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One major implication of the previous two chapters is that the politics of ageing is actually the politics of inequality – not a chimera of intergenerational inequality, but rather the inequalities that scholars of politics, social policy and health have long studied and understood (Lynch, 2020). As chapter two showed, one of the problematic assumptions of the ‘ageing crisis’ narrative is precisely the belief that older populations are homogeneous in their experience and outlook. This ignores the significant health inequalities which exist amongst older populations and overlooks the degree to which the costs of an ageing population are actually rooted in these inequalities. Without this framing, debates about intergenerational inequalities and the ‘ageing crisis’ are a distraction from both the deep social inequalities that exist in terms of gender, geography, race and ethnicity, socioeconomic status and the ways in which these social inequalities produce inequities in health. Intentional or not, to focus on intergenerational inequalities diverts attention from the real inequalities that shape people’s lives and the politics of ageing and health.
Older people are not a homogeneous social group. Their needs and abilities, and the costs associated with providing for their well-being, vary with their socioeconomic status, gender, geographic location and health status, among other relevant dimensions of difference. It should come as no surprise, then, that older adults are not a politically homogeneous bloc, either. In public and policy conversations there is very often a tendency, however, to assume that older people are a singular pressure group that will act through the political system to secure a distribution of societal resources that primarily benefits them – as retirees, health care consumers, people without young children in the house, and the like. If governments fail to invest in policies that can promote well-being across the life-course, and instead focus on maintaining social expenditure on the current generation of older people by squeezing current workers/future retirees, the story goes, it is because most governments are subject to greater pressure from older voters than from younger citizens, because the former vote at higher rates and are represented by powerful lobby groups. This argument was memorably summarized by the late British journalist Henry Fairlie, writing in The New Republic in 1988, as a problem of ‘greedy geezers’ living well at the expense of the young (Fairlie, 1988).
This book has, we hope, destroyed two straw men that are common in debates about intergenerational equity, spending and health. The first is the myth of ‘greedy geezers’ – the stereotype of a pampered pensioner, living off lavish old-age provision including fine health care, while voting against investments in future generations. The second is the myth of unsustainability – of health care costs driven by ageing that make it impossible to finance a welfare state. The two straw men arguments come together in a call for cuts to public health care and other public service provision: the former by demonizing older people, the latter by suggesting that public provision, unlike private finance, is unsustainable. The images of greedy older people and an ineluctably increasing financial burden associated with ageing both strengthen the argument against public provision.
The preceding chapters raise three issues that are crucial to understanding the politics of healthy ageing. First, older voters are not as powerful nor as unified as many politicians, think tanks and commentators often believe. While some elderly voters have preferences for policies that are in their own interests or in the interests of their children and grandchildren, older voters are not sufficiently homogeneous to act as a voting bloc. Indeed, even if they were, it is not clear that their influence on policy would be substantial because policy decisions are not simply determined by voters’ demand. Second, in those few contexts where political conflict over policies is framed intergenerationally, the wellbeing of older people can be preserved without being at the expense of other groups, particularly those of working age. Reframing the debate in this way helps societies move from policies which individualize the responsibility of being healthy – by withdrawing government investment – to an emphasis on healthy ageing which seeks to establish cross-class/cross-generational coalitions. Third, inequalities in healthy ageing are structured according to other kinds of inequality in the social determinants of health, and these upstream inequalities are best understood when situated in a life-course perspective which recognizes that inequalities in ageing are the product of inequalities that manifest at much earlier stages in life. Not everybody gets to be old.
Despite the alleged bias towards older people in many political institutions in Europe, this chapter argues that policymakers often do not introduce the most effective policies for supporting healthy ageing. The following pages show that while public spending on older people (e.g. pensions, old age care) remains more extensive and insulated from cuts than other forms of spending, in many (not all) countries policymakers do not introduce policies that would help people age in a healthy way. These latter policies, which include spending on the poorest older people, ensuring access to high quality services and investing across the life-cycle to enable people to enter old age in good health, are often limited.
