Article writing (550 words)

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Introduction

In December 1984, experts at the first African gerontological conference, held in

Dakar, confronted a new problem: the challenge of Africa’s aging populations. A

report on the conference observed that

This week, the aging of Africa truly began and with it, the recording of its historic

start right here in Dakar. . . . For the first time representatives from all of Africa have

met to exchange ideas and find ways and means of maintaining the graceful and

dignified aging which has been the heritage of Africa and which is likely to tumble

under the rapid social, economic and cultural changes that appear to be the lot of

Africa in this century and beyond. . . . Immediately after political independence,

African societies abandoned agriculture in favor of industrialization which seemed to

them their only way to achieve economic autonomy and assure their development.

The technological choices made, however, have contributed to the marginalization of

aged persons.1

The observation that the moment was uniquely historical is particularly striking; far from

being simple encomium, it highlighted a history that needed to be reset. It underscored a

crucial and disruptive aspect of the problem of aging as a socio-political issue that required

recasting. Aging had so far been approached as an issue that grew out of industrialization and

development. The issue defined industrialized Western societies and populations and their

present, and, in the same form, represented the remote future of the as-yet undeveloped

1 Report, African Conference of Gerontology, Dakar, December 10–14, 1984, under the patronage of HE Mr. Abdou Diouf, President of the Republic of Senegal, organized by the Government of Senegal with the International Center for Social Gerontology, in collaboration with the UN, UNESCO and UNFPA (no publisher, 1984), 9–21.

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world. These assumptions colored the approach to what was really a world problem but was

still not informed by experiences from other parts of the world. In this statement, the writers

of this report put their finger on the pulse of the issue: the problems of aging across the world

were interwoven with issues and historicities of a recent past in Africa: an uneven process of

industrialization, technology shifts, development, and rapid social, economic, and cultural

changes. These events and processes needed to be reconciled and integrated into the

conceptual apparatus of aging, and the “problems” associated with old age needed to acquire

new explanatory sensibilities informed by aging in Africa.

In the 1980s, in Dakar as elsewhere in the global South, aging as a moral and

developmental issue was beginning to engage the imaginations of experts and activists. Apart

from local politicians, the conference also attracted an impressive number of social experts

from across the continent who were advocating for the needs of aging persons. In particular,

the meeting drew and shaped a first generation of African gerontological experts and activists

interested in the study and field of aging in Africa, who claimed that they could guide the

process of mitigating these shifts and renewing African society.2 Speakers at the conference

narrated a story, told and retold since the 1940s, of modernization’s and development’s ills

and the dependence of older persons. The delegates observed that societal choices about

development had produced the social and economic predicaments associated with aging

populations in Africa. The narratives of aging in developing nations were thereby tied to the

2 Several UN representatives posted in Africa and from Geneva were present at Dakar, as were experts from the NGO HelpAge International, leading American and European members of gerontological associations, and rural development experts and social workers from Senegal and across Africa. It was supported by funds from UN agencies and from international gerontological associations. Others heard about the Dakar meeting by word of mouth and tried to plan their own versions to discuss the needs of aging populations (Interview with Father Joseph Hampson, missionary, social worker, and participant at the Dakar Conference, April and June 2015. Hampson is a founding figure of the School of Social Service in Harare, Zimbabwe; in 1985, he was the Director of Fieldwork at the School of Social Service).

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aspirations of decolonization in Africa and associated with attempts by various nations to

forge ahead on a path of unfettered industrial modernization. This flawed vision led to untold

losses in just a few decades: instead of lifting all boats, it diminished certain populations,

such as the aged, who lost the support of their families and communities. The aged became

the face of unfettered development’s failures and challenges.

Changing Demographics, Changing Perspectives

More recently, aging populations have found renewed relevance. For some experts,

aging has heralded the promise of dividends over dependence. These experts link the aging

with Africa’s future and promise rather than its past errors; they project that aging

populations can enable equitable change and the harmonious development of African

societies. As experts from across the continent lay out their development agenda for the

future, aging populations are no longer viewed as neglected, needy, and primarily

representing poverty and destitution.3 For example, at recent meetings of the Organization of

African Unity, in which representatives were asked to imagine the “Africa we want” to see

by the year 2063, older persons were imagined as having a role in issues relating to youth and

women through intergenerational dialogue and pictured as a buffer to future social change.

These visions, however, have not necessarily led to real support on the ground.

The swift changes in perspectives about aging among international experts have been

partly shaped by demographic patterns, or the speed at which aging is occurring in parts of

Asia and Africa. Nations in Europe, such as France and Germany, took over 150 years to

3 I am grateful to Isabella Aboderin for offering a discussion of these new Africa plans. The 2063 vision meeting began to be articulated in a series of consultations held in Addis Ababa, Ethiopia, in May 2013.

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register a decline in death rates, followed by falls in fertility.4 But over the last fifty years or

so, there have been steep improvements in longevity and declines in fertility in China, India,

and other parts of the world.5 This has led to concerns that the absolute number of older

persons in the global South will soon rapidly outpace their numbers in the West. Over the

coming decades, Africa will experience a faster growth in the number of older people in the

population than will other regions of the world. The number of people aged 60 and over in

Africa is projected to increase from the 2007 figures of 50.5 million to 64.5 million in 2015

and reach 205 million by 2050.6 Experts are concerned not simply with the increase in the

proportion of the older population but with the speed and accelerated growth of those aged

over sixty years in the world.7

Historiographic and Critical Approach

While keeping these futures in mind, this book explores the recent past and history of

aging as a sociopolitical global health concern by tracing it through the lens and lexicon of

international health and development concerns since the Second World War. The making and

remaking of aging populations merits this attention because these populations have been

4 Massimo Livi-Bacci, A Concise History of World Population, 5th ed. (London: Wiley Blackwell, 2012); John Bongaarts, “Human Population Growth and the Demographic Transition,” Philosophical Transactions of the Royal Society B: Biological Sciences 364, no. 1532 (27 October, 2009): 2985–2990. The change in the age structures of populations around the world and its demographic determinants are discussed in the World Population Aging, 2015 report published by the United Nations, Department of Economic and Social Affairs, Population Division, ST/ESA/SER.A/390 (New York, United Nations). 5 David Bloom, David Canning, and Pia Malaney, “Demographic Change and Economic Growth in Asia,” in Population Change in East Asia, a supplement to Population and Development Review 26 (2000), 257–90; P. N. Mari Bhat, “Mortality and Fertility in India, 1881–1961: A Reassessment,” in India’s Historical Demography: Studies in Famine, Disease and Society, edited by Tim Dyson (London: Curzon Press, 1989), 73– 118. 6 United Nations, Economic Commission for Africa, The State of Older People in Africa, 2007: Regional Review and Appraisal of the Madrid International Plan of Action on Aging (UN, Economic Commission for Africa, 2007), 12. See also UN Department of Social Affairs and Economic Division, World Population Aging 2015, ST/ESA/SER.A/390 (New York: United Nations, 2015). 7 UN Department of Social Affairs and Economic Division, World Population Aging 2015, 1–2.

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reconfigured by broader historical debates and concerns, such as late-colonial welfare

policies and inquiries into social change in the colonies, scientific and political engagements

during the Cold War years, the politics of decolonization and international development, and

the changing role and perspectives of neoliberal ideas and global health. These critical bends

in the river or historical conjunctures, when knowledge about aging in the international and

later global arena was being created, structure this book’s historiographical work.

In addition to this historiography, this book takes a critical approach to the issues of

global aging, examining how aging became a site of comparison, intervention, evasion, and

engagement in the international arena. How did older populations emerge as definitive

classes, and how did social scientists, colonial actors, scientific researchers, international

bureaucrats, and social activists “discover” them and view them in particular ways? What

discourses and practices, in terms of historical surveys, anthropological and ethnographic

accounts, and scientific studies, campaigns, and mobilizations in international policy debates

and programs, have defined older populations and their vulnerability since the 1940s?

