What Sweden’s Covid failure tells us about ageism

After the pandemic’s deadly first peak in April 2020, it became clear that Sweden’s quest to protect its elderly had failed.

My home country had become the last outpost for a “herd immunity” approach, with the government ignoring international calls for quarantine. Sweden’s strategy had two central goals: Limit the spread to prevent overburdening the health-care system, and protect its older citizens.

It did neither. The virus made its way into nursing homes, spreading from staff and visitors to residents, until the government, too late, banned visits on April 1, 2020. A month later, a report showed that nearly half of the 2,075 deaths in the country — one of the highest per-capita death rates in Europe — had occurred in nursing homes, and 90 percent had happened among those aged 70 and above.

At the time, the failure sparked an intense debate about who was to blame and whether a lockdown would have helped. But today, as criticism of authorities has shifted from failed containment to slow vaccination rollouts, another question has loomed over me and my fellow Swedes: Is there an inherent disregard for older people in my country, a supposed bastion of social welfare and equality?

To Barbro Westerholm, a member of Swedish Parliament and Liberal Party spokesperson for older people and for LGBTQ issues, the answer is clearly yes. She argues that a century-old system of dividing society by chronological age categories dehumanizes the 1.6 million Swedes aged 70 and older. Even the rhetoric around older people during the pandemic — lumping them in one category — is a symptom of long-standing ageism where they’re no longer seen as individuals with different health and experiences, says Westerholm, who is 88.

The debate over how we value the lives of older people isn’t limited to Sweden: It has grown louder in many countries with expanding elderly populations. Some aging advocates say that the West is facing a crisis of systemic ageism, in which older people have become invisible.

There is a general lack of research on the social status of the older population across cultures, but the results of a 2018 survey called the Moral Machine offered interesting insights. The game-format online survey presented participants with car-accident scenarios, asking them to decide whether a self-driving vehicle should plow ahead or swerve — and forcing them to choose between two categories of casualties. Either way, the car would run over someone. As the program went viral, decisions to sacrifice men or women, the healthy or sick, jaywalkers or pedestrians, among other groups, were submitted by millions of people from 233 countries and regions.

Although the experiment aimed to survey moral decisions more broadly, it garnered the most attention for something many might have assumed already — that people in general prefer to sacrifice the old before the young. While there is a rationale for favoring the young — they have more years of life ahead of them — there’s also evidence of widespread ageism beyond imagined binary choices of life and death. One study surveying American workers aged 45 and older estimated that in 2017 nearly two out of three respondents had seen or experienced age discrimination on the job.

Another paper, in 2020 in the Gerontologist, suggested that the mental toll of age discrimination, stereotyping and negative self-perception is contributing to health issues ranging from cardiovascular disease and impaired memory performance to loss of balance and cognitive abilities. Beyond the toll on people’s lives, the authors estimated that these effects amounted to $63 billion in yearly health-care costs.

The Moral Machine experiment also suggested that while people everywhere tended to opt to save the young, it was especially true for countries that the authors labeled “individualistic,” such as France, Sweden and the US. It was less so for East Asian countries (such as Japan and Taiwan) and majority-Muslim countries (such as Pakistan and Saudi Arabia), which the authors labeled “collectivistic” — meaning that the needs of the group are put over those of the individual. The authors suggested that these cultures put greater emphasis on respecting older members of the community.

But some social scientists argue that something other than individualistic culture explains the relative disdain for older people in the West, and thus requires different remedies. That is, people are forced to leave their jobs by a certain age, and their efforts as voluntary workers are rendered invisible.

An East-West divide

The idea that Eastern or more communal societies show a greater regard for the older population is widespread and likely reinforced by the existence of laws in some countries that spell out citizens’ responsibilities toward senior relatives. The Parliament of India, for example, passed a law in 2007 making it punishable to neglect the needs of senior family members, for example. China passed a similar law in 2013, compelling adults to tend to their parents’ spiritual and mental health and to “never neglect or snub elderly people.”

