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BOOK REVIEW |
Department of Population Health Sciences, University of Wisconsin Madison, WI 53726
Grains from Grass: Aging, Gender, and Famine in Rural Africa, by Lisa Cliggett. Cornell University Press, Ithaca, NY, 2005, 193 pp., $54.95 (cloth), $19.95 (paper).
Handbook of Asian Aging, edited by Hyunsook Yoon and Jon Hendricks. Baywood Publishing Company, Inc., Amityville, NY, 2006, 512 pp., $74.50 (cloth).
Intergenerational Support and Old Age in Africa, by Isabella Aboderin. Transaction Publishers, New Brunswick, NJ, 2006, 221 pp., $39.95 (cloth).
The Greying of India: Population Ageing in the Context of Asia, by Rajagopal Dhar Chakraborti. SAGE Publications, Thousand Oaks, CA, 2004, 467 pp., $56.95 (cloth).
With the convening of the 1982 World Assembly on Aging, member states of the United Nations (U.N.) declared their intention to deal with the fact that individual aging and societal aging were becoming compelling issues that warranted serious attention. Twenty years later, the U.N., responding to increasing demands for its members and agencies to address profound issues of an aging world, convened in Madrid the Second World Assembly. In preparation for these two events, governments and nongovernmental organizations assessed the extent to which their nations and organizations were preparing for and responding to the consequences of unprecedented population aging. Attention focused not only on the increase in the number of citizens moving from an active life into a time when many become increasingly dependent on family and society to sustain them, but also on the positive role of older persons; fortunately, a large number of elders have relatively good health, continue to work, and contribute to their families and communities.
Parliamentarians grappled with the changing demographics of their nations and with the prospect of having to care for large and growing populations of people in need of economic security and comprehensive health care. With increased urgency, demographers, sociologists, psychologists, anthropologists, and gerontologists investigated trends and transitions—indeed social transformations. Geriatricians and other clinicians assessed and treated those for whom longevity brought with it disabilities and diseases associated with long life. Economists and advocates contemplated mounting crises of inadequate resources and nascent political will to pay for programs and services essential to the well-being of older citizens.
Given these transformational forces active throughout the world, it is not surprising to find scholars collecting data and applying their analytical skills to understanding what it means personally to grow old, and suggesting how societies should prepare to care for the growing number of people in need of personal and economic security. Numerous books and reports provide serious students of our aging world with comprehensive information, informed analyses, and astute predictions to supplement our growing knowledge of the dynamics of global aging. Thanks to reports and documents from the U.N., the World Bank, international foundations, nongovernmental organizations, and academics, the dimensions of the challenges societies face as their aging populations grow are becoming increasingly clear and urgent. The four recently published books discussed in this essay contribute substantially to our understanding of aging in Asia and Africa—regions for which gerontological literature is relatively underdeveloped.
Emerging Asia
Those who agree that too little serious attention has been given to those parts of the world where the overwhelming populations of older persons reside will welcome the first (for surely others will follow) Handbook of Asian Aging, edited by Hyunsook Yoon and Jon Hendricks. With chapters focusing primarily on sociological and demographic dynamics of nine Asian nations, the Handbook's opening articles set a standard of scholarship and provide a comprehensive context for the cross-cutting demographic, economic, political and cultural forces at work in the region.
The sophisticated reader will not be surprised to discover that, given the speed with which Asian nations are aging, those responsible for the policies and practices—advocates, academics, policy makers, and opinion leaders—have an awesome task to collect, examine, and interpret demographic, economic, and social status data. Many scholars acknowledge that Asian gerontological literature is sparse and somewhat unreliable; nonetheless, the nations of Asia are forging ahead with policy innovations and reforms. The scholars whose findings are included in the Handbook are making concerted efforts to ensure that policies are grounded on solid information and that trends are accurately identified for informed projections. Fortunately, while the number of older people is increasing, some Asian countries are experiencing a strengthening of their economies, building an increased capacity to fund needed economic, health, and social policies to ensure that elders in Asia will live not only long, but also reasonably well. However, as Laura Katz Olson predicts in her well-documented chapter, "The Politics and Policies of Aging, Asian Style":
Certainly, the prospects in the foreseeable future are not promising. Instead, most Asian nations are strengthening filial obligations and shifting greater pension and medical expenses to workers while disregarding the increasingly overwhelming financial, physical, psychological and emotional costs these policies entail. (p. 113)
Ranging widely over the geography of Asia for examples and applying insights from anthropological literature, John van Willigen and Denise Lewis, in their chapter on "Culture as the Context of Aging," discuss why understanding the relationships between culture and family values, caregiving, good health, and aging is essential for one to discern clues to the social transformation of Asia. The authors, while acknowledging the sweep of culture across all elements of society, note that "Older adults may be especially susceptible to stress caused by cultural transformations associated with structural changes in society such as those brought on by rapid technological change" (p. 123). Whether one attributes the social transformations taking place throughout the world to demographics or modernization or globalization (or some combination thereof), one is reminded that, a half century ago, Adlai Stevenson (1953), explaining the profound changes affecting the world, said that "we live in an era of revolution—the revolution of rising expectations." Throughout the cross-cultural and cross-national gerontological literature (and from my travels in some 60 countries), evidence can be found showing the many ways in which people of all ages are influenced by their rising expectations for a better life—for themselves, their families, neighborhoods, and nations.
