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.

Introduction This chapter examines the COVID-19 economic crisis, an economic shock of rare and extreme impact. COVID-19 has had a devastating impact on the world economy with huge reductions in productivity and national income, and record levels of unemployment (for example and 5.2 million people filed for unemployment benefit in just one week in April 2020 in the US). It is widely feared that the economic impact will be far greater than that of the global financial crisis of 2007/ 8, and that it is likely to be worse in depth than the Great Depression of the 1930s. Emerging contemporary data and research from previous recessions suggest that the economic fallout from the COVID-19 pandemic will have huge consequences for health and health inequalities. This chapter will provide an overview of the unequal impacts of COVID-19 in terms of the social and spatial distribution of the economic crisis. It will then use evidence from previous recessions (such as the global financial crisis of 2007/ 8) to explore the likely unequal health impacts and reflect on the role of social safety nets in preventing them.

An unequal crisis

The impact of COVID-19 on health inequalities will not just be in terms of virus-related infection and mortality, but also in terms of the health consequences of the policy responses undertaken in most countries. Traditional public health surveillance measures of contact tracing and individual quarantine were successfully pursued by some countries (most notably by Australia, South Korea and Germany) as a way of tackling the virus in the early stages. However, most other countries failed to employ this approach successfully, so governments worldwide were eventually forced to implement mass quarantine measures in the form of lockdowns and social distancing. These state-imposed restrictions, usually requiring the government to take on emergency powers, have been implemented to varying levels of severity, but all have in common a significant increase in social isolation and confinement within the home and immediate neighbourhood.