The Policy Discourse of Active Ageing: Some Reflections
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Why Active Ageing Matters
By the end of the first half of the twentieth century most European states had introduced public pension schemes of one sort or another. In doing so they were affirming the role of the state in providing individuals with a form of support that all but a few would struggle to provide for themselves. The objectives of these schemes were generally quite limited: to reduce the risk of poverty in old age by facilitating savings during working life. The rationale was simple: to provide access to financial support - a regular and reliable income – for a time of life when the ability to work was increasingly impaired by loss of health or functional ability. In the second half of the century, after the second world war, increasing affluence combined with a more demanding view of the responsibilities of government to improve the generosity of pensions and to expand welfare systems in ways that conferred other benefits on their older populations besides a basic pension income, including the provision of social care (e.g. care homes for older people who had no family and were unable to look after themselves in their own homes). Policy was still broadly conceived as a collective response to age-related losses that undermined independence.
When population ageing – a result of falling fertility, lengthening life expectancy and differential cohort size - appeared on the policy horizon, governments were forced to reconsider not only the sustainability of existing arrangements for age-related entitlements, but also the narrow focus of policy on remedies for age-related losses. It became increasingly apparent that policies for older people had to be more ambitious in their scope. In order to achieve sustainability for public pensions and healthcare systems, it would be necessary to change institutions and behaviours in ways that would maintain the active contribution of older people in social life for as long as possible and delay the onset of age-related health problems for as long as possible.
It was not just the requirements of sustainability, however, that led governments to rethink the framework for their policies. Policies had to change if they were to reflect the realities of individual experience in a changing world. The idea of old age as a stage of life overwhelmingly characterised by dependency and need was no longer adequate as a way of thinking about the lives of post-retirement populations. Retirement became seen increasingly as a time of opportunity and activity because ever larger numbers of people were able to enjoy it as such. Later life was divided into old age and a period of opportunity that preceded it (Laslett 1989; Baltes and Smith 2003). Polices for older populations required a new and more positive paradigm to supersede criteria for success that focussed too exclusively on the provision of support for age-related deficits and needs (Walker and Zaidi 2016).
This positive paradigm of old age has been articulated in a number of approaches over the last few decades. These include ‘Active Ageing’ (WHO 2002; Walker 2002), ‘Healthy Ageing’ (WHO 1990, 2015), ‘Successful Ageing’ (Rowe and Kahn 1987, 1997; Baltes and Baltes 1990) and ‘Productive Ageing’ (Butler and Gleason 1985). What all these ideas have in common is a shift of focus away from a condition that requires support and assistance to a process that we can evaluate as going more or less well. The aims of policy have been reformulated accordingly. Instead of being concerned with the means of providing support for a condition that requires care (in different forms and to different degrees), it is now concerned with the means of shifting individual ageing trajectories in a positive direction. The approaches listed above do, however, differ, both in the purposes that they serve, and also in the criteria they use to distinguish ‘better’ or more desirable ageing trajectories from those that are less desirable. So, for example, concepts of healthy ageing or productive ageing concentrate on a single factor that has been picked out as especially important not only for its contribution to individual well-being in later life, but also for its contribution to collective welfare. This is not to say that healthy or productive ageing are simple ideas. They are not; they are complex and the way they are operationalized will reflect this. The complexity is, however, unified and integrated in the idea of a single overarching policy challenge: how to promote either healthy ageing or productive ageing. Policies that are successful in achieving these goals are valued because they bring multiple benefits both to individuals and to the wider society.
The concept of Successful Aging associated with the MacArthur study of Successful Aging is in both respects quite different. It is a multi-dimensional measure that was developed as a research tool rather than an idea to be used in the formulation of policy objectives. Rowe and Kahn (1987) used scores on different measures - the avoidance of disease and disability, the maintenance of high cognitive and physical functioning and continued engagement in social and productive activities – to pick out a subset of ageing trajectories that can be readily distinguished, as better or more successful, from what they call ‘usual’ experiences of ageing. The multi-dimensionality of the concept was intended to capture a set of criteria for distinguishing ‘high-performing’ individuals from those who do less well; and the main rationale for introducing it into discourse about ageing has very little to do with policy and everything to do with the attempt to explain an important form of heterogeneity in the human population, i.e. why do some individuals age more successfully than others?
