By Peter Lloyd-Sherlock
Writing about ageism and COVID-19 is not for the faint-hearted. Whatever gets said is likely to offend at least one constituency and get shot down in flames by others. And, frankly, I don’t feel sure of my ground about what the right questions should be, let alone the answers.
But, as this is such an important issue of the day, it’s worth having a stab at saying something with the aim of provoking debate. One “safe” question is probably: “What has changed (if anything) in terms of ageism and health as a result of the COVID-19 pandemic?”
This needs breaking down into questions about specific changes, like:
A change in the overall importance of the issue of ageism and health (or at least in a growing profile and awareness of its most egregious forms).
Specific ways in which ageism plays out in the COVID-19 pandemic. Of course, denying older people life-saving treatment is nothing new in high-income countries. And, arguably, it is more the rule than the exception in many developing countries due to the combined effects of resource scarcity and age-discrimination. Ventilators are just the tip of a tragic and unacknowledged iceberg. (As an aside: There is a worrying circularity about using higher fatality rates among older people to justify denying them access to ventilators, which then increases fatality rates among older people).
Changes in the discourse of ageism, ranging from the increasingly desperate efforts of campaigners to promote a rights-based approach that says age should never be a consideration in decision-making to the quasi-eugenic (and to my mind, criminal) advocates of letting a few old people die for the “greater good”. Elsewhere, a new narrative of brutal pragmatism calls for age-based triage on the principals of “women and children first to the life-boats”.
So even as I draft this blog, what seemed a more straightforward question is starting to come apart at the seams…
To figure out what may have changed in my own personal thinking, I re-read a blog on ageism and health I did for a human rights organisation a couple of years ago. You can find it here: https://ageing-equal.org/trying-to-make-sense-of-ageism-in-health/
Here are some bits I picked out with my virtual highlighting pen, interspersed with new thoughts.
“Often, decisions about access to health care take into account the age of the individual. When can this be considered reasonable prioritisation of scarce resources and when does this become unjustifiably ageist?”
An easy question to ask. A fiendishly difficult one to answer.
“there is entrenched ageism in health policy and practice, at both the global and the national levels”.
This has been one of my hobby-horses for many a year, mainly with reference to the marginalisation of older people from non-communicable disease policy and targets. In the light of COVID-19’s disproportionate impacts on older people, it seems fair to ask whether global and national agencies have started to address their own ageism, or whether it is still business as usual.
Sadly, the evidence suggests little change to date. WHO has shown little inclination to place older people at the centre of its responses to the pandemic (despite the best effort of some individuals in that organisation), prompting an open letter in the British Medical Journal. This morning I came across a new UN Policy Brief on COVID-19 and Women. Based on a quick scan (all any of us have time for these days), it appears to be an excellent document. And, yes, it does refer to older people. Just the once, mind you, and on page 14. By contrast, the brief goes to great lengths to discuss the vulnerabilities of girls and younger women, gender-based violence (but not elder abuse). To my mind, this brief is a perfect reflection of the priority-landscapes of global health and development networks. Older people occasionally get a look-in, but almost never more than a glancing mention. Even when they are one of the key stakeholders for that particular issue.
In the past, I was not sure where I stood in terms of the need for a global UN-type agency with an exclusive mandate to represent the interests and vulnerabilities of older people. The COVID-19 pandemic (and WHO’s tragic decision in 2018 to shut down its only department with an exclusive remit for older people) has convinced me of the urgent need for this. Time for another petition or open letter (watch this space…..).
“It isn’t easy to identify a point at which the sad necessity of priority-setting and rationing access to health services crosses a line and becomes unjustifiable discrimination.”
Of course, it isn’t. But there has never been a greater need to develop some broad guidance. This is in everyone’s interest, including health workers who need to be confident about where the line can be drawn between (i) acceptable emergency triage decisions at times of great stress and (ii) discretionary discrimination potentially subject to future prosecution. This isn’t helped by the ageist discourse and neglect of older people in global agencies, which can unwittingly legitimise or encourage discriminatory decision-making.
“We need to go beyond vague platitudes of “good health for all” and identify clear parameters of what is unacceptable.”
I have no idea what those parameters are. It’s beyond my university pay grade (and cowardly disposition) to stick my neck out. Whatever they are, they will have to be workable in the context of this crisis, rather than just another set of idealised protocols of no relevance in most health care settings (especially in developing countries). They require ethical and legal rigour. And, in the final analysis, they will be a political decision, hopefully, based on a modicum of consensus and (dare I say it?) compromise.
OK –that’s my 1000 word take on this thorny issue.
It’s easy to be critical. And I haven’t shrunk from criticising WHO and other organisations over the last few weeks. So please don’t hold back from criticising this blog and helping me get my head around this.
Peter-Lloyd Sherlock is a professor in Social Development at the School of Development Studies, University of East Anglia. His research looks at social protection, health and the well-being of older people in developing countries.