When is the time to act? Now

To act or not to act, that is the question. Or at least that’s where Rachel Wright of Stanford University and Hilary Schaffer Boudet of Oregon State University began their paper when reflecting on what does, or does not, lead to social movements emerging in the context of environmental risk. They note that ‘social movement theory has rarely been tested with counterfactual cases, that is, instances in which movements do not emerge’. 

I was reminded of that when tuning into a webinar from The Oxford Institute of Ageing (@oxford_ageing) which asked ‘Do we need a Human Rights Charter for older people?’. Very much arguing in favour were the two speakers, Nena Georgantzi, Policy Coordinator on Human Rights and Non-Discrimination at Age Platform EU, and Ken Bluestone who leads Age International’s policy and influencing work in the UK and internationally. 

Speaking in the context of COVID-19 which, as I have remarked upon in a previous blog(and in which you will see more from in a forthcoming opinion piece with Town Planning Review), has illuminated openly ageist discourse in public rhetoric and policy narrative, Georgantzi and Bluestone reflected on the issue of age discrimination in society and why it is so critical that we need a charter to protect against it. 

Georgantzi condemned the existing legal frameworks and tools with which we could fight such discrimination, pointing to the very bias that exists in them in the first place. Just as media stories too readily demonise older people and population ageing as a looming crisis, so too is this rhetoric reinforced in policy documents using language of ‘frail’ and ‘elderly’ or where older people become objects of care, a burden on health and social care, the tax-payer, and the individual. Georgantzi spoke of our collective lack of consciousness on ageism, invoking the concept of hermeneutical injustice wherein the experiences of older people, and the injustices against them, are not readily understood as injustice. 

Bluestone delved further into the ways in which COVID-19 has created and contributed to the ‘othering’ of older people, and the extent to which that othering thus grants permission to treat the life of an older person as somehow less valuable, and therefore grants permission to society to treat them differently. 

We do need that Charter, that legal framework which is not built on existing bias and that creates a universal obligation to protect and value older people. 

It is here then, that I was reminded of the idea that we can rarely test social movement theory with the counterfactual, the situation in which the social movement did not occur. We can. At the moment anyway. 

Bluestone noted that there aren’t ‘enough angry older people’, a point picked upon by Professor George Leeson of the Oxford Institute of Population Ageing. And I echo it. We, bar any poor health or accident, will age. The very fact of the apparent crisis of an ageing population should be enough to remind us that one day we too will be the object of that fear. It is time to remember that and look to how our parents, our grandparents, ourselves may be stigmatised and agitate against it. 

But it is also time to look for more understanding. One question in the webinar was what can academics do? 

We can push forward the debate and contribute to efforts to reframe discussions of ageing from ones of crisis, to ones of opportunity that are responsive to need rather than assumptive of vulnerability. Work I am doing with colleagues in the Department of Geography and Planning (@livunigeog @livuniplanning) at University of Liverpool will help with this. 

But there will be challenges. We are developing a tool to better support policy makers in understanding what the nature of need in their local older population is, rather than those automatic assumptions of vulnerability based on counts of ‘65+’. This tool then is limited by what data are available to us that we can best capture that need, or indeed those opportunities. Yet where we are conscious of that we can still help stimulate the debate that is needed to drive forward an ageing movement, one that helps create the space for acceptance of a Charter for Older People even while striving to negate the very need for it. 

International Older People’s Day… let’s talk about challenges, opportunities and geodemographics

It’s International Older People’s Day, and I’ve been tweeting about our Nuffield Foundation funded project: Older people in England: the geography of challenges and opportunities. As Rich Pereira, Head of the Office for National Statistics Centre for Ageing and Demography pointed out, it is certainly a day to shine a light on the contributions of older people, and their needs. So why is this important? 

