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The geographies of health and wellbeing – by Pauline Garvey

LauraHaapio-Kirk15 August 2018

Author: Pauline Garvey

Photo (CC BY) Anna Li

Fairly frequently the Irish media focuses on the ‘downsizing dilemma’ for retirees (O’Rourke 2017), but what receives less attention is the downsizing that comes with marital breakdown. As I conduct research the frequency with which I meet men and women who are separated or divorced is striking. This observation is backed up by recent census data that reveals that separation is currently a significant aspect of life for many Irish families. The Central Statistics Office figures show a significant increase in the percentages of people who separate in the forty-plus age groups (CSO, 2016). The rate of separation peaks at age 48.

This trend in mid-life is significant because, otherwise, marital breakdown is decreasing in the general population. In fact, there was a decrease of 11,115 separated or divorced persons aged under 50 between 2011 and 2016. By contrast there was a substantial increase of 29,224 persons over the age of 50 between 2011-2016. Not only is there an age factor but there is also a gendered dimension in how people report their marital status. Lunn et al. (2009) found that more women than men report themselves to be separated. The conclusion they drew was that men who are separated are more likely to identify themselves as ‘single’ rather than ‘separated’. Also a higher rate of re-marriage by men goes some way to explaining the disparity in figures between the rate of female separation and the rate of male separation, but it also raises questions about how Irish women self-identify following separation (see Hyland 2013).

What we learn from this is that marriage separation is particularly significant for people in their 40s and 50s, that a larger proportion of women do not re-marry and think of themselves as separated rather than single. This alteration in domestic circumstances may be experienced with a mix of emotions but the people I have spoken to are keenly aware of the importance of being accessible to others as they age. This has been discussed with me as either an issue regarding physical (‘what if I fall getting out of the bath?’) or emotional wellbeing (‘my daughter knows when I’m watching Love Island and she’ll text me “he’s a wally” …so I don’t feel alone’). One woman told me of a series of health problems she encountered around the time she was due to retire. As a result of what she calls a ‘bad reaction to life’, she suffered from acute depression and was admitted to a psychiatric hospital for 6 months. On her release and return home she described the effect of having automatic text messages sent to her from the hospital as part of her treatment. The text messages that she received were automatic daily messages: ‘they sent me texts every day or every second day saying ‘how are you doing?’, ‘hope everything is ok?’. So although the messages were not personalised, she describes them as  ‘sending some positivity, it was superb to think that someone knew you weren’t well and could send a text to say you weren’t alone’. The key issue for her is that regular text messages inquiring about her health represented ‘a life line, some contact from the outside world to say we care about you and hope you are getting on alright’. 

As my research continues it is clear that while no life experience can be viewed in isolation, the geographies of age, the places that one experiences midlife, can matter a great deal. My respondents are not just well or unwell, they experience age, health, illness or wellbeing in specific places, whether that is in the privacy of their homes, public spaces or doctors’ clinics. Similarly in contrast to being single, this research causes me to consider the ways in which ‘being separated’ is relational? Should we think of separation as a geographical term, suggesting a lingering connection to place as well as to person?

 

Central Statistics Office, Ireland (2016), available online at https://www.cso.ie/en/releasesandpublications/ep/p-cp4hf/cp4hf/ms/

Hyland, L. (2013) Doing’ separation in contemporary Ireland: the experiences of women who separate in midlife, D.Soc.Sc Thesis, University College Cork, available online at https://cora.ucc.ie/bitstream/handle/10468/1179/HylandL_DSocSc2013.pdf?sequence=2&isAllowed=y

Lunn, P., Fahey, T. and Hannan, C. (2009) Family Figures: Family Dynamics and Family Types in Ireland, 1986-2006, Dublin: ESRI and UCD.

O’Rourke, F. (16/09/2017) The downsizing dilemma? Getting rid of the family furniture, The Irish Times, available online at www.irishtimes.com/life-and-style/homes-and-property/the-downsizing-dilemma-getting-rid-of-the-family-furniture-1.3214649

What is a smartphone?

