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prepared by
Terri Petkau, Mohawk College
CHAPTER SEVENTEEN
Health and Aging
Neena L. Chappell
Margaret J. Penning
INTRODUCTION
• Will examine:
 Individual and population aging, including aging
and ageism
 Diversity within aging
 Apocalyptic demography
 Inequality, health, and aging
Copyright © 2011 by Nelson Education Ltd
 Informal and formal types of health care
 Brief history of Medicare
 Health-care reform
 Globalization and profit-making*
17-3
INDIVIDUAL AND
POPULATION AGING
• Life expectancy: Number of years the average
person can expect to live
 Has increased steadily in Canada during the 20th
century
 Canadians can also expect to live longer after
age 65 than generations before them
Copyright © 2011 by Nelson Education Ltd
• Increased life expectancy into old age is
distinguished from previous historical period:
 Never before in history did vast majority of people
in a particular country expect to live to old age*
17-4
LIFE EXPECTANCY IN
CANADA, 1920–2005
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17-5
POPULATION AGING:
FACTORS
• Main reason for increasing proportion of seniors is
due to decreases in fertility:
 With declines in number and proportion of children
in population, proportion of older persons
necessarily increases
Copyright © 2011 by Nelson Education Ltd
• Fertility was major predictor of population aging
until a population reached life expectancy at birth
of 70 years, at which point almost all young
persons survive:
 Further declines in mortality now concentrated at
older ages, resulting in relatively larger older age
groups*
17-6
CANADIAN POPULATION AGE
STRUCTURE, 1851-2006
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17-7
AGING AND AGEISM
• How the lives of elderly people are experienced
is influenced by social construction of old age
(i.e., how society views elderly people)
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• In contemporary Western societies, we tend to
stereotype older persons, a tendency referred to
as ageism
 Elderly people stereotyped as poor, frail, having
no interest in - or capacity for - sexual relations,
being socially isolated and lonely, and lacking a
full range of abilities in the workplace*
17-8
AGING AND AGEISM
• Factors in ageism:
 Lack of knowledge about aging
 Lack of interaction among cohorts
 Younger people’s fears of their own future
Copyright © 2011 by Nelson Education Ltd
 Equation of old age with poor health or disease
 Result of increasing medicalization of old age 
Medicalization refers to social and political process
whereby increasing areas of life come under
authority and control of medicine*
17-9
DIVERSITY IN AGING
1. Socioeconomic and class differences:
•
People who enjoy socioeconomic
advantages tend to experience better
health and live longer than others do
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•
Economic disadvantage follows many
people into old age
 Having few economic resources affects
one’s everyday life in profound ways…*
17-10
DIVERSITY IN AGING
2. Gender:
• Is gender difference in mortality rates  Elderly
women have lower mortality rates than elderly men
for all causes of death
 Factors in women’s lower mortality  Possibly
biological/genetic component, but also determined
by social and economic factors
Copyright © 2011 by Nelson Education Ltd
• Implications of gender differential:
 Women more likely than men to be widowed, not
remarry, live alone, and be poorer; but also more
likely to maintain social support networks into old
age*
17-11
DIVERSITY IN AGING
3. Ethnicity and race:
•
Among Canadian seniors, are more foreign-born
individuals than in the younger population
•
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Aboriginal seniors comprise less than 5% of
Canada’s total Aboriginal population because of
high fertility rates and high mortality rates
 Although is expected that number of seniors in
Aboriginal population will more than double by
2017 and will represent about 6.5% of population
at that time*
17-12
APOCALYPTIC
DEMOGRAPHY
•
Demography: Study of characteristics of
populations and dynamics of population change
•
Apocalyptic demography: Belief that demographic
trend (e.g., population aging) has drastic negative
consequences for society, including the following:
Inability to afford growing percentage of elderly
people
Tremendous strain on state-financed services
Rise to dangerous levels in government debt and
deficits
