poverty (Barrientos and Lloyd-Sherlock, 2003). Brazil and South Africa also share high levels of inequality and racial discrimination. In essence, this chapter assesses the extent to which two middle-income countries with relatively comprehensive welfare systems have been able to reduce poverty and exclusion from social relations among older people and their households. Discussion focuses in particular on the extent to which social policies in the two countries have sought to extend the reach of pension programmes to disadvantaged sectors of society, and how state support has enhanced older people’s roles and responsibilities within their households and communities, thereby reducing exclusion from social relations. In this respect, the chapter reviews the perceptions of older people themselves regarding the scope and quality of their relations with other people in their households and communities. The chapter is structured as follows.The next section reviews ongoing debates around population ageing and modernisation in developing countries. This provides a basis for a discussion in the following section of the significance and reach of social exclusion, which highlights the value of the exclusion discourse as a means of understanding older people’s social and economic participation. The subsequent section focuses on economic and financial inclusion in Brazil, addressing the relationship between pension provision and elders’ inclusion in social relations. This leads into a comparative analysis of subjective well-being in South Africa and Brazil. Here, the focus is on self-reported life satisfaction, respect from others, capacity to help others and personal achievements – all perceived as being important indicators of inclusion in and exclusion from social relations. 52

Social inclusion of older people in developing countries

The chapter concludes with a summary of the key themes raised, emphasising the value of viewing ageing in developing nations through the lens of social exclusion. Taken together, the chapter demonstrates the key contribution that material resources, in the form of pensions, can make to older people’s social relations and subjective well-being in developing countries. It also shows how these effects are mediated by a wider range of contextual factors, including other aspects of social policy.

Ageing in developing nations: an overview of key debates The starting point for a discussion of inclusion/exclusion within the context of developing nations is Cowgill’s (1976) seminal review of the effects of the dual processes of development and modernisation. Cowgill argues that these processes generally promote the marginalisation and exclusion of older people, and that this may occur regardless of increased pension coverage. He goes on to identify three ways in which modernisation can lead to disadvantage in later life. First, increased technological sophistication and changeability of labour processes reduce the relevance of older people’s skill sets. Second, the separation of workplace from home, resulting from urbanisation and industrialisation, increases older people’s social isolation. Third, as the relative size of older populations grows, there will be intensified competition for resources between older people and other age groups. More broadly, Cowgill observes that processes of modernisation and development lead to a greater emphasis on ‘individualism’ in society and a decline in the roles and jobs traditionally assigned to older people. It is the emphasis that modernised ‘Western’ societies put on individualistic achievement and how this influences value systems that tends to place older individuals at a disadvantage in comparison to those in less ‘Westernised’ societies who are better integrated into mainstream society. This, according to Cowgill (1976), points to a shift in social norms and values, which in turn results in a weakening effect on the social status of older people; they become less valued and, to a degree, lose the respect of younger generations. While it is important to exercise considerable caution in applying concepts taken from richer settings to developing countries (de Haan and Maxwell, 1998; Abu Sharkh and Gough, 2009), despite being over 30 years old, Cowgill’s generalisations remain the point of departure for many studies on development and experiences of later life (El Ghannan, 2001;Aboderin, 2004; Zimmer and Martin, 2007; Lowenstein and Katz, 2010). More recent studies have added a further dimension to this largely negative scenario, with reference to the vulnerability of older people to increasing violence, crime and insecurity (Daichman, 2005). The actual evidence for the negative effects of development and modernisation is in fact quite limited and, where it does exist, suggests that experiences are highly variable across nations. For example, numerous studies from Thailand suggest that, despite rapid social and economic change, older people continue to enjoy high levels of economic and social interaction with their children, other 53

From exclusion to inclusion in old age

relatives and members of the local community (Knodel et al, 2007). Moreover, in developing countries with high rates of HIV/AIDS prevalence, older people have been shown to play a pivotal role in maintaining family and community life (Seeley et al, 2009). While it is also true that increasing proportions of older people in many developing countries live alone (United Nations Population Division, 2005), this should not be taken as an automatic indicator of isolation or exclusion from social relations. Older people who live alone may still be able to sustain good social networks in their local communities. Equally, those who live with their adult children may sometimes face problems of overcrowding and domestic abuse (Ramos, 1992; Sokolovsky, 2001; Lloyd-Sherlock, 2010).

Social exclusion and old age in the South Set against this background, and in light of debates that emerged in developed nations during the 1980s and 1990s (Silver, 1994; Saith, 2001; see also Chapter One), there has been considerable discussion about the value of the concept of social exclusion in framing social and economic problems across the developing world (de Haan and Maxwell, 1998; Saith, 2001). In most low-income countries, social and economic deprivation is intense and widespread and inequality is attenuated. In such cases, the value of applying the social exclusion concept might not be especially helpful, unless it can be substantially modified to suit local realities. Understanding the sources of ethnic differentiation and disparities, for example, may benefit from adopting a social exclusion perspective. In low-income countries, the reduction of income poverty and basic forms of deprivation, such as access to sanitation and infectious disease mortality, has been the main policy priority. It could be argued that a one-sided focus on material resources has often crowded out more nuanced and multifaceted notions of social exclusion. In middle-income countries, such as Brazil and South Africa, stronger and farreaching state capacity to meet basic needs has led to greater attention being placed on social inclusion issues, raising questions about which groups are included and which are excluded. In fact, issues of social exclusion apply across the South, in low- and middle-income countries, and can provide important insights not only into poverty and deprivation, but also into explaining the sources of institutional fragility and conflict (Kabeer, 2000). There are few areas in which the social policy challenge facing developing counties is stronger and more urgent than in that of social policies addressing rapid population ageing. In many developing countries, the challenge is to frame and implement social policies that address the multidimensional character of poverty and deprivation. Policies that address elders’ risks of exclusion are essential to meeting this challenge. Ensuring that everyone is able to participate fully in the life of the community requires a broad set of coherent social policies. Interventions that raise living standards must at the same time enhance general integration into economic, social and political life. This represents a significant challenge as social policies often have complex outcomes at the micro level. Concerns around 54

Social inclusion of older people in developing countries

whether particular levels or design features of public transfers generate dependency among beneficiaries, for example, bring this issue to the fore. The social inclusion/exclusion lens is particularly useful for the consideration of age-related disparities.The ability of older people to participate fully in the life of their communities is an essential, and intrinsic, component of their well-being. It also has an instrumental value in connecting older persons and their families to the sources of income and material resources needed to prevent poverty. Older people’s families and communities, and their social networks, are important in setting the conditions for inclusion or exclusion (Schatz, 2007). As noted earlier with reference to Cowgill (1976), social gerontologists can all too easily fall back on unwarranted assumptions concerning the impact of modernisation on older people. In developing countries, a higher proportion of older people live with their extended families, especially in low-income countries.Yet this is not necessarily a positive indicator of their inclusion in social relations.The HIV/AIDS pandemic, for example, has resulted in a rise in the proportion of households in which older persons are responsible for the well-being of younger household members.These households are referred to as having ‘a missing middle’ (Oduaran and Oduaran, 2010).This situation has imposed significant burdens on older people, and is often in conflict with their life-course expectations (Ferreira, 2006). Labour migration, both domestic and international, also generates new roles and responsibilities for older people in their households and communities. In South Africa, where the enduring legacy of Apartheid’s segregation policies has made domestic migration a necessity for many rural African households, changes in social relations generate complex patterns of inclusion and exclusion, which impact particularly on older people. Migration leads to ‘stretched’ households with a base in rural and at the same time in urban areas (de Toit and Neves, 2009). The spatial extension of social networks is necessitated by the need to secure employment and schooling, with circulation of household members between the rural and urban bases. At the same time, older people are often left with greater burdens and responsibility. These two examples of how social and economic change affects older people demonstrate the importance of social relations in shaping later life. Older people’s agency is mediated by household and community networks in complex and contradictory ways. It is also based on their knowledge and understanding of their relations to these networks, and their expectations of how they work.There is surprisingly little research in developing nations that evaluates older people’s notions of their social relations and how these impact on their well-being, and how this has changed over time. The following discussion seeks to cast light on older people’s assessments of these relational patterns in Brazil and South Africa, suggesting that Cowgill’s (1976) universal pessimism may have been misplaced. Of particular relevance in developing nations is a focus on issues around economic and financial security that reflect the material resources domain of a social exclusion framework (Burchardt et al, 2002; Scharf et al, 2005).This can be seen most directly in areas like social insurance and contributory pension schemes, where coverage is often limited to relatively privileged groups with access to secure 55

From exclusion to inclusion in old age

formal sector employment. Drawing on the analysis of Rofman and Lucchetti (2006), Table 4.1 compares patterns of contributory pension scheme coverage for Brazil and Mexico. The figures reveal significant disparities in participation in contributory pension programmes among the economically active population. Men have higher rates of enrolment in such schemes, reflecting their position in the labour market relative to women, especially as regards occupational choice and employment status.There is also a large difference in participation by income group, with workers in the lowest quintile of the income distribution rarely participating in formal pension schemes due to a range of factors restricting the quality of their employment. In both Brazil and Mexico, the limited extent of the formal employment sector restricts participation, particularly in rural areas, where less than one in five economically active people are enrolled. The limited coverage of contributory pension schemes, and the deterioration in the quality of the employment relationship, has led many countries in Latin America to expand their non-contributory pension provision. However, they have done this to varying degrees of effectiveness (Barrientos, 2006b). For example, the proportion of older people receiving pension benefits varies sharply across Brazil and Mexico when considering those who receive a pension benefit from contributory or non-contributory schemes (Table 4.1).This is because Brazil has large and well-established non-contributory pension programmes that provide benefits to older people regardless of lifetime contributions. These include a dedicated scheme for rural workers, which leads to higher levels of pension coverage for rural than urban populations. By contrast, Mexico had not developed substantial social pension schemes by 2002, and so patterns of pension coverage broadly follow those of contributions. It is notable that older people with the highest incomes (Quintile 5) are 10 times more likely to receive a pension than those with the lowest incomes (Quintile 1). Table 4.1: Participation in pension schemes and aggregate pension coverage, Brazil and Mexico, 2002

Total Men Women Quintile 1 Quintile 5 Rural Urban

Percentage of economically active population contributing to pension schemes Mexico Brazil 34 45 34 46 34 42 7 17 56 67 12 17 41 50

Source: Rofman and Lucchetti (2006).

56

Percentage of people aged 65 and over in receipt of a pension benefit Mexico Brazil 19 87 26 90 12 84 3 79 30 87 8 92 23 86

Social inclusion of older people in developing countries

Put simply, the data indicate that limited access to old-age contributory pensions is an important aspect of economic exclusion and inequality in middle-income countries.There is also an important life-course dimension underpinning pension coverage, given that access to formal pension schemes reflects educational and employment opportunities earlier in life. Lack of access to pensions also has consequences for well-being in old age that extend well beyond financial security. For example, Mexicans with pensions enjoy entitlements to free health insurance coverage that are denied to other older people (Gómez Dantés et al, 2004). Older Mexican males without pensions are also less likely to live with, and receive support from, relatives than those who are in receipt of a pension (Gomes da Conceição and Montes de Oca Zavala, 2004). Moreover, in Mexico, access to pensions is also linked to political participation, with the emergence of increasingly vocal and militant pensioner protest groups, which mainly pursue a self-interested agenda rather than one of old-age solidarity. There are few signs that access to formal sector employment, and hence contributory pensions, is likely to increase dramatically in the future. As such, a combination of labour market dynamics and contributory entitlements is a central driver of rising inequality in Mexico, and raises the prospect of increasing social exclusion in later life (Levy, 2008). In this respect, a recent survey showed that levels of income poverty for people aged 65 and over were 70% higher than for the population as a whole (Scott, 2008).This may explain why extending social pensions has recently become a high-profile political issue and steps have been taken to extend coverage. The government of Mexico has introduced ‘70 y mas’ – a non-contributory pension scheme for people aged 70 and older who live in communities with fewer than 2,500 inhabitants, with the objective of reaching poorer old-age groups. The experiences of most middle-income countries broadly conform to Mexico’s, with low levels of pension coverage particularly for poorer sectors living in rural areas (Barrientos, 2006a). India provides pensions for roughly a quarter of people aged 65 and over, while China only protects around 11% of those in rural areas (Shen and Williamson, 2010). It is arguable that variations in the level of pension coverage across middle-income countries are more a reflection of national political will than economic resources or state capacity. For example, per capita Gross Domestic Product in Mexico is substantially higher than in Brazil. This explains the high levels of international advocacy devoted to non-contributory pensions. While understandable, the focus on pension coverage has served to crowd out a number of other issues that have a large bearing on well-being in later life, including health and social care services. Brazil presents a rather different scenario, as access to old-age pensions is relatively good, even for women in rural areas. A small number of other middleincome countries, most notably South Africa, fit into this category. For example, our own research suggests that around 85% of people aged 65 and over in South Africa were in receipt of some kind of pension in 2008. Of these, the majority are non-contributory social pensions, which share many design features with the Brazilian schemes. Predictably, these schemes are associated with lower levels of 57

From exclusion to inclusion in old age

poverty and economic vulnerability in later life. In stark contrast to Mexico, older Brazilians and South Africans are less likely to face poverty than other age groups. For our purposes, it is important to note the linkages between income security and inclusion in social relations. Differences in well-being for older people in Mexico and Brazil reflect in large part advantages and disadvantages experienced earlier in the life course and in the labour market, as well as differential opportunities related to gender and their affiliation to formal or informal employment. Receiving a pension is, therefore, associated with an advantageous position right through the life course. Whether, and in what ways, access to pensions is related to social relationships in later life is a different matter, and is explored in the following section with reference to Brazil.

Financial security and inclusion in social relations in Brazil The wider context of economic development and public policy in Brazil would seem highly favourable for increased inclusion in social relations of all age groups, particularly those in later life. Since 2003, the economy has experienced rapid and sustained growth, and this has enabled substantial increases in welfare spending. There is strong evidence that this has led to improved social outcomes, including a substantial increase in Brazil’s Human Development Indicator rating, along with falls in poverty and inequality (Ferreira et al, 2008). With specific reference to older people, there have been a number of promising policy initiatives. First and most importantly, there has been a substantial upgrading of the country’s already comprehensive social pension programmes. Brazil had achieved high levels of pension coverage by the late 1990s, and this included poorer households. For example, our 2002 survey found that 87% of households had access to at least one type of pension.While there are indications that coverage has improved somewhat since 2002 – for example, the minimum age for the main means-tested pension has been lowered from 67 to 65 years – our 2008 survey found that coverage levels had remained virtually unchanged. Rather than increasing coverage, the main development in pension policy has been a substantial rise in the value of minimum pension benefits. This was particularly important because a high proportion of pensions, particularly for poorer households, are set at the minimum level. Between 2002 and 2008, the average value of individual pension benefits paid out to surveyed households increased from US$55 to US$241 per month, representing a dramatic improvement in the economic status of poorer households containing older people (Saboia, 2009). However, any relationship between increased access to pension benefits and the broader inclusion of older people within social relations should not be taken for granted. For example, it is widely claimed that pension income is shared between older people and other family members, particularly in poorer regions of Brazil (Schwarzer and Querino, 2002; Delgado and Cardoso Jr, 2005). This is often put forward as a key justification for sustaining public expenditure on pensions. The argument is that older people tend to use their pension income relatively 58

Social inclusion of older people in developing countries

wisely and altruistically and that pensions can make important contributions to human capital formation and the welfare of young grandchildren (De Carvalho Filho, 2000). Our surveys found that the great majority of older people claimed to pool some or all of their pension income. This may lead to gains and losses in terms of older people’s personal welfare.While sharing benefits inevitably reduces income available for individuals’ own consumption, it has been hypothesised that pension pooling may increase older people’s social status in their households and wider communities (Schwarzer and Querino, 2002). Our survey data for 2002 found little evidence either for or against the second effect. For example, there was no clear association between possessing a pension and greater involvement in household decision-making or the extent to which older people were able to manage their own money (Lloyd-Sherlock, 2006). To some extent, the inability to quantify the links between pensions and intrahousehold dynamics is due to their complex and often ambiguous nature. In this context, findings from the in-depth interviews with older people conducted as part of our study are able to reveal some of this complexity. For example, one older woman living in Rio was evidently conscious of her limited contribution to the household economy and her reduced status since she had stopped work: “These days it’s my children who sort out our problems. When I was working, I still helped with things. Now they pay for the rent, water and electricity.… When I used to work, I kept a little money to one side for myself so I could go to Aparecida do Norte [shrine of Brazil’s patron saint].” (69-year-old woman, Rio de Janeiro, 2002) When asked what difference a pension would make to her life, her 47-year-old daughter first answered on her behalf: “Of course she would give all that money to the household, because that’s what she already does with the money she earns [from occasional informal laundry work].” Given her chance, the older woman gave a different response: “I would keep a bit back for myself, and use the rest to buy things for the household. There are times when I want to buy fruit, things that I like. But if I didn’t keep some money aside, it all goes and there’s nothing left if I want to bake a cake or something like that. If I had my own money, I wouldn’t have to worry about money on account [informal credit]. I wouldn’t spend my money on just gadding about.” Put most negatively, there is some limited evidence that access to pension income may expose older people to abuse from other household members, who may forcibly appropriate their benefits (Silva d’Alencar, 2008). Within the context of the study reported here, it is interesting to note that newspapers and other media in Brazil (and South Africa) occasionally report on the financial abuse of pensioners by their families, usually around the distribution of pension income. 59

From exclusion to inclusion in old age

This and other forms of abuse are likely to be under-reported in standard surveys (Ellsberg et al, 2001). Predictably, issues relating to potential financial abuse did not emerge substantively from responses to the questionnaire survey. However, some of the in-depth interviews indirectly hinted at it. According to one 70-year-old man living in Rio de Janeiro in 2008, his children: “Just want to suck my blood. They think I’m earning bags of money so they take me along to the shops and force me to pay for stuff. They never pay me back, you know.” Beyond increasing their household status, there are a range of other means by which increased pension income could boost older people’s general well-being. Again, our data show that these effects are sometimes complex and ambiguous. One good example concerns the issue of credit and personal debt. In many of the interviews conducted in 2008, older people expressed their pleasure in having access to unprecedented levels of disposable income, with many choosing to spend this additional money on furniture or home improvements.Their spending power had also been boosted by a separate government initiative. Introduced in 2003, the Pensioner Credit Programme (Emprestimo Consignado) has enabled pensioners to borrow money at low interest rates.While a large number of surveyed households had taken advantage of the scheme, many subsequently found it difficult to manage their finances: “I’m going to sort the house out … I need to repair the kitchen and bathroom floors next.… Improving my house is the best thing in my life … but I’ve got into a bit of a mess and now I owe money to people … I’m at my wit’s end and don’t know what to do about it.” (79-year-old woman, Ilhéus, 2008) A lifetime of disadvantage had reduced many older survey participants’ ability to manage their loans. Restricted formal education resulted in low rates of functional literacy, while exclusion from financial credit throughout their adult lives meant that only few participants had experience of managing easy credit.This experience reinforces the need to adopt a life-course perspective when developing policy measures to address social exclusion in later life. As well as improvements to pension provision and access to cheap loans, recent years have seen an upgrading in health policies for poorer households in Brazil. From 1988, a fragmented set of health services was merged into a single national health system, with services free at the point of use (Cohn, 2009). However, the 2002 survey found that older people still faced widespread access barriers to health services and made substantial payments for drugs and other health goods. In some cases, these payments absorbed a high share of pension incomes. Since 2002, the introduction of Farmácias Populares – which provide a 90% subsidy on a range of generic medicines – has sought to improve access to free and low-cost medicine in poorer neighbourhoods (Ministry of Health, Republic of Brazil, 2010). Despite this initiative, levels of health spending did not change significantly between the 2002 and 2008 surveys, and the in-depth interviews indicated that 60

Social inclusion of older people in developing countries

older people continued to face a range of access barriers.According to informants in Rio and Ilhéus: “We pay a bit less at the Farmácia Popular. But sometimes I have to go to a normal chemist, or I have to go private. If you use a public clinic, you’ll wait nearly three months to see a doctor.” (71-year-old man, Rio de Janeiro, 2008) “I don’t get any medicines from our government clinic. They don’t have them there. They only stock the basics, like aspirin. Things that don’t cost very much… And waiting [for an appointment] with a government doctor can take you five or six months. I don’t know if I’ll still be alive by then.” (67-year-old woman, Ilhéus, 2008) Overall, the survey demonstrated that the generosity of pension provision was not matched by other aspects of public policy of relevance to older people. As well as limited access to health services, the survey revealed negligible involvement of wider social services in promoting older people’s well-being. For example, barely any of our informants reported participating in organised activities such as lunch clubs. This reflects in part a wider tendency in developing countries to focus on pension provision while neglecting other equally important forms of support for older people (Brodsky et al, 2003). Despite potentially ambiguous relationships between increased personal income and family dynamics, as well as the limitations of other aspects of provision for older people, the survey responses in both Brazil and South Africa show strikingly high scores for a range of subjective well-being indicators (see Table 4.2). Notwithstanding all the caveats outlined earlier, the high subjective well-being scores provide persuasive evidence that the older people who participated in our survey felt that they were doing very well in life. While it is possible to point to several explanations for the high self-reported life satisfaction of older people in Brazil and South Africa, it is likely that their new-found wealth and relative economic security have played an important part in this largely positive pattern. The relationships between financial and income security on the one hand, and inclusion in social relations on the other, are also important. The qualitative component of the study shows how, at least in Brazil, pension receipt both supports and strains intra-household relationships. Data from some of the interviews, reported earlier, suggest a positive synergy between income security and good social relationships, with older people helping to support and sustain their families and receiving recognition and respect in return. In other cases, financial security may be associated with reduced social well-being, as in the case of the older man who looked upon his children as unwelcome dependants.This aspect of the exclusion/inclusion discourse is explored further in the next section.

61

From exclusion to inclusion in old age Table 4.2: Satisfaction with different life domains among respondents aged 60 and over, South Africa and Brazil, 2008 South Africa

Brazil

8 49 20 18 4

16 62 14 6 1

42 52 3 2 0

34 58 5 1 1

37 56 4 2 1

32 61 5 2 1

Overall life satisfaction Very satisfied Satisfied Neither satisfied nor dissatisfied Dissatisfied Very dissatisfied Satisfaction with intra-family relations Very satisfied Satisfied Neither satisfied nor dissatisfied Dissatisfied Very dissatisfied Satisfaction with respect shown by others Very satisfied Satisfied Neither satisfied nor dissatisfied Dissatisfied Very dissatisfied Note: Columns may not add up to 100 due to rounding.

Perceptions of social exclusion and inclusion There is very little discussion in the development literature concerning older people’s perceptions of their inclusion within families and communities. This is important because the analysis of objective outcomes relating to older people’s well-being might not provide sufficient information on the extent to which they reflect older people’s own assessments. In this section, we present findings from the 2008 survey of older people’s well-being. In particular, we look at a set of questions asking older respondents to gauge their levels of satisfaction with their social relations. The responses provide insights into the degree to which older people perceive themselves to be excluded from, or included in, social relations. High levels of overall life satisfaction can be observed among older people in both Brazil and South Africa (see Table 4.2). Elders reporting dissatisfaction represent a relatively small proportion of all respondents; around 7% in Brazil and 22% in South Africa. However, there is a marked difference between the two country samples. In Brazil, levels of satisfaction are significantly higher than in South Africa. The lower scores in South Africa may reflect elements of the wider socio-economic environment, such as high unemployment and the high prevalence of infectious disease. 62

Social inclusion of older people in developing countries

Responses from the household survey also enable us to examine more closely two key components of older people’s inclusion in, or exclusion from, social relations in terms of their relationships with families and the wider communities in which they live. High levels of satisfaction with relations within their households are reported by older people in both Brazil and South Africa, with only a small minority of respondents indicating dissatisfaction with this element of their lives (see Table 4.2). This tends to confirm the findings from the in-depth interviews discussed earlier. Although higher rates of satisfaction are reported in Brazil than in South Africa, the differences are marginal.This suggests that on this particular issue, South African respondents show higher levels of satisfaction than with their lives, taken a whole. Respect represents an important indicator of social inclusion, as well as being a key component of well-being. John Rawls (1971), for example, singles out respect as a ‘primary good’ – a widely shared and fundamental component of well-being and at the same time a multipurpose instrument essential to achieving people’s life plans. Within the context of our study, and looking beyond the immediate household, older people’s assessment of the respect they receive from their communities again points to high levels of satisfaction among elders in both Brazil and South Africa (see Table 4.2). If anything, South African respondents are marginally more satisfied on this issue; a markedly higher proportion of participants report being very satisfied with the respect shown by other members of their communities than in the Brazil sample. In a sense, the assessments of respect from others and intra-family relations could be interpreted as one side of exchange relations. If older people work tirelessly for their communities and selflessly sacrifice themselves and their well-being for their relatives, their positive assessments of community respect and good family relations could well be interpreted as – perverse – indications of adverse incorporation or even exploitation.This issue has been raised occasionally in the literature on the impact of pensions on family relations (Sagner and Mtati, 1999). It is also possible, on a different point, that older people are satisfied with basic or very minimal levels of contact or relations. In asking respondents to make an assessment of their capacity to help others, the survey also allows us to address the other side of exchange relations. Responses to these questions can be examined to see whether they confirm levels of satisfaction with informal social relations among older people. As might be expected, older people’s assessment of their personal capacity to help others in their communities and households points to limitations (see Figure 4.1). As regards capacity to help in the household, the median respondent can provide only ‘a little’ help. A significantly higher proportion of respondents in South Africa can provide no help at all, compared to respondents in the Brazilian sample (44% compared with 14%, respectively). In relation to one’s capacity to help in the community, the vast majority of respondents in the South Africa sample report not having any capacity to help, whereas the median respondent in the Brazil sample is able to provide just ‘a little’ help. On the basis of this 63

From exclusion to inclusion in old age

evidence, the potential for older people to be excluded from social relations – in both their own households and the wider community – appears to be greater in South Africa than in Brazil. Figure 4.1: Self-reported capacity to help others, South Africa and Brazil, 2008 Self-reported capacity to help others – aged 60 and over Not at all

A little

A lot

72.8

54.0 44.1

40.4 34.0

32.6

31.7 24.1

21.7 14.2

12.0 5.1

South Africa

Brazil

Can help others in the household

South Africa

Brazil

Can help others in the community

This section has focused on older people’s assessment of their satisfaction with their social relations and with life in general, and has also addressed their capacity to provide help.The responses are indicative of the degree to which older people are either excluded from or included within their families and communities.We interpreted satisfaction with current informal relations to imply inclusion on this domain of social inclusion/exclusion, but we also checked these findings against older people’s capacity to help others. With the majority of respondents reporting satisfaction with these relations, the overall conclusion is that older people in Brazil and South Africa – albeit to differing extents – feel that they are well integrated within their households and communities. On the whole, the evidence points towards a more positive picture among older people in Brazil than in South Africa. However, South African elders appear to have marginally higher levels of satisfaction with intra-family relations.With regard to community-level inclusion, South African respondents perceive themselves as having less to offer their communities, although they are satisfied with relations as they are. This finding suggests that attaining the social inclusion of older people within the wider community might be more challenging for policymakers in South Africa than in Brazil. 64

Social inclusion of older people in developing countries

Conclusions As the discussion in the chapter shows, there are few areas in which the social policy challenge facing developing countries is stronger and more urgent than in that of social policies addressing rapid population ageing. An improved understanding of the nature and extent of social exclusion in old age is essential if this challenge is to be met.The incidence of poverty and deprivation in developing countries has encouraged a one-sided focus on material resources, but a growing consensus is forming around the view that social relations are also important. In this context, Sen’s (1999) capability approach has been particularly influential in raising awareness of the central role played by social relations in development (see also Chapter Five). Gerontologists initially adopted a pessimistic view of the impact of economic and social development on the social inclusion of older people (Cowgill, 1976). More recent work arrives at a more nuanced assessment of this issue for developing countries. For example, the HIV/AIDS pandemic and labour migration have led to a growing awareness of the contribution that older people make to their households and wider communities in coping with the effects of shocks and transformation.The study of social exclusion and inclusion is central to addressing rapid population ageing in the South. It will play an increasing role in shaping appropriate policy and deserves much greater attention from researchers. In the chapter, the discussion focused on two important dimensions of the exclusion discourse. We examined older people’s inclusion/exclusion in relation both to their material resources and their social relations. The empirical analysis drew on a survey of older people and their households in two middle-income countries, Brazil and South Africa. Two key questions were addressed: does financial support translate into improved inclusion in terms of older people’s social relations? And what are older people’s own perceptions of their inclusion within their households and wider communities? It is not surprising that well-being levels among older people in developing countries reflect advantages and disadvantages that accrue over the life course. For example, disadvantage in access to education, health and employment plays a significant role in determining both the quality and quantity of life in old age. Equally, differences in participation in formal pension schemes are closely related to labour market participation. In this context, social policies can help to counteract some of the impact of exclusion in old age, especially through the provision of income support for older people. In Brazil, pension provision assumes a major role in reducing exclusion in later life. However, as our in-depth interview data show, access to pension income does not in itself guarantee older people’s social inclusion.While inclusion on the social relations dimension is positively related to financial security for some older people, others perceive this relationship in more ambiguous terms. Our research highlighted cases where inclusion in terms of relations with family members occurred at the expense of older people’s material living conditions, through the sharing of pension income.

65

From exclusion to inclusion in old age

The chapter also explored older people’s perceptions of household and community relations and, more generally, their life satisfaction in Brazil and South Africa. High levels of life satisfaction were reported by respondents in both countries. A further analysis of older people’s satisfaction with intrahousehold relations and their perceptions of the respect they are given within their communities appears to confirm high levels of inclusion in informal social relations. Overall, older people in both Brazil and South Africa feel well integrated within their households and wider communities. On the whole, inclusion indicators are stronger and more positive among older people in Brazil than in South Africa.While South African elders appear to have marginally higher levels of satisfaction with intra-family relations, their assessment of their capacity to contribute to their communities is more limited than for older people in Brazil. Focusing on these two areas, the chapter has sought to assess the extent to which two middle-income countries with relatively comprehensive welfare systems have been able to reduce poverty and social exclusion among older people and their households. The discussion shows the importance of social policies in reducing exclusion in later life. It also highlights the interconnectedness of material resources and social relations in bringing about social inclusion for older people. Returning to the pessimistic reading of the effects of economic and social development on the inclusion/exclusion of older people in their communities and societies with which we began this chapter, our limited discussion suggests a different take for developing countries. Social policies in middle-income countries showing awareness of the contribution of older people to social and economic development can help to counter disadvantage in old age and foster greater inclusion. Of course, there are many aspects of older people’s social inclusion that we have not examined in this chapter, such as access to employment and basic services. It will be important to consider these, and other important dimensions, before arriving at a more definitive conclusion. Nonetheless, our findings emphasise the important potential for social policy to attenuate the impact of social exclusion and disadvantage in old age, and to help support the social inclusion of older people. Note The project on ‘Ageing, well-being and development: a comparative study of Brazil and South Africa’ is part of the UK Research Councils’ New Dynamics of Ageing programme (see http://www.sed.manchester.ac.uk/research/ageingandwell-being/). 1

References Aboderin, I. (2004) ‘Intergenerational family support and old age economic security in Ghana’, in P. Lloyd-Sherlock (ed) Living longer. Ageing, development and social protection. London: Zed.

66

Social inclusion of older people in developing countries

Abu Sharkh, M. and Gough, I. (2009) ‘Global welfare regimes: a cluster analysis’, Center for Democracy, Development and the Rule of Law Working Paper, Stanford University. Available at: http://cddrl.stanford.edu/publications/ global_welfare_regimes_a_cluster_analysis/ Barrientos, A. (2006a) ‘Pensions for development and poverty reduction’, in G.L. Clark, A.H. Munnell and M. Orszag (eds) Oxford handbook of pensions and retirement income. Oxford: Oxford University Press, pp 781–98. Barrientos, A. (2006b) ‘The missing piece of pension reform in Latin America: poverty reduction’, Social Policy and Administration, vol 40, pp 369–84. Barrientos, A. (2008) ‘Cash transfers for older people reduce poverty and inequality’, in A.J. Bebbington, A.A. Dani, A. de Haan and M. Walton (eds) Institutional pathways to equity. Addressing inequality traps. Washington, DC: The World Bank. Barrientos, A. and Lloyd-Sherlock, P. (2003) Non-contributory pensions and poverty prevention. A comparative study of Brazil and South Africa. Manchester: IDPM and HelpAge International. Brodsky, J., Habib, J. and Hirschfield, M. (2003) Long-term care in developing countries: ten case studies. Geneva: World Health Organization. Burchardt,T., Le Grand, J. and Piachaud, D. (2002) ‘Degrees of exclusion: developing a dynamic, multidimensional measure’, in J. Hills et al (eds) Understanding social exclusion. Oxford: Oxford University Press, pp 30–43. Cohn, A. (2009) ‘A reforma sanitaria brasiliera após 20 anos do SUS: reflexões’, Cadernos de Saúde Pública, vol 25, no 7, pp 1614–19. Cowgill, D. (1976) ‘Aging and modernization: a revision of the theory’, in J. Gubrium (ed) Late life: communities and environmental policy. Springfield, IL: Charles C. Thomas. Daichman, L. (2005) ‘Elder abuse in developing nations’, in M. Johnson, V. Bengtson, P. Coleman and T. Kirkwood (eds) The Cambridge handbook of age and ageing. Cambridge: Cambridge University Press. De Carvalho Filho, I. (2000) ‘Household income as a determinant of child labour and school enrolment in Brazil: evidence from a social security reform’, mimeo, MIT. de Haan, A. and Maxwell, S. (eds) (1998) ‘Poverty and social exclusion in North and South’, IDS Bulletin, vol 29, no 1, pp 1–9. de Toit, A. and Neves, D. (2009) Trading on a grant: integrating formal and informal social protection in post-Apartheid migrant networks. Manchester: PLAAS and BWPI. Delgado, G. and Cardoso Jr, J. (2005) ‘Ageing and rural social security: the recent experience of Brazilian universalisation’, in A. Camarano (ed) Sixty plus: the elderly Brazilians and their new social roles. Rio de Janeiro: Instituto de Pesquisa Econômica Aplicada. El Ghannan, A. (2001) ‘Modernisation in Arab societies: the theoretical and analytical view’, International Journal of Sociology and Social Policy, vol 21, no 11, pp 99–131.

