Political Economic Approach to Old Age: The Carroll Estes Model
Elif ÇevikAging, a crucial concern within social policy and services, has gained increasing attention from scholars and policymakers because of the accelerating global demographic shift toward the aging population. Despite this, postgraduate studies on aging within Turkey’s social policy and services field remain notably low. Moreover, existing studies predominantly adopt a structural-functional approach, lacking critical analysis. Thus, this article addresses this gap by introducing a critical perspective, notably lacking in current Turkish academic discourse on aging studies. To this end, Carroll Estes’ model, exemplifying such criticality, is presented comprehensively for the first time in Turkish academia. Estes’ model delves into the central phenomenon of aging at both macro and micro levels, scrutinizing ideology, the state, gender system, postindustrial capitalism, globalization, the medical-industrial complex, and elderly care initiatives at the macro level. At the micro level, it examines interlocking systems of oppression, class, race/ethnicity, gender, and citizenship. This multifaceted model promises to enrich various disciplines, particularly social policy, social services, and sociology, offering researchers a broader lens for understanding and analyzing the complexities of aging.
Yaşlılığa Politik Ekonomik Yaklaşım: Carroll Estes Modeli
Elif ÇevikSosyal politika ve sosyal hizmetlerin temel konularından biri olan yaşlılık, dünya nüfusunun hızla artmakta ve yaşlanmakta olduğu demografik gerçeği nedeniyle gerek bilim insanlarının gerekse politikacıların giderek daha fazla ilgisini çekmektedir. Buna rağmen Türkiye’de, sosyal politikalar ve sosyal hizmetler alanında, lisansüstü düzeyde yaşlılık çalışmalarının sayısı oldukça azdır. Yapılan çalışmalar ise ekseriyetle yapısal-işlevselci yaklaşıma sahip olup eleştirel yaklaşımdan uzaktır. Dolayısıyla bu makalede, yaşlılık çalışmalarıyla ilgili mevcut akademik yazında eksikliğini fark ettiğimiz eleştirel yaklaşıma yer verilmek istenmektedir. Bu bağlamda söz konusu yaklaşıma ait en güçlü örneklerden biri Carroll Estes’e aittir. Estes’in modeli ise Türkçe akademik yazınında ilk kez tüm hatlarıyla tanıtılacaktır. Söz konusu modelde, merkezi fenomen olan yaşlılık, makro düzeyde ideoloji, devlet, cinsiyet sistemi, post-endüstriyel kapitalizm ve küreselleşme, medikal endüstri kompleksi ve yaşlı bakımı girişimleri boyutlarıyla incelenirken mikro düzeyde ise birbirine kenetlenmiş baskı sistemleri olan, sınıf, ırk/etnisite, cinsiyet ve vatandaşlık olguları üzerinden ele alınmıştır. Dolayısıyla oldukça katmanlı olan bu modelin, sosyal politika, sosyal hizmetler ve sosyoloji alanları başta olmak üzere birçok disipline katkı sağlayacağı açıktır. Ayrıca ilgili araştırmacılara da yaşlılık olgusunu anlama ve çözümlemede çok daha geniş bir bakış açısına sahip olmalarına yardımcı olacaktır.
The rapid growth and aging of the world’s population pose considerable challenges. While in primitive times, only a fraction of the population reached old age, in modern times, the majority attaining old age raises multifaceted concerns. Consequently, interest in aging studies has increased globally, causing new disciplines such as gerontology and the development of new social theories. Among these, activity theory stands out, dominating much of the Turkish literature. However, this approach overlooks the crucial aspects of aging. Consequently, critical examinations of the political economy of aging are increasingly capturing the attention of scholars. Carroll Estes emerges as a leading figure among these critical theorists. With a distinguished academic career, Estes has delved into Social Security and Medicare policy, healthcare reform, long-term care, and the economic and health security of older women. Recognized as a pioneering scholar in the fields of “political economy of aging” and “critical gerontology” Estes and his theories remain largely absent in Turkish aging literature. Thus, this article aims to bridge this gap by introducing Estes’ theories to Turkish academia. Estes has made notable contributions to the aging literature, with his theoretical models and concepts representing seminal works in the field. This article presents Estes’ model and concepts comprehensively for the first time in Turkish aging literature. For example, Estes’ concept of the “aging enterprise” has been translated into Turkish as “elderly care initiatives” and incorporated into Turkish discourse. Thus, Estes’ model emerges as a valuable resource awaiting exploration, particularly within disciplines such as social policies and services.
Understanding the fundamental concepts proposed by Estes is essential for fully understanding his ideas and contributions. However, delving into these concepts necessitates not only understanding the phenomena they address but also discerning the motives driving their formulation. Hence, our article briefly incorporates the main points emphasized by the political economy theory that forms Estes’s theoretical framework. Political economy theory treats aging through the lens of interwoven connections between the macro-level, social dynamics, intermediate-level organizational and institutional, and micro-level individual experiences (Estes, 1979).
At the heart of Estes’ model lies the public/citizen. Power dynamics among the state, postindustrial capitalism, and gender systems, entailing bidirectional relationships, unfold within the framework of “interlocking systems of oppression” (Collins, 1990, p. 225) stemming from gender, social class, and racial and ethnic statuses across life (Dressel et al., 1997, p. 583; Estes, 2001, p. 2). Moreover, Estes perceives ideology as the main framing element enveloping other concepts in defining aging and shaping policy responses to aging within society (Estes, 2001, p. 2). Employing this model of political economy theory, Estes constructs a theoretical framework of social policy and aging. However, he incorporates additional analytical levels, namely the “medical industrial complex” and “elderly care initiatives” into the framework. These elements emerge as products of and intersect with the relationships among postindustrial capitalism, the state, and gender systems while focusing on the citizen/public. Consequently, the model expands to include a fifth level (Estes, 2001, p. 3).
