This paper explores how the exercise of the ethics of 'responsibility' for health care advanced through 'healthy ageing' and 'successful ageing' narratives in Western countries animates an array of 'authorities', including the 'anti-ageing medicine' movement as a strategy to address the anxieties of growing old in Western societies and as a tool to exercise the ethos of 'responsibility'. The choice of this type of authority as a source of guidance for self-constitution and the exercise of the 'responsible self', this paper will argue, enables the enactment of a type of late modernity notion of citizenship for ageing individuals based on principles of agelessness, health, independence and consumption power. Through interviews with anti-ageing consumers, however, it is also possible to argue the existence of tensions and contradictions that such a rigid model of self-constitution in later life produces, and the potential forms of resistance and contestations that may emerge as a result. In this way the current 'war on anti-ageing medicine' (Vincent 2003) becomes also symptomatic of bigger 'wars' taking place not only between institutions competing for control over knowledge and management of ageing, but between those in favour and against the homogenisation of life under the language of universal science, reason and market rationality.
Summary
The rise of the COVID-19 pandemic has exposed the incongruity of individualization ideologies that position individuals at the centre of health care, by contributing, making informed decisions and exercising choice regarding their health options and lifestyle considerations. When confronted with a global health threat, government across the world, have understood that the rhetoric of individualization, personal responsibility and personal choice would only led to disastrous national health consequences. In other words, individual choice offers a poor criterion to guide the health and wellbeing of a population. This reality has forced many advanced economies around the world to suspend their pledges to ‘small government’, individual responsibility and individual freedom, opting instead for a more rebalanced approach to economic and health outcomes with an increasing role for institutions and mutualization. For many marginalized communities, individualization ideologies and personalization approaches have never worked. On the contrary, they have exacerbated social and health inequalities by benefiting affluent individuals who possess the educational, cultural and economic resources required to exercise ‘responsibility’, avert risks and adopt health protecting behaviours. The individualization of the management of risk has also further stigmatized the poor by shifting the blame for poor health outcomes from government to individuals. This paper will explore how the COVID-19 pandemic exposes the cracks of neoliberal rhetoric on personalization and opens new opportunities to approach the health of a nation as socially, economically and politically determined requiring ‘upstream’ interventions on key areas of health including housing, employment, education and access to health care.
Measuring health and wellbeing outcomes of community aged care programs is a complex task given the diverse settings in which care takes place and the intersection of numerous factors affecting an individual’s quality of life outcomes. Knowledge of a strong causal relationship between services provided and the final outcome enables confidence in assuming the care provided was largely responsible for the outcome achieved (Courtney et al., Aust J Adv Nurs 26:49–57, 2009). The Department of Health has recently reported on the findings of The National Aged Care Quality Indicator Program – Home Care Pilot (KPMG, National Aged Care Quality Indicator Program – Home Care Pilot, 2017). The Program sought to test various tools to measure quality of life outcomes of their community aged care programs. Some of the key issues raised in the study reiterate the findings from The Australian Community Care Outcome Measurement (ACCOM) pilot study (Cardona et al., Australas J Ageing 36: 69–71, 2017), including the value of the ASCOT SCT4 tool (Adult Social care Outcomes Toolkit, http://www.pssru.ac.uk/ascot/downloads/questionnaires/sct4.pdf) to measure social care related quality of life (SCRQoL) in community aged care programs in the Australian context, the collection of additional data to map the relationship of various variables such as functional ability, demographic characteristics and quality of life scores and the governance and administration of measurement tools for the purpose of quality reporting and consumer choice.
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