Pearls and Irritations

In 2006, someone supposedly speaking for Generation Y wrote a book addressed to baby Boomers called “Please Just F* Off: It’s Our Turn Now.” The person who wrote that book in 2006 at the age of 25 is now 42. One day we will all be cast as the villains. It’s just a matter of time.

The Hugh Stretton Oration with Minister Butler, University of Adelaide – 27 April 2023.

Minister for Health and Aged Care, Mark Butler: As a proud South Australian involved in public life, it’s a great honour to be invited to deliver an oration named for the late Hugh Stretton.

His service to the university and to the nation is well known.

He was an allrounder. Someone who traded history for economics and sociology so he could influence public policy. No ivory tower could contain him.

In this age, dominated by sometimes overly narrow technocratic thinking, he was neither narrow nor a technocrat, but a social democrat. Someone who could make connections between problems across geographical space and historical time. A theorist of the city and of how we live in it. An early environmentalist. A moral thinker. The sort of public intellectual any age might welcome.

Today we’d call him a one-person think tank. But how much better that his life has inspired a university institute instead. In a university whose research is doing so much to advance our understanding of ageing and care for the aged.

I have two Stretton books at home – ‘The political sciences’ written in 1969 and ‘Economics – A New Introduction’ written 30 years later.

In ‘Economics’, Stretton unsurprisingly canvases the question of population; as economists have for centuries.

But his framework is a traditional one – focusing on raw numbers and births.

In the past few decades, the study of population has shifted to a much more compositional level – focused more on the age profile – or ageing – than on the Malthusian theory that, if we don’t stop procreating, we’ll run out of food.

Population ageing simply wasn’t on the radar during Stretton’s career.

The first big Australian study of population was commissioned by the Curtin Government during World War Two.

The study was conducted in the shadow of a dramatic fall in birth rates and immigration through the Depression years.

It projected that Australia’s wartime population of 7 million souls would grow slowly to 8 million by the 1980s and then start to fall.

Obviously, the post-war Baby Boom and Immigration changed that story.

Even the next big study – the Borrie Report of the 1970s – contained no analysis of ageing.

In part, that was because the big decline in birth rates seen in the first half of the 1970s had not yet come through the data.

In larger part, though, older Australian weren’t living any longer in the 1970s than they had decades earlier, so the older cohort was static as a share of the population.

The huge improvements we’d seen in life expectancy in the early and mid-20th century almost all accrued to babies, children, and younger adults.

Remarkably, the life expectancy of adults at older milestone ages shifted only modestly – and only really for women.

The remaining time that a 50-year-old Australian man could expect to live increased by only 20 months over the entire century from 1870 to 1970.

For the average 60-year-old, things barely changed at all.

And the average 70-year-old lived longer in 1870 than 1970.

Thank you, tobacco industry!

Happily, public health advances and radically better treatments for cardio-vascular disease have redrawn that picture.

But – again – that all took some years to filter through the data.

Now, ageing is absolutely central to the study of population – ranging through domestic policy into geopolitics, as the recent coverage of China’s latest population data revealed.

And today, the study of population ageing spans a wide range of academic disciplines and almost every area of public policy.

A few months out from the release of the next Intergenerational Report – and the feverish public and media debate that always inspires – we can only imagine the value and insight we’d get from a polymath of such intellectual seriousness as Hugh Stretton.

Raising our policy ambition on ageing 

Ageing is an area of public policy I’ve been involved in for many years, as a minister and shadow minister and trade union leader.

In that time, I’ve talked to many thousands of older Australians.

They have a way of cutting through to the real issues at stake. The ones that matter to people and sometimes don’t occur to policymakers.

Like shopping!

Elizabeth, who was then 78, told me years ago “people do treat me differently now that I’m old. They think that old people are thick or stupid. Some of the ones in the shop talk to me really slow like I don’t understand English anymore. It makes me really cross”

Or take the end of life. One man, planning his final moments, said he wanted to spend his final hours listening to the replay of the radio broadcast of one of Essendon Football Club’s famous 1980s premierships. And he did.