67

From exclusion to inclusion in old age

Ellsberg, M., Heise, L., Pena, R., Agurto, S. and Winkvist, A. (2001) ‘Researching domestic violence against women: methodological and ethical considerations’, Studies in Family Planning, vol 32, pp 1–16. Ferreira, F., Leite, P. and Litchfield, J. (2008) ‘The rise and fall of Brazilian inequality: 1981–2004’, Macroeconomic Dynamics, vol 12, pp 199–230. Ferreira, M. (2006) ‘The differential impact of social-pension income on household poverty alleviation in three South African ethnic groups’, Ageing and Society, vol 26, pp 337–54. Gomes da Conceição, C. and Montes de Oca Zavala,V. (2004) ‘Ageing in Mexico: families, informal care and reciprocity’, in P. Lloyd-Sherlock (ed) Living longer. Ageing, development and social protection. London: Zed Books/United Nations Research Institute for Social Development. Gómez-Dantés, O., Gómez-Jáuregui, J. and Inclán, C. (2004) ‘La equidad y la imparcialidad en la reforma del sistema mexicano de salud’, Salud Pública de México, vol 46, no 5, pp 399–416. Gough, I. and Wood, G. (2004) ‘Introduction’, in I. Gough and G. Wood (eds) Insecurity and welfare regimes in Asia, Africa and Latin America. Cambridge: Cambridge University Press. Kabeer, N. (2000) ‘Social exclusion, poverty and discrimination: towards an analytical framework’, IDS Bulletin, vol 31, no 4, pp 83–97. Knodel, J., Kespichayawattana, J., Wiwatwanich, S. and Saengtienchai, C. (2007) Migration and intergenerational solidarity: evidence from rural Thailand. Bangkok: UNFPA Thailand, Papers in Population Ageing 2. Levy, S. (2008) Good intentions, bad outcomes. Social policy, informality and economic growth in Mexico. Washington, DC: The Brookings Institution. Lloyd-Sherlock, P. (2002) ‘Nussbaum, capabilities and older people’, Journal of International Development, vol 14, no 3, pp 1163–73. Lloyd-Sherlock, P. (2006) ‘Simple transfers, complex outcomes. The impacts of pensions on poor households in Brazil’, Development and Change, vol 37, no 5, pp 969–95. Lloyd-Sherlock, P. (2010) Population ageing and international development. Bristol: The Policy Press. Lowenstein, A. and Katz, R. (2010) ‘Family and age in a global perspective’, in D. Dannefer and C. Phillipson (eds) The Sage handbook of social gerontology. London: Sage. Ministry of Health, Republic of Brazil (2010) ‘Portal da saúde’.Available at: http:// portal.saude.gov.br/portal/saude/default.cfm Oduaran, A. and Oduaran, C. (2010) ‘Grandparents and HIV and AIDS in subSaharan Africa’, in M. Izuhara (ed) Ageing and intergenerational relations: family reciprocity from a global perspective. Bristol: Policy Press. Ramos, L. (1992) ‘Family support for the elderly in Latin America: the role of the multigenerational household’, in H. Kendig, A. Hashimoto and L. Coppard (eds) Family support to elderly people: the international experience. Oxford: Oxford University Press. 68

Social inclusion of older people in developing countries

Rawls, J. (1971) A theory of justice. Cambridge, MA: Harvard University Press. Rofman, R. and Lucchetti, L. (2006) ‘Pension systems in Latin America: concepts and measurements of coverage’, World Bank. Available at: http://siteresources. worldbank.org/EXTGDLNREGIONLAC/Resources/PensionCoverage_ LAC-Rofman-Lucchetti_Final.pdf Saboia, J. (2007) ‘Efeitos do salário mínimo sobre a distribuição de renda no Brasil no Período 1995/2005 – resultados de simulações’, Economía, vol 9, no 2. Sagner, A. and Mtati, R. (1999) ‘The politics of pension sharing in urban South Africa’, Ageing and Society, vol 19, no 4, pp 393–416. Saith, R. (2001) ‘Social exclusion: the concept and application to developing countries’, Working Paper 72. Oxford: Queen Elizabeth House, University of Oxford. Scharf,T., Phillipson, C. and Smith, A.E. (2005) ‘Social exclusion of older people in deprived urban communities of England’, European Journal of Ageing, vol 2, no 2, pp 76–87. Schatz, E.J. (2007) ‘“Taking care of my own blood”: older women’s relationships to their households in rural South Africa’, Scandinavian Journal of Public Health, vol 35 (supp 69), pp 147–54. Schwartzer, H. and Querino, A. (2002) ‘Non-contributory pensions in Brazil: the impact on poverty reduction’, ESS Paper 11, ILO Social Security Policy and Development Branch. Scott, J. (2008) ‘Social security and inequality in Mexico: from polarization to universality’, Well-being and Social Policy, vol 1, no 1, pp 55-76. Seeley, J.,Wolff, B., Kabunga, E.,Tumwekwase, G. and Grosskurth, H. (2009) ‘And this is where we buried our sons: people of advanced old age coping with the impact of the AIDS epidemic in a resource-poor setting in rural Uganda’, Ageing and Society, vol 29, pp 115–34. Sen, A. (1999) Development as freedom. Oxford: Oxford University Press. Shen, C. and Williamson, J.B. (2010) ‘China’s new rural pension scheme: can it be improved?’, International Journal of Sociology and Social Policy, vol 30, pp 239–50. Silva d’Alencar, R. (2008) ‘Núcleo pesuisa violência contra os idosos’, Jornal do UESC, vol 87, p 3. Silver, H. (1994) ‘Social exclusion and social solidarity: three paradigms’, International Labour Review, vol 133, nos 5/6, pp 531–78. Sokolovsky, J. (2001) ‘Living arrangements of older persons and family support in less developed countries’, Population Bulletin of the United Nations, vols 42/43, pp 162–92. United Nations Population Division (2005) Living conditions of older persons around the world. New York, NY: United Nations. Zimmer, Z. and Martin, L. (2007) ‘Key topics in the study of older adult health in developing countries that are experiencing population aging’, Journal of CrossCultural Gerontology, vol 22, pp 235–41.

69

Five

Exclusion from material resources: poverty and deprivation among older people in Europe Asghar Zaidi

Introduction The contexts in which the future generation of older people will be living – and for which we have evidence on poverty and the shifts that are likely to happen in their future income entitlements – are precarious. Europe’s pension systems still have a long way to go to reach the goal of securing financial sustainability, making it difficult to be entirely optimistic about the future.The financial crisis of 2008/09 arising from failures in the regulation of banks in a number of Western nations, the ensuing economic recession of 2009 and 2010, and then the most recent public finance and Euro debt crisis, have had a negative impact on the employment, income and personal welfare of households. Inevitably, this includes the households of many older people in European nations. Against this background, this chapter addresses the exclusion from material resources experienced by many older people living in European Union (EU) countries.The chapter explores some of the conceptual, measurement and policy issues that help, and sometimes hinder, the realisation of the goal of enhancing older people’s social inclusion.Thus, in exploring the current situation regarding older people’s exclusion from material resources, and particularly in light of ongoing pension policy reforms (Martin and Whitehouse, 2008; Economic Policy Committee, 2009a, 2009b; Zaidi, 2011), we are able to provide a baseline for future analyses. The chapter is premised on the idea that while social exclusion for older people might take a range of forms, being excluded from material resources often acts as a key catalyst in a process that leads to involuntary detachment from participation in society or becomes an initial indicator of other forms of social exclusion. In practical terms, inadequacy in pension income first reduces an individual’s standard of living below a decent level. Lack of resources subsequently impinges on other social domains, and combines with factors common to the experience of old age, such as frailty and the onset of disability, to impede a person’s capacity to participate in the society in which they live.

71

From exclusion to inclusion in old age

The chapter is organised into five sections. First, key conceptual and measurement issues regarding poverty, deprivation and the broader theme of social exclusion are reviewed. Second, the salient features of three different approaches to measuring older people’s exclusion from material resources are outlined. Third, the importance of income and the institutional context of pension policy in determining the social inclusion of older people in European countries are highlighted. In this respect, data on income-based poverty rates among older people are presented within a changing labour market and pension policy context that tends to heighten the risk of exclusion in later life. Fourth, drawing on Sen’s (1999) capability approach, ways in which the resources of older people can be measured to complement traditional income-based approaches are discussed. The chapter concludes with a summary of the issues raised and suggestions for further work in this area.

Key conceptual and measurement considerations As part of its 2020 strategy, the EU identifies social exclusion as a process whereby individuals are pushed to the margins of society and prevented from full participation by virtue of their poverty, lack of basic competencies and opportunities, or as a result of discrimination and structural inequalities. The exclusion process distances individuals from the labour market, adequate income, education and training opportunities, and/or access to supportive social networks and services (European Commission, 2004). The EU’s approach emphasises the multidimensionality of social exclusion and extends the concept beyond a narrow consideration of income poverty (notwithstanding the important role that such poverty plays in relation to other forms of exclusion). As part of its monitoring process, the EU has adopted eight indicators of social exclusion, addressing income poverty and material deprivation as well as unemployment, joblessness, education and health (Atkinson et al, 2002). Similarly, the European Council’s target for reducing poverty and social exclusion, as reflected in the EU2020 strategy, encompasses three indicators: the income-based at-risk-of-poverty rate; the multiple index of material deprivation; and the percentage of people living in households with very low work intensity.This approach highlights the value of complementing income poverty indicators with indicators of material deprivation and those relating to the labour market. At its core, the chapter follows Scharf et al (2005, p 77) who argue that the concept of social exclusion potentially represents ‘a flexible and multi-dimensional tool for examining the degree to which older people … simultaneously experience varying forms of disadvantage’. Having reviewed a substantial body of evidence, and drawing in particular on the work of Burchardt et al (2002) and Gordon et al (2000) that sought to operationalise the multidimensionality of social exclusion, Scharf et al (2005) identified five domains of social exclusion that reflect the unique circumstances of older people: exclusion from material resources, social relations, civic activities, basic services, and the neighbourhood (see also Chapter 72

Exclusion from material resources

One). The domain of exclusion from material resources reflects the central role played by income and other financial and material resources in determining an individual’s ability to participate in society (Scharf et al, 2005, p 78). Moreover, Jordan (1996) argues that individuals are most vulnerable when they have fewest personal capacities (eg as a result of hazards of childhood, old age, sickness or disability) and material resources. Such social risks do not necessarily lead to individuals’ social exclusion as long as they are able to enjoy the protections afforded by membership of the society in which they live (Robila, 2006). Thus, the context of the national welfare states as well as the backdrop of civil society and informal networks are crucial in safeguarding individuals from exclusion in later life. In addressing exclusion from material resources in later life, it is helpful to build on an existing body of work around the operationalisation of poverty and multiple material deprivations (Evandrou, 2000; Gordon et al, 2000; Scharf et al, 2005). As emphasised by Atkinson (1989), the income-based approach has an obvious ethical appeal: in a fair and just society, each citizen, whether old or not, has a right to a minimum income entitlement that is linked to the above-subsistence standard of living.The restrictions in labour supply and reduced labour demand as evident in the recession that began in 2009 make it ever-more crucial that older persons are entitled to a minimum level of pension income without conditions that affect their self-respect (eg without any social stigma linked with the receipt of means-tested income). Income-based approaches are widely used to measure poverty rates for older people in many Western nations (O’Higgins and Jenkins, 1990; Teekens and Zaidi, 1990; Förster, 1994; Hagenaars et al, 1994; Atkinson et al, 2002; OECD, 2008, 2009;Atkinson and Marlier, 2010). Nevertheless, concerns arise about the extent to which measures based on a lack of income alone can adequately reflect older people’s exclusion from material resources. While income can be used as a primary measure of material resources, there is a trend towards supplementing income-based approaches with broader measures of material deprivation that focus on older people’s personal capabilities. A growing body of theoretical and empirical work has emerged relating to the adequacy of income-based approaches (Zaidi, 2008; Atkinson and Marlier, 2010) and to the potential of consumption-based measures of welfare to better reflect both conceptually and empirically the material resources domain of social exclusion (Zaidi and de Vos, 2001). A comparatively novel approach to assessing exclusion from material resources examines the availability of alternative levels of living standards from which an individual or ‘agent’ has the freedom to choose.The idea of ‘agency freedom’ forms the basis of the capability approach, as advocated by Sen (1980).This approach to measuring older Europeans’ material circumstances has the potential to supplement the income-based approach with additional information regarding individuals’ personal capacities, or opportunities, within the sphere of material resources (see also Zaidi and Burchardt, 2005; Hick, 2009; Pedace et al, 2010).

73

From exclusion to inclusion in old age

Two key questions emerge when adopting this methodological approach. First, there is the issue of the degree to which the combination of income-based approaches with a capability deprivation approach adequately represents older people’s exclusion from material resources in Europe. Second, there is a need to highlight the insights to be drawn from theoretical debates relating to the concept of social exclusion within the context of the European Union over recent years. Building on this discussion, the empirical analysis that follows seeks to illustrate the advantages associated with adopting a method that uses both income and capabilities as a basis for measuring older people’s exclusion from material resources in Europe.

Approaches to measuring exclusion from material resources In broad terms, three approaches can be used to operationalise the concept of exclusion from material resources within the context of older people living in European countries.

Income-entitlement approach The income-entitlement approach is concerned with the level of resources an individual is entitled to or endowed with (Atkinson, 1989), irrespective of whether such resources become available in the form of cash or commodities or whether they are privately attained or state-provided. Although the overarching objective of achieving a decent standard of living remains important, advocates of this approach are not concerned with whether the required minimum standard is actually attained. The approach centres on the level of income entitlements, irrespective of how individuals dispose of that income. Individual income can be used as the measure of individual entitlements, and the entitlement to the minimum individual income may take varying levels of individual needs into account.Thus, different people may be entitled to different amounts of income depending upon their personal characteristics. For instance, the minimum income guarantee may include age and disability premia to account for the differential needs of individuals.The adoption of this approach also places high importance on the description and explanation of institutional arrangements within which income rights are accumulated. The value of the approach is exemplified by the analyses of the theoretical replacement rates in the OECD flagship reports, Pensions at a glance (OECD, 2009, 2011), where use is made of theoretical replacement rates for stylised workers to reflect differences across Organisation for Economic Co-operation and Development (OECD) countries in terms of pension income entitlements. The same approach is adopted by the Indicators’ Sub-Group of the Social Protection Committee, which is responsible for formulating and defining the indicators to be used for monitoring countries’ progress towards the commonly agreed objectives of social inclusion, pensions, health and long-term care (European Commission, 2009). 74

Exclusion from material resources

Standard-of-living approach The most widely used direct measure of personal resources is given by a person’s attained standard of living, which takes income entitlement as its point of departure and introduces the idea that individuals, families and households differ in their conversion of resources to attain a given living standard. This approach accounts for command over resources (or income) as in the income-entitlement approach, but also how those resources are used in attaining a standard of living. Since individuals differ in their conversion of income into a certain standard of living, this approach emphasises what ends are achieved by command over material resources and not just by a mere indication of what resources one is endowed with (as in the income-entitlement approach). It is only through a meaningful ‘manipulation’ of information on total household income, and family size, that income can be used as an indicator of standard of living (Ringen, 1991, 1996). In this method, equivalent income is interpreted as the value to each person of the equitable share of potential consumption generated by the total household income. An assumption is made that, as the needs of a household grow with each additional member, larger households benefit from economies of scale. For example, the need for housing amenities will not be twice as high for a household with two members than for single-person households. Equivalence scales assign each household type in the population a value that is in proportion to its needs, taking into account the economies of scale. The factors commonly taken into account to assign equivalence scale values are the number of household members and whether they are adults or children.The equivalence scale used in this chapter assigns a value of 1 to the first household member, 0.5 to each additional adult and 0.3 to each child. This so-called OECD-modified scale, first proposed by Hagenaars et al (1994), implies that a two-adult household requires only 50% more income (not 100% more) to have the same potential consumption value as a single-person household, all other things being equal. This is the route that income has to take to be used as a measure of standard of living.

Capability approach The third approach brings a new perspective to debates on exclusion from material resources: the availability of alternative levels of standard of living from which a person has the freedom to choose. The idea of ‘agency freedom’ underlies the capability approach, suggested by Sen (1985, 1990) as the basis for a much-needed change of focus in contemporary debates on well-being. Sen has evolved a strong critique of conventional views concerning the perception and measurement of well-being. He emphasises the fact that command over resources should not be the sole basis of personal well-being, no matter how comprehensive and inclusive the definition of resources (see also Chapter Four). Sen’s response to these limitations is given in his formulation of the capability approach, in which he argues that an individual’s opportunities to achieve well-being are more important than the 75

From exclusion to inclusion in old age

actual outcome, and that these opportunities are determined by their ‘capability set’. By capability set, Sen means the ability and freedom of individuals to achieve a certain set of outcomes with the resources available. In paralleling Gasper’s (2007) notion of an ‘opportunity set’, the ‘capability set’ involves the full set of attainable alternative outcomes a person has the power or ability to achieve. Drawing together the three approaches to assessing exclusion from material resources, it is evident that while the first two approaches operate within the income domain, the capability approach supplements the income domain by offering additional information regarding the capability of older people. Sen (1999) makes a useful distinction between the ‘direct’ and ‘supplementary’ nature of these approaches. The direct approach takes the form of directly examining and comparing standard of living outcomes as well as capabilities, and this may not be possible since it is empirically difficult to directly measure capabilities. The supplementary approach is the second-best option and involves the use of traditional procedures of interpersonal comparisons in income and then supplementing this information with capability considerations (Zaidi, 2008; Pedace et al, 2010). The empirical method adopted in this chapter employs the supplementary approach by analysing income-based measures of poverty, while also making use of other proxies for capabilities on the basis of subjective variables. Data are drawn from the European Union Statistics on Income and Living Conditions (EU-SILC) data set for 2008, which not only collects detailed information on household income, but also addresses such factors as housing, employment, health and deprivation to enable analysis of the multidimensionality of social exclusion. EU-SILC involves the collection of cross-sectional and longitudinal data annually from around 10,000 households in each of the 27 EU member states (Wolff et al, 2010).While EU-SILC provides robust data on household incomes that underpin the income-based measurement of poverty, it falls short of focusing on all the constraints that might prevent individuals from achieving certain outcomes. For example, an older person might have the financial resources to be able to go on holiday, but might not do this because of mobility restrictions arising, for example, from a physical disability.Thus, the proxies selected to measure capabilities do not account for older people’s capabilities in the full sense of Sen’s approach. However, they can be seen as ‘quasi-capabilities’ (Hick, 2009) or proxies for capabilities since they give a sense of the freedom to achieve certain outcomes. The next section presents results that highlight the importance of income and the institutional context of pension policy in determining the social inclusion of older people in European countries.

76

Exclusion from material resources

Income-based measures of poverty for older people in EU countries The institutional context of pension policy and the income entitlement Pension policy across EU countries plays an important role in older people’s entitlement to an income. This objective is pursued through a multitude of national pension schemes that differ in their design, scope, coverage and also redistributional elements (OECD, 2009, 2011; European Commission, 2010). The schemes are governed by public, quasi-public or private agencies and these governance arrangements have been subject to ongoing reform in recent times (Zaidi and Grech, 2007;Whitehouse et al, 2009). In addition, in many countries, separate tax-financed social assistance schemes supplement pension incomes for the objective of poverty prevention for older people. The first and foremost objective of these pension policies is to facilitate provision of adequate levels of retirement incomes so as to ensure that people are able to redistribute income from their working lives to retirement and thus prevent poverty in later life. In pursuing this objective, a particular challenge for policymakers is to ensure that groups experiencing non-standard employment patterns during working age also attain adequate levels of retirement incomes. Such groups include those people whose working lives show patterns of persistent low earnings, engagement in part-time and temporary work, significant career interruptions for unemployment or inactivity, or childcare-related gaps in their employment record.Women, people belonging to some black and minority ethnic communities, informal carers, and people with a range of health or disabling conditions are consistently shown to experience disadvantage arising from nonstandard labour market participation. The theoretical replacement rate (TRR) can be used to analyse individual income entitlements across EU countries. It is calculated for those retiring in 2006 having accumulated pension rights under the current pension policies by using the case of stylised male workers on an average wage throughout their working careers.The TRR calculations cover net pension entitlements from public pensions and mandatory private schemes as well as other private schemes with a significant role in the pension incomes of these retirees (European Commission, 2009). In measuring the extent to which pension systems enable typical workers to preserve their previous living standard when moving from employment to retirement, the TRR provides an evaluation of the extent to which current and future pension systems ensure that older people have the resources to support adequate standards of living. TRRs vary considerably across the EU, providing a rough country-level indication of potential for economic exclusion in later life. Among the 27 EU countries, Romania and Estonia are lowest at approximately 40% and Greece is highest at almost 120%. However, these results do not show the probable impact

77

From exclusion to inclusion in old age

of the most recent reforms in the public pension system. Countries such as Latvia, Poland and the Czech Republic are closest to the EU average of 80% replacement.

Standard-of-living approach: patterns of poverty risk among older people Adopting the standard-of-living approach, one of the indicators that can be reliably measured from the data available is relative poverty. A widely accepted relative poverty measurement approach has been to use household income as the measure of well-being, which identifies individuals as being in poverty when the (equivalised) disposable income of their household is below the threshold of 60% of the national (equivalised) median income (Atkinson et al, 2002). Given the arbitrary nature of the poverty threshold in use, and the fact that having an income below this threshold is just one indication of having a low standard of living, this indicator is referred to as an at-risk-of-poverty measure. This approach is widely adopted by the European Commission, often also drawing on the EU-SILC data set used in this chapter, and by the OECD (2008; see also Zaidi, 2006, 2010). The evidence suggests that about 19% of people aged 65 and over in EU member countries – around 16 million people – were at risk of poverty in 2008 (for detailed results, see Zaidi, 2010). Substantial variations in the poverty risk exist across EU member states. Drawing on this analysis, countries can be grouped into three broad categories. The first group has lower-than-average at-risk-ofpoverty rates (16% or less), with 10 countries falling into this category. Hungary and Luxembourg, two contrasting countries in various respects, are identified as having the lowest poverty risk. This group also includes such nations as the Netherlands, France and Sweden.The second group has close-to-average at-riskof-poverty rates (18–23%). The nine countries in this group include Denmark, Belgium and Ireland. The third group, encompassing eight nations, has higherthan-average at-risk-of-poverty rates (more than 25%). Latvia and Cyprus stand out as having the highest at-risk-of-poverty rates for older people (51% and 49%, respectively). Other countries in this group include the two newest EU member states (Bulgaria and Romania), as well as the United Kingdom, Spain and Estonia. The diversity of countries in each group is particularly striking and suggests the need for a variety of explanations in relation to the distribution of poverty in later life. Thus, the first group of countries, in which the poverty risk of older people is lower than average, includes nations that have a mature, generous and redistributive system of pension benefits (the Netherlands, Luxembourg, Austria, France and Sweden). For example, the Netherlands provides a strong social safety net in the form of a basic pension, which is paid at a single rate, regardless of people’s other resources. Moreover, the basic pension is payable to older people subject only to a residency test.Thus, those who have had disrupted labour market careers are not affected in their full entitlement to the basic pension if they have lived in the country during their working age.The amount of basic pension is also reasonably generous, being close to 31% of average earnings. But there are also other countries within this group where other factors underlie the low poverty 78

Exclusion from material resources

risk rate among older people. For example, pension levels in four Central European countries – the Czech Republic, Hungary, Poland and Slovakia – are not high, because older people fare better in comparison to the general conditions of low income observed in the country. Low poverty risk rates among older people in these four countries are also partly due to large redistributive elements inherent in the guaranteed minimum pensions. Thus, the low poverty risk rates among older people are indicative of a lower level of income inequality across older and younger age groups.Thus, low poverty among older people in these countries is partly a statistical artefact of the country-based relativity inherent in the poverty definition. Taking the higher-than-average group of countries, the element of relativity in the poverty definition can be further explained. Poverty risk rates among older people for some of these countries are high because the incomes of their working-age populations have observed an unprecedented growth in recent years. This is particularly true for Spain. Thus, despite the fact that pension incomes of older people have observed some real-term improvements – either because younger cohorts are retiring with better coverage of and returns from pension schemes, or due to real-term rises in the minimum guaranteed level of income entitlements for older people – older persons in Spain are nonetheless classified as being in a high poverty group. Thus, the high poverty among people of pension age in Spain largely arises from improvements in the comparator group – the working-age population. For the group of countries that had a close-to-average at-risk-of-poverty rate for the older population during 2008, mixed trends are observed. The most notable result is observed for Ireland, which experienced a dramatic decline in the poverty risk for older people between 2004 and 2008, arising from substantial increases in all forms of state pensions. Over the same period, Portugal also observed a marked decline in the poverty risk for older people. This can be attributed to the introduction in 2006 of a means-tested solidarity supplement to pensions. This discussion raises the question of the degree to which older people who are living in monetary poverty also experience exclusion in the capability domain. As a result, the next section discusses how the capabilities of older people can be approximated and how these measures might complement the income-based measures for the purpose of measuring older people’s exclusion from material resources.

Approximation of capability deprivation of older people In supplementing the income space, valuable use can be made of the additional information available in the EU-SILC database. This information is derived from responses to a series of questions concerning older people’s capabilities (opportunities) to achieve an acceptable living standard, instead of merely the outcome as shown by income or other such metrics. This line of enquiry is supported by EU-SILC survey questions such as: ‘Capacity to afford paying for 79

From exclusion to inclusion in old age

one week’s annual holiday away from home’ and ‘Capacity to afford a meal with meat, chicken, fish (or vegetarian equivalent) every second day’.These and other related questions focus on the ‘affordability’ of important aspects of older people’s living standards.‘Affordability’ refers to the ‘ability to pay’ – that is, the household has the resources to afford the item – regardless of whether the household wants it or not at that particular moment, and whether the activity has actually occurred or not. Although useful, these are subjective responses, which have limited international comparability, and they also fall short of providing information on all the constraints that might prevent individuals from achieving certain outcomes related to their personal well-being. For example, an older person might have the financial resources to go on holiday but might be restricted from going on holiday due to, for instance, a physical disability. Thus, these questions lack the full information content to account for older people’s capabilities in the fullest sense of Sen’s concept – they can at best be referred as proxy measures selected to approximate older people’s capabilities (Hick, 2009; Pedace et al, 2010). Selecting relevant dimensions on the basis of the available data is also proposed by Alkire (2007). Guidelines in choosing the relevant capabilities are also provided by others: the list of capabilities used in the Equalities Review (2007); Nussbaum’s (1999) list of central human capabilities; and the study investigating the capabilities that matter to older people by Grewal et al (2006). For the purposes of this chapter, five relevant questions from the EU-SILC 2008 database can be used to determine the capability of older people across EU countries and to extend the earlier discussion of income-based poverty and social exclusion of older people: 1. capacity to afford paying for one week’s annual holiday away from home; 2. capacity to afford a meal with meat, chicken, fish (or vegetarian equivalent) every second day, regardless of whether the household wants it; 3. capacity to face unexpected financial expenses by paying through the household’s own resources; 4. ability to keep the home adequately warm; and 5. ability to make ends meet. The analysis unit for these questions is the household, based on a personal interview with the household respondent.The first four questions are asked with a possibility of either a ‘Yes’ or ‘No’ response. If at least one household member lacks the capability, the response for the entire household is ‘No’. For older persons who have the resources required for a capability, but for other reasons, such as frailty or ill-health, do not undertake the activity, the answer is ‘Yes’. The fifth question relating to the ‘ability to make ends meet’ has response categories ranging from 1 (‘with great difficulty’) to 6 (‘very easily’).While these responses provide richer information about the extent of households’ ability to make ends meet, for reasons of consistency, the data have been reworked to allow direct comparison with the other four questions. It must be noted that the methodological decision to code those who are most frail and unable to answer the questions in relation to the 80

Exclusion from material resources

five areas of capacities is ‘Yes’. Thus lack of affordability may be underestimated for these households. The average incidence of ‘No’ responses for people aged 65 and over in EU member states for each of the five capabilities is reported in Table 5.1. In this respect, the capability to pay for one week’s annual holiday away from home is particularly low among older EU citizens: over one third of older citizens (38%) Table 5.1: Capability deprivation for older people in the EU, 2008 Proportions of people 65+ unable to afford: Country

Romania Bulgaria Lithuania Slovakia Poland Hungary Latvia Portugal Estonia Greece Cyprus Czech Republic Italy Slovenia Spain Ireland Belgium Austria Finland Germany Netherlands UK Sweden Denmark Luxembourg Average

1 2 3 4 meals with one week’s unexpected to make financial ends meet meat every holiday expenses second day away from home 87.1 47.5 51.7 27.4 81.3 78.4 74.4 57.0 76.8 51.0 33.4 28.2 74.8 46.0 45.3 41.1 73.8 58.1 42.6 27.2 73.4 60.1 39.8 29.1 71.8 74.0 52.3 36.0 70.6 27.4 46.8 6.0 62.3 24.5 14.2 7.9 61.4 37.2 59.9 9.8 59.0 54.3 57.2 9.0 50.9 40.4 28.6 15.4 44.4 31.2 36.8 8.4 41.8 48.0 26.7 18.1 38.9 31.1 27.5 2.4 31.1 35.0 13.7 2.0 28.2 17.3 21.6 4.2 27.3 24.6 12.1 17.6 18.9 24.2 4.6 4.1 17.7 22.7 3.6 8.9 17.1 16.0 8.9 2.1 15.1 18.5 10.0 3.6 13.1 13.8 6.0 2.6 11.1 18.5 4.3 1.8 5.8 10.3 3.2 0.9 38.3

31.0

24.4

11.0

5 to keep home adequately warm 29.5 25.7 27.8 8.3 25.8 11.5 22.2 40.0 1.4 20.6 38.6 8.3 12.2 7.1 5.6 2.8 6.2 5.5 2.2 4.0 1.7 4.8 1.5 0.8 0.4 10.5

Note: Data for France and Malta not available in EU-SILC 2008 database. Source: Author’s calculations using EU-SILC 2008 database (August 2010 version)

81

From exclusion to inclusion in old age

report that their household lacks adequate resources to afford a holiday. Older people in Central and Eastern European countries are most disadvantaged in this regard, with around two thirds lacking the resources to pay for this capability. Above-average proportions of older people in some Southern European countries also report high deprivation with respect to this capability. However, those living in Scandinavia and Western European nations are much more likely to be able to afford a holiday. A similar pattern of responses relates to the capacity to meet unexpected financial expenses from the household’s own resources, with around 31% of older persons lacking this capability. People living in Central and Eastern European countries fare worst, alongside Cyprus and Greece. A third capability is approximated by the household respondent’s assessment of the level of difficulty experienced by the household in making ends meet. A household may have different sources of income and more than one household member may contribute to the household income. The idea underlying this question is with which level of difficulty the household is able to afford its usual expenses. Close to one quarter of EU older persons report that their ability to make ends meet is compromised by a lack of adequate resources (ie they make ends meet either ‘with difficulty’ or ‘with great difficulty’). The relative situation of countries is roughly the same as for the previous two dimensions: older people in Central and Eastern European countries and Southern European countries are more likely to be disadvantaged than those living in Scandinavian and the Western European nations. In the two remaining dimensions, the capability deprivation score is lower on average (close to 10%). Older people in Southern Europe are more likely to be able to afford a meal with meat, chicken or fish (or equivalent vegetarian) every second day than might be anticipated given their responses in relation to other capability domains. Similarly, older people in Slovakia, Hungary, Estonia, the Czech Republic and Slovenia are relatively more likely to be able to afford to keep the home adequately warm than to afford other domains. The average capability deprivation count for older persons across EU countries is reported in Figure 5.1, showing how often an average older person is deprived (out of a possible maximum of 5). This is the simplest form of aggregation of results across different domains. While the average deprivation count is around 1.2, showing capability deprivation in one dimension only for an average older person in EU countries, this average masks wide cross-national variations. Central and Eastern European countries (with the exception of Estonia, Slovenia and the Czech Republic) as well as Portugal and Greece have a much higher capability deprivation count than is observed in Scandinavian and Western European countries. Older people in Bulgaria report capability deprivations in excess of 3, and those living in countries such as Latvia, Romania, Slovakia and Hungary have a capability deprivation count of 2 or more. These results, as well as those reported in Table 5.1, identify that the material resources available to older persons in many Central and Eastern European countries and in some Southern European countries, particularly Portugal and Greece, fall short for a good majority of older persons. 82

Exclusion from material resources Figure 5.1: Average capability deprivation for older persons (aged 65+) in EU countries, out of the total of five chosen aspects, 2008 5

Average capability deprivation

4

3.2 3

2.1 2.2 2.2 2.2

2.3

2.4

2.6

1.9 1.9

2 1.3

EU27-average 0.8 0.8 0.9

1

0.2

1.4 1.4

1.1 1.1

0.5 0.5 0.6 0.4 0.4 0.4

LU SE DK NL UK FI

DE BE IE AT ES EE IT

SI

CZ GR PT HU SK LT CY PL RO LV BG

Source: Author’s calculations using EU-SILC 2008 database (August 2010 version).

A different form of aggregation is reported in Figure 5.2, in which a capability deprivation rate is defined as being deprived in at least three of the five capability domains. Results tend to confirm the findings in relation to the individual capability domains and the capability deprivation count. On average, 20% of the EU’s older people can be considered deprived according to this approach. The proportion is highest in Bulgaria (74%), and is more than two fifths in six further Central and Eastern European countries (Latvia, Romania, Poland, Slovakia, Lithuania and Hungary). Portugal, Greece and Cyprus also score well above the average. At the other end of the spectrum, older people in Western European and Scandinavian countries have a relatively high capability score.

83

From exclusion to inclusion in old age Figure 5.2: Capability deprivation rate for older persons (aged 65+) in EU countries, defined as deprivation in at least three out of the total of five chosen aspects, 2008

80

74

70

Capability deprivation rate

60

55

50 41 41 40

48 48

36 37

30 23 20

26 26

17 EU27-average

10 3 0

45 45

4

7

8

LU DK UK FI

8

8

9

10

13 13 13

NL DE IE SE BE EE AT ES IT SI CZ GR PT HU LT SK PL RO CY LV BG

Source: Author’s calculations using EU-SILC 2008 database (August 2010 version).

Conclusions At the time of writing, the recession that began in 2008 is beginning to abate, and most European economies are returning uncertainly to positive economic growth figures. Even so, EU unemployment rates are uncomfortably high (averaging 10% during 2011), common currency ties are testing the solidarity of the European Union, while budgetary cutbacks initiated in many member states are having an impact on the public benefits and services available for vulnerable groups (particularly children, older people and people with disabilities). The impact on future generations of older people – cohorts that are growing in number just as the working population cohorts supporting them are starting to decline in number – depends to a large extent on how current problems are viewed at each country level and resolved with policy reforms, and how such initiatives are supported by European-level initiatives. This chapter has examined the circumstances of the current generation of older people, with particular reference to their exclusion from material resources. The absence of sufficient material resources is perceived as a trigger and indicator of other forms of exclusions for older people. Drawing above all on Atkinson (1989), income is used as a primary measure of exclusion. However, Sen’s emphasis on agency freedom and the capability aspects of welfare represents a useful extension 84

Exclusion from material resources

of the debate around the conceptualisation and measurement of exclusion from material resources. The capability approach, as advocated by Sen (1985, 1990), guides us to measure the ability or freedom people have in achieving the outcomes they value, and indicates ways forward in terms of addressing the conceptual and methodological challenges associated with the measurement of exclusion from material resources for older people. The value of supplementing an income-based approach with the capability approach has been documented in this chapter.When empirically tested – in this case with data from the comprehensive EU-SILC data set – what emerges is a degree of variation in the relative ranking of countries according to which of the two approaches is adopted. The capability approach measures alter significantly the relative ranking of EU countries when compared with the income-based measure. Central and Eastern European EU countries fare much worse in terms of the capability deprivation of older people compared with Western European and Scandinavian countries. Above all, what emerges is the clear methodological implication that income-based measures provide an incomplete picture of the material conditions of older Europeans and must be complemented with nonmonetary measures (such as the capability deprivation measures reported here). The adoption of the capability approach represents a step in the right direction as it leads us to adopt a conceptually richer method. Nevertheless, the issue remains of whether the capabilities chosen in the EU-SILC database to measure deprivation for older people are the right ones. For example, given the choice, we would choose questions about older people’s ability in general, not just their financial capability, to achieve the outcomes they desire. Moreover, further questions should be added to the current set of EU-SILC questions as they relate to other key capability dimensions (eg health and the availability of informal social support). Improving the comparative data on older people’s experiences of social exclusion in this way is an essential step not only in encouraging policymakers to be more informed in their decision-making, but also in persuading Europe’s citizens that their own interest lies in facing the consequences of impending policy reforms. Acknowledgements Comments from Thomas Scharf and from Sean Terry, Oxford Brookes University, are also gratefully acknowledged. Many thanks are due to the Belgian Federal Public Service Social Security, particularly Koen Vleminckx, for support in carrying out this work. Comments from participants of the seminar ‘Promoting Adequate Income and Dignity in Old Age through Civil Dialogue’, held in Brussels on 7 December 2010 under the auspices of AGE-Platform Europe, are also appreciated. Views expressed here are the author’s own and are not necessarily shared by the Belgian government or the European Commission.

