'Sickness unto death' is becoming a thing of the past

Two persistent tendencies mark discussions about population ageing. The first is to focus on the effects of this transition upon older members of the community, if not members of particular generations such as the baby boomers. The second is to limit discussion of this demographic change to single countries or jurisdictions.

In reality, population ageing is a global phenomenon. Its effects reach across national borders. They also span across social groups and stratifications, including but not limited to those defined by age.

There are deep affinities between the propensity to understand population ageing by focusing upon specific generations and the tendency to view it within an exclusively national frame. Identifying and analysing these affinities can help to broaden the debate.

The reason why current demographic debate in Australia often focuses on older people is straightforward. Quite simply there will be more of them. In particular, the ageing of the baby boomers will heighten the country’s age profile.

Nobody bothers to deny population ageing. Demography may not be destiny, but it lays out the future in slabs. According to the United Nations, the impact of the current demographic transition may parallel that of the industrial revolution.

Commentators on this matter range from doomsday sayers to sage professors who believe policy can solve the problems. The predominant concerns are economic and relate to the so-called demographic deficit - the prospect that current working age populations will be unable to foot the bill for the care and maintenance of those who came before them.

But as today’s economy mutates through culture, economic analysis alone is insufficient to take stock of the situation. Population ageing is as much about cultural transition: our family and friendship structures, the media and products we consume, our attitudes toward work, sexuality, and leisure.

To focus the debate on baby boomers and their attitudes toward retirement, health, intergenerational transfers, and so on is to potentially obscure a whole series of questions about ageing at the societal level. What does it mean to be young in an ageing society? What does it mean to be poor in an ageing society? What does it mean to be unemployed in an ageing society? These are questions less often asked.

We live in a time when massive funds are expended for research, medical and otherwise, that seeks to achieve the “compression of morbidity” or confinement of the burden of lifetime illness to a short period before death. The experience of what the Danish philosopher Søren Kierkegaard called the “sickness unto death” is rapidly becoming a thing of the past.

At the same time, the small but flourishing field of anti-ageing medicine promotes the notion that ageing is a disease in search of a cure. Bolstered by the hype that surrounds biotechnological developments but strongly contested by the geriatric medical establishment, markets now sustain the hope that ageing can be forestalled or even reversed. The discourses and practices of anti-ageing medicine provide a strategic site for analysing the cultural effects of population ageing.

When Sylvester Stallone was charged for attempting to carry vials of human growth hormone (HGH) through Sydney’s Kingsford Smith Airport in February 2007, some commentators worried the publicity would generate a demand for this substance, widely marketed on the Internet as an anti-ageing agent. But the reasons for the growth of anti-ageing medicine are more complex than this.

Historically, these are not the only times in which such cultures have blossomed. The early 20th century was also a period in which anti-ageing products and procedures, including hormonal preparations, were widely available. The Viennese physiologist Eugen Steinach, who contributed to the development of hormone replacement therapy, advocated vasectomy as a means of restoring and preserving male vitality. Sigmund Freud and W.B. Yeats were among those who underwent the operation. One company manufactured a product called Spermine, composed of semen, bull’s testicles, calf’s liver and calf’s heart.

As US historian of ageing Carole Haber argues, the disappearance of these anti-ageing treatments was not merely a matter of science. With the introduction of pensions, and consequent emergence of a vision of later life as a time of independence and autonomy, there was less demand for these regenerative preparations and measures. But today with the appearance of defined contribution pension schemes and the emergence of pension funds as major players in the risky world of global finance, there is a re-efflorescence of anti-ageing medicine.

Robin Blackburn is one of the most active analysts of the financialisation of pensions and its effects upon daily life in ageing societies. In his book Age Shock, he worries that pensions have fallen victim to the financial tendency to sacrifice the claims of the past and future to a greedy present. This leads, he suggests, to a situation where individuals and generations feel they must look out for themselves rather than relying on social insurance or spreading risk between generations.

Ageing has become less a collective social responsibility and more a risk for the individual. Pensions are not the only area in which this tendency can be observed. A similar point can be made with regards to health insurance and the emergence of healthy ageing policies. The latter make the business of maintaining functional health part of the life work of each active citizen. Doctrines of mutual obligation are the flavour of the day. If something goes amiss, the state is not necessarily around to assist.

Not surprisingly, markets have stepped in where the state has withdrawn, offering all sorts of products and services to individuals and groups who feel their wellbeing and/or labour market chances affected by their age or perceived age. These include preventive health measures, hormonal treatments, alternative and complementary medicines, dietary and fitness regimes, neutraceuticals, cosmaceuticals and any other number of therapies from protein boosters to steroids.

When it comes to ageing, however, the relation of state to market is not a zero sum game. Demographic pressures themselves have contributed to the diminishment of social welfare programs, slowly eroding the state’s devices for managing the production and reproduction of life. Under current conditions, market and state tend to move in lockstep. Nostalgia is not a viable option when it comes to the challenges of population ageing.

The individualisation of ageing can only be fully understood if studied with regard to a concurrent and only seemingly contradictory process, the globalisation of ageing. There is something to be gained by thinking about the challenges posed by population ageing in analogy to the challenges of climate change. Since while the policies of individual states may be vitally important, they are not by themselves sufficient to address the macro situation.

At a time when wealthy countries like Australia discuss the ageing of the baby boom generation, it is salutary to remember that not everywhere in the world was there a post-World War II baby boom. The so-called developing countries are generally less aged than the advanced capitalist nations but are now ageing at a faster rate. The initial spurt of population ageing in these contexts is usually due to decreased infant mortality rather than increased life expectancies.

Some demographers identify a demographic divide between poor countries with high birth rates and low life expectancies and wealthy countries with low birth rates and high life expectancies. This is clearly a schematic divide since many countries fall between these extremes. But it is a useful device for identifying some of the demographic pressures which, alongside other factors, shape disparities and population flows in the world today.

One phenomenon the notion of the demographic divide helps us to understand is international migration. The decision to migrate cannot be fully explained by demographic trends. But demography is one factor that influences the unprecedented movement of migrants from poor to wealthy nations.

Often for wealthy countries it is a matter of making up labour market shortfalls, both skilled and unskilled. But to stave off the scenario where migrants stay on and age in the host economy, it is necessary to ensure a rotation of workers through these jurisdictions. Technologies of border control, including detention camps, thus become central to the way nation-states shape their age profiles.

Interestingly, aged care itself is one of the sectors increasingly staffed by migrant workers in many parts of the world. When the recently re-elected Berlusconi government in Italy attempted to make clandestine migration a crime, it faced objections from its own constituency. Too many families now depend on migrant workers to care for aged parents who form part of the country’s rapidly ageing population.

The point is that in an interconnected world the policy initiatives introduced by any one nation to deal with population ageing will have effects elsewhere. Whether determined by financial fluctuations, migratory movements or the travelling of anti-ageing practices, an analysis of these links must form a crucial part of informed research.

Ageing is a societal issue and must be approached as such. But can we rest assured that societies begin and end at the borders of nation-states? If we approach the challenges of climate change as global citizens, why should the conversation remain merely national when it comes to population ageing? Baby boom or baby bust, our horizons should expand.