A capabilities approach to healthy ageing: Towards more inclusive identities for older people

From ‘dependence’, to ‘successful ageing’, the dominant discourses of ageing and well-being are on the move again as the World Health Organisation introduces a new ‘functional ability’ policy framework. As this framework is disseminated, we must ask ourselves how this approach will affect the identity of older people in our society? These frameworks for understanding ageing, developed by researchers and policy makers, influence gerontological practice and the identities of older people themselves.

For example, Rowe and Kahn’s ‘successful’ ageing model currently remains an important influence on research, intervention, and public policy around ageing. This model focuses on avoiding disease and disability, maintaining high mental and physical functioning, and remaining socially engaged. These approaches to ageing have contributed to a discursive construction of successful ageing, popularised through print, online, and social media, which influences society’s and older people’s ideas about ageing. A ‘successful ageing’ discourse in general use like this, positions older people as responsible for engaging in exercise, diet, and social engagement to produce good health and contribute to society.

There are now many critiques of the effects of successful ageing discourse. In a paper recently published in Critical Public Health I explain how these critiques centre around three central issues. First, they construct older people as individually responsible for their physical and financial wellbeing. The policy focus on seniors maintaining independence and productive contribution does not acknowledge the many different life circumstances that contribute to the ability to maintain wellbeing. Secondly, such approaches are oppressive. They position those who arrive at older age with different levels of health as the result of different life circumstances as ageing “unsuccessfully’. Older people with poorer health are seen as less deserving of help and may blame themselves for structural inequalities. Thirdly, a successful ageing discourse denies the realities of embodied ageing and death. Ageing bodies are pathologised and death is a failure to age successfully. There is no space in successful ageing discourse for understanding decline and death, leaving older people anxious about their changing bodies.

We suggest that the Capability Approach has the potential to address these critiques. The capability approach provides an environmentally, socially and ethically oriented framework for research, policy, and intervention in ageing and health by taking into account the influence of the social and material environment and the diverse values of older people. Sen’s theoretical focus is on people’s ‘capabilities’ or the extent to which they are able to function in ways that they value. The capability approach recognises differences in social standing and material circumstances that influence these capabilities, and accounts for social and cultural diversity in values. Sen’s capability approach provides a theoretical framework for research leading to social rather than individual change.

As the World Health Organisation rolls out the 2015 global strategy and action plan on ageing and health, critical gerontologists will consider its effects on older people’s social identities. The capability approach (which has been drawn on as part of the theoretical underpinning of the strategy) has the potential to shift the ways in which we generally talk about ageing and wellbeing, from a focus on all older people remaining young and fit, to recognition of the needs of older people in their actual circumstances. From a capabilities perspective, health research, policy, and intervention would focus on the ways in which the environment supports the capability of all older people to achieve valued functioning, rather than individual responsibility for ageing ‘successfully’. Because the dominant discourses that underpin research and social policy have powerful effects, the adoption of a capabilities approach can influence the way in which ageing is constructed by all, including older people themselves.