Saturday, June 20, 2020
Sunday, May 10, 2020
Is Critical Gerontology Getting More Critical?
Is Critical Gerontology Getting More Critical?
Thoughts on a recent article from The Gerontologist
Immanuel Wallerstein, (1930 - 2019) American sociologist and economic historian, in a recently published 1981 interview, talks about liberal social sciences and the need to reinvigorate Marxist thinking.
"... the whole problem of development has to be reformulated as the development of the whole unit. This brings considerable changes: for instance, instead of nations, classes, social strata, and domestic units existing per se, perhaps in some sense being linked among themselves, they are now conceived as structures that have developed in the course of the historical development of the capitalist world-economy. These continually change and have to be explained on the basis of the capitalist process, rather than the other way around."
His world-systems view began to place social science in a global arena, no longer making it possible to rely on the old liberal version of social science, inherited from the 1950's. This quote seemed particularly fitting for a piece I wrote in August 2019 in response to a 2019 article in the Gerontologist, the generally liberal journal of the Gerontological Society of America. Of course, much has changed again as we experience the COVID 19 pandemic. However, this piece preceded that.
__________________
Critical approaches to aging and long term care that present a social structural view of aging are showing up more in academic journals and textbooks though sometimes without clear connection to any specific critical gerontological theory. Instead, they describe concerns with "neoliberalism" or "corporate control" with little discussion of what those terms actually mean. Such critiques often conclude with calls to action by "champions of the Long Term Care Aging Network" as in the article discussed below.
My generation was the last to have the luxury of sitting back and studying problems, handing the critical results of our investigations to "champions" and "policy makers" who really couldn't, and still can't, act outside of the system they are embedded in, just as I was during my working years. While working for public programs serving a growing aging population I was aware of the limitations of these programs, limitations reflected in fears I often had of losing my job due to budget cuts and reorganization. Today, I question the ability of "champions and policy makers" to adequately improve eldercare within what seems to be a failed system that they serve. My approach to critical gerontology is based on the experience of having lived and worked during the period when austerity policies gutted public programs in the 80's, 90's, and early 2000's which in turn led me to a desire to understand the capitalist system that created the conditions of my working life.
Nevertheless, I was happy to see in the April, 2019 issue of The Gerontologist (Gerontology Society of America) the article by Polivka and Luo, "Neoliberal Long-Term Care: From Community to Corporate Control". The article focuses on studies that examine the effects of taking public money (Medicaid mostly) from publicly funded nonprofit long term care providers and giving it to private for-profit providers administered by large insurance companies which are replacing the nonprofits.
The authors argue that studies clearly show that this for-profit corporate model, embraced by both the Republican and Democrat parties, is neither cheaper nor does it provide better care than the public models they replace. To illustrate their point, they discuss four evaluation studies of a Florida Nursing Home Diversion Program which in fact reveal that the program's existing community-based, publicly funded nonprofit providers' costs were actually lower than private corporate HMO's, even if health outcomes for both were comparable. Yet, in spite of evidence given to Florida policymakers from these evaluations-- demonstrating that corporate managed care would tend to be more costly-- Florida proceeded with the conversion of nonprofit public and NGO programs to corporate managed care, aided by legislation passed in 2011 and approved by the Federal Centers for Medicaid and Medicare Services.
The authors also focus on the privatization process of the successful national demonstration project, Programs for All Inclusive Care for the Elderly (PACE). For 25 years, PACE has successfully provided community-based nursing home diversion services through the Medicare and Medicaid programs. In 2015, Federal legislation was passed that allows various PACE services in different states to be operated by private health care corporations.
The authors argue that this "movement" towards privatization of Long Term Care, in spite of evidence that it is more costly, reflects a "neoliberal ideology", which they define as the belief that free markets provide goods and services to the public more efficiently than the government. They outline six political and practical "tendencies" that show rather convincingly (but guardedly) a continuing expansion of corporate-provided care, for profit rather than need, that tends to reduce the quality of care, increase the costs of care, increase reliance on informal care and disconnect services from local community involvement, just as the numbers of older people needing long term care are expanding and informal supports are on the decline.
To combat this trend, the authors call for annual evaluations for both nonprofit and for-profit providers. Their position seems to be that more evaluations will tend to show that nonprofits provide better care at a lower cost than corporate health care providers. Along with better lobbying from advocacy groups, these evaluations, they argue, will bring about a return to the public and nonprofit aging network of service providers.
