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Ageing and Globalisation$

Martin Hyde and Paul Higgs

Print publication date: 2016

Print ISBN-13: 9781447322276

Published to Policy Press Scholarship Online: January 2017

DOI: 10.1332/policypress/9781447322276.001.0001

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(p.179) Eight Conclusion
Ageing and Globalisation

Martin Hyde

Paul Higgs

Policy Press

Abstract and Keywords

This chapter draws together the evidence from the preceding chapters to evaluate the arguments set out in the book. The main conclusion is that there does not seem to be one single global time-space of later life. Yet neither is it the case that we see the continuing presence of a set of mutually exclusive time-spaces of ageing and later life contained within separate nation-states. Instead the economic, political and cultural co-ordinates of later life are located in a series of overlapping, sometimes conflicting, and sometimes co-ordinated spatial logics and temporal frames. However the chapter ultimately concludes that these findings are conditional and compel us to develop new theoretical models within gerontology which would allow us to handle the complex interrelations between these spatial logics as they develop.

Keywords:   gerontology, global, ageing, later life, spatial logics

The aim of this book has been to map out the present day time-spaces of ageing and later life. In drawing together the wide range of different contexts in which old age occurs a number of inferences can be made. The main conclusion is that there does not seem to be one single global time-space of later life. Instead the economic, political and cultural coordinates of later life are located in a series of overlapping, sometimes conflicting, and sometimes co-ordinated spatial logics and temporal frames. This can be illustrated through a number of subsidiary conclusions that relate to the individual chapters. These show that: i) there is evidence that the third age has become what could be described as a free floating global signifier; ii) that material aspects of globalisation have a very weak effect on the conditions of later life; and iii) that there are a number of emerging epistemic communities that are actively involved in trying to shape later life. These findings are, however, conditional and impel us to develop new theoretical models within gerontology which would allow us to handle the complex interrelations between these spatial logics as they develop.

New spaces for old? Multiple spatialities of ageing and later life

The analyses presented throughout the book lend overwhelming support to the argument that there has been a more or less radical transformation of the temporal coordinates of later life during the past few decades. However, the spatial (re)configuration of these new temporalities does not easily map on to a single logic of globalisation. Thus, to answer to the primary research question investigated in the book, there is little evidence for a global time-space of ageing and later life. Yet neither is it the case that we see the continuing presence of a set of mutually exclusive time-spaces of ageing and later life contained within separate nation states. Instead of a simple model we see a number of variegated landscapes which change depending on the lens that is being used. Consequently, when we look at topics such as engagement with consumer culture or patterns of tourism we can see a relatively global landscape. However, when we look at health or the financial circumstances of older people we see a much more uneven terrain (p.180) with different regions or individual nation states standing apart from each other. The multiplicity of spatial logics and the lack of a global time-space lead to the conclusion that it is not possible to definitively describe the state of the world’s older population, rather the picture that emerges from the data is one of spatial variation. In the earlier chapters of the book we have artificially separated the various aspects of ageing and later life to allow for clearer analyses of the conditions and experiences of older people. Here they are reconfigured to permit the exploration of the intersectionalities as well as the inter-spatialities that exist between them.

It is important to note that while we might not have moved into a completely global time-space of ageing and later life, there is strong evidence for the existence of global processes and actors in later life that cut across a number of the different ‘scapes’ we have identified. The clearest examples of this are the emergence of the third age as a free floating global signifier as well as some aspects of the spread of medical tourism and the activities of the epistemic communities connected to ageing and later life. The increased fluidity around the age and timing of LME does seem to coincide with a desire by many older people to push back the onset of old age. This has opened up new spaces in the life course as the end of working life and the start of old age become more and more disconnected. This provides powerful evidence that the third age has transcended its sociocultural moorings in the UK and USA and increasingly suggests that a more globalised dimension to the time-space of later life is currently emerging. The spread of these ideas also comes at the same time as the diffusion of the material conditions for the realisation of a third age, such as improved health and income, now extends beyond Western Europe and North America. This is most clearly evident in the spread of consumer culture among older people in East Asia. Here is a clear example of a ‘global’ rather than a ‘regional’ diffusion of third age identities and practices. In a regional diffusion we would expect these practices to spread out from a regional core, for example the USA, to adjoining countries in neighbouring regions or, alternatively, to countries that belong to a similar welfare regime type if we were to take Esping-Andersen’s (1990) approach. However, our analyses show that these practices have migrated across regions however they may be defined. They show that global consumer capitalism seeks to open up new markets wherever it can take hold and that it has found a market within East Asia. These results suggest that consumerism seemingly has the ability to overcome the assumed cultural differences between the East and West and is (p.181) capable of creating a shared experience of later life constructed around cultural consumption.