Claim that most elderly sufficiently well off to pay
for services themselves but expect subsidization*

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


17-13
APOCALYPTIC
DEMOGRAPHY
• Apocalyptic demography is faulty, and ignores the
following:
 We actually can afford better social services for
the elderly because of economic activity, which
continues to increase over time
Copyright © 2011 by Nelson Education Ltd
 Nearly half of elderly women without a spouse live
in poverty
 Population aging accounts for only small part of
future health-care costs and will require little
increase in public expenditures*
17-14
HEALTH AND OLD AGE
• Although equation of old age with declining health is
valid with regard to physical health, is less true of
psychological and emotional health and social wellbeing
Copyright © 2011 by Nelson Education Ltd
• With advancing age, about 77% of men and 85% of
women aged 65+ suffer from at least one chronic
condition; i.e., persistent physical or mental health
problem
 Chronic conditions do not necessarily interfere with
day-to-day functioning…*
17-15
HEALTH AND OLD AGE
• A functional disability exists when a health problem
interferes with day-to-day functioning
 About one-third of adults age 65+ (25% of men and
34% of women) experience restrictions in their daily
activities because of health problems (figure rises to
40% among those aged 75+)
Copyright © 2011 by Nelson Education Ltd
• Pain is problem for many but not all elderly adults
• Elderly adults also subject to mental or brain
disorders (e.g., dementia – most prevalent form:
Alzheimer’s disease)…*
17-16
HEALTH AND OLD AGE
• Elderly adults do not have poorer mental health or
poorer sense of psychological well-being than
younger age cohorts
• Self-esteem and feelings of mastery or control also
seem to improve with age, peaking in middle age,
followed by modest declines in later life
Copyright © 2011 by Nelson Education Ltd
• Seniors’ social lives tend to be healthy and
characterized by social integration, not social
isolation
 Most seniors are embedded in modified extended
family networks, characterized by mutual and close
intergenerational ties, responsible filial behaviour,
and contact between the generations…*
17-17
HEALTH AND OLD AGE
• According to compression of morbidity
hypothesis, Western industrialized nations
are successfully postponing age of onset of
chronic disability
Copyright © 2011 by Nelson Education Ltd
• Many analysts think that eventually we will
all be able to live relatively healthy lives
until very shortly before death, when our
bodies will deteriorate rapidly
 Until recently, evidence on this subject was
contradictory*
17-18
INEQUALITY, HEALTH,
AND AGING
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• Inequalities in health and longevity are
reflected in stratification within our society
based on factors, such as:
 Education
 Income
 Gender
 Race, ethnicity, and immigration status…*
17-19
INEQUALITY, HEALTH, AND
AGING
1. Education
•
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People with more education are able to
avoid or postpone disability to a greater
extent than those with less education
 But education may be of less benefit once
disability is present
•
People with a university degree often feel
healthy and function well late into their
60s, 70s, and 80s, whereas those with
less education do not…*
17-20
INEQUALITY, HEALTH,
AND AGING
2. Income:
Copyright © 2011 by Nelson Education Ltd
•
Is estimated that 23% of premature mortality (i.e.,
years of potential life lost) among Canadians is
linked to income differences
•
High-income earners (using various definitions)
experience considerably more years of good health
than those with lower incomes (also defined
variously)
•
Low-income elderly adults with disabilities tend to
be more functionally disabled than their highincome counterparts…*
17-21
INEQUALITY, HEALTH,
AND AGING
3. Gender…In comparison to men:
Copyright © 2011 by Nelson Education Ltd
•
Women, who tend to live longer, are generally
found to be less healthy and report more severe
disability
•
Women report more multiple health problems
associated with chronic conditions (e.g., arthritis,
rheumatism, high blood pressure, back problems,
and allergies)
•
Women are more likely to report limitations in
activities of daily living or disability in later life
(although likelihood of disability increases with age
for both sexes)…*
17-22
INEQUALITY, HEALTH,
AND AGING