DanielMiller1 June 2018

Author: Daniel Miller

Photo (CC BY) newkemall

I have spent the last two months in my Irish fieldsite trying to answer a simple question: what is a smartphone? Actually, it’s a fiendishly difficult question. Several older people started our discussion by insisting that the only things they use their phones for are voice calls and texting. Once we looked at the phone in more detail, it turned out that just the most common functions include WhatsApp, maps, voice calls, camera, alarm/time, Facebook, text messages, calendar, weather and news. Once we add a variety of more specialist apps such as sports, music, airlines, banks etc. we easily reach the most typical result which would be that an individual uses between twenty-five and thirty different functions of their smartphone.

In the newspapers, the personalisation of the smartphone is understood as the advances in algorithms and artificial intelligence, which allow smartphones to learn from people and predict their behaviour. But, just as in our previous Why We Post project, for the ethnographer, these corporate developments pale into insignificance compared to the personalisation represented by the diversity of usage that will arise from the way an individual configures this multitude of apps.

Indeed, it may be the personality of the user that comes across most. A man expresses a particular version of masculinity in demonstrating how all his usage is based on need and pragmatism. He mentions more than once how, now his daughter is no longer in Australia, he will never use Skype again. By contrast, a woman, aged 69, has every last detail of her life, from the steps involved in paying each particular type of bill, to the slide decks from workshops she has attended, all carefully classified in nested hierarchies of icons on her iPhone. About the only thing she doesn’t like is the clumsy and intrusive Siri. In both cases the smartphone effectively expresses their personality. Sometimes a particular activity dominates an individual’s phone life; a phone where everything is geared to a retirement spent playing and teaching the banjo, or a phone that contains seven apps all associated with sailing.  It’s not that a woman is addicted to her phone, or even to YouTube per. se., it’s just that she can’t stop spending two hours a day following US politics on YouTube. More commonly the phone will revolve around three or four key activities and concerns such as a combination of family, sports, holidays, and photography.

Working with people in their 60s and 70s, I come to appreciate that they are not elderly, but that much of their life may be devoted to caring for an elderly parent in their 90s. For some of these people everything about the phone is connected with this responsibility of care, whether mobilising family care through WhatsApp, showing pictures of great grandchildren through Facebook, using maps to get to a hospital appointment, employing phone and text to negotiate with the local council and never turning the phone off, because you never know…

An equally important component of what makes the phone is people’s lack of knowledge. An older person is told to download an app, but she has never heard of Google Play and so attempts this action using an icon labelled ‘Downloads’. A man won’t buy a new Samsung Galaxy because it doesn’t have an inbuilt radio and he doesn’t know he can download radio as an app. Many users do not know the distinction between Wi-Fi and data that they have to pay for, so they won’t watch video while on Wi-Fi because they think it will cost them. Many can’t understand that a phone which ‘doesn’t work’, is not a broken phone, rather they just need to go about something in a different way. This is because the smartphone has so little in common with traditions of machines and tools. There is no manual they can actually use. Trying to work out precisely why one 80-year-old finds every little step impossible and another seems entirely comfortable in using these phones may give us many clues as to what, in effect, a smartphone is.

In the newspapers the smartphone appears as the constant development of new capacities – articles about the latest thing you can do with your smartphone are commonplace. For the ethnographer the smartphone is the myriad constellation of new actualities – we strive for an appreciation of what ordinary people create with or cannot understand about these devices.

Infrastructures of Care

LauraHaapio-Kirk19 April 2018

Photo (CC BY) Laura Haapio-Kirk

Someone recently told me about how he encourages his 86-year-old mother, whom he lives with, to use her home blood pressure monitor every day and record her readings in a notebook. He said that doctors had prescribed her medication to lower her blood pressure, which she did not like to take. His solution was to turn to traditional Japanese medicine which he explained is tailored to the individual’s body, rather than western medicine which relies on a universal concept of the body. He was able to track the success of this approach through the home monitoring kit, and now her blood pressure is back to normal. This story reveals how infrastructures of care are made up of various integrated systems – that blockages in the form of non-adherence may reveal alternative routes by which people navigate care and self-care.

