This book focuses on the knowledge tools and technological means used to understand and manage ageing in contemporary societies. It takes as a point of departure the idea that while science and technology are mainly perceived as solutions to the ‘problems of ageing’ they have also contributed significantly to defining and articulating ageing as a societal issue, that is to say, to shaping the institutions and practices of what we usually label the ‘ageing society’. The book investigates this interactive, co-productive relationship between science, technology and the ‘ageing society’. As a consequence of this approach, it proposes that the concept of the ‘ageing society’ should refer not only to the socio-economic transformation associated with demographic ageing but also to the shifting relations between knowledge making practices, innovation processes and life course institutions. The ‘ageing society’, I argue, is first and foremost a collective predicament, a swelling uncertainty concerning how to deploy procedures of scientific research and technological innovation in addressing ageing as an issue. Ageing unsettles the scientific and technological apparatus of contemporary society. In contrast to other sociological approaches to this issue, which emphasise the increased encroachment of science, technology and medicine on the life course, this book stresses the controversial, unstable character of those ways of knowing and managing ageing. It does so by exploring the composition, the difficult coming together, of particular features of the epistemic and technological infrastructure of the ‘ageing society’: the disputes within population science on how to explain and address demographic ageing, the convoluted and still unsuccessful search for new age standards to measure individuals’ evolving abilities and needs, the negotiated attempts to develop new research methods to measure individuals’ unique ageing trajectory, the troubles associated with developing tools to support longer working and active lives, the unsteady character of the relationship between the care of older people and technologies aiming to support it, the critical challenges posed by ageing science to the social, economic and political organisation of contemporary biomedicine and health care, and the related moral and political divergences arising from proposals to extend human longevity. Taken together, these provide a conceptually robust analysis of how experts, policy makers, commercial and civil society organisations and citizens bring ageing to bear on the normative and material contexts of contemporary science and technology.
What is the ‘ageing society’?
Public, policy and media discourses usually identify ageing and the ‘ageing society’ as one of the main societal challenges faced by contemporary societies. In a fairly typical example of this phenomenon, in March 2013 the BBC reported that the House of Lords Committee on ‘public service and demographic change’ had warned that the United Kingdom was ‘woefully unprepared’ for an ageing society, warning that the ‘gift of a longer life’ could lead to ‘a series of crises’ in public service provision (BBC, 2013). Drawing on figures from the Office of National Statistics and statements from experts, politicians and charities, it was reported that the Lords Committee had identified a rising trend in the number and proportion of older citizens, and called on political parties to explicitly address how such a trend could challenge social security schemes and health and social care provision. Summarising this call for action, Baroness Greengross, then chief executive of the International Longevity Centre UK – a think-tank focused on ageing and demographic change – stated that, as a society, ‘we have put off the difficult decisions for far too long’ and that it was now policy makers’ responsibility to make the changes necessary in the welfare system to ameliorate ‘the problems’.
There are three key dimensions that make this event typical of public dis-course on the ‘ageing society’. One is the factual nature of the demographic change that is being reported: demographic ageing is a reality on which experts, civic organisations and politicians of different inclinations agree. The second relates to how this change entails consequences for public institutions and systems that are at the heart of modern, advanced democratic societies: retirement age, old age pensions, health and social care provision, etc. Finally, there is the urgency with which such calls for action on the ‘ageing society’ are pro-nounced: ‘there is no time to lose’, no space for further debates or deliberation. It is now time to tackle the ‘ageing society’. These three dimensions work together to make the ‘ageing society’ a much talked about but seldom examined concept or idea. What is the ‘ageing society’? Why does it entail dramatic changes to the way in which work, family life and social and welfare institutions are organised?