Est’s’ model of social policy and aging offers a multilayered analytical framework that addresses the intricate, conflicting, and competitive relationships among postindustrial capitalism, the state, and the gender/sex system, which in turn shape and sustain the medical-industrial complex and elderly care initiatives. Viewed through a conflict theory perspective, the model acknowledges and attempts to illustrate the ongoing struggle among its actors, underscoring the important role politics plays in determining the extent to which one actor can assert dominance and control over others (Estes, 2001, pp. 3–4).
According to Estes, ideologies wield substantial power in shaping, modifying, and implementing social policies. Particularly, the twin ideologies of neoliberalism and neoconservatism have proven highly effective in efforts to drastically transform Social Security and Medicare programs (Estes, 2001, p. 102). Neoconservative ideology, influential in social policy formulation, exerts notable influence on the sociocultural sphere, giving rise to motivational crises such as exacerbating gender conflicts and imposing emotional pressures regarding familial responsibilities (Estes, 2001, p. 102). In this context, neoliberal ideology limits economic policies to inherently pro-market actions, while neoconservative ideology limits the nature and scope of actions within the traditional family structure (Therborn, 1980, pp. 97–100).
In Estes’ model, the subsequent link after the overarching ideology involves class, race/ethnicity, gender, and age. These elements are viewed as interlocking systems of oppression arising from conflicts and stratification within the social structure (Collins, 1990; Estes, 2001, p. 13). Social class, race/ethnicity, and gender are directly correlated with the resources accessible to individuals in old age, both due to their status as interlocking systems of oppression at the macro level and their intersectionality at the micro level (Estes, 2001, p. 13).
Within Estes’ theoretical framework, the examination of the state revolves around its capacity to (a) allocate and distribute scarce resources, (b) mediate between various societal segments and classes, and (c) address conditions potentially threatening social order. Analyzing public policies governing resource allocation and distribution for older citizens by the state is crucial. This transcends mere considerations of resource availability for social spending. Estes underscores the tangible and perceived ramifications of allocating an increasing share of resources to the elderly on business, economic growth, industry, and industrial relations (Estes, 2001, p. 7).
In Este’’ theoretical constructs, postindustrial capitalism, and its linked globalization hold important positions within the political economy of aging. Estes finds a strong relationship between aging and postindustrial capitalism/globalization. He examines how these phenomena, along with informationalism, shape the lives of older individuals, establishing a relationship between macro- and micro-structures (Estes, 2001, p. 4).
The inclusion of the sex/gender system marks a new addition to the political economy discourse. While previous studies have explored gender’s role at individual and policy levels, its incorporation as a key institutional force in explaining social policy on aging is new (Estes, 2001, p. 8). Estes offers two primary reasons for integrating gender into the theoretical model: First, the increasing proportion of women within the elderly population. Second, women’s greater dependency on the state compared with men, persists across the lifespan regardless of age (Estes, 2001, p. 121). Estes posits that gender differences in the aging experience stem from the entrenched role of gender within social and political structures.
The concept of citizen/public, central to Estes’ theoretical framework, draws upon critical literature asserting the absence of a universally and equitably shared experience of citizenship (Estes, 2001, p. 10). According to Estes, the fundamental issue surrounding citizenship lies in the dichotomy between capitalism and democracy within capitalist democracies, engendering tension and contradiction (Estes, 2001, p. 10). Citizenship, Estes argues, embodies both economic and political dimensions, as the life opportunities offered by states to their citizens are largely based on labor force participation and property ownership.
Understanding aging and social policy requires attention to two overlapping and mutually reinforcing structural arrangements: the medical-industrial complex and elder care initiatives. The medical-industrial complex comprises a highly stratified and expansive healthcare sector dominated by multibillion-dollar corporations (Estes et al., 2001, pp. 165–166). Coined by Estes in 1979 (p. 2), the term “aging enterprise” resides within the confines of the medical-industrial complex, yet extends beyond healthcare to encompass governmental and institutional actions across all facets related to aging. Conversely, aging initiatives generally focus on the relationship between social policy and the circumstances and requirements of older individuals (Estes et al., 2001, p. 167). Estes posits that at the heart of both the medical-industrial complex and the aging initiative lies the commodification of health, wherein healthcare and the needs of the elderly, along with other societal needs, are transformed into commodities for specific economic markets (Estes, 1979). Consequently, both capitalist capital and governments perceive healthcare and elderly services as economic products rather than social goods.
The crisis of the welfare state precipitated by postindustrial capitalism, globalization, and technological advancement has resulted in old age being perceived as a financial burden on public expenditure. While solutions such as “extending the retirement age” and promoting “active aging” have been proposed for the aging population, they have proven insufficient in comprehensively addressing the issue. This inadequacy has spurred an increased interest in critical theory, with old age emerging as a focal point within political economic theory. Estes’ model, encapsulated within this discourse, offers a considerably more comprehensive and detailed framework than other theories of old age. Notably, Estes’ emphasis on gender, which is often neglected in conventional aging theories, constitutes an innovative and valuable contribution. Given the current dearth of Turkish literature on aging, we believe that Estes’ theory holds the potential to considerably enrich aging studies in Turkey. Through this article, we aim to highlight the overlooked aspects of Estes’ model, bringing them to the attention of relevant researchers and scholars.