I am part of a reading group at Osaka University hosted by Gergely Mohacsi and Atsuro Morita. A few weeks ago we discussed Morita’s recent co-edited volume called ‘Infrastructure and Social Complexity’ (Harvey, Bruun, Morita 2017). He explained that a recent focus on infrastructure in social sciences, indeed an ‘infrastrucutural turn’ in anthropology, is a result of infrastructures becoming increasingly precarious and therefore more visible. Ageing infrastructures are becoming more and more tangible as we bump up against cracks in roads and other markers of decay. Infrastructures are systems that should enable things to flow, whether that’s water, electricity, goods, or people. But what happens when people are disconnected from infrastructures, or for whatever reason the flow is blocked?

Photo (CC BY) Laura Haapio-Kirk

I began to think about how smartphones are integral to navigating many of the infrastructures that enmesh us, for example through maps that visually place you within an infrastructure of roads, or health apps that extend the infrastructure of a national health service towards more individualised care. However, as digital technology becomes more integral to health services will people with limited access (through lack of digital literacy, or affordability for example) face increased marginalisation from infrastructures of care? And how are health professionals to identify blockages in the flow of care before it’s too late for individual patients? In such cases where care is not received, it is not only the infrastructure which is revealed to be vulnerable, but individuals themselves.

A couple of days after the seminar I happened to read a newly published article titled ‘Thinking with care infrastructures: people, devices and the home in home blood pressure monitoring’ (Weiner and Will 2018) in which the authors use the concept of care infrastructure to look at the variety of people, things and spaces involved in self-monitoring using a blood pressure device. Their work reveals self-monitoring as a socio-material arrangement that expresses care for self and for others, as opposed to focusing only on the individual and the device: “Specifically, our analysis has drawn attention to the range of local actors and work involved in the practice of self-monitoring, even in the case of consumer technologies. Through this attention to work, monitoring may also come to be seen as involving not just data, but also care amongst kin, family and colleagues.” My intention for my research was always to look at smartphones as situated within wider practices and things including other technologies and people, but thinking specifically in terms of infrastructure expands my scope and gives rise to questions about how multi-layered flows are connected (or not), ranging from state level, to family based care.

References

Harvey, P., Jensen, C. B.Morita, A. (2017). Infrastructure and Social Complexity. Routledge

Weiner, K. and Will, C (2018) ‘Thinking with care infrastructures: people, devices and the home in home blood pressure monitoring’ in Sociology of Health and Illness 40: 270–282. doi:10.1111/1467-9566.12590.

The Sandwich Generation: Mobile Views from Multicultural Milan

ShireenWalton17 March 2018

(CC By) Shireen Walton

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.

(CC By) Shireen Walton

References

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.

Looking to the Future – by Marilia Duque

LauraHaapio-Kirk3 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[1]. 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.

(CC BY) Marilia Duque

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”.

(CC BY) Marilia Duque

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[2]), language classes and a Whatsapp course, especially for people over 60.

(CC BY) Marilia Duque

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.

(CC BY) Marilia Duque

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?

 

 

[1] http://www2.camara.leg.br/a-camara/estruturaadm/altosestudos/pdf/brasil-2050-os-desafios-de-uma-nacao-que-envelhece/view

[2] https://agenciadenoticias.ibge.gov.br/agencia-noticias/2013-agencia-de-noticias/releases/18992-pnad-continua-2016-51-da-populacao-com-25-anos-ou-mais-do-brasil-possuiam-apenas-o-ensino-fundamental-completo.html

Individualised Japan

LauraHaapio-Kirk22 February 2018

(CC By) Laura Haapio-Kirk

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.

(CC By) Laura Haapio-Kirk

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.