Driving the politics of aging in various parts of Asia is a growing sense of empowerment among older persons to achieve positive changes for their lives as well as an increased willingness on the part of their governments to find ways to enable older citizens to live with dignity. Among the nations cited in the Handbook of Asian Aging as undergoing dramatic aging policy shifts are Australia, China, Japan, South Korea, India, Malaysia, Singapore, the Philippines, and Taiwan. Chapters describing the dynamics of political and social change for each of these nations are grouped in sections that focus on economic status, work and retirement, living arrangements, family caregiving and social support, health and long-term care, and community social services. Given Japan's acknowledged leadership in innovative and comprehensive services for older people, readers may want to turn to the chapter by Daisaku Maeda and Hisanori Isikawa on community services and to Koichi Hiraoka's chapter on long-term care insurance to learn about the policy alternatives being implemented in Japan. In their analysis of Australia's services for older people (Chapter 17), Hal Kendig and Susan Quine write, "Australia provides a useful point of comparison for Asia because it has a European tradition and an Asian future."
Throughout the Handbook's fine array of chapters, one can find insights into the dramatic forces forming and reforming the Asian region. Taken together, the contents present both a highly optimistic view of what lies ahead and a critical assessment of social and economic policies that will, undoubtedly, require substantial reform to enable the millions of older persons in the region to fulfill their rising expectations for a good old age and the region's social transformation to a more elder-friendly society.
Graceful Aging
Adding to what seems to be a limitless lexicon of qualifiers to the word "aging," Rajagopal Dhar Chakraborti introduces in The Greying of India a lovely, nuanced adjective, "graceful," to that phenomenon we call, simply, aging. Although one should ask whether such qualifiers as productive, active, successful, healthy—on and on—have narrowed, rather than explained or enhanced the meaning of aging, Chakraborti's contribution, "graceful aging," has a certain charm. It moves the discussion about aging from the pages, graphs, and tables and projections and monographs of demography into a realm more inclusive and comforting than the numerology of demographers. He defines graceful aging as "a process of optimizing opportunities for physical, social and mental well-being throughout life, in order to ensure a healthy, independent, quality of life in older age" (p. 306).
The Greying of India provides investigators with exhaustive details about the numbers and trends of aging in India with frequent referrals to other nations in the region. It also contains five appendices that include governmental documents from India and Viet Nam, the U.N.'s Vienna International Plan of Action on Aging from the 1982 World Assembly, and the World Health Organization's report titled "Major Chronic Conditions Affecting Older People Worldwide" (pp. 349–429). A handy glossary explains in simple language the terms and phrases demographers and gerontologists use in their research and writings. For those new to the often-arcane world of gerontology, this glossary is, indeed, a useful reference as are 10 pages of bibliography and a full index.
Into Africa
Using her well-honed skills and insights as a seasoned anthropologist, Lisa Cliggett brings into sharp focus the complexities, deprivations, and consequences of being an older woman in rural Africa. In Grains from Grass: Aging, Gender, and Famine in Rural Africa, one encounters the poignant, highly personal, indeed intimate, stories of aging women living under circumstances that promise little more than survival. Growing older for women—a feared and terrible prospect due to hunger, extreme poverty, and disease—is further compromised by their status based entirely on their gender. Despite the realities that confront their aspirations for long life, the women of rural Zambia are truly remarkable for their vitality, but constrained by traditions that marginalize their existence and demand extraordinary work with little chance of securing their future.
The title of this small and intense book, Grains from Grass, is taken from the practice of what only old women do—extracting the tiny grains of grass that, after hours of painstaking labor, may be sufficient to make a small bowl of life-sustaining porridge. An old woman's survival depends in large measure on her networking skills among kin, most of whom have fled the village for work or to a distant piece of land that may produce just enough food for one to survive through what has become seemingly endless months and years of drought.
As Cliggett tells the story, from inside the village and through continuing ties with the subjects of her exceptional ethnography of African life at the very edge of survival, one cannot but be both distressed by the extreme measures older women must take to survive, and amazed at their skills in finding ways to persevere. Her description of family life for rural women shatters our notion that Africans venerate their elders.
To understand fully the demographic, epidemiological, and social status data of Africa's emerging elderly population, one who divides large data sets into individuals will appreciate the dimensions of our aging world and, as Cliggett does so well, will hear the voices of marginalized, vulnerable elderly women. Policy wonks manipulate the data and study various models for introducing vital political reforms that provide systemic and sustainable solutions to systemic problems. Social anthropologists are trained—as are many of the volunteers working through such organizations as HelpAge International and numerous other nongovernmental organizations—to listen first and then to be helpful in culturally sensitive ways to those in great social and economic need.