It is interesting and encouraging that careerists and staid academic journals are increasingly willing to publish articles that infer that capitalism's profit-driven drive to privatize everything may be the underlying, systemic cause of the privatization of Long Term Care services. As cautious as they are, articles like this are a sign of dire times.
As the authors point out, the use of formal academic studies as a channel of influence with policy makers made no difference in the political outcome for two well-established nursing home diversion programs. Therefore, it is necessary to understand the broader connections at play under neoliberal policies.
A good place to start might be Colin Leys excellent work, Market Driven Politics: Neoliberal Democracy and the Public Interest. Here he defines neoliberalism as "...market-driven politics... (or)...the political dimension of the shift of power from voters to capital that results from trans-border capital mobility". This shift in political power relations is characterized by Karl Polanyi as "market society", a social order in which privatization of all social relations has escaped political control. It is important to understand that the neoliberal program of absolute capitalism is both global and local. Again, Leys: "Bringing out the connections between seemingly (though not really) remote market forces and the changes occurring in people's everyday lives is harder work than it was when a great deal of effective power over the economy still rested with governments". His book examines the process of privatization of two UK institutions, BBC and NHS, to illustrate the workings of a "market society".
In the case of the nationwide PACE program, I looked into the neoliberal processes which display these market forces at work. In 2015, the Federal Centers for Medicare Services (CMS) hired a private consultant, Mathematica, to conduct a feasibility study for enabling private investment and management of PACE, a program designed to be managed by community-based non-profits. Not surprisingly, the CMS PACE study results showed for-profit management of PACE would not compromise the program which was was successfully managed by community-based non-profits for the 25 years of the program up to that point. Mathematica, interestingly, was previously enlisted to do a similar study in order to promote Teach for America, the training arm of the nationwide school privatization movement. Here you can see how neoliberal ideology has influenced "democratic" government institutions, private think tanks, and private media, working hand in hand in the privatization process. The study results ended up in Bloomberg global media's Health Law Reporter, officially inviting and encouraging private investment in PACE's Medicaid and Medicare funded program:
"Thus, given the need for capital and the infrastructure to be a successful program, there currently is no policy reason to continue excluding for-profit entities from participating. The goal of the PACE program and other similar programs is to provide much-needed services to chronically ill individuals who might otherwise be unable to receive them. The inclusion of for-profit organizations in state PACE programs will only increase such access to care. A positive, uniform state-level approach to for-profit entry to PACE would greatly enhance the program overall. Thus, the states participating in the program may be well advised to follow Colorado's lead and welcome the participation of for-profit entities by amending the applicable statutes and regulations to reflect the CMS findings and current approach."
The authors of "Neoliberal Long Term Care" seem to be saying that PACE's privatization happened because neoliberal lobbyists were more successful than lobbyists advocating for the nonprofit Aging Network (champions). Unfortunately, even if aggressive lobbying efforts could preserve or rescue the non-profits, Older Americans Act (OAA) programs and Medicare and Medicaid-funded services, which make up the majority of publicly funded services for older people, are not enough to cover the care of a growing older population. That is not to say that private interests should take over. Through my work in OAA programs and senior housing from the 1980's onward, and as a caregiver for parents with dementia, I have seen the shortfall in services over the decades and experienced favoritism for private-paying nursing home residents over those relying on Medicaid. Rather than developing a strong, national socialized system to care for the elderly, the Federal policy towards eldercare has always been one of piecemeal programs and questionable "public-private partnerships". It's just worse now.
We are at an interesting conjunction of having reached the predicted demographics of a large older population worldwide and the crisis of global capitalism, which has its roots in the decades-old falling rate of profitability under capitalism. The falling rate of profitability is behind the neoliberal policy of privatization, seeking new profits from services addressing the most basic human needs such as health care, education, food security, and housing. The government under both Democrats and Republicans alike are working within this ideology. Neoliberal austerity measures and privatization of public services can't be lobbied out of existence. Under capitalism there is often a "contradiction between the pursuit of health and the pursuit of profit." (Lesley Doyal, The Political Economy of Health, Pluto Press 1979, p.44). Although 19th century advances in medicine improved standards of health as measured by life expectancy and mortality rates, delivery of health care under capitalism will always end up doing harm simply because of its profit-driven (not health or social-driven) nature. Again, from Lesley Doyle, "while we cannot specify in advance a utopian blueprint for a socialist health policy, we can assume that under socialism profit would no longer be the criterion for making decisions about production or consumption"... and "that a real concern for the population would be reflected in planning and decision making." (Doyal, p.22) We need to be studying how to transition to socialized medicine, away from government underwriting of for-profit "healthcare", and away from having to piece together non-profit community services to meet the huge healthcare needs of frail elders.
