Table Of Content1
Schriften zu Gesundheit und Gesellschaft –
Studies on Health and Society
Björn Schmitz-Luhn
Christiane Woopen
(Editors)
Justice over the
Course of Life
Biographies in a Society of
Long Lives
123
Schriften zu Gesundheit und Gesellschaft -
Studies on Health and Society
Volume 1
SeriesEditor
ChristianeWoopen,UniversitätzuKöln,Köln,Germany
EditorialBoardMembers
JacquiSmith,UniversityofMichigan,AnnArbor,MI,USA
AllenE.Buchanan,DukeUniversity,Durham,USA
Jens C. Brüning, CECAD-Exzellenzcluster und Max-Planck-Institut für
Stoffwechselforschung,Köln,Germany
LucianoFloridi,UniversityofOxfordandTheAlanTuringInstitute,Oxford,UK
Wolfgang Goetzke, gewi-Institut für Gesundheitswirtschaft e.V. und
GesundheitsregionKölnBonne.V.,Köln,Germany
OliverGröne,OptiMedisAG,Hamburg,Germany
Robert Leicht, Langjähriger Politischer Korrespondent/Long-Time Political Corre-
spondent,DieZEIT,Hamburg,Germany
FortschreitendeDigitalisierung,demographischerWandelundkomplexerwerdende
UmweltenstellenWissenschaftundGesellschaft vorneueHerausforderungen.Die
tiefgreifendenVeränderungenbetreffeninbesonderemMaßeauchdenBereichder
Gesundheit. Eine Vielfalt wissenschaftlicher Disziplinen und Akteure aus allen
gesellschaftlichen Bereichen sind gefordert, um die transformativen Prozesse der
Gegenwartzugestalten.
Die ceres Schriften zu Gesundheit und Gesellschaft bieten ein Forum für
besonders gesellschaftsrelevante Fragen im Bereich der Gesundheit jenseits
disziplinärer Grenzen. In ausgewählten Studien präsentieren sie fachübergreifende
und translationale Analysen, Debatten und Konzepte zur partizipativen Gestaltung
unsererZukunft.
* * *
Digital developments, demographic change and increasingly complex environ-
mentsposeallnewchallengesforscienceandsociety.Theseprofoundchangesalso,
and in particular, affect health-related issues. It requires a variety of scientific
disciplines and actors from all areas of society to shape the current transformative
processes.
TheceresBookSeriesonHealth andSocietyprovidesaforumforthediscus-
sion of particularly relevant societal challenges in the area of health, beyond
disciplinaryboundaries.Inselectedstudies,thebooksofthisseriespresentinterdis-
ciplinaryandtranslationalanalyses,debatesandconcepts,contributingtoparticipa-
tivedesignsforourfuture.
Moreinformationaboutthisseriesathttp://www.springer.com/series/16017
(cid:129)
Björn Schmitz-Luhn Christiane Woopen
Editors
Justice over the Course
of Life
Biographies in a Society of Long Lives
Editors
BjörnSchmitz-Luhn ChristianeWoopen
ceres ceres
UniversityofCologne UniversityofCologne
Cologne,Germany Cologne,Germany
SchriftenzuGesundheitundGesellschaft-StudiesonHealthandSociety
ISBN978-3-030-86448-4 ISBN978-3-030-86449-1 (eBook)
https://doi.org/10.1007/978-3-030-86449-1
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Preface
Great advances in political and societal welfare, medicine, and public health have
affordedoursocietyacontinuousriseinlifeexpectancy,makingtheaverageagewe
canreachtodaythehighestwehavewitnessedinhistory.
The increasing life spans mean substantial and systematic changes for many
aspects of life, including education, work and employment, health services, and
culture. Longer lives also transform our own perception of a typical lifetime, and
affectourplans,imaginations,expectations,andneedsatallages.Asallofusneed
toactively shape increasingly long lifetimes, andas thechangesto all ourareas of
lifecontinuetounfold,wearetransformingintoasocietyoflonglives.
Inshapingourlives,wedependonparametersthatprevailinoursociety—which,
in the long term, are themselves influenced by the very biographic realities and
valuesthemembersofsocietycreate,develop,andelaborate.Inaddition,ourlives
arenotonlylonger,butthewayweage,ourindividualideasofhowtoliveourlives,
ouractionsintheirdifferentstages,andourpreferencesinformingoutourexistence
overthedecadesarebecomingincreasinglydiverse.Theconceptofagingthusalso
embraces increasingly multifaceted aspects, making this new society of long lives
onethatispluralistic,andcharacterizedbydiversityandindividuality.
Today’s historic freedom to shape our lives, however, comes along with a
growing and increasingly complex responsibility: Individual responsibility calls us
tofilltheincreasedlifetimeswithaims,meaning,andanswerstowhatweexpecta
“successful” or “fulfilling,” “flourishing” life to be—and the farther we can plan
aheadforourownlaterlife,themoreaspectsandchanceshavetobeweighed and
consideredforourdecisions.Ourvaluesandpreferencesalsochangeoverthecourse
ofourlifetimes,aswemayadjustourconvictionsandaimstochangeopportunities
andconditions.
Alongside, a collective responsibility arises to integrate our different designs of
longer lives with a functioning society in which individual interests are brought to
collective concordance, in order to guarantee maximum freedom for all. While we
reacttothechanceoflongerlives,wealsocreaterealitiesandvalueseverydaywith
ourdecisionsandplansbywhichwe,inturn,collectivelyinfluencesocietalconcepts
v
vi Preface
and frameworks. As the changes brought about by longer lifetimes continue and
become more pertinent, this also includes safeguarding and renegotiating our col-
lectivevaluesaswellasexistingconceptsandprinciplesofsocietalcoexistence.
