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Sixty may be the New Fifty but is Twenty Six the New Old?

alex.clegg14 April 2022

Anonymous illustrator in late 19th century Germany. William Ely Hill (1887 – 1962), a British cartoonist, produced a later, well-known version.

Author: Sheba Mohammid

In Trinidad and Tobago, we may not have Ponce De Leon’s fountain of youth, but we do have a pool. It’s technically an offshore sandbar, but we’ll save that ecology lesson à la David Attenborough for another time. In local folklore, taking a dip in our Nylon pool, can take 10 years off your appearance. But then what is age appearance, or biology, when as many of our research participants say they simply “do not feel their age”.

Here as elsewhere there are many popular clichés as to how sixty is the new fifty, or thirty the new twenty. It is not so much that people think they can transcend age, but frustration with the inelasticity of these categories, a revelry in defying expectations and complicating the linearity associated with ageing as fixed numerically and cumulatively in its standardisation of set expressions.

In fact, the group that emerged in my study as most commonly defining themselves as ‘old’ was actually twenty-something year olds who would regularly complain to me about their feelings of “getting old”. They brought up the topic of ageing more than any other group. Mona sighed with disbelief and exasperation when she told me she had turned twenty-eight that year. There was a shared feeling among many twenty-something year olds that when they crossed 25 and especially as they approached thirty, they were approaching a major milestone that marked the end of their youth. Whether this past phase of their twenties was enraptured by the indifference often associated with youth was not the point so much as the sense that they were leaving something intangible behind that was gone faster than they could ever quite grasp what it was. Much of this had to do with ideas of ageing being linked to ideas of responsibility, domesticity and stability and anxieties of being able to perform these. Many people felt that they had not reached as far as they were supposed to in starting a family, securing a house or finding a foothold in a career trajectory. These feelings were buttressed by feelings of being delayed even further in their prospects by the Covid-19 pandemic.

You may have noticed the picture at the start of this blog, William Elly Hill’s rendition of Young Woman, Old Woman Ambiguous Figure first created by an unknown German cartoonist in the late 19th Century. It is an illusion where if you stare long enough you will see an old and young woman in the same picture. This was the image that came to mind, a metaphor of sorts for the disruption of thinking of ageing as linear and a questioning of the convenient packaging of dichotomies and what they exclude in their delineations.

In my research it was commonplace for both male and female participants of all ethnicities aged 26 to 29 to say “I’m getting old” not ironically but as an exclamation of ageing as unwelcome, unwanted and certainly coming too fast. This discourse is part of a complex lexicon surrounding ageing in Trinidad and Tobago. Maturity embodied in terms like “getting big” or “being a big woman” were met with positive associations but the idea of “getting old” and ageing were often sources of dread. Twenty-something year old’s expectations of ageing were defined in opposition to a general sense of physical fitness and mental freedom from responsibility that they ascribed to youth. They saw this as their experience during school days bringing nostalgia to this period. “Getting old” was reflected in having additional responsibilities and growing weaker and out of shape. By comparison they simultaneously noted that their parents, grandparents, aunts, uncles or neighbours “looked young for their age”. These tensions regarding perceptions about “getting old” problematised the term and underscored the challenges of neatly ascribing age groups as categories and ageing as linear.

How these perceptions of ageing intersect with and impact health are also complex and often problematic. Firstly, when I talked to participants about their feelings of mental wellbeing, they often expressed anxiety and distress surrounding ageing and its negotiations. Secondly, participants often equated “being old” with “being sickly”. These constructions of ageing and health are laden with further tensions and contradictions. For example, participants in their twenties often express that they are “getting old” but do not equally lay claim to feeling that they need to be aware of health with a poignant “yet” often attached to their statements. Similarly, participants upwards from their thirties, forties, fifties, sixties and beyond often do not want to think about getting their blood sugar or blood pressure tested as these associations of ageing and illness are a downer and at odds with the Trinidadian sentiment that “Yuh have to live yuh life” with a subtext of clinging to vitality of youth rather than falling prey to the perceived trappings of ageing. Getting “sugar” (diabetes) or “pressure” (hypertension) are often framed among participants as diseases linked with senescence and not something to concerned about until bothersome or threatening symptoms appear. Doctors we spoke to argued that these beliefs delay testing and preventive health care, as they are seeing rising numbers of lifestyle diseases like pre-diabetes, diabetes, cardiovascular disease and hypertension among all age brackets. They also express concern regarding indications of these rising undiagnosed, “silent” killers as people admit that they do not get tested or only attempt to adjust their lifestyle factors like diet when they have fallen seriously ill.

This is one of the reasons when Daniel Miller and I thought of an applied project, we made the decision to be inclusive about ages and target a wide range of Trinis (Trinidadians) as our research demonstrates that many of the health challenges are linked to wider socio-cultural and systemic issues that are certainly not packed up into neat demographic categories of ageing. At first there was an urge that in studying ageing, I should focus on retired individuals or at least start with those aged over forty but in researching perceptions of Trinis, it became clear that understanding ageing, mobile phones and health necessitated deeper inquiry into a wider network of demographics. On the other hand, many people we spoke to about the potential project urged us to focus only on school children for our nutrition education campaign as they felt it was too late for everyone else who had already built their habits and would not be interested in learning or sharing ideas. We also want to challenge that assumption. Instead, we plan to create enjoyable formats that move away from top-down pedagogies and embrace learning from each other at all ages.

