They say you should not ‘live to work, but work to live’. But what if work actually reduced your chances of having a good life when you are older. To investigate this issue we looked at whether the type of work people in Sweden had done over their working lives impacted on whether they were healthy and active in later life.

What is successful ageing?

Most research on ageing focuses on negative outcomes in older age, such as ill health or poor function. Whilst this is important it does tend to portray later life as one dominated by illness and disability. We wanted to take a different approach and look at what contributes to positive outcomes. Another issue with existing research is that it generally focuses on one outcome, such as poor self-rated health or chronic illness. But in reality, health and well-being are more complex than that and conditions rarely appear in isolation. Hence, we used a multidimensional model of ‘successful aging’, as proposed by Rowe and Kahn, as the focus of our study. The idea behind this model is that ‘successful ageing’ is what may be possible if people are able to reserve capacities and maintain healthy lifestyles throughout the life course. To age successfully, according to Rowe and Kahn, is to have 1) high cognitive and physical function, 2) avoid disease and disability, and to have 3) a high engagement with life, via leisure and social activities.

We looked at people’s working conditions throughout their life, from the age of 18 onwards. Where previous studies have looked at the impact of work on health in later life they have tended to focus on occupational social class, rather than working conditions, and have generally taken a rather static view of occupation by relying on a single measure, e.g. ’lifetime occupation’ or ’most recent occupation’. A unique aspect of our study is that we were able to map each respondent’s entire occupational history. This provides a much more fine-grained understanding of how lifetime working conditions might affect health in late-late life. By using a job exposure matrix, which is a description of the working condition of each type of occupation, we were able to see whether people’s jobs were intellectually stimulating, hazardous, physically demanding, and/or stressful. From this we created trajectories of working conditions across the life course, for example, someone’s first few jobs might have been physically demanding but as they aged they had less physically demanding jobs.

What did we find?

We found that high levels of intellectually stimulating work in the beginning of one’s career followed by increasingly intellectually stimulating work throughout working life were associated with higher levels of successful ageing. In contrast, people began their working lives in stressful jobs, or doing hazardous work, or with a very physically demanding workload, such as unsuitable working postures and heavy lifting, and who experienced an increase in those conditions were least likely to age successfully.

A double-win for society

Many governments are raising retirement ages to reduce economic pressures associated with population ageing. However, there are concerns that working to older ages may come at the cost of ill-health in later life, especially for workers who are exposed to poor working conditions. As retirement ages increase, the influence of work on future health could become even more important. Understanding which working conditions contribute to successful ageing is central to the design of public health policies that aim to reduce health risks over the life course. Promoting a healthy workplace, by supporting intellectually stimulating work and reducing physically demanding and hazardous work and stressful jobs, may contribute to successful ageing after retirement. Interventions early in one’s employment career could have positive, long-term effects. Taken together with existing evidence, our findings underscore the need to promote a healthy workplace to age well. This requires policy makers, employers and practitioners to not only target isolated working conditions, or isolated health outcomes in later life, but rather to take a holistic approach. Investing in healthy workplaces by implementing interventions to improve the health of workers would not only reduce societal costs during working age and promote a sustainable working life, it may also lower the cost of health and social care by improving the health of future generations of older people. Investment in healthy workplaces is a double-win for society.

Guest blog by Dr Charlotta Nilsen, Aging Research Center (ARC), Karolinska Institutet/Stockholm University, Stockholm, Sweden

Nilsen C, Darin-Mattsson A, Hyde M, Wastesson JW. Life-course trajectories of working conditions and successful ageing. Scandinavian Journal of Public Health. May 2021. https://journals.sagepub.com/doi/full/10.1177/14034948211013279

I’m not sure this qualifies as a blog perhaps more of a structured rant. But I’m getting increasingly infuriated at the prevalence and justification of ageist attitudes and language around older adults as a consequence of the current coronavirus crisis. This is something that I expected from certain tabloid newspapers or the army of Twitter trolls that are out there. However, when apparently well-educated academics join the fray, I really do despair. The latest example of this, and the straw broke the camel’s back for me, was this blog by two bio/medical ethicists in which they argue that imposing or extending the lockdown policies for those aged 70 and over is not age discrimination.

I want to take issue with a number of their arguments and work through these one by one. Firstly they argue that any age cut off has to be arbitrary:

Now we cannot settle here where exactly the cut-off for “elderly” is. It will have to correlate with the elbow of an exponential curve and be easily enforceable. And any cut-off will have an element of arbitrariness. For the sake of argument, here we will pick 70. The average age of death in Italy from COVID-19 is 78. Those over the age of 70 are much more likely to die and more likely to need hospitalisation (and also much less likely to be employed).

