This book by Simon Biggs is part of Routledge's series on ‘Key Themes in Health and Society’. As Biggs says in the foreword, rather than being primarily a descriptive textbook, it pursues an argument about contemporary thinking on adult ageing and intergenerational relations. This argument asserts that our modern-day preoccupations with work the economy and consequently labour economics are inappropriate and insufficient with which to judge the purpose and value of a long life. Biggs seeks to present an alternative material basis with which to understand the seen and unseen inherent rhythms of the human lifecourse. In doing so he explores a range of questions and tensions that exist within the study of ageing and are related to health. In doing so he explores a range of questions and tensions that exist within the study of ageing and are related to health. The book is divided into 11 chapters, each of which begins with bullet points of the key themes.
The first chapter sets out what Biggs perceives as shaping contemporary thinking about adult ageing and raises two questions, to which he returns throughout the book:
• What is the purpose of a long life?
• How do we adapt to a society where generations will be approximately the same size?
He presents the data on global demographic shifts, ideas about dependency ratios and global-level policy making on ageing, and points to the cultural uncertainties that have arisen as a result of demographic change. He goes on to Chapter 2 to examine tensions between continuity and change over the individual lifecourse; between ‘within-age’ and ‘between-age’ thinking; and present-centredness and lifetime centredness. These concepts, Biggs argues, are essential to grasp in order to develop what he refers to as a ‘generationally intelligent perspective’. Do we focus primarily on our own lifecourse and the continuities and changes that occur within it, or on the relationships between different age groups? Are we absorbed in the here and now or develop a conscious awareness of past, present and future? He makes the pertinent point that a longer life is more likely to produce discontinuities, although he also argues that these might be positive rather than negative and promote better intergenerational relations. Conscious attention to the implications of ‘not being the same’ within one's own life can produce maturity in the individual and assist in developing empathy with people of different ages.
In Chapters 3 and 4, the focus shifts to examine the question of whether a longer working life helps to identify the purpose of a long life. He presents a strong critique of policies that have conflated active ageing with continued employment or active contribution to community wellbeing. He argues that far from providing the answer to this question about the purpose of a long life, a longer working life risks being used to avoid confronting the challenges of a long life. Looking at the evidence on the relationship between health and work, he concludes that under contemporary conditions the signs are not good. There is little evidence that work will contribute to better health in old age and work cannot therefore be individually fulfilling for the older person nor promote better intergenerational relations. As he points out, a healthy, long life enables people to work longer but working longer does not necessarily keep people healthy.
In Chapters 5 and 6 there is a further shift of focus in the quest for an answer to the question concerning the purpose of a long life as attention turns to the spiritual. He identifies vulnerability as a key issue, juxtaposing the rejection of vulnerability evident in policies and service planning with the acknowledgement of vulnerability evident in a range of gerontological theory. He makes a broad sweep of religious perspectives on ageing and identifies relative consistency between major religions in answer to the question ‘Why a long life?’, which is related to the separation between body and spirit. Turning to a secular version of spirituality, Biggs explores present-day preoccupations with meaning-making and gerotranscendence. He considers Baars’ concept of ‘kairos’, or ‘the right time’ to do something, or an awareness of the propitiousness of conditions at any point in the lifecourse (Baars Reference Baars2012).
The ageing body is the focus of Chapter 7, in which Biggs explores the tension between social and the biological explanations of ageing and competing accounts of ‘natural’ and ‘unnatural’ ageing. In this chapter, he revisits important debates, including that between more rigid biological accounts of ageing and those that perceive ageing as malleable. This chapter also pays attention to how these debates about natural ageing are played out in policy contexts, including in the World Health Organization, which he argues has developed a clearer focus on the inter-relationship between intrinsic human capacities and environmental characteristics. He continues his discussion of ‘natural’ ageing in the next chapter, focusing on anti-ageing, prolongivist strategies, including anti-ageing medicine. Concerning his question about the purpose of a long life, anti-ageing strategies offer little, he argues, because they are about quantity of life rather than a life's value or distinctiveness.
Dementia provides forceful evidence of vulnerability. Biggs argues that dementia has been seen as a disqualification from social engagement but spirituality values how inherently vulnerable old age can be, including the experience of dementia. This means that while anti-ageing medicine is about the maintenance of hope by extending and enhancing the adult lifecourse, dementia teaches us to manage decline. In its focus on intergenerational relationships, the chapter turns to the question of care, focused particularly on care provided by paid workers, which Biggs argues should be balanced between professional distance and interpersonal empathy.
Families, the focus of Chapter 10, are often ambivalent about care and Biggs argues that discourses on family caring appear split between, on the one hand, calls for greater support for informal carers without whom services would collapse, and on the other hand, the demonisation of carers as potential abusers. In terms of his starting questions, Biggs maintains that families can provide valuable lessons in adaptation to changing intergenerational relations and exchanges, which could be applied more widely at a social level.
In general, I found the book interesting in its focus on the individual, extended lifecourse and intergenerational relations. I agree with the view that insufficient attention has been paid to the cultural consequences of changing population age profiles and that policies have been woefully inadequate as a response to population ageing, although the artefactual nature of age groupings is not adequately covered.
From the outset, Biggs has set himself a major task, which involves shifts in levels of analysis and perspective from the intimate and personal, to the global and political. Most of the time, these shifts are handled deftly and he returns to the key themes he set out clearly at the beginning of the book, thus ensuring that the book provides a coherent whole. He raises vitally important questions and confronts vigorously dominant views, such as those on dependency ratios and dementia. There are times, however, when the argument is disjointed and there are gaps in his evidence. For example, his discussion of vulnerability has not really engaged at all with the feminist debates that have taken place over more than 20 years. His discussion of care is also open to criticism, in my view. I am unconvinced that discourses on family care are split between those who want to support carers and those who see carers as potential abusers. In addition, presenting a linkage between the abuse of older people and family carers risks perpetuating a false impression about abuse, which is highly complex and differentiated.
In the final analysis, I remain puzzled by the question ‘What is the purpose of a long life?’ It caused me to ponder what the length of a life has to do with purpose. Moreover, is there not a prior question concerning whether a life of whatever length has a purpose at all? That might be regarded as an atheist's inability to acknowledge the spiritual in life, but I would disagree, of course.