We too often form our perspectives or design policies based on simplistic notions of generational warfare or stereotypes. Precise definitions and examination of data on the life conditions of older people lead us to the same conclusion as a quick contemplation of our own lives: the situations, goals and behaviours of older people are very diverse.
Life in an ageing society is a truly novel experience. For most of our species’ history, a large majority of people were young and life much beyond 60 seemingly a rarity (Thane, 2005). Now, populations around the world are ageing. It might be happening in countries at different speeds and to varying extents, but it is an almost universal phenomenon. In 2000 the median age in Western Europe was 37.7; in 2020 the median age was 42.5. By 2050 it will rise to 47.1 (UN Department of Economic and Social Affairs, 2020). Looking at specific Western European countries, this trend becomes even more impressive. In Italy the median age in 2000 was 40.3, in 2020 it was 47.3 and by 2050 it will be 53.6. Spain follows a similar pattern, with a median age of 37.6 in 2000, 44.9 in 2020 and a projection of 53.2 for 2050 (Statsita, 2020). Figure 1.1 shows us by how much the population is expected to age, looking at over 65 year olds in 2010 and 2050 as a share of the total population and comparing that with over 85 year olds in 2010 and 2050.
One of the most important political and economic challenges facing Europe and elsewhere is the ageing of societies. Must ageing populations create conflict between generations and crisis for health systems? Our answer is no. The problem is not so much demographic change as the political and policy challenge of creating fair, sustainable and effective policies for people of all ages. This book, based on a large European Observatory study, uses new evidence to challenge some of the myths surrounding ageing and its effects on economies and health systems. Cataclysmic views of population ageing are often based on stereotypes and anecdotes unsupported by evidence. How we address ageing societies is a choice. Societies can choose policies that benefit people of all ages, promoting equity both within and between generations, and political coalitions can be built to support such policies. This title is available as Open Access on Cambridge Core.
Bringing together the results of a large-scale review of European Union (EU) policies affecting health and a large-scale analysis of social policy and federalism, this paper uses comparative federalism to identify the scope and tensions of EU health policy at the end of the Juncker Commission. Viewing health care and public health policy through the lens of comparative federalism highlights some serious structural flaws in EU health policy. The regulatory state form in which the EU has evolved makes it difficult for the EU to formulate a health policy that actually focuses on health. Of the three faces of EU health policy, which are health policy, internal market policy and fiscal governance, health policy is legally, politically and financially the weakest. A comparison of the EU to other federations suggests that this creates basic weaknesses in the EU's design: its key powers are regulatory and its redistribution minimal. No federal welfare state so clearly pools risks at a low level while making markets so forcefully or creating rights whose costs are born by other levels of government. This structure, understandable in light of the EU's history and development, limits its health and social policy initiatives and might not be stable over the long term.
Middle East respiratory syndrome coronavirus (MERS-CoV) is a zoonotic disease transmitted from dromedary camels to people, which can result in outbreaks with human-to-human transmission. Because it is a subclinical infection in camels, epidemiological measures other than prevalence are challenging to assess. This study estimated the force of infection (FOI) of MERS-CoV in camel populations from age-stratified serological data. A cross-sectional study of MERS-CoV was conducted in Kenya from July 2016 to July 2017. Seroprevalence was stratified into four age groups: <1, 1–2, 2–3 and >3 years old. Age-independent and age-dependent linear and quadratic generalised linear models were used to estimate FOI in pastoral and ranching camel herds. Models were compared based on computed AIC values. Among pastoral herds, the age-dependent quadratic FOI was the best fit model, while the age-independent FOI was the best fit for the ranching herd data. FOI provides an indirect estimate of infection risk, which is especially valuable where direct estimates of incidence and other measures of infection are challenging to obtain. The FOIs estimated in this study provide important insight about MERS-CoV dynamics in the reservoir species, and contribute to our understanding of the zoonotic risks of this important public health threat.