The Institutional Active Aging Paradigm in Europe (2002–2015)

The Institutional Active Aging Paradigm in Europe (2002–2015) Abstract Background and Objectives The paradigm of active aging has been slowly gaining ground in Europe as the ideal framework for public policy and for responding to the population’s aging. Taking the work by Rune Ervik as its point of departure, this article updates his conclusions on conceptualizations and policies of active aging by performing a study of the institutional discourses in the matter produced by the World Health Organization (WHO), the Organization for Economic Cooperation and Development (OECD), and the European Union (EU). Methods A corpus of 15 WHO, OECD, and EU documents published in the period 2002–2015 and tackling active aging were analyzed qualitatively through a combination of content and thematic analysis, based on a scheme integrated by deductive and inductive iterative manual and computerized codification. Results The institutional discourses on active aging analyzed have not changed dramatically in the period considered. However, a divergent path has emerged regarding the accent placed on participation and contribution in the construction of the paradigm: the more socially productive and health-oriented WHO discourse is slowly separating from the more economically productive and labor-oriented discourses of the EU and OECD. Discussion and Implications The institutional paradigm on active aging is evolving into a reductive treatment of a phenomenon that is multidimensional. International institutions and researchers should pay closer attention and forge a path toward an honest and critical examination of the real conditions and expectations of older people concerning the discursive and practical proposals of active aging, in all its different forms. Policy, Qualitative research, Positive aging, Institutional discourse Since the 1990s, the paradigm of Active Aging (AA) has been slowly gaining ground in European institutional, professional, and scientific spheres as the ideal framework for public policy planning and for responding to the population’s aging. (We use the term paradigm in the sense of a broad cosmovision that establishes common notions and is applied extensively. This article explores what we consider to be the hegemonic institutional form of a paradigm.) In Europe, the paradigm’s preeminence today has much to do with its promotion by certain international institutional actors (Walker, 2015) like, for example, the World Health Organization (WHO), the Organization for Economic Cooperation and Development (OECD), and the European Union (EU). Although in different ways, these actors have given AA the status of a politically valid concept and, in one way or another, they have made it a part of their discourses and have taken positions regarding it (Moulaert & Léonard, 2015). From the institutional point of view, the AA paradigm, initially proposed in its most canonic form by the WHO in its document “Active aging. A policy framework” (WHO, 2002), is a positive vision of aging that underlines the importance of certain aspects such as independence and healthy lifestyles, and uses the term active in a broad sense (Foster & Walker, 2015; Walker & Maltby, 2012). Since the start of this century, some relevant initiatives have been undertaken, particularly in Europe, with a view to normalizing the institutional treatment of AA. Two good examples, from a much longer list, are the Second World Assembly on Aging, which was held in 2002 and gave rise to the Madrid International Plan of Action on Aging, and the 2012 European Year for Active Aging and Solidarity between Generations, as designated by the EU (Lloyd et al., 2014; Ramos & Yordi, 2018). The AA paradigm has spread thanks to a variety of initiatives accompanied by discourses related to certain macrostructural changes, such as the reconsideration of caregiving dynamics, the adaptation of social protection systems, and the containment of public spending (De Sâo José & Teixeira, 2014). Hence, an aging paradigm, as institutional model, is not only a reformulation of premises related to aging well, but also an instrument used by certain public actors to reconfigure the social order (Biggs, 2014; Grenier, Lloyd, & Phillipson, 2017; Katz & Calasanti, 2015; Rubinstein & de Medeiros, 2015). In 2006, Rune Ervik presented a paper on the pitfalls and possibilities of AA. This paper was an early invitation to critically discuss the AA paradigm “to ensure that active aging policies are not only effective but also can be morally justified” (p. 2). Specifically, Ervik stressed the need for a continuous debate on the normative implications of AA. This Norwegian scholar analyzed some of the dimensions and transversal questions of AA—“a new catchword on a global scale” (Ervik, 2006, p. 3) —, in the discourses of the OECD, WHO, and EU until 2001. His research revealed the wide array of dimensions (e.g., temporal dimension, transversal issue dimension), meanings (e.g., praise of autonomy), and implications (e.g., danger of paternalism) that the different institutional discourses can have regarding AA. Each institution’s conceptualizations and political formulation regarding AA determine their respective prescriptions on what the appropriate and recommendable aging experience is; hence, the normative nature of a paradigm pointing out that we must age in a certain way, the way being put forward as institutionally positive and appropriate. However, Ervik (2006) argued, “active ageing does not replace the old social policy questions of inequality, redistribution and security that will arise also within this new paradigm” (p. 9). Nor AA—Ervik posited— can ignore relevant individual differences within the heterogeneous category of old or aging people, for those not fitting into the paradigm would be excluded. The normative nature of the discourses regarding AA has been amply discussed (van Dyk, 2014; Holstein & Minkler, 2007; Ramiro Fariñas, 2012) since Ervik’s paper, and being active has become currently a normative imperative for many older people (Gard et al., 2017 as cited in Evans, Nistrup, & Pfister, 2018). In this regard, there are public actors that, with a view to promoting the different aging paradigms, are even encouraging older people to assume part of the responsibility for these problems (Evans et al., 2018; Katz & Calasanti, 2015; Lloyd et al., 2014; Rubinstein & de Medeiros, 2015), something already put forward by Ervik (2006). Regarding inequality and diversity among older people since Ervik’s work, the OECD (2017) has warned that although generally speaking health status and income levels of older people have improved, socioeconomic disparities remain large, and inequality in old age is at risk of increasing among future retirees given unstable labor conditions and earnings of younger generations at the moment. Likewise, a recent report on older persons’ poverty and social exclusion in the EU (Age Platform Europe, 2018) has concluded that “isolation, invisibility and loneliness are important issues for many older people that hinder their integration into society and undermine the aim of active and healthy ageing” (p. 9). Current stark inequalities—associated for instance with race, ethnicity, gender, migration, and disabilities—in how different people experience later life (Scharf, Shaw, Bamford, Beach, & Hochlaf, 2017) indicate that Ervik’s assertion that individual diversity tends to increase with age is still valid for Europe. Public policy debates seem to be paying more attention to income adequacy and prevention of poverty among retirees (OECD, 2017). In the European context, analysis of the different aging models—successful aging, healthy aging, active aging, and so on—has been the object of great interest and has given rise to a whole series of scientific approaches that delve into the ideological positioning of these models (Biggs, 2014; van Dyk, 2014; Grenier et al., 2017; Lassen & Moreira, 2014; Moulaert & Biggs, 2013). However, the results of different studies on AA performed to date in Europe (De São Jóse & Teixeira 2014; Evans et al., 2018; Fernández-Mayoralas et al., 2014; Kildal & Nilssen, 2013; Moulaert & Paris, 2013; Ramiro Fariñas, 2012) have concluded that this way of understanding aging has limited theoretical grounding that conforms only marginally to reality and has empirical and methodological shortcomings. Moreover, there is no consensus among the different experts and institutions about what a precise definition of the paradigm might be (De São Jóse & Teixeira, 2014; Lassen & Moreira, 2014; Rubinstein & de Medeiros, 2015). Nonetheless, institutional discourses on AA by EU, OECD, and WHO are influencing public policies on aging at different levels. For instance, the European social partners have signed an autonomous framework agreement to contribute to EU policies on AA (ETUC-CES, Business Europe, CEEP, & UEAPME, 2017), and changes in workers’ retirement plans are quite consistent with the AA agenda set by policy makers in Europe (Principi et al., 2018). Still, national and local contexts may twist the pathways to AA formulated by larger institutional policies, at it is the case in Poland where the government has passed legislation lowering retirement age against the international AA trend to extend working lives (Ball, 2019). Objectives Previous studies have questioned the discourses of AA, its dimensions and implications, the conceptualizations and political formulations that derive from the AA paradigm, and its evolution as formulated by different international institutions (De São Jóse & Teixeira 2014; Evans et al., 2018; Fernández-Mayoralas et al., 2014; Kildal & Nilssen, 2013; Lassen & Moreira, 2014; Lloyd et al., 2014; Moulaert & Viriot, 2015; Ramiro Fariñas, 2012). At this point it is evident that within the institutional field, there are divergent political and scientific discourses concerning AA, all struggling for hegemony in the regulation of old age, aging experiences, and life courses. Against this backdrop, our analysis intends to shed further light on and update available knowledge of the AA discourses produced by the three institutions selected by Ervik. To date other contributions similar to the work of Ervik (2006) have been made (Boudiny, 2013; Sánchez & Hatton-Yeo, 2012), but none has updated the conclusions drawn by him nor offered a diachronic view of possible changes in the institutional representation of the AA paradigm. This lack of continuity in the analyses needs to be corrected. So, the objective we set for ourselves, in consonance with Ervik (2006), has been to study and do, within a European perspective, a detailed comparison of the themes and dimensions of the AA paradigm, as formulated in the discourses of three institutional actors who continue to be the main international referents in this area: the WHO, OECD, and EU. This article hopes as well to contribute to the debate on AA by exploring potential changes that may have occurred in these institutional discourses regarding AA after the last document (dated in 2001) included in Ervik’s seminal work. First we will present a qualitative analysis of some official documents related to AA produced by the WHO, OECD, and EU in the period 