Grains from Grass is an enlightening but very disturbing book. The lessons one learns from this book are many, not only about the plight of older women in rural Zambia, but also about the tools anthropologists use and the insights they discern from their investigations.
Intergenerational Conflicts
Underlying the foundation of global aging is the issue of intergenerational support. In Africa and Asia, indeed throughout the world, there has been a belief, unsupported by increasing empirical evidence, that elders are cared for by their children. In fact, governmental officials often cite the idea that the traditional system of families caring for their elders makes it unnecessary, and possibly inappropriate, for governments to establish policies and allocate scarce resources for the care of the nation's elders. However, the four books discussed in this essay offer solid evidence that, without considerable governmental assistance, elders, especially the oldest old, face uncertainty in late life. Isabella Aboderin's volume, Intergenerational Support and Old Age in Africa, documents the extent to which intergenerational support fails to ensure a secure old age. Applying various models used to explain the motivational basis for old age support, she acknowledges a woeful lack of evidence to support claims that in Africa, Asia, and other parts of the globe, elders are, in fact, cared for by their families and their villages.
Enlivening the text with the actual words of Ghanian subjects for this innovative study of intergenerational supports, Aboderin points to policy implications of her findings. After reporting the dearth of economic resources to support national welfare policies, she provides important information on how what once may have been an intergenerational support system is rapidly being undercut by migration, changing family structures, hunger, and disease. However, she directly attributes the decline of family support to two major forces: "a shrinking resource capacity of children to provide support, exacerbated by the fundamental priority given to the needs of the young ... and a change in the normative basis of filial support ..." (p. 139). Aboderin examines in depth and at length the principles underlying the limits of filial obligation and the conditionality of the relationship between children and their parents. Astutely, she concludes that finding answers to perplexing questions about how best to strengthen family ties over the generations is a major objective, given the extent to which both policy and practice decisions follow on assumptions made about who is responsible for whom—and for what—when it comes to the care of vulnerable elders.
Meeting the Challenges and Opportunities of Global Aging
The writers of the books considered in this essay have made substantial contributions to our understanding of what will be required to ensure that the U.N.'s Declaration of Human Rights protects elders throughout the world, and to implement recommendations developed in two U.N. World Assemblies on Aging. Advocates, scholars, elected and appointed officials, elders, and their families need to address, personally, nationally, culturally, and globally, such questions as the following: How will informal care systems be strengthened to provide adequate care for elders, including those who do not have close kin? What is a fair and appropriate distribution of resources for the care of both children and vulnerable elders? To what extent should, and can, formal systems of care replace informal caring systems, including those that are not working well? Acknowledging the huge gap between the "haves" and the "have nots," what responsibility has the gerontological community of scholars and advocates for informing and influencing policies that would increase the transfer of resources from those who have so much to those who have so little?
The revolution of rising expectations has been a powerful force, bringing information and hope to people in all parts of the globe. National and international forums have focused primarily on cultural and economic realities that constrain efforts to deliver the promised benefits of modernization, globalization, and economic advances. Reports on the status of elders in various nations and regions have emphasized serious problems undermining their personal and economic security. Nonetheless, the global gerontological community has taken appropriate preliminary steps in researching the dimensions of a rapidly aging world from demographic, cultural, social, economic, and political perspectives. The volumes discussed in this essay make important contributions to a process of providing resource controllers and political leaders with clear evidence of not only the potential effectiveness of various strategies but also pitfalls to avoid. Researchers need to join advocates to see that the ambitious goals of the two World Assemblies on Aging are realized.
The theologian, Jürgen Moltmann, (quoted in Bean, 1989) suggested:
Social policy only emerges when sociological, economic and purely scientific extrapolations are linked with ethical anticipations. It does not emerge from the calculable and extrapolated future, or solely from ethical maxims and desires, but only from the linking of what we know and can do with what we hope for and desire. (p. 142)
Despite the unevenness of the evidence and the fact that elders in vast regions of the world remain obscure to investigators and even national political leaders, the body of knowledge has expanded (what we know). Model programs and policies are available to those committed to improve the well-being of the world's elders (what we can do). The major challenge for those concerned for the well-being of vulnerable elders and their families is to unleash the power of what we know and can do with a firm dedication to hear the voices of elders and to ensure that their expectations for a good old age are realized. A draft document prepared (author unknown) for the Madrid 2002 World Assembly on Aging includes the following language:
In global terms, appropriate and effective actions to effectively accommodate the challenges of increased individual longevity and population ageing require the coordination of international resources and expertise with local resources and priorities, and must be informed by the best information and knowledge available and by the perspectives of ageing persons at local, regional, state and international levels.
The authors and editors of these four books have contributed to the vital process of gathering solid information, analyzing that information, and informing the public's consideration of strategies and policies. This will increase the likelihood that tomorrow's elders will inherit the dividends of reliable and comprehensive research. We must be both well-informed and concerned citizens—to act urgently and wisely to empower and enable the world's elders to enjoy a good old age.
References
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