85

From exclusion to inclusion in old age

References Alkire, S. (2007) ‘Choosing dimensions: the capability approach and multidimensional poverty’, Chronic Poverty Research Centre Paper No 88, Manchester, UK. Atkinson, A.B. (1989) Poverty and social security. Hemel Hampstead: Harvester Wheatsheaf. Atkinson, A.B. and Marlier, E. (eds) (2010) Income and living conditions in Europe. Theme ‘Population and social conditions collection’, statistical books, Eurostat. Luxembourg: Publications Office of the European Union. Atkinson, A.B., Cantillon, B., Marlier, E. and Nolan, B. (2002) Social indicators: the EU and social inclusion. Oxford: Oxford University Press. Burchardt, T., Le Grand, J. and Piachaud, D. (2002) ‘Degrees of exclusion: developing a dynamic, multidimensional measure’, in J. Hills, J. Le Grand and D. Piachaud (eds) Understanding social exclusion. Oxford: Oxford University Press, pp 30–43. Economic Policy Committee (2009a) ‘The 2009 ageing report: economic and budgetary projections for the EU-27 member states (2008–2060)’, joint Report prepared by the European Commission (DG ECFIN) and the Economic Policy Committee (AWG), European Economy 2|2009. Economic Policy Committee (2009b) ‘Sustainability report 2009’, European Economy 9|2009. Equalities Review (2007) ‘Fairness and freedom: the final report of the Equalities Review’.Available at: http://sticerd.lse.ac.uk/textonly/case/research/equality/ Briefing_Equality_Measurement_Framework.pdf (accessed 11 August 2011). European Commission (2004) Joint report on social inclusion 2004. DirectorateGeneral for Employment and Social Affairs, Unit E.2. Luxembourg: Office for Official Publications of the European Communities. European Commission (2009) ‘Updates of current and prospective theoretical pension replacement rates 2006–2046 (Annex – Country fiches)’, 8 December. Available at: http://ec.europa.eu/social/main.jsp?langId=en&catId=752&news Id=551&furtherNews=yes (accessed 11 August 2011). European Commission (2010) ‘Progress and key challenges in the delivery of adequate and sustainable pensions in Europe: a joint report on pensions’, European Economy, Occasional Papers 71, Secretariat of the Economic Policy Committee/Secretariat of the Social Protection Committee, Brussels. Evandrou, M. (2000) ‘Social inequalities in later life: the socio-economic position of older people from ethnic minority groups in Britain’, Population Trends, Autumn, pp 11–18. Förster, M.F. (1994) ‘Measurement of low incomes and poverty in a perspective of international comparisons’, OECD Labour Market and Social Policy Occasional Paper, No 14, Paris. Available at: http://www.oecd.org/ dataoecd/45/58/1895548.pdf Gasper, D. (2007) ‘What is the capability approach? Its core, rationale, partners and dangers’, The Journal of Socio-Economics, vol 36, pp 335–59. 86

Exclusion from material resources

Gordon, D., Adelman, L., Ashworth, K., Bradshaw, J., Levitas, R., Middleton, R., Pantazis, C., Patsios, D., Payne, S., Townsend, P. and Williams, J. (2000) Poverty and social exclusion in Britain.York: Joseph Rowntree Foundation. Grewal, I., Lewis, J., Flynn,T.N., Brown, J., Bond, J. and Coast, J. (2006) ‘Developing attributes for a generic quality of life measure for older people: preferences or capabilities?’, Social Science & Medicine, vol 61, pp 1891–901. Hagenaars,A.J.M., De Vos, K. and Zaidi,A. (1994) Poverty statistics in the late 1980s: research based on micro-data. Luxembourg: Office for Official Publications of the European Community. Hick, R. (2009) ‘Amartya Sen’s capability approach and poverty analysis’, Paper presented at the Social Policy Association conference, Edinburgh. Jordan, B. (1996) A theory of poverty and social exclusion. Oxford: Blackwell. Martin, J.P. and Whitehouse, E.R. (2008) Reforming retirement-income systems: lessons from the recent experiences of OECD Countries. OECD Social, Employment and Migration Working Papers 66. Paris: OECD Publishing. Nussbaum, M.C. (1999) Sex and social justice. Oxford: Oxford University Press. OECD (Organisation for Economic Co-operation and Development) (2008) Growing unequal? Income distribution and poverty in OECD Countries. Paris: OECD. OECD (2009) Pensions at a glance 2009: retirement-income systems in OECD Countries. Paris: OECD. OECD (2011) Pensions at a glance 2011: retirement-income systems in OECD and G20 Countries. Paris: OECD. O’Higgins, M. and Jenkins, S.P. (1990) ‘Poverty in the EC: estimates for 1975, 1980 and 1985’, in R. Teekens and B.M.Van Praag (eds) Analysing poverty in the European Community. Luxembourg: Eurostat News Special Edition. Pedace, L., Pisani, M. and Zaidi,A. (2010) Employing the capability approach to compare pensioners’ well-being across UK countries. HM Treasury Economic Working Paper No 7. HM Treasury, London. Ringen, S. (1991) ‘Households, standard of living, and inequality’, Review of Income and Wealth, vol 37, pp 1–13. Ringen, S. (1996) ‘Households, goods and well-being’, Review of Income and Wealth, vol 42, no 4, pp 421–31. Robila, M. (2006) ‘Economic pressure and social exclusion in Europe’, The Social Science Journal, vol 43, pp 85–97. Scharf,T., Phillipson, C. and Smith, A.E. (2005) ‘Social exclusion of older people in deprived urban communities of England’, European Journal of Ageing, vol 2, no 2, pp 76–87. Sen, A.K. (1980) ‘Equality of what?’, in S. McMurrin (ed) Tanner lectures on human values. Cambridge: Cambridge University Press. Sen, A.K. (1985) ‘Well-being, agency and freedom: the Dewey lectures 1984’, Journal of Philosophy, vol 82, pp 169-221. Sen, A.K. (1990) ‘Justice: means versus freedoms’, Philosophy and Public Affairs, vol 19, pp 111-21. Sen, A. (1999) Development as freedom. Oxford: Oxford University Press. 87

From exclusion to inclusion in old age

Teekens, R. and Zaidi, A. (1990) ‘Relative and absolute poverty in the European Community: results from family budget surveys’, in R. Teekens and B.M. Van Praag (eds) Analyzing poverty in the European Community. Luxembourg: Eurostat News Special Edition. Whitehouse, E., D’Addio, A., Chomik, R. and Reilly, A. (2009) ‘Two decades of pension reform: what has been achieved and what remains to be done?’, The Geneva Papers, vol 34, pp 515–35. Wolff, P., Montaigne, F. and Rojas González, G. (2010) ‘Investing in statistics: EU-SILC’, in A.B. Atkinson and E. Marlier (eds) Income and living conditions in Europe, Luxembourg: Eurostat, pp 38–55. Available at: http://epp.eurostat. ec.europa.eu/cache/ITY_OFFPUB/KS-31-10-555/EN/KS-31-10-555-EN. pdf (accessed 30 March 2012). Zaidi,A. (2006) ‘Poverty of elderly people in EU25’, Policy Brief Series, European Centre Vienna. Zaidi, A. (2008) Well-being of older people in ageing societies. Aldershot: Ashgate Publishing. Zaidi, A. (2010) ‘Poverty risks for older people in EU Countries – an update’, Policy Brief Series, European Centre Vienna. Zaidi,A. (2011) ‘Population ageing and financial and social sustainability challenges of pension systems in Europe: a cross-national perspective’, in L. Bovenberg, C. van Ewijk and E.Westerhout (eds) The future of multi-pillar pensions. Cambridge: Cambridge University Press. Zaidi, A. and Burchardt, T. (2005) ‘Comparing incomes when needs differ: equivalisation for the extra costs of disability in the UK’, Review of Income and Wealth, Series 51, no 1, pp 89–114. Zaidi, A. and de Vos, K. (2001) ‘Trends in consumption-based poverty and inequality in the European Union during the 1980s’, Journal of Population Economics, vol 14, pp 367–90. Zaidi, A. and Grech, A.G. (2007) ‘Pension policy in EU25 and its impact on pension benefits’, Benefits, vol 15, no 3, pp 299–311.

88

Six

Social inclusion of elders in families Jim Ogg and Sylvie Renaut

Introduction Social interaction, understood as the engagement in meaningful relations with others, is an important element when considering the concept of social exclusion (Burchardt et al, 2002). The absence or poor quality of contact with significant others – family, friends, work colleagues and community groups – is widely acknowledged as being a key indicator of social exclusion (Hills et al, 2002). Although social interaction takes place in many different settings, family relationships provide one of the main contexts within which people act towards or respond to others (Allan, 1999). Families, therefore, fulfil many tasks that mitigate the risk of social exclusion.They are purveyors of social support, assuring that the most vulnerable members receive help. They are the medium through which individuals remain integrated into wider systems of support, and they can provide help, advice and access to external resources such as health and social care. Families can be a source of sustained and enduring support, where other forms of social interaction may be less durable. Family relationships, therefore, form a key component of the dimensions of participation and integration that are central to social inclusion (Scharf et al, 2001). If the positive value of family relations in promoting social inclusion is not in doubt, it is less clear whether the features of contemporary societies are propitious in providing the conditions within which families can flourish. From a demographic perspective, population ageing and falling fertility rates are changing family structures to the extent that family roles are less clear than in the past. Combining work and family life is increasingly complex.The fragility of welfare and social security systems places new pressures on family members, and these pressures can be manifest in decisions that are made concerning the transfer of resources within families. Family norms relating to obligations and responsibilities between the generations may also be changing. Globalisation and its consequences for national and local economies also contribute to the emergence of new family forms (Izuhara, 2010).These social trends can, under certain circumstances, increase the risk of individuals becoming excluded from the positive contribution that families can make to enhancing quality of life. Although social exclusion can be encountered at any stage in the life course, individuals in later life are confronted with specific circumstances, which in 89

From exclusion to inclusion in old age

turn pose particular challenges. Perhaps the most important of these is the high probability of social and health care needs. Frailty and the loss of autonomy, by their very nature, threaten the ability of individuals to maintain family relationships in later life.The fine line between rich and mutually rewarding social relationships on the one hand, and dependency on family members because of deterioration in health or wealth on the other hand, has preoccupied much of the research and debate on the family life of older people. During the 20th century, in countries where strong economic growth accompanied the development of the welfare state, individuals became less dependent on their family members for the basic amenities of life, such as food and shelter. For older people in Western societies, this means that the majority today live residentially and financially independent from other family members. But if this independence is a trend that is largely welcomed, it has not been achieved without a questioning of the degree to which family ties may have weakened. For older people, social isolation from other family members has been a possible consequence of increasingly complex kinship ties and the geographical dispersion of family units (Tunstall, 1966; Abrams, 1978; Bowling and Browne, 1991; Iliffe et al, 1992; Phillipson et al, 2001a;Tomassini et al, 2004;Victor et al, 2009). These concerns still remain today, although new dimensions have been added to the question of the place of older people within families. Family relations in later life and old age depend on a number of factors. At the micro level, the availability of kinship ties, the distance separating family members and the quality of relationships are important determinants. At the macro level, institutional and legal frameworks that place responsibilities and obligations relating to different family members shape normative patterns of behaviour. In this chapter, we examine some of the key trends that influence the inclusion of older people in family life at both the micro and macro levels, giving practical examples from several European countries.We focus on a key theoretical concept – the reciprocity and exchange of goods and services between the generations – which can help in understanding how family relationships and the changes they are undergoing may determine patterns of social inclusion and exclusion in later life.

The generational chain The concept of a generation has been integral to understanding how individuals progress through different life stages and the relationship between family members at different points in their lives (Mannheim, 1952). Although the meaning of ‘generation’ can differ according to the context within which it is used, when applied to family relations, it has mostly been associated with the roles that are occupied at different points in time – dependent child, adult child, parent, grandparent, sibling and so on. Early sociological studies of family life focused primarily on relations between two generations, the parent–child dyad in the context of the nuclear family (Parsons, 1951). Ethnographic studies of modern societies in the 1950s and 1960s showed how the parent–child relationship 90

Social inclusion of elders in families

remained intact after the adult child leaves home, providing important evidence that families transcend households. In the context of the rapid increase in the proportion of older people living alone during the 1960s, these studies for the most part confirmed the continuity of family ties, showing how regular contact and support between parents and children was the norm.The important place of grandchildren, so clearly demonstrated by Peter Townsend (1957) in his book on the family life of older people, drew attention to the need to situate older people within a three-generational family structure. Children in turn become parents, and grandparents and grandchildren add new links to the generational chain.The arrival of grandchildren reinforces the relationship between older people and their children and reaffirms the continuity of older generations within family life. As Townsend (1957, p xiv) remarked, ‘the three generation family, built around grandmother, daughter and grandchild, provides the normal environment for old people’. More recently, data from the Survey of Health, Ageing and Retirement in Europe (SHARE) survey have shown that looking after grandchildren is a common activity, with more than two fifths (43%) of grandparents having been involved in this activity during the preceding 12 months (Attias-Donfut et al, 2005).1 Many other studies undertaken towards the end of the 20th century have provided evidence of the importance of extended family life in minimising social exclusion (Kahn and Antonucci, 1980; Finch, 1989; Berkman et al, 1991; Cherlin and Furstenberg, 1992; Eggebeen, 1992; Kendig et al, 1992; Pyke and Bengtson, 1996). Despite this affirmation of the place of older people in families, the dynamics of different generations within families in modern societies were not fully explored until the 1980s. Important theoretical developments for the motives of family transfers emerged in the field of economics, which explored the competing explanations of altruism and exchange (Becker, 1991). Another key theoretical contribution to emerge in the USA was the intergenerational solidarity model developed by Bengtson and Achenbaum (1993). This model identifies six dimensions of solidarity: associational, affectual, consensual, functional, normative and structural. Drawing on concepts from social psychology and group behaviour, Bengtson’s typology addressed the question of family cohesion and, in later versions, of family conflict (Bengtson et al, 2002). The model has provided a useful theoretical framework to understand the different types of intergenerational transfers, as well as producing powerful insights into the reciprocal exchange content of intergenerational transfers. Bengtson’s model continues to be influential as a framework to help understand the dynamics of intergenerational solidarity and the place of older people within family life. A different approach to theorising and measuring intergenerational solidarity, and one that has received less attention in English-speaking countries, has been adopted by French researchers. Principles of intergenerational solidarity underpin many institutions in France, and these principles mirror the interdependence of the generations in the family, represented as ‘the young’,‘adults’ and ‘the old’ (Chauvel, 1998, 2006; Masson, 2009).This approach introduces dimensions external to the 91

From exclusion to inclusion in old age

family, in the public sphere, which are necessary to take into account if patterns of intergenerational solidarity and themes relating to social inclusion are to be fully explored. Central to the concept of intergenerational solidarity is the labour market, which provides individuals with the means to become less dependent on family support.The different stages of the life course correspond to different levels of need, which are met by the combined forces of private and public sources of help and support.The young are fully dependent on ascending generations; adults are financially independent due to their participation in the labour force, enabling them to fulfil their parenting obligations independently; and the ‘old’, no longer in the labour market, are ‘dependent’ on descending generations (to produce the nation’s wealth) and to receive care and support in ill-health. Of course, in reality, things are much more complex. But this three-generation schema has been an important component in theorising the flow of support between the generations, and demonstrating the interdependency of support in the private and public domains. Above all, it shows that older people are contributors to family life as well as recipients of resources, and that the contribution they make is a key factor of social inclusion. Data from SHARE show that intergenerational transfers are strongly influenced by the position of individuals in the life course. So, although the ‘oldest’ old are net recipients of practical help, individuals belonging to the ‘pivot’ generation (ie with at least one parent alive and one adult child) are engaged in providing practical help and money to their child(ren) and grandchild(ren) (Attias Donfut et al, 2005). In an important empirical study in the 1990s, intergenerational support between the generations within French families was empirically measured at each generational level (Renaut, 2001b). Members of a pivot generation were asked about the nature, direction and volume of exchanges with their parent(s) and child(ren) and the same set of questions was put to the two other generations at separate interviews. The analysis of the totality of these transfers identified five different family groups characterised by increasing flows of transfers in each of the three principal indicators of solidarity: the type of transfer, direction and volume. The analysis showed that there are few individuals, including older people, who are totally excluded from family life. It also revealed some important insights into different patterns of intergenerational exchange. Families with the greatest volume of intergenerational exchanges are those that are also the most reciprocal. Frequent exchanges and mutually supportive relationships promote social inclusion. Families that exchange a lot are those that have more to exchange in the first place, and the reproduction of diverse forms of capital within families acts as a buffer against social exclusion at each stage of the life course, including old age. But a large number of kinship ties are inversely related to the amount of goods and services exchanged. This is an important finding that gives the lie to the assumption that large families are more likely to transfer resources, and offers some reassurance in light of the shrinking size of families. The French three-generational study confirmed the overall pattern that support within families takes – primarily downwards and without skipping a generation. 92

Social inclusion of elders in families

It is rare to find grandparents supporting the grandchild generation but not the parents, or the grandchildren asking for help from their grandparents without going first to their parents. In other words, the French research showed the importance of normative behaviour in intergenerational support, or what has been termed elsewhere ‘the special nature of kinship ties’ (Finch, 1989). At the same time, there are limits to the extent and generosity of intergenerational exchanges beyond which families experience stress and negative consequences. For example, the giving of some forms of support can incur financial difficulties, problems of organisation or even have an adverse effect upon the health of the donor, a finding that has been confirmed in other countries (Szinovacz and Davey, 2007). Individual family members who ‘give too much’ are prone to health problems and other difficulties, which in turn can lead to a greater risk of social exclusion. Other French research has demonstrated the importance of taking into account the dynamics of three generations to understand the inclusion of the older person within family life. With increased longevity resulting in an elongation of family structures into four or more generations, it is clear that a three-generational model of the family is less relevant in contemporary societies than in the recent past. In this context, the recent work of André Masson (2009) that conceptualises intergenerational transfers within a four-generational structure is an important advance. Masson retains the categories of the ‘old’ (not working) and young (dependent), but adult life is divided into two periods that reflect current social and demographic transformations: a period characterised by home-leaving, starting up a family and getting a job; and a later period, adult maturity, which includes the pivot generation (Masson, 2009). According to Masson, the pivot generation is the key link in the generational chain, occupying a crucial place in so far as its members are, above all, donors to ascending and descending generations. An individual in the pivot position is typically aged around 60, with at least one parent alive, adult children and grandchildren. Within this four-generational structure, Masson (drawing on the work of the early 20th-century anthropologist Marcel Mauss) emphasises the importance of the indirect reciprocity of transfers. The interdependence of the generations is assured by the expectation that a service rendered by a pivot generation member will be repaid at a later date. Thus, the pivot generation is guided by the principle that they should give generously to their parents and children because they have received in the past, and they will receive in the future. The eldest generation (the parents of the pivot generation) help out by making downward financial and material transfers, and in so doing ‘oil the wheels’ of the generational chain and ensure the continuity of the exchange structure for future generations. These theoretical models help us to understand the structure of intergenerational solidarity and the integration of elders in family life, but they do so sometimes at the expense of ignoring the costs to family members that arise under certain circumstances. For this reason, the concepts of conflict and ambivalence have been introduced as adjuncts to the prevailing notion of solidarity (Lüscher and Pillemer, 1998; Connidis and McMullin, 2002).The negative psychological consequences of 93

From exclusion to inclusion in old age

conflict and ambivalence that arise from overburdened carers can be an important contributing factor to social exclusion.The Old Age and Autonomy: the Role of Service Systems and Intergenerational Autonomy (OASIS) study, undertaken in 2001 in Norway, England, Germany, Spain and Israel, specifically addressed the dimension of conflict and ambivalence in family relations from the perspective of older people (Daatland and Herlofson, 2001). This research found that overt conflict between older parents and their children is rare, but ‘low-key’ conflicts and ambivalence about roles are common. Other research that has addressed the issues of conflict and ambivalence has found that in situations of intense and prolonged conflict that involve older family members and their adult child carers, social relations are often confined solely within the family and that these families are often at risk of social exclusion (Qualls and Zarit, 2009). To summarise, many studies of intergenerational solidarity have shown that old age is not a period in which individuals are isolated from wider family life. Older people transfer time and money resources downwards through family generations and ascending forms of solidarity by adult children to support their ageing parents have not been broken down by expanding individualism (eg Arber and Attias-Donfut, 2000; Bengtson and Lowenstein, 2003). At the same time, it seems that a significant minority of older people have weakened family ties, which, when combined with a lack of other resources, may place them at risk of social isolation and exclusion (Victor et al, 2009). The reasons for these weak ties are multiple, but they often originate in the accumulation of lifetime disadvantages and interruptions in family and work histories.

Family support to elders The theoretical models of intergenerational solidarity and their ability to explain factors that lie behind the social inclusion of elders in families depend upon specific historical and social circumstances. Current debates on elders and family life tend to focus on the growing need for social care of frail and disabled older people, which is one consequence of population ageing.The European population aged 75 and above is projected to rise threefold between the period 2000 to 2030. As the Green Paper ‘Confronting demographic change: a new solidarity between the generations’ (Commission of the European Communities, 2005) shows, changing dependency ratios are a principal source of concern for governments in terms of increasing welfare costs. In this scenario, family support to elders becomes a crucial component in the attempt to meet the growing demand for care and support that will arise as a result of increased longevity. It is not surprising, therefore, that there have been a number of attempts in recent years to assess the availability and propensity of family members to support their ageing parents, for without family members the risks of exclusion accumulate. Measuring and assessing how family members, mostly middle-aged children, support their older parents is a complex task, and results vary according to the indicators used and the definitions of needs and types of support. However, it is 94

Social inclusion of elders in families

generally acknowledged that the bulk of care needs within couples are met by spouses (Pickard et al, 2007). Where spouses are not available (mostly as a result of widowhood), adult children are the main source of help and support to elders, especially in countries where intergenerational cohabitation is relatively common. Data from Wave One (2004) of SHARE show that more than two thirds of those born during 1945–54 (ie in their 50s at the time of interview) had a parent or parent-in-law alive, and that rates of co-residence (which can be considered as a proxy measure for intergenerational support) with their ascendants ranged from less than 4% in Sweden, Denmark and the Netherlands, to between 17 and 24% in Italy, Spain and Greece (Ogg and Renaut, 2006).The percentage that provided practical help (personal care, help with daily chores or other practical tasks) to their parents during the previous 12 months had a North–South gradient, from approximately one-in-three in the Northern European countries to 15% or less in the Southern countries. However, the proportion of the helpers that provided regular and almost daily help had an inverse pattern, with low rates in Sweden and Denmark and much higher rates in the South. The results suggest that adult children respond to the needs of their ageing parents, but that this response is conditioned by institutional and cultural contexts. In countries with more developed welfare systems, family care of elders is not ‘crowded out’, but rather takes on different forms, such as heavy personal care tasks undertaken by professionals. In countries with less developed welfare states, family members remain the key carers of elders. These figures testify to the overall persistence of intergenerational ties. Nevertheless, migration patterns due to increasing globalisation have resulted in specific sectors of the older population within certain countries being at greater risk of social exclusion. The causes of this exclusion are multiple (see Chapter Three), but one important contributing factor is the geographical separation of family members that often accompanies immigration patterns.The migration paths of current cohorts of minority ethnic older people in many Western European countries are inextricably linked with the demand for labour during the 1960s and 1970s. Many men who migrated to Europe to work during this period did not envisage staying permanently in the host country and, as a consequence, their family members, including spouses, remained in the country of origin.With stricter immigration policies introduced from the 1980s that made it more difficult to reunite families, these men have led transnational family lives, moving frequently between two countries in an attempt to balance work and family lives. A clear example of this process can be seen in the case of North African workers who migrated to France mainly during the 1960s (Gallou, 2005). At this time, the French authorities housed these workers in hostels, most of which were meant to be temporary measures. At the beginning of the 21st century, many of these hostels have a population of ageing and retired ‘guest-workers’. Often sharing small and sparsely furnished rooms, some of these men continue to maintain family ties in their country of origin, while others have lost family contact. Despite frequent hardships, these older men have initiated self-organised systems of support 95

From exclusion to inclusion in old age

between themselves. Nevertheless, their degree of social exclusion remains high and, because of the specificity of their case, practical measures to promote social inclusion have been few and far between (Gallou, 2006; Bousane et al, 2009). A different but related facet to the transnational family support of older people can be seen in the case of the Bangladeshi community living in London (Phillipson et al, 2001b). Many middle-aged women who had joined their husbands in the UK had a mother who was still alive in Bangladesh. These women would regularly send money to their mothers, demonstrating that despite the geographical boundaries that separated the generations, help and support continued to flourish. With increasing migration flows due to globalisation, international financial transfers as a form of support within families is a phenomenon with important social policy implications. Older people may be recipients of this help when they are resident in countries with underdeveloped welfare systems, and donors to children or other family members when they are resident in more economically developed countries. Notwithstanding the pressures on families that result from the geographical dispersion of their members, there is clear evidence overall that older parents are in regular contact with their adult children. Data from SHARE and other European surveys consistently show that most parents in later life have at least one adult child who lives close by and that face-to-face contact is maintained on a weekly basis. In a comparative study of the family life of older people in England and France, it was found that, excluding situations of cohabitation, approximately one third of older people in both countries have daily contact with a child, and about one in 10 see a child less than once a month (Renaut and Ogg, 2003). Children in turn are regularly involved in helping their parents when they live close by, are not working and when the health status of the parents indicates that help is needed (Ogg and Renaut, 2006). Importantly, older people are supported by other family members who are distant in the form of administrative help or help that links them to community resources. This evidence demonstrates that up until now the continuity of the generational chain has mostly been assured. But what about the future? Will there be enough children available, and will they continue to be implicated in the support of their ageing parents? The future availability of family carers, both spouses and children, is an important dimension for ensuring that elders remain socially included in families. Recent demographic evidence from the Future Elderly Living Conditions in Europe (FELICIE) project is cautiously optimistic. Increased life expectancy and mortality decline at old age are likely to result in ‘couples living together longer than ever before and accordingly will offer potential support to each other’ (Gaymu et al, 2008, pp 24–5). Moreover, the increase in the number of severely disabled older people will grow the fastest among those living in a couple. And despite the difficulties in projecting the availability of children, the same authors note that ‘it is certain that elder people in future decades will have surviving children in higher proportions than before’ (Gaymu et al, 2008, p 25). Overall, the FELICIE project

96

Social inclusion of elders in families

concludes that the most vulnerable older people whose care needs are unlikely to be met by family will be female divorcees and, in numeric terms, female widows. The issue of the willingness of future generations of adult children to support their ageing parents is perhaps more difficult to address. However, evidence from current studies of the ‘baby-boom’ adult children again does not point to any significant weakening of family ties (Phillipson et al, 2008; Bonvalet and Ogg, 2011). And importantly, the diverse sources of professional help that are available in many European countries from the public, private and voluntary sectors do not appear to undermine the family’s role.When high levels of disability or ill-health affect the ability to remain independent, a combination of forms of help appears to be the solution that is favoured by families. If the more demanding aspects of personal care are undertaken outside of the family, adult children invest in other forms of help, particularly affective support and administrative or organisational tasks that can include care-management tasks (Daatland and Herlofson, 2003). These aspects are key in preventing social exclusion. The majority of older people are parents with adult children alive. But childless older people represent approximately 10% of the population and their position within family life and their access to family support is also an important component of the inclusion of elders in family life. According to Kohli and Albertini (2009), childless older people have been treated as a problematic group and several studies have found an association between childlessness and isolation (Koropeckyj-Cox, 1998; Zhang and Hayward, 2001). Often assigned a strong social stigma, childlessness is commonly assumed to be a cause of social isolation. Although some patterns observed among older childless groups, such as their over-representation in residential care homes (Renaut, 2001a) or lower levels of social support (Gray, 2009), suggest that they may be an ‘at-risk’ group, much of the research evidence is equivocal. Recently, several authors have challenged the notion of older childless persons as a group ‘at risk’ of social exclusion by refocusing on what they give to their families, friends and wider society rather than what they receive (Albertini and Kohli, 2009). Adloff (2009), for example, reconfirms the general finding presented earlier in this chapter that people with resources are more likely to give than those with few resources, and shows that this is equally true for older childless people who, given favourable institutional frameworks, make donations to charitable organisations. In the US context, older parents tend to give less than the childless to other people (Hurd, 2009). At the same time, childless older people need to draw on resources external to the family if personal care needs arise. The question of how childless older people gain access to support raises the issue of sources that can be found beyond the family. The importance of nonimmediate family members (ie other than spouses, children, grandchildren, parents or siblings) as well as the role of non-family members has been explored through the development of social network studies (Bott, 1957; Allan, 1979; Willmott, 1987; Wellman and Berkowitz, 1988; Phillipson et al, 1998; Nocon and Pearson, 2000). These studies have shown the importance of the social support that exists 97

From exclusion to inclusion in old age

outside immediate family members, although there appear to be limits to the types of tasks, regularity and volume of support that non-family members give to older people. Some commentators see a change taking place from the predominance of ‘family groups to personal communities’, where both families and other social ties form a spectrum of relations that are ‘part of the more fluid social world of late modernity’ (Phillipson, 2001). The importance of friendship as a form of ‘hidden solidarity’, where friends take on roles more traditionally associated with families (as well as family members becoming more ‘friend-like’), has recently been evoked (Pahl, 2000; Pahl and Spencer, 2006). Friendships as a source of social support in later life are clearly important for childless older people, as recent ‘alternative’ trends in cohabitation testify (Durrett, 2005). But friendship may also be an important source of social capital for separated and divorced persons in later life, the numbers of which appear to be growing, at least in the UK (Office for National Statistics, 2005).

Promoting intergenerational policies: a society for all ages The issues discussed earlier concerning the social inclusion of elders in families have focused on the place of older people in the generational chain and access to support that is needed to retain independence after the onset of disability and illhealth. Policy initiatives in response to increasing demands for social care in many countries have been based mostly on a representation of old age as a period in the life course that is inseparable from decline and dependency. In this framework, elders become a burden to society and to their family, both financially in terms of increasing welfare costs and emotionally in terms of the pressure that is placed on families to support their elders. Although population ageing necessarily requires a concerted response to the challenges placed by growing care needs, there is a move in many countries away from an approach that sets ‘old age’ apart as a uniform experience of increasing dependency. At the European level, a number of initiatives have been taken to promote ‘active ageing’ as a means to ensure that later life is not a period of disengagement imposed by society. In the UK, the policy documents ‘Opportunity age’ (Department for Work and Pensions, 2005) and ‘Building a society for all ages’ (HM Government, 2009), as their titles imply, seek to rethink the way that ageing and old age is conceptualised and to focus on the common needs of citizens of all ages as well as the interdependency of individuals in society. The reorientation of debates on ageing and old age towards an intergenerational framework is to be welcomed in so far as it combats the habitual association of old age and dependency and the automatic reliance of elders on their families. At the same time, the consequences of population ageing in terms of the increased likelihood of needing help and support for a significant proportion of the older population cannot be ignored. Reforms of the financing of social care systems are currently taking place in many European countries, and the place of the family lies at the heart of these reforms (Comas-Herrera et al, 2006; Pavolini and 98

Social inclusion of elders in families

Ranci, 2008). The role of the family in the social care of older people, as viewed by governments and policymakers, differs according to the historical evolution of institutions within countries. In countries such as France, where the concept of solidarity underpins the legal framework relating to the obligations of different family members, the family will continue to be on the front line in supporting older members who cannot assume the payment of their own care (les obligations alimentaires). But in countries with a social-democratic tradition, public policy measures that evoke family responsibilities are seen to be arbitrary and unjust measures that accentuate social inequalities by placing undue pressures on lowincome families (Saraceno, 2002; Guo and Gilbert, 2007). The tension that exists between promoting policies that support intergenerational solidarity and ensuring that social inequalities are not exacerbated is a dilemma faced by most European nation states. In an important paper that outlines the ideals of a modern welfare state, Esping-Andersen (2000) makes the point that, everywhere in Europe, it is daughters (who are ageing themselves) who (outside of spouses) are the main source of help for their parents. If, as is happening in many countries,‘care for the carers’ policies are introduced (such as cash-for-care payments), Esping-Andersen argues that such measures will simply reinforce this role of women and exclude them from the labour market. He suggests that it is better that women work, pay taxes and that these taxes pay in turn for the social care of older people.Thus, Esping-Andersen (2000) concludes that although the market can be an appropriate mechanism for the most well-off, to ensure that social inequalities are minimised, the state must have the main role in assuring the social care of older people through a system of citizens’ rights. Although Esping-Anderson’s vision of a modern welfare state operating on citizens’ rights is questioned by both neo-liberal and conservative ideals of organising welfare, there are perhaps areas of common ground where the contradictions of policy measures to address population ageing remain explicit. The ideals of ‘active ageing’ currently promoted by most European countries, whereby working lives are extended, are at times inconsistent with policies that aim to promote intergenerational solidarity. For example, workers, and in particular the growing numbers of mid-life women in paid employment, have to reconcile the demands of work with those of family life, such as older parents at risk of dependency and adult children in the process of establishing their careers and families. Some innovative solutions have been introduced to try to bridge the gap between the competing demands of domestic and work life, including flexible working hours and periods of leave for family obligations that include caring for ageing parents (Phillips et al, 2002; Hamblin and Hoff, 2009; Gautun and Hagen, 2010).While these initiatives are to be welcomed, they require stable economies. The recent economic recession, beginning in 2009, has placed older workers in a weak position regarding their attempt to reconcile work and family life. Moreover, even where countries have introduced schemes of paid leave for parental care, very few employees are involved (Lester, 2011; OECD, 2011).

99

From exclusion to inclusion in old age

The balance between state, family and other (private and voluntary) forms of help is, therefore, an important issue. In countries that have had strong welfare traditions, help and support for older disabled citizens, as well as other ‘vulnerable’ groups, has been ‘defamiliarised’ in the sense that the state has taken over many of the family’s previous responsibilities. However, changing political landscapes and the spiral of economic recessions that have occurred since the 1970s have led many of these countries to ‘refamiliarise’ their social care systems (Lewis, 1998; Burau et al, 2007). Recent studies suggest that families in these countries are again becoming involved in elder care (Rauch, 2007). Also, people are increasingly turning to the market for solutions of social support (Williams, 2009; Anttonen and Häikiö, 2011). One important dimension to this controversy is the introduction of ‘quasimarkets’ in the provision of social care and the mechanism of ‘cash-for-care’ payments. Several European countries have introduced payments or compensation for carers, although the models differ. Italy and Austria have unregulated cash-forcare systems, where older disabled people are ‘free’ to use the cash they receive for care in the ways they see best. In the UK, although carers over 65 can claim a carers’ allowance, the social care system is highly regulated and disabled older people cannot employ relatives. In France, no carers’ allowance exists. The main source of financial help for disabled older people, the Allocation Personalisation d’Autonomie (APA) is a ‘cash-for-care’ measure rather than a ‘cash-in-kind’ measure, since regulations are placed on the use of the benefits received. To this extent, it ‘defamiliarises’ social care less than in countries with unregulated cash-in-kind payments, such as Italy where migrant workers have replaced family carers in important numbers (Polverini and Lamura, 2004; Bettio et al, 2006; Le Bihan and Martin, 2010). Germany encourages the family to continue in elder care, via financial incentives and with a booming care market. As Ungerson (2005) has shown, policy measures that allow unregulated substantial care allowances or ‘routed wages’ to be paid to older disabled people and their families provide incentives to employ carers from outside the family, and increasingly these carers are migrant workers. It is perhaps too early to evaluate the different effects of these policies on the social inclusion of elders within families, although it is clear that they impact on family relations.

