By Shireen Walton, on 17 March 2018
In countries such as Italy, where there is an ageing population and a decline in birth rates, a crucial question is how respective generations are coping/will cope in the future with expectations for care? A key issue is the ‘sandwich generation’. This refers to middle-aged persons caught between, or ‘sandwiched’ by caring for both ageing parents and their children simultaneously.
In Europe, including Italy, academic research has highlighted the sandwich generation issue as a health concern, as well as a socio-economic one – particularly for women, whose roles as primary caregivers stem from deeply entrenched societal and familial expectations (Brenna & Novi 2015). For example, the (mental) health effects that this ‘in-between’ or bridge-like status has on women (daughter) carers (Amirkhanyan AA, Wolf DA. 2006, Coe N., Van Houtven CH., 2009), and the potential for anxiety and depression, relating to the emotional strain, lack of personal time, financial burdens and the general conflict created by carrying out multiple care roles (Barnett RC, Marshall NL, Singer JD. 1992).
Within my project, which focuses upon domestic and international migration, these issues are complicated by having to also take into account human mobility, and what happens when forms of care diversify across time and space, perhaps incurring physical remoteness, but also in some cases, new found digital intimacies?
Deidre McKay’s work (2012, 2016) is a compelling example of the complexities of care practices in transnational/migrant contexts. Within the global networks of Filipino migrant care workers studied over a number of years in the UK, McKay discovered what she terms an ‘archipelago’ (2016) of care practices taking place on– and offline. The concept helps explain how people create a sense of stability for themselves and their loved ones through practices of care exchange and co-operation within the acute circumstances of uncertainty that accompany migration.
With the communities I am working among in a ‘superdiverse’ (Vertovec 2006) neighbourhood of Milan, I am similarly exploring transnational webs of digital caregiving, particularly with respect to smartphones. I am seeing how people routinely traverse physical and digital attention, presence, and care, through social practices – from videocalling parents and grandparents in the park, to negotiating school or hospital lifts, to ordering home-delivered food. All of this is providing much food for thought as I slowly peel back the layers of the sandwich.
Amirkhanyan AA, Wolf DA. (2006). Parent care and the stress process: Findings from panel data, The Journals of Gerontology Series B-Psychological Sciences and Social Sciences, 61(5): 248–255.
Barnett RC, Marshall NL, Singer JD. (1992). Job Experiences Over Time, Multiple Roles, and Women’s Mental Health: A Longitudinal Study, Journal of Personality and Social Psychology, 62: 634-644.
Brenna, E., and Novi, C, D. (2015). ‘Is Caring for Elderly Parents Detrimental to Women’s Mental Health? The Influence of The European North-South Gradient.’ Healthy Ageing and the Labour Market (HALM) Working Paper 1.
Coe N., Van Houtven CH., 2009. Caring for Mom and Neglecting Yourself? The Health Effects of Caring for an Elderly Parent, Health Economics 18: 991-1010
Chisholm, J. F. (1999). The Sandwich Generation. Journal of Social Distress and the Homeless, 8(3), 177-180.
Riley, L, D and Bowen, C. (2005). ‘The Sandwich Generation: Challenges and Coping Strategies of Multigenerational Families’. The Family Journal: Counselling and Therapy for Couples and Families. Vol 13., No.2. Pp.52-58
Rubin RM, White-Mean SI. (2009). Informal Caregiving: Dilemmas of Sandwiched Caregivers. J Fam Econ Iss 30:252–267.
McKay, D. (2012). Global Filipinos: Migrants’ Lives in the Global Village. Indiana University Press.
McKay, D. (2016). An Archipelago of Care: Filipino Migrants and Global Networks. Indiana University Press.
Vertovec, S. (2007). ‘Superdiversity and its Implications’ in Ethnic and Racial Studies, Vol. 30, Issue 6: New Directions in the Anthropology of Migration and Multiculturalism.
By Laura Haapio-Kirk, on 3 March 2018
Author: Marilia Duque
By the year 2050, the Brazilian population over 60 years old is expected to grow from 24 million to 66 million. Fortunately, my first impression of the District of Vila Mariana, in São Paulo city, where I have been conducting ethnography since January, is that there are already innumerable initiatives for the elderly, both public and private.
