Author: Charlotte Hawkins

On 8th June, the ASSA team will host a workshop to bring together different anthropologists of ageing. This will include discussion of comparative papers from each of the team members.

My paper, written alongside ASSA researcher Laura Haapio-Kirk, offers a comparative perspective of ageing and how it is defined around the world. Whilst we bring insights from our colleague’s research, the bulk of the ethnographic comparison is based around my work in Kampala, Uganda, and Laura’s in Osaka, Japan; despite contrasting socio-demographic circumstances, with Uganda one of the world’s youngest populations, and Japan one of the world’s oldest, this comparative framework offers an opportunity to explore how people redefine age and older personhood in ever-changing circumstances, particularly in light of shifting intergenerational relationships.

Like the rest of the ASSA team, both Laura and I quickly realised that the ‘mid-life’ or ‘middle age’ (45-70 years old) category we had set out with, was not particularly applicable in our research contexts. For example, amongst my participants in Uganda, including older people, health workers, researchers of ageing^[i] and age-based advocacy organizations in Kampala such as The Aged Family Uganda (TAFU), Uganda Reach the Aged Association (URAA), HelpAge Uganda, Health Nest Uganda (HENU), age is more likely to be determined by the experience and health of the individual, as well as their income and environment. People with sufficient experience and social status could be considered an elder at as young as 40 years old. Or, in Japan, older age categories are shifting within the ‘super ageing society’. While such age-based categories may be required for developing policy regarding health care and work, Laura found that such categories are of diminished importance for most people in their daily lives. For example, while people may recognise that they are suffering from age-based illnesses or use the category of ‘elderly’ when struggling with their smartphone (“I can’t do it, I’m elderly!”), in their day-to-day lives they also enjoy many continuities with their younger selves and feel rather that their interests and personality have actually become even more pronounced with age. Or, in Ireland, Brazil, Chile and China, people aged 45-70 rebuke the stereotypes associated with middle age which is something the ASSA project explored in more depth as this short video shows.

This is not to say that age categories are not also socially significant, but that they do not necessarily acquire meaning in line with the chronological concept of age we had set out with. Instead, our comparative discussion shows that age categories are socially negotiable, which means that they are dynamic, experiential and continually evolving, but also often articulated in line with established intergenerational norms and family roles. In this articulation, what values are brought to life, re-established, and experienced as part of ageing? How does this relate to contemporary contexts informed by global marketisation, migration, urbanisation and digitisation?

The ASSA project has documented various ethnographic examples which demonstrate how age is redefined by our research participants in diverse settings and within a shared global context of population ageing, longer life expectancies, declining public health investment and increasingly individualised self-responsibility. These redefinitions tend to disrupt chronologies, for example in resistance to meanings attributed to ‘middle age’ or ‘elderly’, and in the more relational and experiential definitions of age, ‘bringing ageing to life’. Often, we found that people seek to re-define established categories of age based on their experience as it deviates from that of their parents’ generation or public discourses around ageing. In some cases, this may reflect ‘active ageing’ discourses or even ageist attitudes, which tend to discriminate against inactivity, poor health and appearances of age.

[i] Thanks to Dr. Annet Nankwanga, Dr. Betty Kwagala and Dr. Abel Nzabona at Makerere University for introducing categories of age in the Ugandan context.

Open access image by Mohamed Hassan

Author: Charlotte Hawkins

As part of the ASSA project, we are currently working to publish a volume called: ‘An Anthropological Approach to mHealth: Health & Care in the Smartphone Age’. This volume consolidates insights from the team’s various anthropological initiatives in mobile health or ‘m-health’ – health-related uses of the phone – in diverse settings around the world. Drawing from an ethnographic perspective, we seek to contribute an anthropological understanding of mHealth, a growing industry often otherwise dictated by top-down priorities such as bespoke app creation. Instead, building from our own ethnographic insights about older people’s everyday uses of phones, and other studies stressing the evident importance of ‘informal mHealth’ (Hampshire et al., 2021), we illustrate a ‘smart-from-below’ approach which prioritises the everyday appropriation of phones and existing communicative apps for health purposes. We analyse the failures of conventional mHealth initiatives and the emergence of our alternative perspective, and how that led to several initiatives in which team members were themselves involved.

In this book, we offer a grounded ethnographic picture of mHealth in our various research contexts, with a view to broader global trends in population ageing, health and economic crises, the Covid-19 pandemic, declining public investment, increasing phone access, and global migration. This shows the potential of prioritising the everyday appropriation of mobile technologies in line with both social change and longer-standing care norms.. This is intended topromote an anthropological approach to support the relevance and effectiveness of mHealth going forward. We have already created a free online course (available here) for those interested in the topic but hope that the book will benefit other medical anthropologists and ethnographers interested in digital health, as well as digital health practitioners interested in social research around the design, implementation and evaluation of their work.

We have organised the book into three parts, reflecting what anthropology can offer for contextualizing, analysing and informing mHealth. Part one consists of three chapters concerned with contextualizing mHealth;

• Xinyuan Wang on mHealth practice in mainland China;
• Shireen Walton on visual digital communications about health during covid in Italy, and
• Laura Haapio-Kirk on social self-tracking in Japan.

This is followed by contributions analysing mHealth:

• Daniel Miller on googling for health in Ireland, and the ways it exacerbates existing disparities;
• Patrick Awondo on the failures of various mHealth initiatives in Yaoundé, Cameroon; and
• Pauline Garvey outlining the uses of phones to seek information and support around the menopause in Dublin, Ireland.

The volume concludes with three chapters informing specific mHealth initiatives:

• Alfonso Otaegui’s recommendations for scaling the ‘nurse navigator’ model in public oncological clinics in Chile;
• Marília Duque’s protocol for meal-logging and WhatsApp communications in Brazil; and
• Charlotte Hawkin’s and John Mark Bwanika’s work on a digital mental health programme in Uganda.

Taken together, the volume seeks to provide a grounded ethnographic discussion on the challenges and opportunities of anthropology for mHealth, and of seeking health and care in the smartphone age. We aim for publication in 2022 with UCL Press, follow ASSA on Twitter, Instagram and Facebook to keep updated.

References

Hampshire et al. (2021). Informal mhealth at scale in Africa: Opportunities and challenges. World Development, 139:105257, 1-23