Conclusion The evidence reviewed in this chapter on the social inclusion of elders in families suggests that although principles and mechanisms of intergenerational solidarity remain intact, older people face new challenges that relate to their position in family life. The ways in which family members exchange help and support are changing, both as a result of new demographic trends and policy shifts relating to the provision of social care. If the evidence is cautiously optimistic on the capacity of families to renew and adapt their relationships in the face of rapid social change, it also points to areas of concern where older people risk social exclusion because 100

Social inclusion of elders in families

of a deficit in family support. Moreover, this risk appears to arise as a result of changes at the macro level – such as the consequences of migration flows and the institutional contexts that regulate them, or initiatives related to combining family responsibilities with labour force participation – rather than families themselves becoming more interdependent and self-reliant.This means that the risk of social isolation and the exclusion of older people from relationships with other family members are omnipresent and a concerted effort is needed at national levels to minimise this exclusion. To conclude, older adults retain an important place within the family and contribute towards promoting intergenerational solidarity. Yet, because of their position in the life course, they can be exposed to specific risks that in turn increase the likelihood of exclusion from family life.These risks include a lower availability of same-generation family members due to widowhood and the loss of siblings, an increased risk of dependency that places pressure on family relationships, and the geographical separation of family members due to migration. These risks can be addressed by effective social policy that helps families to undertake the tasks that are integral to them, namely caring for vulnerable members. This does not mean to say that so-called ‘traditional’ approaches to social care in families, whereby women are heavily involved in personal care tasks, are the solution.The family can ensure the social inclusion of its older members in other ways, notably by providing important links to external sources of support and community engagement. The geographical dispersion of families can, in part, be addressed by the increased use of the internet and other communication technologies that keep families in touch. New social policy that promotes the positive use of these technologies in areas such as social care can help to keep older people integrated into family life. But such measures must be coordinated with other policies aimed at minimising the overall risk of social exclusion, such as those directed to employment opportunities, the provision of quality homes and safe environments. Note This chapter uses data from SHARE release 2.3.0, as of 13 November 2009. SHARE data collection in 2004–07 was primarily funded by the European Commission through its fifth and sixth framework programmes (project numbers QLK6-CT-2001-00360; RII-CT- 2006-062193; CIT5-CT-2005-028857).Additional funding by the US National Institute on Aging (grant numbers U01 AG09740-13S2; P01 AG005842; P01 AG08291; P30 AG12815;Y1-AG-4553-01; OGHA 04-064; R21 AG025169) as well as by various national sources is gratefully acknowledged (for a full list of funding institutions, see http://www.share-project.org). 1

References Abrams, M. (1978) Beyond three score and ten. London: Age Concern. Adloff, F. (2009) ‘What encourages charitable giving and philanthropy?’, Ageing and Society, vol 29, no 8, pp 1183–204. 101

From exclusion to inclusion in old age

Albertini, M. and Kohli, M. (2009) ‘What childless older people give: is the generational link broken?’, Ageing and Society, vol 29, no 8, pp 1261–74. Allan, G. (1979) A sociology of friendship and kinship. London: Allen and Unwin. Allan, G. (ed) (1999) The sociology of the family: a reader. Oxford: Blackwell. Anttonen, A. and Häikiö, L. (2011) ‘Care “going market”: Finnish elderly-care policies in transition’, Nordic Journal of Social Research, vol 2, pp 1–21. Arber, S. and Attias-Donfut, C. (eds) (2000) The myth of generational conflict: family and state in ageing societies. London: Routledge. Attias-Donfut, C., Ogg, J. and Wolff, F.C. (2005) ‘European patterns of intergenerational financial and time transfers’, European Journal of Ageing, vol 2, no 3, pp 161–73. Becker, G. (1991) A treatise on the family. London: Harvard Press. Bengtson,V. and Achenbaum,W. (eds) (1993) The changing contract across generations. New York, NY: Aldine de Guyter. Bengtson,V. and Lowenstein, A. (eds) (2003) Global aging and challenges to families. New York, NY: Aldine de Gruyter. Bengtson, V., Giarrusso, R., Mabry, J.B. and Silverstein, M. (2002) ‘Solidarity, conflict, and ambivalence: complementary or competing perspectives on intergenerational relationships?’, Journal of Marriage and Family, vol 64, no 3, pp 568–76. Berkman, L.F., Oxman, T.E. and Seeman, T.E. (1991) ‘Social networks and social support among the elderly: assessment issues’, in R.B.Wallace and R.F.Woolson (eds) The epidemiologic study of the elderly. New York: Oxford University Press, pp 196–211. Bonvalet, C. and Ogg, J. (2011) The baby-boomers: a mobile generation. Oxford: Bardwell Press. Bott, E. (1957) Family and social network. London: Tavistock. Bousnane, M., Ba, A. and Skanari, F. (2009) Le vieillissement dans l’immigration: L’oubli d’une génération silencieuse [Ageing and immigration: a forgotten generation], Proceedings of the 2006 Conference on Ageing and Immigration. Paris: L’Harmattan. Bowling, A. and Browne, P. (1991) ‘Social networks, health, and emotional wellbeing among the oldest old in London’, Journal of Gerontology, vol 46, no 1, pp S20–S32. Burau,V., Hildegard,T. and Blank, R.H. (2007) Governing home care: a cross-national comparison. Cheltenham: Edward Elgar. Burchardt, T., Le Grand, J. and Piachaud, D. (2002) ‘Degrees of social exclusion: developing a dynamic, multidimensional measure’, in J. Hills, J. Le Grand and D. Piachaud (eds) Understanding social exclusion. Oxford: Oxford University Press, pp 30–43. Chauvel, L. (1998) Le destin des générations, structure sociale et cohortes en France au XXe siècle. Paris: Presse Universitaire Française.

102

Social inclusion of elders in families

Chauvel, L. (2006) ‘Social generations, life chances and welfare regime sustainability’, in P.D. Culpepper, P.A. Hall and B. Palier (eds) Changing France, the politics that markets make. Basingstoke: Palgrave Macmillan, pp 150–75. Cherlin, A.J. and Furstenberg, F.F.J. (1992) The new American grandparent: a place in the family, a life apart. Cambridge, MA: Harvard University Press. Comas-Herrera, A.,Wittenberg, R., Costa-Font, J., Gori, A., Di Maio, A., Patxot, C., Pickard, L., Pozzi, A. and Rothgang, H. (2006) ‘Future long-term care expenditure in Germany, Spain, Italy and the United Kingdom’, Ageing and Society, vol 26, no 2, pp 285–302. Commission of the European Communities (2005) ‘Confronting demographic change: a new solidarity between the generations’, Green paper (COM, 2005, 94-Final). Connidis, I. and McMullin, J. (2002) ‘Sociological ambivalence and family ties: a critical perspective’, Journal of Marriage and Family, vol 64, no 3, pp 558–67. Daatland, S.A. and Herlofson, K. (eds) (2001) Ageing, intergenerational relations, care systems and quality of life – an introduction to the OASIS project. NOVA Rapport 14/01. Oslo: NOVA-Norwegian Social Research. Daatland, S.O. and Herlofson, K. (2003) ‘“Lost solidarity” or “changed solidarity”: a comparative European view on normative family solidarity’, Ageing and Society, vol 23, no 5, pp 537–60. Department for Work and Pensions (2005) ‘Opportunity age. Meeting the challenges of ageing in the 21st century’. Available at: http://www.dwp.gov. uk/publications/dwp/2005/opportunity_age/opportunity-age-volume1.pdf (accessed 26 April 2010). Durrett, C. (2005) Senior cohousing: a community approach to independent living. London: New Society Publishers. Eggebeen, D.J. (1992) ‘Family structure and intergenerational exchanges’, Research on Ageing, vol 14, no 4, pp 427–47. Esping-Andersen, G.A. (2000) ‘A welfare state for the 21st century’, report to the Portuguese Presidencey of the European Union, prepared for the Lisbon summit, March. Available at: http://www.nnn.se/seminar/pdf/report.pdf (accessed 26 April 2010). Finch, J. (1989) Family obligations and social change. Oxford: Polity Press. Gallou, R. (2005) ‘Le vieillissement des immigrés en France. Le cas paroxystique des résidants des foyers’ [‘Ageing immigrants in France. The “problematic” case of hostels’], Politix, vol 72, pp 55–77. Gallou, R. (2006) ‘Le vieillissement des immigrés vivant seuls en France: les différences entre hommes et femmes’ [‘Ageing immigrants living alone in France: gender differences’], Les Annales de la recherche urbaine, vol 100, pp 121–28. Gautun, H. and Hagen, K. (2010) ‘How do middle-aged employees combine work with caring for elderly parents?’, Community, Work and Family, vol 13, no 4, pp 393–409. Gaymu, J., Festy, P., Poulain, M. and Beets, G. (2008) Future living conditions in Europe. Paris: Institut National d’Etudes Démographiques. 103

From exclusion to inclusion in old age

Gray, A. (2009) ‘The social capital of older people’, Ageing and Society, vol 29, no 1, pp 5–31. Guo, J. and Gilbert, N. (2007) ‘Welfare state regimes and family policy: a longitudinal analysis’, International Journal of Social Welfare, vol 16, no 4, pp 307–13. Hamblin, A. and Hoff, A. (2009) Literature review on reconciling employment and care for older family members in the UK. Oxford: Oxford Institute of Ageing. Hills, J., Le Grand, J. and Piachaud, D. (eds) (2002) Understanding social exclusion. Oxford: Oxford University Press. HM Government (2009) ‘Building a society for all ages’, presented to Parliament by the Secretary of State for Work and Pensions by Command of Her Majesty. Available at: www.official-documents.gov.uk/document/cm76/7655/7655.pdf (accessed 19 March 2012). Hurd, M. (2009) ‘Inter-vivos giving by older people in the United States of America: who received financial gifts from the childless?’, Ageing and Society, vol 29, no 8, pp 1205–24. Iliffe, S., Tai See, S., Haines, A., Gallivan, S., Goldenberg, E., Booroff, A. and Morgan, P. (1992) ‘Are elderly people living alone an at risk group?’, British Medical Journal, vol 305, pp 1001–4. Izuhara, M. (2010) Ageing and intergenerational relations: family reciprocity from a global perspective. Bristol: The Policy Press. Kahn, R. and Antonucci, T.C. (1980) ‘Convoys over the life course: attachment, roles and social support’, in P.B. Baltes and O. Brim (eds) Life-span development and behavior. New York: Academic Press. Kendig, H.L., Hashimoto, A. and Coppard, L. (1992) Family support for the elderly: the international experience. New York, NY: Oxford University Press. Kohli, M. and Albertini, M. (2009) ‘Childlessness and intergenerational transfers: what is at stake?’, Ageing & Society, vol 29, no 8, pp 1171–83. Koropeckyj-Cox,T. (1998) ‘Loneliness and depression in middle and old age: are the childless more vulnerable?’, Journal of Gerontology: Social Sciences, vol 53B, no 6, pp S303–12. Le Bihan, B. and Martin, C. (2010) ‘Reforming long-term care policy in France: private–public complementarities’, Social Policy and Administration, vol 44, no 4, pp 392–410. Lester, G. (2011) ‘The aging workforce and paid time off ’, Disability and Aging Discrimination, vol 1, pp 71–91. Lewis, J. (ed) (1998) Gender, social care and welfare state restructuring in Europe. Aldershot: Ashgate. Lüscher, K. and Pillemer, K.A. (1998) ‘Inter-generational ambivalence: a new approach to the study of parent–child relations in later life’, Journal of Marriage and Family, vol 60, pp 413–25. Mannheim, K. (1952) ‘The problem of generations’, in K. Mannheim (ed) Essays on the sociology of knowledge. London: Routledge and Kegan Paul. Masson, A. (2009) Des liens et des transferts entre les generations. Paris: Éditions de l’EHESS. 104

Social inclusion of elders in families

Nocon,A. and Pearson, M. (2000) ‘The roles of friends and neighbours in providing support for older people’, Ageing and Society, vol 20, no 3, pp 341–67. OECD (Organisation for Economic Co-operation and Development) (2011) Help wanted? Providing and paying for long-term care. Paris: OECD Publishing. Office for National Statistics (2005) ‘Divorces in England and Wales during 2004’, Population Trends, vol 121, pp 85–9. Ogg, J. and Renaut, S. (2006) ‘The support of parents in old age by those born during 1945–1954: a European perspective’, Ageing and Society, vol 26, no 5, pp 722–44. Pahl, R. (2000) On friendship. Oxford: Polity Press. Pahl, R. and Spencer, L. (2006) Rethinking friendship: hidden solidarities today. Princeton, NJ: Princeton University Press. Parsons, T. (1951) The social system. London: Routledge and Kegan Paul. Pavolini, E. and Ranci, C. (2008) ‘Restructuring the welfare state: reforms in long-term care in Western European countries’, Journal of European Social Policy, vol 18, no 3, pp 246–59. Phillips, J., Bernard, M. and Chittenden, M. (2002) Juggling work and care: the experiences of working carers of older adults. Family and work. Bristol: The Policy Press/Joseph Rowntree Foundation. Phillipson, C. (2001) ‘Change in the family life of older people’, in V. Bengtson and A. Lowenstein (eds) International perspectives on families, aging and social support. New York, NY: Aldine de Gruyter. Phillipson, C., Bernard, M., Phillips, J. and Ogg, J. (1998) ‘The family and community life of older people: household composition and social networks in three urban areas’, Ageing and Society, vol 18, no 3, pp 259–89. Phillipson, C., Bernard, M., Phillips, J. and Ogg, J. (2001a) The family and community life of older people: social networks and social support in three urban areas. London: Routledge. Phillipson, C., Aihag, E., Ullah, S. and Ogg, J. (2001b) ‘Bangladeshi families in Bethnal Green, London: older people, ethnicity and social exclusion’, in A. Warnes, L.Warren and M. Nolan (eds) Care services for later life: transformation and critiques. London: Jessica Kingsley, pp 273–91. Phillipson, C., Leach, R., Money, A. and Biggs, S. (2008) ‘Social and cultural constructions of ageing: the case of the baby boomers’, Sociological Research Online, vol 13, no 3.Available at: http://www.socresonline.org.uk/13/3/5.html (accessed 26 April 2010). Pickard, L., Wittenberg, R., Comas-Herrera, A., King, D. and Malley, J. (2007) ‘Care by spouses, care by children: projections of informal care for older people in England to 2031’, Social Policy and Society, vol 6, pp 353–66. Polverini, F. and Lamura, G. (2004) Labour supply in care services. National report on Italy. Dublin: European Foundation for the Improvement of Living and Working Conditions.

105

From exclusion to inclusion in old age

Pyke, K.D. and Bengtson, V.L. (1996) ‘Caring more or less: individualist and collectivist systems of family eldercare’, Journal of Marriage and the Family, vol 58, pp 379–92. Qualls, S.H. and Zarit, S.H. (eds) (2009) Aging families and caregiving. New York, NY: Wiley. Rauch, D. (2007) ‘Is there really a Scandinavian social service model? A comparison of childcare and eldercare in six European countries’, Acta Sociologica, vol 50, no 3, pp 249–69. Renaut, S. (2001a) ‘Vivre ou non à domicile après 75 ans: l’influence de la dimension générationnelle’ [‘Living at home or not after 75: the influence of the generational dimension’], Gérontologie et Société, vol 28, pp 65–83. Renaut, S. (2001b) ‘L’entraide familiale dans un environnement multigénérationnel: Familles, vieillissement et générations’ [‘Counting on the family in a multigenerational environment: families, ageing and generations’], Recherches et Prévisions, vol 71, pp 21–44. Renaut, S. and Ogg, J. (2003) ‘Vivre à domicile après 75 ans: une comparaison entre l’Angleterre et la France’ [‘Living at home after 75: a comparison between England and France’], Retraite et Société, vol 38, pp 174–95. Saraceno, C. (ed) (2002) Social assistance dynamics in Europe. Bristol: Policy Press. Scharf, T., Phillipson, C., Kingston, P. and Smith, A.E. (2001) ‘Social exclusion and older people: exploring the connections’, Education and Ageing, vol 16, no 3, pp 303–19. Szinovacz, M.E. and Davey, A. (2007) ‘Changes in adult child caregiver networks’, The Gerontologist, vol 47, no 3, pp 280–95. Tomassini, C., Kalogirou, S., Grundy, E., Fokkema, T., Martikainen, P., Broese van Groenou, M. and Karisto, A. (2004) ‘Contacts between elderly parents and their children in four European countries: current patterns and future prospects’, European Journal of Ageing, vol 1, pp 54–63. Townsend, P. (1957) The family life of old people. London: Routledge and Kegan Paul. Tunstall, J. (1966) Old and alone. London: Routledge and Kegan Paul. Ungerson, C. (2005) ‘Gender, labour markets and care work in five European funding regimes’, in B. Pfau-Effinger and B. Geissler (eds) Care arrangements in Europe: variations and change. Bristol: Policy Press, pp 49–72. Victor, C., Scambler, S. and Bond, J. (2009) The social world of older people: understanding loneliness and social isolation in later life. Maidenhead: Open University Press. Wellman, B. and Berkowitz, S.D. (eds) (1988) Social structures: a network approach. Cambridge: Cambridge University Press. Williams, F. (2009) Claiming and framing in the making of care policies: the recognition and the redistribution of care. Geneva: United Nations Research Institute for Social Development. Willmott, P. (1987) Friendships, networks and social support. London: Policy Studies Institute.

106

Social inclusion of elders in families

Zhang, Z. and Hayward, M.D. (2001) ‘Childlessness and the psychological wellbeing of older persons’, Journals of Gerontology: Social Sciences, vol 56B, no 5, pp S311–S320.

107

Seven

The impact of changing value systems on social inclusion: an Asia-Pacific perspective David R. Phillips and Kevin H.C. Cheng

Introduction Social exclusion involves restrictions on social contact and social relations (Littlewood and Herkommer, 1999). For many older people, this may mean fewer opportunities to interact with relatives, friends or neighbours. Like social ostracism, it can leave the individual in a state of entrapment, isolated from society’s general activities (Lee, 2001) and with ongoing reminders ‘of their own failures … and with inescapable proof of their inability to alter the unwanted circumstances of their lives’ (Pearlin et al, 1981, p 340). There has been growing interest worldwide, and especially in the Asia-Pacific and its Chinese societies, in changes in inter-family and intergenerational relations and how these may impact on older persons’ inclusion or exclusion. This issue has taken on increasing importance in many Asia-Pacific countries, where demographic change and rapid socio-economic development are believed to be associated with a generalised decline in close family relationships, and especially the reciprocal family responsibilities known as filial piety. Therefore, when considering possible marginalisation of older people in Asian societies, especially Chinese societies, there is a need to take account of at least two major issues: demographic change; and value systems, social norms and traditions within filial piety. Many countries in the Asia-Pacific have seen considerable increases in the numbers and proportions of older people, with concomitant changes in family structures (Phillips et al, 2010). Two domains of social exclusion on which these combined influences are likely to impact are exclusion from material resources, including employment (often causing poverty in later life), and social isolation through exclusion from family relations (often stemming from changes in filial piety). We concentrate here on the second of these domains.

109

From exclusion to inclusion in old age

Demographic trends: potential impacts on family relations and older people The Asia-Pacific is now leading many global demographic trends such as demographic ageing, smaller families and the feminisation of ageing. Asia has more than 60% of the world’s total population and also well over half of its population aged 65 and over. While some Asian countries are still relatively young, China already has more people aged 65 years or above than in the countries of the European Union combined (over 100 million versus some 80 million). Another major Asian country, India, is not far behind (at around 60 million) (Population Reference Bureau, 2009). There are, nevertheless, considerable variations in demographic ageing across specific countries in Asia and the Asia-Pacific sub-region (Phillips et al, 2010; Phillips, 2011). Increased life expectancy and low fertility are well established (Kinsella and He, 2009). Some of the region’s countries, especially Japan, Hong Kong,Taiwan, Korea and Singapore, have considerable percentages of older persons and are among the oldest countries in the world. However, the region is by no means uniform demographically. Expected life at birth (ELB) in the Asia-Pacific ranges from 61 years in Cambodia and even lower in Myanmar and Timor-Leste, to as high as 83 years in Japan and Hong Kong. The 65+ cohorts similarly range from 3% in Cambodia to 23% in Japan. A crucial demographic feature for health and well-being, and very likely for social inclusion, is the significant growth of the ‘oldest old’ cohorts (aged 85+), who may risk increasing social isolation if certain of the social trends discussed later continue. We will argue that the rapid pace of demographic ageing in most parts of the region, over just a few decades, and equally rapid and encompassing socio-economic changes, have given little opportunity for family relations to adjust and older people to remain as well integrated as in the past. An underlying demographic trend strongly influencing demographic ageing in the region is falling fertility rates. It is likely that this demographic feature will become the major factor in the region affecting the potential for social inclusion or exclusion of older people. While its effects have often been overlooked, it is emerging as a policy issue in much of the region (McDonald, 2007; Chen, 2009; Phillips et al, 2010).Traditionally, almost all Asian societies have relied heavily on family care to provide for their older members, with living arrangements often being in extended families and institutional or formal care being an anathema (Phillips, 1992, 2000).Today, smaller, more widely scattered families mean that the potential for extended family living is much reduced. Moreover, many Asia-Pacific families are separated by regional or international migration; younger members living locally are likely to be working full time outside the home.

110

The impact of changing value systems on social inclusion:

Socio-economic impacts of demographic change These demographic changes are impacting socially and economically, often in rather unexpected ways. A major issue has been the changes in long-term family and community relations caused by smaller families, fewer relatives and greater longevity. In particular, the numbers of potential family carers are inevitably becoming fewer and many children do not wish to look after their older parents. In cultures where daughters and daughters-in-law have often been assumed to become the carers, many women may well prefer to pursue their own careers outside the home or within a nuclear rather than an extended family.This may be the start of exclusion for some older members from the social relations associated with the immediate family circle. Demographic changes also mean that many countries have to recognise the financial impacts of living longer and of retirement. In Korea, for example, some 30,000 people aged 65 and over have had to explore opportunities for remaining in the labour force as only 28% of the working population is covered by the government pension system (Global Action on Aging, 2009).The Korean government, like some others, has established ‘silver job fairs’ to find jobs for people aged 60 and older and has offered subsidies to private companies that hire older people. However, there are still insufficient openings for older job-seekers. At the same time, competition for employment from younger and middle-aged workers has stimulated negative sentiments towards the older population, even branding them ‘job-takers’ who should be obliged to retire.Alternatively, emerging labour shortages have sometimes enhanced the image and value of older workers, encouraging places such as Singapore to highlight the need for retraining and flexible employment policies to retain older workers.The picture, therefore, differs by both time and place. A further effect of demographic change has been a shift in attitudes regarding the social relations of longer-lived older family members. For example, remarriage of older people was once effectively taboo, especially for older women who generally live longer than men. Today, attitudes may be changing. In China, older people may avoid formal remarriage, although they value having someone to look after them or be available for companionship (Global Action on Aging, 2009). Instead of registering as a legally married couple, some choose to live together, an unthinkable situation a decade or so ago. What, however, are the attitudes of conservative societies and family members towards the remarriage or cohabitation of older people? Remarriage may effectively remain taboo, or frowned upon, in many Asia-Pacific countries, but evidence is unclear. A study comparing filial attitudes in Taiwan and in Baoding, Hebei, China, in the mid1990s, for example, found strong disapproval of remarriage even after an older woman had been widowed for some time in Taiwan. By contrast, over 90% of older respondents in Baoding felt that it was acceptable for women to remarry under such circumstances (Whyte, 2004). This shows clear regional contrasts

111

From exclusion to inclusion in old age

even within ethnically similar societies and suggests greater conservatism in the Taiwanese respondents than in modern China. In the face of shrinking family resources, greater numbers of older adults may need support over longer periods of time. There has been a spectacular epidemiological transition in almost all countries of the Asia-Pacific, and especially in East Asia (including Singapore), marked by the emerging prominence of chronic and degenerative diseases related to population ageing and lifestyle changes (Phillips, 2000, 2011; OECD, 2010; Phillips et al, 2010). Heart disease, cancers and stroke now make up the vast majority of mortality in older age groups, accounting also for a substantial proportion of morbidity. The growing incidence and prevalence of dementias is also likely to become a serious challenge in a number of societies in the region (Access Economics, 2006, 2009). Assuming responsibility for care may well no longer be possible for many families and older adults, with some forms of mental and physical health problems, such as advanced dementias, almost inevitably requiring institutional care. The combination of demographic and epidemiological changes effectively means that health and social care policies will increasingly have to focus on the older cohorts while at the same time attempting to care for other age groups with finite resources and diminishing family capacity to help. This is a major social challenge and there is speculation that resources will be spread so thinly that there will be intergenerational conflicts or competition between demographic and social groups. Questions are raised concerning whether younger generations will agree to redirect public expenditure from mother–child health and education towards long-term care, social and welfare services for the older cohorts.To date, this issue has largely been hidden because of the extensive reliance on intra-family care. Today, challenges are emerging for social service care because of the changes in family structure and potential loss of family caring capacity. Among these major emerging challenges are long-term care and end-of-life care (Chan, 2011a).

Cultural values and changes: filial piety and ancestral duties In recent years, there has been considerable academic and policy-related interest in the region in the topic of family capacity to care. Much of the discussion has focused on the question of whether family relations and filial piety are changing and having adverse consequences for older people’s well-being and care (Chow, 2001, 2006). In most of the Asia-Pacific, the impact of modernisation, sometimes held to be associated with ‘Westernisation’, on cultural and social values and practices has indeed been considerable. There have been changes in family functions, evidenced by departures from traditional practices, and caring attitudes (Hugman, 2000; Kim and Lee, 2003; Lee, 2004; Ong et al, 2009; Zheng and George, 2010). Research and anecdotal evidence also point to qualitative changes in roles and relationships within the remaining multigenerational households. Such changes have potentially adverse implications for older people’s experience of physical and emotional security and well-being (Ingersoll-Dayton 112

The impact of changing value systems on social inclusion:

and Saengtienchai, 1999; Silverstein et al, 2002) and, hence, may affect their social inclusion. One crucial cultural practice that has attracted, and will continue to attract, considerable regional and international interest is filial piety. Filial piety is represented in a Chinese character comprising an upper character for ‘old’ and lower one for ‘son’, which may convey many messages, including support by young of old, or even burden of old on young (Ikels, 2004). The concept is generally agreed to have originated from the teachings of Confucius (551–479 BC) and has been influencing interpersonal relations in China and East Asia for more than 2,500 years. According to Confucian teaching, filial piety covered mutual obligations between the emperor and his subjects, between the father and sons, between husband and wife, and among members within the same sibling generation. It lies at the root of most moral and social values in EastAsian countries such as China, Hong Kong, Japan, Korea and Taiwan. In China, for example, it was held that obedience (or even subservience) to respected old people should arise from love for the parents (Lin, 1992); it should be much more than merely providing food and basic necessities (Chow, 2001). Indeed, filial piety operates at a number of levels: in the provision of fundamentals for parents’ physical needs and comfort; in paying attention to, and obeying, parents’ wishes; and, in behaving so as to make parents happy, bringing them honour and respect in the community (Chow, 2001). Until recently, filial piety certainly exercised considerable influence over practical relations and care between parents and children and relationships among people (Tsai, 1999). It continues to exert considerable emotional influence, even if its practical expressions have become muted in recent years.Traditionally, filial practice encompassed a holistic form of care with clear implications for the overall quality of older people’s lives. There are eight qualities for traditional Chinese people to complete throughout their lives, of which filial piety comes first and foremost. The importance of paying filial duties to parents (and older members) is explained as all physical bodily aspects of one’s being were created by one’s parents. Parents tend to their children’s well-being, especially that of sons, until they can look after themselves.The reciprocal respect and the homage to parents of filial piety are to return to them this gracious deed, both during life and afterwards.

Filial piety: changes, challenges and social consequences Today, the modernisation of filial piety in Asia-Pacific countries appears to have eroded its influence and even changed its practices to allow, for example, the substitution of cash and paid services by others for personal care by the family (Ng et al, 2002; Cheng and Chan, 2006). Indeed, it has increasingly been felt that the traditional aspects of care and veneration are less well-taught and less understood in most modern Chinese societies (Ikels, 2004). In more Westernised Hong Kong, Chow (2001) and Ng et al (2002) found that filial piety is being reinterpreted in a modern way, in which parents’ wishes would not necessarily be paramount or automatically obeyed, and assistance could take as much a financial as a personal 113

From exclusion to inclusion in old age

form. The People’s Republic of China (PRC) under Mao Zedong previously actively attempted to undermine the solidarity of the family in favour of the role of the state. Today, given its large older population and pressing need for social and economic support, the PRC is actively trying to reinstate and redevelop the concept of obligation to provide family care. In Korea, it was officially felt for some time that provision of care for older people outside the family would undermine family solidarity and filial traditions (Choi, 2000; Chow, 2006). However, given the country’s rapid demographic ageing and fertility decline, attitudes have changed and ‘the centrality of informal family support networks in providing care is increasingly absent from the scene’ (Hwang, 2009, p 85). Pressure for more formal social provision has led to an expanded role of the state into personal and long-term care. In this shift, there is potential for providing some care for people in need, but also to further isolate older people from their intimate family and filial networks. In Hong Kong, parts of China, Taiwan and elsewhere, changes have stemmed from the combined forces of modernisation, housing pressures and general social trends towards nuclear families. In Hong Kong, special circumstances have made this even more evident. Hong Kong experienced rapid population growth and an influx of migrants in the 1950s and early 1960s, and has small housing sizes due to high costs. More recently, it has witnessed family fragmentation resulting from migration and emigration for economic and other reasons. It is increasingly common for older persons to be living by themselves. Recent Hong Kong data suggest that some 12% of Hong Kong’s older population live alone (Census and Statistics Department, 2008). This trend is also evident in Singapore and other similar modernising societies (Reisman, 2009). A major social development and consequence of the demographic changes noted earlier is that, in most of the region, multigenerational families have been becoming a rarity rather than the norm over recent decades. This is especially evident in the urban areas such as Hong Kong and Singapore, and in many other cities throughout the region, including Beijing, Shanghai, Seoul and Taipei. In Korea, the proportion of older people living alone or with their spouse has increased substantially from under 20% in 1981 to 62% in 2007 (Choi, 2009). Specific local factors have exacerbated this trend. In China, the growth of economic zones and cities along the eastern seaboard since 1980 has caused considerable social imbalance resulting from labour migration. Millions of young workers have flocked to the main eastern cities and economic zones such as Shenzhen and Zhuhai, leaving relatives and older parents behind, mainly in rural areas. On a smaller geographical scale, housing developments in Hong Kong since 1980 have meant that a considerable proportion of the population moved to new town areas, sometimes placing younger members at a distance from their other relatives.When the moves have involved older people themselves, they have sometimes separated individuals from their established networks of social support, leading to necessity for considerable psychosocial adjustment in old age (Phillips et al, 2005, 2009). As a result, here and elsewhere, 114

The impact of changing value systems on social inclusion:

some older persons have had to look for new sources of social support, sometimes from the formal sector, which are more readily available or accessible.This might have the twin effects of better including older people in social networks outside the family, while simultaneously reducing the importance of the immediate family. It also effectively alters the relationship between older persons and support providers from an obligatory one based on traditional values to one based on the exchange of favours (eg between friends and neighbours) or purchased or ‘rights-based’ care from formal and official welfare services.

Tensions arising? Some believe that the Asia-Pacific is at a turning point, at which traditional values that have maintained social harmony for centuries are now under serious erosion. Nevertheless, there is evidence that some younger adults continue to hold strong filial beliefs. By contrast, many older people seem to have lower filial expectations of the younger generations than they do for themselves. For example, a representative survey in Taiwan in 1995 showed that, while 66% of those aged 31–35 years felt obliged to live with their aged parent, only 57% of those aged 66–70 years actually expected their children to live with them (Hsu et al, 2001). Indeed, it seems likely that adult children often feel uncomfortable and unhappy when their home circumstances and working patterns mean they cannot provide the care they would like for parents. This emotional conflict may well affect the relationships between sons and daughters-in-law, as much of the caring burden still falls on women (especially a daughter-in-law). Despite emotional pressure and even desire, fewer young Chinese people in particular now appear to be fulfilling formal filial obligations (Yan et al, 2002). Increasingly, the younger generations have had different life experiences from their parents, including greater education, working away, travelling, living in nuclear family structures, experiencing formalised caring facilities and exposure to information technology; so many believe that to have older parents living with them full time is neither practical nor possible.This may be contrary to the traditional filial expectations of both generations. But it may also suit some parties. The desire for family care is more or less universal, as even in Western countries, many older people hope that they will be cared for and accompanied by their children when they need help (Chappell and Kusch, 2007). However, the family is often no longer in a position to provide adequate care. By emphasising the rights and equality of all parties, the theme of intergenerational well-being and even a form of potential inclusion through compromise is arguably being achieved. In some places, this is being fostered voluntarily. In others, notably Singapore and China, there are laws in place that require children to maintain and look after their adult children. However, younger adults of today may consider their own well-being as just as important as that of their parents, a notion arising from modern notions of equality and individual rights. Many consider themselves as family members with the obligation to take 115

From exclusion to inclusion in old age

care of their own children in a nuclear family but not necessarily all other family members – a perspective consistent with views of the concept of family unity found in some studies on filial piety (Kao and Travis, 2005).Younger adults may feel that while older parents’ interests are a binding duty, their own (fewer) young children and they themselves warrant greater focus. Some academic research and much popular and media coverage attributes the increased focus on the nuclear family to the fact that many Asian countries are becoming more ‘Westernised’. Individualistic values, allegedly more characteristic of the West, may indeed be growing today in Asian cities. This, of course, does not mean that the younger generations are ‘unfilial’ in the traditional sense of self-sacrifice for parents, but perhaps, as discussed later, they have a new perception of the value and practice of filial piety. A balance between different parties’ interests has increasingly become a desired policy goal, suggesting all generations’ views of practising filial piety is more flexible than in the past (Traphagan, 2006). In effect, the cultural climate is in a state of flux and will continue to change to suit changing times.

Family carers and non-family carers The differences between receiving care provided by the family (especially by adult children) and that from other sources, especially formal and paid sources outside the home, have come to be an important contemporary concern in many countries in the region. Employment of outside sources of help may lead to a type of reconciliation between fulfilling familial obligations and pleasing the younger nuclear family. In many countries of Asia, including Taiwan, Hong Kong, Singapore and Malaysia, the employment of foreign domestic helpers as non-family live-in carers for older, particularly frail, people, has become common among middle-class and even less well-off families. Today in Taiwan, it is increasingly common for older people to live in long-term care settings or to be cared for by hired helpers (Li and Yin, 2005). Generally, such helpers come from poorer countries of the region, previously mainly from the Philippines, but increasingly from Indonesia and Sri Lanka. While the level of care and attention provided by such helpers is often high, and can be round-the-clock, there is the potential for yet further linguistic and cultural isolation and a type of displacement from the family and especially from the expectation of personalised family care. In 2009, Hong Kong tabled plans to allow the employment of domestic helpers from mainland China who would have more cultural and linguistic ease with some older people. This opens up interesting possibilities for further isolation and/or inclusion in that the helper can interact with the older person, and will have at least some shared cultural values. However, for some families, the costs are high and the fact that they need to employ a helper could also foster a sentiment in the minds of some older people that they are a burden on their children. Researchers have further attributed changing trends in individuals’ perceptions of filial piety to the current social and economic environments. In the past, cultural belief systems were expected to be followed strictly and rigorously. In the minds 116

The impact of changing value systems on social inclusion:

of some baby-boomers, a new ‘middle-way’ of thinking seems to be developing, in which responsibilities for the care of older relatives can be shared out to solve care-taking. However, many still wish to adhere to some elements of five prior normative beliefs (Ikels, 2004). First, the ways of practising filial obligations must comply with the general expectations or acceptance of the population (‘I think that the way in which I will treat my parents is the way that people generally expect’); so public approval or even sanctions are relevant. Second, care must be based on intention to reciprocate for parents’ past care and the raising of their children, requiring a response in kind when the parents are old. Third, care can be a way of expressing gratitude and affection, and a way to protect parents from harm. However, it increasingly appears that people do not find it necessary to define precise behaviours in this regard as long as the parents feel the appreciation. Furthermore, it is believed that a diversity of methods can be used to display filial piety, such as meeting parents’ physical, emotional and spiritual needs, and protecting them from worries, loneliness or troubles. Fourth, filial piety should apply when neither parents nor children have to make unilateral sacrifices and when both parties’ well-being and happiness are taken into consideration. It may, for example, be felt that by not living together, unnecessary conflicts will be avoided and relationships preserved. Finally, there may be an economic link between providing care and inheritances.

