By Ellie Parravani, Campaigns Coordinator, HelpAge International
The COVID-19 pandemic is putting ageism well and truly in the spotlight. We have heard of many instances where governments are putting in place age-based policies that could discriminate against older people on the basis of their age. But civil society is fighting back.
I spoke with Prof. Issi (Israel) Doron, who is the head of the Center for Research and Study of Aging at the University of Haifa, and one of the founders of Law in the Services of the Elderly in Israel.
We talked about how ageism manifested itself in Israel during the COVID-19 response, and how civil society has joined forces to counteract it one step at a time. Issi shares his advice for HelpAge’s network members and Age Demands Action activists, who want to challenge ageism.
Prof. Issi Doron
Tell me about the current situation in Israel
Israel reacted quickly to the COVID-19 crisis. We shut down our airports and had significant isolation policies. So overall the death rate from COVID-19 remained relatively low. However, we paid a huge cost and many people lost their jobs and are now unemployed.
When did ageism start to become an issue during the response?
Early on, there was a huge debate about whether older people should be connected to ventilators in case there was a shortage. There were some strong voices saying older people should not be connected and that they should be given a lower priority. This triggered a strong response from civil society, from both older persons’ rights and human rights organisations. The Ministry of Health then made a clear statement that chronological age would not be a criteria to assess whether or not to connect someone to a ventilator.
So our first struggle was to make sure age and chronological age were not used as formal criteria in the allocation of medical resources and the decision-making processes.
In what ways did civil society speak out about this?
For the first time, we successfully created a coalition of NGOs (non-governmental organisations) who work in the field of ageing and represent the rights and interests of older persons. This was one of the nice things that happened during the COVID-19 response!
This included several NGOs which focus on human rights, advocacy and social change, as well as two legal clinics in law schools (at Tel-Aviv and Bar-Ilan Universities). The coalition was effective because each organisation had its own strengths and weaknesses, meaning we worked well together and in a coordinated way.
There were so many issues and lots of manifestations of ageism were identified. So, the coalition focused its collective force on one issue at a time. If we took on many different topics at once, we would lose our power to speak up with a single and loud voice.
Firstly, we spoke out through social and digital media (e.g. Facebook, LinkedIn, web-sites, blogs, etc.). Secondly, we used the public media, especially daily newspapers, either through opinion letters or Op-Eds. Thirdly, we lobbied parliament members, where we have some contacts. Finally, we also directly approached key policy makers that were nominated to have COVID-19 responsibilities.
How did older people respond to the various regulations that were put in place during the COVID-19 response?
There were two different responses from older people. I was surprised to see many signs of ‘ageivism’. This is the ideology of activism in older age which I try to promote! Older people themselves were raising their voices, making themselves heard, and voicing a disability-movement kind of activism of ‘nothing about us without us’. People wrote letters to editors and even went out onto the streets calling for respect of human rights and freedoms!
But then there were voices which I term as ‘self-ageism’. There were many visible older voices saying they felt it was appropriate not to be given a ventilator, agreeing that younger people should be given preference. It felt like these voices had internalised the social expectations of being less worthy in old age. It was fascinating to see two such opposite reactions to the COVID-19 response.
What happened next?
The second hurdle that arose was around the prioritisation of care homes and assisted living facilities.
For the first few weeks, there was little awareness of the risk to people living in care homes. In reality however, once you have even just one person with COVID-19, the combination of frailty, the physical setting, and the higher risk to that population group, care homes become high risk centres for complications and even death.
At the beginning, that lack of awareness meant that not enough resources for testing and protection were supplied to care homes. We needed to get the government to focus on these settings and provide adequate resources and coordinated care. It took time until the government woke up to this. Even though we had a low rate of death overall, around a third were actually residents living in care homes. This might have been prevented if more emphasis had been given to care homes in early stages.
Why did government take a long time to respond to the situation of people in care homes?
I would argue because of ageism, meaning yet another example of negative attitudes towards old age. In practice this means that generally, resources allocated to care homes are relatively low, and that within the public policy priorities, this sector is not viewed as important or worthy for public investment. Moreover, it is also an industry characterised by a low-paid workforce and low prestige.
In Israel, less than 3% of older people live in care homes, so it is like they are forgotten…. Excluded…. Nobody really listens or hears about people living in care homes except in cases of abuse which pop up every few years. The lack of focus on care homes at the beginning of the COVID-19 response was simply an extension to the low priority given to care homes anyway – which turned out to be catastrophic.
What happened once Israel hit the peak and began its exit strategy?
