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PREPUBLICATION COPY—UNCORRECTED PROOFS 5 Constrained Choices: The Shifting Institutional Contexts of Aging and the Life Course Phyllis Moen INSTITUTIONS AS CONTEXTS AND PROCESSES Institutions are taken-for-granted schemas about “appropriate” behavior—formal and informal rules and conventions representing collectively developed patterns of living that often reflect organizational and community answers to past problems and uncertainties (Biggart and Beamish, 2003; Sewell, 1992). According to Scott (1995, p. 13), institutions are “cognitive, normative, and regulative structures and activities that provide stability and meaning to social behavior. Institutions are transported by various carriers—culture, structures, and routines—and they operate at multiple levels of jurisdiction. This chapter proposes that institutional theory constitutes an important prism through which to advance understanding of the range and impacts of patterned social arrangements channeling age and aging processes, though its use is underdeveloped in the study of aging. While there are a multiplicity of social institutions (policies, programs, practices, and conventions) structuring the expectations and choices, transitions and trajectories, risks and resources of aging adults, they tend to serve as background “givens” in the existing research literature on aging, that is, as contexts and/or “neighborhood” effects (Angel and Settersten, 2011; Bengtson et al., 2009; Binstock and George, 2011; Cagney et al., 2012; Settersten and Angel, 2011; Shanahan, 2012), or else as social roles shaped by unique historical events experienced by different cohorts (see Baltes and Baltes, 1990; Elder, 1974; Elder and Johnson, 2002; George, 1993). The closest ties to an institutional approach in the current aging field lie along three lines of inquiry: (1) critical political economy and feminist approaches examining how existing institutional arrangements (norms, policies, and practices) are developed and maintained by those in power to promote their own positions of advantage, thereby preserving the existing distribution (across gender, race, and class) of resources (see Acker, 1992; Arber and Ginn, 1991; Estes, 2004; Harrington, Meyer, and Herd, 2007; Pampel, 1994; Quadagno, 1988); (2) age stratification/life course frameworks underscoring how social welfare and labor market policies have “institutionalized” the age- graded life course (Kohli, 2007; Kohli et a., 1991; Mayer, 2004, 2009; Meyer, 1986; Moen and Spencer, 2006; Mortimer and Shanahan, 2003; O’Rand and Henretta, 1999); and (3) sociological (c.f. House, 2002) and social epidemiological (c.f. Berkman, Glass, Brisette, and Seeman, 2000) theorizing of socially structured conditions—more than individual attributes—as key to health and well-being, generating an emphasis in the interdisciplinary public health literature on the social causes of illness and health (Aneshensel, Rutter, and Lachenbruch, 1991; Berkman et al., 2000; Link and Phelan, 1995; Marmot and Wilkinson, 2006; Mechanic, 2000; Moen and Kelly, 2009; Moen et al. 2011; Siegrist and Marmot, 2006;

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PREPUBLICATION COPY—UNCORRECTED PROOFS Syme, 2007; Turner, Wheaton, and Lloyd, 1995; Wheaton, 2001; Wheaton and Clarke, 2003; Wickrama et al., 1997). Institutional theory “asks questions about how social choices are shaped, mediated, and channeled by the institutional environment” (Wooten and Hoffman, 2008, p.130). This is in sharp contrast to classic economic models emphasizing choice as a (rational) function of perceived advantage or preferences (c.f. Becker, 1981; Gruber and Wise, 2004). Though institutional theory is rarely explicitly invoked, sociological, demographic, and social epidemiological understandings of age, health, and the life course are implicitly if not explicitly about institutional forces, since scholars increasingly emphasize the embeddedness of individuals in particular social-structural contexts (see Figure 5-1). These contexts are replete with rules, claims, risks, and resources serving to open up or constrain choices, thereby shaping family-level and individual-level beliefs, behaviors, health, and life quality (see Berkman and Kawachi, 2000; Fry and Keyes, 2010; House, 2002; Kawachi, and Levin, 2004; Link and Phelan, 1995; Lutfey and Freese, 2005; Phelan and Link, 2005; Phelan, Link, Diez-Roux, and Tilly, 1998; Turner, Wheaton, and Lloyd, 1995). Nevertheless, the state of the field is such that the preponderance of research on aging examines individual-level predictors of individual outcomes, not the institutional-level contexts and processes shaping both. Three things make something an institution: language, customs, and a body of rules and laws —and all serve to “regularize” behavior (Biggart and Beamish, 2003). What is key is that all three are in flux around aging processes, pointing to the importance of institutional change and even deinstitutionalization across cohorts and history. Thus, Boomers (born 1946-1964) now moving to and through the retirement years are confronting unraveling labor market exit and pension expectations, policies and practices that their parents and grandparents took for