In addition to public health units, there is the AME-IDOSO for example, a centre dedicated exclusively to the care of people over 60, taking referrals from other health units in the city of São Paulo. It provides examinations, medical appointments and treatments, as well as activities such as dance classes. Just a few blocks away, you can find the Elderly Coexistence Centre (NCI), also subsidised by São Paulo City Hall. If you are 60+ and live in the Vila Mariana District you can join a large number of activities such as knitting and crocheting, fitness, circular dancing, senior dance, manual work, pilates, painting on canvas, chanting, memory games and rhythm dancing. I went there the week before the carnival. When I arrived, it was snack time. While one group were doing a dance class in the lounge integrated into a beautiful garden, another group were chatting and eating, all dressed up in traditional carnival ornaments. The worker told me that the menu takes into account the food restrictions and needs of the participants.
During this first month, I have already mapped five squares in the neighbourhood, all of them with gymnastics equipment, in another São Paulo City Hall initiative for people over 60 called “Longevity Playground: Happiness is Ageless”.
But if you keep walking you will also see many gyms offering activities for the elderly with special prices, not to mention Aqui Fitness, which has a program of physical activities developed by a geriatrician. And just a few minutes away, you can also exercise your mind and improve yourself; the Nossa Senhora da Saúde Parish offers an adult literacy course (20.4% of the population of Brazil over 60 is illiterate), language classes and a Whatsapp course, especially for people over 60.
One of my ethnographic challenges is to investigate how the ageing population in the neighbourhood perceives these initiatives. Do they really work? Do they work for everyone? Could appearances be deceptive? This is an important point because Vila Mariana District is far from being a utopia. You can choose to see just the modern buildings that are rising everywhere among the two storey houses. But you will have some difficulty ignoring the Mario Cardin Community, a favela where more than 500 families live in precarious conditions, or the homeless people living on the streets.
But for the moment let us take this apparent wealth of amenities at face value. Actually, this raises a rather different question. Do Brazilian people have to get old before they experience something approaching the support and solidarity of an egalitarian state?
By Laura Haapio-Kirk, on 22 February 2018
Yesterday I met a woman who told me about her grandmother who lived until the age of 99 years and 11 months. She told me how she lived alone in the countryside yet was busy every day up until the end of her life. In her later years she took it upon herself to care for the mountain behind her house, focusing especially on ridding it of weeds. Her granddaughter claimed this daily (and apparently endless) work was one of the main reasons why she maintained her health up until the end. Such stories have been told repeatedly to me in the three weeks since arriving in Japan. Stories of elderly people maintaining their health by cultivating vegetables, teaching traditional arts, or indeed weeding mountains, abound.
From the conversations I have had, there appears to be a social expectation for an individual to maintain an active life for as long as possible and to continue to contribute to society in old age. This can also involve minimising the appearance of frailty and dependence. Another woman told me of how her grandmother, who also lives alone, makes use of a local health facility which picks her up in a minibus twice a week. However, she does not let the minibus collect her from outside her house, preferring to walk around the block so that her dependence on institutional support will not be visible to the neighbours. For this elderly woman, the fact that she lives alone and not with her family gives rise to sense of shame. She continually puts pressure on her children and grandchildren, asking when they will move closer to take care of her.
What is fascinating to me is the tension between an individual’s responsibility for self-care and the social motivations for maintaining one’s health. As Japan undergoes a shift towards a more individualised society (Allison, 2013), consequences such as loneliness and isolation are felt particularly by the elderly, especially if they are used to living in traditional multigenerational households (known as ie). However, my project focuses on the middle-aged who are caught in the middle of these tensions. They both desire the privacy and independence of living apart from parents, while wanting to fulfil their sense of filial piety. The couple with whom I am staying are both in their 60s and close to retirement. Their house is attached to that of the husband’s parents who are in their 90s and mostly independent. The elderly parents shop and cook for themselves and I have witnessed only rare interaction between the two households. The main mode of communication is an interphone system which buzzes sometimes in the evening, for example when the grandmother wants to share gifts of food she has received from the temple, or simply to let her son know that she is going to bed. While the elderly parents do not own a telephone, the interphone allows them to maintain a separation while facilitating daily communication. As monitoring and smart home technology becomes more commonplace, it will be interesting to see if this technology accelerates the trend towards an individualised society by facilitating care at a distance.
