Social Policy and Aging : A Critical

This groundbreaking book provides comprehensive treatment of the political economy of aging by a scholar widely credited as the founder and key thinker of this field in the US and internationally. The body of work presented in this volume, in developing this critical perspective, aims to contribute to the understanding of old age and aging in the context of problems and issues of the larger social order in the world's most advanced capitalist nation, the U.S.A. Since Estes' first writing on the political economy of aging in 1979, there has been growing recognition and incorporation of her critical perspective as one of the major paradigms in the field of aging.

Carroll L. Estes, Ph.D., is Professor of Sociology at the University of California, San Francisco

Introduction

xv

Carroll L. Estes

Acknowledgments

xv

Political Economy of Aging: A Theoretical Framework

1

(22)

Theoretical Model

3

(10)

The Multilevel Analytical Framework

3

(1)

Financial and Postindustrial Capital and Its Globalization

4

(1)

The State

5

(3)

The Sex/Gender System

8

(2)

The Citizen and the Public

10

(2)

The Medical-Industrial Complex and the Aging Enterprise

12

(1)

The Interlocking Systems of Oppression

13

(4)

Social Class

14

(1)

Race/Ethnicity

15

(1)

Gender

16

(1)

Ideology

17

(1)

Conclusion

18

(5)

Critical Perspectives on Aging

23

(22)

Prevailing Gerontological Theories and Their Limitations

24

(8)

Disengagement Theory

25

(1)

Activity Theory

25

(1)

Successful and Productive Aging

26

(2)

Theories of the Life Course

28

(1)

Social Constructionist Theories

29

(1)

Age Stratification and the Aging and Society Paradigm

30

(1)

Critical Perspectives on Aging and Health

31

(1)

The Critical Perspective: A Theoretical Retrospective---1960s to the Present

32

(2)

Major Theoretical Perspectives in the Critical Approach

34

(5)

Conflict Theories

34

(2)

Critical Theories

36

(1)

Feminist Theories

37

(1)

Cultural Studies

38

(1)

Applying the Critical Theoretical Approach to Aging

39

(5)

The Political Economy of Aging

40

(2)

Moral Economy and Humanistic Gerontology

42

(1)

Ideology

43

(1)

Conclusion

44

(1)

The Medicalization and Commodification of Aging and the Privatization and Rationalization of Old Age Policy

45

(16)

The Biomedicalization of Aging

46

(3)

The Commodification of Old Age and the Privatization of Medical Care

49

(7)

Commodification of Old Age

49

(3)

Privatization

52

(4)

The Rationalization of Medical Care

56

(1)

Implications

57

(2)

Conclusion

59

(2)

The Transformation of the Nonprofit Sector: Systemic Crisis and the Political Economy of Aging Services

61

(34)

Shocks to the Nonprofit Sector: Historical Transformation, 1980 to the Present

62

(6)

Crisis Theory

68

(1)

Theorizing the Nonprofit Sector From a Political Economy Framework

69

(2)

Health and Human Services

71

(2)

The Nonprofit Sector and Crisis: Hypotheses

73

(19)

Economic Crisis

76

(7)

Political Crisis

83

(6)

Sociocultural Crisis

89

(3)

Conclusion

92

(3)

Crisis, the Welfare State, and Aging: Ideology and Agency in the Social Security Privatization Debate

95

(24)

Creating a Crisis

96

(8)

Objective and Subjective Construction

96

(2)

Symbolic and Material Impact

98

(1)

Legitimacy Crisis of the State

98

(3)

Race/Ethnicity, Class, and Gender

101

(1)

Ideology

101

(3)

The Privatization of Social Security

104

(3)

Framing the Debate

104

(1)

The Costs of Privatization

105

(2)

Media, Think Tanks, and the Disparate Influence of Pro-Privatizers

107

(6)

The Role of the Media

107

(4)

The Role of Think Tanks

111

(1)

Public Opinion and Social Security

112

(1)

Capital and the Attack on Social Security

113

(4)