granted. In this way, cohorts responding to outdated policies and new circumstances become the engines of social change (Alwin and McCammon, 2007; Ryder, 1965). It is now members of the Boomer cohort who are reshaping what it means to retire and grow old in contemporary society. Consider how taken-for-granted language (about elders, the aged, seniors, retirement, being/becoming old) is being redefined or challenged. For example, Gilleard and Higgs, (2005; p. 157) conclude: “… to be done and outside the labour market is no longer to be old. Old age is a status conferred by others, . . . . For the majority, what continues is the symbolic connectedness of individualized lives.” In terms of customs as well as a body of rules and laws, systems of educational, labor-market, corporate, retirement, social-welfare, family, and health-care policies and practices constitute a web of age-graded institutionalized regimes (social structures of resources and schema) based on a very different workforce and “retired” force in the middle of the last century (de Vroom and Bannink, 2008; Ebbinghaus, 2006; Kohli, 2007). These regimes continue to define and shape age, aging, the life course, and health with different logics (and not always internally consistent ones). Moreover, note that such institutional arrangements cannot usefully be studied separately, since they are closely connected and interdependent. They both constrain and facilitate individuals’ options as they confront emerging 21st century risks and realities in family life, the economy, and life expectancy. Consider, for example, the mismatch between presumed institutionalized protections and the disappearing employment contract. Today older workers confront the off-shoring of jobs, 5-2

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PREPUBLICATION COPY—UNCORRECTED PROOFS heightened job insecurity, unemployment, and non-standard employment—all of which have been shown to affect health (c.f. Price and Burgard, 2008). But institutions need not been seen as immovable. Some also provide impetus for change (see Friedland and Alford, 1991; Sewell, 1992), such as the ways higher education as an institution has equipped many Boomers with the tools to redefine age in their own biographies and rewrite their own scripts around the aging process. And social forces—a tumultuous global economy, an aging population, technological shifts, and other social dislocations—are challenging taken-for-granted institutionalized conventions and practices around work exits, retirement timing, life post-retirement, Social Security, pension policies, and health care. This means that social actors (individuals, groups, organizations, governments), facing often contradictory rules, laws, and realities about labor market and retirement exit and entry portals, pensions, and health-care eligibility, must make strategic adaptations, which can then become the seeds of innovation and institutional change. For example, a competitive uncertain global economy has increased concerns of older workers about their job security, retirement timing, and future pensions, including whether they can “afford” to retire. This is the impetus for the development of bridge and part-time jobs, self- employment, and delayed retirement options for a growing older segment of the workforce. Another example is the rising costs of a currently institutionalized arrangement for long-term care—nursing homes. Such facilities are being challenged as unsustainable in their present form, in light of the coming age wave of Boomers. Arrangements like continuing care retirement communities, home care, and new technologies to facilitate aging in place are among proposed alternatives. Institutions may seem static and intractable, but they are transformed through nonconformity, negotiation, improvisation, institutional entrepreneurs, and social movements (DiMaggio, 1988). It is often the mismatch or structural lag among existing institutional logics, or between institutions and the social forces rendering them obsolete, which generates opportunities for social change. Such mismatches (lag) help to deinstitutionalize conventional arrangements and legitimate new institutions, often through a recombination or reconfiguration of existing elements. This chapter illustrates the value of a program of future research using a combined institutional and life course approach to advance understanding of aging as a social process embedded in multilayered institutional contexts, with both individuals and institutions changing over time. It provides an overview of (1) current concepts and research in the sociology of aging, demography, and social epidemiology that articulate (though not always explicitly) with institutional theory and the ways institutions target and/or impact different subgroups of the population; (2) how institutions intersect and change over time in intended and unintended ways as a result of both social actors’ behavior and other large-scale social forces; and (3) potential scientific and societal pay-offs of an innovative program of future research crossing levels of analysis to address ways (taken-for-granted, age-graded) institutions systemically open up and constrain life chances and life quality for those at different ages and life stages, often in distinctively gendered ways. The chapter is organized around several major social science constructs that, when married with an institutional/life course approach to age and aging, offer a promising agenda for a program of research over the coming decades: (1) stratification and inequality (including cumulative dis/advantage and the life course); (2) risk and uncertainty; (3) social support, integration, isolation; (4) 5-3