2002–2015. Then, after examining and interpreting the selected institutional discourses, we will present any advances we have made with respect to the work by Ervik (2006). This, finally, will enable us to see the most current positions and transitions in relation to the AA paradigm as formulated by the three international institutional actors selected. Methods Following the guidelines proposed by Saldaña (2015), a qualitative design was developed by combining a content analysis and a thematic analysis (Vaismoradi, Turunen, & Bondas, 2013). The former made it possible to identify and quantify categories and general thematic patterns existing in each of the selected documents. The thematic analysis was focused on looking more closely at specific trends in the themes identified and on comparing specific aspects of the sampled institutional discourses about the AA paradigm. All of this was performed as a systematic process that included search, reading, organization, categorization, and codification tasks—both manual and computerized—which have been performed with the support of NVivo 11. Corpus of Analysis First of all, to define the corpus of documents that would be analyzed, an exhaustive online search was performed to locate documents on the subject of aging and linked to supragovernmental institutions. Second, and with the aim of aligning our work with that of Ervik (2006), we reduced the search to the same three institutions chosen by that author: the WHO, EU, and OECD. After examining all the material obtained—a total of 26 documents—we selected for analysis the documents published between 2002 and 2015, a period during which some relevant institutional initiatives concerning AA were taken (as illustrated earlier), but that Ervik (2006) could not cover because institutional documents in his study only expanded until 2001. We then discarded all documents that did not meet two basic external coherence requirements: referring to the term “active aging” and having recognized institutional authorship. Finally, the definitive list of documents to examine was submitted to both specialists employed by the three institutions selected and other experts in the field, for their appraisal. These consultants made suggestions and confirmed the pertinence and relevance of the sample. The final corpus of documents consisted of 15 sources (Table 1). Table 1. List of Documents Included in the Corpus in Chronological Order Document number Institution Year Title 1 WHO 2002 Active aging. A policy framework (+) 2 EU 2002 Increasing labor-force participation and promoting active aging (+) 3 OECD 2003 Policies for an Aging Society: Recent measures and Areas (−) 4 WHO 2004 International Plan of Action on Aging: Report on implementation (+) 5 OECD 2006 Live longer, Work longer (−) 6 EU 2006 The demographic future of Europe (+) 7 WHO 2007 Global Age-friendly Cities (+) 8 WHO 2008 Older Persons in emergencies (+) 9 OECD 2009 Policies for healthy aging: an overview (+) 10 EU 2010 Council conclusions on Active Aging (+) 11 EU 2012 The EU Contribution to Active Aging and Solidarity between Generations (+) 12 EU 2012 Council Declaration on the European Year for Active Aging and Solidarity between Generations (+) 13 OECD 2013 Recommendation of the Council on Aging and Employment Policies (−) 14 EU 2014 Result and Implementation of the 2012 European year for Active Aging (+) 15 WHO 2015 World report on aging and health (+) Document number Institution Year Title 1 WHO 2002 Active aging. A policy framework (+) 2 EU 2002 Increasing labor-force participation and promoting active aging (+) 3 OECD 2003 Policies for an Aging Society: Recent measures and Areas (−) 4 WHO 2004 International Plan of Action on Aging: Report on implementation (+) 5 OECD 2006 Live longer, Work longer (−) 6 EU 2006 The demographic future of Europe (+) 7 WHO 2007 Global Age-friendly Cities (+) 8 WHO 2008 Older Persons in emergencies (+) 9 OECD 2009 Policies for healthy aging: an overview (+) 10 EU 2010 Council conclusions on Active Aging (+) 11 EU 2012 The EU Contribution to Active Aging and Solidarity between Generations (+) 12 EU 2012 Council Declaration on the European Year for Active Aging and Solidarity between Generations (+) 13 OECD 2013 Recommendation of the Council on Aging and Employment Policies (−) 14 EU 2014 Result and Implementation of the 2012 European year for Active Aging (+) 15 WHO 2015 World report on aging and health (+) Note: The symbol (+) is used for “central texts” and the (−) for “contextual texts.” EU = European Union; OECD = Organization for Economic Cooperation and Development; WHO = World Health Organization. View Large Table 1. List of Documents Included in the Corpus in Chronological Order Document number Institution Year Title 1 WHO 2002 Active aging. A policy framework (+) 2 EU 2002 Increasing labor-force participation and promoting active aging (+) 3 OECD 2003 Policies for an Aging Society: Recent measures and Areas (−) 4 WHO 2004 International Plan of Action on Aging: Report on implementation (+) 5 OECD 2006 Live longer, Work longer (−) 6 EU 2006 The demographic future of Europe (+) 7 WHO 2007 Global Age-friendly Cities (+) 8 WHO 2008 Older Persons in emergencies (+) 9 OECD 2009 Policies for healthy aging: an overview (+) 10 EU 2010 Council conclusions on Active Aging (+) 11 EU 2012 The EU Contribution to Active Aging and Solidarity between Generations (+) 12 EU 2012 Council Declaration on the European Year for Active Aging and Solidarity between Generations (+) 13 OECD 2013 Recommendation of the Council on Aging and Employment Policies (−) 14 EU 2014 Result and Implementation of the 2012 European year for Active Aging (+) 15 WHO 2015 World report on aging and health (+) Document number Institution Year Title 1 WHO 2002 Active aging. A policy framework (+) 2 EU 2002 Increasing labor-force participation and promoting active aging (+) 3 OECD 2003 Policies for an Aging Society: Recent measures and Areas (−) 4 WHO 2004 International Plan of Action on Aging: Report on implementation (+) 5 OECD 2006 Live longer, Work longer (−) 6 EU 2006 The demographic future of Europe (+) 7 WHO 2007 Global Age-friendly Cities (+) 8 WHO 2008 Older Persons in emergencies (+) 9 OECD 2009 Policies for healthy aging: an overview (+) 10 EU 2010 Council conclusions on Active Aging (+) 11 EU 2012 The EU Contribution to Active Aging and Solidarity between Generations (+) 12 EU 2012 Council Declaration on the European Year for Active Aging and Solidarity between Generations (+) 13 OECD 2013 Recommendation of the Council on Aging and Employment Policies (−) 14 EU 2014 Result and Implementation of the 2012 European year for Active Aging (+) 15 WHO 2015 World report on aging and health (+) Note: The symbol (+) is used for “central texts” and the (−) for “contextual texts.” EU = European Union; OECD = Organization for Economic Cooperation and Development; WHO = World Health Organization. View Large After an initial reading of the sources selected, we observed that although most of them made explicit mention of AA, others referred to it only implicitly. This observation prompted us to reorganize the corpus of documents into two categories: “central texts” are those that cite the expression often and explicitly whereas “contextual texts” are those that refer to it implicitly and only occasionally (see Table 1). Analysis Procedure Two analytical strategies were adopted: in the first place, the analytical reading and manual coding of the central texts, and then a content and thematic analysis, with the support of the NVivo program, of both the central texts and the contextual texts. An exhaustive coding process allowed us to do a description and comparison through idea grouping, graphic representation, fragment selection, and interpretive notes on the discourse of the respective institutions regarding AA. Following the review of the literature and the first manual deductive analysis, a list of draft codes was produced by the first author after qualitative analysis of documents in the corpus, and a preliminary book of codes/subcodes was designed, to which some NVivo subcodes produced inductively during the analytical process were added later. The first author did an initial coding round and the second author reviewed it independently afterwards to ensure validity and consistency. Results To organize the results of the content and thematic analysis more productively, the use of two general taxonomic criteria was decided. On the one hand, the presence/absence of codes and subcodes, and, when present, their proportion in each document. And on the other hand, the specific aspects covered by the codes and subcodes present. Justification and Basic Principles To begin, we observed that several concepts of aging appear in the sample’s documents, with the AA concept predominating in the discourses of the institutions selected. The subcodes active and healthy—in that order—are the ones that appear most commonly in the language of the three institutions. The subcode active appears primarily in the WHO and EU documents, but not in the majority of the OECD cases or in the most recent WHO case (#15-2015), which focus specifically on the concept of healthy aging. (To refer to the different documents analyzed throughout the article, the following methods are used. When a simple allusion is being made to one or more documents, the formula “[#Document no.-year of publication]” will be used. When a fragment of the document needs to be reproduced, then the format will be as follows: “Document #no.: ‘literal fragment’ [correct citation of the source].”) Institutional production of the AA paradigm is often justified, in theoretical terms, by the need to respond to age and work discrimination and also by the need to increase older workers’ employability and create flexible work opportunities for them. The analysis has revealed that the subcodes age/work discrimination and employability/work flexibility appear in most cases and years of all three institutions. In addition, the results show that all three versions of the paradigm share, as basic principles of good aging, the idea of maintaining autonomy, and independence in old age: the subcode autonomy/independence appears frequently in the cases of the three selected institutions. This theoretical justification and these basic principles can be considered vital components of the WHO, EU, and OECD’s institutional definition of the proper way to age, which has been translated into activities, interventions, and reforms included in the design of AA policies. Themes Present, Themes Absent The analysis has allowed us to determine, by quantifying the frequencies of the codes, which themes receive more or less attention by each institution and by the three as a group. The presence of more allusions to a certain theme means that the institution in question gives higher priority to including that theme in its discourse on AA. In this regard, the results tell us that the predominant themes are the following: participation/contribution and preventive health interventions (with a high proportion of references to these particular codes) in the WHO documents; labor perspective, in the sources from the OECD; and labor perspective and participation/contribution, in the cases of the EU. It is also