Changing traditional forms of care for parents and social isolation: an East-Asian perspective The reduction in family size in most countries of East Asia has been seen as an indicator of successful population policies, but, more recently, as a cause of considerable social concern. A particular threat to intergenerational cohesion identified in China over the last two decades, is the growth of the so-called ‘4–2–1 family structure’ (four grandparents, two parents, one child). This was an almost inevitable consequence of the rigorous implementation of the one-child policy in the 1970s and the slightly more relaxed policy since the 1980s. As a result, the government of the PRC, like many others in East Asia, has begun to anticipate the very real likelihood of an inverse population pyramid, with considerably more people in the older than younger cohorts (Chen, 2009). The practical outcome of this, in conjunction with increased employment opportunities for younger men and women, is that the tradition of multiple caregivers being available in each generation has been rather abruptly disrupted; tens of millions of retirees will have only one adult child to rely on. Consequently, these adult children’s situations have rendered them highly conflicted about prospective parent care. Further, they have realised that, when the time comes, they will have little latitude in terms of employment flexibility and being able to provide all aspects of care to their parents. Indeed, so serious is the potential ageing (as well as lack of labour) in large cities in China that the relaxation to a de facto two-child policy in cities such 117

From exclusion to inclusion in old age

as Shanghai, Beijing and Guangzhou was effected in mid-2009, especially for ‘double-single’ couples, parents who are both singletons and products themselves of the one-child policy (Becker, 2010; Li, 2010). Whatever positive view many put on the 30-year population policy, some senior Chinese officials now hold it responsible for what is regarded as a serious problem: rapid population ageing. The pressure is therefore growing for relaxation of the one-child policy even beyond the major cities. Consequences for older people of the population policy are varied but include less family contact and potential isolation from kin. Like many other countries, China is experiencing unprecedented growth in the private aged-care industry, a de facto recognition that family care is insufficient. Previously, socialist welfare policies were undermined by welfare reforms of the mid-1990s, and a socialistic entrepreneurship has seized the chance to provide older people with private residential care services (Gu et al, 2007; Zhan et al, 2006; Cheng et al, 2008).This has come at a time when some Chinese citizens’ affluence and prosperity are similar to those in other major cities in the industrialised world. Now, in China’s urban areas, many adult children who are unavailable to provide adequate care, but who have disposable income, have the option of placing older parents in residential homes.The numbers of such care homes has grown rapidly since the mid-1990s. Rapidly changing socio-economic conditions in China, as in many other parts of East Asia, have also provided a new context for how some older people feel about these changing care practices. Zhan et al (2008) note that older parents have made compromises, such as accepting placement into for-profit residential care homes, to maintain harmony with their child(ren). Rather than feeling abandoned or shamed if they move into residential care, many felt the move denoted privilege and were proud their families could afford the care. Ironically, for some at least, this ability to pay for care appears to have become a symbol of wealth in socialistcapitalist China. Many believe that they will receive good-quality medical and social care as well as enriched social environments with people of similar ages. While in the residential care units, they reported positively about their children’s continued emotional support and care involvement.They may have appeared to be experiencing a form of isolation, but, at this later stage of life, filial obligations were no longer solely about children’s direct physical care. Research among different age groups in Hong Kong has found that, among many older people, placement in an old-age home was not seen as an indication of unfilial behaviour. Contrary to the researchers’ expectations, older respondents were more likely than younger ones to view old-age homes positively, although potential problems of adjustment to such homes should not be minimised (Tang et al, 2009). These findings provide an interesting new perspective on filial piety. Zhan et al’s (2008) China research supports suggestions from studies elsewhere in the region, such as the Hong Kong study, that if adult children are not available to provide adequately personal physical care, filial obligations could still be fulfilled by placement in a good care facility. This may be especially so in China when it signals wealth to neighbours, friends or relatives.These findings from China suggest 118

The impact of changing value systems on social inclusion:

that adult children also contribute to the reinterpretation of filial obligations. Rather than feeling guilty or ashamed about placing parents in institutions, adult children openly discussed their decisions and expressed satisfaction with resulting arrangements.To the older parents, as long as their children’s emotional and financial commitment remained strong, the sense of abandonment or shame associated with the assumed potential stigma of living in a care home dissipated and was even superseded by pride. However, one implication of this trend is that the ability to pay is likely to enlarge the growing gap between rich and poor older Chinese people in their capability and decisions about care options (Zhan et al, 2006). Nevertheless, some research suggests that managing stigma can be an issue in placing parents in institutional care (Zhan et al, 2011). There is potential for an increase in feelings of social exclusion among some people, who might feel shame if they are placed in inferior homes or if they are not visited and supported by their child(ren). However, there is no evidence to date of incomebased differences in family exclusion. For practical reasons, it seems that many older people in China are feeling the need to reinterpret and forge a more liveable version of filial piety (Lee, 2001; Zhan et al, 2008) and this almost certainly also applies elsewhere in the region.This trend supports Gore’s (1992) earlier suggestion of the interactive and compromising role that older people and their adult children should adopt in seeking a new solution for long-term care. Supportive families may sometimes provide older people with a chance to reciprocate by taking part in family roles, with contributions such as caring for, bringing up or educating grandchildren or undertaking household chores, potentially helping to maintain the integration of older people into family life. Perhaps paying for residential care is a modern-day extension and should not automatically be construed as a form of exclusion of older members from the family. Based on the findings of empirical survey research, Chow (2001, p 135) suggests: ‘Looking at the present-day behaviour of Hong Kong people, Confucius would certainly denounce it as improper.… However, he would accept that, since circumstances have changed, putting parents’ wishes above one’s own may no longer be possible’. One particular issue of potentially great importance arising from, and also causing, social isolation is the abuse of older people. This is starting to be acknowledged and is emerging as a policy and family matter in this region. In the West, there has been much discussion of this phenomenon, which can take many forms ranging from overt violence to more subtle psychological and economic neglect. It is now becoming a concern in many countries of the Asia-Pacific. Research-based evidence is as yet relatively slim, although case studies are emerging in places such as Singapore (Chan, 2011b). Elder abuse has been a hidden but probably fairly widespread phenomenon in most of the Asia-Pacific. Socio-political changes mean that more open discussion is now becoming acceptable and is appearing in Singapore, Hong Kong, China,Taiwan and elsewhere. Officially reported cases are relatively rare in places such as Hong Kong and Singapore even with their well-established social welfare organisations (Teo et al, 2006; Chan, 2011b). But 119

From exclusion to inclusion in old age

real figures are almost certainly much higher than those reported. Several places in the region, including Singapore and China, have formal legislation requiring support of older relatives or parents (eg Singapore’s Maintenance of Parents Act with its tribunals for settling stipends since 1994/95). In China, the reciprocal responsibility for care and assistance is actually stated in the 1982 Constitution. Japan’s Elder Abuse Prevention and Caregiver Support Law, which came into effect in 2006, makes reporting of abuse mandatory if the life or health of an abused or neglected older person appears to be in danger (Tsuno and Homma, 2009). These provide evidence of the growing concern about, and at least some policy attempts being formulated towards, disrespect and abuse of older people in the region.

Resilience and the older consumer: evidence of social inclusion? We can conclude on a potentially more positive note for the more developed parts of the Asia-Pacific region. To date, older persons have generally been viewed as less powerful, almost as supplicants, in society and in many families. However, evidence is emerging that this may be an erroneous stereotype, at least for some older groups. Greater numbers of older people are both resilient and have economic power, in increasingly consumer-oriented societies, where the economic value of the ‘silver market’ is growing.The general status and inclusion of older persons may be enhanced if they are viewed as consumers; an area where many have to date been marginalised. The silver market is usually interpreted as services (especially health, welfare, pensions and foods) provided for older persons. However, the silver market is also being interpreted in the Asia-Pacific, as it is in the West, as one in which older people are seen as a growing cohort of consumers in their own right, with economic requirements and purchasing power (Furlong, 2007; Ong and Phillips, 2007). Older consumers will demand, and often be able to pay for, suitable homes, transport, consumer goods, financial services and leisure activities. Many will be able to afford them and be in a position to influence future consumer goods provision and marketing.This is becoming recognised in the region and, indeed, there is a silver market organisation looking at business–consumer connections regionally in the Asia-Pacific (Silvergroup, 2011). Nevertheless, many older people, especially in the currently old cohorts, do not have financial resources or savings, and poverty represents a powerful aspect of social exclusion. However, in the future, it is likely that more older persons will become the ‘canny consumers’ found in one Malaysian study (Ong and Phillips, 2007). Increasingly, older adults are empowered and able to express their demands, requirements and consumer complaints (Ong et al, 2009). Producers of goods and services, marketers, public policymakers, and the families of older people will do well to recognise this growing area of inclusion of older persons in the economy. It seems certain that ever-more independently oriented older people 120

The impact of changing value systems on social inclusion:

will still want filial contact with their children and other family members, so the continuing evolution of filial piety will be an increasingly important research and policy interest. References Access Economics (2006) ‘Dementia in the Asia Pacific region: The epidemic is here’. Available at: http://www.alz.co.uk/research/files/apreport.pdf Access Economics (2009) ‘Keeping dementia front of mind: incidence and prevalence 2009–2050’, Report for Alzheimer’s Australia. Available at: http:// www.accesseconomics.com.au/publicationsreports/showreport.php?id=214 Becker, A. (2010) ‘Is China’s one-child policy coming to an end?’, New Jersey Newsroom, 15 April. Available at: http://www.newjerseynewsroom.com/ international/is-chinas-one-child-policy-coming-to-an-end (accessed 15 April 2011). Census and Statistics Department (2008) ‘Hong Kong 2006 population by-census thematic report: older persons 2008’, Hong Kong Government, Census and Statistics Department.Available at: http://www.censtatd.gov.hk/products_and_ services/products/publications/statistical_report/population_and_vital_events/ index_cd_B1120053_dt_detail.jsp (accessed 10 August 2011). Chan, W.C. (ed) (2011a) Singapore’s ageing population: managing healthcare and end of life decisions. London: Routledge. Chan, W.C. (2011b) ‘Victims of elder abuse in Singapore: a study of cases at TRANS SAFE Centre’, in W.C. Chan (ed) Singapore’s ageing population: managing healthcare and end of life decisions. London: Routledge. Chappell, N.L. and Kusch, K. (2007) ‘The gendered nature of filial piety: A study among Chinese Canadians’, Journal of Cultural Gerontology, vol 22, no 1, pp 29–45. Chen, S.-Y. (2009) ‘Aging with Chinese characteristics: a public policy perspective’, Ageing International, vol 34, no 3, pp 172–88. Cheng, S.T. and Chan, A.C.M. (2006) ‘Relationships with others and life satisfaction in later life: do gender and widowhood make a difference?’, The Journal of Gerontology: Psychological Science, vol 61B, no 1, pp 46–53. Cheng, S.T., Chan, A.C.M. and Phillips, D.R. (2008) ‘Ageing trends in Asia and the Pacific’, Regional Dimensions of the Ageing Situation, UN Department of Economic and Social Affairs, United Nations, New York. Available at: www. un.org/ageing/documents/publications/cp-regional-dimension.pdf (accessed 10 August 2011). Choi, S.J. (2000) ‘Ageing in Korea: issues and policies’, in D.R. Phillips (ed) Ageing in the Asia-Pacific region. London: Routledge, pp 223–42. Choi, S.J. (2009) ‘South Korea’, in E.B. Palmore, F. Whittington and S. Kunkel (eds) The international handbook on aging. Santa Barbara, CA: Praeger, pp 497–506. Chow, N.W.S. (2001) ‘The practice of filial piety among the Chinese in Hong Kong’, in I. Chi, N.L. Chappell and J. Lubben (eds) Elderly Chinese in Pacific Rim countries. Hong Kong: Hong Kong University Press, pp 125–36.

121

From exclusion to inclusion in old age

Chow, N. (2006) ‘The practice of filial piety and its impact on long-term care policies for elderly people in Asian Chinese communities’, Asian Journal of Gerontology and Geriatrics, vol 1, no 1, pp 31–5. Furlong, M.S. (2007) Turning silver into gold: how to profit in the new boomer marketplace. Upper Saddle River, NJ: Financial Times Press. Global Action on Aging (2009) ‘Newsletter’, updated 21 September. Available at: http://www.globalaging.org/quickgo.htm (accessed 26 September 2009). Gore, M.S. (1992) ‘Family support to elderly people: the Indian situation’, in H.L. Kendig, A. Hashimoto and L.C. Coppard (eds) Family support for the elderly: the international experience. Oxford: Oxford University Press, pp 260–70. Gu, D., Dupre, M.E. and Liu, G. (2007) ‘Characteristics of the institutionalized and community-residing oldest old in China’, Social Science and Medicine, vol 64, no 4, pp 871–83. Hsu, H.C., Lew-Ting, C.Y. and Wu, S.C. (2001) ‘Age, period, and cohort effects on attitudes toward supporting parents in Taiwan’, The Gerontologist, vol 41, no 6, pp 742–59. Hugman, R. (2000) ‘East–West dialogue in social work for older people and their families’, Asia Pacific Journal of Social Work, vol 10, no 1, pp 59–76. Hwang, G.J. (2009) ‘Old-age security in Korea: the strengthened role of the state?’, in T.H. Fu and R. Hughes (eds) Ageing in East Asia: challenges and policies for the twenty-first century. London: Routledge, pp 72–88. Ikels, C. (ed) (2004) Filial piety: practice and discourse in contemporary East Asia. Stanford, CA: Stanford University Press. Ingersoll-Dayton, B. and Saengtienchai, C. (1999) ‘Respect for the elderly in Asia: stability and change’, International Journal of Aging and Human Development, vol 48, no 2, pp 113–30. Kao, H.F. and Travis, S. (2005) ‘Development of expectations of filial piety scale’, Journal of Advanced Nursing, vol 52, no 6, pp 682–88. Kim, J.S. and Lee, E.H. (2003) ‘Cultural and noncultural predictors of health outcomes in Korean daughter and daughter-in-law caregivers’, Public Health Nursing, vol 20, no 2, pp 111–19. Kinsella, K. and He, W. (2009) ‘An aging world: 2008’, International population reports P95/09-1, US Census Bureau, US Government Printing Office, Washington, DC. Available at: www.census.gov/prod/2009pubs/p95-09-1.pdf (accessed 10 August 2011). Lee, D.T.F. (2001) ‘Perceptions of Hong Kong Chinese elders on adjustment to residential care’, Journal of Interprofessional Care, vol 15, no 3, pp 235–44. Lee, W.K. (2004) ‘Living arrangements and informal support for the elderly: alteration to intergenerational relationships in Hong Kong’, Journal of Intergenerational Relationships, vol 2, no 2, pp 27–49. Li, I.C. and Yin, J.C. (2005) ‘Care needs of residents in community-based longterm care facilities in Taiwan’, Journal of Clinical Nursing, vol 14, no 6, pp 711–18.

122

The impact of changing value systems on social inclusion:

Li, S.-G. (2010) ‘Should the one-child policy continue?’, Beijing Review, 12 April, no 15. Available at: http://www.bjreview.com.cn/forum/txt/2010-04/12/ content_262716.htm Lin, A. (1992) Study of filial piety in Confucian thought. Taipei, Taiwan: Wen Jin. Littlewood, P. and Herkommer, S. (1999) ‘Identifying social exclusion: some problems of meaning’, in P. Littlewood, I. Glorieux, S. Herkommer and I. Jönsson (eds) Social exclusion in Europe: problems and paradigms.Aldershot:Ashgate, pp 1–22. McDonald, P. (2007) ‘The emergence of low fertility as a policy issue’, Asia-Pacific Population Journal, vol 22, no 2, pp 5–9. Ng, A.C.Y., Phillips, D.R. and Lee, W.K.M. (2002) ‘Persistence and challenges to filial piety and informal support of older persons in a modern Chinese society: a case study in Tuen Mun’, Hong Kong, Journal of Aging Studies, vol 16, no 2, pp 1–20. OECD (Organisation for Economic Co-operation and Development) (2010) Health at a glance Asia/Pacific 2010. Paris: OECD. Available at: http://www. oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-asia-pacific2010_9789264096202-en (accessed 10 August 2011). Ong, F.S. and Phillips, D.R. (2007) ‘Older consumers in Malaysia’, International Journal of Ageing and Later Life, vol 2, no 1, pp 83–115. Ong, F.S., Laily, P. and Phillips, D.R. (2009) ‘Empowerment among older consumers in Malaysia’, Hallym International Journal of Ageing, vol 11, no 2, pp 135–54. Pearlin, L., Menaghan, E., Lieberman, M. and Mullan, J. (1981) ‘The stress process’, Journal of Health and Social Behavior, vol 22, no 4, pp 337–56. Phillips, D.R. (ed) (1992) Ageing in East and South-east Asia. London: Edward Arnold. Phillips, D.R. (ed) (2000) Ageing in the Asia-Pacific region. London: Routledge. Phillips, D.R. (2011) ‘Overview of health and ageing issues in the Asia-Pacific region’, in W.C. Chan (ed) Singapore’s ageing population: managing healthcare and end of life decisions. London: Routledge. Phillips, D.R., Siu, O.L.,Yeh, A.G.O. and Cheng, K.H.C. (2005) ‘The impacts of dwelling conditions on older persons’ psychological well-being in Hong Kong: the mediating role of residential satisfaction’, Social Science and Medicine, vol 60, no 12, pp 2785–97. Phillips, D.R., Cheng, K.H.C., Yeh, A.G.O. and Siu, O.L. (2009) ‘Person– environment P–E fit models and psychological well-being among older persons’, Environment and Behavior, vol 17, pp 127–41. Phillips, D.R., Chan, A.C.M. and Cheng, S.T. (2010) ‘Ageing in a global context: the Asia-Pacific region’, in D. Dannefer and C.R. Phillipson (eds) The Sage handbook of social gerontology. London: Sage, pp 430–46. Population Reference Bureau (2009) World populations data sheet.Washington, DC: PRB. Available at: www.prb.org/Publications/Datasheets/2009/2009wpds.aspx (accessed 10 August 2011). Reisman, D. (2009) Social policy in an ageing society: age and health in Singapore. Cheltenham: Edward Elgar.

123

From exclusion to inclusion in old age

Silvergroup (2011) ‘Newsletter’.Available at: http://www.silvergroup.asia (accessed 10 August 2011). Silverstein, M., Li, S. and Zhang, W. (2002) ‘International exchange among older grandparents in rural China’, The Gerontologist, vol 42, no 1, p 69. Tang, C.S.-K., Wu, A.M.S.,Yeung, D. and Yan, E. (2009) ‘Attitudes and intention toward old age home placement: a study of young adult, middle-aged and older Chinese’, Ageing International, vol 34, no 4, pp 237–51. Teo, P., Mehta, K.,Thang, L.L. and Chan,A. (2006) Ageing in Singapore: service needs and the state. London: Routledge. Traphagan, J.W. (2006) ‘Power, family, and filial responsibility related to elder care in rural Japan’, Care Management Journal, vol 7, no 4, pp 205–12. Tsai, J.H. (1999) ‘Meaning of filial piety in the Chinese patient–child relationship: implications for culturally competent health care’, Journal of Cultural Diversity, vol 6, no 1, pp 26–34. Tsuno, N. and Homma, A. (2009) ‘Ageing in Asia – the Japan experience’, Ageing International, vol 34, nos 1/2, pp 1–14. Whyte, M.K. (2004) ‘Filial obligations in Chinese families: paradoxes of modernization’, in C. Ikels (ed) Filial piety: practice and discourse in contemporary East Asia. Stanford, CA: Stanford University Press, pp 106–27. Yan, E.C.,Tang, C.S. and Yeung, D. (2002) ‘No safe haven: a review on elder abuse in Chinese families’, Trauma Violence and Abuse, vol 3, no 3, pp 167–80. Zhan, H.J., Liu, G.Y., Guan, X. and Bai, H.G. (2006) ‘Recent developments in institutional elder care in China: changing concepts and attitudes’, Journal of Aging and Social Policy, vol 18, no 2, pp 85–108. Zhan, H.J., Feng, X. and Luo, B. (2008) ‘Placing elderly parents in institutions in urban China’, Research on Aging, vol 30, no 5, pp 543–71. Zhan, H.J., Feng, Z.L., Chen, Z.Y. and Feng, X. (2011) ‘The role of the family in institutional long-term care: cultural management of filial piety in China’, International Journal of Social Welfare, vol 20, Supplement S1, pp S121–S134. Zheng,Y. and George, L.K. (2010) ‘Population ageing and old-age insurance in China’, in D. Dannefer and C.R. Phillipson (eds) The Sage handbook of social gerontology. London: Sage, pp 420–9.

124

Eight

Age discrimination as a source of exclusion in Europe: the need for a human rights plan for older persons Astrid Stuckelberger, Dominic Abrams and Philippe Chastonay

Introduction In Europe, people are living longer and in better health than ever before (Jagger et al, 2011). The rise of multigeneration societies has created the potential for unprecedented forms of exclusion and discrimination that are intertwined with age, giving rise to new images of ageing and old age and to different attitudes towards old age among older and younger persons. Yet it would be unwise to conceive of ageing per se as a cause of exclusion. In fact, the problem of social exclusion based on age may take different forms in different countries, reflecting their diverse age profiles and expectations as well as differing cultural orientations to age.The very complexity of these differences calls for a reconsideration of the application of distributive justice and highlights the need for a human rights-based approach that includes the old and very old. In this chapter, we argue that the promotion of social inclusion – with a sustainable governance system – through the allocation of equal rights to people of all ages represents an important element of a ‘society for all ages’ (UNECE, 2008). The European Commission (2000a) regards ‘discrimination’ as being the application of different treatment in a negative and unfavourable way, on the basis of race or origin, ethnicity, religion or convictions, handicap, age, or sexual orientation. In addressing the theme of social exclusion based on age discrimination in Europe, this chapter begins with a review of core processes of discrimination and exclusion based on old age, such as ageism, stigmatisation and stereotyping.Where appropriate, recent European data are presented to illuminate these processes.The chapter then evaluates a range of existing policy responses to age discrimination and exclusion in the form of legislative instruments available in European nations. Extending the lens beyond Europe, the focus then moves towards a variety of mechanisms and programmes initiated by the United Nations (UN) in the field of older persons’ human rights.

125

From exclusion to inclusion in old age

Social exclusion: generation and age As noted in Chapter One, social exclusion can take many forms depending on the types of individuals or groups that are affected, the immediate social context, and the broader societal context. For example, exclusion takes different forms in education, health, housing, business or community contexts (Abrams et al, 2007). In the European Union (EU), exclusion has typically been defined and operationalised as being relational and dynamic, and as involving agency; exclusion is not necessarily a fixed or perpetual state (Millar, 2007; see also Chapter One). It does not merely involve exclusion from material resources and opportunities, but also implies non-participation in key activities in society (Burchardt et al, 2002). Given the breadth of the exclusion concept, different policy emphases for tackling social exclusion have been adopted across Europe. For example, while some countries focus on the alleviation of poverty and inequality, others emphasise cultural integration (Gordon, 2007). Recently, Abrams and Christian (2007) proposed a general framework for analysing and understanding social exclusion. It holds that identifying and understanding social exclusion is aided by articulating four general features: 1. who is involved (as either a target or agent of exclusion); 2. where the exclusion is located, its situation and context (from transnational down to personal); 3. how exclusion is expressed or sustained (through ideological, cultural, religious or institutional rules, norms or practices, or specific acts or communication between individuals); and 4. why exclusion is sustained (eg through conflicts of interest, status motives, historical legacy or duration of relationships, or inequalities of resources or abilities). At the root of social exclusion is typically either a presumption or belief that a particular individual or group does not need or deserve treatment that would give them parity with others. Exclusion is generally perpetrated by groups that already have an advantage, although on occasion disadvantaged groups are complicit in their own exclusion through a shared ideology regarding their status (Tajfel and Turner, 1979; Jost and Hunyadi, 2005). Moreover, there is a key psychological process that defines who is involved in excluding and who is excluded, namely the categorisation of people into social groups. In this chapter, we focus on these elements as they are expressed and revealed in social-psychological processes, national and cultural differences, and in the development of international legislation on age discrimination and rights.

126

Age discrimination as a source of exclusion in Europe

Ageism as a cause of stereotyping and exclusion Butler (1969) introduced the term ‘ageism’ to describe a form of prejudice against old age, later defining it as: [a] process of systematic stereotyping of and discrimination against people because they are old, just as racism and sexism accomplish this for skin colour and gender. Old people are categorized as senile, rigid in thought and manner, old-fashioned in morality and skills.… Ageism allows the younger generation to see older people as different than themselves, thus they subtly cease to identify with their elders as human beings. (Butler, 1975, p 35) Schaie (1993, p 49) expanded the definition of ageism and ageist language to prejudice or discrimination against, or in favour of, any age group: Ageism may be defined as a form of culturally based age bias that involves a) restrictiveness of behaviour or opportunities based on age, age-based stereotyping, and distorted perception in the service of maintaining such stereotypes, positive or negative; b) a cultural belief that age is a significant dimension by definition and that it defines a person’s social position, psychological characteristics, or individual experience; or c) the untested assumption that data from one age group generalize to others, or conversely that age is always relevant to variables studied by psychologists (to which we include all social scientists). Much of the empirical work on ageism has been conducted by psychologists who tend to focus on the micro level, that is, the ageist attitudes and behaviours of social actors, as well as consequences for individuals, be they young or old, who are ‘targets of ageism’ (Nelson, 2002; Hagestad and Uhlenberg, 2005). The cumulative effects of ageist attitudes and language on the older person has been demonstrated by several studies and include: self-fulfilling prophecy effects; over-accommodating or patronising communication (Giles et al, 1993, 1994); mistreatment by professionals (Wilkinson and Ferraro, 2002); and neglect, exploitation and abuse by younger adults (Quinn and Tomita, 1986; Hirsh and Vollhardt, 2002). Much less attention has been paid to the wider consequences of ageism on age discrimination and macro-level social exclusion. Common negative stereotypes and discriminatory attitudes have been studied, for example, through behaviour, communication and language (Nuessel, 1984). These attitudes include views that older people are inflexible, lonely, religious, sickly, depressive, senile, rigid, frail and lacking in energy (Schoenfield, 1982; Greene et al, 1986; Grant, 1996; Bowling, 1999; Palmore, 2001; Cardinali and Gordon, 2002). Other assumptions underlie stereotypes about older workers and lead to them being labelled as costly and relatively unproductive (Taylor 127

From exclusion to inclusion in old age

and Walker, 1993, 1998). Attributing such negative stereotypes through language and other observable behaviours often results in discrimination (Palmore, 1999). Ageist attitudes reflect age categorisations, which are associated with specific stereotypes that depend on the perception each age group has of another age group. Much gerontological research is based upon an assumption that, in all its complexity, the ageing process is a reality, but that chronological age is: a time interval with no intrinsic meaning. It is a convenient, heuristic indicator of the ageing of the individual. It is relevant only in that it is the basis of many institutional regulations that have real consequences for the lives of individuals. (Bytheway, 2005, p 363) Thus, ageing involves characteristics that go beyond chronological age (Kite et al, 2005). This is reflected in research on age perception, which shows a surprising lack of public consensus about age categorisation. A nationally representative survey conducted in the UK, showed that people under the age of 25, on average, judged that youth ends at 38 and old age starts at 55 years. This contrasted with perceptions among people over the age of 65, who believed that youth did not end until after 56, and that old age did not start until after the age of 67 (ACE, 2005). Recent analysis of data from 28 countries and over 50,000 respondents in the 4th European Social Survey (ESS) shows dramatic variation in age categorisation across Europe (Abrams et al, 2011a). On average, youth was perceived to end at 40 and old age to start at 62. But the definitions of these labels vary widely between countries. For example, in Greece, youth was perceived to extend until the age of 52, whereas in Norway, it was perceived to end at 34; old age was perceived to start at 68 and 63 years in these countries, respectively. People in Turkey perceived old age to arrive earliest of all (55 years). The point of these comparisons is that the subjective categorisation of people as young or old is substantially determined by factors other than age itself.Yet, once people have categorised someone as young or old, they are then likely to apply stereotypes about age to that person. It is the fact that age categorisation itself can be so variable that makes it difficult to track social exclusion based on age, and why such exclusion is likely to be manifested differently in different national contexts. In order to understand the implications of age categorisation (eg judging that someone is ‘old’), it is important to understand stereotyping. Stereotypes affect how people treat members of social groups because they underpin prejudices and reinforce images of stereotypical behaviour by members of those groups.The stereotype content model (Fiske et al, 2002) holds that groups in society tend to be viewed with stereotypes defined by warmth/coldness on the one hand, and competence/incompetence on the other. Research with representative samples of the population in the UK (Abrams et al, 2009) and across Europe (Abrams et al, 2011a) consistently shows that older people are stereotyped as warmer but less competent than younger people. Older people are also conscious of these stereotypes and are vulnerable to them (Levy, 2003). For example, in one study, 128

Age discrimination as a source of exclusion in Europe

people aged over 60 were asked to take a cognitive test, either under the impression that it was just a test of different people’s ability, or under the impression that the test was to see whether older and younger people performed differently. This latter situation induced ‘stereotype threat’ (Steele, 1997) – anxiety and concern that the ‘elderly’ stereotype might be applied. Performance of older persons dropped dramatically in that situation (Abrams et al, 2006). The importance of such negative stereotyping of older adults should not be underestimated given that positive self-perceptions of ageing can actually increase longevity (Levy et al, 2002). In addition, Levy et al (2009) showed that ageist attitudes and stereotyping lower self-esteem, affect mental and physical health, and decrease quality of life and longevity.This research also demonstrates that people internalise stereotypes of old age when they are still quite young – with far-reaching consequences. Age discrimination may manifest differently in different cultures, but with similarly harmful consequences. In summary, old age stereotypes lead not only to autodiscrimination, but also to age discrimination at the societal level, both of which can result in exclusion. Ageism is unlike prejudices that are manifested against other groups. For example, whereas racism or homophobia are often characterised by antipathy, contempt or fear (Abrams and Houston, 2006), ageism, particularly ageism towards older people, is paradoxically marked by positive feelings such as admiration and warmth. Nonetheless, as Fiske et al (2002) have argued, it is the coexistence of positive and negative stereotypes, such as warmth and incompetence, which gives ageism its dangerous qualities. For example, when older people are viewed as likeable but harmless and ineffectual, they are potentially denied a voice because they may be respected (for their warmth) but ignored (due to their incompetence), and pitied rather than envied (Abrams et al, 2009).This ‘benevolent’ or paternalistic type of prejudice and stigmatisation is a basis for a social exclusion that is just as powerful, and perhaps harder to combat, than more traditionally hostile types of prejudice.

Ageism as a form of age discrimination But is there evidence that ageism is experienced as a serious form of discrimination, rather than being simply an inevitable consequence of people’s recognition of the realities of ageing? Prior reviews and evidence have called into question the extent to which ageing, as distinct from ill-health, actually is debilitating (Sidell, 1995; Nelson, 2005). However, European survey research has shown that ageism is widely experienced and perceived to be a serious problem. On average, 44% of ESS respondents perceived ageism to be a quite or very serious problem, although there were large variations between countries (Abrams et al, 2011a). For example, only 22% of Danish respondents but 68% of French respondents judged ageism to be a serious problem (see Figure 8.1). Moreover, when asked whether they had personally experienced prejudice based on age, gender or ethnicity, more said they had experienced unfair treatment because of their age (35%) than either gender (25%) or ethnicity (17%), indicating 129

From exclusion to inclusion in old age

the pervasiveness of ageism. Again, there were substantial differences between countries. For example, 47% of respondents from the Netherlands but only 24% from Hungary reported receiving unfair treatment because of age. Ageism was more often experienced as being patronised or ignored (39%) than directly insulted or abused (29%). Figure 8.1: Percentage of respondents from different countries in the European Social Survey who regard age discrimination to be a quite serious or very serious problem, 2008 70

47 44

51

52 52

Poland

50

Sweden

57

61

61

Norway

60

Portugal

68 63 64

59

49

44 42 40 41 41 39 40

40 34 34 34

30

36 36

26 27 22

20

17

France

Romania

United Kingdom

Netherlands

Israel

Hungary

Finland

Czech Republic

Germany

Belgium

Switzerland

Slovakia

Spain

Slovenia

Latvia

Estonia

Croatia

Ukraine

Greece

Cyprus

Russian Federation

Bulgaria

Turkey

ESS mean

0

Denmark

10

Source: European Social Survey (Abrams et al, 2011a).

These results are echoed by the European Commission’s third Eurobarometer survey (2009) on attitudes to discrimination in the EU. Eurobarometer – with a sample of 26,756 people interviewed in 30 countries – tracks perceptions of people in Europe towards different forms of discrimination and diversity. The absolute proportions of people reporting any type of discrimination are much lower than those in the ESS as a result of differences in question wording. However, as in earlier Eurobarometer surveys in 2007 and 2008, age discrimination was reported by more people than any other type of discrimination. In keeping with the ESS data, the Eurobarometer evidence also shows that almost as many people perceive age discrimination to be widespread as ethnic discrimination. Moreover, there has been a disproportionate increase since 2008 in the number of people who consider that there is widespread discrimination based on age (up 16 percentage 130

Age discrimination as a source of exclusion in Europe

points since 2008 compared with an increase of 8 percentage points for disability, no change for ethnicity, and decreases of 4 percentage points for sexual orientation and 3 percentage points for religion) (see Figure 8.2). Figure 8.2: Perceptions of discrimination on the basis of age and other criteria, EU, 2009 QE1 Perception of discrimination on the basis of ...

Rare

... Ethnic origin 2009 2008 ... Age 2009 2008

61

33

62

37

58 42

41

53

49

... Sexual orientation 2009 2008

... Religion or belief 2009 2008

32

52

... Disability 2009 2008

... Gender 2009 2008

Widespread

45 47

43 41 53 56

51 40 36

35 51

39 42

Source: Eurobarometer (European Union, 2009).

Capturing pervasive social attitudes and expectations about work and age is helpful in highlighting the potential value of anti-discriminatory employment legislation. For instance, in the 2008 ESS, 51% of respondents, and particularly those aged 50–64 (57%), were concerned that employers would show preference to people in their 20s. On average, people viewed a suitably qualified 30 year old to be more acceptable as an employee than an equally qualified 70 year old. And 57% of people perceived those aged over 70 years as contributing little to their national economy. Such views vary sharply between nations. For example, while fewer than 15% of UK respondents viewed people over 70 as placing a burden on health services, the respective proportion was 50% in the Czech Republic (Abrams et al, 2011b).

131

From exclusion to inclusion in old age

These data highlight three key points. First, ageism is perceived and experienced as a widespread and serious problem in Europe. Second, it is more likely to take subtle or indirect than direct and hostile forms. Third, there are large variations among countries, showing that ageism is strongly influenced by legislative, cultural and other factors; that is, ageism is something that can, in principle, be challenged and reduced.

