Dr Fiona McGowan, School of Health Care Studies, Hanze University of Applied Sciences, Eyssoniusplein Netherlands f.e.mcgowan@pl.hanze.nl

We are all very much aware of how societies are ageing and this ‘demographic transition ‘ is widely recognised as a global phenomenon. How this shift in population composition impacts health and illness is not so conclusive. While trends have emerged indicating the rise in non-communicable diseases such as heart disease, cancer and diabetes, global patterns of health problems also reflect disparities between and within countries. Different ‘ peoples’ experience ageing in different ways and these are not equal.

WHO (World Health Report 2013) showed that health inequalities remain ingrained globally and reflect disparities marked by sex, age, socio economic status, education, place and other more specific factors including migrant status, race, ethnicity and religion. Mortality data shows that in high-income countries, 7 in every 10 deaths are among people aged 70 years and older. People predominantly die of chronic diseases. Only 1 in every 100 deaths is among children under 15 years. In low-income countries, nearly 4 in every 10 deaths are among children under 15 years, and only 2 in every 10 deaths are among people aged 70 years and older. People predominantly die of infectious diseases and complications of childbirth. (World Health Statistics 2015). These facts illustrate the contrast between what an ageing society looks like in a developed, high-income country and in a low income, developing country (a further example being expected years of retirement which is 24 years in France but only 9 years in Mexico – both countries have retirement age at 65) This also highlights how our knowledge and understanding of ageing societies has been shaped by inequality. The focus remains on how westernised societies experience ageing. The social constructionist approach to ageing largely applies to societies in which people are living longer and sufficiently long enough to experience what Laslett (1996) has defined as a ‘Third Age’. A period post retirement, conceptualised as ‘the crown of life’, a time of self- fulfilment and achievement(Jones et al. 2008).

More recent theorising in the field of social gerontology, categorises the third age and later life as a ‘new cultural and social field’ particular to Westernised consumer society marked by sustaining a youthful appearance, and a ‘performing fit, healthy and sexualised lifestyle’ is maintained (Gilleard & Higgs, 2005). While this presents a more positive approach to ageing – in contrast to dependency and disengagement theories – again the focus is on a specific demographic cohort and this ‘generational field’ is not globally situated. Whether a ‘later life’ is experienced mirrors the accumulative process of ageing and the extent to which illness and disability are suffered. While the worldwide ‘epidemiologic shift’ that has accompanied socioeconomic development is reflected in both individual and population health, inequality remains as a powerful determining force. Global health then is dependent on the global context – environmental, economic, political and social. How a society ages is similarly shaped. As Michael Marmot writes in The Health Gap, “ Societies have cultures, values and economic arrangements that set the context through the life course that influence health” (2015, p259). This is clearly supported by Life expectancy indicators (OECD 2016) which show, for example, Nigeria – 54.5 years, Japan – 83 years.

References

Gilleard, C. & Higgs, P. ( 2005) Contexts of Ageing: Class, Cohort and Community. Polity Press. Cambridge.

Jones, I. , Hyde, M. , Victor, C., Wiggins, R. , Gilleard, C. and Higgs, P (2008) Ageing in a Consumer Society: From passive to active consumption in Britain. The Policy Press. Bristol.

Laslett, P. (1996) A Fresh Map of Life: The Emergence of the Third Age ( 2^nd ed). Palgrave MacMillan.

Marmot, M. (2015) The Health Gap: The Challenge of an Unequal World. Bloomsbury. London.

Organisation for Economic Co-operation and Development (OECD) (2016) OECD Data: Life Expectancy at Birth. https://data.oecd.org/healthstat/life-expectancy-at-birth.htm Accessed 2nd July 2016.

World Health Organisation (WHO) National Institute on Aging (2011) Global Health and Aging. http://www.who.int/ageing/publications/global_health.pdf?ua=1 Accessed 1^st July 2016.

World Health Organisation (WHO) World Health Report 2013. Research for universal health coverage. http://www.who.int/whr/en/ Accessed 2^nd July 2016.

World Health Organisation (WHO) (2015) Global Health Observatory (GHO) Data

World Health Statisitics 2015. http://www.who.int/gho/publications/world_health_statistics/2015/en/ Accessed 1^st July 2016.