From seemingly throwaway comments like these you start to get a sense of what needs to change about ageing policy. People don’t want to stop living. They want reasons to get up in the morning, topics to talk about, things to think about, and people to see. This is a lifelong ambition – there is no use by date.

I want you to consider two images.

The first is of people with the words “Do not resuscitate” tattooed on their chests. As you can see, it’s not an isolated thing. At a seniors’ forum I once held in Newcastle, a tall, healthy, and very articulate man actually undid his shirt and showed me these words on his chest. Like Superman opening his shirt, the statement seemed to give him a magical power – the power of control over his own destiny.

The second image is these two older people kissing. It was painted by a student artist at Seaton High who told me she painted it to demonstrate that older people also feel passion and physical attraction.

It’s an interesting contrast, isn’t it. The older people in the first set of photographs don’t want to be resuscitated. Those in the second are practising quite vigorous resuscitation. One says “yes” to the kiss of life, the other says “no thanks”.

The tattoos and the kiss are telling us people want to be in charge of their own lives, make their own decisions, behave as they choose, even when it confronts younger people.

They’re a message to us, maybe, that taking people’s agency away diminishes them.

And that freedom to choose is important to people no matter what their age.

So, what I want to do this afternoon is look at the issues we need to confront if we are to create a society – not just an aged care system, but a society – that allows people to age better, live life how they choose, and enjoy those later years more.

For the sake of comprehension, I’ve narrowed the priorities down to five.

The first thing we must do is to escape from the mental trap of thinking of older people in terms of population cohorts – or worse still, in terms of aged care “beds” – and instead start thinking about them as individual people, each unique, each determined to live as they choose.

One of the unhelpful features of public debate nowadays is the habit political and social commentators have of slicing and dicing us into generations with opposing interests – for the purpose of selling us things and causing conflict.

In this intergenerational battle, each cohort is constantly portrayed as the enemy of the others, mainly, I suspect, to sell newspapers, boost ratings or attract eyeballs.

Here’s a headline that appeared not long ago in one of our national newspapers in response to changes in the taxation of superannuation deposit earnings: “For Nation’s Sake, Boomer Self-Interest Must End.”

By scapegoating and generalising about millions of people with incredibly varied financial situations and political beliefs, all it does is generate opposition to political reform. ‘The old . . . they’re all rich, all selfish, living off the rest of us . . . etc.’

Younger generations can be dismissed just as unfairly. How easy to label them as entitled, shallow, lazy, and so on, when they are not. ‘If they spent less on woke breakfasts, they could afford to buy a house one day . . .’ You know the rest.

Such generalisations try to push young and old to opposing sides instead of seeing that they are members of interdependent communities. After all, they are often – literally – related, and can help each other.

Think About People Not Cohorts 

This regular criticism we hear nowadays of the Baby Boomers isn’t new.

In 2006, using similar logic, someone supposedly speaking for Generation Y wrote a book addressed to baby Boomers called “Please Just F* Off: It’s Our Turn Now.”

My response is that if we live long enough, we’re all going to be victims of this sort of thing, progressing through each joyless, unhelpful generalisation, with our grandchildren labelling us selfish and thinking of us as a heavy burden whose retirement they shouldn’t be forced to finance.

After all, who wants to pay taxes to support a group you are constantly encouraged to regard as your natural enemy?

One day we will all be cast as the villains. It’s just a matter of time.

The person who wrote “Please Just F* Off: It’s Our Turn Now” back in 2006 at the age of 25 is now 42. I’ll bet he never thought he’d be middle aged so fast!

Happens quickly, doesn’t it?

The result of all this manufactured intergenerational envy is a lack of comradery and common culture between the generations.

How are we going to manage the big generational issues we face, especially ageing, if we turn generations against each other?