EU legal framework for combating age discrimination and exclusion Having identified ageism as representing a source of age discrimination and exclusion, and as something that can be challenged by appropriate policy measures, we now examine the ways in which the EU has sought to address these issues. In this respect, it is helpful to begin by noting the differences that exist between agebased discrimination on the one hand, and discrimination affecting other social groups such as women, children or people with disabilities on the other (Kite and Wagner, 2004).Two main sources of difference can be identified. First, ageing is a process embedded in a lifetime and the great majority of people born today can now expect to reach old age. As a result, ageing might be associated with a cumulative process of discrimination throughout the life course.This distinguishes it from other forms of discrimination. Moreover, where ageing intersects with other disadvantageous social positions, outcomes may be particularly challenging. Women, for example, may experience a lifetime of gender-based discrimination, which bears serious consequences in old age. They may have been denied an education as girls, forced into non-paid labour in their youth, married young, denied their reproductive rights, subjected to physical and/or sexual violence, unable to have an independent economic life with a bank account and assets, and denied multiple rights such as paid work and inheritance rights as an older widow. They may, hence, be destined to spend their old age in poverty, excluded from their fundamental human rights. Second, unlike other types of discrimination, such as racism or sexism, under some circumstances, and in particular nations, age discrimination can be officially sanctioned. Examples include policies that encourage early retirement, as was the case in Europe for much of the 1990s. Similarly, employers may be permitted to discriminate on the basis of age if they can demonstrate that age differentiation is a legitimate aim – for example, when jobs require particular competencies, such as specific technological skills, which are less prevalent in the older age group because of a cohort effect. These features of age-related discrimination highlight the need for ‘evidencebased legislation’ (Jones, 2009), at European and international level, to prevent age discrimination and to ensure equal rights for, and eliminate harmful practices against, older persons (Age UK, 2011). This might explain why age discrimination has been the first feature to be included in recent European legal directives, particularly on employment.While large-scale surveys and experimental 132

Age discrimination as a source of exclusion in Europe

research can demonstrate the overall impact of ageism on individuals’ lives, it is also necessary to generate clear and vivid case studies to exemplify the multiple and cumulative consequences of the violation of older persons’ human rights in terms of such negative outcomes as exclusion, reduced quality of life, ill-health and poverty (Fromont, 2001; Niveau and Dang, 2008). In his later work, Peter Townsend (2007) drew heavily on such case studies to argue for a human rightsbased approach to addressing disadvantage in later life. In the EU, age discrimination is most often used as a legal term. Its definition and description are embedded in European anti-discrimination legislation, which is one of the most extensive in the world (Sargeant, 2008). In considering the ways in which the EU has grappled with the issue of age discrimination, the European experience provides an example of how a wider international framework might be developed. In addition to the EU Directives, outlined later, there are several other provisions that recognise the specific vulnerability of older persons and call on European nations to take measures to protect ageing adults.Viewed through the lens of social exclusion, such measures tend to emphasise the need to provide ageing adults with sufficient material and social resources, and with access to appropriate support and services, to enable their continued participation in society. For example, the Council of Europe’s (1996) European social charter (revised) recognises ‘the right of elderly persons to social protection’ (Article 23), and calls on European states to adopt or encourage appropriate measures to: 1. enable elderly persons to remain full members of society for as long as possible; 2. enable elderly persons to choose their lifestyle freely and to lead independent lives in their familiar surroundings for as long as they wish and are able; and 3. guarantee elderly persons living in institutions appropriate support, while respecting their privacy, and participation in decisions concerning living conditions in the institutions. Within the EU, the most recent reinforcement of fundamental rights and non-discrimination came in 2000 with the proclamation of the ‘Charter of Fundamental Rights’. Article 21 of the Charter: prohibits discrimination on any ground such as sex, race, colour, ethnic or social origin, genetic features, language, religion or belief, political or any other opinion, membership of a national minority, property, birth, disability, age or sexual orientation and also discrimination on the grounds of nationality. (European Union, 2000) Also in 2000, the EU adopted two far-reaching laws to combat discrimination in the workplace. These laws – termed Directives within the EU context – have since been incorporated into Article 19 of the 2009 Treaty of Lisbon, which forms the constitutional base of the European Union. First, the Employment Equality Directive (2000/78) protects everyone in the EU from discrimination 133

From exclusion to inclusion in old age

and represented the first specific acknowledgement of age. Under the Directive, age is granted equal status to other forms of discrimination based on gender, racial or ethnic origin, religion or belief, disability, or sexual orientation. Article 2 of the Directive is explicit about the concept of discrimination drawing on the ‘principle of equal treatment’, particularly in relation to employment: ‘The principle of equal treatment for men and women whatever their age as regards access to employment, including promotion, and to vocational training and as regards working conditions and social security’. Second, the Racial Equality Directive (2000/43) was introduced (European Commission, 2000b).Alongside the Employment Equality Directive, this identifies four forms of prohibited discrimination. In addition to outlawing harassment – conduct that has the ‘purpose or effect of violating the dignity of a person and of creating an intimidating, hostile, degrading, humiliating or offensive environment’ (European Union, 2009) – and instructions to discriminate, both direct and indirect forms of discrimination are prohibited. Direct discrimination occurs when a person is treated less well, in comparison with someone else, because of his or her racial or ethnic origin, religion or belief, disability, age, or sexual orientation.This might arise, for example, when an employer refuses to hire suitably qualified people simply because they are of a certain age, or when an employer specifies in a job advert that only young people should apply even though the job in question could be done perfectly well by an older person. Indirect discrimination reflects a situation in which an apparently neutral specification, criterion or practice would disadvantage people on the grounds of racial or ethnic origin, religion or belief, disability, age, or sexual orientation unless the practice can be objectively justified by a legitimate aim.An example of such discrimination would be when a company insists that all those applying for jobs have a driving licence even though this is not a core requirement for doing the job. This might prevent some people who do not drive (including those who are older or have disabilities that prevent them from driving) from securing the job. It is interesting to note that the first area in which application of the EU’s Charter of Fundamental Rights has been successfully implemented is that of work and employment.The Employment and Equality Regulations have inspired new age discrimination legislation in all EU member states, including Ireland (1998), Denmark (2004) and the UK (2006). Building on the new regulations, several countries have also passed anti-discrimination acts and equal opportunity laws or have either adapted, or are in the process of adapting, their national constitutions (eg Germany, Greece and Lithuania). While Hungary and the Netherlands now have dedicated anti-discrimination and/or equal treatment authorities, Cyprus and Austria have introduced an ombudsperson for equal treatment and are preparing for the establishment of a monitoring and advisory office on age discrimination (UNECE, 2008). Despite the progress made, the outcomes vary across countries and protection in a range of areas requires more development. Of course, many practical difficulties arise when implementing a rights-based policy approach to age discrimination.Three key lessons have been learnt from a 134

Age discrimination as a source of exclusion in Europe

range of countries about this experience. First, legislation by itself is inadequate in bringing about changes in behaviour, and attitude change is crucial. Second, legislation can only help to change attitudes when it is combined with employer education and other policies to promote equal rights for older workers. Third, eradicating ageist employment practices is a ‘long-term process’. Moreover, in the EU context, even though direct and indirect forms of age discrimination are now contrary to law – following the Employment Equality Directive (2000/78) referred to earlier – there are gaps in the legislation. For example, Article 6 of the Directive permits a justification for discrimination where, in the context of national law, it is ‘objectively and reasonably justified by a legitimate aim, including legitimate employment policy, labour market and vocational training objectives, and if the means of achieving that aim are appropriate and necessary’. A case heard in 2009 at the European Court of Justice (ECJ) concerns the extent to which this justification permits an employer to treat workers differently purely on the grounds of age (McKay, 2009). The case raised the issue of retirement in relation to age discrimination leading to the ECJ ruling that there can be justifiable reasons for dismissing workers on account of their age and that this would not necessarily infringe EU law. The case concerned the Incorporated Trustees of the National Council on Ageing (Age Concern England) vs. Secretary of State for Business, Enterprise and Regulatory Reform (Case C-388/07). It addressed the UK’s age discrimination legislation, which specifically permits employers to dismiss their employees at the age of 65 years without such treatment being regarded as discriminatory.The National Council on Ageing, a charity promoting the well-being of older people, challenged the legality of the UK legislation as being contrary to Directive 2000/78, arguing that the country’s legislation had failed to specify the kinds of differences in treatment that would be justified under an Article 6 exemption. In ruling against the National Council on Ageing, the ECJ stated that there was no requirement to specify these differences in national law. Provided that the national courts in EU member states determined that the legislation at issue was consistent with a legitimate aim, as highlighted in Article 6, and that the means chosen were appropriate and necessary to achieve that aim, the law was deemed to be in compliance with Directive 2000/78. This recent case shows that age discrimination – a key element of the exclusion of older people from the labour market and, more broadly, from access to material resources – continues to be a matter of concern despite progressive legislation. Even in the EU, where age discrimination legislation is relatively well developed by international standards, a strong case can be made for suggesting that more needs to be accomplished if age equality in all activities and policies is to be achieved.

The need for an international human rights framework In international terms, the EU effort to develop a legislative framework to protect the rights of older citizens, especially in relation to employment, is unique. This 135

From exclusion to inclusion in old age

situation reflects the general lack of instruments and international consensus over combating age discrimination and the social exclusion of older people. This is perhaps surprising, given that the potential exists to locate older people’s rights within a broader framework of international human rights. The human rights approach to employment is holistic and extends beyond the parameters of the International Labour Organization’s (ILO’s) social justice approach (MacNaughton and Frey, 2010). It was reaffirmed in the 1993 UN Vienna Declaration and Programme of Action, which states: ‘All human rights are universal, indivisible and interdependent and interrelated. The international community must treat human rights globally in a fair and equal manner, on the same footing and with the same emphasis.’ Given that human rights are by definition universal, at least in theory, a whole array of internationally recognised human rights standards and principles also covers and protects older persons. However, potentially reflecting the limited focus on population ageing at the time of its ratification in 1948, the UN’s Universal Declaration of Human Rights fails to accord sufficient attention to old age. Indeed, older persons are not only excluded from the UN’s binding human rights instruments, but also from its mainstream agenda, as reflected, for example, in the Millennium Development Goals. While age at work has been regulated in terms of the minimum age at which one is permitted to work by the Convention on the Child (ILO Convention No 138), no equivalent regulation relates to age discrimination. Consequently, in many nations, older persons continue to experience discrimination on the basis of their age and inadequate recognition of their human rights. Further, older people’s specific needs are too often underestimated, thus providing a context for the risk of abuse, neglect and violence.This not only affects the older person, but also their families and society as a whole (WHO, 2002).Although some countries have enacted partial legislation, to date, the human rights and ethical framework to eliminate discrimination, exclusion, abuse or unequal treatment due to age has barely been addressed at the UN or at the European level (Stuckelberger, 2006, 2008). Numerous international instruments – including, for example, the Covenants on Economic, Social and Cultural Rights, and on Civil and Political Rights, as well as the Convention on All Forms of Discrimination against Women (CEDAW/ General Assembly resolution 34/180, 18 December 1979) – refer to the rights of all without specifically mentioning older persons or age.The Universal Declaration of Human Rights makes passing reference to the particular vulnerability of older persons in Article 25, stipulating that: everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including … medical care and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

136

Age discrimination as a source of exclusion in Europe

It was not until the UN’s Declaration on Social Progress and Development in 1969 that there was more than a passing mention of old age (Article 11). It then took until 1982 for the UN to adopt a First International Plan of Action on Ageing at a meeting in Vienna. In 1991, the General Assembly produced the UN Principles for Older Persons (Resolution 46/91), which reaffirm fundamental human rights, the dignity and worth of the human being, and the need for equality in five areas: independence, participation, care, self-fulfilment and dignity. To date, the most important elements of the international legal standards emerged in 1995 with the adoption of General Comment No 6 on the Economic, Social and Cultural Rights of Older Persons (Doc E/1996/22,Annex IV). General Comments are important in the sense that they reflect the interpretation of the provisions of Covenants adopted by the UN General Assembly by internationally recognised independent experts. Comment No 6 stressed that states belonging to the UN needed to adapt their social and economic policies to respond to the needs of ageing populations and that they should give more consideration to older persons in their human rights monitoring and reporting.The General Comment also sheds light on the relationship between the provisions of the International Covenant on Economic, Social and Cultural Rights, theVienna International Plan of Action on Ageing, and the United Nations Principles for Older Persons, clearly indicating the interrelationship of both binding and non-binding commitments. At present, this remains the only UN document focusing on the rights of older persons that has been adopted by the United Nations Treaty Body. Nevertheless, the General Comment is considered to be a ‘soft law’ – that is, one that is not as binding for signatory states of the Covenant as the articles of the international treaties. In addition, although the issue of older persons’ rights may be related to the mandate of this Treaty Body within the economic, social and cultural areas, the committee monitoring the implementation of the Covenant on Economic, Social and Cultural Rights is not mandated to focus on this issue since there is no particular provision within the Covenant for such a right. Nevertheless, despite such weaknesses, there are recent signs of progress in relation to older persons’ human rights. This draws in particular on the work of non-governmental organisations (NGOs) at the Human Rights Council in Geneva (United Nations, 1999; Stuckelberger, 2011). Strong statements were adopted in 2006 (on the right of older persons, signed by 24 NGOs) and 2009 (on the right of older women, signed by 34 NGOs) (Stuckelberger, 2009). Four key initiatives have since been taken by the UN: • First, General Recommendation No 27 concerning older women and the protection of their rights was adopted by the Committee responsible for the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW, 2010).The recommendation addresses a range of issues relating, for example, to access to education, social pensions and adequate housing. It also has a particular focus on addressing multiple discrimination against older women.

137

From exclusion to inclusion in old age

• Second, the 2010 annual report of the UN’s Independent Expert on Human Rights and Extreme Poverty addresses the role that social protection systems play in reducing extreme poverty and contributing to the realisation of human rights of older persons. In particular, the report focuses on the relevance of social pensions (as discussed in Chapter Four in relation to Brazil and South Africa). The Independent Expert calls on states to recognise that social pensions are critical elements for the progressive realisation of the right to social security for older persons. • Third, in 2010, the fourth session of the Human Rights Council Advisory Committee received a working paper on the necessity of a human rights approach and effective UN mechanism for the human rights of older persons (Chung, 2010).The paper, which has yet to be adopted by the Human Rights Council, makes a strong case for implementation of an international human rights framework for older people, arguing that a ‘systematic and comprehensive mechanism’ is needed to protect older persons’ rights. • Fourth, also in 2010, the UN established an Open-ended Working Group on the Rights of Older Persons with the purpose of ‘strengthening the protection of the human rights of older persons by considering the existing international framework of the human rights of older persons and identifying possible gaps and how best to address them, including by considering, as appropriate, the feasibility of further instruments and measures’. Notwithstanding such developments, the absence of a specific framework for older persons’ human rights at the EU and UN raises several challenging questions. For example, there is the practical question of whether an international human rights framework for older people is even possible. Then there is the issue of whether such a framework should be mainstreamed or adopted as a stand-alone measure, or even a combination of both. In responding to questions concerning characteristics that are specific to old age, the broader issue is raised about the extent to which older persons require particular forms of protection.While some would argue that older people are already sufficiently protected by existing human rights standards and treaty bodies, others hold the view that it is impossible to respond sufficiently to any global agenda – such as the Millennium Development Goals – by systematically excluding or neglecting old age (see, eg, Doron and Apter, 2010; see also Tang and Lee, 2006; Aboderin, 2010; McDonald, 2010).

Conclusion In this chapter, we have argued that the promotion of social inclusion through the allocation of equal rights to people of all ages represents an important element of a ‘society for all ages’ (Stuckelberger and Vikat, 2008; UNECE, 2008). In addressing the theme of social exclusion based on age discrimination in Europe, and drawing on relevant survey data, we reviewed core processes of discrimination and exclusion based on old age, such as ageism, stigmatisation and stereotyping. 138

Age discrimination as a source of exclusion in Europe

We then examined existing policy responses to age discrimination and exclusion in the form of legislative instruments available in European nations, and more broadly through UN mechanisms. In this context, we have suggested that age discrimination and age stereotyping is emerging in different fields as a key area of social exclusion, whether in relation to employment, health care or the fair distribution of assets and resources, especially for women. As a result, there is a strong case to be made for more concerted action at the policy level to address exclusion on the basis of age. Despite some achievements in terms of developing protection and rights for older persons, much remains to be done. And, without additional interventions, legislating for older persons’ rights is insufficient. Appropriately robust mechanisms to monitor and protect those rights are just as important and should be incorporated systematically and comprehensively into future international and national legislation and policies. Exercising rights against discrimination requires a thorough analysis of agespecific situations and factors that accentuate discrimination in contexts beyond the workplace. For example, there is further conceptual work to be done in relation to connecting key dimensions of the exclusion discourse to relevant legal frameworks.This applies to such issues as loneliness, isolation and the sufficiency of material resources in old age. In sum, there is still a lot to do if we are to implement ‘evidence-based policies’, give access to equal rights for people of all ages, prevent the discrimination and exclusion of older men and older women, and to truly achieve the UN’s goal of a ‘society for all ages’. References Aboderin, I. (2010) ‘Understanding and advancing the health of older populations in sub-Saharan Africa: policy perspectives and evidence needs’, Public Health Reviews, vol 32, no 2, pp 357–76. Abrams, D. and Christian, J.N. (2007) ‘A relational analysis of social exclusion’, in D. Abrams, J.N. Christian and D. Gordon (eds) Multidisciplinary handbook of social exclusion research. Oxford: Wiley-Blackwell, pp 211–32. Abrams, D. and Houston, D.M. (2006) Equality, diversity and prejudice in Britain: report for the Cabinet Office Equalities Review. London: Department for Communities and Local Government. Available at: http://kar.kent.ac.uk/4106/ (accessed 8 August 2011). Abrams, D., Eller, A. and Bryant, J. (2006) ‘An age apart: the effects of intergenerational contact and stereotype threat on performance and intergroup bias’, Psychology and Aging, vol 21, pp 691–702. Abrams, D., Christian, J.N. and Gordon, D. (eds) (2007) Multidisciplinary handbook of social exclusion research. Oxford: Wiley-Blackwell. Abrams, D., Eilola, T. and Swift, H. (2009) Attitudes to age in Britain 2004–08, Research Report No 599. London: Department for Work and Pensions.Available at: http://research.dwp.gov.uk/asd/asd5/rports2009-2010/rrep599.pdf (accessed 8 August 2011).

139

From exclusion to inclusion in old age

Abrams, D., Russell, P.S,Vauclair, M. and Swift, H. (2011a) Ageism in Europe: findings from the European Social Survey. London: Age UK. Available at: http://www. ageuk.org.uk/documents/en-gb/id10704%20ageism%20across%20europe%20 report%20interactive.pdf?dtrk=true (accessed 8 August 2011). Abrams, D., Vauclair, M. and Swift, H. (2011b) Predictors of attitudes to age across Europe. Research Report No 735. London: Department for Work and Pensions. Available at: http://research.dwp.gov.uk/asd/asd5/rports2011-2012/rrep735. pdf (accessed 8 August 2011). ACE (Age Concern England) (2005) How ageist is Britain?,Age Concern England Report to the Commission on Equality and Human Rights. London: Age Concern England. Available at: http://www.ageuk.org.uk/documents/engb/for-professionals/equality-and-human-rights/how_ageist_is_britain_pro. pdf?dtrk=true (accessed 8 August 2011). Age UK (2011) Grey matters – a survey of ageism across Europe: EU briefing and policy recommendations. London: Age UK. Available at: http://www.ageuk.org. uk/Documents/EN-GB/For-professionals/ageism_across_europe_report. pdf?dtrk=true (accessed 8 August 2011). Bowling, A. (1999) ‘Ageism in cardiology’, British Medical Journal, vol 319, pp 1353–5. Burchardt, T., Le Grand, J. and Piachaud, D. (2002) ‘Degrees of exclusion: developing a multidimensional, dynamic measure’, in J. Hills, J. Le Grand and D. Piachaud (eds) Understanding social exclusion. New York, NY: Oxford University Press, pp 30–43. Butler, N.R. (1969) ‘Ageism: another form of bigotry’, The Gerontologist, vol 9, pp 243–6. Butler, N.R. (1975) Why survive? Being old in America. New York, NY: Harper and Row. Bytheway, B. (2005) ‘Ageism and age categorization’, Journal of Social Issues, vol 61, pp 361–74. Cardinali, R. and Gordon, Z. (2002) ‘Ageism: no longer the equal opportunity stepchild’, Equal Opportunities International, vol 21, pp 58–68. CEDAW (Committee on the Elimination of Discrimination against Women) (2010) General recommendation No 27 on older women and protection of their human rights. New York, NY: United Nations. Available at: http://www2.ohchr.org/ english/bodies/cedaw/comments.htm (accessed 8 August 2011). Chung, C. (2010) ‘The necessity of a human rights approach and effective United Nations mechanism for the human rights of the older person’, Working Paper, Human Rights Council Advisory Committee, Fourth Session, 25–29 January.Available at: http://www2.ohchr.org/english/bodies/hrcouncil/ advisorycommittee/session4/documentation.htm (accessed 8 August 2011). Council of Europe (1996) European social charter (revised). Strasbourg: Council of Europe. Available at: http://conventions.coe.int/treaty/en/treaties/html/163. htm (accessed 8 August 2011).

140

Age discrimination as a source of exclusion in Europe

Doron, I. and Apter, I. (2010) ‘The debate around the need for an international convention on the rights of older persons’, The Gerontologist, vol 50, no 5, pp 586–93. European Commission (2000a) ‘Council Directive 2000/78/EC of 27 November 2000 establishing a general framework for equal treatment in employment and occupation’, Official Journal L 303, 02/12/2000 P. 0016– 0022. Available at: http://eur-lex.europa.eu/LexUriServ/LexUriServ. do?uri=CELEX:32000L0078:en:HTML (accessed 8 August 2011). European Commission (2000b) ‘Council Directive 2000/43/EC of 29 June 2000 implementing the principle of equal treatment between persons irrespective of racial or ethnic origin’, Official Journal L 180, 19/07/2000 P. 0022– 0026. Available at: http://eur-lex.europa.eu/LexUriServ/LexUriServ. do?uri=CELEX:32000L0043:en:HTML (accessed 30 March 2012). European Union (2000) ‘Charter of fundamental rights of the European Union’, Official Journal of the European Union, C364/1. Available at: http://ec.europa.eu/ justice/fundamental-rights/index_en.htm (accessed 8 August 2011). European Union (2009) Discrimination in the EU in 2009. Special Eurobarometer 317. Brussels: European Commission. Available at: http://ec.europa.eu/public_ opinion/archives/ebs/ebs_317_en.pdf (accessed 8 August 2011). Fiske, S.T., Cuddy, A.J.C., Glick, P. and Xu, J. (2002) ‘A model of (often mixed) stereotype content: competence and warmth respectively follow from perceived status and competition’, Journal of Personality and Social Psychology, vol 82, pp 878–902. Fromont, M. (2001) Grands systèmes de droit étrangers (4th edn). Paris: Dalloz. Giles, H., Fox, S. and Smith, E. (1993) ‘Patronizing the elderly: intergenerational evaluations’, Research on Language and Social Interaction, vol 26, pp 129–49. Giles, H., Fox, S., Harwood, J. and Williams, A. (1994) ‘Talking age and aging talk: communicating through the life span’, in M. Hummert, J. Wiemann and J. Nussbaum (eds) Interpersonal communication in older adulthood: interdisciplinary theory and research. New York, NY: Sage, pp 130–61. Gordon, D. (2007) ‘History and development of social exclusion and policy’, in D. Abrams, J.N. Christian and D. Gordon (eds) Multidisciplinary handbook of social exclusion research. Oxford: Wiley, pp 193–210. Grant, L.D. (1996) ‘Effects of ageism on individual and health care providers’ responses to healthy aging’, Health and Social Work, vol 21, pp 9–17. Greene, M.G., Adelman, R., Charon, R. and Hoffman, S. (1986) ‘Ageism in the medical encounter: an exploratory study of the doctor–elderly patient relationship’, Language and Communication, vol 6, pp 113–24. Hagestad, G.O. and Uhlenberg, P. (2005) ‘The social separation of old and young: a root of ageism’, Journal of Social Issues, vol 61, no 2, pp 343–60. Hirsch, R.D. and Vollhardt, B.R. (2002) ‘Elder maltreatment’, in R. Jacoby and C. Oppenheimer (eds) Psychiatry in the elderly. New York, NY: Oxford University Press, pp 896–918.

141

From exclusion to inclusion in old age

Jagger, C., Weston, C., Cambois, E., Van Oyen, H., Nusselder, W., Doblhammer, G., Rychtarikova, J., Robine, J.-M. and the EHLEIS team (2011) ‘Inequalities in health expectancies at older ages in the European Union: findings from the Survey of Health and Retirement in Europe (SHARE)’, Journal of Epidemiology and Community Health, online first (doi:10.1136/jech.2010.117705). Jones, V. (2009) ‘Evidence-based legislation? Lessons from abroad’, Science-based Medicine, 12 March.Available at: http://www.sciencebasedmedicine.org/?p=405 (accessed 8 August 2011). Jost, J.T. and Hunyadi, O. (2005) ‘Antecedents and consequences of system justifying ideologies’, Current Directions in Psychological Science, vol 14, pp 260–5. Kite, M.E. and Wagner, I.S. (2004) ‘Attitudes towards older adults’, in T.D. Nelson (ed) Ageism: stereotyping and prejudice against older persons. Cambridge, MA: MIT, pp 129–62. Kite, M.E., Stockdale, G.D., Whitley, B.E. and Johnson, B.T. (2005) ‘Attitudes toward younger and older adults: an updated meta-analytical review’, Journal of Social Issues, vol 61, pp 241–66. Levy, B.R. (2003) ‘Mind matters: cognitive and physical effects of ageing selfstereotypes’, The Journals of Gerontology: Series B: Psychological Sciences and Social Sciences, vol 58B, pp 203–11. Levy, B.R., Slade, M.D., Kunkel, S.R. and Kasl, S.V. (2002) ‘Longevity increased by positive self-perceptions of aging’, Journal of Personality and Social Psychology, vol 83, pp 261–70. Levy, B.R., Zonderman,A.B., Slade, M.D. and Ferrucci, L. (2009) ‘Age stereotypes held earlier in life predict cardiovascular events in later life’, Psychological Science, vol 20, p 296. MacNaughton, G. and Frey, D.F. (2010) ‘Decent work, human rights and the Millennium Development Goals’, Hastings Race and Poverty Law Journal, vol 7, p 303. McDonald, T. (2010) ‘Older adults’ human rights – a critical issue for all’, Journal of Nursing Science, vol 28, no 4, pp 14–19. McKay, S. (2009) ‘ECJ rulings on retirement age and discrimination law’,Working Lives Research Institute, EU document EU0905019I. Available at: http:// www.eurofound.europa.eu/eiro/2009/05/articles/eu0905019i.htm (accessed 8 August 2011). Millar, J. (2007) ‘Social exclusion and social policy research: defining exclusion’, in D. Abrams, J.N. Christian and D. Gordon (eds) Multidisciplinary handbook of social exclusion research. Oxford: Wiley, pp 1–16. Nelson, T.D. (ed) (2002) Ageism: stereotyping and prejudice against older persons. Cambridge, MA: MIT Press. Nelson, T.D. (2005) ‘Ageism: prejudice against our feared future self ’, Journal of Social Issues, vol 61, pp 207–21. Niveau, G. and Dang, C. (2008) ‘Nouveaux enjeux de la psychiatrie médicolégale’, Revue Medicale Suisse, vol 4, pp 1600–4. Nuessel, F.H. (1984) ‘Ageist language’, Maledicta, vol 8, pp 17–28. 142

Age discrimination as a source of exclusion in Europe

Palmore, E.B. (1999) Ageism: negative and positive. New York, NY: Springer. Palmore, E.B. (2001) ‘The ageism survey: first findings/response’, The Gerontologist, vol 41, pp 572–5. Quinn, M.J. and Tomita, S.K. (1986) Elder abuse and neglect: causes, diagnosis, and intervention strategies. New York, NY: Springer. Sargeant, M. (2008) The law on age discrimination in the EU. Bedfordshire: Kluwer International. Schaie, K.W. (1993) ‘Ageist language in psychological research’, American Psychologist, vol 48, pp 49–51. Schoenfield, D. (1982) ‘Who is stereotyping whom and why?’, The Gerontologist, vol 22, pp 267–72. Sidell, M. (1995) Health in old age: myth, mystery and management. London: Open University Press. Steele, C.M. (1997) ‘A threat in the air: how stereotypes shape intellectual identity and performance’, American Psychologist, vol 52, pp 613–29. Stuckelberger,A. (2006) ‘Improving the quality of life for older persons: advancing UN global strategies – the European perspective’, Proceedings of Conference for the Department of Public Information, United Nations, NewYork.Available at: http://www.un.org/webcast/SE2006.html (accessed 8 August 2011). Stuckelberger, A. (2008) ‘Human rights and ethics for older persons at the United Nations’, Civil Society Forum on Ageing, Colección Documentos, Serie Documentos Encuentros, No 23005 Ministry of Education, Social Policy and Sports, Secretary of State for Social Services, Family and Disabled People (IMSERSO), Government of Spain, pp 175–81. Stuckelberger, A. (2009) ‘Official Statement on the Rights of Older Women for the 10th Human Rights Council: “Urgent Call to Protect Older Women and their Human Rights” under item 3 “Promotion and protection of all human rights, civil, political, economic, social and cultural rights, including the right to development”’. Available at: http://www.spssi.org/_data/global/images/ NGO%20Statement_Right%20OlderWomen_Official2009.pdf (accessed 8 August 2011). Stuckelberger, A. (2011) Human rights of older persons at the United Nations: how are we advancing?, AAFI-FAFICS Bulletin. Geneva: United Nations. Stuckelberger,A. andVikat,A. (2008) A society for all ages: challenges and opportunities. United Nations Economic Commission for Europe (UNECE). Geneva and New York: United Nations.Available at: http://www.unece.org/pau/pub/mipaa.htm (accessed 8 August 2011). Tajfel, H. and Turner, J.C. (1979) ‘An integrative theory of intergroup conflict’, in W.G. Austin and S. Worchel (eds) The social psychology of intergroup relations. Monterey, CA: Brooks/Cole, pp 33–47. Tang, K.-L. and Lee, J.-J. (2006) ‘Global social justice for older people: the case for an international convention on the rights of older people’, British Journal of Social Work, vol 36, no 7, pp 1135–50.

143

From exclusion to inclusion in old age

Taylor, P.E. and Walker, A. (1993) ‘Employers and older workers’, Employment Gazette, vol 101, no 8, pp 371–78. Taylor, P.E. and Walker, A. (1998) ‘Employers and older workers: attitudes and employment practices’, Ageing and Society, vol 18, pp 641–58. Townsend, P. (2007) ‘Using human rights to defeat ageism: dealing with policyinduced “structured dependency”’, in M. Bernard and T. Scharf (eds) Critical perspectives on ageing societies. Bristol: Policy Press, pp 27–44. UNECE (United Nations Economic Commission for Europe) (2008) A society for all ages: challenges and opportunities. Geneva and New York: United Nations Economic Commission for Europe.Available at: http://live.unece.org/fileadmin/ DAM/pau/_docs/pau/2008/PAU_2008_Publ_LeonTitlePrefaceAndContents. pdf (accessed 8 August 2011). United Nations (1999) Human rights and older persons. Geneva: United Nations. WHO (World Health Organization) (2002) World report on violence and health. Geneva: World Health Organization. Available at: http://whqlibdoc.who.int/ hq/2002/9241545615.pdf (accessed 8 August 2011). Wilkinson, J.A. and Ferraro, K.F. (2002) ‘Thirty years of ageism research’, in T.D. Nelson (ed) Ageism: stereotyping and prejudice against older adults. Cambridge, MA: MIT Press, pp 339–58.

144

Nine

Towards inclusive built environments for older adults Atiya Mahmood and Norah Keating

Introduction Much of the discussion of social exclusion highlighted in this book has emphasised macro issues that influence opportunities for older adults to experience full citizenship. Global patterns of changes in the political economy (Chapter Two), of adherence to strict rules of filial piety (Chapter Seven) and of widespread migration in the face of economic recession, political turmoil and natural disasters (Chapter Three), all point to risks of exclusion of older adults. At a more micro level, the residential context is both immediate and important in shaping older adults’ ability to participate in society (Scharf et al, 2002, 2005). Given the evidence that a major portion of day-to-day living, caregiving, support for activities of daily living and participation in social and civic life by older adults takes place in or near their homes and neighbourhoods (Glass and Balfour, 2003), understanding the opportunities and constraints afforded by residences and neighbourhoods is central to the growing discourse about exclusion of older adults. Further, the residential and neighbourhood environments become increasingly salient to those older adults faced with multiple personal and social changes that may limit their daily activities to their immediate or nearby surroundings (Dobson and Gilroy, 2009;Wahl and Oswald, 2010). It is these older adults who may be at particularly high risk of isolation, especially those in advanced old age who spend the majority of their time in their homes (Baltes et al, 1999; Oswald and Wahl, 2005). The central argument of this chapter is that physical aspects of housing and the neighbourhood play an important role in facilitating or inhibiting social inclusion of older adults, especially those with physical and/or cognitive disabilities. This chapter takes as its focus the built environment, including the residence of the older person and the neighbourhood that extends beyond the home. It is set within the research and policy literature in Western Europe and North America where much of the research on built environments of residences and neighbourhoods has occurred. Reflecting the major focus of research and policy development in Western nations, it is the urban environment that provides the main source of evidence for this chapter. Not only has the number of older adults increased disproportionately in urban locations in recent years (Smith, 2009), 145

From exclusion to inclusion in old age

but also under the influence of globalisation, economic and budgetary pressures, and increasing diversity of their populations, urban environments are regarded as being at increasing risk of exacerbating inequalities among older adults (Wahl and Oswald, 2010).We are cognisant of the gaps left unaddressed by this focus on a particular body of literature in urban settings. In many countries, older adults are more likely to live in rural areas (Keating and Fletcher, forthcoming) and in settings in which the quality of housing stock and community infrastructure are limited. However, we hope that through our focus on the current state of knowledge of built environments in urban settings, we will contribute to the growing discourse about the relevance of space to the global discourse on social exclusion. As Madanipour et al (1998, p 81) have noted: Space has … a major role in the integration or segregation of urban society. It is a manifestation of social relationships while affecting and shaping the geometries of these relationships. This leads to the argument that social exclusion cannot be studied without also looking at spatial segregation and exclusion. Reflecting the centrality of place in the lives of older adults, the chapter is organised into three main sections. The first section seeks to conceptualise the built environment within the context of debates on social inclusion and exclusion. A particular focus is on the notion of ‘ageing in place’ and the ways in which exclusion discourse can potentially challenge taken-for-granted notions about the desirability of older adults remaining in the same home and neighbourhood for the remainder of their lives. Second, the chapter reviews key policy and practice interventions that aim to enhance the built environment and thereby hold the potential to reduce the risks of exclusion for ageing adults. While developments in relation to universal design, visitability and age-friendliness are valuable in terms of addressing different dimensions of the physical environment, the chapter highlights a need to look beyond the ideal city or neighbourhood design in order to examine how effective current cities and neighbourhoods are for an ageing population. Building on this, the third and concluding section addresses steps that might be taken towards achieving more inclusive built environments for older people.This highlights potential contributions not only from policy and practice, but also from within the research community.

Conceptualising the built environment The built environment is a multidimensional concept that encompasses ‘humanformed, developed, or structured areas’ (Weiss et al, 2010, p 2). Planners, architects and urban design professionals focus on private and public/civic buildings, streetscape/roadways, and urban design features including designed open spaces (Frank et al, 2003; Fisher et al, 2004). The World Health Organization’s Agefriendly Cities programme is informed by this work in the development of the 146

Towards inclusive built environments for older adults

checklist of features that make communities supportive to older adults (Menec et al, 2011). Residential or home environments fall within the private realm of built environments and encompass the dwellings in which people reside. Environmental gerontologists privilege the housing of older adults because of its centrality in terms of the social exchanges that take place within it, the ways in which it regulates access to neighbourhoods and its influence in fostering both indoor and outdoor sensory stimulation (Lawton, 1989; Oswald, 2003). A central tenet in research on the built environment is that access to adequate and affordable housing and socially supportive neighbourhood environments can enhance the ability of older people with diverse physical or cognitive abilities and socio-economic backgrounds to ‘live and age successfully with independence and dignity’ (Maisel, 2007, p 26). Substandard housing is strongly associated with difficulties in performing daily activities; and higher rates of dependence are related to having fewer accessibility features in the home (Iwarsson and Stahl, 2003). Findings from Heywood’s (2004, p 129) large-scale study in England and Wales illustrated that housing adaptations positively influenced both physical and mental health, that these benefits were long-term, and that they extended beyond the older adult individual to benefit the health of other family members. Additionally, urban design features such as residential density, type of development (eg residential, mixed-use or commercial), street features (eg slope, width, material or buffer zones) and municipal elements (including speed humps, signage, public transportation hubs and bus stops) are important factors in ease of access to the neighbourhood and beyond. There is a further assumption that neighbourhoods with poor infrastructure, such as a lack of adequate housing, health or social care services, can increase the risks of exclusion faced by local residents (Lupton and Power, 2002). From an ecological perspective, the residences of older adults are seen as being nested within these outdoor spaces and adjacent neighbourhoods. A basic assumption of this approach is that such environmental contexts are interconnected, with changes in one influencing others (Bronfenbrenner, 2004). Thus, neighbourhood services and social interaction opportunities can reduce the likelihood that the settings for daily activities will be confined to the home. The design, quality and cost of housing can also affect who is able to live there. For instance, an older adult with limited income and reduced mobility is unlikely to be able to afford to live in a higher-income neighbourhood that has a poor transit system or insufficient housing that incorporates accessible design features. Thus, it is important to understand how both the residential and the neighbourhood development affect each other, as well as how they contribute to the exclusion and inclusion of older adults in society.

