Healthy Ageing and Mediated Health Expertise

The argument often deployed in scientific and public debate to underline the necessity of activity in old age is the health argument. Paul Higgs et al. (2009) denote health as one of the most dominant discourses in late life and as an absolute driving force in the construction of what is known as the third age’s lifestyle and forms of identity: ‘“The will to be healthy” reflects the fact that health has become a required objective for individual behaviour and synonymous with health in itself’ (2009: 687). It might also be said that health has become synonymous with the actual willingness and the desire to work on becoming healthy, rather than health being an expression of an end status individuals can find themselves in of being healthy. In other words, health requires reflection on how you can and should actively relate to your own health.

The interviews in this study showed that the elderly all agree that ageing and health belong together; that health involves a conscious effort to become healthy and improves your chances of a good old age. For example, a 79 years old woman, Grethe, on health: ‘Yes, it is, of course, about living an active life and eating more or less sensibly’, and Svend (76) says: ‘It has to do with lifestyle, and lifestyle covers a lot of things, doesn’t it – the way you eat and so on – how you put together your meals and how many of them you eat.’

Diet and exercise play an important role in all of the informants’ thinking on health. Thus, when they talk about health, it is only something relevant in a ‘close’ and personal health perspective. The informants also more or less agree on their expectations of growing old. It is almost a moral obligation that despite advancing years you ought to remain committed to your own life, you ought to still be active and maintain yourself and your body. ‘Health for me – it’s activity; it’s keeping active, going to things and keeping an eye on your diet’, says Sonia (74).

The elderly thus indicate a ‘willingness to be healthy’ in their demand to retain their bodies and their self-respect. They assure the interviewer repeatedly that it is a big challenge but also important for them to master life again – i.e. in a new situation, in retirement, and for some of them alone after the loss of a lifelong partner or close friends. They also want to deal with their own general expectations – and those of other people and society – that life should continue to be meaningful and worth living. In the interviews, this is mainly expressed in their active attitude to life. The older do not think that age in itself should be a barrier to ‘growing’, ‘keeping themselves going’ and living life to the full. This expectation of old age is consistent with the understanding they have of themselves as people who lead a healthy life. As a result, they have a considered approach to ideas about active and healthy ageing. However, as we will see, both health and ageing give rise to various types of practice and reflection – not least under the influence of mediated health, to which they have to relate on a day-to-day basis.

As the informants of the study were between 65 and 86 years old, there were different ways of considering and practising health among them. In this context I will, however, focus on two, partly different, health strategies present in the material. These strategies are not representative of all informants; nonetheless they point at particularly important perceptions of health and ageing among those interviewed. The two health strategies identified also reflect different attitudes to mediated health.

One group wants to and endeavours to maintain a certain level of activity from their earlier adult life into late life, not taking into account that they have grown older. The main purpose of their activity is to ward off signs of ageing. This group are keen users of the media’s frequently changing health messages. The other group thinks that in retirement they – so to speak – have to re-invent themselves again as active older individuals, not to, necessarily, ward off signs of ageing or extend middle life, but to verify the expectations of the world around them (and themselves) that they ought to be active in old age. At the same time, they reconcile themselves with their advancing years and, by necessity, with a certain degree of decline. This group has a more sceptical attitude toward mediated health than the first one.

These two strategies for ageing (Maintaining activity into late life and Re-inventing yourself as an active older individual) can be related to the distinction Higgs et al. (2009) make between the idea of normal ageing and natural ageing. Normal ageing is associated with wanting to preserve some specific norms for how to maintain your body and mind at any given point in time, in order to defer or deny decline, which looms on the horizon. By contrast, the natural ageing process is connected with a higher degree of acceptance of growing older and ageing, and thus with a certain acceptance of physical decline.

One example of the first strategy, according to which levels of activity are not affected by age, is Karen (69), who goes to the gym 2–3 times a week, plays golf, skis and goes for walks. She stresses several times how important her planned activities are to her and how much control she would like to have over her body. She underlines that it is important to her to maintain a high level of activity and expresses great awareness of her diet:

I live very healthily, i.e. [laughs] I start my day on a smoothie made of beetroot, pineapple and almond milk, or some such, berries or spinach omelette, and in the evening it’s always the same, lots of vegetables, maybe with grated beetroot and some meat. Yes. In other words, I think about my diet all the time: What is it that I’m stuffing into myself? I don’t eat any gluten or lactose, for example. My stomach’s a little bit delicate, and I found out that I feel much better when I don’t eat that kind of stuff. So I bake my own gluten-free bread, for example. I do.