We need to replace confected intergenerational hostility with genuine intergenerational solidarity.

What’s the cliché? The things that unite us are greater than the things that divide us: happiness, togetherness, friendship, fulfilment, love, good health, travel, intellectual nourishment, security, the hope we can enjoy good years well lived… We all share these goals. Whether young, middle aged or old.

I want the young to think: older people are not my enemy. They are my parents, my grandparents and one day that older person will be me. And I want older people to think about the young “that once was me.”

Tackling age-based discrimination 

Having said that, we’re not going to eliminate the fact that generations exist and they’re not always capable of the same things.

At different stages of our lives, we are going to have different capacities and contributions to make.

What these very real differences don’t give us the right to do is treat older people unequally.

The second of my five suggestions for creating a more ageing-friendly society is tackling age-based discrimination.

As other big and influential social movements of our time have demonstrated, the biggest changes spring from changing attitudes that then flow through to changing behaviours.

Attitudes can change rapidly, much faster than public policy or laws do.

Climate Change, #MeToo, Black Lives Matter, Indigenous Recognition . . . These movements have all started to change the way people think.

Age-based injustice is next. Including age discrimination.

Just as gender discrimination can be a pre-condition for domestic abuse, age discrimination is a precondition for elder abuse.

And like all forms of discrimination, it’s a cause of economic inequality.

I often talk to men and women in their fifties, sixties and seventies who tell me of the enormous difficulty they have in finding a job.

Once they pass 50, they say, you struggle even to get an interview. There’s always someone younger. And maybe also easier to exploit.

20 years ago, just over 1 in 20 unemployed people were between the ages of 55 and 64. Today, it’s 1 in 10.

What’s worse, those Australians are languishing in unemployment for longer.

Older Australians make up a much higher share of the long-term unemployed in this country than they once did.

Twenty years ago, people aged 55 to 64 accounted for a tad more than 1 in 10 people in long-term unemployment. Today, it’s nearly 1 in 5.

It happens whether you are a car mechanic or a lawyer or a business leader.

Inaccurate stereotypes too often kick in – about older people’s comfort with change, about their supposed lack of tech savviness, and about motivation to work. All completely unsupported by evidence.

It’s as if when your hair turns grey, your brain turns grey too.

And older workers discriminated against in this way find it incredibly frustrating because they know they have never been more on top of their game.

Even for manual occupations that involve muscle work and fine motor skills, 50 is not old. Some say it’s the new forty. It’s about individual health and fitness more than age.

Last month the British playwright, David Hare, took part in Adelaide Writers Week, and one of the things he said stuck in my mind. Now aged 75, he said he’s spent his whole life trying to get the hang of writing plays and screenplays. “And the annoying thing of being my age is I’m just beginning to get the hang of it.”

I’m sure many of us in this theatre share David Hare’s frustration.

The creative industries know they can’t afford to lose people like David Hare, 75, or his great friend, the fantastic older actor Bill Nighy, 73, so why should our service industries or manufacturing industries or government?

We should be aiming to create a society in which everyone is offered life membership, not just a season ticket that can be revoked whenever we feel like it.

Locking older people out of the workforce has been a feature of our society for so long now that it seems the normal state of affairs. But there’s nothing normal about it.

Much of it is the result of economic restructuring. We caused it and therefore we can change it.

Let’s look first at what’s happened to men.

In the quarter century from 1973 to 1998 active workforce participation for men in their late fifties declined by 14 percentage points – or 1 in 7.

And for men in their early sixties, it plummeted by 30 percentage points – to under half!

These are huge drops. Society altering.

And the major cause was the decline in manufacturing.

By 2010 only one in seven men who had worked as a labourer was still in work by the time of his 65th birthday. Many may have retired voluntarily. Especially from heavier labouring work. But with rates of 55+ male unemployment now so high, discrimination must be part of the explanation.

