«Ageism – towards a global view A series of 3 seminars. Seminar 1 Age Discrimination in 5 continents: real issues, real concerns Wednesday 31st May ...»
This writer, on visiting a HelpAge “Adopt-A-Granny program in Bhopal, India was taken aback when an older woman said, “We are nothing and you have come to visit us.” Even more dramatic is a report from UN-ESCAP that in the Asian Region “One of the saddest features associated with ageing is a high suicidal rate among older people. Rates are higher than in many western countries, poignant because of the alleged high value placed on age and older people in Asia.” Y.H. Hu (“Elderly Suicide Risk in Family Contexts: A Critique of Asian Family Care Model,” Journal of Cross-Cultural Gerontology) notes that in some East Asian countries, older persons are killing themselves at rates up to five times those in their younger generations and eight times higher than in many western countries.
For economic, social and many other reasons, suicide rates in much of the Asia-Pacific Region in particular, appear often to be both high and on the increase.
A review of suicide in the UN-ESCAP Region (Ruzicka, L.T., “Suicide in Countries and Areas of the ESCAP Region,” Asia-Pacific Population Journal, 1998) identifies a steady increase in suicides with age, a contrast to some other areas in which the young are equally at risk. In Hong Kong, Singapore, the Republic of Korea and China, suicide rates among the oldest males and females aged 75+ are between two and three times those of middle aged groups and between four and eight times higher than those in the 15 – 24 age group. Suicide rates among the younger elderly age group (65 – 74) while slightly lower than those of the 75 + group, are still two to three times higher than those of the young adults. Increasing rates of suicide with age may not be universal in the ESCAP Region but clearly represents a serious social and public health problem in several member countries of the Asia-Pacific.
In January of 2005, Global action on ageing reported on elderly abuse in Japan citing statistics that over 50% occurred from family members and 11% experienced life threatening situations. Authorities in Japan like all of Asia consider it a “domestic problem” and are reluctant to interfere.
Abuse of older persons most prevalent in the family and in institutions is another problem, potentially related to suicide. Both elderly suicide and abuse clearly require a broad-based response to bolster the self-esteem, feeling of value and place in society of older people.
The International Network for the Prevention of Elder Abuse (INPEA) has recently announced the “First Annual World Elder Abuse Awareness Day (WEAAD) to be held on June 15, 2006, stating “Throughout the world, abuse and neglect of older persons is largely under-recognized or treated as an unspoken problem.” Unfortunately, no country or community in the world is immune from this costly, public health and human rights crisis.
In a study conducted for the Coalition of Services of the elderly (COSE) by Edna Co, et al,
professors of the University of the Philippines, (From the Margins to the Center – Ageing:
Situation, Services, Sustainability, and Some Policy Implications, 2005) among urban poor communities, a surprising 26.7% in the 56-60 age bracket and a further 26.7% in the 61-65 age bracket knew personally of abuse committed against older people. A further 40.6% had personally experienced abuse and listed their own children and family as the perpetrators of the abuse. The types of abuse known personally to the respondents were “verbal abuse,” “negligence,” “physical and sexual” (in descending order). Asked what their response was to the abuse, the predominant response was “to leave everything to God” and “not do anything.” What do the respondents feel when they are abused? Self-pity, anger and hurt.
Lastly, the women’s movement has taught us the importance of language and how sexism is incorporated into language. The same might be said of ageism. How do older people describe themselves?
In short, poor older people see their value in being able to contribute to family or community.
Age as status has little value but assumes a value in terms of role – of performing a valuable function. While age as status still retains some value in the Asia-Pacific Region, older people themselves see the value more in terms of the role they play in the family and community.
How Does Society Portray Ageing and Older People?
The attitude of society towards ageing can be compared to the often quoted quip, “Everybody wants to go to heaven but nobody wants to die to get there....” Think of the billions spent annually to create the illusion of youth. To say “she is not as old as she looks” is frankly insulting and in very bad taste to say someone looks old – unlike the supreme compliment “she is a lot older than she looks.” The media and advertising propagate the value of “eternal youth” and the followers of Ponce de Leon continue the search for the “fountain of youth.” Currently the media and television especially, have no coherent policy on ageing issues and no strategy to cover them. A survey conducted by Susan Mende of the Tsao Foundation (patterned after the UK-BBC and Age Concern Study) came up with virtually the same results: that older people are under-represented on prime time television; that when they are represented it is often in a negative stereotypical manner; that older men are presented more often than women and that the age groups 25-29 is over-represented.
There are some indications that change for the better may be in the offing. Given the growing population of older people, ads often feature multi-generational themes (grandparents bring their children for a treat to McDonalds). A television and movie actress is planning a prime time television series featuring outstanding older people (Philippines).
Thailand has a program especially targeting older people as do India and Malaysia.
During a HelpAge-sponsored workshop in New Delhi, participants from 17 Asian countries were asked to role play the situation of poor older people in their respective countries and the barriers to empowerment. In the reflection following the role play, participants divided their comments into: internal constraints (dependency, isolation, lack of opportunity, low selfesteem, marginalization, social irrelevance, worthlessness, lack of recognition) and external constraints (families treating older people as useless, NGO’s unwilling to help older people, negative attitudes about older people, isolation, not enough trust, lack of access to and interest in older people’s skills, lack of resources, lack of information, older people’s needs not thought about, inappropriate projects, lack of interest in older people even from other older people).