Critical structural approaches to Gerontology were not discussed in graduate programs or practical settings. Many of us have spent years advocating for better eldercare yet we have all been victims of an entrenched liberal ideology, now called neoliberalsm, that imposes market-driven policy. However, younger academics and practitioners are recognizing this dilemma and are confronting and challenging capitalism itself. Their precarious future is different from our comfortably precarious present.
How can established Gerontologists join forces with younger, radical academics and activists in multiple disciplines who are making important connections between the current state of health care and its historical, political and economic context, often using a Marxist approach? Critical Gerontologists can begin to connect with the emerging socialist and pro-labor healthcare movements to make sure that the needs of the aging population are understood and included in any discussion or action (Medicare for All, Health over Profit, Physicians for National Health Care, National Nurses United) to name a few. We need to be the voice for the older population among the younger and class-based socialist movements, (DSA, Greens, Poor Peoples Campaign, Working Families Party, etc.) to counteract the privatizers' efforts to pit the generations against each other, just as identity politics separates people into factions based on gender, ethnicity, color. We need a collective push away from capitalism and towards a true socialist project, through education and study, practice and speaking out in order to move beyond politics as we have known it. In the meantime, we can acknowledge the willingness and moral imperative to begin to name and understand the current conditions that affect long term care, as Polivka and Luo have done by describing destructive neoliberal-based policies, while also recognizing that politics as usual is not enough to address the long term care needs of a growing older population.
My generation was the last to have the luxury of sitting back and studying problems, handing the critical results of our investigations to "champions" and "policy makers" who really couldn't, and still can't, act outside of the system they are embedded in, just as I was during my working years. While working for public programs serving a growing aging population I was aware of the limitations of these programs, limitations reflected in fears I often had of losing my job due to budget cuts and reorganization. Today, I question the ability of "champions and policy makers" to adequately improve eldercare within what seems to be a failed system that they serve. My approach to critical gerontology is based on the experience of having lived and worked during the period when austerity policies gutted public programs in the 80's, 90's, and early 2000's which in turn led me to a desire to understand the capitalist system that created the conditions of my working life.
Nevertheless, I was happy to see in the April, 2019 issue of The Gerontologist (Gerontology Society of America) the article by Polivka and Luo, "Neoliberal Long-Term Care: From Community to Corporate Control". The article focuses on studies that examine the effects of taking public money (Medicaid mostly) from publicly funded nonprofit long term care providers and giving it to private for-profit providers administered by large insurance companies which are replacing the nonprofits.
The authors argue that studies clearly show that this for-profit corporate model, embraced by both the Republican and Democrat parties, is neither cheaper nor does it provide better care than the public models they replace. To illustrate their point, they discuss four evaluation studies of a Florida Nursing Home Diversion Program which in fact reveal that the program's existing community-based, publicly funded nonprofit providers' costs were actually lower than private corporate HMO's, even if health outcomes for both were comparable. Yet, in spite of evidence given to Florida policymakers from these evaluations-- demonstrating that corporate managed care would tend to be more costly-- Florida proceeded with the conversion of nonprofit public and NGO programs to corporate managed care, aided by legislation passed in 2011 and approved by the Federal Centers for Medicaid and Medicare Services.
The authors also focus on the privatization process of the successful national demonstration project, Programs for All Inclusive Care for the Elderly (PACE). For 25 years, PACE has successfully provided community-based nursing home diversion services through the Medicare and Medicaid programs. In 2015, Federal legislation was passed that allows various PACE services in different states to be operated by private health care corporations.
The authors argue that this "movement" towards privatization of Long Term Care, in spite of evidence that it is more costly, reflects a "neoliberal ideology", which they define as the belief that free markets provide goods and services to the public more efficiently than the government. They outline six political and practical "tendencies" that show rather convincingly (but guardedly) a continuing expansion of corporate-provided care, for profit rather than need, that tends to reduce the quality of care, increase the costs of care, increase reliance on informal care and disconnect services from local community involvement, just as the numbers of older people needing long term care are expanding and informal supports are on the decline.
To combat this trend, the authors call for annual evaluations for both nonprofit and for-profit providers. Their position seems to be that more evaluations will tend to show that nonprofits provide better care at a lower cost than corporate health care providers. Along with better lobbying from advocacy groups, these evaluations, they argue, will bring about a return to the public and nonprofit aging network of service providers.