An entire generation of men was thrown onto the scrapheap, often leaving the suburbs they lived in devastated.

Restructuring the economy was a deliberate project and we didn’t do enough to ensure we did it in a just and fair way. It constituted a major moral failure on our part.

The situation of older women is if anything even more precarious.

Many of these women have an incredibly strong financial imperative to work, but face the double discrimination jeopardy of age and gender.

Older age is also where employment inequality throughout life comes home to roost for women.

The lost income and superannuation from caring while they were younger can’t be made up easily. And of course, they then often find themselves caring for sick partners, grandparents or grandchildren.

We need a substantial effort to change employer attitudes.

But unequal treatment doesn’t just occur in the workplace.

It follows older people around like a shadow no matter where they are.

One of the worst things we do to older people, especially frail older people, and people with dementia, is treat them as infants.

It’s something I’ve witnessed all too often in my visits to aged care facilities. Maybe you have too. People talking to older people in child-like, sing-song voices.

One study found that their focus groups were incapable of distinguishing between recordings of ‘baby talk’ in an aged care setting and recordings of childcare workers talking to actual babies.

We must change this tendency, deeply rooted in modern consumer culture, to treat older people, either visible or invisible, as objects of derision.

Keeping older Australians out of poverty 

Beyond the obvious question of dignity, one of the other reasons for ending age-based discrimination is the need to keep older Australians out of poverty. Discrimination pushes people to the margins of the economy and robs them of prosperity.

This is the third of my five priorities, tackling the poverty of the old.

Not all older people are poor. In fact, many are quite wealthy. But we also have significant numbers of older people who are poorer than they have been for generations. As I just mentioned, many are older women who don’t own a house and don’t have sufficient superannuation.

A lot of arguments about the effect of ageing on our economy simply won’t die. These zombie arguments are familiar: “a giant demographic wave is coming to engulf us through the cost of health and welfare spending . . . We therefore have to be eternally frugal when it comes to the pension, aged care, health care, etc.”

This is simply overblown.

Obviously, big policy changes have raised older people’s prosperity in recent decades – most importantly compulsory superannuation.

It offers hope of a comfortable and enjoyable retirement. But this is a long-term project. Its greatest benefit is yet to be realised.

In the meantime, the age pension will have to do much of the heavy lifting – something it is perfectly suited to and fully capable of doing.

I want here to re-state a point I have made many times over the years: Australia can afford to give its older people a comfortable retirement. Suggestions that the future cost of a properly indexed pension system is unaffordable are simply wrong. Those arguments are based on comparative analysis with countries with a very different demographic profile and migration system to Australia.

Governments in Japan, China and the European Union do have a very real problem: their populations are old and getting older.

Actuarial logic tells us the real case for Australia.

The proportion of Australians over the age of 65 is now approximately 17 percent. In 20 years from now it will be just 2 percentage points higher.

It’s an increase, but something an economically successful nation like ours, with good future prospects, can easily afford.

15 years ago, the Intergenerational Report predicted that spending on age pensions would balloon over the following four decades, nearly doubling in size to 4.4% of GDP.

The reality has been very different. The last Intergenerational Report showed that spending on the aged pension had actually fallen in the past 15 years, and it will fall further still over the next forty, dropping to a little over 2 per cent of GDP. Publication of our Government’s first IGR later this year will update those figures.

In contrast, Canada and the US will spend three times that. The UK will spend four times more and Germany will spend an incredible six times more.

In fact, the average OECD country will spend five times more on the age pension than Australia will.

So, to be clear:

The age pension is definitely not a financial albatross around Australia’s neck.

It is not a residual system that superannuation will replace.

People are not on the age pension because they failed to save for their retirement.

They’re on the age pension because an age pension is the cornerstone of a socially and economically successful nation.

It liberates older people to be grandparents and great grandparents, volunteers, shoppers and customers, artists, audiences, active citizens, and neighbours. That social capital is immense – but not something we measure.