Soon after the devastating tsunami on 26 December 2004, when Banda Aceh became accessible to outsiders, a team from HelpAge International investigated the quality of care for older people in a disaster situation. While relief agencies did not specifically discriminate against older people, because there was no special provision for older people – in fact, they did discriminate. Older people complained about waiting in long queues for food and medical treatment, about difficulties in travelling, in accessing toilet facilities, water and especially relief from the trauma of having lost multiple family members. HelpAge concludes noting that in other disasters around the world, older people have often played leadership roles in uniting the community and evoking cooperation among the victims. Indeed, an ESCAP report notes, “The conventional perception of older people tends to be negative.
Older persons are often depicted as frail, disabled and dependent. Economically and socially, they are perceived to be at risk of being marginalized, as countries go through rapid economic and technological development.” ((ESCAP, 1999) HelpAge adds, Negative images of ageing are compounded by the fact that there is little public awareness or information about older people’s contributions, situations, issues or needs. These images and assumptions tend to increase the “invisibility” and marginal position of older people. In an emergency where service provision and the allocation of resources maybe less than systematic this invisibility often results in older people failing to gain access to the life-saving resources they need. (Older People – A Burden or a Resource, Helsinki, 16 September 1999)
E. FORMS OF DISCRIMINATION
Accessibility is broadly defined as the degree to which a service, facility or requirement is available. It is usually rather simply measured in terms of physical distance and sometimes in barrier-free access to buildings or facilities. There are several other key aspects of accessibility, however, that are very important especially with regard to older populations.
These include economic accessibility (how affordable are the services or facilities?), social accessibility (do the potential users feel comfortable attending the service or facility in question?), temporal accessibility (is the service or facility available at a suitable time of day?) and administrative accessibility (do users need to be registered, members, pre-paid members of a certain organization?). For older persons, for example, the fact that a neighbourhood is well-served with private clubs and hospitals might be irrelevant.
Effectively, they have no accessibility to these and they are therefore under-served by the
facility in question. (Joseph, A. E. and Phillips, D. R., Accessibility and Utilization:
Geographical Perspectives on Health Care Delivery, London: Harper and Rowe.) This writer (now well past 65) and his wife (nearing 65) are both excluded from participating in a group health insurance plan of their organization. The Philippine Social Security System will not grant small loans to members above 60 years of age. Government as well as private agencies are not willing to risk profits at a time when people potentially most need health insurance – seemingly a question of profit versus service.
Absolute poverty is one of the most serious challenges facing many developing countries in the Asia-Pacific. Based on an international poverty line of US $1 per capita per day at 1993 prices, around 800 million poor, or approximately two-thirds of the world’s poor live in the Asia Region. Poverty implies an inability to meet the basics in life and is often more serious for older persons and children as they may have needs for medicines and health care, as well as suitable diets and accommodation than for working age adults. Older persons are often afflicted by poverty in greater numbers than younger age groups because of lower skills, lack of savings, ill-health or social prejudices. Respondents in the Participatory Rapid Assessment (PRA) in Laos tell the researcher, “It is hard for me to come and meet with you for three days because I have to go to the forest to find food to eat. If I don’t go, I won’t have any food to eat.” Another remarks, “Look at my wrist. I fell planting rice last year and broke it. My family didn’t have time or money to take me to the hospital so now I can’t use that arm and my fingers are stiff..” One is reminded of Gandhi’s remark that “for the hungry, God can only come in the form of food” – echoed in the dumpsite survey in the Philippines when an older woman remarks that “heaven” would be in eating three times a day....
Older women are likely, on average, to outlive their partners and thus poverty among older women, especially those who never married (in some cases, because they took care of their own parents in their old age) is potentially a major problem. It is also likely to increase unless more extensive social safety nets are put in place and is linked with the high incidence of suicide among elderly persons in many countries.
These factors imply that many older persons, especially women, will have to live alone and in poverty in the later years of their lives. As many as two-thirds of Asian women are widows.
Pensions, if any, may be reduced and the loss of a spouse can weaken the support network in times of need. Divorce can have a similar impact. These factors can all add to the worldwide recognized feminization of poverty in old age. (Hosyman, N. and Kiyak, H.A.
Social Gerontology: A Multidisciplinary Perspective, 5th ed. Boston: Allyn and Brown) In Southeast Asia, some 3 to 6 per cent of the older population have no living children, which means they do not have this source of support, and evidence is growing that many children do not or cannot support their parents. (The Ageing Development Report: Poverty, Independence and the World’s Older People. London: HelpAge) Several aspects of poverty are of relevance to older people in the region. These include declining work opportunities, the rising costs of services especially health care in many countries of the region. There are often very great income disparities in the poorer countries of the region especially between rural and urban areas. Most data are “guesstimates,” but stark: for example data suggests that two-thirds of Indonesians would be below the poverty line with perhaps 70 million extra people living in poverty. A head line in Manila’s leading newspaper proclaims, “Number of hungry Pinoys (Filipinos) hits new high, says survey.” Based on 1,200 household heads nationwide, the data indicated that 57 per cent described themselves as living in poverty and 16.7 per cent as having experienced hunger during the last quarter of 2005. One can safely assume that poverty and especially hunger victimizes the most vulnerable members of Philippine society which includes older people, especially women.