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What’s wrong with Healthy Ageing Anyway?

Societies are ageing. There is no need to reiterate the projections to this readership; suffice it to say that an increasingly ageing population presents both challenges and opportunities regarding the future. One strategy, it appears, is to examine how we may grapple with the former and maximise the latter. This endeavour is far too complex to be satisfactorily tackled in a short blog such as this, but hopefully the post can open up conversation regarding a potentially important issue.

Recently, when reviewing the interdisciplinary literature on ageing, I was struck by a divergence of perspective that could, potentially, result in counterproductive divisiveness. On the one hand, there is what I will term ‘prescriptive research’ and, on the other, what I will call ‘exploratory research’.[1] The former employs the concept of ‘healthy aging’ as an interventionist tool, used to make particular recommendations. From this perspective, healthier lifestyles lead to increases in older adults’ well-being and life expectancy. Conversely, in exploratory research the very idea of healthy ageing is problematized on several grounds. Firstly, healthy ageing programs could increase the disadvantage of those without the wherewithal to adopt such practices. Secondly, an old age free from infirmities is ‘unrealistic for most people’ and the very notion of healthy ageing reflects ‘biomedical and Western cultural biases’ (Mattingly 2022: 12). This could result, it is suggested, in normative constructions of ‘normal’ and ‘pathological’ ageing which reinforce the former and stigmatize the latter (Cohen 1998).

Although disagreement plays a significant role in scholarly enquiry, the hope is that the subsequent synthesis of different perspectives will extend understandings of the empirical world. Potential problems arise, however, when work with different aims and objectives enters into dialogue. For example, exploratory research could end up undermining the endeavours of its prescriptive counterpart. This is currently being played out in the context of healthy ageing, whereby exploratory work critiques the healthy ageing programs that prescriptive research seeks to implement. Viewed from the perspective of exploratory research, it is only through intensive investigation that complex social phenomena can be understood; thereby providing material and categories for more focused interventions. But this raises the politics and pragmatics involved in the complexity dilemma; policymakers and other applied practitioners require workable data, purified of what they perceive as extraneous material.   

It is not novel to suggest that the motor driving social research is based on newness (Sanchez 2017) and/or the potential to obviate, or at least reduce, ‘real-world’ problems. In social anthropology and its allied disciplines, a certain level of theoretical innovation is a prerequisite for both funding and publication. This, in many instances, has led to ethnography’s subordination to theory, in a sense putting the conceptual cart before the empirical horse (Biehl 2013). Although the requirement is to merely perform a single click of the theoretical Rubik’s Cube in order to contribute to the scholarly corpus, the need for newness has prompted philosophical flights of imagination that are almost inapplicable to prescriptive contexts because of their complexity. Additionally, in their search for newness, anthropologists, and perhaps other social scientists, may enter into philosophical domains that do not reflect their research participants’ lives. In these cases, one can only wonder how such abstractions might translate into policy or other interventionist applications.

Two pertinent observations ought to be advanced here. Firstly, most metrics demonstrate that, broadly speaking, global living standards are improving, with more people living longer and healthier lives. Secondly, these improvements did not occur in a vacuum but were instead initiated through a series of interventions. By making these suggestions, I do not mean to disregard the enormous amount of suffering, inequality, and poverty, which either still exists or is brought about by both the intended and unintended consequences of these interventions. Instead, the thought piece contained in this blog post is a call for a balanced conversation that takes the strengths and pitfalls of both exploratory and prescriptive research seriously. Surely it goes without saying that we all want people across the globe to have the option and capacity to live longer, healthier lives?

The question remains, then: is healthy ageing an interventionist project worth pursuing? Although healthy ageing could mean very different things to different people, surely common sense dictates that a longer, healthier life is desired by all. Anthropological work complicates this idea by demonstrating that in Indian contexts the acceptance of decline, with all its frailties and limitations, is perceived as part of the transient cycle of existence known as samsara (Lamb 2014). In parts of India, and perhaps other places, ageing well is less about sustaining ‘productive activity and independence’, and more about ‘residing intimately with and receiving respectful loving care from kin’ (Ibid: 42). From this perspective, ‘Western’ notions of healthy ageing fall short of accounting for different ways of ageing well. Considering that such understandings have arisen from fine-grained ethnographic enquiry, or what I have termed exploratory research, we are faced with a real conundrum. One way around this seeming impasse might be to break down the larger problem of healthy ageing by conducting focussed research on different cultural groups and then base interventions on these particular contexts of occurrence. However, the costs and time-consuming nature of such an endeavour, not to mention the problem of class, gender, and religious differentiations (to name a few) might rule it out as a viable method.

That said, if healthy ageing programs are to be rolled out globally, it may be prudent to incorporate non-Western ways of ageing well into the overall scheme, as well as finding ways of establishing the conditions that facilitate responsible culturally specific choices. And while prescriptive interventions undoubtedly play a role, if they are to be effective they must be grounded in rich empirical data. In order to overcome this ‘hard problem’, those conducting exploratory and prescriptive research could find it fruitful to work in dialogue; paying close attention to, and drawing on, each other’s strengths and shortcomings.

I would like to end this blog by taking inspiration from one of the keenest analysts of human psycho-sociality, Fyodor Dostoevsky. It seems reasonable to suggest that the social world is intrinsically more complex than any one of us can ever comprehend. If this is the case, it must follow that interventionist projects such as those promoting healthy ageing will be as much beset with unintended consequences as they are with those that are intended. There is little doubt that many interventions are driven by noble intentions (often balancing powerful political and economic interests), but the fact remains that humans have a demonstrable wont for destabilising the very things that may facilitate their flourishing. We see this time and time again in the sociological literature, the foundational stories infusing our various societies, and, perhaps, in our own lives. This is not a call for resignation, but for enquiry that takes stock of what can be realistically achieved when attempting to build a future that responds to demographic transitions, while simultaneously enabling healthy ageing in whatever form this may take.     

[1] This distinction is not absolute as there is often much overlap between each category. Suffice it to say that they are employed here for analytical purposes.

About the Author

Dr Anthony Howarth is a Research Fellow at the Institute of Population Ageing, a Research Associate at University College, and a Research Affiliate at the Institute of Social and Cultural Anthropology, at the University of Oxford. His current research focuses on how the relationship between design, place, community and intergenerational living might enable healthy ageing. 

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