The statistics we hear about relate to economic growth and productivity, crude measures which consider the level of investment in labour and capital, absent of any consideration of knowledge sharing, wellbeing, and experience – three things that an older generation delivers in spades.

The most prosperous nations on earth have good pension systems and value the strength of relationships with older people. And so must we.

Australia’s record of slow and steady improvement to the age pension is real, if unspectacular. With such large raw sums of money involved, this is how it has to be.

In 2009 the Rudd Government made a long leap forward when it raised the benchmark of the pension from the Whitlam era level of 25 percent of average wages to 28 percent, halving the poverty rate of older Australians in one fell swoop

And over the last three decades, governments of both persuasions have refined and improved the indexation arrangements to better maintain the age pension’s real value.

In short, the pension is safe.

The age pension is also becoming more sustainable every year as more and more people can retire on their superannuation, their assets, and their savings.

Tax concessions for superannuation will help increase the overall cost of the retirement system from 4.6 percent today to 5 percent by 2061, but this slight increase is no cause for panic.

In fact, in a society like ours, with its projected demographic curve, this seems to me a necessary and predictable reallocation of national spending. When we have a baby boom, we build schools. When our average age increases, we spend more on the pension and aged care services. It’s called rational planning.

The really positive news is that the benefits of compulsory superannuation are still yet to be fully realised. And this should help close the gap in seniors incomes that still exists between us and the top rank of OECD nations.

Our long-term aspiration should be to be near the very top of that list.

But of course, averages don’t tell us everything.

Even with rising average affluence, many seniors still live in poverty.

Especially those who don’t own their own homes. Most notably, single women.

In 1995, back when Telstra was still called Telecom Australia, 7 in 10 Australian aged 55 to 64 owned their home outright – that is, they’d cleared their mortgage in the decade before they retired.

Today, the figure is just 3 in 10.

It was 7 in 10 – now it’s 3 in 10.

This is worrying because renting in old age is a major driver of poverty.

The average older household spends $46 per week on housing costs if they own their home outright – but more than $300 per week if they’re in the private rental market.

No wonder, 40 per cent of older renters are officially classified as living in poverty.

Facts like these illustrate the actual complexity of ageing demographics. It’s not just about age, it’s about class, it’s about race, it’s about gender, and it’s about disability too.

Few things are more heartbreaking than the regular stories we hear of older renters, often single women. With few savings, they are often terrified of the prospect of being thrown out of their rental accommodation and having to compete with younger and more affluent people for somewhere to live.

I’ve heard from women, struggling with the rent, bewildered at how people assume everyone to be a wealthy retiree, not realising that many older women retire with next to nothing in savings and very little superannuation.

It’s a big failing of our nation that the fastest growing group of homeless people over the past 20 years has been older women. What an indictment that represents.

The plight of our mothers, our grandmothers, our aunts, and our neighbours, is a moral issue we should all feel compelled to address.

They did the low-paid caring and the unpaid caring, and now they deserve greater care from us.

Sustaining good health 

And this brings me to my fourth priority: sustaining good health as we age.

Getting to retirement age is an achievement. So why not stay healthy and keep it going as a long as possible?

Some huge advances have been made in recent decades. Cardiovascular disease has been slashed, lower rates of smoking and modern treatments. But of course, rising life expectancy has increased the prevalence of other morbidities – often lifestyle diseases like diabetes related to overweight and inactivity – as well as dementia and suicide.

This last point – suicide – isn’t something we typically associate with older people. We think of it primarily as a young person’s affliction, especially young men. But that’s not strictly true.

Once they reach the age of 80, the suicide rate for men is 50 percent higher than for men of all ages. Over 85 years, it rises to 150 percent of the average.

Unhappiness and the wish not to go on is one of the unfathomable mysteries which the great artists have grappled with for millennia. But what leads so many older men to think life isn’t just not worth saving, but worth actively ending.

