As the world ages

Rethinking a demographic crisis

Kavita Sivaramakrishnan

— Reviewed by Joelle M. Abi-Rached

13 Feb 2019

Kavita Sivaramakrishnan, As the World Ages: Rethinking a Demographic Crisis.Cambridge, MA: Harvard University Press, 2018. Hardcover, 336 pp., $39.95. ISBN: 9780674504639

The phrase ‘provincializing Europe’ has become a mantra in postcolonial studies since Chakrabarty’s Provincializing Europe: Postcolonial Thought and Historical Difference (2000). But how is it possible to provincialize Europe when we argue, analyze, think, and oftentimes judge in a Western paradigm of norms and values? Sivaramakrishnan’s As the World Ages is a brilliant demonstration of how such a history can be written.

The book examines the contextual politics of aging as it emerged in the peripheries of the colonial world before it morphed into a crisis of global proportions. It is a ‘history of the present,’ faithful to the Foucauldian subversive genealogical approach of debunking origin stories (Rose 1994). In this case, it is the concept of ‘global aging’ as a natural and essentially Eurocentric consequence of an undisturbed history of linear progress and triumphant modernization that is called into question.

Focusing on South Asia and Africa, As the World Ages is a history of the mutations of the various paradigms, articulations, and definitions of aging from the colonial era to the age of globalization. It examines how aging has been problematized, how its agendas and priorities have shifted, how the actors involved in its making (from colonial bureaucrats to international advocates) have changed, how the context itself has moved from a world where population growth was a threat to one in which declining infertility concomitant with a rising aging population have enabled a ‘demographic crisis’. The book is also concerned with how regional and local voices have grappled with, accommodated, questioned, challenged, and contributed to these various debates. While Sivaramakrishnan illuminates these local voices of discontent, she avoids the temptation to romanticize them.

The first chapter traces four narratives on aging that emerged between the 1930s and 1950s. The key actors are colonial experts (demographers, bureaucrats, anthropologists, and Christian missionaries) who were all invested in the profound social changes associated with rapid modernization in the colonies, as well as with deepening anxieties about declining fertility and the implications this would have on labor and productivity.

In the 1950s, Western gerontologists started to shift their focus to the emergent problem of chronic diseases, such as cancer. The second chapter maps the birth of international research networks centered on the biology of such chronic illnesses. Sivaramakrishnan shows how these concerns, which were pertinent to industrialized societies (hence white, middle-aged, male bodies), were then extended and exported to Asia and Africa through a growing international network of new experts on aging. Chronic diseases were still considered – even in the 1950s – symptoms of civilization and signs of modernization, industrialization, and development.  The rest of the world was either ‘catching up’ or ‘adjusting’ to this seemingly inevitable path of population aging.

The third chapter maps the emergence and consolidation of gerontology as a new discipline of aging. It also probes the dissemination of the ‘gerontological gospel’ from Europe and the United States, which had its own ‘exceptional’ trajectory – lagging behind in its care of the elderly for fear of becoming a welfarist state – to the rest of the developing and underdeveloped world.

The fourth chapter looks at the ‘new frontiers’ of the politics of aging as they started to play out in the 1970s and 1980s in both China (which was still controlling its population with its one-child policy) and India.

The fifth chapter examines more deeply the globalization of the ‘problem of aging’ through an analysis of debates at the United Nations and among other international experts. The birth of aging as a ‘universal phenomenon’ was made possible at the World Assembly on Aging in 1982 in Vienna. This is when discussions about longevity, falling fertility, and new social transformations brought about by migration and the financial crisis of the 1970s started to crystallize. Here, Sivaramakrishnan provides us with an interesting insight. As a way to free themselves from Western concerns and priorities, African leaders reframed the problem of aging as a problem caused by the disintegration of traditional societies, where the elderly played a vital sociopolitical role ‘as moral custodians of the community’ (p. 158). However, as Sivaramakrishnan contends, this rosy picture was in fact a way to shrug off some of these states’ failures and inadequate policies in addressing the profound consequences that aging was starting to have on their own societies.

In the 1990s, as developing economies began to neoliberalize and with the entry of new actors (such as international nongovernmental organizations), the elderly were redefined as precarious lives that needed to be saved from the traumas of war and displacement. Casting light on how the elderly were abandoned, bereft, and invisible helped garner international attention, mobilize funds, as well as heighten the humanitarian sensibility of a suffering developing world that often suffers in silence. However, as Sivaramakrishnan argues, this had the unintended consequence of simplifying a much more complex social reality, compartmentalizing identities of what it means to be old or young, rather than addressing the interdependence of such identities.

Throughout her nuanced and rich analysis, Sivaramakrishnan alerts us to the ‘quick-fixes’ of global health and development, like new private markets and enterprises targeting the elderly that have been burgeoning since the 1990s in Asia and around the world.

Although Sivaramakrishnan’s significant contribution lies in sketching the main ruptures and changes, from older colonial concerns and rhetorical formulations around aging to the new global economy of aging, she also reminds us of some of the deep-rooted continuities, namely ‘colonial traditions in social and welfare policies, national networks and the experiences of local frictions and resistance in the sphere of social policies’ (p. 210).

As the World Changes will be of interest to anyone interested in the politics of aging. Historians, anthropologists, sociologists, policy makers, public health experts, and all those interested in development, globalization, and postcolonial concerns, would welcome the book as an insightful analysis of the rise of aging as a global phenomenon. The demographic crisis, so skillfully unpacked by Sivaramakrishnan, will have far-reaching implications beyond the economic ‘burden’ it might cause (World Health Organization, et al. 2011), such as the rise of extremism and right-wing politics (Descamps 2018). But that is a topic for another book. 

About the author

Joelle M. Abi-Rached is a Mellon Postdoctoral Fellow at Columbia University’s Society of Fellows in the Humanities. She is a medical historian who is currently working on a book that explores the rise of psychiatric thinking and practice in the modern Middle East. She was trained as a medical doctor at the American University of Beirut and holds an MSc in philosophy and public policy from the London School of Economics and a PhD in History of Science from Harvard University. With Nikolas Rose, she coauthored Neuro: The New Brain Sciences and the Management of the Mind (Princeton University Press, 2013).


Chakrabarty, Dipesh. 2000. Provincializing Europe: Postcolonial Thought and Historical Difference. Princeton, NJ: Princeton University Press, 2000.
Descamps, Philippe. 2018. ‘Bouleversement démographique en Europe’. Le Monde diplomatique, 1 June, 13–18.
Rose, Nikolas. 1994. ‘Medicine, History and the Present’. In Reassessing Foucault: Power, Medicine and the Body, edited by Colin Jones and Roy Porter, 48–72. Oxford: Taylor and Francis.
World Health Organization, National Institute on Aging, National Institutes of Health, and US Department of Health and Human Services. 2011. Global Health and Aging. NIH Publication no. 11-7737.