 

References

Allison, A. (2013) Precarious Japan. Duke University Press

 

What If I Choose You To Be Legally Responsible For Me? – By Marilia Duque

ShireenWalton8 January 2018

In 2002, Brazil adopted the World Health Organization guidelines for ageing societies, which protects people over 60 from violence and discrimination, addressing key issues as health, food, education, culture, sports, leisure, work and citizenship. Indeed, the Brazilian Public Health System (SUS) is accessible to everyone. But outside the state health service, the law enshrined in the National Policy for the Elderly sees elderly welfare as a responsibility of “the family, the community, the society and the state”. In other words, the family is also viewed as the primary institution legally responsible for people over 60.

For example, people over 60 are supposed to live with their families, and the state will only intervene when relatives provide evidences that they cannot afford this responsibility. The same applies to nourishment. But the National Policy for the Elderly goes even further. By law, people over 60 can sue their grown-up children to enforce this legal responsibility. If they have more than one child, they can also decide which of them will take on the onus of care. If you are selected, you can sue your brothers or sisters to try to enforce their share in this responsiblity. In most cases however, it will be a lost cause.

My grandmother and me

The National Policy for the Elderly understands that people over 60 can nominate who will become responsible for paying for this support, and it includes choosing just one of their children. If their children don’t have sufficient incomes or are deceased, grandchildren,brothers and even nephews can be nominated, too. Kinship has traditionally been a core topic within anthropology. But in this case, Brazilian law gives it a quite unique dimension – which I will explore during my ethnography of middle-age.

– Marilia Duque

The Burden of Caring in Japan – By Laura Haapio-Kirk

LauraHaapio-Kirk5 January 2018

Image (c) Laura Haapio-Kirk

A recent news story titled Dying at home rather than in hospital, elderly Japanese “go to the afterlife quietly caught my eye with its suggestion of a preference for home deaths in Japan. The location of palliative care and the relationship of a dying person to their caregivers, whether they are relatives or professionals, can reveal a great deal about an individual’s social world, as demonstrated in Miller’s recent book The Comfort of People. Upon closer inspection the article’s title proved to be misleading; Japanese cultural beliefs surrounding death and the avoidance of burdening others (Long, 2012) indicate that the situation is more complicated.

The article claims that the current shortage of hospital beds combined with the expense of professional medical care means that for many people the choice to die in hospital is taken away from them. One reason why hospital care may be preferred over family care is that over half of Japanese carers are pensioners themselves (Hurst, 2017). The Japanese term rou-rou kaigo describes the common practice of care between the elderly. Our ASSA project focuses on people between the ages of 45-70 who may be both experiencing embodied reminders of ageing, while simultaneously caring for their ageing relatives. We will study how care is mediated through technology, specifically through the smartphone, such as by maintaining self-care through mHealth apps or caring for others through connected devices.

In Japan, not wanting to be a burden in death can be understood as a final act of care towards one’s family. I am wondering whether this may help to explain people’s interest in new technologies such as smartphones. Perhaps older people are hoping that technology will give them a means to look after themselves more effectively and so be less dependent upon their families. Or perhaps, as Long’s article suggests, some people resist such technologies precisely in order to preserve what they consider to be traditional Japanese family values. By conducting my research in Japan where life expectancy is the longest in the world, I hope to deepen our understanding of the possibilities afforded by a prolonged mid-life and explore how family relationships and networks of care are affected by the simultaneous rise of the smartphone.

– Laura Haapio-Kirk

 

References

Long, S.O. J. 2012. ‘Bodies, Technologies, and Aging in Japan: Thinking About Old People and Their Silver Products’ in Cross Cultural Gerontology (2012) 27: 119. https://doi.org/10.1007/s10823-012-9164-3

Hurst D. 2017. ‘More than half of Japanese carers are pensioners’ in The Times June 28 2017. Retrived 23..11.2017 (https://www.thetimes.co.uk/article/half-of-japanese-carers-are-pensioners-themselves-n2v3glbkz)

Dying at home rather than in hospital, elderly Japanese ‘go to the afterlife quietly’ (November 20, 2017) Retrieved from https://www.reuters.com/article/us-japan-homedying/dying-at-home-rather-than-in-hospital-elderly-japanese-go-to-the-afterlife-quietly-idUSKBN1DK2LB