At the heart of the critical inquiries in this book lies a larger concern: the politics of

knowledge about aging populations. The norms and paradigms that constituted modern

gerontological knowledge, as well as the developmental agenda for aging from the 1940s

until the present, were largely shaped by a “dominant” narrative drawn from the experiences,

categories, and concerns of West European and American societies.8 These norms and

8 I use the word dominant here to indicate its influence in international mobilization around aging, although, as this book demonstrates, these ideas were being increasingly recast by experts in the South. Social policy experts such as Lloyd-Sherlock, writing on the eve of the Second World Assembly on Aging (2002) have said Western experiences’ influence on global aging are shaped by concerns about withdrawal, dependency, physical frailty, and pensioner status—quite distinct from the concerns of many rapidly aging nations in the global South, where there is still a young labor force and social policies have mostly focused on other age groups, such as children and mothers, or on the poorest strata below the poverty line, leaving a gap in social and health policies that needs to include older persons as a distinct constituency for the first time. Lloyd Sherlock, “Social Policy and Population Aging: Challenges from North and South,” International Journal of Epidemiology 31, no. 4 (2002),

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paradigms reflected critical historical assumptions about how and when non–Western

societies age, how their populations would grapple with sudden transformations, and the

characteristics of aging populations as “traditional” societies experienced rapid change. A

historical analysis of these concepts and their agenda subverts these standards and normative

assumptions about age, diseases, and societies.

Aging has been linked with the modernization of societies and with demographic

challenges, economic adjustments, and social futures that are more or less shared across the

globe. But these notions of global aging and its future often overlook continuing contextual

inequalities and historical legacies of differences and variability between societies. Even

though the easiest and most obvious way to make a case for the interests and needs of older

persons in decolonized societies was often appealing to a loss of culture and “tradition,”

scientific and social experts as well as NGO leaders were acutely conscious that these

debates and engagements were occurring in an intellectually, economically, and politically

unequal world. Aging has therefore been suspended as a global agenda between a belief in

the distinct societal interests and rights of the old, which has deepened since the 1980s, and

its historical nodes, when aging-related debates gained global momentum and resources at

times of economic or humanitarian crises, and when negative “imaginaries” of the

dependence and perils of aging drew attention to older people.

At the same time, aging’s “coming of age” as a global agenda has involved more than

simply recognizing aging and older persons alone: It has consisted of the gradual recognition

that aging and youth need to be tackled as interdependent issues, as are chronic diseases that

754–57. See also, Nana A. Apt, Coping with Old Age in a Changing Africa: Social Change and the Elderly Ghanaian (Aldershot: Avebury, 1996); Lawrence Cohen, No Aging in India: Senility and the Family (Delhi: Oxford University Press, 1999).

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present risks across the lifespan rather than in later life alone. In the same vein, this book

traces debates that demonstrate, as many experts recognized, that there are no “normal” or

predictable places where older persons are found and are at risk—such as the aging peasant

left behind by the young who were lured by wages and capital in the cities—since many

older persons lead precarious lives in urban slums, and many workers return to villages. This

book aims to transcend these persistent values and assumptions about aging based on local

contexts, and it outlines emerging models and assumptions about aging in post-colonial

Asian and African societies.

Critical Backgrounds: Aging in the Postcolonial World

To further explicate the core approach in this book, it may be useful to recapitulate

the ideas voiced at the Dakar conference. From the perspective of several UN

representatives, the blueprint for international debates on aging was the plan and strategy

proposed by the first UN-sponsored World Assembly on Aging (WAA), held in Vienna two

years before the Dakar conference, in 1982. At the WAA, approximately 120 representatives

from developed and developing nations drafted a plan of action to address the challenges

posed by world aging. African nations were expected to adapt and implement the vision of

this World Assembly. At Vienna, aging was declared a world problem, and the world’s

attention had been drawn “to the social, economic, political and scientific questions raised by

the phenomenon of aging on a massive scale.”9 The WAA declared that the demographic

processes causing population aging were at work across the world, not simply in the

9 United Nations, World Assembly on Aging (henceforth WAA), A/CONF 113/22, Annex (New York: United Nations, 1982), 7–8.

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developed world.10 These claims were reiterated at Dakar.

Even as experts in Vienna extolled the gradual, unified unfolding of population aging

across the world, local experts at regional meetings recognized that behind the, pervasive,

worldwide demographic shifts lay a world of inequalities and diversity. Demographers had

been increasingly using population aging, as the United Nations termed it—fixing the

threshold of old age at sixty years—as a statistical category and temporal reference point

since the late-nineteenth century.11 Historians have since argued that relying on this so-called

global indicator and threshold fails to tell a complete story. It means that experts neglected to

consider changing social roles and life expectancy or to acknowledge the uneven value and

pace of aging. Setting sixty years as a proxy for aging also associated old age with the

welfare- and retirement-centered preoccupations of industrialized societies.

At the Dakar conference, local social workers and development experts reflected on

these tensions. They felt that aging in Africa was not merely a demographic fact or pervasive

10 The improvement in mortality rates due to improved nutrition, improved public health measures, and, more importantly, because of a decline in birth rates resulted in an increasing proportion of persons surviving into the advanced stages of life across the world. UN projections noted that in 1950, there were about 200 million persons who were sixty years of age and over throughout the world; by 1975, this figure had increased to 350 million, with the rate of growth of older persons in developing countries increasing rapidly. See “International Plan of Action on Aging: I Introduction,” UN Documents: Gathering a Body of Global Agreements, www.un- documents.net/ipaa-1.htm (accessed in January 2016). 11 For a discussion of the influence Bertillion, Alfred Sauvy, and other French demographers and statisticians had on the perception of “population aging,” see Claudine Sauvain-Dugerdil, Henri Léridon, and C. G. N. Mascie-Taylor, Human Clocks: The Bio-Cultural Meanings of Age (Bern: Peter Lang, 2006), 264–67. The authors argue that nineteenth-century notions of the “immutability” of old age persisted and were associated with an unchanging “age of old age” or a “threshold age” with negative connotations relating to pensions, defense, and economic development, and that these notions colored even reports such as the Committee of Enquiry into the Problems of the Elderly’s Laroque report later in the twentieth century. A “statistical category” increasingly began to prevail over any tendency to blur age categories. For a nuanced analysis of these questions relating to the emergence of population aging as a statistical category, see Patrice Bourdelais, “The Aging of the Population: Relevant Question or Obsolete Notion?” in Paul Johnson and Pat Thane, eds. Old Age: From Antiquity to Postmodernity (London: Routledge, 1998), 110–112. For other notions of aging, see Bernice Neugarten, ed., The Meanings of Age (Chicago: University of Chicago Press, 1996); Peter Laslett, “Societal Development and Aging,” in R. Binstock and E. Shanas, eds., Handbook of Aging and the Social Sciences (New York: Van Nostrand Reinhold Company, 1976), 87–116; John Vincent, “Aging Contested: Anti-Aging Science and the Cultural Construction of Old Age,” Sociology 40, no. 4 (2006), 681–698.

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historic process; rather it was a unique postcolonial condition and dilemma stemming from

rapid social change and unstable modernization. According to them, the marginalization of

older persons resulted from the politics and inequities of technology and resources, in

particular the bankruptcy of international aid and development projects. The aging of Africa

comprised two periods: a past, when its population aged “gracefully,” and a present, when

attempts to modernize gave rise to society-wide changes in attitudes to aging populations.12

This made Africa part of “world aging,” but also distinct from it.