possible to specify, for the sample as a whole, which themes are less frequent in some of the specific institutional discourses (by contrast with the rest), as occurs, for example, in the cases of the WHO with the theme labor perspective, and in the sources of the OECD with participation/contribution (Figure 1). Figure 1. View largeDownload slide Agenda of identified Active Aging themes by institution. EU = European Union; OECD = Organization for Economic Cooperation and Development; WHO = World Health Organization. Figure 1. View largeDownload slide Agenda of identified Active Aging themes by institution. EU = European Union; OECD = Organization for Economic Cooperation and Development; WHO = World Health Organization. Figure 2 provides a different vision of the thematic distribution, one that facilitates a comparative reading of the results. We see that the most recurring and most transversal themes in all the cases of the three institutions are participation/contribution (in EU and WHO documents) and labor perspective (in the EU and OECD cases). As for the WHO discourse, here special emphasis goes to the question of preventive interventions. Figure 2. View largeDownload slide Comparing institutional Active Aging discourses by themes. EU = European Union; OECD = Organization for Economic Cooperation and Development; WHO = World Health Organization. Figure 2. View largeDownload slide Comparing institutional Active Aging discourses by themes. EU = European Union; OECD = Organization for Economic Cooperation and Development; WHO = World Health Organization. Themes Over Time Paying attention to when the different themes have been more or less present in the discourses allows us to better understand their evolution and, as a result, that of the AA paradigm itself, as viewed by the three institutions selected. One finding that stands out in the EU documents is the presence and high proportion of references to participation/contribution and labor perspective in all the cases and years (from #2-2002 to #12-2012). In the OECD sources, changes are observed in the attention paid to labor perspective, with more presence and higher proportion of references in its older documents (#3-2003 and #5-2006) and less in the more recent ones (#9-2009 and #14-2013), in favor of other matters. Finally, the WHO discourse shows considerable allusion to participation/contribution and preventive health interventions, which increases over time (from #1-2002 to #15-2015), albeit with uneven attention (in #4-2004, #7-2007, and #8-2008). Aspects of the Themes The thematic analysis has allowed us to go beyond the mere enunciation of the topics addressed in the selected discourses. We have been able to reach a level of greater detail, discovering which concrete aspects, within each theme, are chosen by each institution to speak about that theme. We believe it is not enough to simply assert that the AA paradigm speaks about certain themes because with the passage of time these themes have developed in different ways. Participation/contribution For instance, we have seen that the theme participation/contribution is transversal to the institutional discourses of the WHO (#1-2002) and some of the EU institutions, more specifically the Council of the European Union (2002) (#2-2002). However, its treatment varies between one institution and another, showing certain similarities and differences. The fundamental similarity is that both organizations consider it necessary to promote participation in AA in the context of demographic aging, in relation to issues such as care costs and the sustainability of pension systems. Nonetheless, the EU (#11-2012) leans toward participation in the work sense and in ways linked, for example, to lifelong learning, but the WHO (#15-2015) favors participation in a broader sense, through, for example, volunteer work or caregiving: Document #11: “Making lifelong learning a reality will enable active aging by developing and maintaining the skills and competences people need to work and to take part fully in society.” (EU, 2012, p. 18) Document #15: “Volunteering and working are two important ways that adults use to find fulfillment in older age and are used [. . .] to illustrate the ability to contribute.” (WHO, 2015, p. 189) Despite their differences, these discourses share the idea of activation and mobilization of older people, especially in the form of productive contribution, something that appeared in the WHO’s first discourse (#1-2002) and continues to this day (#15-2015): Document #1: “Recognize and enable the active participation of people in economic development activities, formal and informal work and voluntary activities as they age, according to their individual needs, preferences and capacities.” (WHO, 2002, p. 51) Document #15: “A third reason for taking action is the economic imperative to adapt to shifts in the age structure in ways that minimize the expenditures associated with population aging while maximizing the many contributions that older people make. These contributions may be made by direct participation in the formal or informal workforce (. . .).” (WHO, 2015, p. 16) As time has passed, the EU has attempted to bring its discourse closer to that of the WHO, with broader proposals for participation, as can be seen in the European Commission’s discourse (#11-2012): Document #11: “It is necessary to act to allow both women and men to remain active as workers, consumers, carers, volunteers and citizens and to preserve solidarity between generations.” (European Commission, 2012, p. 3) Overall, the results show that the measures taken regarding the participation of older people, a central principle of these institutional discourses, are very much in line with the promotion of activities that can be interpreted as economic development. Labor perspective Now we will discuss the treatment of the labor perspective as a transversal component of the thematic structure of AA in the cases of the EU—specifically, the European Commission (#6-2006) —and the OECD (#5-2006). Both institutions advocate that certain reforms be made to existing systems of social protection over time, for example, through the connection between the working life of older people and employment policies: Document #6: “It must also be ensured that it is effectively possible to work for longer and that public employment policies as a whole create more job opportunities for older workers.” (European Commission, 2006, p. 9) Document #5: “More fundamentally, this new reform agenda is intended to convert the process of population and workforce aging into an opportunity for society and older workers themselves.” (OECD, 2006, p. 9) We have found, though, that the EU and OECD approaches to the labor perspective frequently emphasize different aspects. For example, the Council of the European Union (#10-2010) associates the labor perspective with intergenerational solidarity whereas the OECD (#9-2009) associates it more with limiting early retirement or promoting flexible retirement: Document #10: [The Council of the European Union acknowledges] “As many Europeans live longer and healthier lives, enabling and encouraging older workers to remain on the labor market is an important contribution to intergenerational solidarity.” (Council of the European Union, 2010, p. 4) Document #9: “However, as populations age, incentives to remain economically active may need to be reinforced further and there remains some way to go in limiting the scope for early retirement through unemployment or disability benefits).” (OECD, 2009, p. 14) Such differences do not seem very significant when compared to the similarities found in the European Commission (#11-2012) and OECD (#13-2013) discourses in terms of their treatment of the employability and work flexibility of older people with a view to prolonging their working lives: Document #11: “[Active ageing means] Enabling both women and men to remain in employment longer—by overcoming structural barriers (including a lack of support for informal carers) and offering appropriate incentives, many older people can be helped to remain active in the labour market, with systemic and individual benefits.” (European Commission, 2012, p. 3) Document #13: “There remains considerable scope for further progress towards the objective of an integrated and comprehensive policy approach to achieve longer and better working lives and boost labor market prospects for older people.” (OECD, 2013, p. 1) From these results, we can see that the proposal to extend the working life of older people is necessarily linked to raising the age of retirement, which is something that in these discourses appears in combination with employability and with flexible, gradual, or partial retirement. The EU introduces the flexibility of employment periods into the labor perspective, and the OECD view is that that economic sufficiency will be achieved by reforming the systems that provide social protection in old age. Preventive health interventions The theme code preventive health interventions is very common in the WHO discourse (#1-2002; #15-2015). Over time this institution has emphasized health policy development and also issues related to caregiving and long-term care. However, the WHO (#8-2008; #15-2015) coincides with the OECD (#9-2009) in certain aspects of preventive health interventions, specifically, assessments regarding the return on prevention and on the adoption of healthy lifestyles: Document #8: “Adoption of healthy lifestyles and actively participating in one’s own care are vital at all ages to maintain good health.” (WHO, 2008, p. 32) Document #9: “Better lifestyles are likely to be key to further improvements in the longer-term health of the elderly. (. . .) To determine whether preventive interventions will increase social welfare, the costs and benefits of such intentions need to be compared with alternative courses of action.” (OECD, 2009, pp. 10, 12) Something similar occurs with the WHO (#1-2002) and the Council of the European Union (#10-2010), as shown by the importance placed by both institutions on the life course perspective, albeit with differences in its application: Document #7: “A life course perspective on ageing recognizes that older people are not one homogeneous group and that individual diversity tends to increase with age. Interventions that create supportive environments and foster healthy choices are important at all stages of life.” (WHO, 2002, p. 14) Document #10: “Europe’s future economic competitiveness and prosperity depends crucially on its ability to fully utilize its labor resources, including through the extension of employment periods over the life course and through the adoption of appropriate policies to reconcile work, family and private life.” (Council of the European Union, 2010, p. 4) The results show that interest in older people’s health is shared by the three institutions, with certain differences. Health is not just an individual question related to behavior or lifestyle choices, as some EU and OECD discourses would suggest; it is also related to health care systems and to prevention measures, determining factors to take into account in the promotion of decisions that have an impact on health. Document #9: “Better lifestyles