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PREPUBLICATION COPY—UNCORRECTED PROOFS agency, control and adaptive strategies; and (5) time and place. It concludes with a section on future directions. STRATIFICATION AND INEQUALITY OVER THE LIFE COURSE One hallmark of sociology is its emphasis on the effects of social environments on behavior, resources, and health, the seemingly fundamental social structure of inequality (House, 2002; Link, 2008; Link and Phelan, 1995; Lutfey and Freese, 2005; Phelan et al., 2004; Phelan and Link, 2005; Phelan, Link, and Tehranifar, 2010). Some social structures— such as gender, race, education, and income—are markers of location in (institutionalized) status hierarchies. Social environments tied to these attributes produce and reproduce enduring inequalities (Tilly, 1998). Scholarly analysis of disparities associated with these social-locations has been essential in spotlighting the role of existing and emerging social arrangements in the production and reproduction of inequalities. But while race, gender, and even education are enduring factors, other aspects of social structure, such as neighborhoods, work, and social networks, do change with age, as individuals select or are allocated to different social ecological niches (see also Brooks-Gunn et al., 1993) over the life course. Moreover, the deleterious effects of social-locational markers can be lessened or exacerbated by events (such as the Great Recession of 2007-2009) or with age, in light of institutionalized age-graded policies and practices (such as Social Security and Medicare) offering an income and health care safety net for older Americans that in the last century served to legitimize retirement as normal life transition (see Atchley, 1982; Costa, 1998; Han and Moen, 1999; Hayward and Grady, 1990; Henretta, 1992; Wise, 2004). Social forces, as well as deliberate policy changes, can also shift social structures, challenging taken-for-granted institutionalized expectations and practices that disadvantage some segments of the population while advantaging others (Blossfeld and Hofmeister, 2006; Blossfeld, Buchholz, and Hofäcker, 2006; Hudson, 2009; Warner, Hayward, and Hardy, 2010; Williamson, 2011). Consider, for example, public and corporate policy directives aimed at reducing age and/or gender discrimination (Shuey and O’Rand, 2004) or the development of “bridge” jobs as a way of gradually easing older workers into retirement (Kim and Feldman, 2000; Quinn and Kozy, 1996). Age and Gender Stratification Age and gender are not simply characteristics of individuals shaping their preferences; rather, they are themselves social institutions, key axes organizing social life and “channeling” social choices, such that women and men of different ages and life stages are both allocated to and socialized to expect distinctive roles, resources, and relationships (Dannefer, 2011). While concerns about gender stratification are deeply embedded (institutionalized) in social research on inequality (c.f. Grusky, 2001), Riley (Riley, Riley, and Foner, 1994) also emphasized the importance of age stratification: age as a key marker of unequal access built into existing institutions (e.g., the labor market, education, social welfare policies) that perpetuate age differentiation and inequalities within and across organizations, communities, and societies. (See also Settersten and Lovegreen, 1998, for the ways education is constrained to certain ages and stages.) Others point to the intersection of age and gender stratification as institutionalized in families as well as public and 5-4

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PREPUBLICATION COPY—UNCORRECTED PROOFS organizational policies (Allen and Walker, 2000; Harrington Meyer and Herd, 2007; Harrington Meyer and Parker, 2011; Moen, 1994, 2001; Moen and Chermack, 2005; Moen and Spencer, 2006). The ways work and retirement are organized through legislation, regulation, and convention are based on a (male) breadwinner model presuming full-time, full-year investment in one’s job, with family responsibilities off-loaded to someone else (a wife). These built-in assumptions make it difficult for women (or men) with family care obligations to work continuously throughout adulthood in “good” jobs that provide high wages, pensions, and security (Han and Moen, 1999; Moen and Roehling, 2005). Moreover, Social Security in the United States is predicated on this lock-step model, presuming one’s highest wages just prior to retirement. But women’s movement in and out of jobs, in and out of the labor force in light of their family responsibilities, has meant lower wages, lower pensions, lower Social Security benefits, fewer assets, and great risk of economic insecurity in old age, especially for widows