The fullness of life
by Jeremy Seabrook
International Red Cross and Red Crescent Movement has always
acknowledged the elderly among vulnerable populations in its
policies and programmes. But the unprecedented growth in numbers
of elderly people on earth creates a different order of vulnerable
people. Demographic changes over the next generation may be
profoundly disruptive, but imaginatively managed, they can enhance
and enrich societies. Influencing perceptions of the elderly
and their contribution to the world offers the Movement new
An old man lived with his son, daughter-in-law and grandson.
The son and his wife considered him a burden, and didn't want
an old, physically incapable person in their home.
They decided to get rid of the problem. The son took his
handicapped father in a basket and set out for the jungle,
planning to leave the old man there. The grandson, observing
this, said: "Father, be sure to bring back the basket." "Why?"
asked the father. The grandson replied: "Because I will need
it when you grow old." (Bengali folk story).
In an industrial town in northern England, an old man became
a burden to his family. Unable to support him, his son decided
to take him to the workhouse. The father was unable to walk,
so the son carried him on his back. As they climbed the hill
to the workhouse, the son paused on a wall to take a breath.
The father said "Why, this is the very spot where I rested
when I took my own father to the workhouse 40 years ago."
The son turned back and went home. (Industrial folklore, Britain,
The pain and problems of ageing show a surprising congruence
through time and across cultures. While the changing demographic
balance in the contemporary world is unparalleled, the dilemmas
this poses are familiar.
Every month 1 million people in the world turn 60. By 2010
one in ten of the population of the globe will be over 60;
by 2025 this will be one in five. By 2050 the proportion of
over-60s will be higher than that of under-15s. Almost 60
per cent of the elderly live in the developing world; by 2020,
this will rise to 70 per cent. Fifty-five per cent of older
persons are women; among the over-80s, it is 65 per cent.
Of course, projected figures may be contested, but the trend
is clear. In the second half of the 20th century, 20 years
were added to the average lifespan, raising global life expectancy
to 66 years.
Meanwhile, birth rates are falling in many countries, the
result of earlier efforts to slow population growth. In other
cases, people are delaying the age at which they are willing
to start a family, partly because in the rich world, "children
are expensive", but also because young people want to pursue
their careers and have a good time before assuming responsibility.
Consumerism and individualism also contribute to elective
childlessness, a factor in Western societies' failure to replenish
The implications of the statistics are just beginning to sink
in and the issue has fuelled debate within governments, international
agencies and non-governmental organizations (NGOs) as to how
to deal with the potentially explosive problem. Alvaro Bermejo,
head of the health department of the Federation, says the
Red Cross Red Crescent, and more generally the humanitarian
world, are on the whole "not good at long-term planning".
He adds, "We respond to immediate crisis, conflict and disaster.
To anticipate disasters and opportunities that haven't yet
happened is more difficult for us." The ageing population
is not only a disaster that need not happen, but with proper
care, it can be turned to an advantage.
The bonds of family, so
precious in old age, are gradually being eroded by economic
development, globalization and, in some cases, conflict.
Until recently, the preoccupation of international agencies
has been with children - children in poverty, traumatized
by conflict and war, trafficked, enslaved or set to work.
Now the focus is changing, from "too many" children to "an
excess" of old people. The only constant is that people are
seen as the problem. This is unhelpful. People, young and
old, are always a potential resource.
Older people who maintain their health and vigour constitute
a reservoir of skill and energy which can be deployed for
the benefit of society. This is a truth which the developed
world is rediscovering. The time of the passage of the over-60s
into unproductivepassivity has gone. To some extent, the Red
Cross and Red Crescent Movement has already tapped into this,
relying on the good services of large numbers of retired volunteers.
In the same vein, the French government has mobilized pensioners
in an initiative to revive the pleasure of reading among schoolchildren.
However, as more women pursue a career, the energies of young
grand-parents are devoted to caring for their grandchildren:
this may mean the future flow of volunteers is at risk. Alvaro
Bermejo believes that blood donors, who at 65 receive a letter
saying their blood is no longer required, could be offered
another health role, perhaps in caring for the vulnerable
elderly, since blood donors have a strong sense of solidarity
and concern for others.
The other side of the coin
To take a positive view of the capacities of the elderly
is not to deny the problems that arise when the very old and
dependent make up a rising proportion of the people in any
society. Supports of kinship and family in South Asia, for
instance, are seen by governments as relieving them of the
necessity of providing welfare systems. These traditional
security systems are under severe strain imposed by the development
process itself. While international agencies constantly stress
the need to strengthen and maintain such supports, economic
imperatives are tending to undermine them.