Karen is highly aware of her dietary habits, which are carefully planned and have the appearance of a programme to which she has to adhere. The sense of duty is underlined by the fact that she and her husband once in a while agree to ‘take a break’ from the programme: ‘Well, when we’re at a party, we’re at a party, you know. The next day, we start again, you know.’

Another woman, Kirsten (66) stresses that she almost has a need for many activities. She goes to gymnastics twice a week, plays badminton and golf once a week, and goes to the gym, because, as she puts it: ‘You have to do something.’ Asked about her motivation for this high level of activity, Kirsten replied: ‘I go to gymnastics on a Tuesday because I know I don’t have many years left, so keeping my body going seems like a good idea.’ Karen also spoke about what motivates her fitness ‘programme’:

Karen:

Well, it’s something to do with really wanting to keep myself healthy (…) I’m very much into putting the right things into my body. I am.

For Karen, the duties inherent in an active lifestyle belong to everyday life as part of a project that she has to work on all of the time and under controlled conditions. As she puts it: ‘I really want to stay healthy’, which underlines the seriousness of her daily project to maintain herself in the condition she is in now, expressed in terms of ‘keeping myself healthy’. Both women are conscious of risk and view their chosen lifestyle as a form of investment, the return on which they hope will be in the form of a longer life. Several times, Karen gives expression to the uncertainty associated with growing old: ‘Yeah well, okay, you should be happy that you’re able to live a healthy life and exercise. But you don’t know for how long. You just don’t. Not at all, at all.’ Even though Karen means that she ought to be happy that she ‘can live a healthy life and exercise’, it is very much a joyless affirmation. Rather she gives the impression that she sees her life as a brief respite, and the uncertainty about what the future may bring casts shadows over the present. You get the sense that instead of enjoying the ‘freedom’ that comes with old age, she is afraid of ending her days as a fragile, old woman with no control over her own body.

Uncertainty as a motivation to fight back against progressive decline was also evident in Jette (70), who also expressed concern about the uncertainty that the future holds and cited life expectancy statistics as an argument in favour of living more healthily:

When I turned 60, I started to think more about the idea that if I was to last as long as the statistics say, I would have to get a grip. I don’t want to, and I mean it sincerely, I really don’t want to be just another couch potato, getting fatter and fatter and lazier and lazier and just saying: ‘it hurts here, and here and there’, and that sort of thing.

Jette knows rationally that she ‘ought to get a grip’ if she wants to live as long as the statistics for life expectancy suggest she should. Even though she talks of living very healthily, she also says that when she feels bad or sad she eats far too much and all of the wrong things – something that feels like a bit of a failure in terms of ‘getting a grip’. ‘I think that your emotions dictate your eating a bit’, she says, but has sufficient self-insight and awareness to realise that there is ‘no comfort in cookies’. She is caught in a dilemma between norms, statistics, morals and expectations on the one hand, and emotions and physically uncontrollable needs on the other.

The three women quoted above are examples of ageing strategies in which the abstract desire for a ‘longer life’ represents a norm and a logic that makes the women personally responsible and, in Jette’s case, morally responsible for minimising as many as possible of the risks that might lead to physical decline and death. Their daily striving to extend time (before death) becomes an attempt to stop time and perpetuate the condition they are in here and now. It might be said that their efforts reflect the paradox that Alftberg & Lundin highlight in their study of older people’s experience of ageing, namely that ‘people want a long life, but do not want to be old, or rather: they want to be old in a very particular way’ (2012: 493) – a way that Alftberg and Lundin describe as ‘successful ageing’.

