2.3 Age and the lifecourse: healthy ageing
Lifecourse perspectives draw on age, sex and hereditary factors to show how health effects accumulate throughout a person’s life. Illness and ageing are seen to go hand-in-hand and old age is often portrayed as a period of decrepitude and decline. However, as Featherstone and Hepworth (1988) rightly note, there have been considerable attempts to deconstruct lifecourse explanations and to show how the ‘mask of ageing’ is socially constructed, rather than biologically determined. For example, a study of urinary incontinence (Mitteness and Barker, 1995) shows that whilst this condition is aggressively managed and treated in young people, in older people urinary incontinence is perceived as an inevitable and untreatable consequence of old age, in spite of the fact that it is often treatable and even reversible in some cases.
As a consequence of changes to the age structure of the population and a subsequent moral panic over welfare the concept of positive, or healthy, ageing has been promoted as the way forward for older people. Whereas illness in old age was once seen as a consequence of chronology and biology, it is now recognised that behavioural, social and environmental factors all have a part to play (Sidell, 2007). Attention has been given to the relationships between ageing, activity and health. For example, particular emphasis has been given to the role of physical activity throughout the lifecourse and into later life (de Groot et al., 2004).
It is also important to recognise that later life and experiences of ageing are socially differentiated. For example, while many people believe that older people are now financially better off, what we have is a polarisation of the pensioner population with most of the wealth going to those who are already more wealthy. According to Age Concern (2005), in Scotland, one-quarter of households of older people have a low income (that is, below 60 per cent of median disposable income), and many of these incomes are so low that the older people are entitled to claim other benefits.
This situation is most likely to affect older women, who are less likely to have paid into an occupational pension or state earnings related pension (SERPS).
Unusually high mortality in winter is also higher among the older population; however, this does not affect all older people equally. Although the exact numbers of people who die ‘from the cold’ are not known, older people are more likely to experience fuel poverty (generally defined as a household which needs to spend more than 10 per cent of its income on all fuel; slight variations in definition exist across the UK); this is largely caused by the cost of domestic fuel, the level of disposable income and the energy efficiency of the home. Older people are more likely to live on a low income, in poor quality housing and with expensive and inefficient heating systems.
Activity 2 The multifactoral nature of health inequalities
This activity focuses on the health of black and minority ethnic groups, asking questions about which factors most influence their health and highlighting the complex, multifactoral nature of health inequalities.
Read the article by Hannah Bradby and Tarani Chandola (2010) ‘Inequalities and ethnicity: evidence and intervention’, Chapter 5 in the course reader. Then consider the questions below.
- What main dimensions of health inequality are more likely to be present in ethnic minority groups?
- What explanations for ethnic minority health inequalities does the article put forward?
- What concerns are raised about interventions to improve the health of ethnic minorities?
Bradby and Chandola present census evidence indicating that some ethnic minority groups are more likely to report ‘not good health’ and note that some groups experience higher rates of some diseases. As part of the explanation they highlight a life course approach, noting the health impact of socio-economic disadvantage across lifetimes and generations, together with the impact of racism. But they also note that treating ethnic minorities as a homogenous group when developing health interventions can cause problems because there is much variation between and within different groups. Health inequalities are complex and difficult to challenge. It is important to act but the absence of good monitoring data makes it difficult in some cases to tell what is needed and what works.