Allison, A. (2013) Precarious Japan. Duke University Press
By Laura Haapio-Kirk, on 16 February 2018
Author: Pauline Garvey
Just last month the Irish government launched the latest national initiative to promote health and wellbeing across the country. The Healthy Ireland campaign 2018 was launched on the 6th January and aims to encourage people to ‘get active, eat well and mind their mental wellbeing’ (www.healthyIreland.ie). Many of the planned initiatives run through local libraries and are advertised by pictures of families cycling through wooded glades or groups of friends exercising outdoors.
On the day of the launch in Dublin’s sporting venue Croke Park, Taoiseach (Prime Minster) Leo Varadkar said:
The message of the Government’s Healthy Ireland 2018 campaign is simple; I’m encouraging everyone to get involved, by making the small changes needed to improve your health and your family’s health. That could mean including a walk in your daily routine, making healthier choice at meal times or taking a break from your phone to give your mental health a boost. These positive and sustainable changes can help us all build a healthy Ireland (MerrionStreet 06/01/18).
The webpage dedicated to HealthyIreland acknowledges that social factors such as levels of education and income, or housing and work conditions may adversely affect health, and are determined by social, environmental and economic policies beyond the direct responsibility or remit of the health sector. Therefore the campaign asserts the ‘health sector alone cannot address these problems – we must collectively change our approach.’
Excessive mobile-phone use has now been added to nutrition and exercise as a health risk. And while this is interesting, it is perhaps not surprising. Frequent associations between an unhealthy attachment or addictive behaviour and mobile-phone use have been profiled in the national media recently. For example in December 2017 new research from Deloitte, found that 90% of 18-75-year-olds in Ireland now own or have access to a smartphone – putting Ireland among the top users of smartphones in Europe. By comparison 88% of people own, or have access to a smartphone in Europe. Richard Howard, head of technology, media and telecommunications at Deloitte greeted this figure with some caution: “Mobile devices are a relatively new ‘addiction’ to our social fabric and they form an important part of our daily activities and interactions’ (Quann 2017).
There are lots of unknowns in smart-phone use, which is why we are currently investigating this topic, and why we try to understand the smartphone in actual life situations. For example while the Deloitte study found that half of Irish people thought they used their phone too much, 60% thought their partner used it too much! What does this tell us of the place of the phone in negotiating relationships? Are people neglecting their loved ones, forging new friendships or engaging with existing friends and family in novel ways?
Meanwhile the government’s response in the Healthy Ireland Campaign is clear: “Take the stairs rather than the lift, Eat more fruit and veg, Take a 30-minute break from your phone”. And Varadkar describes his own practice of turning off the phone during meals – “it not only makes the meal more pleasant and your interaction with people more pleasant, it is actually good for your headspace.” (O’Connor 07/01/18)
HealthyIreland 2018, www.healthyireland.ie
MerrionStreet Irish Government News Service 06/01/18, available online at https://merrionstreet.ie/en/Issues/Taoiseach_Leo_Varadkar_launches_Healthy_Ireland_2018_campaign.html (http://www.healthyireland.ie/about/)
O’Connor, Wayne 07/01/18 ‘Healthy Ireland 2018 aims to get us all fitter and more mindful’ Irish Independent, available online at https://www.independent.ie/irish-news/health/healthy-ireland-2018-aims-to-get-us-all-fitter-and-more-mindful-36464484.html.
Quann, Jack 05/12/17 ‘Three million Irish people now own or have access to a smartphone’, available online at http://www.newstalk.com/Mobile-phone-habits-of-Irish-people-revealed
By Xin Yuan Wang, on 13 February 2018
One week ago, when I finally arrived in Shanghai and started flat hunting, the estate agent urged me to make a decision within a few hours as “the Spring Festival (chun jie) is coming and everything will be closed very soon”. Chances were that he exaggerated things so that he could close the deal more quickly, but he did have a point.
With the approaching Chinese New Year, or Spring Festival, every day I notice more businesses closing – from restaurants to express delivery services. The 24/7 super convenient metropolis has become less efficient and fast-paced as more migrant workers embarked upon their journeys back to their home villages for the Spring Festival reunion. Many people in Shanghai only start to notice the massive contribution of migrant workers when a whole range of services fails – just as when they appreciate their dependence upon their smartphone the moment they realise they have left it behind.