If the spread of the third age represented a possible global ‘ethnoscape’ of ageing and later life, then the activities of the various epistemic communities that we have identified in the book constitute a number of competing global ‘ideoscapes’. Each of the three epistemic communities which we identified (the new pension orthodoxy, the active ageing approach and the global ageing enterprise) contained actors operating within different spatial logics. In concert with this, global actors such as the World Bank and the UN form key constituents of these communities. They occupy crucial positions for the dissemination of information, funding of programmes and as fora for discussions and institutions in the coordination of action. However, they do not operate alone. Regional, national and local actors are present in each of these communities. Neither do they operate in a regulatory void. Instead the multiplicity of spatialities has created a super-regulatory field with many overlapping regimes. This was clearly evident in the analyses of the ‘global’ cosmetics and cosmeceutical industry. These analyses, and those for pensions and retirement, show that the regulatory spaces of health and financial wellbeing have not simply shifted ‘up’ to a global level but have also moved ‘down’ and include actors at each spatial level. Our analyses support our central argument that there appears to be no single time-space of ageing and later life. Instead we see a mosaic of different spatial logics through which the conditions and meaning of later life are constructed and contested.

This conclusion is evidenced when we look at the issue of medical tourism. Although it is important to be cautious about the data on this phenomenon we would argue that it exemplifies this complexity and operates in a multiplicity of spaces. It is possible to see how it touches on and incorporates all the spatial layers, from the global to the local. A global dynamic clearly exists with older people from many countries travelling to medical tourist hubs in Asia, Europe and Latin America. However this is overlaid with regional patterns. The majority of medical tourists tend to travel to neighbouring countries. At the same time regional bodies, such as the EU, are trying to create a common market for these services within their borders. Contrary to the globalisation literature, nation states also play a huge role in both the receiving and sending countries. These hubs or hospitals which operate at the local level are highly connected to, as well as being supported by, their national governments as well as by their economic and health policies. On the other side of the equation, governments in the sending countries have extended their juridical boundaries to (p.182) include these hubs by giving them forms of accreditation. In this way the nation states and regions remain key actors in the production and reproduction of the conditions of later life. Instead of disappearing it could be argued that they have adapted to the multi-scalar environment.

Indeed, throughout the chapters in this book there has been ample evidence of the importance of regional patterns and actors for the various dimensions of ageing and later life. The fact that population ageing remains relatively confined to the advanced industrial nations is perhaps the most potent argument against the emergence of a global time-space for later life. What we see, instead, is an intersection between economic geography and demography. So, while it is true that life expectancy is increasing and fertility rates are declining in almost all countries, at present and in the near future, older people only make up a small proportion of the population in many developing countries. The fact that these countries tend to be concentrated in the global South adds a broader regional dimension to these analyses. Thus international or intraregional variation sit alongside interregional patterns which partition the world in the relatively more aged and less aged populations. This is reflected in many of the policy discourses pertaining to these regions. As noted earlier the Millennium Development Goals neglect any mention of older people as a key group and are instead overwhelmingly focused on children and those of working age. Conversely the issues of pensions and ‘old age’ care feature largely in Europe and North American politics. These twin discourses reflect and reinforce the different time-spaces of ageing and later life in the economically more- and less-prosperous world(s). These analyses are also important as they caution us from wrongly extrapolating from one indicator, life expectancy, to another, population ageing. They also point to problem of treating demographic trends as static and politically neutral. Rises in life expectancy might stall or even reverse, as they did in Russia after the fall of Communism, due to economic shocks and/or poor health behaviours, notably alcoholism.

