Islamset - Further questions of equity

place during this century in both industrialized and developing countries. He is right to stress that, in the former, the demographic transition took place over many years and owed more to steady improvements in nutrition, public hygiene and rising standards of living than to medical measures. By contrast, in the latter, where the transition has only recently begun, it will have taken only a few decades and will have owed much more to public health measures which prevent the ravages of infectious diseases and to effective pharmaceutical and clinical methods of curing and caring.

As a social scientist interested in the health and welfare of older people and in intergenerational relationships, however, what I particularly appreciated was the emphasis Dr Darnton-Hill gave to the social of the transition and to the cultural factors which, along with economic resources and political power structures, influence the capacity and willingness of societies to provide adequately for the increasing number of older people in their midst. In a short paper, of course, he could not mention everything which should be borne in mind by those concerned with the health and welfare of older people. In the spirit of collaboration rather than criticism, there are three important related points which I would like to add.

The notion of a burden

The first concerns the so-called "burden " which the survival of an increasing number of older people is often assumed to represent for declining proportions of younger people.

This view of aging is often expressed by economists and is essentially a gloomy one. Older people, it is alleged, make no contribution to the productive economy and consume more of its health and social support resources than other age groups.

Although there is some truth in this, it is a one-sided picture. It reflects not the inevitable and unbearable cost of an aging population but our present social arrangements, which are not immutable. The undue emphasis given to the" dependency ratio" concept ignores the fact that in industrial societies older people are often excluded from the labour force not by choice but to benefit younger individuals looking for work, or because their health is poor. Many could stay in the labour force and would like to do so. Their exclusion is not their own choice. Moreover, the argument assumes that present levels of ill-health among older people are changeless. It assumes, furthermore, that human productivity is static while demand for resources grows. Both propositions need to be challenged.

Dependency-ratio arguments assume that all goods and services are produced and consumed in the formal economy. They ignore the fact that most caring takes place in the non-monetary domestic economy. In it, older people, mostly women, who are excluded involuntarily or by choice from paid work, are significant producers as well as consumers. They provide a substantial part of the tending services for their peers, as well as those required by their younger kin in child-minding and caring for the sick and disabled. They may also be net contributors to, rather than recipients of, those "affective" services which cement families and provide them with psychic and emotional support in good and bad times. This is true of older women everywhere, but it is seldom acknowledged, because it is not easily costed.

Daughters and daughters-in-law

The second point concerns men's and women's roles in informal social support systems. In societies where traditionally long-lasting mother-daughter ties of affection are strong, frail old women survivors are likely to receive informal care from their own daughters, whether or not they live in the same household. In societies where the cultural imperative has been for sons to take charge of their widowed parents, care is likely to fall to daughters-in-law. Although generalizations can be misleading, there is increasing evidence to suggest that family tensions (possibly leading to abuse of elders) are more likely to occur in households where older women depend on their daughters-in-law rather than their daughters for support. This is especially likely to occur in societies which have more recently increased their average expectation of life spectacularly (like China and Japan) or are about to (like India).

The value of women

Most societies have hitherto valued males more than females. Veneration of the elderly has usually been reserved for male heads of household and, by extension, their spouses. The more successful and powerful they are (i.e. in the command of resources) the more veneration they enjoy. Given current differential mortality trends, however, it is increasingly women, including those with little wealth or privilege, who survive into extreme old age and dependency. A change in cultural assumptions about the value of women, in their own right and not merely as bearers and rearers of future generations of males and as their servants, is necessary if future generations of older people are to achieve the healthy old age to which they are entitled.