The end of the world as we know it | Marvin Formosa

By 2050, the over-60s will outnumber the younger generation by five to one. Gerontologist Dr Marvin Formosa advises preparation for a very different reality ahead

Dr Marvin Formosa (Photo by Ray Attard).
Dr Marvin Formosa (Photo by Ray Attard).

“Every two seconds in the world, someone turns 60. In fact, at present one out of nine people is over the age of 60, and by 2050 it will be one in five. Within a few decades the percentage of elderly people will be greater than that of children. So… it’s the end of the world as we know it, basically.”

Not perhaps the most auspicious start to our conversation… but then again, I did ask Dr Marvin Formosa, gerontology lecturer in the Faculty of Social Well Being at the University of Malta, to give an overview of the changing demographics in Malta and the world.

Dr Formosa is a gerontologist and chairman of the National Active Ageing Commission. He worked on a National Strategic Policy for Active Ageing, launched by the newly rechristened ‘Parliamentary Secretariat for the Rights of Persons with Disability and Active Ageing’ in November last year. But with the landscape constantly changing, he expresses concern that there is not enough awareness of the need to mitigate an impending time-bomb.

“Where before the ‘pyramid’ was thin at the top and wide at the bottom, now it’s going to be very much… square-ish,” Dr Formosa observes, sitting beneath a bookcase that looks like it might collapse at any moment under the sheer weight of sociological research.

“If you look at how things were before, when the pyramid was fat at the bottom” – i.e., the ratio of workers to pensioners was very high – “the logic behind social policy was easy to understand: you’ve got this small percentage of older people who are in their sixties – basically, life expectancy [back then] was late sixties anyway, so they had just a few years between retirement and death…

"In many cases they would be very frail… and government policy was to help these people and provide for their needs. Today, the situation is rather different. People are not only living longer, but living with a higher standard of health, their aspirations are different… and even their income levels are higher.”

Formosa breaks off to explain that while there are people in that age bracket who are at risk of poverty, the majority still enjoys an adequate standard of living compared to their predecessors. “Statistics indicate that around 20% are at risk of poverty, even though academics tend to take statistics with a pinch of salt. It’s impossible to know the exact percentage. Still, it is true that these people exist.”

Nonetheless, any policy catering for the over-60 age bracket can no longer be limited only to providing assistance or benefits. Other issues also come into the picture: leisure, the right to work, and the right to be an active participant in society.

“The problems that we as a faculty look into are: number one, that just because you are older than others, obviously it doesn’t mean you are a second-class citizen. Society must offer opportunities for people to remain active… active not just in the leisure sense of the word: not just bingo or coffee mornings. This is why I like to use the term ‘active citizenship’: it implies that you participate in society… and also in the decision-making processes of society.”

As a practical example, Formosa points towards a recent change in administrative methods at State-owned homes for the elderly.

“This year I was very happy to note that the government set up ‘association boards’ in day centres, homes and also at St Vincent [de Paul]. Older people who are residents at St Vincent or a home, or are members of day centres, can elect their own representative committees, and these committees put forward either the success stories… because there are lots of success stories within these homes… it’s not all doom and gloom… but if there are areas which need to be improved, these association boards would put forward such suggestions.”

But with longer life, new exigencies inevitably arise. Dr Formosa points out how the ‘incoming elderly’ – namely, those now in their 60s – are also the first to reach that age-bracket having eaten (so to speak) from the fruit of consumerism in their youth.

“Today, we are living in a world dictated by consumption. And today’s incoming elderly also consume. The maxim that ‘I consume, therefore I am’ applies just as much to those in their 60s as to everyone else…”

In this respect there has been a striking change in mind-set from the preceding generation. Formosa remarks how it seemed possible a few years ago for people to not only survive, but even save on a pitiful pension.

“This is the first cohort of older people who have experienced the 1960s. Not exactly the ‘swinging sixties’ in Malta,” he admits with a laugh, “but even in Malta, the sixties were the sixties; there were dance-halls, and so on. This is why the older people of today are qualitatively – not just quantitatively – completely different from their predecessors. Their whole way of perceiving the world has changed.

"They have experienced consumption in their early adulthood; and sociologists know that when you have experienced the 1960s in your 30s, with children, it would have just passed you by. It is those who went through the sixties when they were still 18 or 19 that were most affected. It’s like music: good music comes out every year, but what is the music that influenced you most, that you feel most connection with? The music that came out when you were 18…”

One practical way in which this change can be felt is that people turning 60 today are more likely to accept the idea of payment for social services than their predecessors: if not the total amount, at least to top-up subsidised services. “It is becoming more common that people availing of services expect to pay at least something towards its sustainability. This was unheard of in the past. People used to regard the government as being there to provide them with everything for free…”

This brings Dr Formosa to the second major concern: the sustainability of the existing welfare state, given the demographic changes and the bleak prospects for the future.

“Statistically, in Malta we have 102,026 in the 60+ category, according to the latest census. That’s one quarter of the population. The real challenge is not there, however. The real challenge is in the 75+ bracket. I don’t know the exact figure offhand, but it’s somewhere in the region of 16,000. What is certain, however, is that these 16,000 or so people are going to triple in number in the next 20 years, because people are living longer…”

Is that a certainty, or an educated guess? “We can talk about it as a certainty. And it’s practically around the corner. The challenge is that people in this bracket are very often in receipt of some form of service or another. Statistically, the probability that a person may need assistance over the age of 75 is very high. So we can predict from now that applications for social services will also triple in the next 20 years, more or less. Of course, we need to have strong levels of community care, intermediate care, and long-term care….”