It is interesting and encouraging that careerists and staid academic journals are increasingly willing to publish articles that infer that capitalism's profit-driven drive to privatize everything may be the underlying, systemic cause of the privatization of Long Term Care services. As cautious as they are, articles like this are a sign of dire times.
As the authors point out, the use of formal academic studies as a channel of influence with policy makers made no difference in the political outcome for two well-established nursing home diversion programs. Therefore, it is necessary to understand the broader connections at play under neoliberal policies.
A good place to start might be Colin Leys excellent work, Market Driven Politics: Neoliberal Democracy and the Public Interest. Here he defines neoliberalism as "...market-driven politics... (or)...the political dimension of the shift of power from voters to capital that results from trans-border capital mobility". This shift in political power relations is characterized by Karl Polanyi as "market society", a social order in which privatization of all social relations has escaped political control. It is important to understand that the neoliberal program of absolute capitalism is both global and local. Again, Leys: "Bringing out the connections between seemingly (though not really) remote market forces and the changes occurring in people's everyday lives is harder work than it was when a great deal of effective power over the economy still rested with governments". His book examines the process of privatization of two UK institutions, BBC and NHS, to illustrate the workings of a "market society".
In the case of the nationwide PACE program, I looked into the neoliberal processes which display these market forces at work. In 2015, the Federal Centers for Medicare Services (CMS) hired a private consultant, Mathematica, to conduct a feasibility study for enabling private investment and management of PACE, a program designed to be managed by community-based non-profits. Not surprisingly, the CMS PACE study results showed for-profit management of PACE would not compromise the program which was was successfully managed by community-based non-profits for the 25 years of the program up to that point. Mathematica, interestingly, was previously enlisted to do a similar study in order to promote Teach for America, the training arm of the nationwide school privatization movement. Here you can see how neoliberal ideology has influenced "democratic" government institutions, private think tanks, and private media, working hand in hand in the privatization process. The study results ended up in Bloomberg global media's Health Law Reporter, officially inviting and encouraging private investment in PACE's Medicaid and Medicare funded program:
"Thus, given the need for capital and the infrastructure to be a successful program, there currently is no policy reason to continue excluding for-profit entities from participating. The goal of the PACE program and other similar programs is to provide much-needed services to chronically ill individuals who might otherwise be unable to receive them. The inclusion of for-profit organizations in state PACE programs will only increase such access to care. A positive, uniform state-level approach to for-profit entry to PACE would greatly enhance the program overall. Thus, the states participating in the program may be well advised to follow Colorado's lead and welcome the participation of for-profit entities by amending the applicable statutes and regulations to reflect the CMS findings and current approach."
The authors of "Neoliberal Long Term Care" seem to be saying that PACE's privatization happened because neoliberal lobbyists were more successful than lobbyists advocating for the nonprofit Aging Network (champions). Unfortunately, even if aggressive lobbying efforts could preserve or rescue the non-profits, Older Americans Act (OAA) programs and Medicare and Medicaid-funded services, which make up the majority of publicly funded services for older people, are not enough to cover the care of a growing older population. That is not to say that private interests should take over. Through my work in OAA programs and senior housing from the 1980's onward, and as a caregiver for parents with dementia, I have seen the shortfall in services over the decades and experienced favoritism for private-paying nursing home residents over those relying on Medicaid. Rather than developing a strong, national socialized system to care for the elderly, the Federal policy towards eldercare has always been one of piecemeal programs and questionable "public-private partnerships". It's just worse now.
We are at an interesting conjunction of having reached the predicted demographics of a large older population worldwide and the crisis of global capitalism, which has its roots in the decades-old falling rate of profitability under capitalism. The falling rate of profitability is behind the neoliberal policy of privatization, seeking new profits from services addressing the most basic human needs such as health care, education, food security, and housing. The government under both Democrats and Republicans alike are working within this ideology. Neoliberal austerity measures and privatization of public services can't be lobbied out of existence. Under capitalism there is often a "contradiction between the pursuit of health and the pursuit of profit." (Lesley Doyal, The Political Economy of Health, Pluto Press 1979, p.44). Although 19th century advances in medicine improved standards of health as measured by life expectancy and mortality rates, delivery of health care under capitalism will always end up doing harm simply because of its profit-driven (not health or social-driven) nature. Again, from Lesley Doyle, "while we cannot specify in advance a utopian blueprint for a socialist health policy, we can assume that under socialism profit would no longer be the criterion for making decisions about production or consumption"... and "that a real concern for the population would be reflected in planning and decision making." (Doyal, p.22) We need to be studying how to transition to socialized medicine, away from government underwriting of for-profit "healthcare", and away from having to piece together non-profit community services to meet the huge healthcare needs of frail elders.