4. Race, ethnicity, and immigration status
•


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

In comparison to non-Aboriginal adults, Aboriginal
Canadians…
Have life expectancy six years shorter
Suffer from more chronic illnesses and disabilities,
including heart disease and diabetes
Do not generally rate their health as excellent or
very good
Fewer than one-half of non-reserve Aboriginal
adults over age 64 report having excellent or very
good health…*
17-23
ABORIGINAL AND NONABORIGINAL POPULATION
AGE, 2006 (PERCENTAGE)
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17-24
ABORIGINAL AND NONABORIGINAL CANADIANS’ LIFE
EXPECTANCY AT BIRTH BY SEX,
1991 AND 2001
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17-25
INEQUALITY, HEALTH,
AND AGING
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• In Aboriginal populations…
 Have death from infectious and parasitic
diseases, which is associated with inadequate
housing and unsanitary conditions
 Have (i) high suicide rates; and (ii) high death
rates from drowning, fire, homicide, and motor
vehicle accidents
 Are affected by racism and discrimination,
which increases risks of psychological distress,
depression, and unemployment
 Often faced with lack of access to opportunities
and resources*
17-26
INEQUALITY, HEALTH, AND
AGING
• Health inequities are also evident when
comparing other ethnic and racial groups
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• Less than 25% of Canadians aged 65+ born in
Canada or U.S., Europe, Australia, and Asia
tend to report fair or poor health
 Contrasts with roughly 33% among those born
in Central and South America and Africa
• Health and longevity also vary widely from
one country to the next…*
17-27
LIFE EXPECTANCY AT BIRTH AND AT AGE
60 FOR SELECTED COUNTRIES WITH
HIGH AND LOW LIFE EXPECTANCY,
2002–2006
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17-28
INEQUALITY, HEALTH,
AND AGING
• Immigrants, especially recent arrivals, generally enjoy
better health than their Canadian-born counterparts
 Healthy immigrant effect reflects Canadian
government requirement that potential immigrants
meet minimum standard of health before they are
admitted to the country
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• However, immigrants’ health tends to decline after
immigration
 Factors: Negative health implications of changes in
diet and activity levels, discrimination, declines in
income and other resources, and difficulties in
accessing health-care services in years following
immigration*
17-29
EXPLAINING SOCIAL
INEQUALITIES IN HEALTH
• First explanation  Research findings support
link between (i) social location and individual
behaviour; and (ii) lifestyle factors
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• Compared to those with lower levels of
education and income, individuals with higher
levels of education and income are:
 More likely to engage in health-promoting
practices
 Less likely to engage in risky health practices 
But…*
17-30
EXPLAINING SOCIAL
INEQUALITIES IN HEALTH
• Overall, studies suggest impact of health
behaviours is minor compared with other
factors, such as income inadequacy
Copyright © 2011 by Nelson Education Ltd
• Focus on individual role in health is criticized
for:
 Ignoring more important structural inequalities
that contribute to health outcomes and even
limit potential options for health behaviours
 Encouraging a blame-the-victim mentality for
what are socially-produced structured
inequalities*
17-31
EXPLAINING SOCIAL
INEQUALITIES IN HEALTH
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• Second explanation  Stress associated
with
(i) lack of access to economic
and other resources; and (ii) perception of
inequality = Hierarchy stress perspective:
 Stress and depression may result from
perception of relative deprivation when
people compare own situation with that of
others
 Stress also can indirectly negatively affect
health by leading people to smoke, consume
too much alcohol, and eat too much or too
little*
17-32
EXPLAINING SOCIAL
INEQUALITIES IN HEALTH
• Third explanation: Emphasizes resources and
material conditions as mechanisms linking people’s
social location to health outcomes
Copyright © 2011 by Nelson Education Ltd
• Such arguments hold that one’s social class, age,
gender, race, ethnicity, etc. contribute to differential
access to range of resources that contribute to
good or poor health
 Resources include enough income to buy nutritious
