Theory and applications of the capabilities approach to individual and global ageing
Venkatapuram, Sridhar (2018). 'Theory and Applications of the Capabilities Approach to Individual and Global Ageing' Paper presented at the annual conference of the HDCA, Buenos Aires, Argentina 2018.
Rising life expectancies is one of the greatest human achievements of the 20th century. The United Nations (DESA) recently confirmed that significant gains in life expectancy have been achieved throughout all the regions of world. (1) At a global level, a human being born today can expect to live 70.8 years which is an increase of about 3.6 years from a little over a decade ago. Alongside increasing life expectancies worldwide, the percentages of populations of older persons—defined as 60 years or older--are also increasing in all regions. This phenomenon is called ‘population ageing’. Projections are that by 2050 populations of all regions of the world, except Africa, will be made up of 25% or more of older persons. Stated in another way, the percentages and absolute numbers of older persons are rapidly going to increase; the estimated 962 million older people are projected to more than double to 2.1 billion by 2050. Of those, 80% will be living in developing countries.
While increased longevity is much celebrated, throughout many parts of the world, old age is perceived as an end of life stage of declining physical and mental faculties, increased risk of morbidity, and withdrawal from productive social activities. Interestingly, at what chronological age a person begins to be perceived as old varies across societies. (2,3) Who is considered to be old seems to be linked to the expected life expectancy in a particular society or world region. As longevity increases, the chronological age when old age begins also rises. Dramatically different life expectancies across the world mean that different societies have different starting points for old age. (4) Alongside research on the great global diversity in who is considered old and what is expected during old age, an important body of scientific research has been examining whether chronological age is, in fact, linked to physical and mental decline as generally assumed. (5)
The findings suggest that chronological age is only loosely correlated to declining functioning. Other factors such as genetic inheritance, individual behaviours and, most substantially, social factors throughout the life course, are more strongly correlated with physical functioning and quality of life in old age. (6) Closer examination shows that some individuals who are 60 years or older have similar abilities to be and do things as 20 and 30 year olds, until quite near their deaths. In contrast, other older people are severely impaired and die sooner. The implications of these findings are profound and impact a whole range of disciplines and professional practices. For example, in healthcare and gerontology the existing models of what is good, healthy or successful ageing are being scrutinized and alternatives being sought. In 2015 the World Health Organization presented a new model of healthy ageing as ‘functional abilities to be and do what an older person has reason to value’. This definition was based on the social disability model as well as the capabilities approach, and specifically the health capability model of Sridhar Venkatapuram. (6) By drawing on the capabilities approach, the WHO is availing itself of the large breadth of related empirical and normative resources and discussions on human wellbeing.
This proposed panel brings together some of the recent ageing work done by three leading capability scholars and their colleagues to present their latest work pushing forward both theoretical and empirical applications. Sophie Mitra’s paper discusses the prominent ‘successful ageing’ model how its metrics exclude older people who have impairments or health conditions. Mitra and colleagues use an alternative human developing definition of healthy ageing that is more inclusive, and then apply that to US panel data to identify some predictors of healthy ageing. Meerman’s paper presents results from one part of the OPTIMISTIC study that measured the impact of a novel intervention on capabilities of older people. Myotonic dystrophy type 1 (MD1) is a progressive neuromuscular disorder that accelerates ageing among older people, and has no curative treatment at present. The OPTIMISTIC trial compared a multifaceted intervention with standard biomedical treatment to see if there are any improvements in patient’s activities and participation. Venkatapuram’s paper discusses the equity and justice aspects of global ageing, and the state of art research on ageing and social determinant of health inequalities among older people. This analysis is related to the WHO’s conception of healthy ageing and initial attempts to develop an ethical framework for healthy ageing policies.
1. United Nations Department of Economic and Social Affairs (Population Division). World Population Prospects. The 2017 Revision. Key Findings and Advance Tables. United Nations, 2017.
2. World Health Organization, HelpAge International. Information Needs for Research, Policy and Action on Ageing and Older Adults. Geneva: WHO, 2000.
3. Taylor P, Morin R, Pew Research Centre. Growing old in America : expectations vs. reality2009.
4. Sanderson W, Scherbov S. Rethinking Age and Aging. Popul Bull. 2008;63(4):3-16.
5. Burkle A, Moreno-Villanueva M, Bernhard J, Blasco M, Zondag G, Hoeijmakers JHJ, et al. MARK-AGE biomarkers of ageing. Mech Ageing Dev. 2015;151:2-12.
6. World Health Organization. World report on ageing and health. Geneva: World Health Organization, 2015.