This uneven ‘bioscape’ of population ageing is an important corrective to a rather simplistic view which treats population ageing as a uniform global phenomenon and draws our attention to the impact that different spatial formations have on the experience and expectations of later life around the world. This is important given that it sets up a number of the key demographic parameters that drive and to some extent are driven by the impact of population ageing. Hence, from the World Report on Health and Ageing and the most recent Global Burden of Disease statistics we also see highly regionalised patterns of morbidity and mortality. This again shows us that, far from a global time-space of (p.183) health in later life, we see a largely divided world in which older people in the more advanced industrial economies are much more likely to die from non-communicable diseases while those in the developing world are subject to a double burden of disease with both communicable and non-communicable diseases presenting threats to life.

Similar regional patterns are identifiable across the ‘financescapes’ of later life when we look at the data on labour market participation. Our analyses extended those done elsewhere (see Kohli and Rein 1991, Hofäcker 2010) by looking outside of the advanced industrial economies of the OECD or EU region in order to explore these trends more clearly. The results show a clear distinction between the global North and the global South. This bifurcation, with people working much later in life in the developing world, is reflected in a dual discourse in which the aim in the North is to encourage older workers to work longer, while in the South there is real concern that older workers do not have the opportunity to retire. However, even within the more advanced industrialised economies the pattern is neither completely homogenous nor completely fragmented. Here there is tacit support for Esping-Andersen’s (1990) typology of welfare regimes. Countries in the social democratic category tend to have higher rates of labour market participation in later life as one would expect from their more state interventionist approach and greater commitment to labour market activation programmes. In opposition to this, the corporatist countries could be classified as being part of an ‘early exit’ regime. There is also evidence that the East Asian countries have a similarly high rate of LMP in later life. Although these countries fall outside Esping-Andersen’s original formulation these data, along with the relatively low levels of spending on healthcare in these countries, do fit with a classification of the productivist-welfare regime (Hort and Kuhnle 2000, Gough 2001). Again, data add additional support to the argument that different political and welfare structures produce different responses to the issue of population ageing. Furthermore, they demonstrate that there are a number of regional time-spaces which sit alongside those of the nation and set specific constraints on policy direction and change.

The overlap between these regional bioscapes and financescapes is most clearly seen in the data for the former communist economies of East and Central Europe. In these countries poverty and poor health are still the dominant experience for older people. In many respects ageing and later life in these countries continue to be constructed along modernist spatial and temporal lines. The data from these countries offers some of the most convincing evidence for the existence of (p.184) regional dynamics of later life. While the patterns for self-rated health, disability and poverty are generally marked by a wide degree of international variation with very little global or regional homogeneity, this part of the world stands out as the exception. Moreover, despite having rates of life expectancy and LME that are comparable to their Western European neighbours, older people from the former Soviet Union and Eastern Bloc countries are grouped at the most disadvantaged end of the distribution on health and wellbeing. This finding is interesting as, unlike the EU or ASEAN, there are no longer any formal regional political or economic institutions that unite these countries. In fact, an increasing number are to be found within the EU. Nonetheless, it is clear that older people in these countries share a common set of experiences which lends support to the new regionalist argument that present day regions are greater than their associated political institutions (Hettne 2005).