The World Health Organisation, on the other hand, is interested mainly in the formulation and shaping of policy, and they require a view of ‘ageing well’ that is inclusive rather than exclusive. The ultimate aim of policy, as they see it, is to enhance the quality of life that is enjoyed by people who are ageing and the best way of achieving this (for everyone) is to optimize opportunities for health, social participation and security (WHO 2002; Sidorenko and Zaidi 2013). An Active Ageing policy will promote healthy and active ageing by enabling everyone to age as well as they can. The idea has clear affinities with the WHO’s very wide definition of health1: individuals are to be enabled to maintain good health – in this sense – for as long as possible.
As with healthy or productive ageing, the WHO’s ideas about Active Ageing are intended to play a role in policy formulation. Policy is to be shaped in a way that combines the promotion of individual well-being with the achievement of benefits to the wider society. Like Rowe and Kahn’s concept of Successful Aging, it is multi-dimensional in the sense that it integrates ideas about health and social activity. Unlike Rowe and Kahn, however, the idea has a policy rather than a research focus. It is intended to reflect a set of values that should shape and underpin policies for promoting well-being in later life: maintaining health and functional ability is important because we value these things in themselves; they are also important as conditions of continuing engagement in social life and participation in productive activities; and because we value social engagement and participation in their own right, policy should aim to promote and recognise the active participation of all citizens irrespective of age. Policy should be guided and informed not by a set of ideas about the inevitable deficits of old age, but rather by a rights-based approach that recognise equality of opportunity and the potential of older people.
All this requires active ageing strategies to take on the tasks of changing attitudes and behaviours and creating a social environment that is rich in opportunities for maintaining engagement and avoiding unnecessary dependence on others. The paradigm of healthy and active ageing affirms the value of policies that enable older people to make the most of their potential and reduce dependence on family and state (WHO 2015; Zaidi et al. 2016). Active ageing strategies should encompass and interact with many different specific policy areas: fostering employment, promoting engagement, reducing poverty, improving health and well-being, lifelong learning, and much more. Although it is necessary for these policies to have their domain-specific goals, it is important also that they should be incorporated into a more inclusive perspective that addresses all positive aspects of lives of older people. And most of these are brought together in the Active Ageing Index (AAI) project of the United Nations Economic Commission for Europe (UNECE) and the European Commission.
Although the WHO’s conceptualisation of active ageing is a kind of trailblazer for the AAI, it is important to flag up some of the differences between them, and in particular their connection with measures of well-being or quality of life. For WHO, active ageing is about the opportunities to participate, and a society which acts to promote such opportunities is ipso facto improving the quality of life for older people. The AAI is not a measure of well-being in later life, nor should we assume that policies to promote active aging will invariably promote individual well-being or a better quality of life for older people. It purports rather to measure the actual and potential contribution that the older population make to societal welfare, and there are undoubtedly social conditions in which high levels of contribution will be correlated with low welfare, e.g. continuing to work in spite of ill-health because of the limitations of the public pension system.
What does the Active Ageing Index Offer?
For governments to progress beyond rhetorical commitments to active ageing as a social ideal, they have to be able to formulate effective policy and behavioural responses across a wide range of challenges. The value of the Active Ageing Index is that it provides a high-quality and independent evidence base which integrates information on individual experiences of ageing across different domains with a view to informing the public policy priorities to improve activity, health and autonomy and independence in later life. By conceiving of age-related policies across different domains as contributing to a single, common objective, policy-makers themselves generate the demand for an evidence base that shares the same underlying structure.
motivate countries that are laggards in healthy and active ageing to improve their performance;
pinpoint important areas for policy learning;
identify specific domains as priorities for policy action.
The AAI tool consists of the overall AAI, as well as its gender and domain-specific breakdown and the constituting individual indicators. It has twenty-two indicators grouped into four domains: Employment; Social participation; Independent living, and Capacity for active ageing. The first three domains measure achievements, while the fourth is a measure of preparedness for achieving positive results. All indicators and their aggregation into composite measures are available separately for men and women (Zaidi and Stanton 2015).