Critical structural approaches to Gerontology were not discussed in graduate programs or practical settings. Many of us have spent years advocating for better eldercare yet we have all been victims of an entrenched liberal ideology, now called neoliberalsm, that imposes market-driven policy. However, younger academics and practitioners are recognizing this dilemma and are confronting and challenging capitalism itself. Their precarious future is different from our comfortably precarious present.
How can established Gerontologists join forces with younger, radical academics and activists in multiple disciplines who are making important connections between the current state of health care and its historical, political and economic context, often using a Marxist approach? Critical Gerontologists can begin to connect with the emerging socialist and pro-labor healthcare movements to make sure that the needs of the aging population are understood and included in any discussion or action (Medicare for All, Health over Profit, Physicians for National Health Care, National Nurses United) to name a few. We need to be the voice for the older population among the younger and class-based socialist movements, (DSA, Greens, Poor Peoples Campaign, Working Families Party, etc.) to counteract the privatizers' efforts to pit the generations against each other, just as identity politics separates people into factions based on gender, ethnicity, color. We need a collective push away from capitalism and towards a true socialist project, through education and study, practice and speaking out in order to move beyond politics as we have known it. In the meantime, we can acknowledge the willingness and moral imperative to begin to name and understand the current conditions that affect long term care, as Polivka and Luo have done by describing destructive neoliberal-based policies, while also recognizing that politics as usual is not enough to address the long term care needs of a growing older population.
Sunday, April 9, 2017
The Intersection of Resilience, Climate Change and Aging: Rethinking the Concept of Resilience
March 27, 2017
Gerontology is a relatively new field of study, which recognized the challenges of the coming population aging (longevity plus baby boomer demographics). Although originating as a field of study in the 1940's, gerontology gained an institutional foot-hold with the Administration on Aging in 1965 and the National Institute on Aging in 1974, just as neoliberal austerity policies were gaining ground. The study of aging and related assistance programs have been in a maintenance mode ever since, to keep that foot-hold and build the profession.
While I am not a climate change expert or activist, I do consider myself a Gerontologist. The framing of issues in both gerontology and climate science can be misleading. Using a recent Monthly Review article about climate change as an example, this blog post highlights that there are similar, core issues hidden in both respective fields.
Aside from a few advocacy groups, Gerontologists (academics and practitioners) have generally functioned conservatively. Political resistance to anything but minor public reformist responses to aging has left harmful systems of care in place, and has resulted in piecemeal social programs and erosion of Medicare coverage over the years. Yet an "aging enterprise" has evolved, which has placed too much emphasis on professionalizing and profit-making solutions to age-related social and public health issues. (see Estes, 1979). This has been partially due to the initial fragmentation of programs for older people created by the Older Americans Act, each competing for special interests and funds. Individualistic approaches to social problems are often characterized as a need for individual "resilience" or "success", this detracting from socially structured causes and collective responsibility in finding solutions. Aside from a few prescient sociologists such as Carroll Estes (1), no one took a critical look at all of this, until recently. (see also: Baars, Dannefer, Phillipson, and Walker, 2006; Estes and Phillipson, 2002, Vincent, 2003; Walker and Deacon, 2003.)
Critical Gerontologists have a wealth of material to use from critiques of political economy found in reliable journals such as The Monthly Review, New Left Review and the radical press that gives voice to left-leaning thinkers and writers (e.g. Verso, Haymarket, PM Press, to name a few). My life-long interest in gerontology has taken a radical turn in recent years. Political economy perspectives of aging draw from Karl Marx's rejection of classical economists' conception of an economy that existed "independently of the mediation of human beings". (2) For Marx, it is the "social relations between actors" that "constitute the economic structure of society". (3) And from critical Sociologist, Carroll Estes: "People positioned differently within the political power structure reap different levels of benefits in the redistribution of social good". (4) A case in point is that we are now grappling with a reality where the eight richest people on earth own as much combined wealth as half of the human race. (5)
Making Critical Connections With Radical Literature: An Example
To make a seemingly unrelated connection between the predominant approach to "successful" aging and the mainstream characterization of responses to climate change, consider this quote from the editors' notes previewing the key article, 'Trump and Climate Catastrophe', in the February 2017 issue of The Monthly Review:
"The dominant ideology subtly shifted from sustainability to resilience." (6)
By redirecting the discourse to the concept of resilience, it is easier to justify avoidance of more costly sustainable environmental impact measures that are designed to prevent environmental destruction. The focus then becomes the ability to rebuild after and environmental disaster has occurred, in a macro sense, and finding new ways to cope in the face of a disaster in an individual, micro sense. Think of Hurricane Katrina and the opportunities for profit in the privatization of the entire school system while long-time residents of New Orleans were forced to cope with losing housing, losing schools they were familiar with, and displacement. Both responses, privatization of schools, and individuals having to adapt to these changes, can be characterized as resilient. The emerging climate change discourse of resilience is also being applied organizationally:
"The concept of resilience, while adopted by some progressive thinkers and organizations, such as the Stockholm Resilience Centre, is nonetheless being rapidly incorporated into a survival-of-the-most-resilient philosophy, in which poor nations and indeed exploited and dispossessed people everywhere, are told they must simply become more "resilient" in order to survive-- but in a world in which such dynamic adaptability is available mainly to the rich, who enjoy monopolies of capital, resources, and technology". (Editors notes, 2017)
They go on to point out that "Donald Trump has declared on his hyperactive Twitter account that:
'Resilience is part of the survival of the fittest formula' (Jan 14, 2014).
