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BOOK REVIEW |
Editor, Global Ageing Senior Advisor for Aging Policy Department of Population Health Sciences University of Wisconsin Madison, WI 53705
Growing Older in World Cities: New York, London, Paris, and Tokyo, edited by Victor G. Rodwin and Michael K. Gusmano. Vanderbilt University Press, Nashville, TN, 2006, 416 pp., $79.95 (cloth), $39.95 (paper).
Lessons on Aging from Three Nations, Volume I: The Art of Aging Well, edited by Sara Carmel, Carol A. Morse, and Fernando M. Torres-Gil. Baywood Publishing Company, Inc., Amityville, NY, 2007, 242 pp., $49.00 (cloth).
Lessons on Aging from Three Nations, Volume II: The Art of Caring for Older Adults, edited by Sara Carmel, Carol A. Morse, and Fernando M. Torres-Gil. Baywood Publishing Company, Inc., Amityville, NY, 2007, 254 pp., $49.00 (cloth).
Longevity and Social Change in Australia, edited by Allan Borowski, Sol Encel, and Elizabeth Ozanne. UNSW Press, Sydney, NSW, Australia, 2007, 397 pp., AU$59.95 (paper).
Global aging has moved from the recesses of discussion into what has recently become a hot issue. However, it is abundantly clear that the gerontological community has paid little attention to the fact that the bulk of the world's aging people live in third world regions where they share few of the benefits that have become almost entitlements in the developed world. Many researchers have concentrated their efforts mining the data readily available about the status of older persons in developed nations. What is known about their social, health and economic status and about the demographics of the so-called first world nations is considerable, and expanding. Unfortunately, what is known about the social, health and economic status of elders in third world nations is paltry.
Recently, we have been exposed to disturbing images and poignant stories from impoverished regions of malnourished older persons overwhelmed with caring responsibilities for their disease-ravaged children and their children's children, forced from their homes by war, civil strife, and natural disasters. These images of distraught elders share media space with equally distressing photos and stories of children struggling to survive in all parts of the globe. Not only are the heart-wrenching stories of survival among people in the third world deeply disturbing, but also—as we are discovering—their suffering affects all of us and should, at least, get our attention.
It seems to this observer that gerontological researchers would give some attention to the world's compelling problems, especially investigating the extent to which the effects of poverty, displacement, and dysfunctional support systems affect older people, and their families. Demographers have amassed the data that show that population aging is more rapid in developing countries than among developed nations. So the consequences of an ever-increasing number of older persons, including frail elders, should not be ignored. But they are. Global aging, the timely theme for the Gerontological Society of America's 2007 conference, has, to an astonishing degree, attracted relatively little attention among gerontological researchers.
However, a growing number of gerontologists are finding that cross-national and cross-cultural studies, while challenging to do and difficult to fund, offer tremendous rewards. A few investigators are jetting across the oceans to collaborate with colleagues to examine how various nations—even cities—are preparing for and coping with the challenges of their aging populations. Given the sophistication of demographic and social, health and economic status data in developed nations, it is hardly surprising that enterprising scholars are finding new markets for their studies, data analyzed this way and that, comparing residents of this city with those of another, gathering articles from one, two or more countries, and publishing the results in special collections with such inviting subtitles as "The Art of Caring for Older Adults" and "The Art of Aging Well."
And given the dearth of reliable data about older people in developing nations, it is not at all surprising to find few gerontological studies being published that report how the global dimensions of population aging are affecting the elders of impoverished nations and regions. While it is widely reported in the popular media that the quality of life of older people in poor nations is dismal—a consequence of their homelands' economic, social, geographic and political status—it is about time that scholars and advocates bring forcefully to the public's awareness that pitifully few resources are allocated to relieve the suffering of those nations' poor, ill and vulnerable populations, which certainly include their elders.
It is fortunate that a few economists have responded to the world's urgent need for information about both the plight of the people in the third world and the possibilities for effective reforms. For example, such texts as The Bottom Billion, by Paul Collier (2007); The End of Poverty, by Jeffrey Sachs (2005); How to Change the World, by David Bornstein (2004); and Nobel Peace Prize winner Muhammad Yunus' (1999) Banker to the Poor, provide powerful evidence and compelling stories about the world's poor. And they also provide both a context for doing national, regional, and global research and a framework for improving the well-being of older people in impoverished regions. Gerontologists need the insights of economists, anthropologists, political scientists, social historians and, indeed, journalists to inform their work. Conversely, those colleagues and world opinion leaders need the insights of gerontologists who have developed expertise regarding what is required for the elders of society to do well and not simply to survive.