The built environment and ageing in place The concept of ‘ageing in place’ and the centrality of place in the ageing process are key elements in understanding processes of exclusion and inclusion.Ageing in 147

From exclusion to inclusion in old age

place has been used to describe the living arrangements of individuals who remain in their homes for as long as possible (Ponzetti, 2003). Much of the discussion has centred on the continuity of identity and strong sense of attachment afforded by long-standing residence in the same location (Smith, 2009). Strong emotional bonds with home and community that have developed over time through daily practices and routines become closely linked to individuals’ identity, sense of control and self-esteem (Chaudhury and Rowles, 2005). The research evidence suggests that people prefer to remain in their homes even in the face of declining physical and cognitive health and increased physical environmental risks (Lawlor and Thomas, 2008; Maisel et al, 2008; Pynoos et al, 2009). Ageing in place has also been seen as important in helping older adults maintain connections with others – a key element of social inclusion (Keating, 2011). Longstanding relationships with neighbours and family members can be foundational to the continuity of proximate social networks that are the source of ongoing social support. Social support in turn serves as a protective health factor and helps older people to remain socially active within their communities (Seeman et al, 2001). Strong networks of families, friends and neighbours are important for older people, especially those living in areas characterised by intense social deprivation, in order to avoid feelings of social isolation (Scharf et al, 2001). Researchers have shown that even in urban areas with disproportionately high rates of poverty, proximate social networks serve as a buffer against economic hardship (Phillipson et al, 2002). However, few studies to date have explored the role that spatial proximity and boundaries play in supporting older adults’ social networks.There is a need for research that examines where social support networks are formed and how the physical infrastructure facilitates or hinders the optimal functioning of these networks. Housing location also represents an element of place that is important in the debate of social exclusion in later life. In addition to proximity to social relationships, location influences perceived safety and individuals’ access to community services (Scharf et al, 2001). Perceptions of safety (such as the threat of falling) and security (eg potential threats posed by others) play important roles in older adults’ use of space. Environments perceived as being unsafe or unsecure may deter an older person from using certain spaces or may limit their daily activities to some areas of the residential neighbourhood and thus contribute to their exclusion from neighbourhood-based social relationships or broader forms of civic engagement. Transportation can be useful in connecting people and services across distances when housing is not situated in sufficiently close proximity. Access to public transportation or the ability to drive have long been viewed as built environment resources that are linked to social inclusion and exclusion. Poor transportation infrastructure is, in turn, associated with income-based social exclusion (Lupton and Power, 2002; Smith, 2009). In contrast, older adults with adequate transport and sufficient material resources have better connections with their social networks, engage more effectively in civic action or volunteer work, and have better access 148

Towards inclusive built environments for older adults

to support services than those who do not (Abbott et al, 2009). Loss of a driving licence can influence whether services and members of one’s social network are seen to be at a convenient distance. Drivers are more likely than public transport users to participate in community activities (Dahan-Oliel et al, 2010). These examples illustrate how housing location in combination with urban resources, such as transportation systems, plays an important role in the social interaction and integration of older adults across the latter part of the life course (Knapp, 2006; Migita et al, 2005). Just as the acknowledgement of the interface between home and neighbourhood is important in understanding ageing in place, ageing in place requires acknowledgement of neighbourhood as well as residence, setting the home environment within its broader physical setting. As Shaw (2004, p 414) argues, ‘people do not just live in houses, they live in and experience neighbourhoods’. Broadening the notion of place beyond the residence to include the neighbourhood (Lawler, 2001) focuses attention on the ways in which familiarity and comfort with the local area help to foster autonomy and a psychological sense of control (Oswald et al, 2003; Phillips et al, 2005). Amenities in the broader built environment can facilitate older adults’ mobility, enable them to access services and provide opportunities to be active and use their neighbourhood environments on a regular basis (Phillips et al, 2005; Chaudhury et al, 2011).Access to adequate and affordable public transportation and age-friendly urban design features helps to integrate older people into the social fabric of the community and foster their inclusion (Saelens et al, 2003; Stav et al, 2008). Such design features include, for example: traffic calming (roundabouts and speed humps); safety, security and comfort features (well-lit and maintained pavements and streets, benches along walking paths, presence of public washrooms/toilets); and wayfinding (easy signage). Placement of open, public square-type spaces at intersections of streets and face-to-face seating arrangements in open spaces have been found to be especially relevant in this regard as they create places for people to congregate, meet, socialise and rest during their journey (Lipman, 1969; Mehrabian and Diamond, 1971). Emphasis on the place-based relevance of community also provides potential for evaluating the importance of remaining in a familiar neighbourhood even when changing one’s dwelling to facilitate the receipt of more supportive services (Abbott et al, 2009).This more comprehensive approach to setting home within the context of community also provides a basis from which to better understand how places act as settings for inclusion and exclusion. It must also be noted that the concept of ageing in place is not universally embraced as the ideal pathway to an inclusive old age. Gilleard et al (2007) provide a more critical view when they state that while ageing in the same place can be a positive experience, it can also be limiting through fostering conservatism and rigidity and increasing vulnerability to risk for those who remain in poor settings such as impoverished communities. They argue that: ‘aging in place is thus an ambiguous position … as people grow older, they may be grounded by their area 149

From exclusion to inclusion in old age

of residence, or they may be trapped by it’ (Gilleard et al, 2007, p 591).They note evidence of tensions between age-related increases both in attachment to place and in sensitivity to social and physical environments. This increased sensitivity emerges in part from difficulties inherent in being ‘spatially bound’. In this context, Scharf et al (2001) have highlighted the fact that, as they progress through the life course, younger adults have a greater potential to move out of different forms of exclusion than do older adults. For example, younger people who live in poverty may be able to lift themselves out of poverty by securing better-paid employment. In contrast, without state intervention, for example in the form of increased pension payments, older adults typically have less opportunity to increase their incomes.The exclusion that affects older people may thus be more permanent than that of younger adults. A similar case can be made in relation to place-based dimensions of exclusion. Older people who age in places that exclude them may have fewer opportunities to relocate to more inclusive places than younger adults. Other disadvantages associated with staying in the same location accrue from the changing interface between personal circumstances and neighbourhood characteristics. For example, Deeg and Thomése (2005) showed that older adults whose income had declined but who still lived in high-status neighbourhoods had poorer physical functioning, poorer cognitive ability and felt more lonely than those whose incomes had not declined.As a result of social and geographical mobility of people in urban areas, community-based social supports may erode and engender a sense of loss of community among older adults (Phillipson et al, 2001). A recent set of discussions about ageing in place has added to the discourse by focusing on the vulnerability of some groups for whom ageing in place carries particular risk. Phillipson (2007) argues that globalisation creates vulnerability through the creation of new social divisions that are recreated in neighbourhoods. Older adults with higher income and education have greater freedom to choose their residences and neighbourhoods compared to those who have lower incomes, less education or who are immigrants without relevant language skills. These groups face increased marginalisation, a sense of displacement and lack of access to social and health care resources and labour market participation.This approach emphasises the fact that age-based risks of exclusion are more likely to affect some groups of ageing adults than others. In this context, there are particular concerns about the neighbourhood segregation and risk of exclusion faced by immigrant older adults. Even those who live for many years in their new land may experience profound disadvantage due to lack of access to resources such as income, adequate housing and support services. As also noted in Chapter Three, these resource deficits may be compounded further by lack of language skills and knowledge of the host country’s socio-cultural norms (Mahmood et al, 2008). Isolation of immigrant older adults can generate inequalities between them and the older adults of the host culture, making it more likely that they will experience exclusion in multiple domains (Becker, 2003; Scharf et al, 2005; Mahmood et al, 2008). 150

Towards inclusive built environments for older adults

Civic participation seems the antithesis of an example of neighbourhood exclusion. Defined as voluntary activities that have direct impact on the local community (Kaskie et al, 2008), civic participation by older adults is believed to be one of the pathways to community connections (Reed and Selbee, 2001). Features of the built environment, such as places in which to gather, and social infrastructure, such as formal volunteer organisations, can potentially play an important role in making older adults feel socially included and contributing towards their well-being (Shaw et al, 1999).Yet some forms of participation can also be isolating. Scholars such as Minkler and Holstein (2008, p 197) have stated that the current ‘civic engagement narrative extends into old age rewards for public activity and not private acts of sustenance and nurture, including self-nurture’. Private acts, such as caring for grandchildren or for a partner, occur outside of the public sphere, effectively rendering providers who are in the community as not being part of it. From this research and theorising about ageing in place, there is evidence of the need to better understand changes over time in the interface between ageing individuals and the places in which they live. Neighbourhoods are not static and, consequently, the relationship between housing location, access to services and social networks of older people is a dynamic one (Howden-Chapman et al, 1999). Places transform themselves over time as landmarks disappear and the social composition of the neighbourhood changes. The disappearance of local stores, restaurants and other environmental landmarks may have special meaning to long-term residents as familiar and appealing neighbourhoods evolve into unfamiliar places (Gilleard and Higgs, 2005).Additional research that explores the impact of a changing neighbourhood landscape on older adults’ social exclusion is needed to understand how ageing in a location that becomes unfamiliar might be more or less unsettling than ageing in a new location.

Policy and practice interventions to enhance the built environment In recent years, there have been concerted efforts to enhance home and community environments through policy and practice interventions. Developments in universal design and ‘visitability’ have moved forward our understanding of how to create homes that are functional and liveable for older adults and adults with disabilities. A parallel movement, the ‘age-friendly communities’ initiative, is aimed at the broader neighbourhood and community level with the goal of making communities more supportive of the older adults who live there. Both initiatives have the potential to increase inclusion of older adults who are ‘ageing in place’ through reducing their environmental risks. Physical environments that are designed to promote independence, mobility and access to resources for older adults are meant to contribute to their inclusion into the neighbourhood and community fabric.

151

From exclusion to inclusion in old age

To date, there has been little systematic analysis of key questions relating to such policy and practice interventions. For example, little is known about whether universal design/visitability or age-friendly city recommendations promote social inclusion for older adults. Similarly underexplored is the issue of whether there is a differential emphasis on promoting particular groups of older adults, such as those with mobility impairment, tenuous economic status or housing preferences based on their ethnic backgrounds, into the social fabric of their community life. In the next section, environmental guidelines for these movements are presented and evidence of their effectiveness in promoting social inclusion for different groups of older adults is evaluated.

Universal design and visitability The principles of universal design and visitability were developed to promote the independence of older adults and to increase access to their neighbourhood services and social support through design adaptations and modifications. These principles were developed and articulated primarily in Europe and North America and thus reflect cultural contexts in which municipal regulations around housing codes and community planning have a long history (see guidelines from, eg, Center for Universal Design, NC State University, 1997; Preiser and Ostroff, 2001; National Centre for the Dissemination of Disability Research, 2004). There are a number of key principles of universal design, based on assumptions that good housing design enhances the living situation of all residents. Designs should be created for people of all ages and allow for multiple uses as needs differ or change. Simplicity and intuitiveness are viewed as important since they promote easy use; design features must also communicate information needed by users to use the space effectively regardless of their sensory abilities (Hartje et al, 2006). Designs that minimise hazards and negative consequences of accidental or unintended action reflect a ‘tolerance for error’ (Hartje et al, 2006). Finally, adequate space and appropriate size to allow for approach, reach and use regardless of the user’s body size, posture or mobility correspond to principles of ‘low physical effort’ and ‘size and approach for space and use’ (Hartje et al, 2006). Preiser and Ostroff (2001, p 14) describe these principles of universal design as reflecting ‘non-discriminatory accommodation for people with disabilities and attention to the aging demographics’. Proponents of universal design guidelines argue that applying the principles of universal design creates a safe, secure and enabling physical environment that is ‘accessible, flexible, adaptable, healthy, and encourages socializing and mutual support’ (Davis, 2000, p 11). Visitability is a concept closely aligned with universal design, although more limited in scope.The idea of visitability emerged from the disabilities movement, motivated by an attempt to make residential single-family housing more accessible through community and neighbourhood planning. The goal is to ensure a basic level of accessibility in all housing by ensuring that certain design features are incorporated (Maisal, 2007). North American guidelines require that for a home 152

Towards inclusive built environments for older adults

to be visitable, it must include a zero-step, no-threshold entranceway, have wide interior doors (32 to 36 inches) and hallways (at least 36 inches), and have at least a half-bathroom with toilet on the main floor with sufficient depth for someone in a wheelchair to enter and close the door (Ringaert, 2009). A visitable home is intended to provide general access for most people. While visitability was developed to provide ease of access so that people could visit someone at home, these same features also allow for ease of movement and function within the house and ease of egress and access to surrounding neighbourhoods.The potential advantages of neighbourhood access have not been exploited fully within the framework of inclusion of older adults. Both universal design and visitability are consumer-oriented strategies that are targeted towards people of different abilities, gender and age (Maisel et al, 2008). Rather than focusing on losses related to chronic conditions, both reflect the idea that shortcomings and barriers in the near environment can be addressed to facilitate daily living and social connections (Truesdale and Steinfeld, 2002).Their strengths lie in addressing the interface between the physical/health resources of individuals and their homes. This is an important contribution to addressing social exclusion because the residential environment of an older adult can limit their face-to-face interaction or participation if they cannot navigate within their residences and have comfortable and safe access to and egress from their residences. Equally, these strategies have weaknesses based on their lack of integration with other interventions focused on improving the lives of older adults. Ringaert and Krassioukova-Enns (2007) articulated some of these weaknesses based on a review of the literature on implementation of visitability guidelines in the USA and Canada. Their analysis made two key points. First, they found that municipal- or city-level implementation of guidelines has been more successful than interventions at state, provincial and federal levels. Second, they suggested that because interventions have been created at the community level, there is little opportunity to generalise best practices. The authors conclude that visitability can be more effectively achieved and benefit more people if it is part of a more comprehensive initiative that pays attention to smart growth, which concentrates development in compact areas that are walkable and have a range of housing choices, and to liveable communities in which planning is concentrated on the quality of social interactions and recreational opportunities as well as local environmental conditions such as clean air and water quality. Ringaert and Krassioukova-Enns (2007) also argue that the next steps forward in terms of successful outcomes will occur when age-friendly, disability-friendly and universal design principles are incorporated into official community plans.

Age-friendly cities In 2007, the World Health Organization published the influential document Global age-friendly cities: a guide. In broad terms, the document’s purpose was to ‘engage cities to become more age-friendly so as to tap the potential that older people 153

From exclusion to inclusion in old age

represent for humanity’ (World Health Organization, 2007, p 1). It included a call for policies and programmes to focus on promoting active ageing by encouraging self-care, age-friendly environments and intergenerational solidarity. A checklist of measures that would underpin the development of an age-friendly city was proposed, based on a series of focus groups with older adults, service providers and caregivers in cities distributed across the world. Age-friendly features that emerged from these initial consultations fall into eight broad areas: outdoor spaces and buildings; transportation; housing; social participation; civic participation and employment; communication and information; community and health services; and respect and social inclusion (World Health Organization, 2007). Many of the recommendations in the agefriendly checklist address aspects of the built environment and are consistent with approaches to reducing different forms of social exclusion. For example, outdoor spaces and buildings recommendations include: well-maintained roads and sidewalks, with safe and well-spaced pedestrian crossings with sufficient time to cross; clustered services that are easily accessible; and universally designed buildings. Housing recommendations highlight the need for affordable housing for older people with the presence of essential services. A main feature of transportation is convenient and reliable public transit. These guidelines have helped to raise awareness of the interface between population ageing and urban design. Responses to the age-friendly strategies have been mixed. There has been substantial uptake of age-friendly approaches in municipalities around the world that have embraced the idea of making their cities more supportive to older residents. For example, Barcelona, London and Toronto, among others, have been accorded official age-friendly designation in recent years. In 2010, new impetus was put behind the age-friendly cities initiative with the formal establishment of a WHO Global Network of Age-friendly Cities. Such recognition alone could be important in reducing the exclusion of urban-dwelling older people, although formal evaluations of their impact are not yet fully developed. Notably, as these strategies have been implemented around the world, their limitations have also become evident. One is the lack of a clear definition of what an age-friendly community actually is (Lui et al, 2009). In their review of age-friendly communities, Menec et al (2011) argue that a commonality in all conceptualisations is the importance of community environments in meeting needs for housing and essential services, promoting social and civic engagement, and maximising independence by providing accessible transportation. While modification of the built/community environment is the central element of the age-friendly agenda, these definitions position the age-friendly initiative as one that is closely aligned with the reduction of exclusion from services, social connections and civic participation. A second limitation of the age-friendly approach is the lack of explicit attention to diversity among older adults and among the cities in which they live. Buffel et al (2012) have questioned the adequacy of using a universal checklist to gauge the appropriateness of all cities for all older adults. They note that although 154

Towards inclusive built environments for older adults

world trends are towards city dwelling, patterns of urban growth are changing. For example, UN-HABITAT (2008) statistics demonstrate a reduction of urban population density in high-income countries and an increase in lower-income countries. Older persons in these countries have differential access to resources, infrastructure and services based on the type of cities in which they live, raising concerns about the need to develop age-friendly benchmarks for both low-income and high-income countries. Menec et al (2011) make a parallel argument about the need to better understand diversity both in communities and among older adults.They note that age-friendly domains must be considered from an ecological perspective; that is, age-friendly domains must be examined in interaction with each other and take into account the characteristics of individuals, such as their income and functional status, as well as broader contexts, such as local, regional and national policies. Research on the ways in which older adults connect to their communities (Eales et al, 2008) provides insight into how relevant age-friendly features of communities can differ considerably from the perspective of different groups of older persons. In their qualitative analyses of community connections of older rural adults in Canada, Eales et al (2008) found that there were three distinct styles of interaction. ‘Stoic seniors’ valued hard work and productivity. They did not value connections to social organisations and had small social networks developed cautiously over many years. For them, the most important age-friendly features of their communities were opportunities to stay in their own homes and continue to have friendly but not close relationships with long-standing neighbours. In contrast, ‘community active seniors’ sought volunteer and cultural opportunities, had broad social networks that extended beyond the communities where they lived and did not rely on local services for shopping or entertainment. Most important to them were places with recreational amenities and volunteer opportunities. ‘Marginalised seniors’ had fragile health and economic status and were most dependent on their local communities for affordable services and housing and local health care. Eales et al (2008) also found that communities had very different resources, which made for a better fit for some older adults than for others. Asking ‘Which communities are age-friendly for which older adults?’ is an essential question. Proponents of age-friendly city guidelines suggest that barrierfree buildings and streets enhance the mobility and independence of both younger and older persons, benefiting the entire community through the participation of older persons in volunteer or paid work and civic activities (Scharlach, 2009).Yet Buffel et al (2012) propose that to achieve an age-friendly city, planning policies need to incorporate intervention measures that would engage and involve older adults as key actors in the regeneration of their cities to reduce the invisibility of older adults in the policy arena, and increase opportunities for the engagement of older people in civic action. The two major environment-fostered inclusion movements – age-friendly cities and universal design/visitability – were developed in parallel to each other with little intersection of thoughts and ideas. While the age-friendly cities movement 155

From exclusion to inclusion in old age

was initiated mainly by public health officials and gerontologists, the universal design movement came about through the efforts of advocacy groups for people with physical disabilities. Recognition of the convergence of the goals of visitability and age-friendly cities is an important part of the discussion of environmentfostered inclusion. By connecting visitability to affordability, mixed-income development and safety ‘each goal gets a boost from the other’ (Maisel, 2012, p 4), potentially resulting in more holistic environment-fostered inclusion.There is a need to look beyond the ideal city or neighbourhood design and examine how effective current cities and neighbourhoods are for an ageing population.

Steps towards inclusive built environments for older people Despite overwhelming evidence of the centrality of built environments in the lives of older adults, there are still substantial gaps in knowledge concerning how residential and neighbourhood community environments foster inclusion or exclusion in later life. Research has only just begun to articulate the complexity of the interfaces of diverse groups of older adults in a variety of community settings and across the latter part of the life course. Moreover, little is known about the relative importance of built environments in terms of the inclusion or exclusion of urban dwellers living outside of Europe and North America. Given the dual processes of demographic ageing and urbanisation that characterise societies around the world, these knowledge gaps will be of increasing relevance in the years ahead. However, researchers also need appropriate tools if they are to address the existing knowledge gaps in an appropriate manner. The theoretical framework used in this chapter to articulate issues and questions about the built environment comes from a tradition of environmental gerontology. In his synthesis of the state of theorising in this area, Kendig (2003) notes the great promise of this theoretical tradition but acknowledges the lack of empirical testing of important underlying concepts such as environmental press or person–environment fit. Debates about the notion of ageing in place, articulated in this chapter, can usefully add to theorising about interfaces between older adults and elements of their built environments. Such debates can also raise critical questions concerning the circumstances under which ageing in place should be a goal for older adults in general, and particular subgroups of older adults in particular. In a similar vein, ageing in place debates give rise to a number of methodological questions concerning how best to operationalise and measure complex and concurrent processes of individual and community change in empirical studies. Intervention research with the intention of reducing the disability/mobility challenges and loss of autonomy of older adults is also needed. Wahl and Oswald’s (2010, p 120) hypothesis that ‘improving the physical-social environment via home modifications or ecological optimizations of neighbourhoods [or creative, non-traditional and innovative housing solutions] will result in decreased social exclusion’ needs further testing and research.

156

Towards inclusive built environments for older adults

Grounding the policy and practice work of the design and planning profession within ongoing debates in social gerontology around social exclusion and inclusion would help to bring depth to the understanding to the concept of the social exclusion of older adults and contribute to generating policies and practices that are more reflective of the needs of older adults who live in diverse urban neighbourhoods. Inclusion promoted through built environment design and planning has the potential to facilitate older adults of all types of background and abilities to participate and contribute much more fully to their communities.The offer of resources, services, support and opportunities for participation in turn will promote and empower older adults who often are excluded from planning, decision-making and policy development processes in the places in which they live.Viewed against this background, universal design/visitability programmes and initiatives such as the World Health Organization’s Age-friendly Cities scheme reviewed in this chapter appear well-placed to make a valuable contribution to filling key knowledge gaps. When linked to new theoretical approaches and appropriate research designs, there is the opportunity for policy and practice innovation to enhance understanding of the ways in which built environments might enhance the social inclusion of older adults. References Abbott, P., Carman, N., Carman, J. and Scafo, B. (2009) Re-creating neighbourhoods for successful aging. Baltimore, MD: Health Professionals Press, Inc. Baltes, M.M., Maas, I.,Wilms, H.-U., Borchelt, M.F. and Little,T. (1999) ‘Everyday competence in old and very old age: theoretical considerations and empirical findings’, in P.B. Baltes and K.-U. Mayer (eds) The Berlin ageing study. Cambridge: Cambridge University Press, pp 384–402. Becker, G. (2003) ‘Meaning of place and displacement in three groups of older immigrants’, Journal of Aging Studies, vol 17, pp 129–49. Bronfenbrenner, U. (2004) Making human beings human: bioecological perspectives on human development. Thousand Oaks, CA: Sage Publications. Buffel, T., Phillipson, C. and Scharf, T. (2012) ‘Ageing in urban environments: developing “age-friendly” cities’, Critical Social Policy, forthcoming. Center for Universal Design, NC State University (1997) ‘Universal design principles’. Available at: http://www.design.ncsu.edu/cud/about_ud/ udprinciplestext.htm (accessed 27 November 2009). Chaudhury, H. and Rowles, G. (2005) ‘Between the shores of recollection and imagination: self, aging and home’, in G. Rowles and H. Chaudhury (eds) Home and identity in late life: international perspectives. New York, NY: Springer, pp 3–18. Chaudhury, H., Sarte, A., Michael,Y.L., Mahmood, A., Keast, E., Dogaru, C. and Wister,A. (2011) ‘Use of a systematic observational measure to assess and compare walkability for older adults inVancouver, British Columbia and Portland, Oregon neighborhoods’, Journal of Urban Design, vol 16, no 4, pp 433–54.

157

From exclusion to inclusion in old age

Dahan-Oliel, N., Mazer, B., Gelinas, I., Dobbs, B. and Lefebvre, H. (2010) ‘Transportation use in community-dwelling older adults: association with participation and leisure activities’, Canadian Journal on Aging, vol 29, no 4, pp 491–502. Davis, C. (2000) Supportive housing for seniors. Canada Mortgage and Housing Corporation Research Report. Ottawa: Government of Canada. Available at: http://www.ryerson.ca/crncc/knowledge/related_reports/pdf/CMHC_ Supportive_Housing_for_Seniors_Distinct_Housing_Needs_3889450.pdf (accessed 27 November 2009). Deeg, D. and Thomése, F. (2005) ‘Discrepancies between personal income and neighbourhood status: effects on physical and mental health’, European Journal of Ageing, vol 2, no 2, pp 98–108. Dobson, N.G. and Gilroy, A.R. (2009) ‘From partnership to policy: the evolution of active living by design in Portland, Oregon’, American Journal of Preventive Medicine, vol 37, no 6, pp S436–44. Eales, J., Keefe, J. and Keating, N. (2008) ‘Age-friendly rural communities’, in N. Keating (ed) Rural ageing: a good place to grow old? Bristol: Policy Press, pp 109–20. Fisher, K.J., Li, F., Michael, Y. and Cleveland, M. (2004) ‘Neighborhood-level influences on physical activity among older adults: a multilevel analysis’, Journal of Aging and Physical Activity, vol 11, pp 45–63. Frank, L., Engelke, P. and Schmid, T. (2003) Health and community design. Washington, DC: Island Press. Gilleard, C. and Higgs, P. (2005) Contexts of ageing: class, cohort and community. Cambridge: Polity Press. Gilleard, C., Hyde, M. and Higgs, P. (2007) ‘The impact of age, place, aging in place, and attachment to place on the well-being of the over 50s in England’, Research on Aging, vol 29, pp 590–605. Glass,T. and Balfour, J.L. (2003) ‘Neighborhoods, aging, and functional limitations’, in I. Kawachi and L. Berkman (eds) Neighborhoods and health. Oxford: Oxford University Press, pp 303–34. Hartje, S., Tremblay, K.R. and Birdsong, C. (2006) ‘Universal design in housing’, in J. Merrill, S. Crull, K. Trembley, L. Tyler and A. Carswell (eds) Introduction to housing. Upper Saddle River, NJ: Pearsons Education, pp 191–224. Heywood, F. (2004) ‘The health outcomes of housing adaptations’, Disability and Society, vol 19, no 2, pp 129–43. Howden-Chapman, P., Signal, L. and Crane, J. (1999) ‘Housing and health in older people: ageing in place’, Social Policy Journal of New Zealand, vol 13, pp 14–30. Iwarsson, S. and Stahl, A. (2003) ‘Accessibility, usability, and universal design – positioning and definition of concepts describing person–environment relationships’, Disability and Rehabilitation, vol 25, no 2, pp 57–66. Kaskie, B., Imhof, S., Cavanaugh, J. and Culp, K. (2008) ‘Civic engagement as a retirement role for aging Americans’, The Gerontologist, vol 48, no 3, pp 368–77. Keating, N. (2011) ‘Critical reflections on families of older adults’, Advances in Gerontology, vol 24, no 2, pp 343–9. 158

Towards inclusive built environments for older adults

Keating, N. and Fletcher, S. (forthcoming) ‘Older rural adults and their families’, in R. Blieszner and V. Bedford (eds) Handbook of families and aging. New York, NY: Praeger. Kendig, H. (2003) ‘Directions in environmental gerontology: a multidisciplinary field’, The Gerontologist, vol 43, no 5, pp 611–14. Knapp, K. (2006) ‘The housing of older New Yorkers’, in V. Rodwin and M. Gusmano (eds) Growing older in world cities: New York, London, Paris and Tokyo. Nashville, TN:Vanderbilt University Press, pp 103–25. Lawler, K. (2001) Coordinating housing and health care provision for America’s growing elderly population. Cambridge, MA: Joint Center for Housing Studies of Harvard University. Lawlor, D. and Thomas, M. (2008) Residential design for aging in place. New Jersey: John Wiley and Sons. Lawton, M.P. (1989) ‘Three functions of the residential environment’, in L.A. Pastalan and M.E. Cowarts (eds) Lifestyles and housing of older adults: the Florida experience. New York, NY: Haworth, pp 35–50. Lipman, A. (1969) ‘The architectural belief system and social behaviour’, British Journal of Sociology, vol 20, no 2, pp 190–204. Lui, C.W, Everingham, J.A., Warburton, J., Cuthill, M. and Bartlett, H. (2009) ‘What makes a community age-friendly: a review of the international literature’, Australasian Journal on Ageing, vol 28, pp 116–21. Lupton, R. and Power,A. (2002) ‘Social exclusion and neighbourhoods’, in J. Hills, J. Le Grand and D. Piachaud (eds) Understanding social exclusion. Oxford: Oxford University Press, pp 118–40. Madanipour,A., Cars, G. and Allen, J. (eds) (1998) Social exclusion in European cities: processes, experiences and responses. London: Jessica Kingsley. Mahmood, A., Chaudhury, H., Kobayashi, K. and Valente, M. (2008) ‘Housing and community characteristics of South-Asian immigrant older adults’, Journal of Architectural and Planning Research, vol 25, no 1, pp 54–75. Maisel, J. (2007) ‘Visitability: a major “no step” towards inclusive housing’, Planning Commissioners Journal, vol 66, pp 4–6. Maisel, J.L. (2012) ‘Visitability’, in J.H. Stone and M. Blouin (eds) International encyclopedia of rehabilitation. Buffalo, New York: Center for International Rehabilitation Research Information and Exchange, pp 1–7. Available at: http://cirrie.buffalo.edu/encyclopedia/en/pdf/visitability.pdf (accessed 18 March 2012). Maisel, J., Smith, E. and Steinfeld, E. (2008) ‘Increasing home access: designing for visitability’, American Association of Retired Persons Public Policy Report. Washington, DC. Available at: http://grupodorados.es/pdf_noti_norma/ normativa_46.pdf (accessed 11 August 2011). Mehrabian, A. and Diamond, S. (1971) ‘Seating arrangement and conversation’, Sociometry, vol 34, no 2, pp 281–89. Menec,V., Means, R., Eales, J., Keating, N. and Parkhurst, G. (2011) ‘Conceptualizing age-friendly communities’, Canadian Journal on Aging, vol 12, pp 1–15. 159

From exclusion to inclusion in old age

Migita, R.,Yanagi, H. and Tomura, S. (2005) ‘Factors affecting the mental health of residents in a communal-housing project for seniors in Japan’, Archives of Gerontology and Geriatrics, vol 41, no 1, pp 1–14. Minkler, M. and Holstein, M. (2008) ‘From civil rights to … civic engagement? Concerns of two older critical gerontologists about a “social movement” and what it portends’, Journal of Aging Studies, vol 22, pp 196–204. National Center for the Dissemination of Disability Research (2004) ‘Accessibility in our built environment: visitability. NCDDR Technical Brief 8’, National Center for the Dissemination of Disability Research. Available at: http://www. ncddr.org/kt/products/focus/focus8/Focus8.pdf (accessed 15 October 2010). Oswald, F. (2003) ‘Linking subjective housing needs to objective living conditions among older adults in Germany’, in K.W. Schaie, H.W.Wahl, H. Mollenkopf and F. Oswald (eds) Aging independently: living arrangements and mobility. New York, NY: Springer, pp 130–47. Oswald, F. and Wahl, H.-W. (2005) ‘Dimensions of the meaning of home’, in G.D. Rowles and H. Chaudhury (eds) Home and identity in late life: international perspectives. New York, NY: Springer, pp 21–45. Oswald, F.,Wahl, H.W, Martin, M. and Mollenkopf, H. (2003) ‘Toward measuring proactivity person-environment transactions in late adulthood: the Housing Related Control Belief Questionnaire’, in R. Scheidt and P. Windley (eds) Physical environments and aging. New York: Hawarth Press, pp 135–52. Phillips, D.R., Siu, O., Yeh, A. and Cheng, K. (2005) ‘Ageing and the urban environment’, in G.R. Andrews and D.R. Phillips (eds) Ageing and place: perspectives, policy, practice. New York, NY: Routledge, pp 147–63. Phillipson, C. (2007) ‘The “elected” and the “excluded”: sociological perspectives on the experience of place and community in old age’, Ageing and Society, vol 2, pp 321–42. Phillipson, C., Bernard, M., Phillips, J. and Ogg, J. (2001) The family and community life of older people. London: Routledge. Phillipson, C., Ahmed, N. and Latimer, J. (2002) Women in transition. A study of experiences of Bangladeshi women living in Tower Hamlets. Bristol: Policy Press. Ponzetti, J. (2003) ‘Growing old in rural communities: a visual methodology for studying place attachment’, Journal of Rural Community Psychology, vol 6, no 1, pp 1–11. Preiser, W. and Ostroff, E. (2001) Universal design handbook. New York, NY: McGraw Hill. Pynoos, J., Caraviello, N. and Cicero, C. (2009) ‘Lifelong housing: the anchor in aging-friendly communities’, Journal of the American Society on Aging, vol 33, no 2, pp 26–32. Reed, P.B. and Selbee, L.K. (2001) ‘The civic core in Canada: disproportionality in charitable giving, volunteering, and civic participation’, Nonprofit and Voluntary Sector Quarterly, vol 30, no 4, pp 761–80.

160

Towards inclusive built environments for older adults

Ringaert, L. (2009) ‘Analysis of housing for seniors with disabilities using a livable and inclusive community lens’, synthesis papers, Canadian Centre on Disabilities Studies Research Report. Available at: http://disabilitystudies.ca/completedactivities-research-program/ (accessed 11 August 2011). Ringaert, L. and Krassioukova-Enns, O. (2007) Understanding the status of visitability in Canada. Canada Mortgage and Housing Corporation Research Highlights. Ottawa: Government of Canada. Saelens, B.E., Sallis, J.F. and Frank, L.D. (2003) ‘Environmental correlates of walking and cycling: findings from the transportation, urban design, and planning literatures’, Annals of Behavioral Medicine: A Publication of the Society of Behavioral Medicine, vol 25, no 2, pp 80–91. Scharf, T., Phillipson, C., Kingston, P. and Smith, A. (2001) ‘Social exclusion and older people: exploring the connections’, Education and Ageing, vol 16, no 3, pp 303–20. Scharf,T., Phillipson, C., Smith, A. and Kingston, P. (2002) Growing older in socially deprived areas: social exclusion in later life. London: Help the Aged. Scharf, T., Phillipson, C. and Smith, A. (2005) ‘Social exclusion of older people in deprived urban communities of England’, European Journal of Ageing, vol 2, pp 76–87. Scharlach, A. (2009) ‘Creating aging-friendly communities’, Generations – Journal of the American Society on Aging, vol 33, no 2, pp 5–11. Seeman,T., Lusignolo,T., Albert, M. and Berkman, L. (2001) ‘Social relationships, social support, and patterns of cognitive aging in healthy, high-functioning older adults: MacArthur studies of successful aging’, Health Psychology, vol 20, no 4, pp 243–55. Shaw, M. (2004) ‘Housing and public health’, Annual Review of Public Health, vol 25, pp 397–418. Shaw, M., Dorling, D. and Smith, G.D. (1999) ‘Poverty, social exclusion, and minorities’, in M. Marmot and R. Wilkinson (eds) Social determinants of health. New York, NY: Oxford University Press, pp 211–39. Smith, A. (2009) Ageing in urban neighbourhoods: place attachment and social exclusion. Bristol: Policy Press. Stav,W.B.,Arbesman, M. and Lieberman, D. (2008) ‘Background and methodology of the older driver evidence-based systematic literature review’, American Journal of Occupational Therapy, vol 62, pp 130–5. Truesdale, S. and Steinfeld, E. (2002) Visit-ability: an approach to universal design in housing. Buffalo, NY: RERC on Universal Design and the Built Environment. UN-HABITAT (2008) State of the world’s cities 2008/2009. London: Earthscan. Wahl, H.-W. and Oswald, F. (2010) ‘Environmental perspectives on ageing’, in D. Dannefer and C. Phillipson (eds) The Sage handbook of social gerontology.Thousand Oaks, CA: Sage, pp 111–24. Weiss, R., Maantay, J. and Fahs, M. (2010) ‘Promoting active urban aging: a measurement approach to neighbourhood walkability for older adults’, Cities and the Environment, vol 3, no 1, pp 1–17. 161

From exclusion to inclusion in old age

World Health Organization (2007) Global age-friendly cities: a guide. Geneva: WHO Press. Available at: http://www.who.int/ageing/publications/Global_ age_friendly_cities_Guide_English.pdf (accessed 15 September 2008).

162

Ten

Revisiting social exclusion of older adults Norah Keating and Thomas Scharf

Introduction The exploration of global issues relating to ageing and social exclusion, undertaken by the contributors to this book, has resulted in convergences of theoretical perspectives and substantive understandings. Equally, it has highlighted regional and disciplinary differences in the importance of the multiple domains of exclusion and beliefs about appropriate policy responses. The authors have illustrated the need to be more critical in our exploration of inequalities among older adults and in the methodological rigour that is a precursor to filling knowledge gaps around the domains of exclusion and the risks for experiencing them. In this chapter, we address these issues, setting the stage for further the integration of research, policy and practice approaches to reducing risks of exclusion in later life.