Similarly, the women quoted above may well want to live for a long time but they refuse to allow the ageing process to take a hold of their bodies. When asked, however, they express no desire to look young or youthful. Nevertheless, they see ageing as a dilemma, and are frustrated by the transition to being physically old and their inability to stop the process. When Karen is asked if she feels younger than she actually is, she replies in the affirmative: ‘Of course, I know that I look old in the mirror, but I do feel much younger. That’s why it annoys me that I’m seen as old because I feel younger, you know. Yes, that is annoying!’ She may well recognise the signs of ageing on her body, but on the other hand she is unable to reconcile herself with the thought of actually looking older. She craves acknowledgement for her ‘inner’ youthfulness, and not to be judged on her actual age, as revealed by her body.

It might be said that she and the other two women (as well as several others who took part in the study) are exponents of the idea of ‘normal ageing’ (cf. Higgs et al. 2009). In their efforts to live a healthy life they mobilise persistently – but with differing results – their bodies as the resource which shows that – despite their age – they can still cope with a high level of activity that they hope will stave off physical decline. Their strategies for ageing centre around activities designed to minimise the risk of lifestyle-related diseases and death, rather than to make them happy about their bodies as they are or about life in general. In that sense, it might be claimed that these women over-compensate when it comes to complying with prevailing norms for how a health practice should manifest itself in the form of active and successful ageing.

What is interesting is that the same women (and several others in the study) unequivocally identify the media as a resource that plays a crucial role in the maintenance of their healthy lifestyle. Karen says, for example:

I read – I swallow any useful tips I can pick up. I read anything I can get my hands on. I mean I don’t buy your actual women’s magazines – but if I do read them, those are the pages [about health and diet] I look up right away, you know. I get Health, so I read it as well, you know. Yes, I’m really into only putting the right things into my body. I am.

Karen reflects almost a greed for media content that will instruct her in the ways of a healthy lifestyle. She trusts the media, saying that they point her in the direction of ‘putting the right things’ into her body, and she energetically seeks out media content with which to experiment. When asked about the media narrative on health and their influence in general, she replies that she has a positive view of the media because they ‘reach out to ordinary people who aren’t experts’. She is not at all tired of the media preoccupation with health, on the contrary she says: ‘I just can’t get enough of it. No, no, no.’ Similar to several of the other informants, Karen is informed, proactive, makes choices, experiments with the help of the media, and she represents the type of reflexive consumer that Henwood et al. (2003:597) characterise as wanting ‘to take more and more responsibility for their own health and [ …] this involves active information searching, above and beyond the traditional visit to the doctor’. Though the informants have a computer/tablet, they do not mention it in this context. They are not interested in information on illness, but in health-related topics they may use to improve their own health condition.

A similar faith in mediated health expertise is expressed by Jette, an avid viewer of TV programmes about health, and, in particular, obesity, diet and exercise. She is such a big fan of two TV health ‘gurus’, Chris MacDonald and Christian Bitz, that she attends lectures they give in Copenhagen. When asked why she is interested in them, she replies: ‘Well, it’s because I like their philosophy of life, and I think it’s important to keep yourself going, you know. I think it’s important to live a healthy life.’ Jette listens to media experts’ advice and ‘philosophy’ and knows what she ought to think about health, in the same way as she measures her own life against life expectancy statistics and, therefore, has a benchmark for how long she should be able to live.

As mentioned previously, Jette (and several others in the study) have problems living up to the design for ‘normal’ or ‘successful’ ageing propagated by the media. She is not capable – unlike others such as Karen – of following the instructions the media issue for a healthy lifestyle. On the one hand, she sees them as norms that exert pressure on the life she leads, and which she therefore thinks that she should change. In other words, the media motivates her to change, to appear like a strong woman capable of looking after herself, someone for whom nobody should feel sorry. However, the level of effort that a lifestyle change requires is not something that she personally has the resources to implement, and she often finds herself frustrated by her lack of ability to do what the media experts (as she repeatedly calls them) believe is healthy for her. Nonetheless, the knowledge filtered through the media represents a form of expertise that she seeks out time and time again, has faith in and tries to live up to, not least because for her it represents a socially authoritative voice. However, this knowledge also places her in a dilemma, and she often has to succumb to the fact that her mind is often more capable of change than her will and emotions.

