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)…