The migrations and uprooting of people all over the world
upset the demographic balance in local communities: there
are villages in many parts of the world where the able-bodied
have gone, leaving only the old and the very young, dependent
on remittances. A majority of the world's elderly live in
the countryside, but in Latin America, many have grown old
in the barrios and favelas of the cities.
Development itself wages a war of attrition against older
collectivities of family, kin, clan and neighbourhood. Indeed,
the developing countries are the site of an untried experiment,
the consequences of which are yet to be seen. Globalization
imposes great stress on the fabric of human belonging. If
governments are unable to provide social security, while kinship
networks are extended to breaking point, how is the gap to
NGOs intervene in one form or another; the contribution of
religious charities is not negligible. There is great potential
for the Red Cross Red Crescent to address the results of these
developments. In the slums of Khartoum, the Sudanese Red Crescent,
with HelpAge International, is not only offering care to the
elderly, many of them displaced by war, hunger and poverty,
but also has a programme of loans and microcredit for older
people to set up small businesses, earning an income and renewing
their self-confidence and status in the community.
Many National Societies in the developed world have identified
the elderly as a matter of concern: Spain pioneered the use
of alarm systems to help the elderly remain in their homes,
while the American Red Cross, with its Caregiving Nurse Assistant
Training Program, trains 10,000 people annually, with special
regard for the critical needs of the elderly population. The
American Red Cross is currently contemplating extending this
programme to include family carers of vulnerable and dependent
Alvaro Bermejo is critical, however, of the "service provision"
to which many National Societies have limited themselves:
"The target populations must themselves become more involved,
and we should be supporting a rights-based demand. Are we
going that way? Or are we just competing with other service
providers - NGOs, governments, the private sector? Elderly
people should not just be the target, the object, of our interventions;
they should be at the centre of what we do and how we do it."
Percentage of world population over 60
and under 15.
Numbers of over-60s.
A women's issue
Common to both rich and poor countries is the greater longevity
of women. In the US, one in three households consists of a
single person, many of them older women.
More and more people of retirement age in the developed world
are taking care of a spouse or their own very elderly parents.
A woman in her 70s in an English town says, "I looked after
my mother till she died at 93. I was then 70. She had a heart
condition, she became incontinent. She often cried out in
her sleep. For the last ten years of her life, I never had
a night's rest. I was always half-listening, alert to her
needs. Even now, I sometimes wake up, trembling, thinking
I heard her call, although she died six years ago."
It is impossible to exaggerate the value of lone individuals
taking care of the very old. Yet they often remain invisible,
as do many struggling with dementia, Alzheimer's, incontinence
and the need for constant nursing. It is easy for the unpaid
contribution of elders, especially women, to be overlooked
or taken for granted as an extension of women's "normal" responsibilities.
To some degree the problem of isolation of the elderly is
compensated, as the Red Cross in many European countries has
demonstrated, with home visiting programmes which understand
psychological and emotional needs as well as the mechanics
of physical caring. This is even more urgent in places where
conflict and catastrophe, social and ethnic violence have
stranded some of the most vulnerable without support, and
in societies which discriminate against women.
Unable - or unwilling - to
flee the ravages of conflict, an elderly Chechen woman salvages
the treasures of her past from the ruins of Grozny.
In Asia, Africa and Latin America,survival of the elderly
depends on employment. As it is, a majority of the 400 million
elderly in Asia and Africa - farmers, labourers, rickshaw
drivers - work until they die. They have been poor all their
lives; their labour has been exhausting and excessive.
The issues in the rich world have already appeared with the
starkest clarity. Social security systems cannot sustain growing
numbers of beneficiaries supported by a declining proportion
of contributors. Between 2000 and 2050 the ratio of older
people to those of working age will more than double.
One way of dealing with the old-age dependency ratio in the
West is the reinsertion of the young-elderly (55-70+ group)
into the economy. This is a delicate issue, since recent experience
has been the opposite - the exclusion and early retirement
of the elderly. How this may be reversed requires greater
attention than it has so far received. In any case, rapid
technological change has made existing skills obsolete, and
devalued the knowledge of an older generation.
Ali Taqi works with the International Labour Organization
(ILO), concerned with the employment of the elderly in developed
countries. "Social security systems, especially pensions,
cannot support the numbers in need. It is vital that working
life be prolonged, particularly as there is a critical shortage
of labour in some industries. On the other hand, many people
regard retirement as a just reward for a lifetime's work."
The Finnish experience
The Red Cross in Finland developed its programmes for the
elderly over a long period. After the Second World War, the
National Society worked not only in reconstruction, but also
with the elderly displaced from the area annexed by the Soviet
Union. During the 1950s, a system of home visiting to the
vulnerable elderly was established, using volunteers to befriend
them and to help with shopping, cooking and hospital visiting.