The departing migrant workers are part of the largest annual human migration in the world – the number of passenger-journeys during the Spring Festival travel season, so called chun yun, hit 2.9 billion in 2017. Shanghai, as the major destination of migrant workers in China, all of a sudden has become “an empty city” as one of my new neighbors Mr. Zhu put it. Mr. Zhu is in his late 60s, and was also packing, flying to the USA to celebrate New Year with his son’s family. A common traveling pattern here seems to be migrant workers moving inland to their home towns while local well-off Shanghainese flying overseas to have a New Year holiday.
Compared to physical migration, the ‘digital migration’ in China, taking place from offline to online, may cause much less tension in terms of domestic transportation pressure, however it is equally massive and significant. You may ask what is digital migration and in what ways it is possible? Hopefully, today’s (13/02/2018 London time 1:32pm) BBC world service radio documentary ‘Digital Migration’ will provide one of the answers. In this documentary, I re-visit factory workers who were my key contacts in my previous project, exploring how the use of social media has allowed Chinese migrant workers to live in a modern China.
It was because of my own observations of Chinese migrant workers, with whom I lived for 15 months in a small factory town, who saw Shanghai as the symbol of modern China, that I decided to pick Shanghai as my new field site to explore the impact of smartphones. As far as the new project is concerned it is definitely too early to draw any conclusions, but the first week’s exploration has shown me the ‘digital migration’ among urban Chinese is taking a different form.
By Laura Haapio-Kirk, on 6 February 2018
Written by Alfonso Oteagui
I arrived in Santiago de Chile over a week ago, in order to conduct a 16-month ethnography on the experience of age, the use of smartphones and their relation to healthcare among migrants working in this city.
The very first time I walked around Santiago I was puzzled by the sudden and stark changes in its architecture and general appearance. You can be walking by a beautiful cobbled street among art nouveau three-storey houses with iron work in their wooden doors (Photo 1) and just fifty meters later you can find a whole block of damaged late 60s ugly functionalist six-storey buildings (Photo 2). It is a feature local Chileans are aware of and remark on: the absence of transitional features that might soften these abrupt changes.
These stark contrasts are evident in the neighbourhood where I am conducting fieldwork. Yungay is a protected heritage zone inhabited by the Chilean upper class in the early twentieth century. Nowadays this population has migrated Eastwards and uphill leaving behind many of these beautiful old big houses, which have been occupied by multi-rental low income migrants. By contrast, other old houses, restored as lofts, provide huge continuous areas for the few. As a result, we find well maintained homes within dilapidated neighbours. While art nouveau houses are covered by colorful graffiti, as part of this architectural palimpsest of different eras and social classes (Photo 3).
These contrasts make manifest a deeper material contrast: the income inequality gap. As is sadly the case in much of Latin America, Chile has a high index of income inequality (47,7 2015 World Bank estimate). According the National Institute of Statistics, the average income in Chile in 2016 was of $ 517.540 (roughly U$S 862). But only 28,6% of the working population, receive this amount or a higher salary, with just 9,7% of the working population earning over one million Chilean pesos (around U$S 1660).
Notwithstanding the high index of income inequality, Chile shows deeper internet penetration (71,7% had access to Internet in 2016) compared to the rest of Latin America (average 56,1%). The same study by IMS Mobile showed that 9 out of 10 users connect to the internet through their smartphones. As in the Why We Post project, with which a number of the ASSA team were involved, this suggests that greater equality in online access may not result in diminished inequality more generally. But the situation is likely to be quite complex and hopefully the next 16 months will provide a more nuanced picture, beyond the facades of the architecture.