food; enough education to be aware of health
issues
 Examples of resources: What constitutes a
nutritious diet; access to means of illness
prevention; ability to avoid risk factors, such as
living in environments where dangerous chemicals
are present, etc.*
17-33
INTERSECTING INEQUALITIES AND
HEALTH OVER THE LIFE COURSE
•
Increasingly, sociologists are interested in effects
of multiple statuses on health outcomes:
1. Age as leveller hypothesis  Argues age effects
cut across all other statuses, in effect levelling
inequalities from earlier in life
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2. Competing multiple jeopardy hypothesis 
Argues effects of membership in multiple lowstatus groups is cumulative
• Example: Being female and old has more
negative consequences than being either female
or old…*
17-34
INTERSECTING INEQUALITIES AND
HEALTH OVER THE LIFE COURSE
• More recently, researchers have argued that
statuses cannot simply be added together to judge
their effects
 Instead, statuses intersect and interact, and we
cannot fully understand them apart from one other
Copyright © 2011 by Nelson Education Ltd
• Researchers also note as a person ages, the
social and economic factors that influence health
change
 According to the life course perspective, the
circumstances of later life and those of early life
combine to influence what happens to health in
later life*
17-35
HEALTH CARE: IMPLICATIONS OF
VARIOUS UNDERSTANDINGS OF
CAUSES OF HEALTH PROBLEMS
Copyright © 2011 by Nelson Education Ltd
i.
If health problems of older adults viewed only as
result of what happens in later life, interventions
will be targeted to older adults
ii.
If health problems attributed to freely chosen
personal behaviours, interventions will be aimed
at educating people
iii. If life course perspective adopted and health
problems viewed as arising from social structural
inequalities, attempts will be made to improve
health beginning early in life…*
17-36
HEALTH CARE: IMPLICATIONS OF
VARIOUS UNDERSTANDINGS OF
CAUSES OF HEALTH PROBLEMS
iv. If health inequalities attributed to perceptions
of stress, we may focus on altering how
people view their circumstances rather than
changing circumstances themselves
Copyright © 2011 by Nelson Education Ltd
v. If organization of society and distribution of
economic and social resources regarded as
main determinants of health, we will likely
direct attention to economic and social
policies as means of improving health*
17-37
SELF CARE AND
INFORMAL CARE
• Primary form of care when health declines is self
care: Range of activities that individuals undertake
to enhance health, prevent disease, and restore
health
Copyright © 2011 by Nelson Education Ltd
• Except in emergencies, when we do need help from
others, we turn first to our informal network of family
and friends
 Despite claim for modern Western societies (such
as Canada) being dismissive of the elderly, about
75% of all care provided to seniors comes from their
informal network (usually readily provided and
primarily by family members, mostly women)*
17-38
FORMAL MEDICAL AND
HOME CARE
• Canada’s publicly-funded health-care system
offers “Medicare”:
 Universal access to physicians and acute care
hospital services for its citizens based on need
Copyright © 2011 by Nelson Education Ltd
• Prior to establishment of Medicare, people needing
health care were required to pay for it, or do
without
 Situation was especially problematic for poor
people whose health needs were great, especially
given disproportionately large number of the
elderly, the unemployed, and chronically disabled
among the poor…*
17-39
BRIEF HISTORY OF
MEDICARE IN CANADA
• Gaps in access to health care particularly apparent
in years that followed WWI and Depression of 1930s
• 1957: Hospital Insurance and Diagnostic Services
Act introduced, leading to hospital care coverage
for entire population
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• 1966: Medical Care Act passed, laying groundwork
for universal health insurance for physician services
• By 1972, all provinces and territories had joined
program, which operated on 50/50 cost sharing
arrangement between federal government and
provinces…*
17-40
BRIEF HISTORY OF
MEDICARE IN CANADA
• From the outset, health care was structured
as provincial responsibility
 Federal government develops policy and
assists with funding services, but each
province is responsible for delivering services
Copyright © 2011 by Nelson Education Ltd