are likely to be key to further improvements in the longer-term health of the elderly. But because they require changes to individual behaviour, improvements in this policy dimension may be difficult to engineer. While it is ‘never too early and never too late’ to change lifestyles, it is clear that, the earlier risky behaviour changes, the higher the chances of enjoying longer healthy lives.” (OECD, 2009, p. 10) Discussion and Implications According to the documentation analyzed, in general terms, the institutional discourses on AA formulated by the OECD, EU, and WHO are still different, although they show certain similarities, as the work by Ervik revealed in its day. As for the differences, the WHO discourse on AA focuses on participation in a broad sense and it is increasingly emphasizing health improvement by means of interventions all along the life course. It stresses the return on prevention and its impact on health care costs. The EU and OECD tend to highlight more the productive and economic nature of AA. They direct their attention toward the relationship between employability/work flexibility and the reform of labor and pension systems, although they also make reference to health interventions, for example, through the maintenance of healthy lifestyles. On the one hand, the EU attempts to move closer to the WHO discourse and distance itself from the OECD by intending to use a broad concept of participation and emphasizing the importance of the life course. However, on the other hand, both the EU and the OECD allude to the extension of the working period and they both introduce the issue of rethinking retirement as a relevant factor. Likewise, all three discourses similarly consider AA a necessity (hence, the normative nature of the paradigm), especially taking into account the financial effects of the demographic changes underway, which point to the importance of engaging in productive activities—whether socially or economically productive—and maintaining independent and healthy lifestyles so as to counter age and work discrimination. In short, our analysis reveals that the different institutional discourses regarding AA have undergone some changes but not very significant ones since Ervik’s study in 2006. Said discourses already had different conceptualizations and political formulations that Ervik (2006) looked at closely and even represented graphically as a “rough heuristic device” (p. 5) (Figure 3). Figure 3. View largeDownload slide Dimensions of Active Aging in conceptualizations and policies of international actors. Source: Adapted from Ervik (2006, p. 5). EU = European Union; OECD = Organization for Economic Cooperation and Development; UN = United Nations; WHO = World Health Organization. Figure 3. View largeDownload slide Dimensions of Active Aging in conceptualizations and policies of international actors. Source: Adapted from Ervik (2006, p. 5). EU = European Union; OECD = Organization for Economic Cooperation and Development; UN = United Nations; WHO = World Health Organization. Making use of such representation, our research makes it possible to offer a reformulated and updated vision of these differences. Our alternative schematic representation (Figure 4), a heuristic device too, is composed of three dimensions—one more than those suggested by Ervik (2006)—stemming from our analysis: a labor dimension (y-axis), which distinguishes between work understood mainly until the stage ending upon retirement to connect it with amore extended period of the life course; a participation/contribution dimension (x-axis), which reflects the different treatments of productive participation as a dimension of AA, from linking it mainly to economic productivity to connecting it with a broader sense of social participation; and finally, the health dimension (circular tags), which represents how much attention is paid to health and preventive measures as a key feature in the AA paradigm: the larger the circular tag, the stronger the call for a health focused AA. Figure 4. View largeDownload slide Current dimensions of Active Aging in WHO, EU, and OECD discourses. EU = European Union; OECD = Organization for Economic Cooperation and Development; WHO = World Health Organization. Figure 4. View largeDownload slide Current dimensions of Active Aging in WHO, EU, and OECD discourses. EU = European Union; OECD = Organization for Economic Cooperation and Development; WHO = World Health Organization. Implications Although it is rarely performed, a first implication for practitioners and policymakers is that they should really speak of AA in the plural rather than in the singular, in order to convey that in truth different versions of AA exist, something that our analysis has confirmed. In fact, the differences identified in the institutions’ discourses concerning AA reflect their different roles and contexts. The development of the AA paradigm thus faces a dilemma that is both conceptual and political, due to the coexistence of heterogeneous institutional discourses and practices which, moreover, refer to a reality that is even more diverse (Moulaert & Léonard, 2015). The AA paradigm is built semantically in divergent ways through the ideological positions of different institutional actors, although such positions are not always made explicit. In general, the paradigm’s operational aspects are heavily shaped by interests that may be scientific, political, or of practical application (Fernández-Mayoralas et al., 2014). In harmony with the findings of Lassen (2015), it is easy to see that there are different institutional histories and understandings of the AA paradigm, that they all seek to establish—again, the normative tone—an imaginary about AA at the European level, and that they partially share a vision about how to regulate the aging of the population (Lloyd et al., 2014). As Ervik (2006) pointed out, some of the normative implications of the AA paradigm are associated with its emphasis on productive practices, which contributes to the creation of expectations in old age that can be quite unrealistic or even imposed. This brings with it the risk that the political use of the paradigm will be empty of meaning and content (Foster & Walker, 2015; Walker, 2015; Walker & Maltby, 2012). The normative prescription that old age should be positive—present in the discourses analyzed—gives a certain homogenous meaning to AA, which facilitates it being perceived as a tool for renegotiating old age (van Dyk, 2014). One tendency that has grown since Ervik (2006), and something that stands out among the data analyzed, is that despite the existence of different institutional discourses on AA, they all include increasingly the productive ideal of extending the working lives of older people, with the OECD and EU at the front. So, there seems to be a tendency to institutionally homogenize the diversity that characterizes aging experiences and life courses, based on certain impositions linked mainly to economically productive activities, health interventions framed in certain individualist lifestyles, and the reform of social protection systems (Lassen, 2015; Lassen & Moreira, 2014). Overall, there is an emerging duality implicit in how institutional discourses in Europe understand the AA paradigm (Moulaert & Léonard, 2015). We see, on the one hand, the normative approach to good aging mainly circumscribed to employment and working life (Moulaert & Biggs, 2013) and, on the other hand, the defense of a supposed free choice which, in reality, is concealing an exercise in governance from afar (van Dyk, 2014). Normativity and the push for productivity coexist in the period transpiring since the analysis by Ervik (2006), making it possible to speak of active and inactive aging experiences (the latter would include the forms of aging that do not conform to the indications institutionalized by the hegemonic paradigm). AA institutions should pay attention to this new cleavage. The vision of AA that ensues from the addition of health and activity is conditioned by the introduction of normative and economic values, with implications that were already pointed out by Ervik in 2006. As Sánchez and Díaz (2018) maintain, with the passage of time institutional discourses have converged around the defense of a form of aging that is healthy but at the same time does not cease to be productive. Nonetheless, as our analysis reveals, a divergent path has slowly emerged in terms of the accent placed on productivity by the reference institutions in the construction of the paradigm: the more socially productive and health-oriented WHO discourse is slowly separating from the more economically productive and labor-oriented discourses of the EU and OECD (Boudiny, 2013; De São Jóse & Teixeira, 2014; Kildal & Nilssen, 2013; Moulaert & Paris, 2013; Sánchez & Hatton-Yeo, 2012). One conclusion to be drawn is that, in general, and imagining the AA paradigm as a palette of colors, the changes occurring in the discourses since the paper by Ervik (2006) have been more in (productive) tone than in substance; that is, these discourses still revolve around the ideas of aging healthfully and staying productive, always against the backdrop of an ideal type of aging understood in positive terms. We have also seen that the institutional discourses on AA tend to end in a reductive—i.e. quite homogenous—treatment of a phenomenon that is multidimensional, beyond the triad of labor, participation/contribution, and health. The concepts of AA and its policies in Europe as institutional models vary. There are many ways to understand AA and not all are justified by demographic changes alone. Therefore, in terms of another implication for practice and policy, it would be worthwhile to review the models put forward by institutions and experts, and consider a more multidimensional approach to AA, one that corrects its current dominant logic—normative and production-oriented, and in some cases revolved around individual responsibility—and takes into account as well the inequality and redistribution questions associated with aging already raised by Ervik. An implication for researchers, it is important to move forward in the study of AA placing emphasis on the heterogeneity of aging and consequently showing both the positive and not-so-positive aspects in the AA paradigm. Research advances into these diversities will be useful in public policy development and in the organization of more appropriate services for the promotion of AA or other ways—yet to be determined—of understanding not just how persons should age but how they want to age. As regards this last point, international institutions and policymakers should pay close attention and forge a path toward an honest and critical examination of the real conditions and expectations of older people concerning the discursive and practical proposals of AA, in all its different paradigmatic forms. Funding Translation of this work into English has been supported by the Facultad de Ciencias Políticas y Sociología (University of Granada). Conflict of Interest None reported. 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The Institutional Active Aging Paradigm in Europe (2002–2015)

The Gerontologist, Volume Advance Article – Jan 9, 18

