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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.

An Anthropological Approach to mHealth: Health & Care in the Smartphone Age

alex.clegg3 March 2022

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