Francesco Miele, Anziani, salute e società: Politiche di welfare, discorso pubblico e cura quotidiana, Il Mulino, 2021
10.6092/issn.2038-3460/17585
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2038-3460
17585
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Michela Cozza
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Tecnoscienza – Italian Journal of Science & Technology Studies
Francesco Miele, Older people, health and society: Welfare policies, public discourse and daily care, Il Mulino, 2021
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Book Reviews
2023-02-19
2023-06-30
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156-159
TS
Michela Cozza
2022
10.6092/issn.2038-3460/17585
156
Mälardalen University
2038-3460
2
en
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Francesco Miele, Older people, health and society: Welfare policies, public discourse and daily care, Il Mulino, 2021
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156                                                           Tecnoscienza – 13 (2)


    Francesco Miele
Anziani, salute e società: Politiche di welfare, discorso pubblico e cura quo-
tidiana [Older people, health and society: Welfare policies, public discourse
and daily care] Bologna, il Mulino, 2021, pp. 180

Michela Cozza Mälardalen University, Sweden

    Demographic ageing is a key driver of social change. Science and Tech-
nology Studies (STS) have increasingly turned to ageing as a topic and have
done so in trans-disciplinary endeavours at the crossroad of STS and age
studies. The theme is not new to Tecnoscienza, which has recently pub-
lished a special issue on this topic (see Issue 2, 2020). Being one of the
guest editors of that special issue, I can say that the response to that call
was mainly international, with no contribution coming from Italian re-
searchers working on ageing. There are certainly many possible reasons for
this absence that, however, does not help to highlight the state of the art of
(Italian) studies on this matter and how age and later life are (or not) matter
of concern for policy- and decision-makers in one of the oldest countries
in the world (Statista 2021).
    Francesco Miele’s book is, thus, worthy for two main reasons, among
others. First, it contributes an overview of the ageing process in Italy by
focusing on – as the subtitle says – three key dimensions: welfare policies,
public discourses, and daily care. This choice enables us to appreciate and
situate the complexity of the theme. Second, it draws from STS and the
Sociology of health as well as from the author’s research experience. Na-
tional and international literature are combined in the analysis of ageing by
positioning this book within the landscape of subject-related Italian publi-
cations. I wish to further emphasise this second merit as corresponding, in
my view, to a necessary effort to legitimise the theme in the Italian scientific
environment, especially among the social sciences.
    The book is easy to read and clear in articulating its main argument:
ageing is a processual “constellation” (p. 10) of policies, discourses, and
material practices that co-construct and signify older people’s health. It is
noteworthy that, throughout the book, Miele makes room for considera-
tions related to how the Covid-19 pandemic has worked as a sort of “stress
test” (p. 24) – as he said – magnifying existing criticalities. The reader is
accompanied through four chapters that, by examples and conceptual def-
initions, describe the Italian context.
    The first chapter is aimed at presenting the main changes in public pol-
icies about Italian older people’s health. The description is developed in
terms of changes that occurred over time in relation to family networks,
care work and its gendered feature, and various services and solutions
(long-term care, residential and nursing homes, ageing in place policies,
Book Review                                                                   157

cash for care). Miele’s attention to gender and women’s work reveals a sen-
sibility for aspects that are often overlooked in the literature on health and
(elderly) care, although – I add – care and careworkers’ (mostly women)
labour are vital to society in a very material sense. The lack of political and
financial support for elderly care in Italy is matched, by Miele, with the
neoliberal principles leading contemporary society to prefer “marketiza-
tion”, that is the partial or complete privatization of care services, over any
public investments in this sector. This analysis (sadly) aligns Italy to the
international context, including the Nordic countries that are often looked
at as better equipped when it comes to welfare policies compared to the
rest of the European countries (Hansen, Dahl, and Horn 2022). While –
based on my reading and research experience both in Italy and Sweden –
I am fully convinced by this argument, what disappoints me on a different
note is the incipit of this first chapter. Miele frames ageing as a “passage”
and associates it with “risk” (p. 15). As long as we – Miele included – agree
on defining ageing as a process, we should acknowledge that getting older
is not limited to a phase of life but rather progresses since birth: this is what
characterises human life. Associating ageing to a specific age (convention-
ally, 65+), according to a bio-deterministic understanding of it, clashes
with the argument of ageing as co-constructed by policies, discourses, and
practices. The same argument that matches older people with risks, or higher
risks compared to a younger population, is quite controversial. In STS, this
issue has been discussed in relation to the concept of “frailty” by stressing that
it is important to uncover how science, technology, and medicine have been
themselves implicated in the making of the ageing society (Moreira 2017).
     Although the beginning of the first chapter may generate disapproval
in the readership, especially in critical gerontologists and other (STS)
scholars inquiring into this matter, the second chapter comes as a sort of
compensation for the previous deterministic introduction of later life as
problematic and vulnerable. Indeed, in this chapter, Miele starts by saying
that older people have been targeted with many social representations that
stereotype them as passive and “in need”. In this chapter, as well as in the
following two, the author applies STS concepts to elaborate on ageing. In
particular, he uses the concept of “biomedicalization” (the complex mul-
tisited, multidirectional processes of medicalization extended and recon-
stituted through emergent social forms and practices of technoscientific
biomedicine) and highlights its connection with the molecularization of
ageing. According to the “molecular model” (p. 55) an older “patient” can
be reduced to their biological components to the point that ageing is meant
to be preventable via specific technoscientific interventions. In bringing to
the fore this association, Miele highlights an important matter of concern
that is related to the above-mentioned marketisation in that, as I discuss
elsewhere (Cozza, Ellison and Katz 2022), anti-ageing biohacking is quite
a business growing in Europe and in full bloom in US. It is noteworthy that
158                                                               Tecnoscienza – 13 (2)