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Abstract

Abstract Background and Objectives The paradigm of active aging has been slowly gaining ground in Europe as the ideal framework for public policy and for responding to the population’s aging. Taking the work by Rune Ervik as its point of departure, this article updates his conclusions on conceptualizations and policies of active aging by performing a study of the institutional discourses in the matter produced by the World Health Organization (WHO), the Organization for Economic Cooperation and Development (OECD), and the European Union (EU). Methods A corpus of 15 WHO, OECD, and EU documents published in the period 2002–2015 and tackling active aging were analyzed qualitatively through a combination of content and thematic analysis, based on a scheme integrated by deductive and inductive iterative manual and computerized codification. Results The institutional discourses on active aging analyzed have not changed dramatically in the period considered. However, a divergent path has emerged regarding the accent placed on participation and contribution in the construction of the paradigm: the more socially productive and health-oriented WHO discourse is slowly separating from the more economically productive and labor-oriented discourses of the EU and OECD. Discussion and Implications The institutional paradigm on active aging is evolving into a reductive treatment of a phenomenon that is multidimensional. International institutions and researchers should pay closer attention and forge a path toward an honest and critical examination of the real conditions and expectations of older people concerning the discursive and practical proposals of active aging, in all its different forms. Policy, Qualitative research, Positive aging, Institutional discourse Since the 1990s, the paradigm of Active Aging (AA) has been slowly gaining ground in European institutional, professional, and scientific spheres as the ideal framework for public policy planning and for responding to the population’s aging. (We use the term paradigm in the sense of a broad cosmovision that establishes common notions and is applied extensively. This article explores what we consider to be the hegemonic institutional form of a paradigm.) In Europe, the paradigm’s preeminence today has much to do with its promotion by certain international institutional actors (Walker, 2015) like, for example, the World Health Organization (WHO), the Organization for Economic Cooperation and Development (OECD), and the European Union (EU). Although in different ways, these actors have given AA the status of a politically valid concept and, in one way or another, they have made it a part of their discourses and have taken positions regarding it (Moulaert & Léonard, 2015). From the institutional point of view, the AA paradigm, initially proposed in its most canonic form by the WHO in its document “Active aging. A policy framework” (WHO, 2002), is a positive vision of aging that underlines the importance of certain aspects such as independence and healthy lifestyles, and uses the term active in a broad sense (Foster & Walker, 2015; Walker & Maltby, 2012). Since the start of this century, some relevant initiatives have been undertaken, particularly in Europe, with a view to normalizing the institutional treatment of AA. Two good examples, from a much longer list, are the Second World Assembly on Aging, which was held in 2002 and gave rise to the Madrid International Plan of Action on Aging, and the 2012 European Year for Active Aging and Solidarity between Generations, as designated by the EU (Lloyd et al., 2014; Ramos & Yordi, 2018). The AA paradigm has spread thanks to a variety of initiatives accompanied by discourses related to certain macrostructural changes, such as the reconsideration of caregiving dynamics, the adaptation of social protection systems, and the containment of public spending (De Sâo José & Teixeira, 2014). Hence, an aging paradigm, as institutional model, is not only a reformulation of premises related to aging well, but also an instrument used by certain public actors to reconfigure the social order (Biggs, 2014; Grenier, Lloyd, & Phillipson, 2017; Katz & Calasanti, 2015; Rubinstein & de Medeiros, 2015). In 2006, Rune Ervik presented a paper on the pitfalls and possibilities of AA. This paper was an early invitation to critically discuss the AA paradigm “to ensure that active aging policies are not only effective but also can be morally justified” (p. 2). Specifically, Ervik stressed the need for a continuous debate on the normative implications of AA. This Norwegian scholar analyzed some of the dimensions and transversal questions of AA—“a new catchword on a global scale” (Ervik, 2006, p. 3) —, in the discourses of the OECD, WHO, and EU until 2001. His research revealed the wide array of dimensions (e.g., temporal dimension, transversal issue dimension), meanings (e.g., praise of autonomy), and implications (e.g., danger of paternalism) that the different institutional discourses can have regarding AA. Each institution’s conceptualizations and political formulation regarding AA determine their respective prescriptions on what the appropriate and recommendable aging experience is; hence, the normative nature of a paradigm pointing out that we must age in a certain way, the way being put forward as institutionally positive and appropriate. However, Ervik (2006) argued, “active ageing does not replace the old social policy questions of inequality, redistribution and security that will arise also within this new paradigm” (p. 9). Nor AA—Ervik posited— can ignore relevant individual differences within the heterogeneous category of old or aging people, for those not fitting into the paradigm would be excluded. The normative nature of the discourses regarding AA has been amply discussed (van Dyk, 2014; Holstein & Minkler, 2007; Ramiro Fariñas, 2012) since Ervik’s paper, and being active has become currently a normative imperative for many older people (Gard et al., 2017 as cited in Evans, Nistrup, & Pfister, 2018). In this regard, there are public actors that, with a view to promoting the different aging paradigms, are even encouraging older people to assume part of the responsibility for these problems (Evans et al., 2018; Katz & Calasanti, 2015; Lloyd et al., 2014; Rubinstein & de Medeiros, 2015), something already put forward by Ervik (2006). Regarding inequality and diversity among older people since Ervik’s work, the OECD (2017) has warned that although generally speaking health status and income levels of older people have improved, socioeconomic disparities remain large, and inequality in old age is at risk of increasing among future retirees given unstable labor conditions and earnings of younger generations at the moment. Likewise, a recent report on older persons’ poverty and social exclusion in the EU (Age Platform Europe, 2018) has concluded that “isolation, invisibility and loneliness are important issues for many older people that hinder their integration into society and undermine the aim of active and healthy ageing” (p. 9). Current stark inequalities—associated for instance with race, ethnicity, gender, migration, and disabilities—in how different people experience later life (Scharf, Shaw, Bamford, Beach, & Hochlaf, 2017) indicate that Ervik’s assertion that individual diversity tends to increase with age is still valid for Europe. Public policy debates seem to be paying more attention to income adequacy and prevention of poverty among retirees (OECD, 2017). In the European context, analysis of the different aging models—successful aging, healthy aging, active aging, and so on—has been the object of great interest and has given rise to a whole series of scientific approaches that delve into the ideological positioning of these models (Biggs, 2014; van Dyk, 2014; Grenier et al., 2017; Lassen & Moreira, 2014; Moulaert & Biggs, 2013). However, the results of different studies on AA performed to date in Europe (De São Jóse & Teixeira 2014; Evans et al., 2018; Fernández-Mayoralas et al., 2014; Kildal & Nilssen, 2013; Moulaert & Paris, 2013; Ramiro Fariñas, 2012) have concluded that this way of understanding aging has limited theoretical grounding that conforms only marginally to reality and has empirical and methodological shortcomings. Moreover, there is no consensus among the different experts and institutions about what a precise definition of the paradigm might be (De São Jóse & Teixeira, 2014; Lassen & Moreira, 2014; Rubinstein & de Medeiros, 2015). Nonetheless, institutional discourses on AA by EU, OECD, and WHO are influencing public policies on aging at different levels. For instance, the European social partners have signed an autonomous framework agreement to contribute to EU policies on AA (ETUC-CES, Business Europe, CEEP, & UEAPME, 2017), and changes in workers’ retirement plans are quite consistent with the AA agenda set by policy makers in Europe (Principi et al., 2018). Still, national and local contexts may twist the pathways to AA formulated by larger institutional policies, at it is the case in Poland where the government has passed legislation lowering retirement age against the international AA trend to extend working lives (Ball, 2019). Objectives Previous studies have questioned the discourses of AA, its dimensions and implications, the conceptualizations and political formulations that derive from the AA paradigm, and its evolution as formulated by different international institutions (De São Jóse & Teixeira 2014; Evans et al., 2018; Fernández-Mayoralas et al., 2014; Kildal & Nilssen, 2013; Lassen & Moreira, 2014; Lloyd et al., 2014; Moulaert & Viriot, 2015; Ramiro Fariñas, 2012). At this point it is evident that within the institutional field, there are divergent political and scientific discourses concerning AA, all struggling for hegemony in the regulation of old age, aging experiences, and life courses. Against this backdrop, our analysis intends to shed further light on and update available knowledge of the AA discourses produced by the three institutions selected by Ervik. To date other contributions similar to the work of Ervik (2006) have been made (Boudiny, 2013; Sánchez & Hatton-Yeo, 2012), but none has updated the conclusions drawn by him nor offered a diachronic view of possible changes in the institutional representation of the AA paradigm. This lack of continuity in the analyses needs to be corrected. So, the objective we set for ourselves, in consonance with Ervik (2006), has been to study and do, within a European perspective, a detailed comparison of the themes and dimensions of the AA paradigm, as formulated in the discourses of three institutional actors who continue to be the main international referents in this area: the WHO, OECD, and EU. This article hopes as well to contribute to the debate on AA by exploring potential changes that may have occurred in these institutional discourses regarding AA after the last document (dated in 2001) included in Ervik’s seminal work. First we will present a qualitative analysis of some official documents related to AA produced by the WHO, OECD, and EU in the period 2002–2015. Then, after examining and interpreting the selected institutional discourses, we