Unequal Until the End

For the affluent, old age has its challenges. For the impoverished, it's only harder.

Mike Blake/Reuters

“No one understands old but old people.”

James made this proclamation over an ancient pool table in an impoverished neighborhood of the greater San Francisco Bay. The other men gathered at the senior center nodded in agreement. A slender African American man who grew up in segregated Georgia during the Great Depression, he elaborated for the benefit of the Gen-X sociologist by his side. As James deliberately lined up his next shot he explained: “Everything changes. Old is a different animal all together. And the only way you can understand it is you have to get there.”

I met James while researching how inequalitiesbased on race, socioeconomic status, and genderthat structure an American’s working years, also shape later life. (James is not his real name, in accordance with institutional review board requirements all the names in this article are pseudonyms.) I began this project because I was interested in what the lives of aging Americans could tell us about growing inequalities, and how these inequalities affect the graying U.S. population. The larger six-year project included several years of listening to, watching, and accompanying a racially diverse group of over a hundred seniors from both rich and poor neighborhoods as they went about their everyday lives. These seniors shared the unique physical, social, and psychological challenges of growing older in America's youth-focused society. Just a few weeks before James explained the experiences of growing old, I observed Lila, a white woman around the same age as James, make a similar comment to a friend over lunch in their upscale, tree-lined, and predominantly white neighborhood. She said, “When you get old things change. How you think and feel.”

Though they lived but a short car ride apart, James and Lila were separated by an immense social chasm created by the socioeconomic, racial, and gender inequalities that structured their opportunities from birth. Yet, in their later years, both faced many similar challenges such as declining physical mobility, watching friends and loved ones perish, and even being treated differently by clerks at the supermarket. One of Lila’s friends poignantly expressed a common frustration, when she quipped “All they [younger people] see is wrinkles.”

Perhaps the presence of shared challenges in later life explains why we’ve glossed over inequality’s effects among the elderly, despite paying so much recent attention to the growing consequences of inequality among those currently in the workforce. But the questions lingers: Does inequality dissipate in old age?

Some assert that inequality is less of an issue in later life. The argument goes like this: While inequalities shape much of our lives—including where we are born, the schools we go to, and the jobs we get—the physical challenges of aging and the effects of programs such as Social Security and Medicare mean we play life’s end game on a relatively level playing field. Panglossian optimists take this a step further by arguing that we all have at least a nominal chance to “age successfully” if we simply adopt a positive mindset and make good choices.

The problem with this common portrayal is, it obscures more than it reveals.

First, consider the sobering fact that many of the most disadvantaged simply die before they are eligible for their first Social Security check—a process demographers euphemistically call “selective mortality.” A recent review by public health experts puts this in perspective: "In 2008 white U.S. men and women with 16 years or more of schooling had life expectancies far greater than black Americans with fewer than 12 years of education14.2 years more for white men than black men, and 10.3 years more for white women than black women. These gaps have widened over time."

Life Expectancy at Birth, by Years of Education at Age 25 (2008)
Courtesy Health Affairs

Social circumstances affect not only how long we live, but how healthy we are when we become seniors. An overwhelming body of evidence suggests that differential exposure to toxic environments, the stresses of poverty and discrimination, and unequal access to medical institutions are contributing factors to the gap between rich and poor elders. New research suggests that the influence of social factors can even be seen on the genetic level. Jeremy Freese and Karen Lutfey, sociologists at Northwestern University and University of Colorado, summarize the empirical relationship between inequality, health, and aging in unambiguous terms when they note, “The lower status people are, the sooner they die, and the worse health they have while alive.”

The simple, but profound, point is social inequalities largely determine who lives to grow old and who dies before having the chance.

But what about the robust survivors who manage to make it to their “golden years?” Do basic entitlements even things out for them? While Social Security and Medicare help, they don’t level the playing field. Disparate resources—monetary, social, and spatial—continue to shape the lives of elders. Some of the elderly I encountered in my study aged with immense wealth, social support, and education. Others did so in poverty and isolation. The wealthiest people in my study had aged in or retired to communities with voluminous senior programs, while many of the poor became increasingly isolated as they struggled with piecemeal social services.

Consider the experiences of Bernard and Jessica. I met Bernard in 2010 in a senior center in a poor, impoverished, and multi-ethnic neighborhood with disproportionately high rates of crime and unemployment. He was a large, jovial, African American man who always wore a leather jacket regardless of the weather. Big B (as his friends called him) explained that he had prided himself on his physical and mental capacities earlier in life—both earning a living through manual labor and competing in sports (he remained a huge baseball fan), and hustling in pool. Although he was only in his early sixties when we met, his body had already broken down. In fact, unlike James across town, Big B could no longer stand up long enough to play a game of pool. He had severe arthritis as well as heart problems, and the doctors considered him obese. Bernard was on lots of meds and complained that being “fuzzy headed” prevented him from competing with the younger men in chess. He explained that although he was a “former hustler,” he was all “hustled out.”

Despite being popular with the other seniors in the center near his home, Big B had few close ties. He was never married and had no children. He lived with his mother, who was in her 90s and had been homebound for years. He took care of errands for her, and she fed him leftovers from her Meals on Wheels deliveries. Sometimes, she gave him some of her Social Security money. When she died, Bernard was left not just sad and alone, but also without her resources. He was barely getting by on his disability check with her help. When she passed away, Big B lost his key source of social and material support. He had no back-up, or even a back-up plan. He had no pension, was not healthy enough to work, did not own a house, and although it did have a senior center, his neighborhood offered comparatively few senior services. His own poor health worsened, and he slowly sank into the same sort of isolation chronicled by NYU sociologist Eric Klinenberg in his account of the deadly 1995 heat wave.