Finally, these global and regional patterns are overlaid with high levels of international variation. This is particularly noticeable when we consider older people’s subjective accounts of their situation along a number of different dimensions. Despite the clear evidence for distinct regional patterns of mortality and morbidity, we need to be cautious not to read off other aspects of the bioscapes of ageing from these demographic patterns. The evidence shows that these do not neatly intersect with older people’s attitudes to health. Here these regional patterns are largely crosscut by national differences, strongly suggesting that subjective assessments of health in later life are highly culture-bound and that older people draw on a range of social comparisons from within their own country to make sense of their health. Following on from this and despite having relatively low life expectancy and higher rates of morbidity, older people in India have the highest rate of very good self-rated health. This may be due to some form of survivor effect: compared to those who did not survive into later life, those who did survive rate their health as good. This reinforces the need to contextualise the meaning of health in later life within a national cultural framework in most cases. We see similar apparently contradictory spatial patterns operating across the financescapes too. Notwithstanding our earlier observation regarding the uniformly negative assessment of financial wellbeing among older people living in the former Soviet bloc countries, subjective assessments of income satisfaction in later life appear to be highly dependent on one’s national cultural context. This leads to the seemingly anomalous situation that in countries where older people appear to be objectively worse off they report that they are highly satisfied with their income. Again this leads (p.185) us to conclude that they are taking the national, rather than the global, context as their normative horizon when making social comparisons. Hence older people in Ecuador are probably not comparing their income situation with their peers in the USA when they say that they are largely satisfied with their income but are perhaps comparing it to previous generations who did not have access to a social pension.

The spatial limits to globalisation and the continued salience of national time-spaces are clearest when looking at the impact of the material dimensions of globalisation on the conditions of ageing and later life. It is clear that global actors have not created a ‘race to the bottom’ in the services and institutions that aim to ensure the wellbeing of older people. Rather there are still wide international variations in spending on healthcare, rates of labour market participation and pension provision. The evidence clearly shows that exposure to economic openness has little or no impact on these aspects. These findings are in line with the historical institutionalist argument that welfare institutions create a set of path dependencies that achieve a certain degree of inertia over time. When one considers that the pension and healthcare systems in some of the advanced industrialised economies have been in existence, in some form or another, for over 100 years such a conclusion makes sense. It seems that national governments still have a good deal of discretion in determining how and where to spend their money. Moreover, there is some evidence that high social spending and economic openness are quite compatible. This international variation is also partially overlaid with ‘regional’ patterns. The data on healthcare spending show that at the extreme ends of the distribution on expenditure and privatisation there are identifiable clusters of countries among the Scandinavian, North American and Asian regions. Thus when we look at spending on pensions and the make-up of pension income, such regional or welfare clusters are much less evident than they are for rates of labour market participation in later life. Here the picture is clearly one of international variation. There is very little regional homogeneity between countries who share similar welfare structures, such as Sweden and Denmark. However, these international, or intraregional, differences do not appear to be the product of direct global economic flows. Exposure to economic globalisation appears to be unrelated to social expenditure on pensions or to their composition. Yet this does not mean that they are unaffected by global actors, or more precisely by ‘global’ discourses on ageing. As noted above there is evidence that it is the activities of a number of epistemic communities that have had a greater impact on population ageing, through the setting agendas and/or policy goals, than the more (p.186) material aspects of globalisation that are usually mentioned. As a result, the evidence from across all these different arenas allows us to argue that we have yet to enter a global time-space. This is not to deny that globalisation is a real phenomenon, but rather to posit that it is not the dominant spatial logic. Neither is it inevitable or irreversible. A closer examination of economic, cultural and political life reveals a far more complex pattern that cannot be simply examined through the binary distinction of national versus global planes. The world and the action that takes place within it is a mosaic of different, sometimes competing, sometimes cooperating, spatial logics. The global and the national operate alongside the local and the regional. Each spatiality has its own set of logics as well as its own actors. The relations between them may continually shift, but none can be said to be reducible to the others.