One possible answer to the first of these questions would be to provide a widely used definition of the ‘ageing society’ – often attributed to the United Nations (2001) – which describes the category on the basis of a percentage of the total population in any given country (7 per cent) being 65 or more years of age. This is seen to indicate a threshold in a population’s sustainability, that is to say, to specify the levels of fertility and longevity affecting a population’s ability to maintain its current volume. Underpinning this assessment of population dynamics lays the claim that a decline in the average number of children born per woman, combined with an increase in life expectancy – as observed in most developed economies – is associated with a growth in the number and proportion of older people. This, in turn, furthers the decline in fertility levels, as reproduction is mostly expected to occur below the ages of 30–40.
This dynamic state is furthermore generally seen to have consequences for the social and economic relationships between age groups within a society. Because economic participation declines in later life, economic vitality is expected to deteriorate, leading to rising ‘dependency ratios’ – the proportion of money that has to be transferred from active to inactive sections of the population. From this widely accepted perspective, in such conditions active workers will have to increase productivity and to generate more income to sustain older, ‘dependent’ non-workers through pension schemes and other welfare programmes. Additionally, because of the increased burden of illness associated with later life, population ageing is also regarded as having straining effects on demand for health care services and funding of health insurance schemes. In the same way, declines in functional capacities associated with ‘old age’ are linked to increased pressures on systems of formal care and on processes of informal care within families and communities. Finally, ageing populations are said to produce consequences in the political and cultural attitudes of a society, which becomes more conservative and less open to social and technological innovation.
While most would agree with the factual assessment regarding the demographic forces and magnitude of population ageing, there is, however, a growing academic and policy debate about its social, economic and political consequences. Denouncing what Robertson (1990) once labelled ‘apocalyptic demography’, scholars and policy analysts have pointed to the problematic way in which ageing populations have become linked to emerging problems in public finances, and have proposed alternative scenarios of social and economic change. Harper (2006), a leading social gerontologist, suggested most social implications of demographic ageing are based on flawed or rigid assumptions about older people and the ageing process. She argues, for example, that inflexible retirement systems are more to blame for rising dependency ratios than older people’s unwillingness or incapacity to work. Equally, Harper proposes that health care systems’ rising costs are as much explained by ageing populations as by changes in lifestyle, public expectations in relation to medicine and increased use of health technologies. Finally, she proposes that, if anything, there is continuing commitment of younger generations to the care of older relatives or friends – albeit differentially distributed across genders – and that there is little evidence of decreasing intergenerational solidarity. In alignment with this view, in the much-debated book The Imaginary Time Bomb, Mullan (2000) argues that, from a historical perspective, population ageing has been a consistent feature of modern societies, being observable in countries such as France or Sweden at the turn of the twentieth century. Questioning the assumptions of the economic models where the present ‘ageing society crisis’ is based, Mullan denounces the erroneous assumptions on employment, productivity, economic dependency of older people, or the health and functional status of older people implied in those models. These scenarios, he argues, are based on the assumption that old age leads to functional decline, whereas contemporary population statistics point towards a more plastic relationship between ageing and health or disability (see Chapter 3).
Based on the same, optimistic understanding of the relationship between ageing and functional ability, demographers, epidemiologists and policy analysts have, for at least two decades, emphasised the opportunities as well as the challenges arising from population ageing. They highlight the benefits of moving away from age-segregated societies, where roles and capacities are ascribed in terms of belonging to an age group (‘the elderly’), towards increasingly age-integrated social relations. These opportunities are linked to flexible retirement policies, the promotion of active involvement of older citizens in economic and social life, intergenerational assimilation, and support for health maintenance activities and social relations, aims encapsulated in the ‘active ageing’ policy frameworks of the European Union and the World Health Organization (Kalache and Kickbusch, 1997; Fernández-Ballesteros et al., 2013; Lassen and Moreira, 2014). Active and healthy ageing policies wish to articulate strategies for optimising economic, social and cultural participation throughout the life course, emphasising the societal gains yielded through ‘maturing’ social relations, such as political and cultural stability, allowing for normative and worldview connections between generations.
