dieter ferring 16 9 Medium Speaker 

Dieter Ferring  

Professor of Developmental Psychology and Geropsychology
Head Research Unit INSIDE
Head Institute for Research on Generations and Family
Course Director “master en gérontologie"
University of Luxembourg

BIOGRAPHY

Enlarging the frame: Issues of inclusion and mental health in an ageing society

Introduction

This contribution frames the notions of inclusion and mental health by describing trends in European societies at the social and economic level that will have direct consequences for a participative civil society and social cohesion. Our starting point is the observation that the world faces challenges at the start of the 21st century that are new and unprecedented in its history. The four global forces that break all the trends known so far in human history include urbanisation, accelerating technological development, greater global connections, and population ageing (Dobbs, Manyika and Woetzel, 2016). We will first describe the scale of population ageing, as ageing populations characterize several developed economies. In a second step, we will highlight some consequences of population ageing for social welfare, and in a third part we will elaborate on the notion of justice and inclusion in rapidly changing societies.

The World and Foremost Europe are Ageing

It is a well-known fact that Europe is ageing; UN data from 2012 show that nine of the 10 oldest populations of the world are from Europe: While Japan has the highest proportion of elderly people, Germany and Italy take second and third place – followed by Bulgaria, Finland, Croatia, Greece, Latvia, Slovenia and Malta. However, the demographic trend of an ageing population is also showing in China and will soon reach Latin America as well. Dobbs et al. (2016) state that–for the first time in human history–ageing could mean that the planet’s population will reach higher age everywhere.

Due to growing life expectancy and at the same time decreasing fertility, societies run the risk of over-ageing with the older part of the population forming the majority and leaving children, adolescents and adults in the minority. This demographic change has severe consequences at all levels of the socio-ecological context ranging from differential experiences of ageing at the personal level, intergenerational relationships to effects at the wider social and macro-economic level (Ferring, 2017). This latter point is elaborated in the following.

Social Welfare and Public Expenditure

The sustainability of public expenditure as well as the division and distribution of public resources provides a new challenge and is heatedly debated in most European countries. In the public media, at government level, and in scientific discourse the balance of public investments in work and employment, education and training, social security and health care provision as well as the sustainability of the welfare state model as a whole are widely discussed. The costs of an ageing society are enormous. The longer people live, the more likely it is that they will attract a (chronic) illness and will require care. The cost estimates with respect to the high prevalence of Alzheimer’s and neurodegenerative diseases illustrate this point. The estimated global cost of dementia amounts to a total of USD $818 billion estimated 2015 worldwide (Alzheimer’s Disease International, 2015). In Europe, the total expected cost of dementia reaches €189 billion per year across the 15 EU countries before the Eastern enlargement (Luengo-Fernandez, Leal, & Gray, 2011).

An ageing population will also put social security and pension financing at risk. The active work force is getting smaller in many European countries and a rapid decline of the worker-to-retiree ratio can be observed across Europe. Moreover, people live, on average, longer post retirement and with increasing age, people tend to show a pronounced need for public support. Yet the distribution of public resources depending on the needs of persons appears no longer sustainable and this has led to a reflection and review of the social welfare model in some European countries. This potential reform of the welfare system is sometimes framed in terms of return of investment. The logic behind this is simple: The state invests into education, training as well as employment and work, and expects active participation from its citizens and a return of its investment both in terms of social and financial returns. The open question within such a framework is, however, what will happen to persons who cannot live up to the standards of an achievement-related society and will not be able to provide a specific return of investment – a question of social and economic cohesion.

However, not only individuals are affected by this question of cohesion. Within some European societies, players within the economic sector have gained public attention, in particular some banks and investment banks which had run into liquidity problems. These private banks were saved by public money; national households saved these banks because of their so-called system-relevance. It goes without saying that this poses additional strain to national and European households as well as to discourses about the justification of such actions by the public. Linked to this is also the phenomenon that the unequal distribution of wealth in most countries is increasingly being challenged as socio-economic inequalities widen within Europe and beyond (see Ferring & Albert, 2013).

These observations set the frame for the discussion of inclusion and mental health in society. The underlying question of is what is just and justified when it comes to the distribution of resources will be deliberated next.

Justice and Inclusion

The question at the heart of social policy and academic discourse is: “How will our present decisions and actions at the political level affect the future of the individual and the society?” There are the intended consequences, which also imply at the first level a realization that today’s political decisions will impact future developments in all domains of a civil society including education, economy, health, and social policies. The unintended consequences are of course more difficult to predict. At a second glance, the impacts may not be that clear-cut and easy to detect. However, one problem of the political decision-making process is also that the different parties and interest groups involved have from the outset differing and often conflicting ideas about what to achieve. Some goals are equally desired, but difficult to achieve. Examples include the need to increase or at least to maintain productivity, but not at the risk of environmental pollution, weighing up investment decisions into education and employment against finite resources vis-à-vis the health care needs of an ageing population. These examples illustrate that thinking about the consequences of present decisions and actions for future developments almost always implies an ethical statement about which consequences should be expected for future generations.

This leads then to the concept of justice and, more specifically, distributive justice and the underlying notion of the fairness of resource allocation. Justice is a relative term and depends on the criterion used to evaluate justice. There are several principles to be discussed here. Arts and Gelissen (2001) elaborate that some welfare states “have embraced a notion of equality that reflects a redistributive justice of collective solidarity. Others, however, have cherished a conflicting notion of solidarity, i.e. equity, which reflects the rationality of a quid pro quo actuarial principle of distributive justice” (p. 283). Underlying these models are different justice principles such as “neediness” favouring persons in need of help and resources or “achievement” favouring persons who achieve the most with respect to a given criterion. At the individual level, persons may experience existential guilt when having the impression of being advantaged (Schmitt et al., 2000) or people may feel disadvantaged and excluded.

It is an open question how societies will develop in the coming decades with respect to distributive justice and the inclusion of all parts of civil society, given all the trends up to this point. It goes without saying that social cohesion and peace will depend on the answers that are found here.


References

Alzheimer’s Disease International (2015). https://www.alz.co.uk/research/ WorldAlzheimerrepport2015.pdf. Accessed 25 May 2016.

Arts, W., & Gelissen, J. (2001). Welfare states, solidarity and justice principles: does the type really matter? Acta Sociologica, 44, 283-299.

Dobbs, R., Manyika, J., & Woetzel, J. (2016). No ordinary disruption: The four global forces breaking all the trends. New York: PublicAffairs.

Ferring, D. (2017). The experience of ageing: Views from without and within. In: Rosa A, Valsiner J (Hg), The Cambridge handbook of cultural psychology (2nd ed.). Cambridge, UK: Cambridge University Press.

Ferring, D., & Albert, I. (2013). Where do we go from here? An epilogue concerning the importance of solidarity between generations. In I. Albert & D. Ferring (Eds.). Intergenerational relations. European perspectives on family and society (pp. 241-243). Bristol, UK: Policy Press.

Luengo-Fernandez, R., Leal, J., & Gray, A. M. (2011). Cost of dementia in the pre-enlargement countries of the European Union. Journal of Alzheimer's Disease, 27(1), 187-196.

Schmitt, M., Behner, R., Montada, L., Müller, L., & Müller-Fohrbrodt, G. (2000). Gender, ethnicity, and education as privileges: Exploring the generalizability of the existential guilt reaction. Social Justice Research, 13, 313-337.