The general respect for older individuals in Asian, African and the Middle Eastern countries could be traced to the interdependence between generations that has created strong social networks, says Kavita Sivaramakrishnan of Columbia University, a public health historian of South Asia. But, she adds, with globalization and urbanization reshaping family structures, it’s hard to make generalizations.

And while interdependence can foster intergenerational solidarity, it tends to break down in times of crisis. For instance, in South Africa, where apartheid and HIV wiped out a large part of the middle generation, many young and unemployed people have come to rely on the pensions of the older generation. In some cases, that has led not to respect but to elder abuse as “young people tried to take away the pensions of older people,” Sivaramakrishnan says.

Similarly, in the slums of Nairobi and Mumbai, there is a tension between generations because scarce resources such as toilets or even pedestrian paths in these cramped communities must be shared, says Sivaramakrishnan, who has worked in both regions. So the idea that certain cultures are uniformly caring toward the elderly doesn’t capture the full picture.

In fact, some scholars say there are flaws in earlier research supporting the idea that Eastern cultures are less prone to ageism. For example, a 2017 paper in the International Journal of Psychology examined a prevailing idea that Eastern cultures are influenced by Confucian values, promoting positive views of aging, while Western societies are more youth-oriented, leading to more negative perceptions. The evidence is surprisingly sparse, the authors wrote. Some studies suggest that attitudes vary widely between different Eastern countries — making it hard to generalize — while other findings show that Easterners, in fact, have similar attitudes towards the older population as Westerners.

The authors’ own findings — from a survey of 184 young people from the UK and 249 from Taiwan — as well as those of several other studies suggest an explanation for the conflicting results: Researchers likely receive one kind of answer from Easterners describing their country’s cultural norms, and another kind when they’re expressing personal opinions. Underlying cultural values might motivate Easterners to express more positive judgments than Westerners do, in other words, no matter what their own (possibly quite different) attitudes might be.

Another methodological problem, the authors suggest, is that previous research focuses on only one or two of ageism’s three components: stereotypes, prejudice and behavior. Taking all three factors into account, they conclude from those they surveyed in Taiwan that there is an “ageism paradox” — a coexistence of both positive and negative views of older people in the East.

Similarly, a 2019 review of research on attitudes toward aging in Arab culture also found issues with clearly distinguishing the overarching ideas a society holds versus individual views. Adding to that problem, studies often define “old age” differently, while some don’t do so at all, the authors noted.

Countries are not as different as they make themselves out to be, says psychologist Toni Antonucci of the University of Michigan, who studies social relations across the life span, a topic she explored in the 2019 Annual Review of Developmental Psychology. Rather, “the difference is what they say, culturally.” Antonucci adds that she’s skeptical of the “communal” versus “individualistic” divide. Instead, she thinks another factor drives the view that older adults are disposable: the decommissioning of the elderly.

“In many countries in Europe, you are mandatorily retired,” Antonucci says. “You might be a world-renowned scientist, but you still have to retire at 60 or 65.” That’s despite a 2000 EU directive prohibiting age discrimination in employment; the European Court of Justice has since ruled that mandatory retirement ages — giving employers the option to terminate contracts of older workers — are legal if achieving a “legitimate aim.” Governments, in other words, can prescribe mandatory retirement ages into countrywide (or sector-specific) law by claiming that younger people need access to work. And employers can include mandatory retirement ages in contracts, claiming, for example, that it spares older people from the embarrassment of being dismissed when no longer able to do their jobs.

These practices are widespread in many countries; in fact, an OECD report shows that only three of its European member states — the UK, Denmark and Poland — had banned mandatory retirement ages as of 2017 (outside of Europe, a ban existed in four OECD countries: Canada, Australia, New Zealand and the US).

Permission to fire people because of age is increasingly seen as outdated policy on a continent where health among the elderly has improved and lifespan has increased. Typically, national mandatory retirement ages in European countries correspond with statutory pension ages — usually between 65 and 67 — and these have remained largely the same in many countries, including France, Italy, Germany and Sweden, for at least half a century.