In addition, some expert proposals go as far as suggesting that increases in human longevity accrue societal bonuses – the so-called ‘longevity dividend’ (Olshansky et al., 2007). They argue that by supporting healthy behaviours and lifestyles, instruments and policies of active ageing can extend working and consuming lives, sustaining so-called mature or ‘silver markets’. Health becomes thus an economic investment (Olshansky et al., 2012). Crucially, Olshansky and colleagues suggest that, in knowledge-based economies, age-integrated workplaces would lead to an efficient use of the accumulated experience and wisdom on the steering of innovation. Last but not least, older people’s time and wisdom can be used to embolden and cement intergenerational relationships. The ‘longevity dividend’ proposal specifically aims to draw on the ‘science of ageing’ to achieve or extend a deceleration in the rate of ageing, so as to delay all ageing-related diseases and disorders by about seven years and halve the age-specific incidence of illness in later life. Bringing together biology, epidemiology, social demography, economics and policy, the ‘longevity dividend’ idea crosses disciplinary boundaries to outline a radical societal horizon where increases in longevity are associated with economic sustainability and social renewal.
The contrast between the pessimistic and the optimistic versions of the ageing society could not be more striking and is indicative of the significance of ageing for contemporary societies. It is indicative of this because both sides seem to agree that our collective future hinges, in a fundamental way, upon ageing. To what extent is ageing the key for our impending social, cultural and economic ways of living? To answer this question, we need to examine further the means through which claims about the opportunities and/or challenges of the ageing society are made. One approach to this would be to argue that either – or both – positions on the ageing society have got it somehow wrong, that their data is in fact incorrect, that their analysis is flawed, their assumptions biased, or influenced by vested interests. There are a variety of books, including Harper’s (2006), which focus on this type of critical evaluation of claims about the ‘ageing society’. This book aims to do something different. It asks the question: what if the controversies about the ‘ageing society’ were not only a sign of the importance of ageing in our collective life but also shaped the way in which we approach, understand and manage ageing processes in society?
Contrary to what is usually assumed, controversies – particularly public disputes of a technical variety hinging on a matter that concerns most people in society – are not mere surface phenomena, denoting only the biases of the opposing sides. Instead, controversies can be seen as key windows to understand how the society we live in is put together, or how, in this process of making the social, knowledge, technology and society become interlinked. As Latour put it, controversies are ‘not simply a nuisance to be kept at bay, but what allows the social to be established’ (Latour, 2005: 25). This is because, among other things, they substantiate ways of knowing and acting on the world, and mould institutions, policies and programmes. From a social science perspective, they give us direct insight into institution building, group formation, or identity construction processes (Latour, 2005; Venturini, 2010). That is to say, they give us a way to trace and explore how the ‘ageing society’ was put together. My proposal, throughout this book, is that this insight only comes to fruition if we delve deep into the knowledge making practices, tools, technologies, the knowledge making institutions that underpin positions within controversies about the ‘ageing society’. This proposal veers however from the usual understanding of the role of science and technology in the ‘ageing society’.
Typically, science and technology are viewed mainly as solutions to the ‘problems’ or challenges of the ageing society, discussed above. Hence, in the past two decades or so, ageing research has become increasingly acknowledged as a key area to focus economic and intellectual resources. This focus is seen as essential to generate the technological, medical and social innovations to address the age-related processes that structure public finances, health care systems and social care programmes, and seemingly affect the experience of ‘old age’ for a large proportion of the population. New fields of research, such as gerontechnology, biogerontology or geroscience (Kennedy et al., 2014) have emerged, whose only concern is the exploration and validation of such solutions. In addition, significant investments have been made by companies, governments and international organisations in this domain of research and technological development as it is seen to be a route for significant financial returns. This is seen as an investment, enabling the exploration of new opportunities arising from the consolidation of ‘silver markets’.