Here be monsters: theorising later life in a global era

These conclusions raise a number of empirical and theoretical challenges for gerontology. We would argue that these can be rather crudely summarised in the answers to three broad questions: 1) Where are we measuring? 2) What are we measuring? 3) What are we analysing? Turning to the first of these it is clear that at present any attempt to analyse the state of the global ageing population is constrained by the spatial limits in data coverage. While there have been some real strides forward in this area, such as the Survey of Global Ageing (SAGE) and the work done by HelpAge International in the creation of their Global Age Watch Index, there are still many countries where we do not have much or any data on the experiences of ageing and later life. This is not to overlook the many good studies done with older people in Africa and other less developed regions. Yet the great majority of these are small-scale, qualitative studies. While these are immensely valuable, for example in demonstrating the complexity of family relations in these countries (see Aboderin 2004b), their limited scope and the lack of a standardised set of questions make it very difficult to draw comparisons with older people in other countries. For our analyses we have been fortunate to be able to use data from a number of more ‘global’ surveys, the ISSP and WVS, which include some middle and lower income countries. However, these are general population surveys, rather than surveys of older people. As a result, in countries with low rates of population ageing, it is often difficult to get sufficiently large numbers of older people into surveys to have any confidence in statistical analyses. Hence, although throughout the book we have made every effort to ensure that data were presented (p.187) from as wide a range of countries as possible, it is simply the case that very few cross-national studies include countries from Africa or Central Asia. This is a potentially serious drawback when trying to conduct comparative research in order to draw conclusions about the nature of ageing and later life around the world. An additional consideration relates to the balance of breadth and depth of analyses. This is reflected in our decision throughout the book to look at older people in as many countries as possible. But this has been at the expense of looking at social-demographic variations, such as gender and social class, among the older population and how these might intersect with different spatialities. It also has to be acknowledged that because our aim was to explore these ‘global’ dynamics a certain degree of depth has had to be sacrificed to achieve maximum breadth. This it is potentially problematic given that it possibly ascribes a false homogeneity to older people living in different countries. We are unable to see, for example, if older women in different countries have more in common with each other than they have with men in their own countries, or whether or not there are gendered forms of globalisation. We fully recognise that these are important issues that hopefully can be explored in the future. Thus our first challenge as gerontologists must be to extend the breadth and depth of data collection about ageing and later life to encompass all countries around the world.

Our second challenge is to be clear about what it is we are measuring. A common argument of much of the more recent gerontological literature is that contemporary patterns of ageing call for a reassessment of the frames we use to study later life (Phillipson 1998, Gilleard and Higgs 2000, 2005, Metz and Underwood 2005, Jones et al 2008). This does not merely entail extending the field of enquiry to include areas such as leisure, consumption and lifestyle, but requires us to critically reflect on the utility of the definitions used to identify older people themselves. As Harper and Laws (1995: 200) noted ‘the age variable itself, its social and spatial construction’ is a key concern within geographical gerontology. A central issue that appears throughout the book is the problematic nature of the measurement of later life. In line with both critical and cultural gerontology, we have shown that the temporalities of later life in late or reflexive modernity have become more unstable, more complex and more varied. Although it might be premature to declare the complete collapse of the modernist life course it is fairly apparent that the sociodemographic indicators that have previously been used to demarcate the boundary between mid and late life have become decoupled from one another, and from chronological age. Older, modernist temporalities of decline and finitude have been (p.188) replaced by more open, positive, but also contingent, temporalities of renewal. The transformation of the sociodemographic markers of later life, such as health, retirement and poverty, has been reflexively incorporated in to the world views of older people themselves. This is seen in the data on the subjective assessment of the onset and characteristics of old age. The markers by which older people seek to fix or locate these boundaries are themselves mobile and subject to change. Yet the shifting and contested discourses around the age of retirement and the rapid growth of anti-ageing technologies provide a very unstable basis on which to fashion a new life course. Almost as soon as new parameters are established, they dissolve to be replaced by new goals and ever more fantastic potentialities. Hence regardless of which of the dimensions of ageing that are considered, it is clear that chronological age is a poor indictor for later life. The shift to a more pluralistic set of identities and lifestyles, as well as the increasing malleability of later life indicate that these methodological challenges are also theoretical challenges too. Hence there is an evident tension in the book between an awareness of these issues and our reliance on chronological age for many of our analyses. This is a product of the continued absence of alternative measures of age in many large-scale surveys and official statistics, despite evidence that older people often actively employ alternative temporal schema, such as subjective age, cognitive age and desired age to locate themselves. This issue is not confined to our analyses but takes on an added saliency when undertaking international comparisons as it raises additional questions about whether the meaning of being aged 60 differs for someone who lives in a country with a life expectancy of 65 compared with someone who lives in a country where they can expect to live to 80 or 90 years of age. Consequently, we need to adopt a much more critical perspective when we are forced to rely on chronological age as well as lobbying for survey organisers to include alternative measures of age when conducting cross-national studies.