IMS Mobile in Latam Study, 2nd Edition, September 2016, free access through https://www.imscorporate.com/news/Estudios-comScore/IMS-Mobile-Study-Septiembre2016.pdf
OECD (2018), Internet access (indicator). doi: 10.1787/69c2b997-en (Accessed on 04 February 2018)
The World Bank. Databank. Poverty and Equity. http://databank.worldbank.org/data/reports.aspx?source=poverty-and-equity-database
By Daniel Miller, on 2 February 2018
Our team is certainly blessed, in that just as we set out on our study of midlife, a joyous and profound book is published on exactly this subject: Reflections on Midlife: A philosophical Guide by the philosopher Kieran Setiya. I can’t imagine a better treatment by a philosopher of topics ranging from whether there is a mid-life crisis, how to be reconciled to the lives we haven’t and won’t live, the fear of death, or the issues of regret, missing out and retrospection. It’s a clear read and acts a collection point for some of the `best bits’ on this topic from sources ranging from Aristotle, through Schopenhauer to Simone de Beauvoir. It is also a kind of practice guide for the actually middle-aged (such as myself) on how to live in the present, how to value activities in their own right and not just as projects, and why the path to happiness is always through others. As it happens there were also substantial sections whose aspirations I do not share, such as his concluding sections on Buddhism and mindfulness, which to me still speaks to an orientation to the self and the body. I would prefer to watch paint dry than to contemplate my own breathing, and generally I prefer a more social and ethical orientation to resolving these dilemmas.
This book takes nothing away from our task as anthropologists. Setiya’s volume is an exercise in thinking about how other people might think about midlife, and much of it is about contemplation. But as I note in my own recent book The Comfort of People, the hospice patients I worked with don’t do much of this contemplation about the meaning and purpose of life. They valorise the life they have actually lived through continuities of practice, such as watching TV and keeping up with family relationships. We have a perhaps harder task in extrapolating our insights on how people relate to midlife from our interrogation and interpretation of such embedded practices within everyday life. And in our case, we will do this comparatively, considering the difference in such practices around the world. Anthropology is not a handmaiden to philosophy – it is trying to achieve rather different goals, but I feel equally important ones. Still I suspect there are going to be quite a few of my informants to whom I might end up recommending Setiya’s book, simply for the good I think it can do in understanding one’s life and in the pleasure of just reading a well crafted book.
By Shireen Walton, on 29 January 2018
The Economist recently published an article called ‘what technology can do for Africa’. The article covers key discussions around the potential of technological development in sub-Saharan Africa, but falls into pitfalls common to the subject. Determinism is evident in emphatic statements like: “countries are on the cusp of a tech-driven transformation that is already beginning to make people healthier, wealthier and better educated at a pace that only recently seemed unimaginable”. Mobile phones are top of the list, said to have made ‘leaps’ possible. This pervasive image of Africa ‘leapfrogging’ stages of ‘Western development’ with mobile phones in order to improve health, education, communication and business is certainly compelling. But in reality, many digital development practitioners are increasingly skeptical of this utopian ideal, said to be Western-centric (Suchman, 2002, 2011; Tunstall, 2013; Nussbaum, 2010) and to result in unsustainable ‘pilots’ (Holeman, 2017; Huang et al, 2017) which can leave new gaps in their wake.
The Economist article attempts to acknowledge this critique by countering optimism with evidence that the region’s infrastructure is increasingly “sluggish”. The below map of Africa is entitled merely ‘Ill-equipped’, and shows limited access to electricity and mobile phones across much of the continent; in Uganda, 25% and 41% respectively. Besides a few tech hubs, technological advancement and education are unfavourably contrasted with that of Silicon Valley and “the rich world”, from which “Africa risks falling even further behind”; implying a sense of failure, and of technology as a global race.
Through 16-months ethnography in Kampala, I hope to find a different middle ground with a more considered optimism towards ‘what technology can do for Africa’, or instead, ‘what Africa can do for technology’. In the article, Liberian medic Dougbeh Chris Nyan is poignantly quoted to say: “We are forced to be inventive to become masters of our destitution”. In line with Katrien Pype’s exploration of the meaning of technological inventiveness in Kinshasa, ‘smart’ solutions are built around constraints and ‘from below’ (2017). For example, mobile money, “the bank account in your pocket”, a pertinent example of technology adapted to African requirements.
How do people in Uganda appropriate mobile phones and mHealth to accommodate their preferences and needs? During my fieldwork, this question will direct an enquiry into the active role people take as users of technology. As evident in the pilots which do scale and survive, initiatives must begin and meet with sociocultural realities.
– Charlotte Hawkins
- Holeman, I. (2017) Human-Centered Design for Global Health Equity.
- Huang, F., Blaschke, S., Lucas, H., 2017. Beyond pilotitis: taking digital health interventions to the national level in China and Uganda. Glob. Health 13.