will present any advances we have made with respect to the work by Ervik (2006). This, finally, will enable us to see the most current positions and transitions in relation to the AA paradigm as formulated by the three international institutional actors selected. Methods Following the guidelines proposed by Saldaña (2015), a qualitative design was developed by combining a content analysis and a thematic analysis (Vaismoradi, Turunen, & Bondas, 2013). The former made it possible to identify and quantify categories and general thematic patterns existing in each of the selected documents. The thematic analysis was focused on looking more closely at specific trends in the themes identified and on comparing specific aspects of the sampled institutional discourses about the AA paradigm. All of this was performed as a systematic process that included search, reading, organization, categorization, and codification tasks—both manual and computerized—which have been performed with the support of NVivo 11. Corpus of Analysis First of all, to define the corpus of documents that would be analyzed, an exhaustive online search was performed to locate documents on the subject of aging and linked to supragovernmental institutions. Second, and with the aim of aligning our work with that of Ervik (2006), we reduced the search to the same three institutions chosen by that author: the WHO, EU, and OECD. After examining all the material obtained—a total of 26 documents—we selected for analysis the documents published between 2002 and 2015, a period during which some relevant institutional initiatives concerning AA were taken (as illustrated earlier), but that Ervik (2006) could not cover because institutional documents in his study only expanded until 2001. We then discarded all documents that did not meet two basic external coherence requirements: referring to the term “active aging” and having recognized institutional authorship. Finally, the definitive list of documents to examine was submitted to both specialists employed by the three institutions selected and other experts in the field, for their appraisal. These consultants made suggestions and confirmed the pertinence and relevance of the sample. The final corpus of documents consisted of 15 sources (Table 1). Table 1. List of Documents Included in the Corpus in Chronological Order Document number Institution Year Title 1 WHO 2002 Active aging. A policy framework (+) 2 EU 2002 Increasing labor-force participation and promoting active aging (+) 3 OECD 2003 Policies for an Aging Society: Recent measures and Areas (−) 4 WHO 2004 International Plan of Action on Aging: Report on implementation (+) 5 OECD 2006 Live longer, Work longer (−) 6 EU 2006 The demographic future of Europe (+) 7 WHO 2007 Global Age-friendly Cities (+) 8 WHO 2008 Older Persons in emergencies (+) 9 OECD 2009 Policies for healthy aging: an overview (+) 10 EU 2010 Council conclusions on Active Aging (+) 11 EU 2012 The EU Contribution to Active Aging and Solidarity between Generations (+) 12 EU 2012 Council Declaration on the European Year for Active Aging and Solidarity between Generations (+) 13 OECD 2013 Recommendation of the Council on Aging and Employment Policies (−) 14 EU 2014 Result and Implementation of the 2012 European year for Active Aging (+) 15 WHO 2015 World report on aging and health (+) Document number Institution Year Title 1 WHO 2002 Active aging. A policy framework (+) 2 EU 2002 Increasing labor-force participation and promoting active aging (+) 3 OECD 2003 Policies for an Aging Society: Recent measures and Areas (−) 4 WHO 2004 International Plan of Action on Aging: Report on implementation (+) 5 OECD 2006 Live longer, Work longer (−) 6 EU 2006 The demographic future of Europe (+) 7 WHO 2007 Global Age-friendly Cities (+) 8 WHO 2008 Older Persons in emergencies (+) 9 OECD 2009 Policies for healthy aging: an overview (+) 10 EU 2010 Council conclusions on Active Aging (+) 11 EU 2012 The EU Contribution to Active Aging and Solidarity between Generations (+) 12 EU 2012 Council Declaration on the European Year for Active Aging and Solidarity between Generations (+) 13 OECD 2013 Recommendation of the Council on Aging and Employment Policies (−) 14 EU 2014 Result and Implementation of the 2012 European year for Active Aging (+) 15 WHO 2015 World report on aging and health (+) Note: The symbol (+) is used for “central texts” and the (−) for “contextual texts.” EU = European Union; OECD = Organization for Economic Cooperation and Development; WHO = World Health Organization. View Large Table 1. List of Documents Included in the Corpus in Chronological Order Document number Institution Year Title 1 WHO 2002 Active aging. A policy framework (+) 2 EU 2002 Increasing labor-force participation and promoting active aging (+) 3 OECD 2003 Policies for an Aging Society: Recent measures and Areas (−) 4 WHO 2004 International Plan of Action on Aging: Report on implementation (+) 5 OECD 2006 Live longer, Work longer (−) 6 EU 2006 The demographic future of Europe (+) 7 WHO 2007 Global Age-friendly Cities (+) 8 WHO 2008 Older Persons in emergencies (+) 9 OECD 2009 Policies for healthy aging: an overview (+) 10 EU 2010 Council conclusions on Active Aging (+) 11 EU 2012 The EU Contribution to Active Aging and Solidarity between Generations (+) 12 EU 2012 Council Declaration on the European Year for Active Aging and Solidarity between Generations (+) 13 OECD 2013 Recommendation of the Council on Aging and Employment Policies (−) 14 EU 2014 Result and Implementation of the 2012 European year for Active Aging (+) 15 WHO 2015 World report on aging and health (+) Document number Institution Year Title 1 WHO 2002 Active aging. A policy framework (+) 2 EU 2002 Increasing labor-force participation and promoting active aging (+) 3 OECD 2003 Policies for an Aging Society: Recent measures and Areas (−) 4 WHO 2004 International Plan of Action on Aging: Report on implementation (+) 5 OECD 2006 Live longer, Work longer (−) 6 EU 2006 The demographic future of Europe (+) 7 WHO 2007 Global Age-friendly Cities (+) 8 WHO 2008 Older Persons in emergencies (+) 9 OECD 2009 Policies for healthy aging: an overview (+) 10 EU 2010 Council conclusions on Active Aging (+) 11 EU 2012 The EU Contribution to Active Aging and Solidarity between Generations (+) 12 EU 2012 Council Declaration on the European Year for Active Aging and Solidarity between Generations (+) 13 OECD 2013 Recommendation of the Council on Aging and Employment Policies (−) 14 EU 2014 Result and Implementation of the 2012 European year for Active Aging (+) 15 WHO 2015 World report on aging and health (+) Note: The symbol (+) is used for “central texts” and the (−) for “contextual texts.” EU = European Union; OECD = Organization for Economic Cooperation and Development; WHO = World Health Organization. View Large After an initial reading of the sources selected, we observed that although most of them made explicit mention of AA, others referred to it only implicitly. This observation prompted us to reorganize the corpus of documents into two categories: “central texts” are those that cite the expression often and explicitly whereas “contextual texts” are those that refer to it implicitly and only occasionally (see Table 1). Analysis Procedure Two analytical strategies were adopted: in the first place, the analytical reading and manual coding of the central texts, and then a content and thematic analysis, with the support of the NVivo program, of both the central texts and the contextual texts. An exhaustive coding process allowed us to do a description and comparison through idea grouping, graphic representation, fragment selection, and interpretive notes on the discourse of the respective institutions regarding AA. Following the review of the literature and the first manual deductive analysis, a list of draft codes was produced by the first author after qualitative analysis of documents in the corpus, and a preliminary book of codes/subcodes was designed, to which some NVivo subcodes produced inductively during the analytical process were added later. The first author did an initial coding round and the second author reviewed it independently afterwards to ensure validity and consistency. Results To organize the results of the content and thematic analysis more productively, the use of two general taxonomic criteria was decided. On the one hand, the presence/absence of codes and subcodes, and, when present, their proportion in each document. And on the other hand, the specific aspects covered by the codes and subcodes present. Justification and Basic Principles To begin, we observed that several concepts of aging appear in the sample’s documents, with the AA concept predominating in the discourses of the institutions selected. The subcodes active and healthy—in that order—are the ones that appear most commonly in the language of the three institutions. The subcode active appears primarily in the WHO and EU documents, but not in the majority of the OECD cases or in the most recent WHO case (#15-2015), which focus specifically on the concept of healthy aging. (To refer to the different documents analyzed throughout the article, the following methods are used. When a simple allusion is being made to one or more documents, the formula “[#Document no.-year of publication]” will be used. When a fragment of the document needs to be reproduced, then the format will be as follows: “Document #no.: ‘literal fragment’ [correct citation of the source].”) Institutional production of the AA paradigm is often justified, in theoretical terms, by the need to respond to age and work discrimination and also by the need to increase older workers’ employability and create flexible work opportunities for them. The analysis has revealed that the subcodes age/work discrimination and employability/work flexibility appear in most cases and years of all three institutions. In addition, the results show that all three versions of the paradigm share, as basic principles of good aging, the idea of maintaining autonomy, and independence in old age: the subcode autonomy/independence appears frequently in the cases of the three selected institutions. This theoretical justification and these basic principles can be considered vital components of the WHO, EU, and OECD’s institutional definition of the proper way to age, which has been translated into activities, interventions, and reforms included in the design of AA policies. Themes Present, Themes Absent The analysis has allowed us to determine, by quantifying the frequencies of the codes, which themes receive more or less attention by each institution and by the three as a group. The presence of more allusions to a certain theme means that the institution in question gives higher priority to including that theme in its discourse on AA. In this regard, the results tell us that the predominant themes are the following: participation/contribution and preventive health interventions (with a high proportion of references to these particular codes) in the WHO documents; labor perspective, in the sources from the OECD; and labor perspective and participation/contribution, in the cases of the EU. It is also possible to specify, for the sample as a whole, which themes are less frequent in some