Pervasive and deeply rooted inequalities in the United States underscore the economic and health crises of COVID-19. A political economy perspective sheds needed light on the many levels of individual and social experiences of precarity in the United States.
Precarity is a “politically induced condition in which certain populations suffer from failing social and economic networks of support and become differentially exposed to injury, violence, and death … heightened risk of disease, poverty, starvation, displacement … without protection.”
Disproportionate suffering and sacrifice reflect vast wealth and income gaps, as well as the erosion of welfare state supports to protect the dignity and rights of U.S. peoples, particularly historically disadvantaged individuals, families, communities and neighborhoods, which affects multiple generations. Simultaneously, Wall Street and billionaire income and wealth skyrockets.
The State’s Role in Precarity
The state, power and ideology are force fields meting out distributional fairness and unfairness. These statements are not abstractions. Webs of state and non-state power and economic networks are shored up by mantras, belief systems and think tanks that open and close pathways, compromising opportunities and sharpening chasms between the haves, have nots and have mores.
The role of the state is torn between democracy and capitalism, which some have called an “impossible partnership.” Democracy is predicated on the principle that every individual and every vote counts. In contrast, capitalism accords legitimacy to private property and vastly disparate wealth creation.
Markets thrive on creating surplus populations, which are desperate and willing to work in low-wage, suppressed, even exploited jobs. Globalization incentivizes outsourcing for cheaper labor, displacing local workers and increasing precarity. The most marginalized may be seen as “perfect” workers—people who are used the most and cost the least.
Contingent workers generally do not qualify for benefits or sustained investment beyond their immediate use-value. Hence, they are discarded and dispatched through normalized health and education disadvantages and impoverishment. Perhaps the most quickly discarded are workers ages 60 and older, and increasingly workers ages 50 and older, who have experienced discrimination and multiple jeopardies accumulated over a lifetime.
COVID-19 spotlights the historic devaluation of older and vulnerable peoples, revealing how precarity across the life course and in old age resides within societal institutions of colonialism, white supremacy, patriarchy and capitalism. Older adults, stranded without resources, acquiesce to devaluation, as happens with mass exploitation of any workers.
Aging policy and practice perpetuate deepening inequalities in old-age income distribution. Decades of austerity policies have produced a mélange of confusing, mercurial, underfunded policies and bedeviling administrative controls that vary across the globe. Social Security and Medicare are contingent on age, work history, citizenship, marital status and health-disability status. Means-tested safety net programs address pockets of marginalized people, and are highly variable by place. Coverage is unequal, sketchy and time-limited. The administrative burden is high, cruel, stigmatizing and fraught with potentially criminalizing traps. Essentially it is designed to discourage or deny benefits to those who are eligible.
People ages 65 and older, the group often seen as most advantaged by Medicare, have been severely affected by the costs and coverage penalties in Medicare privatization, rising out-of-pocket costs, prohibition of drug price negotiation and non-existent long term services and supports.
COVID-19 is the mirror, reflecting structural inequities and injustices that have pervaded our society for centuries.
Similarly, although long-term care is highly dependent on Medicaid for older adults and people living with disabilities, the shocking preponderance of COVID-19 case and death rates among long-term care residents and staff illuminates Medicaid’s “failure to meet even ludicrously minimal staffing standards,” and cuts in home- and community-based services and managed care.
Governmental and public responses to COVID-19 demonstrate pervasive ageism and discrimination. Repeated and failed policy efforts to legislate universal public access to long-term care and social infrastructure have underwritten the private sector, which is increasingly dominated by for-profit conglomerates and is a dumping ground for the discarded (and low-paid caregivers who tend to them), who are often women and men of color.
How Do We Compare, Globally?
The U.K. and United States face similar problems, with decades of austerity and the poorest bearing the cuts. Local authorities received a 49 percent reduction in central government funding in the last decade, impacting public services. COVID-19 has further stifled charities and the voluntary sector from fundraising activities and income to assist deprived neighborhoods. The U.K. government’s failure to provide aid to its poorest communities underlines the degree to which social processes relating to inequality, discrimination and racism have contributed to the distribution of illness and deaths caused by COVID-19.
India, the world’s second most populous country, also faces significant socioeconomic inequality with an aging population. Indian democracy gives little weight to the needs of disadvantaged groups, and its deep-rooted caste hierarchy often reinforces the social distance between privileged groups and the rest. Only in recent decades has India moved toward central government–sponsored programs resembling a social security system, rather than individual states implementing their own schemes.
Unlike in the United States, where moving older adults into care facilities is more commonly practiced (and where COVID-19 cases have raged), in India, more than 99 percent of older adults either live alone or with their children. However, like in this country, older adults and the poor bear a higher burden of disease and ill health. The vulnerability of India’s older adults to COVID-19 depends upon dimensions such as place of residence, gender, caste, marital status, living arrangements, surviving children and economic dependence.
Can We Turn It Around?
The pandemic has accelerated rising poverty, food lines, child hunger and the danger to and hardships of essential workers, women, older adults and caregivers. COVID-19 is the mirror, reflecting structural inequities and injustices that have pervaded our society for centuries.
COVID-19 forces us to reimagine what kind of society we want to build. The isolating shutdowns have provided time and opportunity to experience formative consciousness-raising, abetted by continuous immersion in news and social media streaming. Anxieties incubate as older adults; Black Americans, indigenous peoples, people of color and intergenerational families witness daily traumas on devices and screens.
Visual and virtual realities transition into a shared copresence, perhaps of fear, disbelief or outrage. Social movements may grow from the embodied emotions that are nurtured as we turn our attention to the collective.
As two economists from UC Berkeley said recently in the New York Times, “[T]these are not normal times. The big battles—be they wars or pandemics—are fought and won collectively. In this period of national crisis, hatred of the government is the surest path to self destruction.” An effective response to COVID-19 demands solidarity and personal and social responsibility in public health by all levels of government and of each of us regardless of age, class, genders, color, indigeneity or health condition.
All people across the life course and globe have a vested stake in aging policy, as we are all aging. We are inextricably linked to others who will enter or have entered old age. Our rights must not be sacrificed. For older adults, there is little hope that their scarcity and dearth of security is a necessary sacrifice, but this is the delusion of survival for generations who avoid their developing experience of precarity.
Gray Panthers co-founder and visionary activist, Maggie Kuhn, recognized the inextricable intergenerational stakes in humanity, peace and collective social justice in nations and around the globe. The security of the young and old are interdependent. She taught us that elders carry the memories of loss and survival. Without these stories, identity is severed and knowing is lost for present and future generational consciousness. Collective interdependence resists neoliberal agendas of globalization and privatization, and discourses that celebrate blaming individuals.
Carroll L. Estes, PhD, is professor emerita of Sociology at the University of California at San Francisco (UCSF), co-founder of its Institute for Health & Aging and past president of ASA, the Gerontological Society of America and the Association for Gerontology in Higher Education. Jarmin Yeh, PhD, MPH, MSSW is an assistant professor at the Institute and Department of Social and Behavioral Sciences. Nicholas B. DiCarlo, LCSW, is a psychotherapist and research analyst with the Institute.