The latest results presented in the 2015 analytical report give a clear indication that a healthy and active life during old age is no longer considered just an ideal in European countries; rather it is a reality for many and a genuine possibility for many more. The fact that the countries at the top of the AAI score have done consistently well across all domains is an indication that active ageing is a coherent policy area where a balanced and well-founded approach can lead to achievements that leave nobody behind. At the same time, no country scores consistently at the very top in each domain, indicating that there is progress to be made for everyone but in different dimensions. A robust progress of about 2 points in the AAI on average happened over the four years since 2008 in the EU countries. This improvement is observed despite the fact that many countries experienced the financial and economic crisis and introduced fiscal austerity measures during this period.
Different Perspectives on Ageing and Older People
1940s–1960s: when ageing was viewed as the social problems for an individual arising from disengagement and dependency in old age;
1970s–1980s: ageing emerging as an economic and employment issue; promoting positive experiences of later life and challenging the dependency narrative and the idea that ageing equates only with disease and decline.
1990s onwards: ageing viewed as a global phenomenon requiring a concerted efforts of learnings from varying practices around the world.
To this we should add the recent emphasis of active and healthy ageing emerging from the European Commission policy frameworks (such as the European Innovation Partnership – Active and Healthy Ageing)2 and also from WHO Global Strategy on Ageing and Health (WHO 2015).
Disengagement Theory, posited by Cumming and Henry (1961), was one of the first theories of ageing in social gerontology and outlines the ‘natural’ tendency for people to disengage from society as they get older. It postulates a view of old age as a time of life when people step back from all kinds of commitments and social roles, including work. This process of disengagement is meant to benefit both ageing individuals and the wider society. By shedding responsibilities that are becoming increasingly burdensome or difficult to fulfil, individuals are given the space and freedom they need to confront their own none-too-distant death. From the point of view of the wider society, the process permits more capable (because younger) individuals to take on responsibilities that would otherwise be performed less satisfactorily. Disengagement theory, in other words, provided a functionalist account of old age as a distinct stage in the life course with a distinct status.
Disengagement Theory is interesting not least because of the way it highlighted what was then seen as an important gender dimension to the experience of ageing. By making the loss of roles and responsibilities a central feature of the experience of ageing, and by accepting a relatively clear gender division of labour, it led to the conclusion that the process of disengagement should be harder and more psychologically disruptive for men than for women. This is because men, unlike women, were thought to have a social identity – a sense of self – more dependent on paid work than women, who were thought to be more orientated towards family life. Retirement from the labour force, especially when it was forced on individuals, made for an abrupt and painful transition, more so for men than women.
Disengagement theory is now so much out of tune with the times that it seems not just outmoded, but pernicious It has been much criticised for viewing ageing through a narrow and excessively negative lens in which social structure is over-dominant and societal norms for ageing are assumed to operate universally without allowing for heterogeneities in the way individuals experience later life (Hochschild 1975).
Activity Theory, Productive Ageing and Successful Ageing
One of the earliest critics of Disengagement Theory was Robert Havighurst, who insisted not only that social gerontology should have a strong practical component, but also that it should be able to produce what we would now call evidence-based advice on how to age ‘successfully’. At the time there seemed to be only two options: disengage successfully (i.e. not like most men) or stay engaged and active. The question which option was better could be tested empirically – so argued Havighurst – by developing an appropriate measure of life satisfaction and comparing outcomes in individuals who are disengaged with those in individuals who persist in active roles. The hypothesis that defines this early version of Activity Theory is that there is a positive relationship between activity and life satisfaction, and the greater the role loss, the lower the life satisfaction (Havighurst 1963). The practical implications are clear: rather than disengage from social roles, older people should maintain activities for as long as possible or find substitute roles for those they relinquish.