In general, our approach should be to think about “healthy ageing”.

The World Health Organisation has declared this to be the decade of healthy ageing and Australia should lead the way.

It means getting people not to fear getting old – but to acknowledge its reality, plan for it, and create conditions where they have greater control over how they live it.

Commonwealth programs are now encouraging people to do just that.

For older people especially, we need to consider a move away from the acute, reactive, and episodic model of health care we currently provide – towards a more integrated system of multidisciplinary team-based care that recognises and supports the complex physical and mental health needs of older people.

The recent report of the Strengthening Medicare Taskforce focused on these matters and supports the Government’s vision for a stronger Medicare, designed and funded for the 21st Century.

Giving back control to people 

And the priority of making the later years better and more positive must extend to the final years.

My fifth priority therefore is to hand back control of their own lives to the aged.

One of the fears I hear often in my travels as Minister for Health and Aged Care is the fear of not being in control of your own life when you’re getting near the end. It’s the fear that drives people to get those “Do Not Resuscitate” tattoos I mentioned earlier.

It’s easy to see how these fears are formed. While most people in aged care facilities are lovingly cared for, some aren’t. The Royal Commission into Aged Care Quality and Safety heard devastating testimony from people who were shocked about how their older loved ones were treated. Many were rightly incensed.

Having witnessed what happened to their parents and grandparents, their fear is that their own final years will be spent being similarly patronised, mistreated, neglected and worse – the victims of cruel penny-pinching, lingering pointlessly, without enjoyment or human dignity.

It leads many to demand the right to control the end of their own lives!

We can all see their point. Life stripped of all dignity and respect can be life in name only.

I see this as a debate not only about how to manage the end of life, but how to live it better. We need to give people in care all the dignity and purpose they need to live as they choose.

Older people should be able to exercise decisions – yes, including bad decisions – relating to every aspect of their residential and home-based care – from the quality of care they receive to what they want to eat, to the activities they want to do. It’s their life, no one else’s.

Since our election, the Albanese Government has responded strongly to the Royal Commission’s recommendations, driving change, and putting choice for older people at the centre of the aged care system.

Legislation and sustainable spending are guaranteeing 24/7 care… paying staff better… raising standards of care… and helping fund providers to make the necessary transitions. From their first pay packet of the 2023 financial year, aged care staff wages will rise by 15 percent.

Paying fair wages to aged care workers values those workers and it values those they provide care to.

This is real, concrete improvement to the care we provide to older Australians. The sort of change many have been demanding for so long. Helping Australians age positively.

Conclusion 

Labor has a great legacy when it comes to ageing and health. The Strengthening Medicare process we have initiated will enable access to a world class, patient centred and equitable primary care system that better addresses the needs of an ageing population.

But significant change in areas like ageing is devilishly difficult. And our political culture hasn’t been good at change in recent times.

The demographic changes underway, though, give us little option but to pursue reforms in ageing.

With more thought and better approaches than we have now, we can keep older people out of poverty, keep them healthy and make the later years good years ­– with better care, more rights and more personal control.

I believe age equality must become another of the great human rights issues of our time.

After the history of the Covid pandemic and the global tragedy it meant for the aged, especially those in aged care, societies everywhere need to act.

Pressure for change is coming from older people themselves, as well as from their articulate, determined and justifiably angry children.

Theirs is the spirit we must emulate as we seek to make this country a better place for all of us when we get old. Not denouncing other generations, or labelling them, but looking out for them. Building solidarity between the generations. Making Australian citizenship a life membership not a season ticket.

Governments must provide the leadership – by building understanding of how discrimination against the aged manifests itself economically, socially, and legally. And turning that understanding into concrete change that makes this a far better country in which to live out your life in equality, safety and happiness.

Which is something the great social-democratic thinker Hugh Stretton would have agreed with, I’m sure.

Thank you.

 

Republished from Health.gov.au, 27 April 2023