The third challenge relates how we treat space in our analyses. As we hope to have shown we are not advocating an abandonment of the nation state as a meaningful spatial frame through which to understand ageing and later life. Rather, we are arguing that we need to develop better theoretical and empirical models that can deal with the complexity of multiple spatialities as well as the interrelationships between them. From a social gerontology perspective this means that we should not rush to discard the nation state as a key focus of study. It does mean, however, that we do need a new vocabulary or set of analogies to describe its present incarnations. Urry (2002), drawing (p.189) on Bauman’s dichotomous representations of the state as either ‘gamekeeper’ or ‘gardener’, argues that we have returned to the state as gamekeeper due to the complex mobilities which render the ability of the nation state to control flows, objects and information relatively ineffectual. However, the image of the gamekeeper is imperfect so long as it relies on the notion that the state still presides over a distinct geographical area (the grounds). The analyses presented throughout the book illustrate the argument that this is no longer the case. Today the state has to manage not only the flows within its borders, but has itself become fluid; managing relations and people through a range of bilateral, multilateral and international policies. If, therefore, we are looking for a new agricultural analogy, maybe the ‘cowboy state’ would be a better choice. Here the state has a ‘loose’ control over its mobile mass, while itself being increasingly mobile. Under such circumstances, it retains loose control over the general direction of travel (mainly through reactive policies at the national and supranational levels) but it cannot control the herd in all circumstances. In this analogy the state loses some cattle, gains others and has some stolen, while all the time it is constantly at risk of a stampede. For all its insights, it could be argued that this analogy also has its drawbacks as it suggests a largely free floating state untethered to others. This is also not the case in the real world. Instead, the data, most notably those on medical tourism, suggest that the ‘plastic state’ might be a better term to denote a state that shifts its juridical borders in expectation and response to global flows. While the search for analogies is certain to go on, it is equally true that we need to be constantly more critical about what the ‘national’ spaces (for example, political, juridical, geographical, and so on) are when we look at how state agencies extend their reach beyond the confines of the nation.

The need for more nuanced models is perhaps most clearly illustrated when looking at the activities of the various epistemic communities. These have been critical for our understanding of the shifting landscapes of ageing and later life in this book. If we were to limit our analyses to one spatial frame, for example the global, we would miss the complex interplay between different actors operating at different scales. The analyses show that these are incredibly important networks which connect actors across a range of organisations and spatial levels. In so doing they operate as multi-layered spatial assemblages of power seeking to project their vision for ageing and later life. The way in which these networks come together, their membership and their means of operation are crucial issues for gerontology. In particular, we should aim to understand the relationships between members of (p.190) these communities and how they seek to capture the roles of key actors operating across different spatialities. While certain actors may be more central to particular communities they must also mobilise actors at other levels to ensure their own success. It is clear from the three examples of epistemic communities used in this book that each of them has been able to achieve a high degree of alignment and include actors from every scale who share similar goals. It is also clear that when they fail to recruit actors within a certain scale, as was noted in the IEG report on the activities of the new pension orthodoxy (Andrews 2006), they are also largely unable to realise their goals. Therefore, rather than seeing the relationships between these actors in reductionist terms, they are best seen as ‘elective affinities’, to borrow a term from Albrow (1996).

Ultimately, our conclusions are relatively simple. It is a paradox that as population structures become more homogenous, the experience of ageing and later life becomes more heterogeneous. There has definitely been a collapse of chronological age as a meaningful marker for the identification of old age within social gerontology. There is no longer a single spatial or temporal fix for its understanding. It has become much more contingent and fluid. Alongside this, the economic, political and cultural coordinates of later life have also become increasingly located in a series of overlapping spatial logics and temporal frames. It is therefore a problem that present approaches to globalisation within social gerontology have been often too narrowly focused on either the global or the (inter)national to be able to explore the complex ways in which these different spatialities, along with those of the regional and the local, interconnect to produce specific spatial (and temporal) constellations. If this book has had one implicit overriding aim, it has been to re-orientate the gerontological understanding of globalisation so that it can better address these complex and interlocking levels that provide much of the context of contemporary later life.