four - Ageing, populations and health

Summary

Demography itself has become one of the key axes along which ageing has reconfigured the spatial and temporal regimes of later modernity. The uncertainty of the increases in life expectancy has become a constituent part of the ongoing problematic of reflexive modernisation and lays the foundation for understanding the extent to which population ageing is a global phenomenon. Furthermore, if as we have argued earlier, notions of time and space are intimately interconnected then, through changing our notions of time, the demographics of population ageing can impact on the reconstitution of space. This confluence between the processes of re-spatialisation, the shift away from the nation state as the key political actor, and scientific-medical developments that are reconfiguring the possibilities of health and longevity are seen to have led to a series of ‘temporal world view paradoxes’.

Nation-states’ social policy making (e.g. pensions, health) now has to grapple with the historically unprecedented socio-demographic realities of ageing populations, and with the need for long-term intergenerational planning in a context in which public policy is simultaneously required to prioritize short-term adaptability in the face of an assumptively unpredictable future. (Roche 2003: 104)

This brings into being a whole host of other contingencies that go beyond purely demographic concerns. Given that old age has been synonymous with poor health for much of history then any break in this association would be crucial for opening up spaces for the realisation of alterative images and narratives of later life. So, although Appadurai (1996) leaves the issues of health and demography out of his model, we believe that they are crucial for understanding the contemporary spatial world order. Thus, following his formulation of the other ‘scapes’ we believe it is possible to identify what could be called the ‘bioscape’. We see this as the uneven, shifting demographic landscape that encompasses not just fertility and mortality but extends to health, disease, illness and wellness, all of which have become more contingent. This concept of the bioscape forms a crucial component of our approach as it allows us to explore the global landscape of health for the ageing population and to see whether it is possible to identify areas of extreme good or poor health or whether older people around the world converging around a similar experience of health.