Carroll L. Estes - Social Policy and Aging

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SOCIAL POLICY
&AGING

A
Critical
Perspective

Carroll L. Estes

and Associates

Carroll L. Estes and Associates

Robert R. Alford

Elizabeth A. Binney

Julia E. Bradsher

Liz Close

Chiquita A. Collins

Anne Hays Egan

Charlene Harrington

Karen W. Linkins

Marty Lynch

Jane L. Mahakian

David N. Pellow

Steven P. Wallace

Tracy A. Weitz

Copyright 2001 by Sage Publications, Inc.

All rights reserved. No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher.

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For information:

Sage Publications, Inc. 2455 Teller Road Thousand Oaks, California 91320 E-mail: Sage Publications Ltd. 6 Bonhill Street London EC2A 4PU United Kingdom Sage Publications India Pvt. Ltd. M-32 Market Greater Kailash I New Delhi 110 048 India

Printed in the United States of America

Library of Congress Cataloging-in-Publication Data

Social policy and aging: A critical perspective / by Carroll L. Estes and Associates.

p. Cm.

Includes bibliographical references and index.

ISBN 0-8039-7346-2 (cloth: acid-free paper) ISBN 0-8039-7347-0 (pbk.: acid-free paper)

1. AgedUnited States. 2. AgingUnited States. 3. AgedGovernment policyUnited States. 4. AgedMedical careUnited States. 5. Social stratificationUnited States. I. Carroll L. Estes and Associates.

HQ1064.U5 S5945 2000

305.260973dc21 00-010918

06 07 08 09 10 9 8 7 6 5 4 3

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Acquiring Editor:	Jim Brace-Thompson
Editorial Assistant:	Anna Howland
Production Editor:	Diana E. Axelsen
Editorial Assistant:	Victoria Cheng
Copy Editor:	Linda Gray
Typesetter/Designer	Denyse Dunn
Indexer:	Jeanne Busemeyer
Cover Designer:	Michelle Lee

Contents

Dedicated to

Maggie Kuhn
mentor, friend, and visionary for social justice and
founder of the Gray Panthers

Tish Sommers
mentor, friend, and feminist guide and
founder of the Older Womens League

Solomon Davis
late student, colleague, and friend
whose life and example taught us the importance of this work

Duskie Lynn Estes
and to the generations to follow:
The best reason for a critical perspective and praxis

Introduction

Carroll L. Estes

S ocial Policy and Aging: A Critical Perspective offers the only comprehensive book-length treatment of what is a new and widely recognized theoretical paradigm and approach in social gerontologythe political economy of aging. The book is authored by the scholar who is widely acknowledged and credited as the founder and key thinker in the political economy of aging in the United States and internationally (Bengtson, Burgess, & Parrott, 1997; Bengtson & Schaie, 1999; Hendricks, 1992; Hendricks & Leedham, 1991; Marshall, 1996, 1999; Phillipson, 1998; Quadagno & Reid, 1999; Walker, 1999).

The body of work presented in this volume, in developing and theorizing 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 worlds most advanced capitalist nation, the United States of America. Since the first writing on the political economy of aging in 1979 (Estes, 1979), there has been growing recognition and now full incorporation of Estess critical perspective as one of the major paradigms in the field of aging.

In the past 20 years, there has been a revolution in the globalization of capital and in health care restructuring as well as major theoretical advances in work on the welfare state and in social gerontological theory, both of which are addressed in this new volume. Included in the book is an exposition of theoretical developments and their application to the issue of social policy and aging. The 11 chapters that compose this volume explore the issue of social policy of aging from various components of the political economy model. They include overlapping and interwoven themes, each taking a slightly different orientation or specific topic of analysis.

In ). This framework examines the political, economic, and social conflicts at and between the institutional levels of postindustrial capital, the state, the sex/gender system, and the public/citizen and including the mesolevel of the medical-industrial complex and the aging enterprise. Conflicts over social policy are power struggles that must be analyzed in terms of reigning and competing ideologies and the interlocking systems of oppression of race, class, gender, and age to understand the social construction of aging and the aged and the formation of social policy.

In and discuss the application of a critical theoretical approach to social policy and aging.

In , Estes, Wallace, Linkins, and Binney discuss four social processes that shape old age, aging, and policy formation: medicalization, commodification, privatization, and rationalization. The social construction of aging as a medical problem and the resulting production of medical commodities are analyzed in terms of the relations between postindustrial capital and the state. With the realization of profitability, the transition to privately dominated provision of commodified medical services formed the foundation for the medical-industrial complex and the aging enterprise. Attempts to rationalize this transformation have led to the restructuring of health care in pursuit of efficiency and cost reduction.

In , Estes, Alford, and Egan examine in greater detail the role played by the nonprofit sector in relation to postindustrial capital and the state. This chapter explores the literature on crisis and capitalism and crisis and the state to understand how the nonprofit health and social services sector may be employed both as a buffer and as a resource for capital and how the state responds to its own legitimation crisis tendencies. A detailed review of crisis theory precedes a critical analysis of the political economy of nonprofit service provision.

In to analyze the roles of postindustrial capital, the state, and ideology, with particular attention to the media.

Table 1.1

Development of the Estes Model of the Political Economy of Aging

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Theories	Dates Introduced
Conflict	1972, 1976
Organizational	1972, 1976
Sociology of knowledge	1972, 1976
Symbolic interaction (social constructionism and labeling)	1972, 1976, 1980
Political economy	1979
Feminist	1984
Critical	1991
Cultural studies	1999

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SOURCES: Estes (1972, 1976, 1979, 1980, 1991, 1999b) and Estes, Gerard, and Clarke (1984).

In , Estes proposes a framework to understand the political economy of gender and aging that identifies aging as both a gender and a womens issue. This chapter analyzes the particular situation of older women within the gendered state and womens roles in social institutions and social policy. The state, in conflicts over capital and resources, promotes and reproduces the dominant institutions that support the sex/gender system and that create and perpetuate the economic and social dependency of women.

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