Understanding Covid Vaccine Resistance

Laura Haapio-Kirk19 January 2022

Authors: Sheba Mohammid and Daniel Miller

Open access image by Volodymyr Hryshchenko.

Right now, Trinidad and Tobago are suffering amongst the highest death rate from Covid in the world. As small islands, everyone seems to know people who have died. According to a Trinidadian doctor specialising in this field one reason for this is co-morbidity with diabetes, obesity and hypertension. Diabetes is also the leading co-morbidity factor in Europe[1]. These are exactly the health conditions our final ASSA project in Trinidad is focusing on. Yet we would estimate perhaps half the population is resistant to getting the Covid vaccination, either not having it (48.3%), or being vaccinated only because of pressure, such as keeping their job. In response Sheba Mohammid has focused on researching the reasons people remain opposed to vaccination even in such tragic circumstance, as part of her online ethnographic in Trinidad.

The first thing that became clear in Sheba’s investigations was a fundamental problem with research on this topic. She began, as most researchers would, by asking the people concerned. People gave her many reasons for not being vaccinated, but it soon became obvious that when one reason no longer applied, the emphasis was shifted to another. For example, a person might say they didn’t want AstraZeneca and were waiting for Pfizer. But when Pfizer came along, they give an entirely different reason based on some nurses not being vaccinated. It gradually became clear that what people say in answer to this question is based on the pressure to legitimate their actions. The way these various forms of rationale are replaceable suggests that a deeper investigation was required.

The second stage of her research then tried to focus on two main issues that had developed as possibly the core underlying reasons for taking this stance, using additional evidence from their wider discussions and concerns. The first is general fear and mistrust that the vaccine might itself make one ill. The second was a general resistance to top-down assertions that the facts were clear and that they should take the vaccine. Indeed, it is likely that a response such as fact-checking would only harden the resolve to resist those people from above who cannot be trusted and keep insisting that only their facts were the true facts. By contrast, the stories that made them more fearful of vaccination came not from government, but from people more like themselves. Yet it was also clear that this opposition to authority was different from other regions. The people in Trinidad did not call themselves anti-vaxx or associate with US opposition movements to the vaccine about which they were well informed.

The third stage, began with a realisation that these oppositions may have deeper roots that relate more to local cultural values. The US movement is a more organised opposition reflecting the current degree of politicisation in the US. Danny’s conversations with people in Ireland suggest that an important factor there is the degree of personal support that people opposed to vaccination give each other in the community. Trinidad turns out to have its own quite specific reasons for opposing the vaccine, less political than the US and more individualised than Ireland for opposing the vaccine. In each region      there are deeper resonances that may account for the local resistance.

The traditional relationship in Trinidad between health and the body is not a culture of preventative medicine but rather “If it eh broken, why fix it.” Healthcare is often framed as problem-solving medical intervention that seeks to ease the consequences of an illness and is a last resort. Medicine then is largely framed as curative and many people recount how they avoid health tests saying that they “have one life to live and doh want to know,” but will only seek medical care as a treatment if they feel all else has failed and they are now willing to go to the doctor for help. Indeed, patients may then complain when a doctor merely gives them a painkiller that they could get over the counter  since they expect a special injection. But otherwise, in deeper discussion and sustained participant observation as to why people have not taken the vaccine, they insist that `Ah Good’ – basically they are feeling fine and they fully intend to remain feeling fine. So, at that stage why take a risk by being injected with something that at least some other people are saying, especially on circulating social media, that will itself harm your health.

Sheba interviewed doctors regarding diabetes and hypertension who regularly underscored that a main challenge is this lack of preventative healthcare that is in fact a key challenge to the health system. This idea of “being good” intersected with the insights she gleaned on how people refuse to take high blood sugar or pressure seriously if on the surface they seem fine and thus the proliferation of these “silent killers” in the population.  She found that it was the norm that if participants were taking something to keep healthy it should be a natural food or substance that has no associations at all with becoming ill and seem to pose no risk. This meant that an illness which has an asymptomatic phase such as Covid19 would be particularly devastating, because as long as people feel good, they are confident that they cannot be a danger to others or contract it themselves if they spend time with people who seem asymptomatic. In the meantime, it is taking the vaccine that represents risk, not the failure to have taken it. Appearance matters and there is considerable stress on showing to others that one is healthy, while even talking about ill health and medicines ‘kills the vibe’ and should be avoided unless one is actually ill. This study also showed us that our original plans for helping to improve diet in relation to diabetes would probably not have worked, at least in this context, and a different approach is now being considered.

Clearly these generalisations only apply to some of this population. But it may be an important underlying part of the culture surrounding the body and health. Extrapolating from this conclusion, it would seem that research based simply on asking people for their reasons for not taking the Covid vaccination, or worse still projecting upon them one’s assumptions, are not likely to be helpful. A more anthropological insistence on taking vaccine hesitancy seriously and finding the deep roots that sustain it in people’s values and wider attitudes may be required for each region of concern.

[1] Corona. G. et. al 2021 Diabetes is most important cause for mortality in COVID-19 hospitalized patients: Systematic review and meta-analysis Rev Endocr Metab Disord Jun;22(2):275-296.

doi: 10.1007/s11154-021-09630-8.