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Initiatives for ‘age-friendly environments’ need precarity-thinking

The main focus of my research is what one might call ‘the shadow side of old age’: living with dementia, tiredness of life, living towards death in modern times, and the question of how to find meaning in the midst of all this. The focus makes me sensitive to the precarious situation, not only of older people, but of human beings in general. There is, I think, in our societies a tendency to overlook or play down the precariousness of our existence, both as individuals and on a meta-level. In this blog, I want so suggest that there is a potentially humanizing value in using what might be called the ‘precarity lens’. To be an age-friendly society, I think we need to relate to situations of precarity and vulnerability, even though this seems a bit at odds with dominant thinking in many Western cultures and societies. So what do I mean by precarity?

Following the American philosopher Judith Butler, who – among others – extensively discussed the idea, I hold a double perspective on precarity as being both inherent to the human condition (acknowledging mortality, (inter)dependency, needs and vulnerability as being constitutive to human life) and always situational  (denoting certain socio-political and/or economical circumstances). We are all bodily and relational beings, contingent upon others for food, care, shelter, social trust and recognition. Consequently, we are always at risk of our needs not being met by other individuals or institutions. Indeed, to a large extent, our sense of precarity is dependent upon the presence or absence of sustaining social infrastructures and institutions, and thus inextricably linked with policies that address the organization and protection of bodily needs.

While precarity is an existential condition, concerning all human beings, it is unevenly distributed throughout our world. Some people find themselves in a more precarious situation than others. Besides, people experience different states of precarity during their lives. In old age, for example, people might experience increased forms of dependence (on others and on institutions) than earlier in life. My point in this blog is that we need to fully acknowledge these forms of precarity, vulnerability and dependence – and think beyond the narrow terminology of autonomy and participation – if we wish to formulate truly age-friendly politics.

Despite criticism from gerontology, in policy and health-related services, the discourse of “menus of options” with various packages of services and supports – all understood as ways to support self-determination and participation – is still dominant. It reflects a framing of the experience of older adulthood as a time of activity, health, and happiness. For example in 2007, the World Health Organization (WHO) launched the concept of age-friendly environments. With this initiative, the WHO aims to provide an answer to challenges associated with population ageing worldwide. The WHO wants to enable older people to continue to participate in and contribute to society.

Following this, in 2011, the European Commission created a European Innovation Partnership on Active and Healthy Ageing (EIP on AHA). The EIP on AHA aims to foster improving the health and quality of life of Europeans with a focus on healthy and active ageing. The number of Europeans aged over 65 will double in the next 50 years, and the number of over 80 year olds will almost triple. While life expectancy will continue to increase, living longer does not necessarily mean living a healthier, more active and independent life. Unhealthy life years still make up around 20% of a person's life. The overarching target of EIP on AHA is therefore to increase the average healthy lifespan of EU citizens by 2 years by the year 2020.

The emphasis on age-friendly societies is without doubt of crucial importance for the humanization of our societies. However, to really have a humanizing and age-friendly potential, initiatives for ‘age-friendly environments’ should not narrowly focus on ‘healthy and active ageing’, but also take into account the precarious situation of many older people. Indeed, in my opinion, our policies can only be age-friendly if we include precarity-thinking. As mentioned before, we all experience precarity at different points in our lives, since interdependence and mortality are features of the human condition. Old age, however, is empathically precarious due to physical and cognitive deterioration, loss of friends and increasing social isolation, and in some cases loss of income and uncertain access to needed care. This fact of life needs our full recognition, not only in our personal encounters, but also in our policies.

Why is our relationship to precariousness ethically, politically, and socially problematic? Why do we do such a bad job standing before difficulties, impairment, and vulnerabilities as humans? Among other things, the idealization of autonomy and independence seems to encourage a disavowal of precarity as pertaining to the self, and it makes us blind to the positive dimension of our interdependence and interconnectedness. A vulnerable person is regarded as lacking in power and incapable of protecting her own interests and exercising agency. Indeed, agency is often regarded as incompatible with vulnerability and precarity. They are associated with weakness, incapability and powerlessness; and they undermine agency. Besides, we also seem to have difficulty understanding ourselves as participating in the social structures that create precariousness.

In arguing for recognizing the inherent precarity of human beings in general, and older people more specifically, I envision age-friendly societies with public health goals that are much broader than “healthy” or “active” ageing. Indeed, I would argue that we need to formulate goals that also include unfixable situations of fragility, illness, loneliness, disability, or hardship as being part of human life as it is. We should ask ourselves: how do such precarious conditions constitute affect, subjectivity, psychological interiority, and everyday life experiences? How can we do justice to the complexity of these precarious experiences and how to make room for such experiences and relate to them? I think it starts with our ability to accept and relate to the precariousness of our own existence.

About the author: Els van Wijngaarden was an Academic Visitor at the Oxford Institute of Population Ageing in 2018. She is based in Utrecht, The Netherlands, where she works as an assistant professor in Care Ethics at the University of Humanistic Studies.

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