Third edition, 18 May 2020

On 21 March 2020, the Greek Chief Scientist Dr Tsiodras, a modest, softly spoken man, was leading the daily Greek government briefing on Coronavirus. Greece had recorded its first death from Covid-19 on 12 March. Schools had already been closed in the country on 10 March, followed – within days – by all cafes and restaurants and (in an unprecedented move) even Churches. 

Following the description of the latest figures, Dr Tsiodras shared that he was asked by an internationally respected fellow scientist as to why Greece was making so much fuss over a small number of elderly and chronically ill people. 

His voice breaking from emotion and holding back tears, Dr Tsiodras said:

"[T]he miracle of medical science in 2020 is the prolongation of good quality life for those people. Many of whom are our mothers and fathers, are grandmothers and grandfathers. The answer is that we honour everyone. We respect everybody. We protect everybody. But above all them. We cannot exist nor have an identity without them."

Nine days earlier, on 12 March, the British Prime Minister Boris Johnson’s ‘I must level with you’ message pointed to a much more chilling position: “many more families are going to lose loved ones before their time”, he stated, whilst going on to advise older people and those with serious medical conditions “against going on cruises”. 

At the time, with 12 recorded deaths in the country, the UK government response was predominantly advice on social distancing, rather than freedom-restricting measures. At the time of writing, tragically the UK has the highest number of deaths in Europe (surpassing 30,000), whilst ‘debt-hit’ Greece counts 148 deaths, and is hailed as the ‘surprising success story’.

Focusing on the words of leading figures in both countries is not merely a linguistic exercise. It holds deep personal resonance for me, as a Greek who lives and works in the UK, whilst her ageing parents reside in Athens. 

Unable to rush to their aid, I have anxiously followed the unfolding developments in both countries, the content of the daily briefings directly impacting on myself and loved ones. 

Language is not neutral; it creates identities, it constructs social reality, it leads to social action. Our culturally shared representations of the world often have far reaching implications for how we treat people. This extends to responses to social problems; as asserted by Dizon, Wiles and Peiris-John (2020) the language policy makers choose to construct policy problems will directly influence the solutions created. In the context of a pandemic, those very words can mean life and death.

Even before the pandemic, the prevailing discourses around older people often depicted them as frail, dependent, a ‘burden’ on social resources, especially in Western societies (Duffy, 2017). Quite often the language is one of ‘othering’ as well as homogenising of a very diverse population (Fealy et al, 2012). This is detected in the language used in the above examples. 

Boris Johnson wanted to “speak directly to older people”: “Because this disease is particularly dangerous for you, for older people…”. The direct address, however, did not last long - very soon the ‘you’ turned to ‘they’: “we should all be thinking about our elderly relatives, […] and everything we can do to protect them over the next few months”. 

The emotional words by Dr Tsiodras also seem to point to older citizens as ‘them’ and defined through their family roles. Yet, his emotive assertion that older people are not only a medical priority, but are indispensable to who ‘we’ are, to the collective identity, is galvanising a different social contract. 

The Greek Prime Minister, Kiriakos Mitsotakis, called Dr Tsiodras’ statement a "wake up call" and justified the implementation of strict measures as “the responsibility of young people toward the elderly” (22 March). The day after, PM Johnson’s announcement of the lockdown included no direct mention of older people, focusing instead on NHS capacity (in what has become the motto of ‘Save the NHS’). 

The othering and invisibility of older people in public discourse has had dire consequences in the ongoing Covid-19 crisis in the UK: care homes remained obscured from the government’s gaze (a process already in place via decades of care sector privatisation). Not even the celebrated image of Captain Tom Moore, raising funds for the NHS, just shy of his 100th birthday, was enough to alert the government (and the public conscience) to the unfolding tragedy simultaneously taking place in care homes. 

Initial death figures did not include care home numbers, with the UK government having to be pushed to account for this population and make it visible as part of the national statistics. At the moment of writing, over 6,000 care home residents have died of Covid-19 between April and May (ONS), a crisis that PM Johnson ‘bitterly regrets’, yet a crisis that was preventable.

This is not new knowledge; structurally produced and on the main preventable inequalities are highlighted by Milne (2020) as particularly damaging for older people: “As a society we could address them and by so doing reduce harm; it is a political choice that we do not and a matter of social justice.” (p. 4). 

There are existing calls to move to critical social work principles when working with older people: Milne et al. (2014), Ray et al. (2015) not only argue for a recognition of the specialist role of gerontological social work, but also stress the need to reconnect such practice with social justice values, challenging poverty, health inequalities, ageism and promoting rights. 

Duffy (2017) outlines advocacy practices based on an awareness of negative discourses on older people as crucial in promoting critical social work practice. I want to argue that this work cannot only be directed at recognising and challenging unjust and ageist discourses ‘out there’. In order to shift the narrative, a lot of critical reflection needs to also be facing inwards for us all as social workers: our views, attitudes and deeply held assumptions on what it means to be ‘old’.

The evidence is not encouraging: studies across countries have found that social work students are not interested in working with older adults, as the work can be seen as too depressing, linked to ageist views of older people (eg as unable to change), or anxieties about their own ageing (Wang, et al, 2013; Goel, 2019). 

Greek health and social work students reported higher anxiety over ageing (Koukouli et al, 2013), pointing to negative views on old age and potentially feeding this unwillingness to work in the field. More worryingly, unfavourable or even well-meaning but patronising attitudes can also underpin professional practices, resulting in adverse outcomes for older people in health and social care settings (Hanson, 2014). 

As a social work educator, I have been aware of my own preconceptions and fears, and those of students around old age and have been unnerved by ways in which narrow, homogenising perceptions of ‘the elderly’ can seep through into the teaching language. As those over 70 are absent from the students’ university classroom experience, an inevitable ‘us and them’ forms when covering the topic in lecturers and seminars. 

Stereotypical views of older people as obstinate, passive, asexual are common. Recognition and skilled challenging of these is important as part of the classroom experience, as is consideration of innovative pedagogy with diverse groups of older people as co-producers of the curriculum.

Social workers should be at the forefront of a societal response to the care of older members of society and we as social work educators need to consider how best to prepare future social workers for the challenge. The Covid-19 crisis has laid bare the need for a multi-faceted, co-ordinated and social justice-informed response to the needs of older citizens. 

This challenge is urgent and - in many ways - desperate given the care home crisis in the UK; yet, it is also long term, as the repercussions of this pandemic will be felt for years, nationally and globally. Changes will have to occur on many fronts, but it is imperative that we engage with the discursive dimensions of any potential ‘remaking of the social contract’ (The Lancet, 2020). 

A brave examination of our own professional narrative power to define, exclude, silence, make visible is imperative. After all, the most chilling words were not those of well-known right-wing politicians. They were instead the words of the world-renowned, and undoubtedly highly influential, scientist who asked Dr Tsiodras “why are you making so much fuss over them?” 

Dr Eleni Skoura-Kirk

Senior Lecturer in Social Work, School of Social Policy, Sociology And Social Research, University of Kent

Email: E.Skoura-Kirk@kent.ac.uk

Twitter: @Clemencyrows

References

Milne, A. (2020). Mental Health in Later Life: Taking a Life Course Approach. Bristol: Policy Press.

Milne, A., Sullivan, M. P., Tanner, D., Richards, S., Ray, M., Lloyd, L., Beech, C. and Phillips, J. (2014). Social Work with Older People: A Vision for the Future. London: The College of Social Work.