The ageing of the population is all too often demonised as a looming crisis, a ticking time bomb. You only need to look to the tongue-in-cheek presentation of the work of demographers from Danny Dorling and Stuart Gietel-Basten’s (2018) opening pages to Why Demography Matters

“Demography appears to promise more bombs and explosions than a Hollywood blockbuster… the demographic future is presented like Die Hard (and its four sequels), as an endless fight against explosion after explosion…”

Dorling and Gietel-Basten (2018: 1)

Following up with the great line from Stephen Emmott’s account of population growth, 

“I think we’re fucked”

Emmott (2013)

But let us argue otherwise. Though it is, in many countries, inevitable that the population will age, if we reframe debates around not only the challenges that such an ageing will of course herald, but also the opportunities within that demographic, are we faced with a demographic dividend and not a demographic burden?

To do this, it is critical we move away from policy, public and media narrative that homogenises older people. There are some that champion this. Professor Tom Scharf frequently calls out adverts and images from news articles that perpetuate a homogenised view of frailty and suffering, particularly from those that should know better. More broadly, the current pandemic has sparked a lot of debate, particularly amongst gerontologists, as to how reframe ageing positively. Though these efforts are not new, they are perhaps gaining more traction as the ‘threat’ of an aged population becomes the reality of a shifted age-structure. So what can geographers bring to this debate, and these efforts to shift policy emphases away from vulnerability to opportunity? 

The old adage that birds of a feather flock together underpins the field of geodemographics research, research that sets out to uncover generalities of particular places or to explore the geography of particular domains of interest, such as health (see Singleton and Spielman, 2014). As Singleton and Spielman (2014) explain, geodemographic classifications organise areas into categories that share similarities across multiple socioeconomic attributes. These classifications are then a valuable resource from which a range of policy insights – such as developing interventions or targeting services – can be gleaned. The classifications equip policy-makers, planners and service providers with an understanding of the features or characteristics of local populations in the areas in which they serve. 

Such a tool, if developed to organise areas into categories according to attributes of the older people who live there, and indeed features of the local environment which are pertinent to the needs and opportunities of that older population, would then do much to shift policy emphases away from tropes of vulnerability. 

Perhaps the easiest way to evidence how such a shift would arise, let’s take an example from the current pandemic. Policy responses to COVID-19 risk deepening and entrenching social, economic and health inequalities, as well as inequities in service planning, provision, and resources. Though we have increasingly seen a turn to more localised interventions, such as the various curfews and bans on household mixing across much of the North East and North West, policies still homogenise groups generalised as at risk. Older people are a prime example of this. 

A geodemographic classification of older people would provide policy-makers with a detailed understanding of the social and spatial variation in the characteristics, behaviours and needs of their local older residents. As I argue with colleagues in a forthcoming opinion piece, this sort of sensitivity to the geography of our older population at a small area level is essential if we are to both channel resources and services to those most in need, and counter ageist narratives in policy and public debate. 

We are developing a bespoke, multidimensional classification to capture the social and spatial heterogeneity of the older population in England. Drawing on a variety of data sources, spanning the Census to more novel data sources such as Access to Healthy Assets and Hazards, this classification will be built around a number of domains including: Socio-demographic; Health; Consumption; Digital; Mobility and Accessibility; Environment. 

Once built, the resources will be freely available for anyone to download and use. Our tool will equip policy-makers, planners and service providers with the insights needed to effectively meet the needs of their local older population. It will highlight need, but also resilience, opportunity. 

If you would like to be involved in helping to ensure we develop and deliver a meaningful tool, whether you are a policy maker, a service provider, an advocate, or someone who identifies as part of that older population we want to support, get in touch

COVID’s insidious toll on society

On 31st July, I posted a piece reflecting on the toxic narrative of blame seeping through British political narrative. It is picked up and rolled out to frame discussions on how we should tackle COVID-19 and more importantly, who we should blame as it goes wrong. Now, some 6 weeks later, more and more places are entering some form of local lockdown. Bizarrely, while I am still unable to meet friends and family in my back garden yet able to socialise in an outdoor public space (no more than 6 of course), elsewhere across the North West, places with lower local infections rates have even more stringent measures imposed. 