This programme expanded, and the Red Cross gave training and
salaries to home helps. In the late 1960s, this professional
service ceased, since as Finland became richer, the government
extended the welfare state and considered NGOs should not
be involved in delivering such services. Red Cross intervention
was reduced to friendly visiting of the elderly. The recession
in the early 1990s led to cuts in government spending, and
the Red Cross once more stepped into the breach. The work
in this area grew, imaginatively supplementing care in the
community which the government could no longer afford. The
system has been based upon a network of about 10,000 volunteers,
the majority of them mature women. It has been subsidized
in recent years by funds from the national lottery.
However, since many of the older generation in Finland are
no longer poor, and can afford to pay for care, private enterprise
is now capable of providing such services, which are also
increasingly professionalized. Local authorities will still
be responsible for care, but they will buy in from elsewhere
- the private sector and NGOs. The Finnish Red Cross has responded
to the changed situation, and is now creating a business plan
for service delivery, whereby volunteers will be backed up
by professionals. With more than 15 per cent of the people
over 65, the demand is growing; the level of provision remains
below that of the time before the recession. The Red Cross
will at the same time carefully monitor the quality of services.
Certainly, existing volunteers serve as an inspiring resource.
In Esboo, close to Helsinki, there is a community "village"centre,
run by a retired librarian. This serves as a focus for activities
for the elderly, and a base from which volunteers visit those
in need, arrange hospital visits, provide psychological support
to the bereaved and isolated and try to motivate the helpless.
The impact upon volunteers of professionalizing services remains
to be seen. Whether this represents a compromise of basic
principles or a response by the Red Cross to a changing environment
is a debate that will run through the Movement in the years
A new role for the Movement?
The picture of increasing life expectancy is by no means
uniform throughout the world. In the "transitional economies"
of eastern Europe, where former welfare systems collapsed,
many victims of the abrupt change to the market economy have
been the elderly. In the Russian Federation life expectancy
fell from 65 to 58 between 1987 and 1994; a result, in part,
of the loss of state systems, but also of the abuse of alcohol,
drugs and increasing impoverishment. This has been an aggravated
version of the slower erosion of existing welfare systems
in the rich market economies. In both, there is a growing
gap which can be only partially filled by NGOs and voluntary
and charitable organizations.
In Azerbaijan, 30,000 elderly people living alone have received
Red Cross Red Crescent support; in the Czech Republic, 7,000
home-care nurses have been trained; in Croatia, the Red Cross
provided relief, medical and psychological support to 10,000
isolated elderly people left to fend for themselves as a result
of conflict. Indeed, in many other parts of eastern Europe
and in the former Soviet Union, the Federation, ICRC and individual
National Societies have been running assistance programmes
to help the elderly and destitute to survive the harsh winters,
providing them with food, warm clothing, shoes, blankets,
mattresses, candles and medicines. For many of the beneficiaries,
who have no other means of support, these basic goods are
often the difference between life and death.
This poses a sharp dilemma for the Movement. In a situation
in which governments are privatizing and retreating from universal
provision of welfare services, how appropriate is it for the
Red Cross Red Crescent to step into the breach created by
the exposure of vulnerable populations to the rigours of the
On another front, in parts of sub-Saharan Africa, life expectancy
has been reduced by almost 20 years by AIDS. In 1999, 13.2
million children lost their parents to AIDS; and in ten countries,
life expectancy has fallen to 46.3 for women, 44.8 for men.
In Côte d'Ivoire, Kenya, Uganda and Malawi, grandparents are
taking over the care of orphaned children. Just when they
might have expected their own children to look after them,
they must continue to work in the fields as well as bring
up a new generation. In such circumstances, there is no agonising
over the role of the elderly: AIDS has summoned them to a
vital function. But it is a result of the direst necessity.
Bekele Geleta, head of the Federation's Africa department,
believes the capacity of elders to cope with the enormity
of AIDS should not be overstated. "To talk of sex has been
taboo in many societies. The wisdom of elders has no relevance
in this situation. To expect a grandmother with no work to
look after 12 grandchildren is too much for anyone to bear."
Alvaro Bermejo says of the debate within the Red Cross Red
Crescent over care versus prevention of AIDS, that you can't
do prevention if you don't do care. He says, "It won't save
lives, but they'll die a different death." This is a useful
metaphor for the issue of growing older - you can't stop ageing,
but you can age positively.
Affirmation of continued
usefulness or harsh reality, economic activity late into life
is for many in the developing world a necessity.