The Good News from Developed Nations
The works specifically discussed in this essay bring, by and large, good news. Elders in Australia, Israel, the United States and those living in Paris, London, Tokyo, and New York are the beneficiaries of health care and social support systems that work, notwithstanding certain gaps in services and systemic barriers to full participation of elders in their societies. Comparative analyses of the social and economic status of elders in four of the world's largest cities—the subject of Growing Older in World Cities, edited by Victor G. Rodwin and Michael K. Gusmano—provide readers with reasons to feel good about the quality of life of older residents of these highly developed urban centers. Volumes I and II of Lessons on Aging from Three Nations—both edited by Sara Carmel, Carol A. Morse, and Fernando M. Torres-Gil—present considerable evidence that older people are doing rather well in Australia, Israel and the United States. And indeed, prospects for a good old age are positive in Australia, given the evidence included in Longevity and Social Change in Australia, edited by Allan Borowski, Sol Encel, and Elizabeth Ozanne.
These four books reveal remarkably well the current status of older persons in these places and the impact rapid population aging has on their cities and countries. Each text describes how aging policies have developed, provides reports on social and demographic trends, and discusses emerging policy and practice initiatives that affect older residents. The lessons one gains from reading these texts have clear implications for other developed nations, but shed little light on what needs to be done for and with the world's vulnerable elders who survive, but poorly, in third world nations.
In the context of global aging, these volumes describe a small minority of the world's elders. While the respected editors of these four books did not set out to provide a global assessment of the status of older persons, this reviewer finds little that is new or particularly informative from the texts based on data that have been available for years. However, the eight editors have done a commendable job of connecting the issues through their introductions and summaries. The 91 authors who produced 1300 pages of texts, and created 204 figures and tables to support their texts, provide ample evidence that palpable progress has been made to improve the quality of life of older populations in the countries and cities selected for the four books.
Fortunately, readers already have a plethora of material on which to draw, describing the status of elders in developed countries. With numerous data bases to analyze and by applying appropriate methodology, scholars have developed useful generalizations that enable editors to offer lessons on aging using such a subtitle as "The Art of Aging Well." But before returning to my screed about the critical importance of understanding the dimensions of global aging—especially growing old in third world nations—let me describe briefly what I learned from each of the texts.
Growing Older in World Cities
Victor Rodwin and Michael Gusmano have produced a book that combines considerable quantitative information about older people living in New York, London, Paris, and Tokyo. In the opening chapter, the editors, aided by Robert Butler, make the case for focusing on the impact that human longevity and population aging have on "health and quality of life in cities where most of the world's population will reside in the future" (p. 3).
Devoting major segments of the text to each of the cities, the editors provide subsections for each city on "socioeconomic and health status of older persons" and "living arrangements and use of long-term care." One may—as I did—choose to follow the "living arrangements and use of long-term care" subsections in all four cities, and then do the same with the "socioeconomic and health" subsections. This approach to the text provided me with the basis for drawing cross-cultural generalizations from diverse living arrangements and various long-term care schemes in the four cities. For those who prefer raw data, the writers provide about 150 figures and tables comparing data from the various rings of Paris, suburbs of New York, inner and outer London, and 23 wards of Tokyo. Anticipating the distress readers face with complex acronyms, the editors provide a glossary of more than 60 items to guide one through the maze of each city's bureaucracies.
It is amazing how many ways researchers can cut and dice data to test hypotheses and answer questions about differences between and among people based on where they live. And where one lives, I believe, makes all the difference in the world, a reality that is especially true for older persons. In addition to providing massive doses of data for each city, the authors expertly synthesize the data and offer thoughtful analyses. I was particularly moved by an essay in the Tokyo section, "Growing Old with Tokyo," in which John and Ruth Campbell take the reader through a day in the life of older residents in a neighborhood that they came to know well. With nary a chart or table, the Campbells put a human face on how national policies affect older residents. From statistical data, one may, it seems to me, know everything about a group, a sample, a subpopulation, but little about what it means to be an old person in the community.