Immediately this exposes a fundamental flaw of their argument that an age cut off point would not be discriminatory. Not all those above the age of 70 contract or die from coronavirus and not all those who contract or die from coronavirus are aged over 70. It is indeed far from clear at present how the association between older age, symptom severity and mortality from coronavirus can be explained. As the UK’s chief medical officer, Professor Chris Whitty, has said the over-60s have a good chance of surviving if infected and the “great majority” of patients as old as 80 will recover. Indeed there is evidence that those in very late life, e.g. centenarians, have a better chance of recovery than younger adults. Conversely there are children as young as 5 years old who have died from this virus. Hence, underlying health conditions also play a role, regardless of age. For example, there are about five-and-a-half million people in the UK of all ages who have asthma and this increases the risk of severe illness for those who contract coronavirus. So by imposing an arbitrary age cut off at 70 you are not only discriminating against those who are fit and healthy who are over 70, but also those under 70 who are at risk of coronavirus.

Secondly, their argument seems to treat older adults as if they are a separate group divorced from any social or familial ties. The idea that allowing people to go back to work but keeping the over 70s in a state of lockdown will help the economy get back on its feet seriously ignores the fact that a significant proportion of the population rely on the unpaid care provided by grandparents for grandchildren to allow those of working age to return to work. Older adults play a vital part in the life of UK society. As the British Society of Gerontology notes in its statement on the UK plans to isolate those aged 70 and over:

There are currently more than 360,000 people over 70 in paid work, including one in seven men between 70 and 75 and one in sixteen women (see Table 1). Almost one million people over the age of 70 provide unpaid care, including one in seven women in their 70s. One in five people aged between 70 and 85, over 1.5 million people, volunteer in their communities. People in good health are especially likely to volunteer at older ages with almost a third of those in their early 70s doing so. Older adults should not be excluded but should be seen as a vital and necessary part of economic and community life.

Thirdly, the authors argue that because those who are aged 70 or over are statistically at a higher risk of dying that this justifies the policy to keep them in lockdown for an extended period of time:

It is using age like sex [for breast cancer screening] as a basis for a medical decision only because that feature correlates with a robust statistically higher likelihood of getting ill. 

The argument is that this is not discriminatory because it is statistically proven that there is an increased risk. Putting to one side for the moment the point I made earlier that this is not universal but a statistical average relative to other arbitrary age groups I’m surprised that the authors don’t carry the same argument forward for other groups that have an increased risk. For example, the authors argue that increased breast screening for women relative to men is not discriminatory against men because women have a higher chance of getting breast cancer than men. Statistics show that men are much more likely to die from coronavirus than women. By the same logic why aren’t the authors extending their argument that men should remain in extended lockdown because they have an increased risk of mortality from coronavirus? The same applies to people from BAME backgrounds. Statistics from the UK and the US suggest that they are at an increased risk of mortality from coronavirus. Yet the authors do not argue that we should extend the lockdown for members of these communities. So why do they think that it is okay for people to be locked down on the basis of age but not sex or ethnicity?

Moreover, even though this does not form part of their argument, I’m surprised that the writers do not see the connection between a policy of selective lockdown based on age and the perpetuation of wider negative age stereotypes against older adults. Singling out older adults as a group who are frail, at risk of poor health and economically less productive sends broader signals about the value that we place on people in this age group. Whilst I’m generally reluctant to agree with David Blunkett he is right when he says that by introducing this policy based on an age cut off point you are stigmatising older adults purely on the basis of their chronological age. That this conflation between older age and vulnerability is becoming more prevalent is evidenced by the fact that every time I go into my local supermarkets I am told that they are putting on special opening hours for those who are at risk such as the ‘elderly and the vulnerable’. Whilst I do not think that supermarket managers are part of a global ageist conspiracy this sort of ‘common sense’ approach represents the kind of compassionate ageism about which Mervyn Eastman has so eloquently ranted and with which I fully agree (to the point where I feel that members of the wider gerontological community sometimes stray into this dangerous area). At the other end of this spectrum is the much more virulent gerontocidal language being perpetrated on social media through hashtags such as #boomerremover. Not only is this sort discourse eroding the possibility of intergenerational social solidarity when it is needed most, there is now a vast literature that shows that ageism has negative consequences for the health of older adults, healthy life expectancy and health expenditure . So – to quote Donald Trump – the cure should not be worse than the disease. Hence, if selective lockdowns of people based purely on age lead to increased ageism and intergenerational strife, which seems to be the case, then in the long run this will only store up greater and more wide ranging health problems for society which would ultimately undermine any shorter term benefits of the lockdown.