- Suchman, L., 2011. Anthropological Relocations and the Limits of Design. Annu. Rev. Anthropol. 40, 1–18.
- Suchman, L.A., 2002. Practice-Based Design of Information Systems: Notes from the Hyperdeveloped World. Inf. Soc. 18, 139–144.
- Pype, K. (2017) ‘Smartness from Below’, in What do Science, Tehcnology and Innovation mean from Africa? eds Clapperton Chakanetsa Mavhunga. MIT Press
- Tunstall, E. ‘Decolonizing Design innovation: Design Anthropology, Critical Anthropology and Indigenous Knowledge’. In Gunn, W. Otto, T. Smith, R. (2013) Design Anthropology: Theory and Practice. Bloomsbury Publishing, London.
By Shireen Walton, on 25 January 2018
Recently, the smartphone app Kuaishou emerged from China’s cutthroat online entertainment market with more than 400 million registered users and an estimated worth of some two billion USD. It is now the fourth largest social media platform in the country, after WeChat (an instant messaging, and e-commerce and payment app), QQ (instant messaging), and the Sina Weibo micro-blogging site. The majority of the content on Kuaishou is made up of self-harm videos with “comic” twists, rather like the American TV show “Jackass.” Viewers can watch daredevils do everything from swallowing lightbulbs to lighting firecrackers under their own backsides. Those taking part are almost all from smaller, third-tier cities or rural-urban fringe zones. They seek internet stardom by harming their bodies in unconventional ways.
In China’s cosmopolitan cities, Internet celebrities are able to rake in tens of thousands of yuan every month by live-streaming themselves eating or shopping. Kuaishou users emulate their urban counterparts, hoping to making a fortune by becoming famous. However, for these people, without wider networks or resources, the results are generally disappointing, and mostly they remain mired in poverty.
For rural China, kuaishou culture expresses, in a particularly eye-catching manner, both this population’s desire for achieving a better life, and more importantly, the cultural difficulties of being poor in contemporary China. Through these practices of bodily harm and self-insults, these people reveal, among other issues, just how unacceptable they find the condition of poverty.
– Xu Zhiwei
By Shireen Walton, on 23 January 2018
Israel is perceived as a start-up nation; in 2016, alone 1,200 hi-tech companies were founded. Israelis have established several global start-up companies such as “mobileye”, “waze”, “gettaxi” and “wework”. There is also an Israeli presence in the field of mobile health and medicine. One of the criticisms within Israeli society is that the wealth created by these companies fails to trickle down, which is evident in that 2.4 million Israelis are considered poor. Nevertheless, in Israel there is a relatively good and largely public health system, which serves both citizens and non-citizens.
The term “non-citizens” refers to Palestinians living in East Jerusalem holding the legal status of “permanent residency”. They are eligible for some rights, including medical services, but are not considered citizens of the Israeli state. East Jerusalem, an area of 70sqkm with 66,000 Arab inhabitants, was annexed/occupied by Israel from Jordan immediately after the 67’ war.
Today, in East Jerusalem there are 300,000 Palestinians, of which 78% are considered poor, and state welfare services are relatively inactive, Their ‘gray’ status has led to a different situation which includes the creation of private medical services clinics that are financially supported by the state. Last November, I met Mr. Fuad Abu-Hamed, an owner of two semi-private clinics in Beit Safafa and Sur Baher, two Palestinians neighborhoods/villages located in East Jerusalem. These clinics are linked to a major state public clinic, and have managed to provide better services, for example access to doctors without queues. They also have improved their online services including a website and an app in Arabic.
When I asked Mr Fuad if his 9,000 clients use the Clalit app, he replied “so-so, people here are not use to being online when it comes to health matters.” He then asked an intern, a young nutritionist, who graduated from Bir Zeit University in the West Bank, if she knew any popular health apps. She mentioned several apps in the field of fitness, wellbeing and diabetes. Mr. Fuad confirmed that diabetes is a serious condition within the Arab population. I am therefore expecting to include diabetes and associated digital applications in my research, but first, I need to know a good deal more about the general condition of health amongst the Palestinians of East Jerusalem; the way they access health services, and how this relates to their ambiguous status. I wonder, if perhaps eventually the ASSA project might encourage a startup that focuses upon this and other disadvantaged populations?
– Maya de Vries