The three women mentioned above exemplify some recurring trends among the informants who are trying, albeit in different ways, to live up to ideas related to what we call the ‘normal’ ageing discourse, and which is based on older individuals’ attempts to delay their own physical decline by living up to mediated health expertise. Some of them manage to follow the instructions in practice. They successfully base their old age on a (healthy) strict diet and a high level of activity in the hope of a longer life. In that sense they go all in. Others, however, struggle in vain and despair at their own inability to adapt their needs to fit the media advice on healthy and active lifestyles. For them, age always feels like a process over which they are not exerting control.

Another group of elderly informants are exponents of what is, in many ways, a different lifestyle – one in which health has a different status and, importantly, the media play a different role. They are, to a greater extent, examples of older people oriented toward ‘natural ageing’ (Higgs et al. 2009). This group also links health to diet and exercise, but they do so based on a different argument than prolonging life and disciplining the body, and they have a more sceptical attitude to the health expertise propounded by the media. In this sense, they seem to represent a different strategy for ageing. They refer to health mainly as a question of not being sick, i.e. they subscribe to the idea that the concept of health must necessarily be linked to a concept of ailment. Christian (73) says, for example:

By health, I think about whether you’re well and mobile. That’s the first thing that springs to my mind when I hear the word health. Whether or not I can do the things I ought to be able to do – my age taken into account – that’s the first thing I think of. For me it’s also, of course, about being mobile, being able to look after my house and garden.

This group stresses good physical condition as an important health factor, something that gives them a feeling of satisfaction with life. Ingeborg (77) says much the same: ‘If you’re well, growing old isn’t hard, is it? (…) In fact being well is a prerequisite for growing old. That you are able to walk properly, are well and don’t suffer from ailments.’ Ingeborg does not exercise, and has a pragmatic attitude to diet: ‘If you enjoy the food you eat I think it’s okay [that you eat food you like] and you don’t get too fat’. Diet is not something that Ingeborg bothers about to any appreciable extent. However, she returns repeatedly to how enriching she finds the day-to-day social interaction with other older people in their local centre – ‘the time we spend together there is good for our health, I think’.

Several members of this group see health less as the object of a well-planned, pro-active campaign, e.g. following a carefully planned diet and exercise programme, and more a matter of not being ill. Several of them repeatedly return to the idea that social relationships with other people mean a great deal to them, and that they actively seek them out. Several of them criticised the ‘health mania’, which is what many of them call the great contemporary focus on health, because they think it is out of control and has displaced compassionate care and attention. Dagmar (81), for example, says that although health is important,

It isn’t enough to get you through life on its own. I mean, as a person, you’ll miss out on what’s important in life if you only think about health – by which I mean physical health – because I think relationships, human relations, are immensely important – things like giving and receiving care.

The worship of the physical body Dagmar refers to is not, in her opinion, enough on its own as an expression of what health is. She sees reciprocal care and social relationships as the important things in life. Several other informants focused on health as an expression of the general quality of life. Quality of life refers, among other things, to satisfaction with life and self-confidence. Britta (74) says, for example:

When I think about health I think about what makes up our quality of life. That’s what I associate health with. That you feel well, are mobile and not sick, you know. (…) I don’t go pestering the doctor every other day to have my cholesterol and blood pressure taken and so on, because your body tells you when something’s wrong, doesn’t it?

Britta also sees health as being synonymous with mobility and feeling well. She keeps herself going physically by taking the stairs and cycling every so often, but does not seem nervous at the thought of being in the process of growing old. She tries to come to terms with her age by accepting that ‘at some point I’ll have to maybe stop cycling and perhaps just make do with taking the stairs, and the likes’. In a similar manner, Christian expresses a certain degree of acceptance of his own physical shortcomings: ‘I can’t run any more. It hurts my back, so I’ve had to stop. But I swim every morning, which is just as good. And it’s very social as well, so that’s all right, isn’t it?’

Compared to the first groupof informants described above and their faith in mediated health expertise, a pronounced scepticism about the media is the order of the day in the second group. Britta, who was just quoted, for example, thinks that the media exacerbate or even create health problems. She says: ‘Nor am I the type who’ll rush off to look things up online if I spot symptoms. Because if you do that you will have whatever it is! [laughs]. I’m more into just feeling and being well and mobile. That’s what I associate with health.’ Other informants also critiqued the way that the media handle health issues and think they have a negative effect on people. For example, Svend (76) was very angry and outraged about TV programmes about cooking because, in his opinion, they transmit conflicting information to the viewers, who will, therefore, be influenced in the wrong way. Of a very popular TV prime time cooking programme, he says:

It’s filthy the way they juggle the different types of food – bacteria and the likes – you should be properly hygienic if you’re on the telly, and they just aren’t, so I can’t be bothered watching it anymore. And then the food isn’t always healthy either. The chances are that it is unhealthy. And if you happen to be in any doubt, just look at the presenters.