But despite my disgust at the way in which politicians are deliberately seeking to frame events, even I am falling foul to scowling at social media posts of acquaintances and beyond quite blatantly flouting the guidance and laws I know they should be following. I simultaneously read in amazement the vitriolic comments characterising those lambasting these flouters, or the outrage from others demanding to know why they shouldn’t be allowed to meet family and friends however they please. 

It is hard not to feel anger, however you position yourself. The pain, suffering and mental anguish gripping society as we battle with rage against rule-breakers and rule-makers is growing. As a society, we are pulling further and further apart. Even the chaos of Brexit is proving less divisive than the shambles and violence of COVID. Just look at the blatant racism both in responses to a recent Daily Mail tweet over No 10 conjecture as to a Christmas reprieve of lockdown, and the possibility of that reprieve in the first place. 

And what are we doing to stop this? Either the public disintegration of societal goodwill, or the ramping up of a second wave to COVID? 

Not enough. 

We’re tiptoeing around the knife edge of economic disaster, a surge of COVID deaths, and the entrenchment of social, economic and health inequalities that is going to ruin the life chances of generations. 

Our children need to be in school. Our local businesses need to be supported. Our communities need to be united

Ineffective, conflicting and confused messages as to local lockdowns are not enough. When it’s needed, impose it. And do it decisively – how can something be so critical yet we can wait for days for it to come into force? 

But more importantly, do morethan create a set of policies that readily slide responsibility awayfrom those who have the power to do more. Professor Devi Sridhar, Chair of Global Public  Health at the University of Edinburgh, is quite clear as to the importance of a functioning test-and-trace system as the only viable alternative to more restrictions and attempts to modify mass public behaviours. We should be demanding this. 

With each failure to fix our allegedly ‘world beating’ system, public trust in Government policy and ability erodes further, whether consciously or unconsciously. With each incorrectly reported statistic as to daily tests, with each inability to secure a test when needed, the despair and anger plaguing us all means we again, turn on each other, we blame those few flouters, and we roll over. 

Inequality has long been present in our society. COVID is making it worse. But it’s doing something more insidious too. We are polarising more than ever before in our thoughts and our behaviours. It is a case of ‘us’ – i.e. that small group of people that creates your social and daily lives – and ‘them’, the rest of the population. It is a suspicious, wary, concerned society. It is not one that can readily withstand and recover from the ravages of a pandemic. 

We have to stop blaming and hating each other. We have to ask more of those we put in power to lead us. We have to ask more of ourselves. 

A toxic narrative of blame

#covid19 #inequality #toxic

I and many others have woken to the frustration and disappointment of a return to a more stringent lockdown. But I know that for many in Greater Manchester, East Lancashire and West Yorkshire, this is even more acute given the impact on their celebrations for Eid. 

The announcement was shambolic. MPs and local politicians variously tweeting or facebooking contradicting pieces of information with no indication that they had any idea this was coming. 

BBC North West went as far as reporting that my local Director of Public Health (DPH) had said only the day before that no significant changes were imminent. This is not the fault of our local MPs or  our DPHs who are working with whatever information they have. 

But more worrying, is the extent to which this new lockdown announcement is continuing a narrative of blame that is both toxic and irresponsible.  

Hard on the heels of a return of the ‘fat shaming’ policy approachesare repeated statements that the lockdown is because people in the affected areas are “not abiding social distancing”. 

This may be true for some. For example, in my local area, texts from GPs alerting us as to a rise in cases ‘especially amongst 17-23 year-olds’ points to a level of frustration, claustrophobia and loneliness pushing younger people outwards to seek solace with their friends. Indeed this is considered as a factor across Europe, according to Hans Kluge, the World Health Organization’s Europe regional directorreported on BBC News today.

But other than supposition, what evidence is there to suggest that it is specifically because of these groups lack of adherence to social distancing that is the problem? 