During the discussions at Dakar, many pointed out that Africa’s unique, complex

pathology of climate, communicable diseases, malnutrition, and poverty, which affect and

even accelerate the aging process, was also redefining population aging, making it distinct

from population aging in other societies. As a result, the pathway to address these

gerontological challenges, some delegates noted, was through health, education, and training

“that should be rooted in African traditions” rather than in an “undigested imitation of

European and American models.” This view that aging was diverse rather than unitary was

not new. In 1982, two years prior to the Dakar conference, this view was voiced in

conversations at a conference supported by the United Nations Population Fund (UNFPA) in

Delhi. At the conference, urban sociologists, demographers, and social activists from across

South Asia asserted that most aging populations in Third World countries were acutely

marginalized; only a few of the “privileged aged,” mostly in urban areas in India,

Bangladesh, and Nepal, could access better resources.13 An urban sociologist and activist

12 See quotation from Report, African Conference of Gerontology, Dakar, December 10–14, 1984, 9–10 at the beginning of this introduction. 13 Walter Fernandes, “Aging in South Asia as Marginalization in a Neo-Colonial Economy: An Introduction,” in Alfred de Souza and Walter Fernandes, eds., Aging in South Asia: Theoretical Issues and Policy Implications, papers presented at the Asian Regional Conference on Active Aging, Manila, 1982, sponsored by the UNFPA and Opera Pia International (New Delhi: Indian Social Institute, 1982), 1–13. The co-sponsor Opera Pia International was an international Catholic charity founded to mobilize church leadership throughout

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involved in slum development in Delhi observed that a majority of families with elders in

South Asia had few means of economic survival available to them, unlike elders in the West,

where citizens were eligible for universal social security, pensions, and other welfare

support. For countries in the developing world, the major challenge, therefore, was not

reintegrating the retired into political and cultural life. Nor did these particular aging

populations need rescuing from their social and psychological isolation, as in Europe and the

US. Rather, the majority of the aged were most adversely affected by the urbanization and

migration that compounded the problems of poverty and deepened their vulnerability.14

Taken together, the Dakar and Delhi conferences give us a glimpse of the remaking

of world agendas and the transactions occurring in sites across Africa and Asia. They also

provide evidence of a deep-seated critique of international development in general,

particularly the inequities of development and its difficulties in developing nations. More

obliquely, many of these development experts and activists were skeptical that “world aging”

could be addressed through rounds of high-sounding international conferences followed by a

few development projects and assistance funded from abroad. For instance, at the Delhi

meeting, it was observed that the longstanding imbalance caused by a “neocolonial world

order” that subjected developing countries to inequitable economic and aid policies only

compounded the problems of marginalization the old faced in these nations.15

The meetings at Dakar and Delhi are useful places to begin a book that aims to

the world, especially in developing countries, to participate in the World Assembly on Aging (1982). One of its founders, Erdman Ballagh Palmore, wrote the Handbook of the Aged in the United States (Westport, Connecticut: Greenwood Press, 1984). See Andrew W. Achenbaum and Daniel M. Albert, Profiles in Gerontology: A Biographical Dictionary (Westport: Greenwood Press, 1995), 117 for a discussion of the role played by Father Charles J. Fahey from the Diocese of Syracuse, who was the representative of the Holy See at the WAA and founded institutions that promoted education and training in the “Third Age.” 14 Walter Fernandes, “Aging in South Asia as Marginalization in a Neo-Colonial Economy,” 11. 15 Ibid., 8.

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explore how universalizing “global” agendas focused on aging populations emerged in the

West and were then received and remade —or “provincialized,” as the historian Dipesh

Chakrabarty has termed it—in “developing countries” as experts in these countries made this

knowledge their own by recasting aging in light of the social, economic, and moral

imperatives of their societies.16

An Interdisciplinary Debate

Aging populations across the world have been the subject of growing policy interest

based on demographic, economic, and social forecasts. Their rapid rise in numbers,

proportions, and needs across the globe have engendered predictions about the cataclysmic

onset of a gray wave, a “second population explosion,” or a global “tsunami.”17 These

predictions have not merely been the preserve of demographers; security analysts too have

predicted that a rapidly aging world will be characterized by developed nations facing a loss

of dynamism and world power and a challenge to European pre-eminence.18 Nations in the

16 I have retained the term and category “developing countries” here based on its common and politicized usage in the 1980s, referring to decolonized, industrializing societies and distinct from industrially advanced, “developed” nations in the West. The term emerged during the development decades in the 1960s, replacing terms such as “backward societies” and “traditional societies,” and was synonymous with the “Third World” as coined by the French demographer Albert Sauvy. I also borrow from the work of Dipesh Chakrabarty, in his analysis of the marginalization of non-European histories and of the remaking of Western knowledge in non- Western settings. Dipesh Chakrabarty, Provincializing Europe: Postcolonial Thought and Historical Difference (Princeton: Princeton University Press, 2000). I have used ideas from Ashis Nandy, ed., Science, Hegemony and Violence: A Requiem for Modernity (New Delhi: Oxford University Press, 1988), and from writings by Warwick Anderson on postcolonial science. Warwick Anderson, “Postcolonial Techno-Science,” Social Studies in Science 32, no. 5–6 (2002), 643–58. 17 Central Intelligence Agency, USA, Long-term Global Demographic Trends: Reshaping the Political Landscape, Report (CIA, July 2001); Richard Jackson and Neil Howe, The Graying of the Great Powers: Demography and Geopolitics in the 21st Century (Washington, DC: Center for Strategic and International Studies, 2008); Peter G. Peterson, Gray Dawn: How the Coming Age Wave Will Transform America and the World (New York: Three Rivers Press, 2000). For a framing of global demographic shifts, see World Population Aging: Highlights, 2015 (New York: UN, DESA, 2015), 1–6, accessed in January 2016 at www.un.org/esa/population/publications/worldageing; Global Aging: Aging in Africa, accessed in December 2015 at www.global-ageing.eu/agafrica.html. 18 Mark L. Hass, “A Geriatric Peace: The Future of US Power in a World of Aging Populations,” International Security 32, no. 1 (2007), 112–47.

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global South will rapidly follow the West as they face the challenges and “burdens” posed by

aging, even as they are still coming to terms with increasing life expectancy, containing

infectious diseases, and continuing malnutrition.

Recent UN reports and global demographic studies have expressed more measured

and optimistic views.19 They have summed up the challenge of population aging, or the rise

in the population above sixty years of age around the globe, as unprecedented, profound, and

pervasive.20 According to a 2001 UN report, the global population of older persons was

growing at a rate of 2.6% annually, with the developing world being likely to reach the same

stage in the aging process that the developed world currently occupies by 2050.21 Many see

this juncture in human history as unprecedented because it represents the powerful successes

of longevity, such as innovations in health, nutrition, and education; declining birth rates and

family size; and the ability to control fertility. Together, these trends and shifts in the

structure of populations have created historically unique and long-term challenges.

For historians, however, population changes and their deep-seated influence and

impact on politics and society have a precedent in the debates and mobilization around the

global population control and family planning programs that intensified across the world in

the decades after the Second World War. Rapid changes in population growth were

understood to have world-changing implications. However, just as debates about population

explosion, as Alison Bashford argues, were initially justified as being an issue of “space” and

migration rather than of “sex,” debates about population aging have similarly been

19 David E. Bloom, David Canning, and Gunther Fink, Implications of Population Aging for Economic Growth, Program on the Global Demography of Aging, January 2011, PGDA Working Paper no. 64, www.hsph.harvard.edu/pgda/working.htm, accessed October 2015. 20 United Nations, World Population Aging: 1950–2050, ST/ESA/SER.A/207 (New York: Department of Economic and Social Affairs, Population Division, UN, 2001). 21 Ibid.

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legitimized as an international agenda under various guises, and the concerns about it have

varied over time.22

Even though historical demography has put aging on various policy agendas, in terms

of institutional regulation and interventions, as Foucault noted, only in the modern era, in the

context of industrial capitalism, did the state deploy public-health and population policies to

regulate the experience of aging.23 In the West, older populations emerged as definitive

classes in the nineteenth and twentieth centuries, with the social sciences and natural sciences

playing a significant role in this by “seeing” them in specific ways.24 By the mid-twentieth

century, social movements led by pensioners and others in Europe and the US began

challenging certain generalizations made by state policies and programs about aging—

generalizations related to issues such as retirement, leisure, and social interactions, for

