Feature Story | 4-Mar-2024

The ingredients of unequal aging: Housing, income, and health

How a lifetime of poverty and discrimination leads to unequal aging, and what will help us take care of the most vulnerable

Boston University

"More generations are alive together than ever before,” says Judith Gonyea, a Boston University School of Social Work professor of social research. This is a gift, she says, as generations can support and learn from each other. But for more people to fully experience a stable and healthy retirement, a number of societal changes need to happen.  

Gonyea studies aging inequality—the idea that not everyone has equal access to the resources needed to reach a secure, healthy old age, and that barriers disproportionately impact marginalized people. And, as the global population gets older, creating a world more supportive for all is more important than ever: by 2030, one in six people worldwide will be aged 60 years or over, and the number of people over 80 years old is expected to triple between now and 2050, according to the World Health Organization.  

Unequal aging is often reinforced, and even amplified, by how social programs and policies are structured, Gonyea says, and by embedded systemic racism, sexism, ageism, and other forms of discrimination. 

“Solving unequal aging requires directly addressing the unequal social contexts individuals experience across the life course,” she says. For most older Americans, achieving a secure old age depends on addressing three pillars: income, housing, and health. 

“They are interconnected, yet for many older Americans, much remains beyond their reach,” says Gonyea, who is also SSW’s associate dean of faculty affairs. Huge gaps in access to quality healthcare, affordable and accessible housing, and livable wages accumulate over a person’s whole life—so there’s no easy starting point. The Brink spoke with Gonyea about how addressing each of these pillars is key to helping solve unequal aging, and how she envisions a world designed for people of all ages to thrive. 

Pillar 1: Income

Research shows that it becomes more difficult for a person to escape poverty in their later years, Gonyea says, causing economic inequality among older adults to remain inescapable without outside assistance, like income from the US Social Security program.

“The importance of Social Security cannot be overstated—it provides a foundation of retirement protection for nearly all persons in the US,” she says. Without Social Security benefits, about 40 percent of people 65 years and older would have incomes below the federal poverty line, she says, as opposed to today’s 10.3 percent of older Americans officially counted as living in poverty. “However, it does not lift all older persons out of poverty, and many remain in the federal government’s category of the near poor.” 

As helpful as it is, the program doesn’t alleviate structural inequalities that put people in poverty to begin with. US government benefits are lower than those in many other developed countries, Gonyea says, and Social Security was built around the traditional nuclear family of a working husband, a stay-at-home wife, and children. Although this is not the reality for many households, Social Security has yet to evolve to better support different family structures, often penalizing women financially. 

“Women are out of the labor force on average longer than men, primarily because of caregiving responsibilities for older parents and children, and each year of unpaid labor translates to zero earnings in Social Security benefits,” Gonyea says. Women also make on average 82 cents for every dollar men earn—a gap that is even wider for women of color, and continues to widen with age. “It’s pennies of a difference by the hour, but over a lifetime, significantly impacts one’s retirement income,” she says. “We need to pay attention to how future policy changes and reforms impact different groups, since women and persons of color often have accrued fewer financial resources.”

To Gonyea, ending unequal aging and income inequality is both a race and a gender justice issue. “Historical and ongoing structural racism and sexism in the labor market have placed persons of color and women at greater risk of poverty,” she says. Over the last decade, Gonyea has worked closely with older women living in extreme poverty and experiencing homelessness. By partnering with local organizations like Boston’s Hearth Inc. and Women’s Lunch Place, she has set out to learn the needs of this population, what supports are deeply lacking, and how to improve the systems they navigate every day—from offering free access to public transportation to pet-friendly shelters.  

Pillar 2: Housing 

Poverty and homelessness are inextricably linked. The last US Census found that 19 million renter households—40 percent of all renters—are cost burdened by their housing, spending more than 30 percent of their monthly income on keeping a roof over their heads. According to the US Interagency Council on Homelessness, Black and Latinx groups are both overrepresented in poverty and in the homeless population

And as the US population ages, the homeless population is aging, too. Many unhoused women Gonyea has spoken to in Boston who are over the age of 50 reported lengthy waiting lists for affordable public housing and limited space in shelters. 