The elderly in crisis
During emergencies - war or natural disasters - the elderly
suffer disproportionately. The less mobile cannot even become
refugees. Left behind in war zones, they face bombardment
and, as occurred in Kosovo, vengeful harassment. Images from
Chechnya of elderly women, emerging from cold basements to
pick their way through rubble in search of basic provisions,
remain an enduring symbol of the sufferings of the old. As
in conflict, in "natural" disasters - Hurricane Mitch, the
1999 cyclone in Orissa, to name some recent examples - the
infirm often remain to live or die according to chance.
The Red Cross Red Crescent, as one of the few agencies to
remain in the dangerous places of the world when others have
departed, has always fulfilled a unique role. Jennifer Inger
has been working with the Federation in Bosnia and Herzegovina,
where the Red Cross home-care programme, which is assisting
15,000 vulnerable elderly throughout the country, has been,
literally, life-saving. "The situation of the vulnerable elderly
in Bosnia and Herzegovina is worse now than it was during
the conflict," she explains. "There is no normal community
support; families are dead or fled; the government cannot
provide even the most elementary services. The Red Cross is
the biggest non-government provider of social services in
the country." Through cross-entity community contacts activities,
the elderly have themselves become agents for reconciliation
between Serb, Croat and Muslim communities.
It seems that all the rhetoric of "giving" the elderly a
purpose, integrating them into society, remains theoretical
until harsh material circumstances call forth their otherwise
neglected powers. If this is true, it is a sobering prospect
for industrialized countries, puzzling over what to do with
their ageing peoples. Can a role be found for them without
a major catastrophe?
The wisdom of age
Many societies where elders retain power are poor and conservative.
In Somalia, they have been one of the few guarantors of civility
in a country where central authority collapsed into competing
clans. The recent re-establishment of a traditional assembly,
which elected the president, was initiated by traditional
elders, together with support from civil society. Thomas Merkelbach,
ICRC desk officer for the Horn of Africa, says they hold a
moral power superior to that of political and military leaders.
"The town of Belet Huen, where tension had been held in check
by a respected elder, became a site of conflict when he died
early this year, because there was no one to replace him.
The municipality is now divided."
Josephine Shields, of the Federation's disaster preparedness
department, states that "in the Caribbean, the elderly are
regarded as precious, and all Red Cross programmes recognize
this - there is always a component for the protection of old
people." A cooperative convergence exists in the small societies
of the Caribbean, where governments, NGOs, churches, families,
neighbours and the Red Cross all do their part.
"We also respect the old because when preparing for disasters,
we call upon their experience: they remember how high a river
has ever risen, what are the signs, the extent of damage to
The experience of the rich societies has often been the contrary
of this. AGE CONCERN in the UK drew attention to the increasing
number of assaults "by the young" upon the elderly. Far from
being regarded as repositories of valuable wisdom, the old
are seen as competitors for scarce resources. This also affects
sections of the middle class in the South. The director of
Age Care in New Delhi said, "Many young people resent grandparents
sharing the family home. When there is a party, the old people
go without supper, they are required to absent themselves
from the festivities. They occupy rooms that grandchildren
want for their video games, TV sets and toys."
In many societies, too, the authority of older people has
been subverted by "development" and "modernization". Older
knowledge-systems have decayed or been overtaken. There are
other factors, of course. Lengthening life expectancy has
also damaged the respect formerly accorded to the relatively
few who survived into old age. Venerability is a consequence
of scarcity: in an ageing world, it is in steep decline.
An Egyptian Red Crescent
volunteer personifies the commitment and experience of the
older people who constitute a valuable resource for the Movement.
The benefit of foresight
The growing proportion of the elderly in the world, by the
scale and magnitude of the issue, presents the Red Cross Red
Crescent with scope for new interventions, but it also raises
new questions. What should be the response by the Movement
to a private sector capable of answering the needs of the
well-to-do elderly in the developed world on a profit-making
basis? Should National Societies step into a role vacated
by governments unable or unwilling to fund adequate care of
the most vulnerable? What kind of economic activities can
be devised for the elderly in developing countries to enable
them to contribute to family income? Should the Movement go
beyond service-provision, to motivate its members in the interests
of a rights-based approach to the elderly? How can fresh sources
of volunteers be tapped, given the claims upon the time of
those mature women who have always been primary actors in
the social programmes? How can the reservoir of unused talent
and energy in the young elderly be harnessed for the work
to be done?
These questions, in a world of increasing mobility, where
family networks are breaking down, where the gulf between
rich and poor continues to widen, are not academic; and no
doubt, the Movement will respond to them according to the
priorities of the moment. The ageing of the world is not a
disaster; but without the vision and energy to transform the
wisdom of time into a benefit for humanity, it may become
one - not a sudden catastrophe, but a disaster by stealth
and by omission.
Jeremy Seabrook is a freelance journalist based
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