Like Svend, several of the informants point out that the media have a major responsibility for conveying information about health in a manner that is not misleading or directly contrary to general recommendations issued by the health authorities. Their mistrust of the media arises from a lack of transparency, which makes them doubt the credibility of the mediated expertise. Dagmar puts her confusion into words:

For many years, I bought the women’s magazine, Søndag, and they have a whole section in the middle of every edition all about health. Part of me thinks that’s fine, and they do try to be serious – it’s proper information, written by doctors and the like. But it’s still confusing because the messages change. Take diet for example. Do this. Don’t do that. Okay, now you can do it again. No, you really don’t know whether you’re coming or going. I find it interesting but it’s too much.

Britta expresses a similar scepticism and ambivalence and points out the frustration to which the media give rise because, as she sees them, they are the reason she finds it difficult to make an informed choice:

One day this is healthy, the next day that. And then it all changes, and so on, and so on (…) if you take it all seriously. Me, I’m just thinking – well if you don’t die of it, you’ll die of something else, won’t you? So I have a bit of a relaxed attitude to the stuff the media puts out.

With the statement ‘if you don’t die of it, you’ll die of something else’ Britta gives vent to both irony and powerlessness. She exemplifies a dilemma expressed by several of the informants. On the one hand, they yearn for knowledge and would like to follow the experts’ recommendations, but on the other hand, they do not feel that they can make informed choices, since the knowledge available to them in the media is imprecise and lacks credibility. However, the fatalistic attitude several of them express should not be mistaken for indifference. Rather, it is an expression of the powerlessness that they feel about being made personally responsible for their own health (see also Lupton 2012: 103). On the one hand, they feel left in the lurch by the many contradictory messages in the media but, on the other hand, their critique in itself bears witness to their attempts, albeit in vain, to understand the health advice proffered by the media.

Unlike some of the other informants who, as mentioned earlier, have faith in the media and throw themselves into new experiments with both diet and exercise, this group’s attitude to the media is highly sceptical but also characterised by a more traditional recipient awareness, by virtue of which they expect to receive clear and reliable answers they can use to inform themselves and their own decisions. They expect the media to cite authoritative sources, which in their eyes means in particular doctors of various types, and they expect that the media will actually be able to vouch for their health recommendations and not change their mind from one day to the next.

They cannot be bought off with any health story in the media or, as Britta puts it: ‘They shouldn’t just try to fob me off with any old stuff. I want to decide for myself what I consume and what I don’t want to consume’, which testifies to both scepticism about the general health mania she thinks characterises the media, and to an attempt to carve out a certain degree of autonomy. She does not feel associated with the consensus about health as if it is just a matter of wanting to experiment with your lifestyle. Britta points out that: ‘It’s a matter of feeling good about yourself and not going about thinking about what you should do in case of this, that and the other, you know? Because that can be stressful.’ Britta and several other informants adhere to the idea that it is the voice of more traditional, science-based expertise that should be the recurring one in the media when it comes to health recommendations, and not what ordinary people agree from time to time constitutes a healthy lifestyle.

Despite the criticism of the media’s changing health recommendations, this group’s views nevertheless show that the media’s ‘health fad’, as one of them calls it, does in fact play a role for them as something they have to relate to all the time but also something they feel ‘left behind’ by. Even though they share concerns about the fluctuating nature of health recommendations in the media, they have, conversely, a great deal of confidence in their own ability to find the ‘solution’ that is best for them based on what several of them call ‘common sense’ – ‘I’ll do what I’ve always done and it’ll be fine’. In this situation, their lifelong experience helps them when they decide to be pragmatic about how much influence they want to allow the media to exert on their lives; but they also stress that it annoys them that the world around them – in this case the media – expects them to make judgements and be constantly ready to revise what they think is best and the right thing to do in terms of health.