Rant over (for now)…

On the 5^th November the International Consortium of Investigative Journalists (ICIJ) released a trove of over 13.4 million leaked documents mostly from the offshore law firm Appleby and the Singapore-based international trust and corporate services provider, Asiaciti Trust, along with corporate registries in 19 tax jurisdictions, which reveal the financial dealings and tax avoidance of politicians, celebrities, corporate giants and business leaders. These have been dubbed the Paradise Papers as many, although certainly not all, of the offshore financial companies identified in the documents operate in tropical islands such as the Cook Islands, Cayman Islands and Bermuda. The leaked data covers seven decades, from 1950 to 2016. Although the investigation in the extent of any financial irregularities and tax avoidance is ongoing early revelations show that there is a vast network of such companies and agreements that are used by the global rich to move money around the world.

Alongside any personal or political interest that we might have in this story I would argue that, as gerontologists, each of us should have a professional interest in this issue and what any investigation will eventually show for 2 reasons:

1. Because they highlight the often-neglected role of capital in the debates on population ageing
2. Because they expose the fallacy that national governments are helpless in the face of global corporate power

We are continuously being told that, on both an individual and societal level, we cannot afford to grow old in the way that we have done in the past. The argument, crudely put, is that as more and more of us live for longer we draw down on a finite and shrinking pot of public funds. So, on the one hand, we are told that we must reduce public spending on things that matter to many older people like pensions, healthcare and social care, under the guise of austerity politics. Yet on the other hand the Paradise Paper reveal that global corporations and the super-rich are allowed to avoid paying huge sums of money in taxes. As Murray Worthy, Global Witness corruption campaigner, states;

“The Paradise Papers have exposed how some of the world’s most prominent public figures, including The Queen and a key Trump associate, are involved in a global secrecy scandal of offshore accounts and hidden financial dealings. They have laid bare the social damage, undue influence and corruption hard-wired into our financial system, and the failure of governments around the world to tackle the role of tax havens and the white-collar professionals who facilitate such deals.”

These are not insubstantial amounts. It is estimated that between $7.8-$10tn of global GDP is held offshore beyond the reach of tax authorities. This is money that is being taken out of various countries that could be going to pay for essential public services. Moreover, the evidence shows that it is the super-rich who are benefitting from these offshore financial institutions. A report this September, co-authored by the economist Gabriel Zucman, says 80% of all offshore cash is owned by 0.1% of the richest households, with 50% held by the top 0.01%.

These figures show how these offshore financial companies allow global corporations and the super-rich to take huge sums of taxable income out of the country. This has particular salience to the debates and research on extending working lives. Here we have seen some of the most radical shifts in policy to both cut back on state and occupational pensions pay-outs and get people to remain in work until later in life. We have seen the state pension age rise from 60 to 65 for women which has had a huge impact on many women. From 2019, it will increase for both men and women to 66, then to 66 to 67 between 2026 and 2028 and it is planned to rise to 68 by 2037-2039. At the same time, we have seen a huge shift away from more generous defined benefit (DB) to defined contribution (DC) occupations pensions. Yet in the debates on extending working lives we very rarely, if at all, talk about productivity or, more importantly, profits. For example, if we take the ‘old age dependency ratio’, which is often used to justify the argument that we need to reduce pension spending and work for longer, is based on the simple relation between the number of people in ‘working age’ versus the number of people in ‘pensionable age’. This reduces the old age dependency to one between different classes of workers – capital is conspicuously absent from this equation. Yet, as both Robin Blackburn and Chris Phillipson have shown, capital is heavily engaged in the construction of (the conditions of) work and retirement. On the 100^th year anniversary of the Russian Revolution it seem appropriate that we need to bring capital (back) into the debates on ageing and later life.

However, in bringing capital back in to our discussions and analyses we must not make the mistake of assuming that national governments are impotent in the face of these global economic giants. National governments often paint themselves as hapless victims in these new global realities. However, as a number of writers have pointed out, the nation-state is a complicit actor in these developments. As Paul Higgs and I showed in our book on Ageing and Globalization, state agencies, alongside global organisations such as the World Bank, play a key role in shaping these ‘global’ economic landscapes. In fact, when we look at these so-called ‘off-shore’ companies we see that many of them are very much ‘onshore’. Many of the tax havens identified in the Paradise Papers, such as Bermuda and the Isle of Mann, are British Crown Dependencies. The BBC’s Panorama investigation suggests that these changes to the tax laws in the Isle of Mann were approved by politicians and the HMRC. Moreover the City of London acts as the facilitating hub for Crown dependencies and overseas territories that channel trillions of offshore dollars. On the other hand, the EU and UN are pushing for policies to prevent tax avoidance. Ministers at the EU have called for a blacklist of global tax havens backed by sanctions; new transparency rules for tax intermediaries, bankers, and lawyers; and mandatory country-by-country reporting for profits. Indeed, what the Paradise Papers show, and what Paul and I argued, is that rather than being truly global the current world order is made up of a myriad of overlapping geo-political and jurisdictional spaces. The challenge for gerontology is to develop models to examine how the relations between these spaces, ranging from the global to the local, affect and are in turn affected by population ageing.