In this regard, research and development on ageing has been underpinned by what Rip (2002) labelled ‘strategic science’, where attempts are made to align laboratories, policy makers and wider publics with recognised forms of the ‘good’, such as wealth creation, sustainability or social integration. As a consequence, researchers and technological developers in the domain of ageing are increasingly required to orientate their projects and programmes towards shared societal expectations. This means that knowledge making institutions and tools cease to be solely an expert’s domain, and are made more open to extended peer review and evaluation, seeking alignment between research and social needs and values, and where lay users or citizens become directly involved in the innovation process (Nowotny et al., 2001). Indeed, social research has amply documented how and for what reasons lay members are increasingly asked to participate in the articulation of expectations from research, and in the co-production of knowledge more generally (Callon, 1999; Irwin, 2006; Marres, 2007; Callon and Rabeharisoa, 2008). This is also true in the domain of ageing. For example, in the Research Agenda on Ageing for the Twenty-First Century, produced by the United Nations and the International Association of Gerontology and Geriatrics (IAGG), it is recommended that dialogue should be under-pinned by the use of a ‘common language’ between researchers, policy makers and publics, and that this ‘should lead to a sense of association of all key players’ involved in research (UNPoA/IAGG, 2007: 11, my emphasis).
However, as the research on social robust science above also demonstrates, the aim to involve publics in innovation and promote dialogue between lay, expert and policy groups is a difficult business (Irwin and Horst, 2015). In the domain of ageing, there are signs that the association or alignment ‘of all key players’ is difficult to achieve. For example, in the UK Biological and Biomedical Sciences Research Council/Medical Research Council 2006 public consultation on ageing research a gap was identified between, on the one hand, scientists’ interest in tracing the ageing process to find conjoint biological roots to down-stream age-associated illnesses and, on the other, established cultural perceptions that ageing, in and of itself, is not a problem for which a solution is required (Ipsos Mori, 2006; also Irwin, 2006). This finding is indicative of key, wider uncertainties about ageing as an issue in contemporary society, of which the ageing society controversy is but one example. Questions abound.
Is ageing a ‘normal’ biological process from which pathological states emerge, or is it a condition that requires only prevention and management? Is the aim of ageing research and technological development to erase what we recognise as the experience of becoming older? Or should technology be used only to ameliorate the functional decline associated with ageing? Can the ‘negative side’ of ageing be erased without consequences for how we experience the later part of life? Can we keep younger and still enjoy the brighter or wiser dimensions of later life experience? What legitimate public expectations should the public have from ageing research? Should we expect to continue to extend our life span, or just to ensure that we are living healthier lives? Can we do the latter without the former? Is healthy ageing an appropriate, achievable aim for all individuals in all societies? There is also uncertainty as to which publics to involve in addressing these societal issues. Is ageing research and innovation only relevant to ‘older people’ or should a wider public be called into the fold? Is the experience of living longer a key form of knowledge to guide the direction of research on ageing? Does the involvement of ‘older people’ reinforce age categories and ageism? How are we to identify who should be involved if the accuracy of age grouping is itself questioned by ageing researchers? What criteria other than chronological age can be used to delineate the concerned publics of ageing research?
Ageing thus presents a challenge to contemporary research policies and institutions. There is uncertainty regarding its normative aims and social expectations, the means through which these aims are supposed to be attained and the identity of the beneficiaries of scientific, technological and social innovation. Why, how and for whom should ageing science and technology be supported? My suggestion is that the relevance and significance of these questions are, in no small part, linked to a lack of understanding of the role of technology, science and medicine in the ageing society. Current debates on the ageing society, as I suggested above, tend to view science and technology solely as a solution to the ‘problems of ageing’. In this perspective, science and technology are cast in terms of the consequences, the positive – or negative – ‘impact’ they might have on socio-economic relations, welfare programmes or the experience of old age. However, as most social demographers would agree, ageing societies are themselves the product of changing living contexts associated broadly with industrialisation processes and the establishment of modern science and technology. As a consequence, focusing on science and technology merely as a solution to the ‘ageing problem’ has undermined our capacity to uncover how science, technology and medicine have been themselves implicated in the making of the ageing society. Investigating this relationship requires more than simple, general models on how science and society are related or should interact. It demands conceptually r...