The area which needs most urgent attention, he continues, is the one that currently receives the least public attention: informal care. “People who have to look after an ailing relative: a dementia sufferer, for example… these people, the informal carers, tend to get burnt out in the end, because taking care of a relative is a 24-hour job…”

Sticking to the same example, Formosa adds that dementia accounts for some 5,000 such cases in today’s Malta. The incidence of dementia in itself may not change over time, but people suffering from that condition in future are expected to live with its symptoms for much, much longer. Consequently, informal carers will also have to work far longer today than they would have only 20 years ago.

“With life expectancy now in the mid-80s, the same dementia patients who until recently were expected to die in their late 60s or early 70s, are now living for 12, 15 years longer.”

This naturally has a huge impact on the workload of the people caring for them: which in turn creates a ripple effect that can be felt in other areas of the economy. People take more leave, stop working earlier, or become less productive in other ways. And in the long term, increased longevity can only increase the demand for support services from the government.

“Informal carers – most of whom would be family members – are providing an essential service to the government. If it wasn’t for them, their ailing relatives would have to live in a home. They would have to be dependent in some way on the state. If all informal carers had to stop working simultaneously, the entire system would crash. And some of them are stopping…”

For whatever reason, Dr Formosa points out that a percentage of informal carers will feel they just can’t continue, and will eventually turn to social services for help. This is already happening today, and for the same reasons outlined above, the number of persons made to rely exclusively on the state for their basic needs is likely to dramatically increase in the very near future. “There is a lot, a lot, a lot that needs to be done so that these informal carers get the help they need to take care of the elderly.”

Faced with this scenario, what sort of policy approach is currently being discussed? As a ‘Freirian’ – i.e., an advocate of Paolo Freire, the author of ‘Pedagogy of the Oppressed’ - Formosa believes that social policy has to be based on dialogue.

“In the past there was a tendency towards a top-down approach. The policy-maker knew what’s best, and dictated from above. I am not trying to be judgmental here; if I lived in those times I would probably have favoured the same approach myself. That was the consensus of the time.

But the world has changed, and policy-making has to change with it. No one should be allowed to have a total upper hand: neither the elderly themselves, nor the policy-maker. Obviously some form of authority will remain in the hands of the policy-maker. But it is important that any social policy that is devised for the elderly, should be partly ‘by the elderly, for the elderly’.

This is why we have done a number of public consultation exercises... even though it’s not a perfect scenario: as a rule it is always the same people who attend these meetings. But at least, it shows that on behalf of the policy-maker, they are willing to listen…”

In a nutshell, we need to reach a point where social policy is not dictated by the government, but not left entirely up to the elderly either. “The main reason for this is the question of sustainability. Both society as a whole and the elderly as a group have a responsibility to ensure that the system remains sustainable. You cannot expect to be provided with services which will also bring the country to the brink of financial ruin. At the same time, that responsibility also rests on the policy maker…”

Even the recent change in the nomenclature of this policy area is significant, Dr Formosa adds. “Before it was ‘the Parliamentary Secretariat for the Elderly and Community Care’. I had some problems with that: first of all it is a bit patronising towards the elderly; and secondly, ‘community care’ implies that all older people need ‘care’… which is not the case at all.”

Formosa however admits that political correctness has its limitations. “The politically correct term to use today is not the elderly, but simply ‘older people’.” The use of the comparative is important: it is ‘older’, not ‘old’. “There is no cut-off point when you are ‘old’. It’s not as though, because you turn 60, suddenly you are an old man when you were young just an hour earlier…”

At the same time, however, government policy does operate precisely that way sometimes. Upon turning 60, citizens become eligible for a ‘kartanzjan’ (ID card for the elderly). Dr Formosa acknowledges that, for practical reasons, some form of categorisation has to take place.

“Of course you cannot be so philosophical to reason that old people don’t exist at all, so let’s dismantle everything. Let’s not be too post-modern. But at the same time, when we speak of ‘the elderly’, it places the entire spectrum of 60+ people into the same box. The reality, however, is that ‘the elderly’ is an extremely heterogenous group… they have different needs, different aspirations. You cannot reduce them to a single label.”

The new name, on the other hand, encompasses a far-reaching change in policy outlook. “If you had to narrow down the basic rights of older people to one term, it would be ’active ageing’. It means three things. The right to work – and with it, the right to an adequate income, adequate pension, etc. - then the right to social participation, and the right to independent living. Active ageing encompasses all three of these things. Even if you are bedridden you still have, not only a right, but also the potential to be an active ager…”

Active citizenship is therefore one key goal of the Faculty of Social Wellbeing. “We want to treat older people as people and citizens first, rather than as just ‘older’.”

But while the issue has been discussed at length in public consultation meetings and in parliament, Marvin Formosa expresses concern that the wider public seems to be unprepared for the changes that will become necessary in the future.

“In my opinion, we are underestimating the problem. I think we are not paying enough attention to the implications of ageing. There is not enough discussion, not enough preoccupation. Even if we look at what has been discussed over the last 15 years regarding pensions… yes, there were talks, working groups were set up… even today, things are happening. But the way I see it, there is not enough impetus.

"What I am most afraid of is that there will be a watershed moment: I don’t want to alarm people, but… things are changing. The ratio of workers to pensioners is decreasing. In 15 years’ time there will be two workers for every 60+ person. Whether we like it or not, how we do social policy also has to change.”