“When we look at what the housing market is, and the long waiting lists for public housing, it’s a big issue,” she says. For older adults, it’s particularly tough to find affordable housing that’s also accessible. But well-suited and well-located housing can have a positive impact on quality of life—like being near a bus stop, being within walking or driving distance of a grocery store and doctor’s office, having an elevator to high floors, and having sidewalks.

“Low-income urban elders, those persons in public housing, are amongst some of the most vulnerable older adults in the nation,” Gonyea says. The nonprofit research organization ​​Urban Institute reports that more than half of the 1.13 million households in public housing are headed by someone who is 62 or older and/or disabled; poor housing stock, it says, is putting older adults’ well-being at serious risk.

Pillar 3: Health

For all the necessities that Medicare provides—before its creation, one in every two older Americans had no health insurance—there’s a lot it doesn’t cover: vision and hearing exams, glasses and hearing aids, dental care and dentures. While Medicaid currently provides health coverage to about two million older people living in extreme poverty, many lower- and middle-income older Americans cannot afford to purchase private supplemental health plans. Those enrolled in Medicare, adds Gonyea, “still face out-of-pocket expenses, which can amount to thousands of dollars.” 

More than 17 million older Americans are economically insecure and struggle to meet healthcare costs, according to the National Council on Aging, and wide gaps exist by race and education level. 

“Poverty is a core social determinant of health. One’s work history, including the type of occupation and employment stability, affects retirement income and health in old age,” Gonyea says.

One theme through her research has been the impossibility of separating health from other aspects of people’s lives—economic stability, where they live, the food they eat, the people they spend time with. In a series of studies that focused on low-income urban elders, Gonyea investigated whether experiencing loneliness in old age increases health risks, and if social connectedness acts as a protective function from food insecurity.

She found that loneliness increased depression significantly and placed people at elevated risk of being food insecure. But she also discovered that having a family member involved in someone’s life provided a protective factor against food insecurity. Even if food stores were close by, traveling in cold weather, cracks in sidewalks, and physical limitations impacted access to food. 

“We need to be better aware of how loneliness and health are linked and have profound impacts on people’s lives,” Gonyea says.  

Solutions: A Shared Sense of Responsibility 

“The solution involves adopting a shared sense of responsibility between government, businesses, and communities to support older people’s well-being,” Gonyea says, and helping people stay in their homes and communities—aging in place—instead of relocating. “Federal and state policies are important, but it also involves local efforts to transform communities so that persons can age in place safely and comfortably, regardless of income or ability level.” 

She points to a global initiative for age-friendly cities, established by the World Health Organization in 2010, which encourages municipal leaders to work collaboratively with their aging populations and transform physical and social environments to enhance older folks’ quality of life.

“It’s really about making cities healthier for all,” says Gonyea. “When we talk about the need for more and better sidewalks for older adults, there are parents of young children with baby carriages that also benefit. Age-friendly is the integration of older adults into the community so that they can fully participate and maximize their lives to the fullest.

“It’s important that we see older adults not just as vulnerable, but also as contributors to communities and society. This starts with throwing away ageist stereotypes, ideas, and assumptions about what people are capable of, and communicating across generations.”

Gonyea hopes that transforming communities will help end social segregation of people by age, and allow everyone to benefit from the gift of so many generations sharing the planet at one time.

“If you ask most young people what older persons they’ve been involved with in the past three months, it’s either their parents or their grandparents,” Gonyea says. “Families generally feel a strong sense of responsibility to care for members, but changing demographics, combined with shifting social forces, may increasingly place physical, emotional, and financial strain on families to perform these roles.”

Some families are becoming multigenerational as demographics shift, with family members caring for multiple people who are older—children who are in their 60s and 70s caring for parents in their 80s or 90s, even their 100s. Add in divorce, remarriage, and cohabitation, changing family dynamics, and the need for two household incomes (versus a single breadwinner), and expectations for caretaking can easily get complicated—socially, financially, and emotionally. 

“We have to think about, what is our social contract to building community?” Gonyea says. “Is it all about individual and self-responsibility, or is there a collective sense of taking care of more vulnerable groups, both children and older adults? How do we have shared responsibility?”


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