COVID-19 and intergenerational justice: trying to get the bigger picture

By Peter Lloyd-Sherlock

A few weeks ago I participated in a fascinating discussion with fellow members of a new Task Force on Humanitarian Relief, Social Protection and Vulnerable Groups, as part of a Lancet Commission on COVID-19 (https://covid19commission.org/humanitarian-relief). I was the only member with a particular focus on older people, while several others had interests in children and young people. This age bias is of course problematic, but it was also a good opportunity to hear the thinking of people I don’t usually interact with professionally. Among other things, this forced me to think harder about how older people fit into the “bigger COVID-19 picture”. How does age fit and intersect with other issues and identities? How can we encourage more inclusive, joined-up thinking?

Task Force members were asked to put together short notes setting out their thoughts. The rest of this blog sets out my own effort. Part of this fed into a very short piece just published in The Lancet here (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32547-2/fulltext). Other parts fed into a presentation given as part of a Global Platform webinar on COVID-19, intergenerational justice and people of different ages, along with excellent contributions from Sridhar Venkatapuram, Paul Ladd and Ola Abualghaib (https://www.youtube.com/watch?v=XT11g-hHeFs&feature=youtu.be).

Long-term care facilities (LTCFs) for older people have been major foci of COVID-19 mortality, not just in high-income countries, but across Latin America. There are many reasons for this, including:-

One of the main points of viral entry into LTCFs has been through care workers, who work part-time across a number of facilities. When one LTCF becomes infected, these workers spread the virus to the others. Often, these women have no choice other than to work across multiple facilities, since they are part of a low-status, casual workforce. Often, LTCFs prefer not to employ them on a full-time, formal basis. Many are immigrants and from deprived communities. Almost none own cars and so travel from facility to facility on public transport, adding a further risk of infection. They are afraid of being tested, since they may well lose their jobs if found to be positive (and they lack access to adequate social protection). Most have large families who depend on this income and many live in over-crowded environments, which are high-risk infection environments.    

This story applies a gendered lens to understand multiple, intersecting vulnerabilities and deprivations. It shows that we cannot look at vulnerabilities of people at different ages (frail older people in LTCFs, low status care workers) independently of each other. Instead, it shows that (always through a gendered lens), we need to view age, life course and generation as fundamentally connected shapers of life chances and vulnerabilities.

COVID-19 affects all age groups greatly and in multiple ways. These effects are different for different age groups and for people in different situations, be they frail older people, children/youth in education or “workers” of all ages.  And these differential effects and experiences are playing out within a broader crisis of inter-generational justice. Even before the pandemic hit, it was evident that the established (partly mythic) inter-generational contract based around education (re)production and retirement was in crisis on many fronts including.

Mounting pressures of population ageing on public services and care.

Less access to secure employment during “working years”.

A growing generation gap in opportunities to participate in housing markets.

Changing norms and practices of gender roles though the life course.

Concerns about how current consumption, environmental degradation, etc. will affect future generations.

The COVID-19 pandemic has exacerbated many of these tensions and these have often been framed in terms of impossible policy dilemmas: should we prioritise keeping schools open, saving jobs or keeping at-risk older people safe? And they have heightened existing discourses of ageism and “youthism” (such as blaming feckless young people for irresponsible behaviour). Increasingly, there seems to be a zero-sum tug of war between the generations.

This view of fundamentally conflicting group interests is profoundly unhelpful and damaging. It could feed into a bitter post-pandemic legacy of social division. How can we respond to this threat?

A starting point is to critically rethink the generational social contract, applying new ideas of intergenerational justice and consumption through the life-course. Potentially, this could explore new ethical frameworks to guide policy responses to those “impossible dilemmas”. It will require new ways of thinking among academics, policy-makers and societally, with contributions from across the disciplines: moral philosophy, fiscal economics, social science and more. It will also need high-level political support, perhaps in the form of a new United Nations Commission on generational justice.

Another response to the crisis will be to build on existing experiences that demonstrate how to construct communities of interest across the ages. Examples include high rates of volunteering by retired older people, often for causes addressing the needs of children or other groups. Here is a specific example from my own “research world” of what that new type of thinking might look like. It offers a contrast to the “story” at the top of the page.

The Programa Maior Cuidado (PMC) in Minas Gerais, Brazil employs women from deprived communities as part of a new system of integrated health and social care for frail older people in these same communities. These women are paid a basic wage and provided training to support family carers and liaise with local health and social assistance providers. The aim is to build the capacity of family carers at the same time as reducing their daily care burden. PMC has continued to operate during the pandemic. There is evidence that PMC has provided sustainable and socially useful paid employment for hundreds of women. It has enhanced the quality of life of older people, as well as family carers. There is also evidence that it has reduced risk factors for unnecessary hospitalisation and emergency health service use. Other cities in Brazil are now looking to develop similar interventions. More detail about PMC is available here: Belo Horizonte’s pioneering community care programme for older people.

Promoting policies like PMC to build interests across age groups will be just as great a challenge as developing new ways of thinking about intersectional intergenerational justice. It’s high time to make a start.