So, the third issue we responded to was the exit strategy. The exit strategy allowed people to return to work, to go out of their homes and to start to meet up with each other. Restaurants are still closed, and public gatherings are not allowed. But we recently opened the beaches. For Israelis, that symbolised the end of the crisis!
However, one of the restrictions that was part of the exit strategy was that workers above the age of 67 were not allowed to go back to the workplace. Automatically, this raised big opposition and uproar from various groups, including our coalition.
This time, we decided that if we were not successful in challenging this policy through lobbying, advocacy and the media, we would challenge it in courts. We hoped this would set some kind of a legal and public precedent, or would establish a strategic litigation in the field of age discrimination (this is where a case is brought to court with the aim of creating a binding legal precedent bringing broader social change).
And by the way, Israel is an interesting case because, on one hand, we have a law to ensure equal opportunities in employment, which makes age discrimination in the labour force illegal – but on the other we still have a mandatory retirement age which allows employers to retire people at the age of 67.
So, we wrote a formal letter to the prime minister, minister of health and minister of labour, demanding they amend the regulation and allow workers over the age of 67 to return to work. But they did not respond, so we filed a petition to the Israeli Supreme Court challenging the legality of the above policy.
What were your main arguments to challenge this regulation that over 67s could not return to work?
In the petition, our main arguments were that chronological age as the sole criteria was not rational or relevant, because comorbidities and other illnesses are much more important in the context of COVID-19. For instance, you can be 85 with no medical conditions, and you can be a 56-year old with diabetes or high blood pressure. The 56-year-old would be at much higher risk of death from COVID-19. We tried to provide empirical data to support this. Secondly, we argued that being ‘old’ is a social construct. Biologically no body is ever old, unlike ageing which is a natural process which everyone goes through. The starting point of being considered ‘old’ is totally a cultural construct, which differs between different countries, different cultures and throughout history. So, legally using an artificial number as a benchmark to differentiate between different groups of people is inappropriate in the same way as using gender, race, or religion.
Finally, we used the legal argument of age discrimination, and the lack of proportionality in the sense that the same outcome of protecting people at risk could be achieved by using alternative measures like wearing a mask, physical distancing and differentiating between kinds of workplaces.
What was the reaction to your petition to the supreme court?
During the time it took for the state to respond to our petition, the government continued to hold meetings every week. So, before the case actually reached the court itself, the government changed the policy and abolished the specific regulation on older 67s being prevented from returning to work!
It was a bittersweet success. The petition itself placed pressure on decisionmakers, as our legal petition received coverage in the media. People knew there was something before the supreme court and a public debate started to evolve around it. Decisionmakers would have had to come to the supreme court and defend the regulation.
Of course, I cannot predict what could have happened, but from our perspective it was still a big success that we went in with attack and challenged the regulation before the highest legal tribunal in Israel. It was symbolically important to show that the Elders’ Rights movement is alive and kicking, and we proved we can take things to the supreme court if we want to. It gave us a lot of motivation as well as significant public exposure and support.
What’s your advice to HelpAge’s network members and Age Demands Action campaigners who want to challenge ageism during COVID-19?
Try to gather forces and work together to collaborate and coordinate. It is much more effective and powerful than each NGO working on its own, trying to make its own struggle while others are doing different things.
Use digital technology – especially during this COVID-19 period. All these social media platforms, especially during times of people being locked down in their homes, have become a key way to communicate and advance a social movement. So, a lot of older people who didn’t use technology or used it very little, started to become familiar with it to stay in touch with family. At least, in Israel there was a significant rise in internet usage and digital media by older people themselves.
The law is a powerful tool for social change – and we need to use it to protect and promote the human rights of older persons. In many countries, you have anti-age discrimination legislation either specifically in the context of labour law, but also broader human rights legislation which prohibits any discrimination. Many constitutions have within them articles that prohibit discrimination. Of course, you need expertise to use the law effectively. In Israel, there are some legal clinics in the faculties of law which provide pro bono advice and legal representations.
And finally, as countries start to ‘build back better’, what needs to happen longer term to combat ageism in Israel?
Improve and empower community-based services for older people! We must enable older people with disabilities, or those in need of support, to continue to live in their own homes, in the community. This will allow them to continue to live independently without the need to move to care homes and become fully dependent. That’s one key lesson learned in this crisis.
We must also listen to older people, and provide more place and space for them within decision-making and policy-making processes. These decisions are usually decided in a top-down manner, with smart professional people sitting up their office decided what is the best thing to do to protect older people without ever listening to them.
Finally, we need to advance an ideology of ‘ageivism’! So, older people adopt what we call ‘politics of identity’, or a self-identity of being a proud older person. Not being ashamed but rather being proud of being old and wearing it out front. That message must be clear, strong and sound.