In a closing chapter of Growing Older in World Cities, the editors raise five questions (that might better have been asked in the introduction):
These are compelling questions that will require the energy, knowledge, insights and compassion of advocates and scholars in all parts of the globe. The World Cities Project at the International Longevity Center–USA should expand its agenda to include cities in developing countries and invite advocates to share in a next volume offering their perspectives on the above questions. The potential for great progress toward an elder-friendly world would be enhanced were scholars to be also advocates, and advocates to be scholarly in their search for solutions to problems associated with long life and rapidly aging populations.
Lessons on Aging from Three Nations
What do Israel, Australia, and the United States teach the world about aging? Why these countries? And to what extent do policies and practices in these countries provide lessons about aging well and caring for older people? The editors declare that these countries share "certain similarities in history and experiences that ferret out the issues of global aging" (p. viii). So? The same could be said for a nearly unlimited number of countries from among which editors could select groups of nations ostensibly to expand our understanding of the complexities of personal and societal aging, select various themes or key words like the art of aging well and caring for older adults, and produce texts that compare and contrast the experiences of elders in diverse nations. To this observer, that may be a necessary, but hardly a sufficient reason for bringing out another text that massages existing data, presents case studies and offers opening and closing chapters that draw conclusions to prove the wisdom of the chapter selections and the generalizability of the reported findings.
While thinking about the importance of these texts to the field for advancing what we know and suggesting what we need to know, I found many of the chapters both interesting and informative. Were I still teaching a graduate seminar on cross-national perspectives on long-term care, these texts could be added to the reading list, and particular chapters assigned. It may be my bias, but the value of cross-national and cross-cultural analyses is best discovered in texts that guide readers into applying selected criteria to each of the countries and drawing conclusions about what social, political and geographical factors explain and influence which outcomes.
The Art of Aging Well (Volume I) includes a number of chapters that while informative, led this reader to infer that because the dynamics of aging are highly personal, studying social and economic status statistics and demographic trends may not be particularly helpful in grasping what growing old in various countries may entail. For example, in "Developing Intergenerational Solidarity: A Global Imperative" (Chapter 9), Terence Seedsman calls for substantial reform in how elders are perceived and valued. His review of the gerontological literature is both focused and comprehensive with particular attention to such authors as Robert Theobold, Erik and Joan Erikson, Vern Bengston, Andrew Achenbaum, and numerous Australian gerontologists who have influenced both academic and public understanding of what happens to people as they age, and what impact increasing numbers of elders have on society. He weaves together the social and psychological insights of Robert Theobold on community with his own views regarding optimal conditions for intergenerational solidarity, especially an end to ageism, a persistent obstacle to progress. The global imperative is to integrate scientific findings that explain the dynamics of personal and societal aging with the humanistic values that require people to alleviate suffering through action based on both good science and strategic advocacy.
Relying primarily on his Israeli experience, Howard Litwin in "The Interpersonal Milieu of Older People" (Volume I, Chapter 12) reveals the pivotal role social networks have in the quality of life of older people. In an era of major social upheavals, Israel's experience in integrating older immigrants from primarily the former Soviet Union provides lessons for how nations facing waves of immigrants may alleviate some of the stress older people experience when they are uprooted. Dana Miller-Martinez and Steven Wallace provide an in-depth look at the United States experience with older Mexican immigrants (Volume I, Chapter 10). As public debate about U.S. immigration policy rages, such studies as those undergirding the chapter titled, "Social Networks of Older Mexican Immigrants" should be read by political leaders seeking a way out of the current policy quagmire. As is so often true in public discussions, the impacts of policy on older people are seldom considered.