• Through Medicare, every province offers
physician and acute care hospital services at
no out-of-pocket cost to its residents
 Services are publicly funded (paid for by the
government)…*
17-41
BRIEF HISTORY OF
MEDICARE IN CANADA
• Most physicians operate as private
entrepreneurs: Government pays them for
services that they deem necessary and
that they render
Copyright © 2011 by Nelson Education Ltd
 The more services physicians provide, the
more they earn
Difference between their jobs and those of
other private entrepreneurs is that their
incomes are virtually guaranteed…*
17-42
BRIEF HISTORY OF
MEDICARE IN CANADA
• Historically, Canada structured its healthcare system mainly to provide physiciandominated medical care in physicians’
offices and hospitals
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 We defined health as absence of disease,
excluding from coverage preventative
measures and those that took a broad view
of health as a state of physical, social, and
psychological well-being…*
17-43
MEDICARE IN CANADA
TODAY
• 2006: Health-care expenditures in Canada totalled
$151.3 billion
Copyright © 2011 by Nelson Education Ltd
• Availability of many types of health care (e.g.,
home care, nursing homes, physiotherapy, home
nursing, counselling, chiropractic services,
podiatry, and massage therapy) varies across
provinces
 Some provinces provide these services as part of
their healthcare system at no cost to the user
 Others provide them at minimal cost or on a
means-tested basis*
17-44
HOME CARE SERVICES
IN AN AGING SOCIETY
• One type of health service especially important in
an aging society is home care, which brings
services into people’s homes to help them live
there rather than move to a nursing home
• Most people, including older adults, prefer living in
own home as opposed to a long-term care facility
Copyright © 2011 by Nelson Education Ltd
• Adequate home-care services are critically
important because they allow older individuals to
remain independent
 Despite importance, home care receives relatively
little governmental funding*
17-45
HEALTH-CARE SYSTEM
CHANGE AND REFORM
• In years following establishment of Medicare, cost
of health care rose leading federal and provincial
governments to try to contain costs
Copyright © 2011 by Nelson Education Ltd
• Was widespread recognition of need to shift away
from system almost entirely biomedically-focused
and concerned only with treatment and cure of
disease, and towards broader conception of care
that incorporates health promotion and disease
prevention
 Result: Deinstitutionalization of health services and
providing more care outside hospitals…*
17-46
HEALTH-CARE SYSTEM
CHANGE AND REFORM
• Other major reforms followed
• Most provinces regionalized health-care services,
yielding authority to subprovincial health boards
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• Fewer people received acute and extended care;
hospital admissions fell; length of hospital stays
dropped; and many surgical treatments moved to
outpatient settings
• Reforms also failed to acknowledge need for
enhanced long-term home-care services*
17-47
GLOBALIZATION AND
PROFIT MAKING
Copyright © 2011 by Nelson Education Ltd
•
Economic globalization involves use of variety
of technologies to boost transnational
investment, finance, advertising, and
consumption, thereby increasing profitability of
multinational corporations
•
Proponents of globalization emphasize need
for:
Privatization  Turning publicly-owned
organizations into privately-owned companies
Profitization  Turning institutions into profitmaking organizations…*
i.
ii.
17-48
GLOBALIZATION AND
PROFIT MAKING
• For-profit health care tends to be
more expensive than universal public
schemes
Copyright © 2011 by Nelson Education Ltd
• For-profit health care costs
governments less, but people who
use the services pay more
Much of increased cost comes from
administrative “overhead” charges…*
17-49
GLOBALIZATION AND
PROFIT MAKING
• A for-profit system also leaves many citizens
without any health insurance
 Risk is that as more of our health-care services
are profitized, more people with health-care needs
are going to be disadvantaged
Copyright © 2011 by Nelson Education Ltd
• Many sociologists argue that economic
globalization does not support type of health-care
system appropriate for an aging society; i.e., a
system that combines medical care and strong
long-term home-care program, including social
services for the elderly**
17-50