Limited Control of Market Forces

114

(1)

Contribution to the Growth of the Federal Budget

115

(1)

Costs to Corporate Capital

115

(1)

Globalization of Capital

116

(1)

Conclusion

117

(2)

Sex and Gender in the Political Economy of Aging

119

(18)

The Political Economy of Gender and Old Age

120

(2)

The Situation of Older Women

122

(1)

The Gendered State

123

(5)

Feminist Theories of the State

123

(2)

Patriarchy and the Sex/Gender System

125

(1)

Welfare State Regimes

125

(2)

Social Reproduction

127

(1)

Aging and State Theory

128

(3)

Race, the State, and Aging

129

(1)

Social Class, Gender, and Aging

130

(1)

Women's Roles, Social Institutions, and Social Policy

131

(3)

Conclusion

134

(3)

Inequality and Aging: The Creation of Dependency

137

(28)

Creating Dependency

137

(3)

Population Growth and the Dependency Ratio

140

(5)

Demographic Changes

140

(1)

The ``Impending'' Health Care ``Crisis''

141

(2)

Changing Dependency Ratios

143

(2)

Economic and Social Well-Being

145

(4)

Role of Age and Marital Status in Income Inequalities

146

(1)

Role of Gender and Race/Ethnicity in Income Inequalities

146

(3)

Social Class and Health

149

(2)

Social Support and Health

151

(3)

Mortality

154

(3)

Morbidity

157

(5)

Use of Health Care

162

(1)

Conclusion

163

(2)

The Medical-Industrial Complex and the Aging Enterprise

165

(22)

The Health Care System

167

(1)

Structure of the Health Care Industry

167

(1)

The Role of Capital and the Marketplace

168

(10)

Changes in the Structure of the Industry

168

(1)

Rapid Growth and Consolidation

168

(2)

Horizontal Integration

170

(1)

Vertical Integration

171

(1)

Changes in Ownership

171

(2)

Diversification, Restructuring, and Growth

173

(1)

Financial Status and Profits

174

(4)

The Role of the State

178

(3)

The Need for Regulation

178

(3)

The U.S. Medical-Industrial Complex in a Global Context

181

(2)

Conclusion

183

(4)

A Political Economy Critique of ``Productive Aging''

187

(14)

The Development of the Productive Aging Perspective

188

(4)

Recognizing the Social Determinants of Health

188

(1)

Addressing the Health of Older Persons

189

(1)

``Successful Aging'' as a New Model for Health Promotion

190

(1)

From ``Successful'' to ``Productive'' Aging

191

(1)

A Critique

192

(6)

Promoting the Role of the Market in Addressing Health

193

(1)

Limitations of a Microlevel Approach

194

(1)

Perpetuation of the Biomedicalization of Health, the Medical-Industrial Complex, and the Aging Enterprise

195

(2)

Perpetuation of Inequalities From the Systems of Oppression

197

(1)

Constructions of Reality

198

(1)

Conclusion

198

(3)

The Underdevelopment of Community-Based Services in the U.S. Long-Term Care System: A Structural Analysis

201

(16)

Aging and Disability in the United States

202

(2)

Long-Term Care and Community-Based Care

204

(1)

Financial and Industrial Capital

204

(3)

The Role of the State

207

(4)

Professionals and Delivery Systems in Long-Term Care

211

(2)

Conclusion: The Public, Users, and Family Members

213

(4)

The Political Economy of Health Work

217

(14)

Health Work in the Capitalist Economy

218

(8)

Health Work Cost Management

221

(1)

Informalization of Health Work

221

(5)

Health Work Policy Environment: The Role of the State

226

(2)

Conclusion: A New Perspective on Health Work

228

(3)

Concluding Observations on Social Policy, Social Theory, and Research

231

(8)

Social Policy

231

(2)

Social Theory and Research

233

(6)

References

239

(32)

Index

271

(12)

About the Authors

283

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Social Policy and Aging : A Critical Perspective

Summary

Author Biography

Table of Contents

Supplemental Materials