In this approach, responsibility for "natural" disasters, which strike with ever-greater frequesncy and intensity due to climate change, is decentralized.
'The poor are offered this message of resilience ostensibly as one of empowerment, yet its underlying ideology is that of a reemerging social Darwinism". (6)
It is not much of a stretch to see the persistent application of this "resilient" concept to aging, for example, by substituting aging vocabulary into the last sentence of the above excerpt:
"The aging population (poor) are offered this message of successful aging (resilience) ostensibly as one of empowerment, yet its underlying ideology is that of a reemerging social Darwinism."
In climate change science and age studies, the political economy of capitalism affects our thinking and therefore our discourse and we feel compelled to find solutions within that framework. Yet both climate change and challenges of population aging are each global issues that have reached a truly critical phase, one that their respective fields of expertise saw coming. If climate change, as documented by natural scientific research, has been allowed to get to this dire status, there is a need to look to the social sciences to understand why, and how this has happened. The authors and editors of The Monthly Review discuss this consideration:
"However, as a rule the social sciences are compromised from the start. As shown in particular by the discipline of economics, they are ideologically compelled to answer all concrete issues in terms set by capitalism, excluding any perspective that seriously challenges that system or its boundaries. Social scientists are this discouraged from questioning--or indeed even naming--the fundamental structures and workings of the historical system in which we live." (7)
Our failure to systemically discuss and confront problems related to a global aging demographic (inadequate health care, housing, basic income support) is similar to our failure to develop sustainable approaches to climate change. The readily accepted language of individual resilience has provided a discourse that fits a system based on monetized approaches to virtually everything. Aging individuals are offered a whole menu of choices to help them age successfully from mental stimulation activities to well-appointed assisted living facilities, yet how many people really have access to these things? As in climate change discourse, a gerontological focus on individual resilience "decentralizes responsibility" for healthy aging. Relentless examples of individual and cultural resilience create a false hope about aging in this world and create despair in those who fail to be resilient through no fault of their own. Critical approaches call out this discourse and explain structural realities. From there, it is possible to imagine actual systemic change, for example "green"socialized modes of production to sustain the planet in the environmental sense, and socialized medicine as a critical gerontological response to long term care.
What to Do?
As critical gerontologist Chris Phillipson concludes in his chapter on globalization and aging, from the Handbook of Theories of Aging,
"Globalization...highlights the importance of a macro-level focus within the study of aging. New opportunities are provided for understanding the way structural factors influence the organization of daily life. Analyzing the implications of this for social theory is now an urgent task for gerontologists to incorporate into their research". (8)
Critical gerontology is positioned to confront the current assault on social programs including social security and medicare. By drawing from critical analysis in other disciplines, gerontologists will be liberated from conventional approaches that end with policy reform and can begin to address aging in society in terms of the basic human right to age with dignity and security. Intersectionality (9) has been embraced in academia because we are beginning to see the connectivity of all social problems based on a structural analysis. When the political economy's driving ideology is one of "survival of the fittest", and the focus is on developing mechanisms to increase profit at the expense of society itself, you can be sure that marginalized populations, which include the vulnerable elderly, will continue to be an easy mark for the expendability necessary to prop up a failing capitalist system with "resilient" measure that will benefit the few.
Consider critical gerontology as part of a new Frankfurt School (10), an interdisciplinary awakening that now includes gerontology. As the social contract between the state and the people is eroded by global finance capital, an intersectional, critical approach will help to clarify the real causes of, and inspire new solutions to the ongoing failure to provide a place for aging with dignity and support.