Consider a tweet from Dominic Harrison, DPH in one of the most affected areas in England: “I do not think that there is any evidence that the northern towns now taking extra control measures are seeing rising rates because of exceptional local failures to social distance”.

Social distancing is only part of the problem. What other determinants of health matter here? 

In tackling local rises in cases, policy approaches must not focus on the individual as the primary source of either the problem or the blame. There are more than individual health-related practices at work here, and far more that the Government and its policy should be considering. 

Bambra et al. (2020) describe the devastating interaction of persisting toxic social conditions which contribute to uneven exposure to social determinants of health and unequal experience of chronic disease that has magnified the severity and impact of COVID19 in more deprived communities. They augment a framework which for any working in public health is very familiar, forcing us to continue looking upstream when we evaluate unequal health outcomes. 

It is not just individual level-health related practices (e.g. the decision or ability to effectively adhere to social distancing measures). It is not just the role of local social and community networks. It is also the interaction with uneven exposure to social determinants of health. What are your working conditions? Your housing? Do you have stable employment? Can you access services? But then look again, move further upstream. What are the political, economic and environmental conditions you live in. 

Source: See Bambra et al. 2020 

The areas affected by this new lockdown are relatively deprived. This is about social and economic vulnerability. It is about inequality. It is not about blaming individuals and their social distancing measures alone. Policies should emphasise thisGovernment statements should emphasise this

We should not blame each other. We should mobilise, and tackle the social, economic and political conditions that mean some are more vulnerable to a devasting disease while others, in their security, their stability, their position of power, can shift responsibility and instigate a toxic narrative of blame.  

Does migration, deprivation change at the area level, or social mobility influence health inequalities within the population?

Inequalities in health are well documented. But it is less clear why inequalities between people and places change over time. One mechanism that may contribute is the redistribution of differently healthy people between locations, area types or social classes. 

Though the relationship between these highly inter-dependent mobility processes, the resulting socio-spatial trajectories, and health inequalities is widely explored, conclusions vary. This, in part, is due to the different approaches employed. 

For example, modelling individual-level outcomes – a common approach – reveals the relationship between particular socio-spatial trajectories and health outcomes. Yet it does not reveal the influence on health inequalities at the population level. There may be a strong implication that differences between groups may affect either area or class relationships, but this is not specifically measured. 

A more appropriate framework of analysis must establish three key questions to determine the relationship between socio-spatial trajectories and changing health inequalities. Specifically:

  • To what extent do health gradients vary when populations are able to move between area types or social classes compared to those arising when populations are put back into their area type or social class of origin? 
  • To what extent does the health status of those entering the most and least advantaged areas, or highest and lowest social classes differ from those leaving these areas or classes?

And finally, given the inter-relationships between opportunities for migration or residential mobility and social mobility,

  • To what extent does the patterning to health by transitions into and out of differently deprived areas or social classes vary migrant status? 

Using data from the Office for National Statistics Longitudinal Study, we demonstrate three methods that collectively reveal whether and how different socio-spatial trajectories can contribute to changing health inequalities at the population level. Our framework offers insights into the nature and extent of inequalities within population, identifying mechanisms that can contribute to changing inequalities while also illustrating differences in opportunities for and nature of social or geographic mobility. 

Future work, in combination with this framework, must examine the complex interplay between people, places and politics to better unpack the injustices in uneven opportunities for social or geographic mobility, particularly where this contributes to widening health inequalities. 

To learn more, see our open access paper published by Population, Space and Place: ‘Establishing a framework of analysis for selective sorting and changing health gradients’, Frances Darlington-Pollock and Paul Norman https://doi.org/10.1002/psp.2359

Looking to University this Autumn?