and divorcees (Budig and England, 2001; Budig and Hodges, 2010; Harrington Meyer and Herd, 2007; Harrington Meyer and Parker, 2011). Gendered scripts also guide relationships with organizations and institutions. For example, among dual-earner couples, it is wives who tend to time their retirements around their husbands’ retirement plans (Moen, Huang, Plassman, and Dentinger, 2006; Moen, Sweet, and Swisher 2005). The processes by which people are allocated to different roles, resources, and relationships and socialized to expect and choose different life paths depending on their age and gender (as well as their race and class) are the direct result of social policies as well as cultural conventions —norms and practices—related to them. European scholars have pointed to the ways social welfare policies have constructed and institutionalized the life course as a series of patterned role entries, trajectories, and exits based on men’s occupational careers in the mid-20th century (Guillemard and Rein, 1993; Kohli, 2007; Kohli et al., 1991; Krücken and Drori, 2009; Marshall, 2009; Mayer, 2009; Meyer, 1986). Thus the institutionalized life course is in reality a gendered life course (Arber and Ginn, 1991, 1995; Harrington Meyer and Herd, 2007; Harrington Meyer and Parker, 2011; Moen, 1994, 2001; Moen and Roehling, 2005; Moen and Spencer, 2006; Pavalko, 2011; Venn, Davidson, and Arber, 2011), grounded in gendered norms and social policies about work, family, and social relations that intersect with age. As an example, in the United States, unemployment insurance is typically based on men’s experience of being laid off. People (women) who have spent time out of the workforce raising children are not “eligible” for unemployment insurance when they re-enter the labor market but cannot find jobs. And women who “work” at home taking care of children or infirm adults do not earn Social Security credits. The distinctive life courses of women and men tend to disadvantage older women, in particular, in light of the gendered nature of their care-work obligations, along with discriminatory practices in the labor market and in welfare distributions throughout the life course (such as the ways part-time jobs do not provide pensions, unemployment insurance, or even health insurance). Family obligations and gender discrimination made it unlikely that current cohorts of older women followed the conventional lock-step of continuous full-time work, often for the same organization, that became the “hook” for the development of labor market and social welfare policies (Barley, 1989; Moen and Roehling, 2005). The result? Older women find themselves with no or low pensions, Social Security payments based on lower wages, and caregiving obligations for ailing spouses or infirm parents that often 5-5

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PREPUBLICATION COPY—UNCORRECTED PROOFS precipitate unexpected and early labor market exits (Dentinger and Clarkberg, 2002; Harrington Meyer and Herd, 2007). But institutional innovations in the form of greater flexibility offering employees greater control over the time and timing of work and opportunities for more customized careers (Benko and Weisberg, 2007), together with the greater proportions of women attending college and having fewer children (along with men’s declining wages), mean that some women’s career paths are becoming more continuous than discontinuous, suggesting that future cohorts of older women may have different sets of resources. However, women’s greater engagement in the labor market is occurring even as both men and women are increasingly at risk of (1) discontinuities due to layoffs and forced early retirement buyouts and (2) declining pension/income security (Shuey and O’Rand, 2004; Sweet, Moen, and Meiskins, 2007). Whether this has implications for narrowing gender differences in aging processes (compared to gender disparities among prior cohorts) in future cohorts is an empirical question. Similarly, Bonilla-Silva (2006) proposes a racialized social system framework emphasizing racism as a structure and a set of social practices developed to maintain the advantages of the dominant group, not merely a set of ideas or beliefs, with this system of racialization developing “a life of its own” (p. 32) (see also Jackson, Govia, and Sellers, 2011; Mutchler and Burr, 2011). Future research is necessary to identify the ways women and men of different minorities, immigrants, and other disadvantaged subgroups are aging, and whether institutionalized safety nets narrow or accentuate inequalities within and across gender in intersection with these identifiable subgroups. An institutional/life course theoretical approach points to the ways the social, economic, and political institutions of particular societies—public and business policies and practices embedded in work, career paths, family, unemployment, pensions, retirement norms, and disability regimes —were developed based on the everyday experiences of mostly white-collar and unionized blue-collar men in the middle of the 20th century, but then came to organize the lives of everyone, including women who entered the workforce, along with other displaced and disadvantaged groups. These outdated templates