of the specific institutional discourses (by contrast with the rest), as occurs, for example, in the cases of the WHO with the theme labor perspective, and in the sources of the OECD with participation/contribution (Figure 1). Figure 1. View largeDownload slide Agenda of identified Active Aging themes by institution. EU = European Union; OECD = Organization for Economic Cooperation and Development; WHO = World Health Organization. Figure 1. View largeDownload slide Agenda of identified Active Aging themes by institution. EU = European Union; OECD = Organization for Economic Cooperation and Development; WHO = World Health Organization. Figure 2 provides a different vision of the thematic distribution, one that facilitates a comparative reading of the results. We see that the most recurring and most transversal themes in all the cases of the three institutions are participation/contribution (in EU and WHO documents) and labor perspective (in the EU and OECD cases). As for the WHO discourse, here special emphasis goes to the question of preventive interventions. Figure 2. View largeDownload slide Comparing institutional Active Aging discourses by themes. EU = European Union; OECD = Organization for Economic Cooperation and Development; WHO = World Health Organization. Figure 2. View largeDownload slide Comparing institutional Active Aging discourses by themes. EU = European Union; OECD = Organization for Economic Cooperation and Development; WHO = World Health Organization. Themes Over Time Paying attention to when the different themes have been more or less present in the discourses allows us to better understand their evolution and, as a result, that of the AA paradigm itself, as viewed by the three institutions selected. One finding that stands out in the EU documents is the presence and high proportion of references to participation/contribution and labor perspective in all the cases and years (from #2-2002 to #12-2012). In the OECD sources, changes are observed in the attention paid to labor perspective, with more presence and higher proportion of references in its older documents (#3-2003 and #5-2006) and less in the more recent ones (#9-2009 and #14-2013), in favor of other matters. Finally, the WHO discourse shows considerable allusion to participation/contribution and preventive health interventions, which increases over time (from #1-2002 to #15-2015), albeit with uneven attention (in #4-2004, #7-2007, and #8-2008). Aspects of the Themes The thematic analysis has allowed us to go beyond the mere enunciation of the topics addressed in the selected discourses. We have been able to reach a level of greater detail, discovering which concrete aspects, within each theme, are chosen by each institution to speak about that theme. We believe it is not enough to simply assert that the AA paradigm speaks about certain themes because with the passage of time these themes have developed in different ways. Participation/contribution For instance, we have seen that the theme participation/contribution is transversal to the institutional discourses of the WHO (#1-2002) and some of the EU institutions, more specifically the Council of the European Union (2002) (#2-2002). However, its treatment varies between one institution and another, showing certain similarities and differences. The fundamental similarity is that both organizations consider it necessary to promote participation in AA in the context of demographic aging, in relation to issues such as care costs and the sustainability of pension systems. Nonetheless, the EU (#11-2012) leans toward participation in the work sense and in ways linked, for example, to lifelong learning, but the WHO (#15-2015) favors participation in a broader sense, through, for example, volunteer work or caregiving: Document #11: “Making lifelong learning a reality will enable active aging by developing and maintaining the skills and competences people need to work and to take part fully in society.” (EU, 2012, p. 18) Document #15: “Volunteering and working are two important ways that adults use to find fulfillment in older age and are used [. . .] to illustrate the ability to contribute.” (WHO, 2015, p. 189) Despite their differences, these discourses share the idea of activation and mobilization of older people, especially in the form of productive contribution, something that appeared in the WHO’s first discourse (#1-2002) and continues to this day (#15-2015): Document #1: “Recognize and enable the active participation of people in economic development activities, formal and informal work and voluntary activities as they age, according to their individual needs, preferences and capacities.” (WHO, 2002, p. 51) Document #15: “A third reason for taking action is the economic imperative to adapt to shifts in the age structure in ways that minimize the expenditures associated with population aging while maximizing the many contributions that older people make. These contributions may be made by direct participation in the formal or informal workforce (. . .).” (WHO, 2015, p. 16) As time has passed, the EU has attempted to bring its discourse closer to that of the WHO, with broader proposals for participation, as can be seen in the European Commission’s discourse (#11-2012): Document #11: “It is necessary to act to allow both women and men to remain active as workers, consumers, carers, volunteers and citizens and to preserve solidarity between generations.” (European Commission, 2012, p. 3) Overall, the results show that the measures taken regarding the participation of older people, a central principle of these institutional discourses, are very much in line with the promotion of activities that can be interpreted as economic development. Labor perspective Now we will discuss the treatment of the labor perspective as a transversal component of the thematic structure of AA in the cases of the EU—specifically, the European Commission (#6-2006) —and the OECD (#5-2006). Both institutions advocate that certain reforms be made to existing systems of social protection over time, for example, through the connection between the working life of older people and employment policies: Document #6: “It must also be ensured that it is effectively possible to work for longer and that public employment policies as a whole create more job opportunities for older workers.” (European Commission, 2006, p. 9) Document #5: “More fundamentally, this new reform agenda is intended to convert the process of population and workforce aging into an opportunity for society and older workers themselves.” (OECD, 2006, p. 9) We have found, though, that the EU and OECD approaches to the labor perspective frequently emphasize different aspects. For example, the Council of the European Union (#10-2010) associates the labor perspective with intergenerational solidarity whereas the OECD (#9-2009) associates it more with limiting early retirement or promoting flexible retirement: Document #10: [The Council of the European Union acknowledges] “As many Europeans live longer and healthier lives, enabling and encouraging older workers to remain on the labor market is an important contribution to intergenerational solidarity.” (Council of the European Union, 2010, p. 4) Document #9: “However, as populations age, incentives to remain economically active may need to be reinforced further and there remains some way to go in limiting the scope for early retirement through unemployment or disability benefits).” (OECD, 2009, p. 14) Such differences do not seem very significant when compared to the similarities found in the European Commission (#11-2012) and OECD (#13-2013) discourses in terms of their treatment of the employability and work flexibility of older people with a view to prolonging their working lives: Document #11: “[Active ageing means] Enabling both women and men to remain in employment longer—by overcoming structural barriers (including a lack of support for informal carers) and offering appropriate incentives, many older people can be helped to remain active in the labour market, with systemic and individual benefits.” (European Commission, 2012, p. 3) Document #13: “There remains considerable scope for further progress towards the objective of an integrated and comprehensive policy approach to achieve longer and better working lives and boost labor market prospects for older people.” (OECD, 2013, p. 1) From these results, we can see that the proposal to extend the working life of older people is necessarily linked to raising the age of retirement, which is something that in these discourses appears in combination with employability and with flexible, gradual, or partial retirement. The EU introduces the flexibility of employment periods into the labor perspective, and the OECD view is that that economic sufficiency will be achieved by reforming the systems that provide social protection in old age. Preventive health interventions The theme code preventive health interventions is very common in the WHO discourse (#1-2002; #15-2015). Over time this institution has emphasized health policy development and also issues related to caregiving and long-term care. However, the WHO (#8-2008; #15-2015) coincides with the OECD (#9-2009) in certain aspects of preventive health interventions, specifically, assessments regarding the return on prevention and on the adoption of healthy lifestyles: Document #8: “Adoption of healthy lifestyles and actively participating in one’s own care are vital at all ages to maintain good health.” (WHO, 2008, p. 32) Document #9: “Better lifestyles are likely to be key to further improvements in the longer-term health of the elderly. (. . .) To determine whether preventive interventions will increase social welfare, the costs and benefits of such intentions need to be compared with alternative courses of action.” (OECD, 2009, pp. 10, 12) Something similar occurs with the WHO (#1-2002) and the Council of the European Union (#10-2010), as shown by the importance placed by both institutions on the life course perspective, albeit with differences in its application: Document #7: “A life course perspective on ageing recognizes that older people are not one homogeneous group and that individual diversity tends to increase with age. Interventions that create supportive environments and foster healthy choices are important at all stages of life.” (WHO, 2002, p. 14) Document #10: “Europe’s future economic competitiveness and prosperity depends crucially on its ability to fully utilize its labor resources, including through the extension of employment periods over the life course and through the adoption of appropriate policies to reconcile work, family and private life.” (Council of the European Union, 2010, p. 4) The results show that interest in older people’s health is shared by the three institutions, with certain differences. Health is not just an individual question related to behavior or lifestyle choices, as some EU and OECD discourses would suggest; it is also related to health care systems and to prevention measures, determining factors to take into account in the promotion of decisions that have an impact on health. Document #9: “Better lifestyles are likely to be key to further improvements in the longer-term health of the elderly. But