such interventions, which vary in type, costs, and extremism (from the cos-
metic anti-ageing industry to experimental, often unauthorised, biohack-
ing interventions) co-construct the sociotechnical imaginary about ageing
and feed ageism – that is, stereotypes, prejudice and discrimination to-
wards others or oneself based on age. This imaginary emerges also in the
results of Miele’s longitudinal study (January 1985-November 2020) on the
Repubblica database – the second Italian newspaper regarding circulation
– where risk is associated with ageing and biomedical interventions become
a moral duty to manage it (age management).
    The third chapter is devoted to discussing ageing and health care in
relation to older people living at home (in literature called “ageing in
place”) and affected by multiple chronic diseases. In the author’s view,
multiple chronic conditions are ideal to study the entwining of formal and
informal elderly care work. In particular, Miele mobilises the concepts of
“burden of treatment” and “articulation” (p. 85). The former was formu-
lated by May et al. (2014) to understand how people and informal caregiv-
ers manage multiple chronic diseases; the latter was used by Corbin and
Strauss (1985) to refer to practices and activities to take care of a patient
without clashing with other aspects of daily life. By applying these concepts
to the results of a qualitative study (2013-2016) conducted in Italy on prac-
tices related to ageing in place and multiple chronic diseases, Miele appro-
priates four daily constructs originally presented in May et al. (2014) to
describe caring practices (i.e., sensemaking, monitoring, cognitive partici-
pation turned by Miele into “articulation”, collective action replaced by
“care work”). The overall chapter conveys the complexity of ageing in place
with regards to issues such as the availability of a more or less sufficiently active
family network, the role of general practitioners subjected to a progressive in-
fra-structural marginalization at the national level, and the constant need for
maintenance executed by informal caregivers to keep home elderly services up
and running. Surprisingly, what I did not find in this chapter is a wider em-
phasis on the role of multiple and ubiquitous technologies and various objects
and devices that populate older people’s homes (Cozza, De Angeli and Tonolli
2017) and multiple chronic conditions all the more.
    As in the case of chapter two, which compensates for what I consider a
flaw of chapter one, chapter four – compared to chapter three – widely
shows the role played by devices in co-defining who/what an older patient
is/become. Miele devotes the first part of the chapter to introducing the
person-centered care model and comparing it with the standard medical
approach regarding dementia care. The choice of focusing on dementia is
due to being representative of the main target of long-term care in nursing
and residential homes. By drawing on STS, the author shows how dementia
is “multiple” (p. 120) and its definition and treatment depend on the insti-
tutional context the older person lives in. To substantiate his analysis,
Book Review                                                                     159

Miele refers to a past ethnography (2019-2020) that he conducted in spe-
cific institutional contexts – called nuclei protetti in Italian – by paying at-
tention to the daily work of healthcare professionals (in Italian, operatori
socio-sanitari or OSS). In expanding the (national) narrative about ageing
and dementia, Miele highlights also the role of devices such as patients’
medical records and affordances of institutional spaces in enacting multi-
ple definitions of dementia and, ultimately, co-constructing situated ideas
of personhood. At the end of the chapter, Miele emphasises how caring is
not detached from sentiments and emotions, which – I add – are deeply
interrelated with the concept of care as affective relations and, even more,
with caring as a form of relating.
    All in all, this book is worth reading to get an overview of the Italian
context and how ageing is part of or overlook by policies and public dis-
course, and co-shaped by social and material practices at home and in in-
stitutional settings. Readers knowledgeable about scholarly contributions
on ageing and elderly care may appreciate the continuity between Italian
trends sketched in this book and those discussed in the international liter-
ature (for example, the marketization of care, the gendering of care, the
biomedicalization of age-based interventions).

References
Corbin, J. and Strauss, A. (1985) Managing chronic illness at home: Three lines of
       work, in “Qualitative Sociology”, 8(3), pp. 224-247.
Cozza, M., De Angeli, A. and Tonolli, L. (2017) Ubiquitous technologies for older
       people, in “Personal and Ubiquitous Computing”, 21(3), pp. 607-619.
Cozza, M., Ellison, K. and Katz, S. (2022) Hacking Age, in “Sociology Compass”,
       16(10), e13034.
Hansen, L.L., Dahl, H.M. and Horn, L. (eds.) (2022) A Care Crisis in the Nordic
      Welfare States? Care work, gender equality and welfare state sustainability,
      Bristol, Bristol University Press.
May, C.R., Eton, D.T., Boehmer, K., Gallacher, K., Hunt, K., MacDonald, S., Mair,
       F.S., May, C.M., Montori, V.M., Richardson, A., Rogers, A.E. and Shippee,
       N. (2014) Rethinking the patient: Using burden of treatment theory to un-
       derstand the changing dynamics of illness, in “Bmc Health Services Re-
       search”, 14(1), e281.
Moreira, T. (2017) Science, Technology and the Ageing Society, London and New
       York, Routledge.
Statista (2021) Aging population of Italy: Statistics & Facts, Statista Research De-
        partment. Available at: https://www.statista.com/topics/8379/aging-popu-
        lation-of-italy/#topicHeader__wrapper (retrieved August 15, 2021).