continue to shape the lives of those in new cohorts now working, retiring, and aging in the 21st century in gendered ways. The range of institutionalized options in the wake of certain biographical events (such as illness, retirement, divorce, death of a spouse, or long-term unemployment) depends on a person’s age, gender, and education (see also Dannefer, 2011). For example, there are both pull factors (such as Social Security, SSI, and pensions) and push factors (corporate hiring, training, firing, pension, health insurance, and retirement policies) that shape the timing of and pathways through the retirement transition (Ebbinghaus, 2006; Guillemard and Rein, 1993; Henretta, 1992; Kohli et al., 1991; Rix, 2011; Williamson, 2011; Wise, 2004), but these may well operate in different ways for men and women. Future research is needed on the different resources and experiences of different cohorts as they age—and on the heterogeneity of resources and experiences depending on one’s gender, but also on one’s race/ethnicity, nativity, education, occupation, and disability status—in the context of both outdated and innovative institutional arrangements. Cumulative Advantage/Disadvantage A key theoretical and empirical question that could benefit from an institutional/life course approach to advance the study of aging is: Does growing older amplify or reduce existing disparities (by gender, socioeconomic position, race/ethnicity, and their 5-6

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PREPUBLICATION COPY—UNCORRECTED PROOFS intersections) in stressors, health risks, and material or emotional resources? Cumulative advantage/disadvantage theory proposes that the amplifying process has been the case historically (Dannefer, 2011; O’Rand, 1996; Wilson, Shuey, and Elder, 2007). A variant of cumulative advantage/disadvantage proposes heightened disadvantage as a result of a cumulation of adverse risk factors (Ferraro, Shippee, and Schafer, 2009), and the fundamental cause approach holds that existing social-locational inequalities persist throughout adulthood despite medical advances that are disproportionately allocated to or adopted by those with higher levels of education (Link and Phalen, 1995). But an alternative, age as leveler hypothesis suggests that institutional arrangements advantaging older Americans may help to attenuate economic and health disparities with age (Berkman, Ertel, and Glymour, 2011; Herd, Robert, and House, 2011). However, studies of age as a leveler need to take into consideration the differential mortality of different subgroups. Life course scholars have shown that rewards in later adulthood accrue to those following the standardized lock-step life course of first education and then continuous full- time work, an option available to increasingly fewer individuals and never a reality for most women, the poorly educated, or minorities (Han and Moen, 1999; Moen and Roehling, 2005). As an example, Elman and O’Rand (2004) find that those Boomers who went back to school to obtain college degrees in midlife (typically women and minorities) did not receive earnings commensurate with those who obtained their degrees prior to beginning their full- time labor market participation. An important question for future research: Is it still the case that being “off-time” in transitions continues to matter, in light of the fact that labor market and family transitions no longer adhere to strict templates as to timing, sequence, or duration? In contrast to the medical model focusing on helping individuals who are already sick, a growing body of scholarship emphasizes illness prevention, and with it the value of theorizing inequalities in illness and dependency as the consequence of existing, but modifiable social conditions (Berkman and Kawachi, 2000; Syme, 2007). Health is improved or hindered by age- and gender-graded paths and possibilities embedded in existing systemic arrangements shaping family, education, work, retirement, religion, health care, and communities. An example, Medicare insurance becomes available only at age 65, constraining the health care of those older Americans (often women) out of work or without work-related health insurance. Future research advances can come from understanding the ways institutionalized social factors affect health, as well as from investigations of the health impacts of emerging innovative arrangements. This promising research agenda could capture the significance of existing— and emerging—institutional conventions and conditions for both life chances and life quality over the life course. RISK AND UNCERTAINTY IN THE CHANGING LIFE COURSE An example of ways institutions reflect past solutions to past social problems: earlier th 20 century concerns about economic insecurity and mortality hazards produced historically organized ways of insuring against risk in old age, in the form of the taken-for-granted institutionalization of life insurance, Social Security, SSI, disability policies and long-term care insurance (see also Costa, 1998; Gruber and Wise, 2004). In the middle of the last century, Social Security provisions (such as linking levels to earnings histories), mandatory 5-7