In Sweden, for example, when its pension system was implemented in 1913, the average Swede lived to roughly 57 years; the 2020 number is 83. At the same time, fertility rates among the general population have fallen. As a result, people aged 65 and older made up 8 percent of the population in 1900 and roughly 20 percent today — with a projected increase to 40 percent by 2030. And yet the age at which an employee can be forced to retire has increased only by one year since the 1970s, from 67 to 68.

As long as older people are passive receivers of care and aren’t given the chance to contribute to society, they are bound to have a low social status, says Andreas Motel-Klingebiel, a sociologist and gerontologist who studies aging and social change at Linköping University in Sweden. The problem is amplified, he says, when societal values center around employment and activity in the labor market. This might be particularly pronounced in northern European societies where labor is central in the social contract, a link that some experts trace to the Reformation and the spread of the Protestant ethic emphasizing hard work and discipline.

This perception of the elderly as a burden holds true even for countries with strong social welfare policies, like Sweden. The country “isn’t a welfare state in the American meaning,” says Lars Trägårdh, a modern historian of civil society and the welfare state at Ersta Sköndal Bräcke University College in Stockholm. “It’s not about charity, but about social contribution and reciprocity, where you work and pay your taxes, etcetera. That social contract is ironclad.”

A time for reform

Europe has been slow to adapt policies to address its graying population. But as the trend increases, so does the pressure on politicians to drive through reforms to combat age discrimination. For example, AGE Platform Europe launched in 2001 as a network of nonprofits against ageism. Today, it encompasses 40 million senior citizens across the EU and gives a voice to older and retired people in EU policy debates. One of its key objectives in 2021 is advocating for the creation of a UN convention on the rights of older persons.

Another way to strengthen the position of the elderly in society is to pay more attention to the work done in civil society, such as nonprofits, advocacy groups and, especially, volunteer work in education, sports and charitable organizations. In the US, for instance, people 65 and older made up almost 25 percent of the volunteer population in 2015.

And yet, while most countries include the contribution of civil society in GDP estimates, volunteer work — often referred to as an invisible segment of the economy — isn’t part of the calculus. “We only measure people’s contribution in money,” says Westerholm, the Swedish parliamentarian. She suggests that politicians start to measure and publicize the economic value of volunteer work to highlight the contribution of older people. Such a move has already been suggested on the EU level. In 2013, the European Economic and Social Committee called on the European Commission to standardize research and data collection on volunteering in member states. Two years later, in a survey measuring income and living conditions in member states, the EU for the first time included a module for countries to estimate volunteer work.

Of course, solutions have to be adapted to the circumstances in each country, and Sivaramakrishnan cautions against reforms that exclusively focus on keeping people in the workplace for longer, as that could risk creating an elitist culture that favors the wealthy and healthy. There are, for example, people within minority communities in the US and Europe who work in physically demanding occupations — at warehouses, factories or as cleaners or gardeners — and they will not benefit from policies, such as raising the pension age, that are aimed at keeping everyone in the workplace for longer. Sivaramakrishnan adds that universities should offer opportunities for people to reeducate themselves at older ages, as many might be willing to keep working if they’re able to continue in a new role or field.

With projections that 2 billion people in the world will be over 60 by 2050, the potential for ageism will become ever more present. And as the pandemic has brought the problem of age discrimination to the surface, Westerholm sees this time in history as an opportunity to push through reforms. She thinks the focus could speed up legislative action, such as the European Parliament’s languishing 2013 recommendation that member states put a ban on mandatory retirement, overturning the loopholes provided by the European Court of Justice decision. Efforts are afoot in the US as well. In March this year, the Protecting Older Workers Against Discrimination Act was reintroduced to the US Congress. If passed, it would allow older adults to fight workplace discrimination more easily.

Above all, Westerholm argues, our success in fostering equality among generations hinges on people realizing that fighting ageism is also in the interest of the young, as this is about their future too. “It will take time,” she says. But, she predicts, “when the 21st century draws to a close, we’ll say this was the century of old people — when the view of the old in society changed.”