The idea of Productive Ageing, which emerged in the 1980s, followed Activity Theory in affirming the desirability of older people remaining as participants in society. By this time, however, the social problem to which these theories and ideas may be seen as responses had changed. The focus of concern in Activity Theory had been the psychological effects of role loss, especially involuntary role loss, on ageing individuals. Productive Ageing, as this concept was first developed by Butler and his colleagues, was a response to emerging worries about the economic costs of supporting older populations who had left the labour force (see, e.g. Butler and Gleason 1985). As a consequence, there was a tendency to view social activity through an exclusively economic lens. Policies that promoted Productive Ageing would be policies that maintained the participation of older people in the labour force for as long as possible. They should either continue contributing to the production of goods and services or they should occupy themselves with developing the capacity to do so (Caro et al. 1993).
Since Havighurst (1961) first introduced the notion, ideas about Successful Ageing have appeared in various forms, all of them concerned with the various components that make later life a ‘success’. Where subsequent ideas differ from Havighurst is that they do not rely solely on measures of life satisfaction. They add complexity to the assessment of success by incorporating additional (or alternative) dimensions of measurement. These have included continued social engagement, aspects of physiological functioning (Franklin and Tate 2009), the avoidance of disease or disability (Rowe and Kahn 1987, 1997), and the ability to adapt to age-related changes (Baltes and Baltes 1990). Rowe and Kahn’s notion of successful ageing does not stand alone, therefore. It does, however, have particular significance because of its influence on the development of a research agenda for the discipline of Gerontology. It brought rigour to the operationalisation of observations allowing researchers to focus on the predictors and correlates of successful ageing, i.e. those individuals with better-than-usual experiences of ageing in old age (See several articles included in the Special Issue of Gerontologist, ‘Successful Aging 2.0: Conceptual Expansions for the twenty-first Century, particularly Rowe and Kahn 2015).
These then are the main precursor ideas to the development, in the 1990s, of a new and more far-reaching concept of active ageing. It differs from earlier ideas in having a more ‘sociological turn’. Ageing trajectories are to be understood as embedded in and shaped by opportunity structures, which defines a central role for policy in optimizing opportunity structures. In the European context, the active ageing concept was further elaborated by Walker (2002, 2009), who sets outs a multi-layered policy-oriented model with a strong life course perspective (i.e. identifying the scope for interventions and behavioural changes to promote active ageing at all stages of life).
Activity Theory, Successful Ageing and Productive Ageing theories have all made important contributions to our understanding of individual ageing as a socially mediated phenomenon. They all challenge the kind of dependency narrative that previously dominated the way we think about older people and their well-being. They helped to undermine the idea that ageing is to be equated to a biologically driven process of disease and decline, and they can take some credit for the fact that there is now a well-established acknowledgement, among policy-makers as well as social scientists, of the role of social structures and processes in shaping how we experience ageing. This has not prevented, however, the emergence of a substantial body of criticism that highlights the dominance of work and work-related activities in their perspectives (Estes et al. 2003); the narrowness of their definitions of well-being and success; and their failure to find conceptual room for the position of marginalised older people who may not be able to enjoy health, wealth, or social connectedness (Powell 2001).
Critical Political Economy Approaches
These criticisms were originally developed by the proponents of the so-called political economy approach to ageing which emerged in the 1980s and 1990s. The political economy theory takes a critical approach and purports to integrate perspectives of economics, political science, sociology, and gerontology, each of which it argues have previously proven inadequate to understanding ageing when employed in isolation (Estes 2001).
Theorists within this school made their mark by their emphasis on the strength of the causal links between individual experiences of ageing and the social, political, economic and cultural structures in which people live, which is another way of saying that ageing trajectories are determined by factors such as class, wealth, ethnicity and gender. A political economy approach and wider critical theories emphasise ageing as a public not a private issue and argue that social structures create the structured dependency of older people as a result of restricted access to resources, particularly income. This emphasis on the social structuring of ageing trajectories goes hand in hand with criticism of the perceived dominance of bio-medical models of ageing. Old age, it is argued, has been over-medicalised as well as over-institutionalised.
Feminist theory has also made a significant contribution to this critical stance, highlighting the disadvantages women face across their lifespan and how these accumulate in older age, resulting in women having less often full-time employment, lower wages, poor access to pensions, and being dependent upon their husbands and male family members for pension income security (Estes 2001).