example.25

22 I draw here primarily from the work of Matt Connelly and Alison Bashford on the subject of population control movements and their neo-Malthusian ethos and geopolitics. Matt Connelly, Fatal Misconception: The Struggle to Control World Population (Cambridge: Harvard University Press, 2008); Alison Bashford, “Nation, Empire, Globe: The Spaces of Population Debate in the Interwar Years,” Comparative Studies in Society and History 49, no. 1 (2007), 170–201. Other notable works on international development, the politics of population growth, and anxieties about imperial power and population decline include John Sharpless, “Population Science, Private Foundations, and Development Aid: The Transformation of Demographic Knowledge in the United States, 1945–65,” in Fred Cooper and Randall Packard, eds., International Development and the Social Sciences: Essays on the History and Politics of Knowledge (Berkeley: University of California Press, 1997), 176–202; Michael Teitelbaum and Jay Winter, The Fear of Population Decline (Orlando, FL: Academic Press, 1985). Sharpless, Teitelbaum, and Winter discuss how France and Italy, among other nations, voiced fears of “denatalite” (de-natality) in the face of falling birth rates and feared threats to imperial power and “national grandeur” early in the twentieth century. 23 Several of Foucault’s works discuss these efforts to impose a homogeneity on old age and to delimit it. See Discipline and Punish (London: Tavistock, 1977), 184–85 and The History of Sexuality (Harmandsworth: Penguin, 1976). For a discussion of his influences on gerontology and the place of the professional and intellectual power of gerontologists and gerontology and other aging fields, see Stephen Katz, Disciplining Old Age: The Formation of Gerontological Knowledge (Charlottesville: University of Virginia, 1996). 24 Ian Hacking, The Social Construction of What? (Cambridge: Harvard University Press, 2000) 25 Social policy advocates such as Carol Estes have critiqued those who projected aging as an “enterprise” or its commodification and suggested alternate vocabularies for and perspectives on aging. C. L. Estes and E. Binney, “The Biomedicalization of Aging: Dangers and Dilemmas,” Gerontologist 29 (1989a), 587–96; C. L. Estes, The Aging Enterprise (San Francisco: Jossey Bass, 1979). For other critiques, see Pat Thane, “Social Histories of Old Age and Aging,” Journal of Social History 37 (2003), 93–111; Patrice Bourdelais, L’Age de la Vieillesse: Histoire Du Vieillissement de la Population, Opus 60 (Paris: Editions O. Jacob, 1997); Anne-Marie Guillemard, Aging and the Welfare Crisis (Newark: University of Delaware Press, 2000).

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The emergence of studies around aging populations worldwide, however, has

attracted little interest among historians of global health. Global health histories, with

significant exceptions, have tended to focus on colonial medicine and health interventions

based on local and regional studies. Historians have also studied large-scale disease or

immunization programs and global population control interventions and their politics, as

traced through international institutions and philanthropies, and they have explored the

emergence of global health through its association with public-private partnerships, new

disease threats such as HIV, and the neoliberal turn in health priorities.26 This has created an

emphasis on the most “visible” and documented burdens of infectious diseases, epidemic

26 Some notable historical studies offer critiques of the medical and technological paradigms that shaped colonial health history and the international development led by colonial authority, scientific experts, missionaries, local leaders, and international foundations; see David Arnold, “Introduction: Disease, Medicine and Empire,” in David Arnold, ed., Imperial Medicine and Indigenous Societies (Manchester: Manchester University Press, 1988), 1–26; Arnold, Colonizing the Body (Berkeley, University of California Press, 1993) and “Nehruvian Science and Postcolonial India,” Isis 104, no. 2 (June 2013), 360–70; Alison Bashford, “Global Biopolitics and the History of World Health,” History of the Human Sciences 19 (2006), 67–88; Heather Bell, Frontiers of Medicine in the Anglo-Egyptian Sudan 1899–1940 (Oxford: Clarendon Press, 1999); Sanjoy Bhattacharya, Expunging Variola: The Control and Eradication of Smallpox in India, 1947–1977 (New Delhi: Orient Longman, 2006); Nandini Bhattacharya, Contagion and Enclaves: Tropical Medicine in Colonial India (Liverpool: Liverpool University Press, 2012); Marcus Cueto, Cold War Deadly Fevers: Malaria Eradication in Mexico (1955–75) (Baltimore: Johns Hopkins University Press, 2007); Andrew Cunningham and Bridie Andrews, eds., Western Medicine as Contested Knowledge (Manchester: Manchester University Press, 1997); John Farley, To Cast Out Disease: A History of the International Health Division of the Rockefeller Foundation (1913–1951) (New York and Oxford: Oxford University Press, 2004); Achintya Kumar Dutta, “Kala-Azar in Assam: British Medical Intervention and People’s Response,” in A. K. Bagchi and K. Soman, eds., Maladies, Preventives and Curatives (New Delhi: Tulika Books, 2005), 15–31; Soma Hewa, “The Hookworm Epidemic on the Plantations in Colonial Sri Lanka,” Medical History 38 (1994), 73–90; Sarah Hodges, “The Global Menace,” Social History of Medicine 25 (2012), 719–28; Richard C. Keller, “Geographies of Power, Legacies of Mistrust: Colonial Medicine in the Global Present,” Historical Geography 34 (2006), 26–48; Lenore Manderson, Sickness and the State: Health and Illness in Colonial Malaya, 1870–1940 (Cambridge: Cambridge University Press, 1996); Laurence Monnais and H. J. Cook, eds., Global Movements, Local Concerns: Medicine and Health in Southeast Asia (Singapore: NUS Press, 2012); Randall Packard, White Plague, Black Labor: Tuberculosis and the Political Economy of Health and Disease in South Africa (Los Angeles: University of California Press, 1989); Gyan Prakash, Another Reason: Science and the Imagination of Modern India (Princeton: Princeton University Press, 1999); Amy Staples, The Birth of Development: How the World Bank, Food and Agriculture, and World Health Organization Changed the World, 1945–1965 (Ohio: Kent State University Press, 2006); Sujit Sivasundaram, “Sciences and the Global: On Methods, Questions, and Theory,” Isis 101, no. 1 (2010), 146–58; Megan Vaughan, Curing their Ills: Colonial Power and African Illness (Stanford, Stanford University Press, 1991). For a discussion of the colonies such as the West Indies and India as sites and spaces of medical innovation, see Mark Harrison, Medicine in the Age of Commerce and Empire: Britain and its Tropical Colonies, 1660–1830 (Oxford: Oxford University Press, 2010).

15

diseases, and public health challenges, which have historically been associated with the

environments and populations of Asia and Africa and have taken a devastating toll in these

societies. So far, historical scholarship has approached these diseases and health

interventions through certain fixed temporal lenses and approaches. For instance,

international health and decolonization have mostly been examined through histories of

international institutions and international disease programs rather than through a

comparative or regional focus. Some historians have pointed out that these perspectives have

often created implicit silos and have not sufficiently explored, for instance, the links between

colonial medicine and post–Second World War international health and development

projects.27 These perspectives also hold deeper intellectual consequences, because they

overlook histories of health conditions, human experiences, diseases at the “borders,” and

intersectionalities. For instance, chronic diseases and co-morbidities, cognitive decline and

disabilities, and regional histories of medicine from within the global South are rarely traced;

and mobilization and meetings that lie on the edges or margins of large UN institutions or

Cold War networks and assistance are also less visible.

Aging populations as a worldwide agenda and its historical roots offer a productive

engagement for global-health historians. They present a less “predictable” and well-known

cast of international social actors as well as less orthodox networks and mobilization. This

cast’s activities and engagements have often occurred at the margins of influential

international institutions; “global” aging circumvents power centers and structures, such as

27 Packard attributes these silos partly to the convenience of academic divisions in labor and calls for greater probing of “entanglements.” See Randall M. Packard, A History of Global Health: Interventions in the Lives of Other People (Baltimore: Johns Hopkins University Press, 2016), 1–14, 133–37. For an interesting discussion of the shifts in focus and politics from international to global health, see Allan Brandt, “How AIDS Invented Global Health,” New England Journal of Medicine, 388, no. 23 (June 6, 2013), 2149–2152.

16

the colonial metropolises or Cold War capitals, and offers insights into alternate pathways

and scales of mobilization. 28

Of all the modern agendas that have emerged over the past decades, aging has

reflected a complex and unequal world of global health and development. It has presented

uneasy political relationships in a seemingly egalitarian world of demographic predictions

and promise, and it has lacked confident “cures” and interventions that can be suggested

globally. Experts have argued that health becomes a global issue when it transcends

boundaries and needs to be addressed by “cooperative actions,” but aging demonstrates that

stating historical concerns and asserting an agenda that unites vulnerable populations across

borders are not necessarily followed by resources and globally coordinated interventions.

Thus aging retains strong moorings in local and regional contexts and approaches.29 This also

makes it vital to understand the plural historical genealogies of aging in societies where

disease and demographic transformations are ongoing. These changes need to be understood

on their own terms, and they require reflection on how experts have historically framed

knowledge about aging and its social implications.