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PREPUBLICATION COPY—UNCORRECTED PROOFS retirement ages, and the development of defined benefit pensions served to institutionalize retirement as a taken-for-granted one-way, one-time status transition protected from extreme income insecurity (Costa, 1998; Henretta, 1992; Kohli, 2007). But, as an example of unequal distribution of risk in later adulthood, Quadagno (1994) describes how domestics and farm workers were initially excluded from Social Security policy, thereby fostering racial disparities. Scholarship reinforces that insurance against risks continues to be unevenly distributed, with a distinction between public policies framed as “insurance” and policies framed as providing (often means-tested) “assistance” (Estes et al., 2009). Aging as a Risk for Society Research underscores that risk is also a way policy makers and practitioners are framing the “problems” of an aging society, producing a focus on older individuals as inherently “at risk” (Carr and Muschert, 2009). This risk approach to later adulthood defines old age (and population changes producing rising numbers and proportions of older people) as a social problem, creating challenges for the larger society. This framing, in turn, sets the stage for a politics of aging grounded in a scarcity model of intergenerational conflict and a medical/biological model of the inevitability of disability and dependency with increasing age (Estes and Associates, 2001; Estes et al. 2009; Hudson, 2005, 2009; Pampel, 1994). It also produces social arrangements (such as health care practices, residential facilities, and the potential privatizing of Medicare and Social Security) that both diminish the autonomy of older adults and emphasize the dependence of frail older adults, often ignoring others in the same age group who are not at risk. Another potentially rich area for inquiry involves the ways age is being socially constructed (Berger and Luckmann, 1966) to take on biomedical, commodified, privatized, and rationalized aspects (Estes, 2004; Estes and Associates, 2001; Estes et al. 2009; Estes, Wallace, Linkins, and Binney, 2001). The biomedicalization of aging emphasizes aging as a medical problem associated with disability and dependence, along with the behavioral and policy implications of this medicalization approach. “Commodification” of old age relates to services and goods that are bought or sold. What Estes and associates (2001) call the aging enterprise—pension programs and businesses focused on older people—further serves to differentiate older from younger adults through the use of age thresholds and programs that effectively “commodify” old age. Commercial efforts amplified in the mass media create age groups and cultures as “cultural fields,” such as the youth culture, a set of products and practices of young people (especially related to their leisure and buying of goods and services; see Capuzzo, 2001) that continue to define the beliefs and behavior of the large Boomer cohort. “Privatization” has to do with the financing of health insurance, social services, and health care through the private sector, a trend that may promote rather than reduce inequality. “Rationalization” of old age refers to the provision of care in the most efficient ways, with cost concerns and cutbacks often trumping the quality of the care provided, even in nonprofit organizations providing medical and social services. Exposure and Vulnerability In another body of literature sociologists, demographers, and social epidemiologists theorize exposure and vulnerability to the risks of poor health and mortality as systematically stratified by age, gender, and other social-locational markers (such as education, income, 5-8

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PREPUBLICATION COPY—UNCORRECTED PROOFS labor force status, nativity, occupation, race and ethnicity, and marital status). Pearlin’s (1989, 2010) stress process model theorizes the importance of the structural contexts of lives contributing to disparities in the risks of chronic stress exposure and in the personal and social resources and capabilities with which to deal with both chronic and acute stressors. Life course epidemiologists model the health impacts of risk exposures at different ages and life stages (Davey Smith and Lynch, 2004; Kuh and Ben-Shlomo, 2004), as well as the accumulation of risks through the life course. However, Syme (2007) warns against an exclusive focus on classifications of health risks, encouraging scholars to focus instead on the social, environmental, and community forces contributing to them. Most existing social institutions are (deliberately or not) designed to produce age- graded distinctions that affect the allocation of goods, services, income, risks, and opportunities for those of different ages. (Thus, educational scholarships are available for “college-age” young people; entry-level jobs are expected to be filled by “young” adults; academic tenure is based on both productivity and years in the system; pensions are “earned” through years of service.) These arrangements can exacerbate, perpetuate, or reduce age, gender, or socioeconomic inequalities in health and other outcomes. For example, there is some evidence that age-graded policies (such as Social