Critical theories of ageing, including those that arise from political economy and feminist perspectives, have been criticised in their turn for being over-deterministic in their assessment of the role played by societal structures in shaping an individual’s life-course and for failing to overthrow the dominant image of old age as an illness and decline, in spite of challenging this image (Vincent et al. 2006). They go too far in downplaying the agency of the individual.
As highlighted by Lloyd-Sherlock (2002), the capabilities approach of Amartya Sen brings to the fore the tension between agency and structure issues going beyond viewing ageing as a purely social construct by recognising the individual as an active agent (see, e.g., Sen 1980). However, as in the critique of the active ageing approach, it is important to contextualise the capabilities within the specific values and preferences of older people rather than generalise them.
Critical political economy approaches to the analysis of ageing trajectories have nonetheless proved vital in highlighting the social determinants of ageing and how social structures affect outcomes in later life. Critical theory has also played a part in shaping the application of life-course approaches to the analysis of ageing trajectories. The process of ageing is therefore to be understood as an accumulation of ‘not just biological and psychological processes, nor life history and present circumstances, but also of the attitudes, expectations, prejudices and ideals of the societies and cultures in which people develop and grow old’ (Coleman and O’Hanlon 2004 11).
WHO’s Healthy Ageing Framework
The 2015 World Health and Ageing Report sets out an important new policy agenda for ageing by laying a new definition of healthy ageing. It argues that in older age, diseases and co-morbidities are as such much less important for the individual well-being than the impact they have on older peoples’ abilities to function in society. The premise of this updated approach to healthy ageing is that, although the biological process of ageing generally results in the progressive degeneration of cells, this process is by no means linear nor is it directly linked to chronological age. Policy makers should concentrate their attention and efforts on the heterogeneity and diversity of experiences of later life. Building on previous conceptual frameworks, this diversity is modelled as the outcome of a lifetime’s interaction between a set of intrinsic capacities of individuals and the environment in which men and women live.
‘This combination of individuals and their environments, and the interaction between them, is their functional ability, defined […] as the health-related attributes that enable people to be and to do what they have reason to value’ (WHO 2015, 227).
Healthy Ageing is thus conceptualised ‘as the process of developing and maintaining the functional ability that enables well-being in older age’ (WHO 2015, 28). Emerging from the fundamental principles of healthy ageing is WHO’s Global Strategy and Action Plan for Ageing and Health, adopted in the Sixty-ninth World Health Assembly, May 2016. The strategy was further endorsed by Health Minister’s statement during the G-7 Summit in Tokyo, September 2016, putting ageing firmly on the agenda of health ministries.
The active ageing framework moves policy thinking away from a one-sided concern with the affordability of age-related entitlements and the challenges posed by the increasing burden of a continually expanding older population. The wider platform of active ageing strategies emphasises that government policies designed to achieve participation in both paid employment and social engagement will act as social investments. These policies will help to prevent the loss of valuable expertise and the accumulated experience of older people. They will strengthen the human and structural resilience of ageing societies, and enable them to deal more effectively with the longer-term economic and societal challenges of population change.
Using the Active Ageing Index framework enables European Union Member States to take stock of their respective position in the base year, 2012, and observe progress, or lack of it, in the recent past (since 2008). Comparisons with other countries can help to highlight domains with the biggest potential for future policy interventions. They should also provide the opportunity for mutual policy learning in the common task of designing policies to ensure older people are supported in their wish to be active healthy participating members of society. This may not be an absolute precondition of achieving sustainable pension and healthcare systems, but it will surely make it much easier. These comparisons and assessments will inform policy makers and allow them to set targets and monitor progress towards them.
For the future, important developmental work remains to be done to assess the feasibility of applying the Active Ageing Index at the sub-national level and to specific population groups. The papers included in this Special Issue on Spain and Russia provide a good example of the AAI evidence required for policy making purposes. Poland, Italy and Germany have also made strong headway with respect to sub-national analysis of the Active Ageing Index. The policy paper provides the perspective of Malta in making use of the Active Ageing Index as a policy tool. The lessons learnt will facilitate a stronger partnership between different layers of policymaking within a single country.