Domains and drivers of social exclusion In Chapter One, we presented five domains of social exclusion (from material resources, social relations, civic activities, basic services and neighbourhoods) that reflect the unique circumstances of older people. These were positioned as an orientation point for an interrogation of the extent to which older adults are excluded from specific features of societal participation. Across the chapters of the book, the authors have addressed these domains, emphasising some more than others and adding a critical lens to assumptions about the relationship between ageing and risks of exclusion. Factors increasing risks of exclusion were discussed in all chapters. Exclusion from social relations was the most widely explored domain. At its core is exclusion from family relationships, a preoccupation in all world regions in response to population ageing. The authors have commented on regional discourses about how macro changes have affected families.These differ considerably. In East Asia the focus is on changes in filial piety; in Europe, on changing family structures and the individuation of risk; and in the middle-income countries of South America and Africa, on the evolution away from ‘generalised scarcity’ and on the effect of increasing financial security on family relations. 163

From exclusion to inclusion in old age

Through their examination of the modernisation of filial piety in East Asia, Phillips and Cheng (Chapter Seven) challenge the assumption that obligations dictated by filial piety are the necessary glue in generational relationships in families. They point to a new ‘inclusion through compromise’, that allows for more discretion by children to live separately from parents, and more opportunities for older parents to be included in social networks outside the family. LloydSherlock et al (Chapter Four) also see increasing relaxation of traditional ways of late-life family interactions. In their treatise on middle-income countries in South America and Africa, they discuss household composition, rejecting the notion that living separately from adult children is a clear marker of exclusion from family relations. For example, they illustrate how financial resources can foster choice in older people’s living situation and the opportunity to avoid problems of overcrowding and financial exploitation through having a separate dwelling. Close family contact is examined for its potential to reduce autonomy and choice as well as increase connectedness. Discussions about the centrality of family relationships in Europe also address quality and complexity in family interaction.The European perspective, presented by Ogg and Renaut (Chapter Six), is that generational exchanges of resources are central to inclusion in family relationships. Contrary to received wisdom about older persons as recipients of the benevolence of younger generations, most resources flow down the generations. Despite this evidence, contributions of older persons continue to be largely invisible in the face of strong adherence to apocalyptic rhetoric of population ageing. Across the chapters, there is consensus that quality of late-life family interactions is enhanced when there are choices in living situations and an exchange of resources. Yet there are also both macro and micro drivers of exclusion from positive family relations. At the macro level, institutional and legal frameworks that enshrine family responsibilities and obligations have yet to be tested in terms of their ability to increase the quality of family relationships. Assumptions from developed countries that opportunities to purchase services in the marketplace will reduce the negative impact of unequal access to family members also remain unproven. Micro-level factors increasing the risk of exclusion from family relationships include the frailty and poverty of individuals, family network size, and proximity of family members. There are complex interactions between these risks and the likelihood of exclusion. Findings that the larger the family, the fewer goods and services are exchanged (Chapter Six) should prompt further consideration of the belief that structural changes in families will lead to a lack of support. Similarly, research on international migration shows that distance can lead to exclusion. According to Torres, the transfer of financial resources helps to maintain family connections (Chapter Three), although having a pension in later life does not necessarily ensure access to household decision-making with younger kin or to control over personal finances (Chapter Four). Ogg and Renaut’s conclusion about exclusion from family relationships (Chapter Six) provides a fitting statement 164

Revisiting social exclusion of older adults

reflective of the broader discussion. They say that older age is not a period when people are isolated from their families, although a significant minority have weakened family ties when combined with a lack of other resources that accumulates from a lifetime of disadvantages and interruptions in family and work histories. In the social exclusion literature, material resources, particularly poverty, have been seen as foundational to understanding social exclusion. The discussion of poverty rates among older persons is taken up by Zaidi who provides evidence of the diversity in risks of poverty among the 27 European Union (EU) countries (Chapter Five). He imports Sen’s idea of ‘capability deprivation’ to illustrate that older persons in the poorest countries are not necessarily at greater risk of exclusion from other material resources.This discrepancy between low objective levels of monetary resources and the ability to gain access to basic goods and services may arise in part because of our lack of knowledge about the importance of social contexts that may foster non-monetised exchanges of goods and services, or instrumental support from proximate networks that augment or replace financial resources. Lloyd-Sherlock et al take a critical view of the relationship between financial resources and inclusion through reference to the life course as a context for understanding how financial resources in later life might foster inclusion (Chapter Four). They report on findings that access to pensions or loans can be less useful to those whose lifetimes of marginalisation have resulted in their having poor skills to benefit from these resources. Just as we need to move beyond household composition as a proxy for family inclusion, so too is there a need to better understand contexts and life courses that moderate adequacy of financial resources. The built environment is an important addition to understanding exclusion from material resources. Housing is a central concern to older persons, affecting their quality of life and access to amenities in their neighbourhoods and communities. As noted by Mahmood and Keating, the discussion of ageing in place positions exclusion from material resources as a process at the intersection of personal resources and surrounding neighbourhoods or communities (Chapter Nine). Neither person nor place is static; at different points in the ageing process, the ‘same’ home in the ‘same’ neighbourhood can foster or impede access to other material resources or social relationships. Together, these treatises on material resources (financial resources and housing) would benefit from examination of these intersections by addressing, for example, the question of whether poor people in poor neighbourhoods experience more depth of exclusion than poor people who live in affluent neighbourhoods that have abundant services. Exclusion from basic services is a central theme in the North American literature on the needs of older people (see, eg, Keating et al, 2011), but was not featured in this book.The global scope of chapters in this book has incorporated diverse areas, including some with little tradition of formal sector institutions and limited access to services, and others in which there has been an erosion of services resulting from a movement away from the post-war welfare state. It is not surprising, then, 165

From exclusion to inclusion in old age

to see renewed emphasis on the ability of families to provide needed support and of income adequacy or capabilities to purchase services. Macro discussions of globalisation, international migration and human rights have extended knowledge of elements of exclusion from civic engagement. The discussion of these themes is more broadly constructed than involvement in local decision-making, volunteer activity and voting that have set the boundaries around previous research on the civic engagement of older adults. Phillipson frames the scope of the civic engagement discussion as global and the discourse as one of citizenship (Chapter Two). He positions global involvement in the construction of old age through the design of policies aimed at managing population ageing. In the UK, these national constructions are juxtaposed against the increasing individualisation of risk resulting from policies that are differentially exclusive to groups such as women, recent immigrants and those who have had insecure attachments to the labour market. In combination, he believes that these forces have led to an erosion of the inclusive world. We are reminded that the construction of old age is informed by national age profiles and cultural orientations that in turn have differential influence on the nature and extent of exclusion across world regions, but that some exclusionary processes such as ageism are pervasive, as highlighted by Stuckelberger et al (Chapter Eight). Torres also sees a lack of citizenship rights as the core domain of social exclusion (Chapter Three). In her treatment of patterns of international migration flows, she contributes a perspective on how migration influences these national constructions. Her critical analysis of the impact of large-scale migration includes a call for countries to recreate their views of culture based on the increasing racial and ethnic diversity of (immigrant) older people. She warns of the risk of creating an even larger group of older people at the periphery should this re-envisioning not occur. She sees the migratory life course as a driver of exclusion from citizenship, often associated with tenuous or interrupted employment, minimal formal education, rural backgrounds, and poor language skills. Closer alignment of these discussions of global strategies to manage population ageing with the debate on the need for an international human rights framework (Chapter Eight) would augment understanding of the drivers of exclusion with citizenship and policy interventions designed to reduce them.

Conceptual advancements Together, the contributing authors to this book have moved forward conceptual understandings of the social exclusion of older adults, raising issues for debate and adding theory from a variety of disciplinary perspectives and methodological approaches. It is beyond the scope of such a book to address adequately and in sufficient detail the situation in all world regions. Notable gaps remain, for example, in relation to sub-Saharan Africa, South East Asia and Oceania. Nevertheless, notwithstanding these shortcomings, the global scope of the book has fostered a positioning of domains of exclusion that are broader than the European roots 166

Revisiting social exclusion of older adults

in which much of the theoretical work concerning social exclusion is grounded. The authors have addressed three domains in some detail: social relations, material resources and civic engagement. In each of these, attention to ideologies and value bases have been important. One conceptual contribution has been to highlight regional differences in the salience and important components of domains of exclusion. For example, while exclusion from family relationships is important in all regions, there is a stronger sense of urgency in developing countries in which family support may be essential to the receipt of basic services. In Europe, the exclusion discourse is about quality of family interaction, solidarity and ambivalence, perhaps, of the less obligatory nature of family ties. Ogg and Renaut’s conceptual work on intergenerational solidarity that introduces labour market engagement as a means to become less dependent on family provides a theoretical tool for the exploration of interactions among domains of exclusion (Chapter Six). In contrast, while poverty has been a long-standing theme in exclusion from material resources, focus on the built environment and home as a location for engagement with family and others has been centred on North America. The ‘rights-based’ approach to citizenship, articulated by Stuckelberger et al (Chapter Eight), is not (yet) universally embraced as an overarching framework for understanding exclusion. The convergence of theoretical perspectives across disciplines has augmented the set of conceptual tools and perspectives on the domains and drivers of exclusion and added new points of debate. Torres compares approaches from international migration/ethnic relations and social exclusion in old age that illustrate how theoretical lenses can lead to different questions (Chapter Three). In her example, the migration approach identifies migration status as being the most important factor in determining exclusion rather than one’s status as an older person. Like other authors in the book, she advocates the importance of incorporating life-course perspectives, arguing that we cannot challenge social gerontology’s assumptions that a good old age results from continuities unless we further explore the lives of those who have experienced disruption and discontinuity. The theoretical grounding of the ageing in place discourse in changes in both people and place over time (Chapter Nine) augments this approach. Adding the dynamics of life-course perspectives would add considerably to our ability to explain variability in exclusion among older adults. The theoretical positioning of exclusion at the interface of individuals and the contexts of their lives is also promising. It moves the discussion of exclusion beyond questions of the domains of exclusion of those who are aged towards understanding the dynamic processes of person–context fit. Several of these interfaces have been presented in the book. Discussions at the societal level have illuminated interactions between globalisation and the individualisation of risk, and societal beliefs about filial piety and increased choices in family interaction and support. Although the community context is seen as an important setting for inclusion, the interface of communities and ageing individuals requires further development. The age-friendly communities initiative, referred to by Mahmood and Keating, is 167

From exclusion to inclusion in old age

a promising beginning, although currently under-theorised (Chapter Nine). Much work has been done by the authors of this book’s chapters in challenging received wisdom of the interactions between older adults and their families. Authors have deconstructed assumptions about the negative impact of structural family changes on support to older adults. The addition of the family theoretical constructs of solidarity and ambivalence has added to our understanding of the coexistence of tensions and support in family life. Further theorising is needed to advance understanding about the place of non-kin relationships in fostering inclusion. Together, these theoretical advances have provided better conceptual tools for the study of social exclusion in later life.The life-course accumulation of advantage or disadvantage, discussed in Chapter One, needs to incorporate changes in contexts such as policy environments and neighbourhoods as well as individual changes. The global perspective taken has increased awareness of the universals and particularities in the domains of exclusion. Theoretical imports from other disciplines have added strength to the exploration of nuances in exclusion from family connections and material resources. A key area requiring further conceptual development is the realm of ‘social inclusion’. Increasingly articulated as a societal goal, especially in Europe, inclusion remains under-theorised. This applies to the social sciences in general and social gerontology in particular. In this book, the authors have viewed inclusion as the antonym of exclusion, but have not directly confronted its conceptualisation. In future work, it would be helpful to deepen our understanding of social inclusion and related concepts, such as social integration and social cohesion, by exploring the degree to which the notions of relativity, agency, dynamism and multidimensionality that underpin existing conceptualisations of social exclusion also relate to inclusion.

Methodological issues Measurement issues were not in the forefront of the conceptual and substantive work on the domains and drivers of exclusion of older persons presented in the book. However, authors have drawn on a variety of empirical and policy sources to substantiate their arguments. For example, large national and international data sets have been used in the book to illustrate broad demographic patterns and changing family structures, as well as to show national differences in rates of poverty and capability deprivation, and in perceptions of ageism and age discrimination. Further methodological development is needed to expand on indicators of exclusion that do not capture fully the key elements of a particular domain. An example is the use of living arrangements as a proxy for inclusion in or exclusion from family relationships. The addition or development of indicators of family solidarity could capture these elements of exclusion from the family, as could measures of the size and composition of family networks. Income-based poverty as an indicator of exclusion from material resources also has its limitations. In this domain, measures of economic status within a family or community context 168

Revisiting social exclusion of older adults

would further support the measures of the capability of older persons to gain access to needed goods and services. Built environment indicators of exclusion are also underdeveloped. Nevertheless, there are promising beginnings in the visitability programmes that have objective indicators expressed in municipalities’ building codes, which set standards of accessibility.The age-friendly cities initiative was developed around a checklist of community resources meant to increase the inclusion of older adults. However, to date, testing of the inclusiveness of those measures is underdeveloped. In a similar vein, indicators of exclusion from civic engagement remain poorly defined. In sum, much remains to be done to operationalise the concepts of social inclusion and exclusion in gerontological research.

Policy responses Throughout the book, questions have been raised about responsibility for addressing exclusion in later life.There are policy elements in each of the chapters that provide insight into this question, indicating current approaches to policies that target the different contexts that might exclude. At the international level, human rights legislation is proposed to address the impact of ageism and its various manifestations.The difficulties inherent in creating a climate for its uptake around the world may be a result of the rights-based approach being embraced more strongly in Western societies.At the national level, a case is made for maintaining or expanding the role of the state in developing public programmes.The movement away from the welfare state in parts of Europe and the ideological shift in China from state to family responsibility for support to older persons are indications that there may be little appetite for state intervention in the current volatile global economic milieu. However, the focus in some middle-income countries on developing public pension schemes suggests recognition that state support may have beneficial outcomes in relation to older people’s social and material resources. Policies at local/municipal and family levels are gaining traction, although their impact is more localised. The creation of building codes for private homes to enhance ease of movement across changing levels of physical abilities has been at the forefront of policies in the built environment. The growing awareness of the increasing size and purchasing power of older persons in some regions has created interests from the consumer market in developing products and services tailored to their needs. This is an area of private sector policy development that has not been explored in this book. Similarly, there has been considerable development of public policy in the area of family engagement with, and support of, older people. Many nations have either new or long-standing policies placing obligations on family members to care for their older members. However, it is not at all clear that such policies are either effective or inclusive of older persons. Policy development to reduce exclusion would benefit from paying further attention to the long-standing accumulation of evidence concerning the diversity of older persons.There are many examples in this book of people at the periphery 169

From exclusion to inclusion in old age

because of their migratory histories, conflicted or neglectful family relationship, long-term disabilities, or newly created marginalisation arising from changing neighbourhoods. The authors have indicated the need to have ‘protected spaces’ to support vulnerable and marginal groups, such as people with dementias, and protect them from abusive relationships in home and institutional settings. Our proposed expansion of social exclusion to add explicit acknowledgement of the impact of contexts on exclusionary processes of ageing could provide a framework for systematic evaluations of the impact of policies across contexts and throughout the ageing life course.

Conclusion In summary, the expanded conceptualisation of social exclusion positions it as a worthy addition to the growing body of theoretical frameworks in social gerontology. It has clear advantages in the contextual and life-course lens, which we believe can be used to better understand diversity within a cohort of ageing adults as well as processes that may exclude.The critical perspective taken here can be advantageously used to inform the policy debates about addressing the ‘problem’ of population ageing and in being more inclusive of those at the periphery. The four steps to evaluating inclusion developed by Abrams and Christian (2007) and discussed in Chapter Eight would provide an excellent starting point.To expand the links between ideologies and inclusion, we would add the question of what policies or programmes have proven effective in reducing exclusion to expand the steps. These ideas, and those identified elsewhere in this synthesising chapter, are essential as part of a response to the challenge of exclusion in later life. Population ageing is rightly regarded as one of the key achievements of the modern age. Improving understanding of the ways in which ageing interacts with other farreaching social and economic trends to increase the risks of exclusion faced by older adults around the world remains a key task for social gerontology. Responding to the challenge of exclusion in later life requires concerted action by policymakers and practitioners in all world regions.We are hopeful that this book can become part of a necessary response, assisting in developing understanding of exclusion in later life and helping to shape debates around appropriate interventions that might contribute to overcoming the types of disadvantage faced by many older people across the world. References Abrams, D. and Christian, J.N. (2007) ‘A relational analysis of social exclusion’, in D. Abrams, J.N. Christian and D. Gordon (eds) Multidisciplinary handbook of social exclusion research. Oxford: Wiley-Blackwell, pp 211–32. Keating, N., Swindle, J. and Fletcher, S. (2011) ‘Aging in rural Canada: a retrospective and review’, Canadian Journal on Aging, vol 30, no 3, pp 323–38.

170

Index

Index Note: The following abbreviations have been used: f = figure; n = note; t = table.

A Abrams, D. 126, 170 abuse: elder 59–60, 119–20 ‘accumulation by dispossession’ 19 ACE (Age Concern England) 135 Achenbaum, W. 91 active ageing 98, 99, 153–4 Adloff, F. 97 age categorisations 128–9 Age Concern England (ACE) 135 age discrimination 11, 125–6, 138–9 ageism as a cause of stereotyping and exclusion 127–8 ageism as a form of 129, 130f, 131f, 132 EU legal framework and 132–5 need for an international human rights framework 135–8 age-friendly cities 146, 149, 151, 152, 153–6, 157, 167–8, 169 ageing active ageing 98, 99, 153–4 Asia-Pacific 110, 117–18 historical development 25 risks 1, 9, 20–1, 36 as a ‘threat’ 2 ‘ageing in place’ 11, 146, 147–51, 156 ‘Ageing, well-being and development: a comparative study of Brazil and South Africa’ (UK Research Council) 51–2, 66n agency 4, 6–7, 73, 75 Albertini, M. 97 Alkire, S. 80 Allocation Personalisation d’Autonomie (APA) 100 amenity-seeking international retirement migrants (AIRM) 40, 41, 43–4 ancestral duties 112–15 Angel, J.L. and R.J. 43 anti-poverty strategies see poverty Asia-Pacific 10–11, 109 changing traditional forms of care 117–20 cultural tensions 115–16 demographic trends 110–12 family carers and non-family carers 116–17 filial piety and ancestral duties 112–15

resilience and the older consumer 120–1 socio-economic impacts of demographic change 111–12 Atkinson, A.B. 4, 5, 6, 73, 84 ‘Averting the old age crisis’ (World Bank) 20

B baby boomers 2, 26, 97, 117 Bangladeshi community 96 Bauman, Z. 21 Bell, J. 37 Bengtson,V. 91 Berghman, J. 35–6 birth cohorts 2, 6, 26 Blackburn, R. 19 Brazil 10, 51, 52, 54, 65, 66, 163, 164 capacity to help others 63, 64f life satisfaction 62t, 63 pension schemes 55, 56t, 57, 58–61 policy responses/interventions 58, 60, 65 Buffel, T. 154–5 ‘Building a society for all ages’ (HM Government) 98 built environment 11, 145–6, 165, 169 multidimensional concept 146–51 networks 148, 151, 155, 164 policy and practice interventions 146, 151–6, 157 steps towards inclusive built environments 146, 156–7 Burchardt, T. 4, 36, 37, 43, 72 Butler, N.R. 127 Bytheway, B. 128

C capability approach 73, 74, 75–6, 85, 165 deprivation 79–80, 81t, 82, 83f, 84f capacity to help others 63, 64f ‘care for the carers’ policies 99, 100 CEDAW (Convention on the Elimination of All Forms of Discrimination against Women) 137 Center for Strategic and International Studies 20

171

From exclusion to inclusion in old age Central and Eastern Europe 79, 82, 85 Central Intelligence Agency (CIA) 20 Charter of Fundamental Rights (European Union) 133–4 childlessness 97 China 3, 41, 57 intergenerational relations 109, 110, 111, 113, 114, 115, 117–18, 119, 120 Chow, N.W.S. 113, 119 Christian, J.N. 126, 170 CIA (Central Intelligence Agency) 20 citizenship 2, 3, 42, 145 rights 35, 37, 41, 166, 167 civic participation 5, 7, 8, 36, 72, 166, 167, 169 built environment 145, 148–9, 151, 154, 155 classic welfare state 18, 19 Commission of the European Communities see European Commission community active seniors 155 ‘Confronting demographic change: a new solidarity between the generations’ (Commission of the European Communities) 94 consumption activity 36 consumption-based measures of welfare 73 Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) 137 Council of Europe 133 Cowgill, D. 10, 53, 55 credit and personal debt 60 cumulative advantage and disadvantage 2

D Daly, M. 5, 8 Declaration on Social Progress and Development (1969) (United Nations) 137 Deeg, D. 150 defamiliarisation 100 demographic trends 1, 2, 17 Asia-Pacific 10, 109, 110–12, 114 built environment 152, 156, 168 developing countries 52 families and 89, 93, 94, 96, 100 globalisation and 18, 22 migration and 9, 33, 41, 42 Department for Work and Pensions (DWP) 98 Deppe, H-U. 27–8 developing countries 10, 51–3, 65–6 financial security and social relations in Brazil 58–61, 62t key debates 53–4 networks and 54, 55 perceptions of social exclusion and inclusion 62–3, 64f Southern Hemisphere 54–5, 56t, 57–8 direct discrimination 134 directives: European Union 133–4, 135 disability-friendly housing 152–3, 156

172

disaster capitalism 18 disengagement theory 35 dispossession 19 disruption: life course 42–3 domestic helpers 116 Durkheim, E. 35 DWP (Department for Work and Pensions) 98 Dwyer, P. 40, 41, 44 dynamic exclusion 4–5, 7

E Eales, J. 155 economic crisis and recession 18–24, 71, 73, 84, 99 economic integration 36, 37 Elder Abuse Prevention and Caregiver Support Law (2006) (Japan) 120 Employment Equality Directive (2000/78) (European Union) 133–4, 135 environmental drivers 8 erosion of social capitalism 21 Esping-Andersen, G.A. 99 Estes, C. 24 ethnic relations 37–8 EU2020 strategy (European Council) 72 Eurobarometer survey (2009) 130, 131f Europe 11, 125–6, 138–9 ageism as a cause of stereotyping and exclusion 127–8 ageism as a form of discrimination 129, 130f, 131f, 132 approaches to measuring exclusion 74–6 approximation of capability deprivation 79–80, 81t, 82, 83f, 84f income-based measures of poverty 10, 77–9 key conceptual and measurement considerations for material resources 72–4 legal framework for ageism 132–5 material resources 10, 71–2, 84–5, 109 need for an international human rights framework 135–8 European Commission 4, 78, 94, 125, 130, 131 European Convention on Human Rights 28 European Council 72 European Court of Justice (ECJ) 135 European international labour migrants (EILM) 39, 40, 41 European Social Charter (revised) (1996) (Council of Europe) 133 European Social Survey (ESS) 128, 129, 130f, 131 European Union (EU) 3–4, 11, 33, 41, 94, 126, 132–5 European Union Statistics on Income and Living Conditions (EU-SILC) (2008) 76, 78, 79, 80, 83f, 84f, 85 exclusionary discourses/services 22 expected life at birth (ELB) 110

Index

F families 89–90, 100–1, 163–5, 167 Asia-Pacific 109–121 diversity of 1 generational chain 90–4 networks 114, 115, 168 promoting intergenerational policies 98–100, 101 support to elders 94–8 family-oriented international retirement migrants (FIRM) 39–40, 41, 43 Farmácias Populares (Brazil) 60–1 FELICIE (Future Elderly Living Conditions in Europe) project 96–7 Ferge, Z. 20 Fernández, J.-L. 23–4 filial piety 11, 109, 112–15, 116, 117, 118–119, 121, 163–4 financial security see pension schemes First International Plan of Action on Ageing (1982) (United Nations) 137 Fiske, S.T. 129 ‘flexible’ employment 23 Forder, J. 23–4 four-generational structure 93 4-2-1 family structure 117–18 France 2, 3, 41, 91–3, 95, 99, 100 Friedman, M. 18 friendship 8, 98 functionalist social theory 35 Future Elderly Living Conditions in Europe (FELICIE) project 96–7

G Gallou, R. 41 Gasper, D. 76 General Comment No 6 on the Economic Social and Cultural Rights of Older Persons (Doc E/1996/22, Annex IV) (United Nations) 137 General Recommendation No 27 (United Nations) 137 generational chain 90–4 Germany 2, 100 Gilleard, C. 149–50 ‘Global age-friendly cities: a guide’ (World Health Organization) 153–4 Global Network of Age-friendly Cities (WHO) 154, 157 Global retirement crisis, the (Center for Strategic and International Studies) 20 globalisation 9, 17, 28–9, 89, 166, 168 built environment 150 economic crisis and recession 18–24 new goals for gerontology and social policy 25–8 policy responses/interventions and 19–21 Gordon, D. 72

Gore, M.S. 119 Gray, J. 28 Grewal, I. 80

H Hagenaars, A.J.M. 75 Harvey, D. 19 health care 17, 22, 24, 27, 60, 90, 112 Hedges, A. 27 Heywood, F. 147 HIV/AIDS 3, 54, 55, 65 HM Government 98 Holstein, M. 151 Hong Kong 113–14, 116, 118, 119 Horton, T. 23, 27 housing 147, 148, 149, 152–3, 154, 156 Human Rights Council 137, 138

I ILO (International Labour Organization) 136 income entitlement: Europe 77–8 income poverty 10, 77–9 income-entitlement approach 73, 74, 75 Independent Expert on Human Rights and Extreme Poverty (United Nations) 138 Independent Public Service Pension Commission 22 India 57, 110 Indicators’ Sub-Group of the Social Protection Committee 74 indirect discrimination 134 ‘individual drivers’ 8 ‘individualism’ 53, 94 ‘individualization of the social’ 20–1 institutional care provision 11 intergenerational solidarity model 1, 10, 26–7, 91–2, 94, 95–6, 98, 99, 100–1, 164, 167 International Covenant on Economic, Social and Cultural Rights (United Nations) 137 International Labour Organization (ILO) 136 Ireland 79

J Japan 120 Jordan, B. 73 Judt, T. 18, 25, 26

K Kendig, H. 156 King, R. 33 Klein, N. 18 Kohli, M. 97 Korea 111, 114 Krassioukova-Enns, O. 153

173

From exclusion to inclusion in old age

L Levitas, R. 5 Levy, B.R. 129 Leys, C. 22 life-course perspective 10, 167, 168 life satisfaction 34, 42–3, 62t, 63, 64, 66 Loury, G.C. 37 low-income countries 54, 55 Lucchetti, L. 56t, 57

M Madanipour, A. 146 Maintenance of Parents Act (1994/95) (Singapore) 120 making ends meet 82 Malaysia 116, 120 marginalised seniors 155 Masson, A. 93 material resources 10, 71–2, 84–5, 109 approaches to measuring exclusion 74–6 approximation of capability deprivation 79–80, 81t, 82, 83f, 84f income-based measures of poverty 10, 77–9 key conceptual and measurement considerations 72–4 networks and 72, 73 Menec,V. 154, 155 Mexico 56t, 57, 58 middle-income countries 10, 51, 52, 54, 57, 58–61, 62t, 66 migration 1, 9–10, 33–4, 43–5, 55, 110, 166, 167 Asia-Pacific 110, 114 built environment 150 intergenerational ties 95–6 migratory life course 34, 42–3 networks and 36, 40, 43 older migrants and diversity 39–42 policy responses/interventions 38, 42–3 research perspective 37–8 social-gerontological perspective 34–6 Millennium Development Goals 136, 138 Minkler, M. 151 ‘missing middle’ 55 modernisation and development 10, 52, 53, 55, 112, 113, 114, 116, 164 multi-generational family relationships 10 multidimensional nature: exclusion 5, 7, 21, 35, 51, 54, 72, 76 Muus, P. 33

N National Council on Ageing (Age Concern England) 135 National Health Service (NHS)(UK) 19

174

National Strategy Reports on Social Protection and Social Inclusion (European Commission) 4 neighbourhoods see built environment neo-liberalism: growth of 20 networks built environment and 148, 151, 155, 164 developing countries 54, 55 families and 114, 115, 168 material resources and 72, 73 migration and 36, 40, 43 Ng, A.C.Y. 113 non-European labour migrants (NELM) 39, 40, 41 non-family support 97–8, 116–17 non-governmental organisations (NGOs) 137–8 non-standard labour market participation 77 Nussbaum, M.C. 80

O O’Brien, M. 34–5, 38 OECD see Organisation of Economic Cooperation and Development Old Age and Autonomy: the Role of Service Systems and Intergenerational Autonomy (OASIS) 94 Open-ended Working Group on the Rights of Older Persons (United Nations) 138 ‘Opportunity age’ (Department for Work and Pensions) 98 opportunity set 76 Organisation of Economic Co-operation and Development (OECD) 20, 74 Ostroff, E. 152 Oswald, F. 156 ‘others’: ethnic/racial 38, 44

P Papadimitriou, D. 40, 41, 44 Penna, S. 34–5, 38 pension schemes 8, 17, 19, 20, 22, 24, 150, 164, 165 Europe 71, 74, 77–9 social inclusion and 58–61, 62t South Hemisphere 51, 52, 55, 56t, 57–61, 63, 65 unsustainable burden 2 Pensioner Credit Programme (Emprestimo Consignado) 60 ‘Pensions at a glance’ (OECD) 74 perceptions: social exclusion/inclusion 62–3, 64f, 66 Phillipson, C.R. 42, 150 pivot generation 92, 93 place, ageing in 11, 146, 147–51, 156, 165, 167 policy responses and interventions 1–2, 8–9, 54, 166, 169–70

Index Brazil 58, 60, 65 built environment 146, 151–6, 157 European Union (EU) 126, 132–5 globalisation and 19–21 migration 38, 42–3 promoting intergenerational policies 98–100, 101 political activity 36 politicisation of ageing 20 Portugal 79 poverty 6, 7, 8, 17, 18, 21, 26, 29, 71–2, 109 approaches to measuring exclusion 74–6 approximation of capability deprivation 79–80, 81t, 82, 83f, 84f, 85 chronic poverty indictors 35 definition 3, 5 developing countries 51, 52, 54, 55, 57, 58, 65 income-based measures of poverty 10, 77–9 key conceptual and measurement considerations for material resources 72–4 migration and 37 relative poverty 78–9 Preiser, W. 152 Principles for Older Persons (Resolution 46/91) (1991) (United Nations) 137 production activity 36 protected social spaces 9, 27, 170 public expenditure 17, 22, 23–4, 27, 58, 112 public services 9

Q Quadagno, J. 37

R Racial Equality Directive (2000/43) (European Union) 134 Rawls, J. 63 recession 18–24, 71, 73, 84, 99 Reed, H. 23, 27 refamiliarisation 100 refugees 40 relative concept of social exclusion 4, 6 relative poverty 78–9 remarriage 111 Renaut, S. 92–3 residences see built environment residential care homes 118, 119 resilience: older consumer 120–1 retirement 20, 22–3, 25, 28, 111 discrimination and 132, 135 families and 91 financial security and 77 migration and 36, 39–40, 41 rights-based approach 9, 28, 125, 133, 134–8, 166, 167, 169 Ringaert, L. 153 risks: ageing 1, 9, 20–1, 36

Rofman, R. 56t, 57

S safety and security 148 savings activity 36 Scandinavia 82, 85 Schaie, K.W. 127 Scharf, T. 7, 35, 72, 150 scientific approach 4 Sen, A. 51, 65, 72, 73, 75–6, 84–5, 165 Sennett, R. 21 SHARE (Survey of Health, Ageing and Retirement in Europe) 91, 92, 95, 96, 101n Shaw, M. 149 Silver, H. 3, 4, 5, 8, 35 silver job fairs 111 silver market 120 silver tsunami 2 Singapore 111, 114, 115, 116, 119, 120 social care system 23–4, 27 social cohesion 5 social exclusion ageing societies 2 characteristics of 6–7 concepts of 3–5, 166–8 definition (European Union) 72, 126 definition (UK) 4 domains and drivers 7–9, 72–3, 163–6 methodological issues 168–9 social inclusion 5, 36, 89, 147, 148, 155–6, 168 social justice approach 136 social relations 8, 52, 54, 55, 98 Brazil 58–61, 62t, 66 social-gerontological perspective: migration 34–6 society for all ages 10, 11, 125, 138, 139 sociological perspective 21 South Africa 10, 51, 52, 54, 57–8, 163, 164 capacity to help others 64f life satisfaction 62t, 63, 66 South Hemisphere 54–5, 56t, 57–8, 61, 62t, 65 Spain 79 spatially bound 150 Spending Review (2010) (UK) 24 spouses 95 standard-of-living approach 75, 78–9 state responsibility 25–8, 52, 169 stereotypes 127–9 ‘stoic seniors’ 155 structural drivers 8 structured dependency 7, 8, 28 Survey of Health, Ageing and Retirement in Europe (SHARE) 91, 92, 95, 96, 101n

T Taiwan 111–12, 114, 116 Thailand 53–4 theoretical replacement rate (TRR) 77–8

175

From exclusion to inclusion in old age third age 25 third sector services 19 Thomése, F. 150 three-generation schema 92–3 Townsend, P. 28, 91, 133 transportation 148–9, 154

U UN-HABITAT 155 Ungerson, C. 100 United Kingdom 4, 5, 22 United Nations (UN) 125, 136, 137, 138, 139 United States 2, 42, 97 Universal Declaration of Human Rights 28, 136 universal design 146, 151, 152–3, 155 urban environments 146, 147, 149, 150, 151, 152, 153–6, 157, 167–8, 169

V Vienna Declaration and Programme of Action (1993) (United Nations) 136, 137 visitability 146, 151, 152–3, 155, 156

W Wahl, H.-W. 156 Walker, A. and C. 4, 5 Warnes, A.M. 33, 39, 40, 41, 42 welfare eligibility 41, 42 White, P. 44 women 23, 24, 33, 111, 132, 137 World Bank 20 World Health Organization (WHO) 146, 153–4, 157 World Trade Organisation (WTO) 20

Y Yeates, N. 20 Young, J. 21

Z Zhan, H.J. 118–19

176

Edited by

“This is an important book for students, policy makers and practitioners in the ageing and social policy fields because it provides essential theoretical and empirical insights into a critical issue for the well-being of older people. It is highly recommended.” Alan Walker FBA, Professor of Social Policy and Social Gerontology, University of Sheffield

Leading international experts challenge traditional understandings of exclusion in relation to ageing in From Exclusion to Inclusion in Old Age. They also present new evidence of the interplay between social institutions, policy processes, personal resources and the contexts within which ageing individuals live to show how this shapes inclusion or exclusion in later life. Dealing with topics such as globalisation, age discrimination and human rights, intergenerational relationships, poverty and migration, the book is essential reading for anyone interested in ageing issues.

Series Editor: Judith Phillips, Professor of Gerontology and Social Work, Swansea University The study of ageing is continuing to increase rapidly across multiple disciplines. This wide-ranging series provides students, academics, professionals and policy makers with much-needed texts and critical perspectives on the latest research, theory, policy and practice developments. Focusing on the social rather than the medical aspects of ageing, the series bridges the gap in the literature as well as providing cutting-edge debate on new and traditional areas of ageing from a lifecourse perspective.

SOCIOLOGY/AGEING ISBN 978-1-84742-772-4

www.policypress.co.uk

Scharf_From exclusion to inclusion_limp.indd 1

Edited by sCHARF AND KEATING

Ageing and the Lifecourse Series

AGEING AND THE LIFECOURSE

Evidence of widening inequalities in later life raises concerns about the ways in which older adults might experience forms of social exclusion. Such concerns are evident in all societies as they seek to come to terms with the unprecedented ageing of their populations. Taking a broad international perspective, this highly topical book casts light on patterns and processes that either place groups of older adults at risk of exclusion or are conducive to their inclusion.

From Exclusion to Inclusion in Old Age

“With contributions by scholars at the cutting edge of their fields, this interdisciplinary collection of reports from around the world will be crucial to the study of the global political economy of aging.” Toni Calasanti, Virginia Tech

THOMAS SCHARF AND NORAH C. KEATING

From Exclusion to Inclusion in Old Age A global challenge

9 781847 427724

25/05/2012 13:49:10