I first met Jessica a few months after Bernard, when I began working in a volunteer program to help seniors avoid the sort of social isolation Bernard faced in his final days. She was a spry 92-year-old white woman, with a collection of fedoras that any hipster would envy. Although Jessica was three decades Bernard’s elder, she was better off in many ways. Jessica was college educated, and she had a pension, substantial assets, and a big family that helped out. Jessica lived in desirable senior community-subsidized housing in a white middle-class neighborhood. Her location ensured access to a robust menu of services: transportation, food programs, clinics and in-home health, continuing education, and safe sidewalks. Although she and Bernard both valued their independence and said they did not need help, Jessica’s siblings, nieces, and nephews came by to help with everything from grocery shopping to doctor's appointments (often without being asked), while Bernard struggled alone. Jessica was also in excellent health for her age: She had to use a walker for longer trips, but the public spaces in her neighborhood were better maintained and easier to navigate than Bernard's.

Jessica did face many of the afflictions encountered by other seniors in less affluent neighborhoods. Health problems like her recurring digestive problems, the passing of friends and relatives, and her own steadily declining mobility were both painful and tough. As is true for many seniors, handing over her car keys was an immense blow to Jessica’s identity. Still, she managed these challenges with support from an array of private and public resources that simply did not exist for seniors like Bernard. Though growing old was hard for both of them, the disparities that shaped their life chances never disappeared: Jessica lived an active life for three decades—a whole generation—longer than Bernard.

While poverty rates among seniors stayed relatively constant throughout the Great Recession compared to other groups, wealth differences continued to matter immensely. The presence of a Social Security check did not erase a lifetime of wealth inequalities. Such checks reflect lifetime earnings that exclude the informal “off the books” labor and care-work most likely to be done by women and minorities. To paraphrase one of my many older friends, some reach their golden years without a whole lot of gold; and who has more gold is not random. Often this has a racial component, a fact highlighted in a recent Pew Research Center report that shows that by 2013 the median wealth of white households was almost thirteen times that of black households—and these gaps expanded during the Great Recession.

Growing wealth inequality, and its racial components, continue to have profound ramifications for seniors’ lives. In addition to larger Social Security checks, the affluent seniors I encountered often owned homes, received pensions, had relatives who could hire health aides, and could afford supplemental health insurance. In contrast, seniors from poor and working-class backgrounds, who were also disproportionately people of color, often had little choice but to engage with public services even when they would prefer not to. Dave, a poor senior I describe in detail in my book, hated the idea of being dependent on public resources (even Social Security, which he likened to “welfare”). However, with a broken-down body, lots of health problems, no nearby family, and few assets, he felt he had little choice if he wanted to avoid being institutionalized for self-neglect. So he felt he had to invite the social worker into his meager apartment and make a show of both his competence and need to make sure he got the basic services he used to survive.

Unfortunately, but perhaps not surprisingly, those who needed public resources the most—people like Dave and Bernard—lived in neighborhoods that provided fewer services. Social scientists like myself might refer to this as the “unequal spatial distribution of resources for health and well-being.” Dave explained it more succinctly when he told me: “the safety net is thin” in poor neighborhoods like his. In contrast, seniors like Jessica who lived in more affluent neighborhoods had better access to all manner of senior services—food, housing, healthcare, and transportation. These neighborhoods also better weathered the devastating austerity measures that followed the Great Recession as their organizations were able to locate both public funds (categorical and block grants) and private donations to keep services running.

Yet, despite the evidence—and the experiences of people like Bernard, Jessica, and Dave—some pundits continue to view aging through rose-colored glasses by promoting an unflappable belief that age is the ultimate leveler and that we all have the chance to age well if we adopt a positive attitude. Of course, all else being equal, having a positive attitude may matter as data from the Harvard Study for Adult Development show.

The problem, however, is that all else is never equal. Starkly disparate individual and neighborhood resources shape our options in later life just as they do in youth. Who we know, their resources, as well as our individual differences in cultivated skills (often related to education) reflect lifetimes of unequal circumstances that shape our experiences and opportunities to the end. The ideal of “successful aging,” emblazoned in the collective consciousness by glossy magazine pictures of smiling senior couples watching sunsets from a beach, is more attainable for some of us than others. The reality is old age is not the end of inequality, but its end game.

So what can be done? First, it is hard to overstate how vital government services and volunteer programs are to older Americans across the social spectrum. Issues that may seem minor to those in the Capitol, such as the disruptions to Meals on Wheels services during budget freezes, have a profound impact on the lives of seniors. Cutting the already thin safety net, which is anchored by Social Security and Medicare, would be catastrophic. Second, it is important to examine how political and economic structures funnel resources into some neighborhoods and starve others. Seniors in impoverished areas would also benefit immensely from the services that eased Jessica’s trials in later life.

Finally, we must acknowledge the uncomfortable reality that decades of unequal circumstances are etched in our bodies and cannot be easily wiped away at the end of life. Long-term solutions require a deeper dialogue about what we are willing to do about inequality at all life stages. From my years of studying seniors in our country, one thing is painfully obvious: Until we address the unequal circumstances Americans face over the course of their lives, the specter of inequality will continue to haunt our final years.