28 A few significant histories have focused on key intersectionalities in colonial and international health, traced regional/local perspectives, and provided critiques of ideological paradigms and normative epidemiological and policy assumptions in international and global health, such as Sunil Amrith, Decolonizing International Health: India and Southeast Asia, 1930–65 (Basingstoke: Palgrave, 2006); Warwick Anderson, “Where is the Postcolonial History of Medicine?” Bulletin of the History of Medicine 72 (1998): 522–30; Julie Livingston, Improvising Medicine: An African Oncology Ward (Durham: Duke University Press, 2012); Randall Packard, A History of Global Health (Baltimore: Johns Hopkins University Press, 2016); Anne-Emanuelle Birn and Theodore Brown, eds. Comrades in Health: US Health Internationalists, Abroad and at Home (New Jersey: Rutgers University Press, 2013); Laurence Monnais and David Wright, eds., Doctors Beyond Borders: The Transnational Migration of Physicians in the 20th Century (Toronto: University of Toronto Press, 2016); Helen Tilley, Africa as a Living Laboratory: Empire, Development and the Problem of Scientific Knowledge, 1870– 1950 (Chicago: University of Chicago Press, 2011) and David Arnold, “Diabetes in the Tropics: Race, Place and Class in India, 1880–1965,” Social History of Medicine 22, no. 2 (2009): 245–61. 29 Mark Nichter, Global Health: Why Cultural Perceptions, Social Representations, and Biopolitics Matter (Tucson: University of Arizona Press, 2008); see also, Laëtitia Atlani-Duault and Laurent Vidal, “Le moment de la santé globale,” Revue Tiers Monde 215, no. 3 (2013): 7–16.

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Normative Models of Aging and the Politics of Knowledge

At the start of this book, I trace ideas concerning chronological age and aging in

Africa and Asia, and I argue that discourses about aging and modernization were still in the

making from the 1940s to the early 1950s. Surveys and studies by colonial officials,

Christian missionaries, sociologists, and anthropologists at the Rhodes-Livingston Institute,

Zambia and in India displayed an urge to compare and contrast notions of chronological age

and to understand the role played by gerontological authority and elders in securing social

stability. Soon after this, gerontological, sociological, and demographic writings began

representing aging as a classical, normative model characteristic of modern Western societies

that reflected these societies’ successes in industrialization and modernization.30 In the

decades following the Second World War, the growth of aging populations was widely

associated with a historical trajectory of modernization emblematic of “civilized” nations.31

In fact, this stage of development was held out as a model to be envied and emulated.

In the 1950s, when a group of American scientific experts toured research centers and

institutional care facilities in Western Europe, they declared that the latter was an

“unintended laboratory” to study the social aspects of aging; in the same breath, they also

emphasized that America had joined the ranks of other civilized nations in addressing these

30 In the West, aging in international policy debates has largely engaged attention as an issue related to social marginalization, pension reform, chronic disease, flows of capital, and financing of care and, until recently, far less in terms of intergenerational relations and disparities. There are some significant exceptions to this perspective in the field of aging research, such as the work of Martin Kohli, Simon Biggs, Elise Feller, Sheila Neysmith, and Chris Phillipson, to name a few of the notable scholars working at the intersections of sociology, psychology, critical social gerontology, and social work on questions of intergenerational relations, social and ethnic identities, and unpaid family care in settings such as Germany, Australia, France, Canada, and the United Kingdom. 31 Ernest Burgess, ed., Aging in Western Societies (Chicago: University of Chicago Press 1960). See also other studies such as Shanas, Townsend, et al., Old People in Three Industrial Societies (New York: Atherton, 1968) and Wilma Donahue and Clark Tibbitts, “European Approaches to Aging,” Public Health Reports 70, no. 6 (June 1955): 581–84.

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concerns and problems—the rise in old age dependence, retirement, claims on social security

and medical care for the chronic “diseases of aging”—associated with the shared

demographic changes in life expectancy and fertility.32

American social gerontologists and scientists were referring not simply to the experience

of aging but to a stage of industrial, advanced development emblematic of the West;

significantly, they characterized population aging as a social condition that liberal, welfare

regimes in Western Europe and the US had in common. The power of the Western

gerontological imagination, shaped by research on the so-called diseases of old age,

demography, and social policy, was influential. It was premised on an unwavering sense of

primacy—of having aged and matured “first”—and it derived from a specific set of

circumstances and characteristics of technological changes and the organization of production

and labor in the West. A certainty that the changes and experiences of aging in Western societies

impacted and shaped changes elsewhere underpinned these claims, and this ideological self-

confidence, articulated in the 1950 and 1960s, when American social gerontologists began to

deepen their studies of aging, has persisted. Writing in 1960, for instance, American

gerontologists Clark Tibbitts and Wilma Donahue opined: “Never in human history has a society

set such a rapid pace of change in the manner and means of living as our American society

today. In turn, we have set in motion processes that are resulting in accelerated change in the rest

of the world, from the USSR to the most primitive areas of Africa and South-East Asia.”33

Gerontological frameworks and their assumptions that emerged in the West have in

turn been supported by ideas and enduring models about disease and demographic change. In

32 Burgess, ibid. 33 The spread of civilization in this case was imbued with Cold War connotations of the spread of both democracy and development; both were interlinked in this thinking. Clark Tibbitts and Wilma Donahue, Aging in Today’s Society (New Jersey: Prentice-Hall, 1960), xvii.

19

the 1940 and 1950s, international health projects, deepened by UN leadership and often led

by philanthropies and resources now centered in the US, recast older colonial stereotypes

about disease and demography. Developing nations on the path to industrialization that had

not yet modernized were regarded as “young societies,” both in developmental and

demographic terms, and were associated overwhelmingly with the burden of infectious

diseases.34 Public health programs, including campaigns relating to infectious diseases, high

fertility, and maternal and child health, addressed the need for a productive labor force on the

one hand and, on the other, were premised on racialized demographic anxieties that ignored

the relationship between infections, environmental risks, and chronic diseases such as

cancers.35

These linear demographic and epidemiological transition models that hold the

promise of modernization—as societies progress to conquer infections, influence life

expectancy and lower fertility—have significant implications for my narrative. By the 1970s,

the accepted progress of an epidemiological transition was a linear model with “stages” of

progress modeled on industrialization and shifts in life expectancy in Western countries.

Non-Western nations, it was predicted, were bound merely to play “catch-up” with this linear

model.36 Public health scholars such as Julio Frenk (1989) have challenged this model, and

34 Abdel R. Omran, “The Epidemiologic Transition: A Theory of the Epidemiology of Population Change,” The Milbank Memorial Fund Quarterly 49, no. 4 (1971): 509–38. 35 Julie Livingston, Improvising Medicine: An African Oncology Ward in an Emerging Cancer Epidemic (Durham: Duke University Press, 2012); George Weisz, Chronic Disease in the Twentieth Century: A History (Baltimore: Johns Hopkins University Press, 2014). 36 The epidemiological transition originated as a model in demography and has had wide uptake in public health. It implies changing patterns of population-age distributions, mortality, fertility, life expectancy, and causes of death. Central to the model it represents are changes in patterns of mortality (including increasing life expectancy and reordering the relative importance of different causes of death, including a shift to chronic, “lifestyle” diseases). The rise of cancer and heart disease in the US and Europe in the early twentieth century, for instance, reflected their transition from receding pandemics to degenerative and man-made diseases. There have been several critiques of it including by John Caldwell. Others have argued that it was advanced at a time of “naïve optimism” about the elimination of diseases and did not take into account nutrition, poverty, income inequalities, and “the global nature and historical sequence of the mortality transition as it spread.” John C.