Security and Medicare) actually mitigate prior disparities in income, health care, or health outcomes. An empirical example: Herd, Schoeni, and House (2008) drew on census data to investigate whether within-state changes in maximum SSI benefits lead to changes in disability among those age 65 and older, theorizing that changes “upstream” in socioeconomic status through income supports would reduce subsequent health problems. They found that more generous state benefits— specifically a $100 increase in SSI benefits—produced lower disability rates (in terms of reporting having a mobility limitation). This provides tantalizing support of the idea of age as a leveler, in that modifications with age to individuals’ socioeconomic position (in the form of increasing income supports in later adulthood) can improve health, among even the poorest Americans. An important theoretical focus with potential for future research advances is on “upstream” risk factors very early in the life course (such as parents’ education and childhood deprivation) affecting older adults’ life chances and life quality. However, this framing could result in scholars paying insufficient attention to: (1) the ways people’s current social location moderates or exacerbates risk factors at every stage of the life course; (2) the disparities in exposure, duration, and vulnerability to risk factors and disparities in actual health outcomes, not only across, but also within social groups; (3) the ways biographical pacing and pathways (trajectories and transitions in employment, family, education, military service, neighborhood residence) change income, knowledge, perceived mastery, and other psychosocial resources, and, in doing so, perpetuate, exacerbate, or moderate risk exposures and vulnerabilities; and (4) how risk exposures and vulnerabilities are shifting within as well as across larger populations, including the increasing risks of downward mobility among previously “advantaged” groups. An empirical example of how risks change is a Health and Retirement Study (HRS) study showing that, unlike with younger workers, job strain is not related to older workers’ (average age 60) alcohol misuse, though it is related to their depressive symptoms. In line with these considerations, Kuh and Ben-Shlomo (2004, p. 458) argue for the need for life course epidemiologists and policy makers to move beyond childhood interventions to “identify opportunities to break adverse chains of risk at other life stages” 5-9

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PREPUBLICATION COPY—UNCORRECTED PROOFS (see also Berkman et al., 2011). Their emphasis on the need for policies around adolescent and early adulthood transitions “to provide not just safety nets but springboards to alter life course trajectories with benefits for subsequent health” could also be applied to transitions throughout older adulthood. Consider, for example, the effects of taken-for-granted policies that limit access by age (such as Medicare at 65) or age discrimination related limiting the rehiring of laid-off older workers. Risk is also rooted in the theory of socioeconomic position as a fundamental cause (House, 2002; Link and Phelan, 1995; 2002) of health disparities. A promising future sociological research agenda on age, health, and well-being would build on a growing body of work emphasizing the embeddedness of individuals in particular social structures with corresponding risks, rules, claims, and resources that shape their beliefs, behaviors, health, and life quality over the life course (see House, 2002; Link and Phelan, 1995; Lutfey and Freese, 2005; Phelan and Link, 2005; Phelan et al., 2004; Tilly, 1998; Turner, Wheaton, and Lloyd, 1995; Wheaton and Clarke, 2003). The fundamental cause theoretical approach suggests that changing the allocation and distribution of key socioeconomic resources (such as education and income) early in life may well be the best way to prevent health and mortality risks and to reduce disparities in them (Hasse and Krücken, 2008; Hayward and Gorman, 2004). But adult development and aging are not simply path dependent, unfolding as a result of childhood experiences and early adult choices. (Related to this focus on the early life experience, Kuh and Ben-Shlomo [2004] suggest that “magic bullet” policies of a particular pill or early biological programming of fetal or infant growth are deeply suspect.) Rather, development throughout adulthood takes place within interdependent structures and schemas of interpretation (institutions) guiding its progression and possibilities through processes of allocation, socialization, and strategic adaptation throughout the life course. A promising area of future inquiry concerns institutionalized mechanisms: how the social organization of education, occupations, neighborhoods, consumption, and health care perpetuates differential access to and quality of information, medical treatments, income, stress, self-esteem, and other resources, along with different lifestyle behaviors (such as smoking, exercise, and diet/eating habits). Stress process and life course scholars (e.g., Avison, Aneshensel, Schieman, and Wheaton, 2010; Elder, 1974, 1998; Moen and Chesley, 2008; Pearlin, 1999; Pearlin, Lieberman, Menaghan, and