because they require changes to individual behaviour, improvements in this policy dimension may be difficult to engineer. While it is ‘never too early and never too late’ to change lifestyles, it is clear that, the earlier risky behaviour changes, the higher the chances of enjoying longer healthy lives.” (OECD, 2009, p. 10) Discussion and Implications According to the documentation analyzed, in general terms, the institutional discourses on AA formulated by the OECD, EU, and WHO are still different, although they show certain similarities, as the work by Ervik revealed in its day. As for the differences, the WHO discourse on AA focuses on participation in a broad sense and it is increasingly emphasizing health improvement by means of interventions all along the life course. It stresses the return on prevention and its impact on health care costs. The EU and OECD tend to highlight more the productive and economic nature of AA. They direct their attention toward the relationship between employability/work flexibility and the reform of labor and pension systems, although they also make reference to health interventions, for example, through the maintenance of healthy lifestyles. On the one hand, the EU attempts to move closer to the WHO discourse and distance itself from the OECD by intending to use a broad concept of participation and emphasizing the importance of the life course. However, on the other hand, both the EU and the OECD allude to the extension of the working period and they both introduce the issue of rethinking retirement as a relevant factor. Likewise, all three discourses similarly consider AA a necessity (hence, the normative nature of the paradigm), especially taking into account the financial effects of the demographic changes underway, which point to the importance of engaging in productive activities—whether socially or economically productive—and maintaining independent and healthy lifestyles so as to counter age and work discrimination. In short, our analysis reveals that the different institutional discourses regarding AA have undergone some changes but not very significant ones since Ervik’s study in 2006. Said discourses already had different conceptualizations and political formulations that Ervik (2006) looked at closely and even represented graphically as a “rough heuristic device” (p. 5) (Figure 3). Figure 3. View largeDownload slide Dimensions of Active Aging in conceptualizations and policies of international actors. Source: Adapted from Ervik (2006, p. 5). EU = European Union; OECD = Organization for Economic Cooperation and Development; UN = United Nations; WHO = World Health Organization. Figure 3. View largeDownload slide Dimensions of Active Aging in conceptualizations and policies of international actors. Source: Adapted from Ervik (2006, p. 5). EU = European Union; OECD = Organization for Economic Cooperation and Development; UN = United Nations; WHO = World Health Organization. Making use of such representation, our research makes it possible to offer a reformulated and updated vision of these differences. Our alternative schematic representation (Figure 4), a heuristic device too, is composed of three dimensions—one more than those suggested by Ervik (2006)—stemming from our analysis: a labor dimension (y-axis), which distinguishes between work understood mainly until the stage ending upon retirement to connect it with amore extended period of the life course; a participation/contribution dimension (x-axis), which reflects the different treatments of productive participation as a dimension of AA, from linking it mainly to economic productivity to connecting it with a broader sense of social participation; and finally, the health dimension (circular tags), which represents how much attention is paid to health and preventive measures as a key feature in the AA paradigm: the larger the circular tag, the stronger the call for a health focused AA. Figure 4. View largeDownload slide Current dimensions of Active Aging in WHO, EU, and OECD discourses. EU = European Union; OECD = Organization for Economic Cooperation and Development; WHO = World Health Organization. Figure 4. View largeDownload slide Current dimensions of Active Aging in WHO, EU, and OECD discourses. EU = European Union; OECD = Organization for Economic Cooperation and Development; WHO = World Health Organization. Implications Although it is rarely performed, a first implication for practitioners and policymakers is that they should really speak of AA in the plural rather than in the singular, in order to convey that in truth different versions of AA exist, something that our analysis has confirmed. In fact, the differences identified in the institutions’ discourses concerning AA reflect their different roles and contexts. The development of the AA paradigm thus faces a dilemma that is both conceptual and political, due to the coexistence of heterogeneous institutional discourses and practices which, moreover, refer to a reality that is even more diverse (Moulaert & Léonard, 2015). The AA paradigm is built semantically in divergent ways through the ideological positions of different institutional actors, although such positions are not always made explicit. In general, the paradigm’s operational aspects are heavily shaped by interests that may be scientific, political, or of practical application (Fernández-Mayoralas et al., 2014). In harmony with the findings of Lassen (2015), it is easy to see that there are different institutional histories and understandings of the AA paradigm, that they all seek to establish—again, the normative tone—an imaginary about AA at the European level, and that they partially share a vision about how to regulate the aging of the population (Lloyd et al., 2014). As Ervik (2006) pointed out, some of the normative implications of the AA paradigm are associated with its emphasis on productive practices, which contributes to the creation of expectations in old age that can be quite unrealistic or even imposed. This brings with it the risk that the political use of the paradigm will be empty of meaning and content (Foster & Walker, 2015; Walker, 2015; Walker & Maltby, 2012). The normative prescription that old age should be positive—present in the discourses analyzed—gives a certain homogenous meaning to AA, which facilitates it being perceived as a tool for renegotiating old age (van Dyk, 2014). One tendency that has grown since Ervik (2006), and something that stands out among the data analyzed, is that despite the existence of different institutional discourses on AA, they all include increasingly the productive ideal of extending the working lives of older people, with the OECD and EU at the front. So, there seems to be a tendency to institutionally homogenize the diversity that characterizes aging experiences and life courses, based on certain impositions linked mainly to economically productive activities, health interventions framed in certain individualist lifestyles, and the reform of social protection systems (Lassen, 2015; Lassen & Moreira, 2014). Overall, there is an emerging duality implicit in how institutional discourses in Europe understand the AA paradigm (Moulaert & Léonard, 2015). We see, on the one hand, the normative approach to good aging mainly circumscribed to employment and working life (Moulaert & Biggs, 2013) and, on the other hand, the defense of a supposed free choice which, in reality, is concealing an exercise in governance from afar (van Dyk, 2014). Normativity and the push for productivity coexist in the period transpiring since the analysis by Ervik (2006), making it possible to speak of active and inactive aging experiences (the latter would include the forms of aging that do not conform to the indications institutionalized by the hegemonic paradigm). AA institutions should pay attention to this new cleavage. The vision of AA that ensues from the addition of health and activity is conditioned by the introduction of normative and economic values, with implications that were already pointed out by Ervik in 2006. As Sánchez and Díaz (2018) maintain, with the passage of time institutional discourses have converged around the defense of a form of aging that is healthy but at the same time does not cease to be productive. Nonetheless, as our analysis reveals, a divergent path has slowly emerged in terms of the accent placed on productivity by the reference institutions in the construction of the paradigm: the more socially productive and health-oriented WHO discourse is slowly separating from the more economically productive and labor-oriented discourses of the EU and OECD (Boudiny, 2013; De São Jóse & Teixeira, 2014; Kildal & Nilssen, 2013; Moulaert & Paris, 2013; Sánchez & Hatton-Yeo, 2012). One conclusion to be drawn is that, in general, and imagining the AA paradigm as a palette of colors, the changes occurring in the discourses since the paper by Ervik (2006) have been more in (productive) tone than in substance; that is, these discourses still revolve around the ideas of aging healthfully and staying productive, always against the backdrop of an ideal type of aging understood in positive terms. We have also seen that the institutional discourses on AA tend to end in a reductive—i.e. quite homogenous—treatment of a phenomenon that is multidimensional, beyond the triad of labor, participation/contribution, and health. The concepts of AA and its policies in Europe as institutional models vary. There are many ways to understand AA and not all are justified by demographic changes alone. Therefore, in terms of another implication for practice and policy, it would be worthwhile to review the models put forward by institutions and experts, and consider a more multidimensional approach to AA, one that corrects its current dominant logic—normative and production-oriented, and in some cases revolved around individual responsibility—and takes into account as well the inequality and redistribution questions associated with aging already raised by Ervik. An implication for researchers, it is important to move forward in the study of AA placing emphasis on the heterogeneity of aging and consequently showing both the positive and not-so-positive aspects in the AA paradigm. Research advances into these diversities will be useful in public policy development and in the organization of more appropriate services for the promotion of AA or other ways—yet to be determined—of understanding not just how persons should age but how they want to age. As regards this last point, international institutions and policymakers should pay close attention and forge a path toward an honest and critical examination of the real conditions and expectations of older people concerning the discursive and practical proposals of AA, in all its different paradigmatic forms. Funding Translation of this work into English has been supported by the Facultad de Ciencias Políticas y Sociología (University of Granada). Conflict of Interest None reported. 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This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

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The GerontologistOxford University Press

Published: Jan 9, 18

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