20

nuanced anthropological studies of the fluid boundaries between “acute” and “chronic”

diseases have emerged. But there has been a lack of historically informed reflection on how

these debates played out in the 1940s and 1950s, when the dichotomies between young and

old nations, their distinct geographies or environment, and their burdens of acute and chronic

diseases were first inscribed and challenged; nor do these binaries allow spaces for

alternative narratives.37

In this book I trace the emergence of these linear and evolutionist ideas about aging

and development in the international arena, and I examine how these ideas and models were

questioned, adapted locally, and became more inclusive of alternate perspectives. I argue that

political and intellectual possibilities existed to mediate and shape ideas and policies

regarding age, aging, and their place in society. In non-Western settings, there was the

possibility for experts and activists to engage with these ideas about aging and insert other

ways of viewing aging in society, in particular by including discourses regarding families,

intergenerational ties, and dependence. Analysis of these normative models is critically

important, as it can promote thinking about aging from a historical and contextual

Caldwell, “Population Health in Transition,” Bulletin of the World Health Organization 79 (2001): 159–60; Robert E. McKeown, “The Epidemiologic Transition: Changing Patterns of Mortality and Population Dynamics,” America Journal of Lifestyle Medicine, 2009 (July, 3, 1 Supplement): 19S–26S; Abdel R. Omran, “The Epidemiologic Transition: A Theory of the Epidemiology of Population Change,” The Milbank Quarterly 83, no. 4 (2005): 731–57; Omran, “The Epidemiologic Transition Theory Revisited Thirty Years Later,” World Health Statistics Quarterly 51 (1998): 99–119. For contemporary references to these debates, see Richard Horton, “The Neglected Epidemic of Chronic Disease,” The Lancet 366 (2005): 1514 and “Non-Communicable Diseases: 2015 to 2025,” The Lancet 381 (February 2013): 509–10. 37 Julio Frenk, Joseé L. Bobadilla, Jaime Sepúlveda and Malaquias López Cervantes, “Health Transition in Middle-Income Countries: New Challenges for Health Care,” Health Policy and Planning 4, no. 1 (1989): 29– 39; Lenore Manderson and Carolyn Smith-Morris, Chronic Conditions, Fluid States: Chronicity and the Anthropology of Illness (New Brunswick: Rutgers University Press, 2010). See James Ferguson’s work for explorations of alternative trajectories to these ideas in the context of Sub-Saharan countries that have been undergoing a “counter-transition” leading to a reversal of falling mortality trends. James Ferguson, Expectations of Modernity: Myths and Meanings of Urban Life on the Zambian Copperbelt (Berkeley: University of California Press, 1999).

21

perspective and in a way that, rather than simply “exporting” Western experiences to other

parts of the globe, identifies commonalities.

Efforts to challenge these notions, or to “provincialize Europe” are crucial not simply

as an intellectual agenda that aims to limit, decenter, and localize these ideas but also to

inform the field of aging and its policies.38 The latter needs to be informed by diverse

development approaches and policies that will address aging in the global South on its own

terms, without viewing these transformations as deviant or deficient from “standard” norms

of age and aging.39

Thematic Frames and Historical Intersections (circa 1940–2000)

This book structures its historical exploration of aging through several broadly

chronological thematic frames. They are not mutually exclusive, nor are they confined only

to certain decades; rather, they reflect historical intersections or convergences when certain

actors or agencies that shared international visions of aging were at a crossroads, engaged in

debates or faced a crisis.

The first encounters I trace were in the late-colonial period and the early years of

decolonization in Asia and Africa. The encounters were characterized by efforts to “know”

and map these “traditional” societies. They are a crucial beginning to our story, and that is

why I consciously start this narrative from what were believed to be the edges or margins—

the colonies—rather than the Western metropolis. Demographers, epidemiologists,

anthropologists, missionaries, colonial officials, and others were the “experts” involved in

38 Dipesh Chakrabarty, Provincializing Europe. 39 Ibid.

22

efforts to measure and manage colonial subjects when colonial policy was veering towards

introducing developmental reform in these societies. Their observations about chronological

age, elders, and the aged in local communities marked an effort to understand aging in Asia

and Africa as being the “opposite” of that in the West. They also demonstrated flexibility in

interpreting old age in multiple ways, such as social aging; some social anthropologists, in an

effort to address the problems of the “maladjusted” old in America, even characterized

traditional societies as models in the adaptability of the old. Investigations of old age and

aging in the colonies and in traditional pasts were efforts at controlling local power

structures. They demonstrated competing visions, but they were also useful in eventually

formulating typologies of aging in “traditional” and “modern” societies.

These views, however, did not immediately shape the agenda of the early

international gerontological networks. In the 1940s and 1950s, groups of scientists in Europe

and the US projected aging as primarily a biological and medical challenge. These

perspectives coincided with the founding of the first international gerontological

associations. Their discourses and partnerships focused on research on “diseases of old age,”

and some scientists initiated comparative studies of chronic diseases and aging in Asia and

Africa in that period. Early gerontological visions focused primarily on Europe and North

America, although indirectly these normative claims about aging and chronic diseases, as

well as their association with modern societies and lifestyles, were already being challenged

in Asia and Africa. Historically, in India and South Africa for instance, this research and its

science were being shaped by the politics of decolonization and its aspirations. They showed

that these societies faced different and often divergent challenges and that aging and chronic

diseases were not necessarily associated with a longer life expectancy and “Western”

23

lifestyles. In turn, these framings of aging populations have wider implications. They remind

us that these stigmatized assumptions regarding chronic disease and modernity have had

implications for poor and racially marginalized sections of society not only in formerly

colonized worlds but in the developed world as well.

In the following decades, with anxieties about aging and retirement deepening in the

West, social scientists in the West became influential in shaping a perspective of aging as a

“problem” rooted in social-psychological issues of maladjustment, mostly of middle-aged

white male populations. In the US, concerns about employment and labor productivity led to

an increasing interest in exploring societies in Europe that had aged earlier. These forays

demonstrated that the making of “Western” gerontology involved facing the challenges of an

uneven, contingent terrain. Experts who tried to forge a common international vision of and

platform on the social problems of aging found it challenging to do so even between Europe

and the United States. The politics of the Cold War in particular shaped notions of aging and

civilization, and American demographers tried to center these gerontological collaborations

between Western European researchers and American social scientists rather than extend

them to Eastern Europe.

As networks of international development and aid deepened and links grew with

developing nations after the Second World War, social scientists and social workers became

interested in the “old” in developing nations due to concerns that modernization projects and

urbanization were leading to changing family ties, creating instability, and making older

persons vulnerable and visible in Asia and Africa. However, pensions, welfare, and the age

of retirement were not always central issues in their development reports. In many social

surveys, the “decline” of family life and the migration of youth attracted interest, and older

24

persons began to be viewed as a socially vulnerable group—poor, needy, and victims of

changes in family life and migration.

In the 1970s and 80s, the promise of development soon took a more pessimistic turn

in the international arena with a world economic downturn and recession. With growing

pressure from aging experts in the US and Europe, leadership within the UN summoned a

World Assembly to reflect on the “problems” of aging worldwide, and a developmental

vision of aging began to take shape. Aging had begun to be associated with dependence and

welfare costs in some settings; in other places in the global South, urban sociologists and

social workers focused on old age and poverty as a deepening crisis due to the failures of the

promise of social development and industrialization. As worries about international or

“world” aging began to crystallize, experts stressed the priorities of productivity and

development. In the short term, the need to plan measures of mitigation and address the

issues of aging populations’ vulnerability and marginalization were agreed upon.

Finally, by the 1990s and thereafter, international meetings made progress in

developing an international agenda that often spurred national initiatives in aging. However,

the balance between aging policies and the aspirations of development remained a central

concern at all levels. But as these meetings did not yield large-scale resources needed for

aging programs as anticipated, some international NGOs began undertaking more visible and

aggressive international campaigns in support of the aged in sites of humanitarian crisis in

developing countries. Their views about aging were colored by humanitarian empathy, and

they attempted to build local networks and diverse international partnerships that aligned

with older persons’ interests based on local needs.

At the turn of the twenty-first century, gerontological experts and social activists

25

stressed the need for social justice and rights for the aged. They have forged partnerships in

the global South, and these campaigns shaped the agenda of a Second World Assembly

(2002) held at Madrid. International discourse on aging also increasingly emphasizes

individual responsibility, coping strategies, and “success” in controlling and delaying aging

(including delaying cognitive decline and disease); this implies that both at the national and

international levels, more care-giving responsibilities have devolved upon individuals and

families. This neoliberal approach leaves those who are the old and vulnerable, such as the

oldest of old, older women, aging informal workers, and those who are aged and in poor

health due to a lifetime of poverty, poor nutrition, and poor immunity excluded or recognized

only symbolically, with very few actual resources committed to them.

The Role of Experts

By the 1980s, aging had increasingly begun to capture the imagination of political

and bureaucratic elites as well as enterprising experts in developing countries. On an

international scale, groups of well-traveled American gerontologists and a few UN experts

were a predictable presence at aging discussions from Dakar to Delhi. These experts—

ranging from UN officials, researchers in gerontology, and social scientists to international-

and national-level NGO activists and social workers—tried to identify the needs and interests

of “aging populations.” This book maps how these experts and individuals from various

disciplines and fields (including colonial bureaucrats and missionaries in the 1940s) began to

collect evidence and articulate agendas around aging in various guises—for instance, in

terms of migration, chronic diseases, or as a humanitarian question. Although they seldom

considered themselves lifelong flagbearers in support of the agenda of aging populations in

26

the international arena, these experts often moved between the realms of domestic and

international politics.