Volume II: The Art of Caring for Older Adults is conveniently divided into three parts: "The Art of Caregiving," "The Art of Family Care," and "The Art of Letting Go." The chapters provide side by side descriptions of policies and services under each of these categories for Israel, the United States, and Australia. Arguably, such an arrangement facilitates the cross-national analyses serious students of gerontology will want to do to enhance their understanding of how three distant developed nations deal with the same set of challenges. In fact, the authors draw material from various additional countries to achieve a fairly high level of integration of ideas across national borders. For example, the section on letting go reviews the literature from each country regarding end-of-life care, decision-making and terminal care, citing cases and highlighting the conflicts that inevitably arise. While this is old material, the exercise of reading through how end-of-life conflicts are dealt with in the United States, Australia, and Israel provides new insights for the critical reader. Issues around family care and caring for caregivers are well-known to gerontologists, but using the particular experience of the three countries gives one a renewed sense that problems associated with long life are, indeed, rather common to all societies. For those with limited time to explore these two volumes in depth, reading the introductions and summaries by the editors will be time well spent.
Longevity and Social Change in Australia
There is little doubt that among the nations of the world, Australia has what appears to this observer to be a commendable record of caring for its older citizens. This book documents the extent to which Australia delivers on its extensive promises toward its aging population. There are, of course, considerable differences between aging policies in the United States and in Australia, but for most Australian elders, a safety net is in place, housing options are available. In the States, housing arrangements that are most appropriate seem nearly unaffordable to elders with limited income, and the cost and provision of long-term care services are, for most United States elders, problematic. What, then, can gerontologists learn from Australian research about the dynamics of social change? Certainly longevity and the promise (or is it a threat?) of ever greater numbers of very old, and increasingly dependent persons force individuals, families, governments, and non-governmental organizations (NGOs) to prepare not only for baby boomers, who seem to have captured center-stage for the present, but also for those frail persons age 80 and older who draw down their own and society's resources.
Longevity and Social Change in Australia presents a scholarly examination of Australia's highly effective social policies. Due in no small measure to scientific studies evaluating early experiments and innovative models, Australia's aging policies clearly benefit from excellent research and an informed electorate. These policies are driven by a national commitment to the well-being (dare I say, welfare?) of its vulnerable citizens, and that certainly includes elders. This Australian tome is an impressive book offering the scholarship and analyses of well-known Australian scholars. The themes and chapters are tied nicely together by the editors, whose introduction and individual contributions are especially noteworthy. I found the chapter titled "The Politics of Aging" to be reminiscent of Carroll Estes' (1979) The Aging Enterprise in the topics covered and in the similarities between Australia and the United States in policy developments and the emergence of NGOs eager to represent and advance the needs of their aging constituencies. Longevity provides a balanced view between "the sky is falling" warnings that some pundits use for questionable political reasons to describe population aging as a crisis about to destroy our civil society, and the overly optimistic futurists who announce that older people (in developed nations) are, indeed, doing well and need little, if any, governmental interventions to continue to do well. On closing the book, one cannot help but wonder about the ways in which social change impacts on the older population and how the increasing number of people living longer affects a nation's social climate.
A Personal Perspective
The evidence presented in the books reviewed in this essay is impressive. It reflects the findings of a vibrant group of scholars who discuss how policies have evolved in developed countries in the light of political and social environments that produced these results. Today, as global aging attracts at least rhetorical attention, it is clearly time for scholars to focus their attention on developing nations, apply their considerable methodological skills and strategies to produce findings that can be presented to national legislatures, donor nations, and world financial institutions. Policy wonks armed with quantifiable evidence have but a part of what is needed to develop policies that improve the quality of life for older persons. Thoughtful scholars who want to avoid the onus of producing reports that gather dust while their subjects—older people in third world nations—barely survive, need to bring both their science and their passion to the arena where policy affecting older people is being considered.
In reviewing these four fine books that add material and analyses to what is already well known about the social, economic and health status of older citizens, I have taken the opportunity to suggest that gerontologists should take seriously the possibilities of becoming scholarly advocates. We should expand our universe to include third world regions where, working with indigenous collaborators, we could undertake studies with an eye to policy implications. Gerontologists, justifiably proud of being part of a discipline that draws from various branches of the sciences, should, it seems to me, look for opportunities to collaborate with advocates and journalists to deliver actionable findings—in fact, solutions—to what appear to be intractable problems of older persons in impoverished countries. If in our lifetime, and theirs, we are to act responsibly about the plight of the world's vulnerable elders and their families, we will surely want to be part of an effort to focus the light of research on developing nations, and propose solutions based on rigorous evaluation research, that will make the difference between life and death, hope and despair.
References
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