The analysis of group-specific AAI, e.g. for people with and without disability, should help improve understanding of ageing trajectories of the less privileged populations in our societies. This will allow governments to formulate active ageing strategies that are better able to reflect the very considerable heterogeneity within the older population. Last but not least, we would expect the multidimensional nature of the AAI evidence to encourage the kinds of partnerships across different ministries that are so important for the development of a comprehensive active ageing strategy.
- Baltes, P. B., & Baltes, M. M. (1990). Psychological perspectives on successful aging: the model of selective optimization with compensation. In P. B. Baltes & M. M. Baltes (Eds.), Successful Aging: Perspectives from the Behavioural Sciences, 1–35. UK: Cambridge University Press.CrossRefGoogle Scholar
- Butler, R., & Gleason, H. P. (1985). Enhancing vitality in later life. USA: Springer.Google Scholar
- Caro, F., Bass, S., & Chen, Y. (1993). Achieving a productive aging society. Westport, CT: Auburn House.Google Scholar
- Coleman, P., & O’Hanlon, A. (2004). Ageing & development. New York: Arnold.Google Scholar
- Cumming, E., & Henry, W. (1961). Growing old: the process of disengagement. New York: Basic Books.Google Scholar
- Estes, C. (2001). Social policy & aging: a critical perspective. London: Sage.Google Scholar
- Estes, C., Biggs, S., & Phillipson, C. (2003). Social theory, social policy and ageing. Maidenhead: Open University Press.Google Scholar
- Franklin, N. C., & Tate, C. A. (2009). Lifestyle and successful aging: an overview. American Journal of Lifestyle Medicine, 3(1), 6–11.Google Scholar
- Havighurst, R. L. (1963). Successful aging. In R. H. Williams, C. Tibbits, & W. Donahue (Eds.), Processes of aging (pp. 299–320). New York: Atherton Press.Google Scholar
- Laslett, P. (1989). A fresh map of life: the emergence of the third age. London: Wiedenfeld and Nicolson.Google Scholar
- Lloyd-Sherlock, P. (2002). Nussbaum, capabilities and older people. Journal of International Development, 14(8), 1163–1173.Google Scholar
- Phillipson, C., & Baars, J. (2007). Social theory and social ageing. In G. Westerhoff (Ed.), J. Bond, S., peace, F., Dittman-Kohli (pp. 68–84). London: Ageing in Society. Sage.Google Scholar
- Powell, J. L. (2001). Theorising gerontology: the case of old age, professional power, and social policy in the United Kingdom. Journal of Aging and Identity, 6(3), 117–135. doi: 10.1023/A:1011308231981.
- Rowe, J. W., & Kahn, R. L. (2015). Editorial: successful aging 2.0: conceptual expansions for the twenty-first century. The Gerontologist, 55, 1–4.Google Scholar
- Sen, A. K. (1980). Equality of what? In S. McMurrin (Ed), Tanner lectures on human values. Cambridge: Cambridge University Press. Google Scholar
- Sidorenko, A., & Zaidi, A. (2013). ‘Active Ageing in CIS Countries: Semantics, Challenges, and Responses’. Current Gerontology and Geriatrics Research 2013: Article ID 261819, available at doi: 10.1155/2013/261819.
- Vincent, J., Phillipson, C., & Downes, M. (Eds.). (2006). The futures of old age. London: Sage.Google Scholar
- WHO. (1990). Healthy ageing, technical report. Geneva: World Health Organization.Google Scholar
- WHO. (2002). Active aging. Geneva: A Policy Framework. World Health Organization.Google Scholar
- World Health Organization (WHO). (2015). World report on ageing and health. Geneva: Switzerland.Google Scholar
- Zaidi, A., & Stanton, D. (2015). ‘Active ageing index 2014: analytical report’, report produced at the Centre for Research on ageing, University of Southampton, under contract with UNECE (Geneva), co-funded by European Commission, Brussels, available at: http://www.southampton.ac.uk/assets/sharepoint/groupsite/Administration/SitePublisher-document-store/Documents/aai_report.pdf.
- Zaidi, A., Gasior, K., Zólyomi, E., Schmidt, A., Rodrigues, R., Marin, B. (2016). Measuring active and healthy ageing in Europe. Journal of European Social Policy. doi: 10.1177/0958928716676550.