While I am not a climate change expert or activist, I do consider myself a Gerontologist. The framing of issues in both gerontology and climate science can be misleading. Using a recent Monthly Review article about climate change as an example, this blog post highlights that there are similar, core issues hidden in both respective fields.
Aside from a few advocacy groups, Gerontologists (academics and practitioners) have generally functioned conservatively. Political resistance to anything but minor public reformist responses to aging has left harmful systems of care in place, and has resulted in piecemeal social programs and erosion of Medicare coverage over the years. Yet an "aging enterprise" has evolved, which has placed too much emphasis on professionalizing and profit-making solutions to age-related social and public health issues. (see Estes, 1979). This has been partially due to the initial fragmentation of programs for older people created by the Older Americans Act, each competing for special interests and funds. Individualistic approaches to social problems are often characterized as a need for individual "resilience" or "success", this detracting from socially structured causes and collective responsibility in finding solutions. Aside from a few prescient sociologists such as Carroll Estes (1), no one took a critical look at all of this, until recently. (see also: Baars, Dannefer, Phillipson, and Walker, 2006; Estes and Phillipson, 2002, Vincent, 2003; Walker and Deacon, 2003.)
Critical Gerontologists have a wealth of material to use from critiques of political economy found in reliable journals such as The Monthly Review, New Left Review and the radical press that gives voice to left-leaning thinkers and writers (e.g. Verso, Haymarket, PM Press, to name a few). My life-long interest in gerontology has taken a radical turn in recent years. Political economy perspectives of aging draw from Karl Marx's rejection of classical economists' conception of an economy that existed "independently of the mediation of human beings". (2) For Marx, it is the "social relations between actors" that "constitute the economic structure of society". (3) And from critical Sociologist, Carroll Estes: "People positioned differently within the political power structure reap different levels of benefits in the redistribution of social good". (4) A case in point is that we are now grappling with a reality where the eight richest people on earth own as much combined wealth as half of the human race. (5)
Making Critical Connections With Radical Literature: An Example
To make a seemingly unrelated connection between the predominant approach to "successful" aging and the mainstream characterization of responses to climate change, consider this quote from the editors' notes previewing the key article, 'Trump and Climate Catastrophe', in the February 2017 issue of The Monthly Review:
"The dominant ideology subtly shifted from sustainability to resilience." (6)
By redirecting the discourse to the concept of resilience, it is easier to justify avoidance of more costly sustainable environmental impact measures that are designed to prevent environmental destruction. The focus then becomes the ability to rebuild after and environmental disaster has occurred, in a macro sense, and finding new ways to cope in the face of a disaster in an individual, micro sense. Think of Hurricane Katrina and the opportunities for profit in the privatization of the entire school system while long-time residents of New Orleans were forced to cope with losing housing, losing schools they were familiar with, and displacement. Both responses, privatization of schools, and individuals having to adapt to these changes, can be characterized as resilient. The emerging climate change discourse of resilience is also being applied organizationally:
"The concept of resilience, while adopted by some progressive thinkers and organizations, such as the Stockholm Resilience Centre, is nonetheless being rapidly incorporated into a survival-of-the-most-resilient philosophy, in which poor nations and indeed exploited and dispossessed people everywhere, are told they must simply become more "resilient" in order to survive-- but in a world in which such dynamic adaptability is available mainly to the rich, who enjoy monopolies of capital, resources, and technology". (Editors notes, 2017)
They go on to point out that "Donald Trump has declared on his hyperactive Twitter account that:
'Resilience is part of the survival of the fittest formula' (Jan 14, 2014).
In this approach, responsibility for "natural" disasters, which strike with ever-greater frequesncy and intensity due to climate change, is decentralized.
'The poor are offered this message of resilience ostensibly as one of empowerment, yet its underlying ideology is that of a reemerging social Darwinism". (6)
It is not much of a stretch to see the persistent application of this "resilient" concept to aging, for example, by substituting aging vocabulary into the last sentence of the above excerpt:
"The aging population (poor) are offered this message of successful aging (resilience) ostensibly as one of empowerment, yet its underlying ideology is that of a reemerging social Darwinism."