The emergence of global expertise on aging however, is not a grand narrative that

originates primarily from the ranks of the UN bureaucracy or from experts in large

international philanthropies based in the US, such as the Rockefeller Foundation. The

concerns relating to aging populations did not receive consistent support from large

foundations in the US engaged in international development work, such as those focused on

infectious diseases, nor was there a dedicated international cadre of trained gerontological

workers and researchers, as had been the case with population research that created the

intellectual climate for the local dissemination of population control programs.40 More often

than not, in the earlier decades. the vision and politics of aging were incubated outside of or

on the peripheries of UN agencies.

Several scholars have explored the specialized knowledge promoted by development

experts, who were engaged in planning and monitoring development projects (such as

population control, agricultural development, immunization, disease eradication, and

community development projects) or in offering social science expertise in the education

sector. Through their ideas and services, these experts framed development projects as a

means for decolonized societies to undertake a pathway to social change and economic

progress.41 This book draws from historical scholarship on the politics of development and

40 John Sharpless, “Population Science, Private Foundations, and Development Aid: The Transformation of Demographic Knowledge in the United States, 1945–65,” in Fred Cooper and Randall Packard, eds., International Development and the Social Sciences: Essays on the History and Politics of Knowledge (Berkeley: University of California Press, 1997), 21, 176–202; Matt Connelly, Fatal Misconception: The Struggle to Control World Population (Cambridge: Harvard University Press, 2008); Alison Bashford, “Nation, Empire, Globe: The Spaces of Population Debate in the Interwar Years,” Comparative Studies in Society and History 49, no. 1 (2007): 170–201. 41 The following focus on Peace Corps volunteers and social workers: Sunil Amrith, Decolonizing International Health: India and Southeast Asia, 1930–65 (New York: Palgrave Macmillan, 2006); Sanjoy Bhattacharya,

27

discussions on the tensions and, often, the skepticism that international health experts

encountered locally in Asia and Africa. It draws especially from research focusing on the

more ambiguous place of non-elite experts, such as Peace Corps volunteers and social

workers.42 My research demonstrates that, in the absence of well-funded, transnational

programs, the interactions between international gerontological experts, officers from

international aging NGOs, and local experts were not based on claims to authority drawn

from Western techno-science alone; indeed, these interactions were only marginally

influenced by the power and legitimacy that flowed through UN officials and from a

supportive national political elite. Instead, the exercise of authority and initiative was based

on day-to-day transactions in relief programs and a shared mind-set to advance

gerontological education that was promoted by exchanges at conferences. A paucity of aid

funds and human resources created more spaces for experts at various levels to bargain

conceptually and administratively regarding teaching, training, and welfare or relief

programs for older persons.

Expunging Variola: The Control and Eradication of Smallpox in India, 1947–1977 (New Delhi: Orient Longman, 2006); Matt Connelly, Fatal Misconception: The Struggle to Control World Population (Cambridge: Harvard University Press, 2008); Frederick Cooper and Randall M. Packard, eds., International Development and the Social Sciences: Essays on the History and Politics of Knowledge (Berkeley: University of California Press, 1997); Nick Cullather, The Hungry World: America’s Cold War Battle against Poverty in Asia (Cambridge: Harvard University Press, 2010); Inderjeet Parmar, Foundations of the American Century: The Ford, Carnegie, and Rockefeller Foundations in the Rise of American Power (New York: Columbia University Press, 2014); Daniel Immerwahr, Thinking Small: The United States and the Lure of Community Development (Cambridge: Harvard University Press, 2015) and James Midgley, Professional Imperialism: Social Work in the Third World, Studies in Social Policy and Welfare, vol. 16 (London: Heinemann, 1981). I am grateful to Elana Sulakshana for having brought Nicole Sackley’s work to my notice: Nicole Sackley, “Foundation in the Field: The Ford Foundation New Delhi Office and the Construction of Development Knowledge, 1951–1970,” in American Foundations and the Coproduction of World Ordering the Twentieth Century (Göttingen, Germany: Vandenhoeck & Ruprecht, 2012). There are many historically framed studies of the politics of expertise in international and global health; see for instance Johanna Tayloe Crane, Scrambling for Africa: AIDS, Expertise, and the Rise of American Global Health Science (Ithaca, NY: Cornell University Press, 2013). 42 For a discussion that shifts attention away from Cold War rivalries to French colonial experts and the WHO, see Jessica Pearson-Patel, “French Colonialism and the Battle against the WHO Regional Office for Africa,” Hygiea Internationals: An Interdisciplinary Journal for the History of Public Health, 13, no. 1 (2016): 65–80.

28

Aging was a latecomer to the UN’s mission for social development in Asia and

Africa. Old age as an issue was raised by individual countries such as Argentina through

efforts that attempted to safeguard the rights of older persons, but these sporadic attempts

remained early, isolated instances.43 Only in the mid-1970s did the UN General Assembly

give repeated consideration to “the question of the elderly” at a worldwide level, publishing

its first report on aging policies a few years later, with data and sources that were mainly

drawn from industrialized nations.44 Until then, the Economic and Social Council (ECOSOC)

had gathered information on old-age pension schemes and standards of living among the

aged, but most of its seminars and expertise had focused on Europe, on countries where “the

socioeconomic conditions of the aged are marked.”45 At a consultation held in 1980 before

the First World Assembly on Aging in Vienna, the WHO representative for its Global

Program on Aging observed, “WHO’s general activities in the field of aging have been

limited, except in Europe where they have been very active. In fact, in 1976 the Director

General decided that it would be better to transfer the global responsibility of our aging

program to the European office in Copenhagen. He felt that European expertise could help

us stimulate interest on a worldwide basis and help countries in other regions to develop

43 UN General Assembly, Declaration of Old Age Rights: Draft Resolution/Argentina: 30/09/1948A/C.3/213, September 30, 1948, UN Library, New York. See http://research.un.org/en/undhr/ga/thirdcommittee (consulted in December 2016). 44 A lack of comparative research and disaggregated information based on age continued to nag international experts even at the Second World Assembly on Aging held in Madrid (2002). United Nations, The Aging: Trends and Policies (New York: United Nations, 1975); UN General Assembly, Follow-up to the Second World Assembly on Aging Report of the Secretary-General, 58th Session, Item 109, 17 July 2003, Document A/58/160 (New York: United Nations, 2003): 7–8. 45 An initial study of the aged was conducted in 1948 in recognition of the rights of old persons. Resolution 213–III, 1948 by the Economic and Social Council. See Official Records of the Economic and Social Council, Eleventh Session, Supplement no. 3, Chapter II, Section C (c) (UN Depository, New York) at Columbia University, Law Library for UN General Assembly Resolutions. For an outline of these studies, see United Nations, The Aging: Trends and Policies, 2–6, 5.

29

their programs.”46 What seemed to be a broader worldview or unified coming of age was still

overwhelmingly informed by Eurocentric perspectives and backed only by limited funding.

The ECOSOC secretariat and its social development department remained the main votaries

of the world aging agenda in the 1980s, and in the following years various UN agencies

pursued certain dimensions of the aging agenda—in terms of health, labor, family policies,

and refugee relief—based on the flows of resources, leadership, and intersections with other

coinciding programs.

Western experts, primarily American social scientists, cultivated ties with UN

agencies and tried to shape its agenda of “world” aging. They recast their domestic

experiences of population aging into a universal narrative and model of how societies and

families would modernize. The trajectory of aging in the developing world was projected as

either conforming to or being a distortion of the events and ideas about aging populations in

the West. As a new field, there was something akin to a missionary enterprise involved in the

efforts of many of these experts, as many believed that they were offering moral solutions

and righting the wrongs of development. Through their writings, gerontological congresses,

and training programs, they aimed to suggest means to rebuild family solidarities and heal

societies that had taken a downturn from filial piety to abandonment in the course of their

industrialization. Migration remained a consistent and escalating concern for these experts.