Mullan, 1981; Pearlin, Schieman, Fazio, and Meersman, 2005) underscore the fact that both resources and claims shift with time, altering the social environments in which lives play out. For example, it has been well established in observational research that social conditions of work matter for health and life quality, including positive self-conceptions, depressive symptoms, and behavior, as well as heart disease (e.g., Kahn, 1981; Karasek, 1979; Karasek and Theorell, 1990; Keyes, 1998; Kohn and Schooler, 1982; Mirowsky and Ross, 1998; Muhonen and Torkelson, 2004; Ross and Mirowsky, 1992; Ryff and Keyes, 1995; Thoits, 1999; Wheaton, 1990). But how are favorable social conditions of work and of retirement distributed by age and social location? Much is known about healthy work and the psychosocial job conditions promoting physical and mental health, but the impacts on health and well-being of psychosocial retirement conditions have not been as fully investigated. Rather than focusing on health care or the treating of medical conditions once they have arisen, scholars are increasingly pointing to the value of social and economic policies as “health” policies, in terms of the potential for policy initiatives lessening the risks of 5-10

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PREPUBLICATION COPY—UNCORRECTED PROOFS socioeconomic, gender, race/ethnic, age, and other inequalities at all ages and life stages. This opens up a fertile future research agenda when prevention is framed as social and economic policies, such as those shaping labor markets, social welfare, housing, and pensions, not only health-care policies (Hedge and Borman, 2012; Mechanic, 2006; Schoeni, House, Kaplan, and Pollack, 2008; Syme, 2007). Even ostensibly “age-neutral” policies and practices are often age-graded. For example, a cable company has launched an initiative to “Bridge the Digital Divide” by providing poor households with a computer and Internet connection for a low monthly fee. But “eligibility” is defined by whether the household has a child who qualifies for free breakfasts at school, effectively removing the households of older adults from the pool. A New Risk Environment Scholars are increasingly theorizing “risk” as characterizing the contemporary life experience, concomitant with an uncertain global economy, new information technologies, and the unraveling of conventional employee protections around job security and conventional retiree protections around health insurance and income security (Beck, 1992; Blossfeld, Buchholz, and Hofäcker, 2006; Neumark, 2000; Quadagno, Kail, and Shekha, 2011; Schmid, 2008; Taylor-Gooby, 2004; Williamson, 2011). Taylor-Gooby (2004) defines new social risks as “the risks that people now face in the course of their lives as a result of the economic and social changes associated with the transition to a post-industrial society” (p. 2-3). One set of risks emerges from the need for two incomes to support a family and the attendant difficulties of integrating work and family obligations. Another comes from the rising numbers of older people, along with gendered and family-based patterns of care (Daly, 2001; Pavalko, 2011; Saraceno, 2008). Third are changes in a labor market that has become globally competitive, interdependent, and unpredictable. The risk concept has moved beyond simply safety nets, given that existing safety nets are both increasingly costly and eroding, producing a need for future scholarship capturing the escalation of uncertainty and risk now being institutionalized in the form of temporary jobs, the erosion of the contract linking seniority with job security, and the dismantling of economic security in the move from defined benefit to defined contribution pension programs. A combined institutional and life course research agenda theorizing and investigating age-graded risk would emphasize the ways both the structures and cultures of society (and the social policies and processes they generate) operate so as to unevenly distribute risk across social groups and how these disparities shift with age, life stage, and across cohorts. Research is needed on how established protections for older adults are at risk of diminishing or even unraveling (being deinstitutionalized) and how institutional entrepreneurs might be responding with the development of new arrangements. Sociologists, demographers, and social epidemiologists can make real contributions to science and society by investigating whether and under which conditions deliberate shifts in social structures—including policy regimes shaping retirement, civic engagement, education, housing, income supports, and paid work—produce corresponding shifts in exposure to and durations of risk factors contributing to poor health and mortality. Income and insurance supports (such as Social Security and Medicare aimed at later adulthood), SSI programs (aimed at those with a disability), and private-sector pensions and disability insurance can be key mechanisms for reducing socioeconomic disparities in health and risks among adults as they age. Required are systemic programs of research similar to that by Herd, Schoeni, and House (2008) showing 5-11

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