In climate change science and age studies, the political economy of capitalism affects our thinking and therefore our discourse and we feel compelled to find solutions within that framework. Yet both climate change and challenges of population aging are each global issues that have reached a truly critical phase, one that their respective fields of expertise saw coming. If climate change, as documented by natural scientific research, has been allowed to get to this dire status, there is a need to look to the social sciences to understand why, and how this has happened. The authors and editors of The Monthly Review discuss this consideration:
"However, as a rule the social sciences are compromised from the start. As shown in particular by the discipline of economics, they are ideologically compelled to answer all concrete issues in terms set by capitalism, excluding any perspective that seriously challenges that system or its boundaries. Social scientists are this discouraged from questioning--or indeed even naming--the fundamental structures and workings of the historical system in which we live." (7)
Our failure to systemically discuss and confront problems related to a global aging demographic (inadequate health care, housing, basic income support) is similar to our failure to develop sustainable approaches to climate change. The readily accepted language of individual resilience has provided a discourse that fits a system based on monetized approaches to virtually everything. Aging individuals are offered a whole menu of choices to help them age successfully from mental stimulation activities to well-appointed assisted living facilities, yet how many people really have access to these things? As in climate change discourse, a gerontological focus on individual resilience "decentralizes responsibility" for healthy aging. Relentless examples of individual and cultural resilience create a false hope about aging in this world and create despair in those who fail to be resilient through no fault of their own. Critical approaches call out this discourse and explain structural realities. From there, it is possible to imagine actual systemic change, for example "green"socialized modes of production to sustain the planet in the environmental sense, and socialized medicine as a critical gerontological response to long term care.
What to Do?
As critical gerontologist Chris Phillipson concludes in his chapter on globalization and aging, from the Handbook of Theories of Aging,
"Globalization...highlights the importance of a macro-level focus within the study of aging. New opportunities are provided for understanding the way structural factors influence the organization of daily life. Analyzing the implications of this for social theory is now an urgent task for gerontologists to incorporate into their research". (8)
Critical gerontology is positioned to confront the current assault on social programs including social security and medicare. By drawing from critical analysis in other disciplines, gerontologists will be liberated from conventional approaches that end with policy reform and can begin to address aging in society in terms of the basic human right to age with dignity and security. Intersectionality (9) has been embraced in academia because we are beginning to see the connectivity of all social problems based on a structural analysis. When the political economy's driving ideology is one of "survival of the fittest", and the focus is on developing mechanisms to increase profit at the expense of society itself, you can be sure that marginalized populations, which include the vulnerable elderly, will continue to be an easy mark for the expendability necessary to prop up a failing capitalist system with "resilient" measure that will benefit the few.
Consider critical gerontology as part of a new Frankfurt School (10), an interdisciplinary awakening that now includes gerontology. As the social contract between the state and the people is eroded by global finance capital, an intersectional, critical approach will help to clarify the real causes of, and inspire new solutions to the ongoing failure to provide a place for aging with dignity and support.
References
(2) Marx, K. (1983a). A contribution to the critique of political economy in E. Kamenka (Ed.), The portable Karl Marx. New York: Penguin in The Political Economy Perspective of Aging, (2009)in Bengston, Gans,Putney, Silverstein (Eds) Handbook of Theories of Aging New York: Springer Publishing, p.556
(3) Giddens,A (1971). Capitalism and modern social theory. An analysis of the writings of Marx, Durkheim and Max Weber, Cambridge: Cambridge University Press in The Political Economy Perspective of Aging, (2009)in Bengston, Gans,Putney, Silverstein (Eds) Handbook of Theories of Aging New York: Springer Publishing, p.556
(4) Estes, C.L.(1999). Critical gerontology and the new political economy of aging. In M.Minkler and C.J. Estes(Eds), Critical gerontology: Perspectives from political and moral economy Amityville, NY: Baywood Publishing (pp.17-35)
(6) Foster, Yates, Vanderburg, (eds) “Notes from the Editors”, p.65, February 2017, Monthly Review, Vol. 68, No.9, Feb. 2017
(7) Foster, John Bellamy, ‘Trump and Climate Catastrophe’, p.4, Monthly Review, Vol. 68, No.9, Feb. 2017
(8) Phillipson, Chris (2009) ‘Reconstructing Theories of Aging: The Impact of Globalization on Theories of Aging’, in Bengston, Gans, Putney, Silverstein, (eds)Handbook of Theories of Aging, p.626
(9) Wikipedia: “Intersectionality or Intersectional Theory is a term coined in 1989 by American civil rights advocate and scholar of critical race theory, Kimberle Willams Crenshaw.”
(10) For more on the Frankfurt School see Carroll Estes, Social Policy & Aging: A critical Perspective, Thousand Oaks, Ca: Sage Publications, p.31 and Scott Bass, Handbook of Theories of Aging, Toward and Integrative Theory of Social Gerontology, p. 356.
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