Over time, as social workers and others joined these concerns and founded international

46 Italics in original. Florence Palmer, “The World Assembly on the Elderly and the World Health Organization,” in Charlotte Nusberg, ed., The UN World Assembly on the Elderly The Aging as a Resource: The Aging as a Concern and The Situation of the Elderly in Austria, Proceedings of the Two Meetings Organized by the International Federation on Aging, May 27–29, 1980, Vienna, Austria (Washington, DC: International Federation on Aging, 1981), 8.

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NGOs, there was also an effort to engineer dramatic rescues of the aged during the many

political and economic crises that deepened worldwide in the 1980s.

Many international and national experts worried that, unlike in the past, families

would be unable to support the old, thus assuming all “traditional” societies shared a

common past when the old were looked after due to their social and moral authority. Issues

around aging in developing countries invariably stressed the “failures” of family support,

with local leaders being urged to repopulate rural areas with young people to support the old

and vulnerable who had been left behind in villages. As early as the 1950s, experts in South

Asia had observed that improvements in public health were causing life expectancy to rise,

leading to a growing number of old persons even though fertility was not really in decline.47

They were of the view that there was also a discomfiting visibility of the old in public life.

The numbers of the old were rising, but more significantly, they were increasingly “seen” in

places where earlier they had not been present. They “were out of place” or were simply

living longer, even in villages. Older persons had always been present in the countryside,

within extended families or on their own, and they had suffered, languished, and died of what

has been termed the “poverty of age.”48 They were now manifesting alternate forms of

deprivation and dependence that were compounded by growing urban poverty, migration,

and economic instabilities in cities that were rapidly expanding all over the developing

47 “Old” in these surveys was defined as 60 years and above in age, though it clearly conveyed little in terms of their functional condition, especially in the case of the rural or urban poor who died in old age in what some termed a “euphemism for death due to starvation.” For a discussion of old age and the effects of poverty in the 1970s in South India, see Goran Djurfeldt and Staffan Lindberg, Pills Against Poverty: A Study of the Introduction of Western Medicine in a Tamil Village (New Delhi: Macmillan Press, 1980), 94. See also a wider discussion in Alfred De Souza and Walter Fernandes, eds., Aging in South Asia: Theoretical Issues and Policy Implications (New Delhi: Indian Social Institute, 1982), 11–15. 48 John Illife, in his carefully nuanced work on poverty in urban Africa, describes a lack of “social identification” associated with those old people who had drifted to the city without families or other ties. John Illife: The African Poor, 166.

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world.49 In the words of a longtime activist, the priority was for the state to mitigate the

effects of rural decline and to extend support to the elderly in urban slums and shanty towns

whose families had left them to the care of state welfare services due to the pressures of

urban life in developing countries.50 The increasing lack of family support for the aged was

seen as likely to create pressures that could destabilize the development goals the countries

envisaged.

Writing about ‘Global’ Aging

The primary focus of much of this book’s narrative is anchored in events, ideas, and

voices from South Africa (and later developments in West and North Africa), South Asia,

and China. I have used the “global” as an approach to write an intellectual history of the

politics of aging by tracing key transformative moments, comparisons, and divergences,

rather than attempting or even contemplating a worldwide survey of aging.51 This approach

means that I have concentrated on certain defining moments, historical conjunctures, and

representative sites that were formative in aging’s emergence as a global concern and were

critical to the debates relating to decolonization, development, and modernization. The aim

underlying this transnational narrative is to draw attention to the critical intersections when

certain turns in international debates and meaningful regional responses were articulated.

Many nations that provide fascinating examples of the political inequities around debates on

social security and pensions at a national level are mentioned but not discussed in detail. In

49 Ibid. 50 Ken Tout, Aging in Developing Countries, 47, 52. 51 For an interesting discussion on some of these challenges and approaches, see Maxine Berg, ed., Writing the History of the Global: Challenges for the Twenty-First Century, British Academy Original Paperback Series (Oxford: Oxford University Press, 2012).

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the accounts of specific events, such as the discussion of age and aging in the context of civil

war, genocide, and authoritarian rule in and around Zimbabwe (which I explore in chapter 5,

there is a focus on local actors and NGOs, leaving a dense set of archival and oral accounts.

Given the constraints of space, I have not discussed areas with similar challenges and

tensions, in particular South East Asia.

There were significant national and regional debates about aging and dependence, and

also pioneering concerns relating to social security in Latin America; in particular some of

the earliest debates on the identity and social claims of aged persons took place in

Argentina.52 Later, in Brazil, Chile, Columbia, and Mexico, there were efforts to establish

links with gerontological researchers in the US and to build education programs that included

gerontological training. Experts in these countries were influential in debates on urbanization

and aging and in stressing the intergenerational aspects of aging.53

I have chosen to focus on Asia and Africa given because they are linked subjects in

the developmental arena through cross-regional, historical comparisons and shared

intellectual and scientific networks in the period I examine. The purpose here is not to leave

any nations out or replace one asymmetry with another, but rather to foreground key

52 I am grateful to Anne-Emanuelle Birn for discussions on these aspects, especially on social policy and equity debates relating to older persons in Latin America, in particular Argentina.

53 For an account of Latin American countries’ ties with the International Association of Gerontology, such as the first regional meeting held in Mexico (1956), see Historia De La Gerontogia Y Geriatrica En Latino America, (COMLAT0IAGG), np; and also Revista Argentina de Gerontología y Geriatría Año 28, (April 2011). Peter Lloyd-Sherlock’s work discusses population aging in Argentina and other sites in Asia and Africa. See Population Aging and International Development: From Generalisation to Evidence (Bristol, UK; Portland, Oregon: Policy Press, 2010). In the case of Brazil, see Otávio T. Nóbrega, Vicente P. Faleiros and José L. Telles, “Gerontology in the Developing Brazil: Achievements and Challenges in Public Policies,” Geriatrics & Gerontology International, 2 (June 2009): 135–39; Silva Ana Lucia, “Population Aging in Brazil: Current and Future Social Challenges and Consequences,” Revista Brasileira de Geriatria e Gerontologia 19, no. 3 (September 2016): 507–19.

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historical moments in international debates and scientific controversies when aging

populations emerged as an analytical category and identity.

In order to avoid constructing cultural monoliths and binaries about the “West” and

“non-West,” I have spotlighted social distinctions in the West in relation to views and

debates on gerontological research agendas—differences between white and African-

American medical subjects in the US relating to “diseases of aging” (for example, cancers) in

the 1950s; tensions between American and European medical researchers, including between

American and Soviet researchers, that, however, did not escalate deeper into Cold War

rivalries that marked other spheres of health and development. I have also discussed an

emerging strain of critical social gerontology that questioned the paternalist and productivity-

centered assumptions of gerontological ideas. Many social gerontologists resisted a

chronological, age-based focus on the “problems” of old age in the 1980s, offering instead a

perspective based on lifespan and wider social and structural factors affecting old age and

aging. What is stressed here are the ideas and expositions projected through UN institutions

and mediated by their global agenda. The critical perspective and agenda of this book has

remained centered on tracing how aging and its concerns became transnational and how

aging and debates on aging came to engage with the lives of “others” in the global South.

What I have aimed to present in this book is a history of the present or a genealogical

inquiry of the multiple, overlapping strands of ideas and challenges that represent the diverse

nature of global population aging. I have traced its emergence as a collective “worldview” at

various points when care and dependence, rather than food, space, and resources (which were

characteristic of anxieties about population growth and control in earlier decades) seem to

become foregrounded.

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In exploring the interconnected lineages of aging, I have dwelt in particular on

concerns about the aging scenarios in Asia and Africa, where the norms of chronological age

and disease as well as notions of dependence have been recast. At an ideological level,

debates on aging have underscored a central tension in international and global affairs,

namely the imbalance of an international economic order and a global development process

that was viewed as reflecting persistent historical inequalities. Despite longstanding critiques,

modernization is still seen as a linear process with an optimal pathway, which is based on

Western models. Thus it is assumed that “developing” nations will inevitably confront the

problems associated with aging at a particular and predicted time in the process. Asia’s

transition to aging is seen in contemporary reports as being distorted. China, experts argue,

will have to confront aging as a challenge (and implicitly a burden) before “growing rich,”

when welfare and social security resources to support a needy population of elderly people

would be sufficient, based on a Western model. It is this teleology of development and its

discourses that are an important focus of my inquiry.