“Your studies may have been disrupted, but the opportunity to engage critically with geographically relevant issues has not”

I share my thoughts and some advice for all aspiring Geographers who have faced significant disruption to their studies over the past three months. Whether it is a few months or a few years before you begin your academic career, you might find this post useful!

https://geographical.co.uk/opinion/item/3728-a-message-to-new-geography-undergads-from-a-university-lecturer-in-this-time-of-crisis-there-is-opportunity

#geographical #alevels #highereducation #tips #lecturer #studies

Older people in England: the geography of challenges and opportunities

**New Research**

The COVID-19 pandemic has illuminated openly ageist discourses which not only negatively impact on older people, but also highlight a frequent failure in policy approaches and public narrative. Old-age is too readily equated with dependency, frailty, and vulnerability, ignoring the diversity of experiences within the older population, both in capability and need. As the population ages, it is ever more critical that we better understand variation in characteristics, behaviours and needs within the older demographic, and challenge ageist discourses.

Funded by The Nuffield Foundation, this project will develop an open access, multidimensional classification of the older population in England at a small area level, enabling more effective service planning and policy development.

We will produce an online open access platform visualising the geodemographic classification of older people in England. This tool will classify areas according to different characteristics of the older population. It will capture information on demographics, socio-economic status, health, consumption pattern and digital use. It will also capture information on pertinent features of the local built and natural environment.

The project will produce an online open access platform visualising the geodemographic classification of older people in England, including interactive maps and pen portraits of the identified clusters.

The project will take place across three work packages: creating the geodemographic classification, ground-truthing, and applying the classification. It will provide a robust account of the social and spatial stratification in the older population nationally, and demonstrate the importance of understanding this stratification for policy. In this project, we will be working with local stakeholders including Liverpool City Council and the Liverpool City Region Combined Authority to showcase how the purpose built classification of older people can support policy development, service planning and retail provision to better meet the needs of our local older population. 

If you are interested in knowing more, please follow my ReseachGate page here; or contact me on f.darlington-pollock@liverpool.ac.uk.

On the eve of polling day…

On 10th December, data released by the Office for National Statistics suggested that since the General Election was called, there have been 2,531 more deaths than the average for the same weeks of the last 5 years (thanks to @Lu_Hiam for this). As we face the polls on Thursday there can be no more damning call for a change in Government.

Improvements in life expectancy began to falter back in 2014, with early evidence indicating signs of reversal amongst older ages. Indeed more recent evidence has clearly confirmed that trend. And what does this mean in reality? Women living in the most deprived areas  of England will not only live shorter lives than their more advantaged peers, their previous gains in life expectancy have been lost. All this in a time of unprecedented spending cuts and pay freezes. Though women may be particularly vulnerable, austerity is hurting us all.

People are talking about this. In June, The Observer asked Why is life expectancy faltering?  Since then, we have seen academic papers (e.g. work at the London School of Hygiene and Tropical Medicine) and national reports (e.g. evidence from National Records Scotland) adding to the evidence. Just a few months ago, a host of practicing clinicians, epidemiologists, demographers, geographers, public health practitioners debated this at an event I organised on behalf of the British Society for Population Studies. Not to mention all the recent media. It seems unsurprising that mortality suffers in a society where our health system is operating far beyond its limits. Yet will we act?

On the eve of polling day, I want to take this opportunity to reprise a recent Twitter thread of mine.

 I, like many of us, will be watching with bated breath over the next 48 hours. I hope that come December 13th, we have more to be thankful of then an opportunity to rehash memes on the horror that is Friday 13th

A break from marking

We are now well into prime marking season and I am as eagerly anticipating the results for my third years as they are (well, perhaps not quite). Amidst this season of marking and reflecting on the success (or otherwise!) of my first semester lecturing, I had the opportunity to read and review a new book. Never one to turn down a free book, I happily agreed to write the review for the British Society for Population Studies’ (BSPS) latest newsletter. For those of you who are not members, join! But in the meantime, read my review of “People and Places, A 21st-century atlas of the UK” by Danny Dorling and Bethan Thomas.

People and Places review.