In light of all these changes and challenges to shape our society, one principle
seemstostandout:Thelongerourlivesandthemoreimportantourresponsibilityto
considerourlaterlives,themore fundamentalistheroleofsafeguardingjusticeto
andbetweengenerations.Itisnotonlyanenablingconditionforsecureandrational
planning ahead, but also a foundation for a sound and resilient order of society in
whichagrowingnumberofgenerationswhoarealiveatthesametime,willcoexist.
Ajustandequitablesocialsystemisanaturalprerequisiteformeetingtheevolving
changesbytheguaranteeofhumanrights,security,andfairness,whileenablingall
generations to react to them with developing evermore pluralistic and individual
lifestyles.
Inthisvolume,theauthorshighlighttheprincipleofjusticefromtheperspectives
of most pertinent areas of change and challenges associated with an aging society.
The chapters in this book, therefore, focus on three major aspects of justice in an
aging society: Planning ahead, life-long engagement, and participation, as well as
medicalcareandhealthliteracy.
In part one, justice is examined as a condition for successful advanced life
planningandsocialsecurityschemes.Old-agepensionschemesareamosttangible
example.Additionally,socialsecuritymechanismsguaranteeinggoodmedicalcare
at a higher age are considered elementary. Philosopher Dieter Birnbacher shows,
based on John Rawls’ Theory of Justice, and looking at other EU states’ social
systems, that it isprimarily an older generation being at the center of socialpolicy
issues,whereasayoungergenerationtendstobeneglected.Empiricalpsychologist
KlausRothermundpresentsfactorsthatinfluencepeople’spreparationsforoldage,
analyzing the concept of old-age preparation as well as specific measures, e.g.,
regarding health planning and housing. He also shows the difference in their
intensity depending on the phase of life people are in but also on gender, age, and
income. Regarding age-related discrimination in social security systems, legal sci-
entistandphilosopherStefanHusteroffersanewperspectivebyshowingthatageas
such is a particularly egalitarian criterion for legal differentiation, since everyone
will have a certain age at some point in time—but points out that accordingly,
age-related discrimination is seldom based directly on age but rather found in the
shapeofunjustenablingprovisionsofsocialsecurity.
Another fundamental part of human life is social engagement. Part two is
thereforededicatedtojustice asanenablingprinciple forlife-longsocialparticipa-
tion,highlightingbothinter-generationalexchangeandcoexistenceaswellaswork
asoneofthemajorusesoftimeandattainmentinhumanlife.PeterDabrockputsthe
relationshipbetweenfreedom,socialparticipation,andjusticeinthecenter,explor-
ing a synchronic perspective of the relationships between the age groups on theo-
logical grounds. He points out that justice, solidarity, and care are the factors
guaranteeingindividualandsocialbenefits,especiallywithinasocietyfacingdemo-
graphicchanges.MathildeNiehausdevelopsmodelstostrengtheninter-generational
fairness in the workplace, working out the relationships between work, health,
Preface vii
productivity, and age, with particular respect to older workers. Jutta Allmendinger
andEllenvondenDrieschtakealookatthedifferingemploymentsituationbetween
menandwomen,aswellasthedistributionofwork-relatedactivitiesanddutiesover
thelifetime.Theycomeupwithacomprehensiveproposaltobetterallocatework-
relatedeffortsoverthelifetimeaccordingtothedifferentspecificdemandsinvarious
phasesoflifeandwithaviewtolongerlivesandactiveperiodsofemployment.
In its third part, the book deals with inter-generational and social justice for
medical care and health literacy. Health awareness has gained considerable impor-
tanceinallgenerations,andhasalsobecomeanimportantconsiderationforpeople
wanting to live longer lives while avoiding age-related ailments. Psychologist Ralf
Schwarzerdebatespossiblemotivationalandbehavioralsupportinhealthbehavior
changes and the ways in which individuals could be giving an incentive to reduce
health-compromising behaviors. However, as the age of the population increases,
age-relatedconditions,e.g.,Alzheimer’sdisease,mayalsobecomemorecommon.
LegalscientistReinhardDammtakesacloserlookatself-determinationandcarein
people affected, punctuating the specific legal problems regarding care-related
decision-makingofveryyoungandveryoldpeople,andadvocatingfurtherdiscus-
sion about the calibration of self-determination and care. Regarding health literacy
and public enablement for health, Kristine Sørensen presents the findings of the
EuropeanHealthLiteracyProject,whichmeasuredhealthliteracyineightEuropean
countries, and calls for the involvement of health professionals as well as patients
and citizens, the redesign of health infrastructure, and further investment in health
literacy activities. Oliver Gröne continues to carve out the achievements of patient
involvement, citing quality improvements in clinical effectiveness, safety, and
patientcenteredness.
Thetreatisesofthiscollectivevolumehavebeenfirstmadeontheoccasionofthe
inaugurate conference of the Cologne Center of Ethics, Rights, Economics, and
Social Sciences of Health back in September 2014. They haven’t lost any of their
topicality,andcontinue,updatedwhereaffectedbytheongoingdebate,tohighlight
importantaspectsofthedynamicdiscussiontowhichwehopetocontributewiththis
work. It aims to clarify and carve out some of the most significant effects and
requirements brought about by an aging society. We hope that they succeed in
pointing to possible solutions, necessary discussions, and impulses on how to
safeguardandshapeajustandsecuresocialfutureforbotholdandyoung.
Cologne,Germany BjörnSchmitz-Luhn
May2021 ChristianeWoopen
Contents
HowFairIstheGermanOld-AgePensionSystem?. . . . . . . . . . . . . . . . 1
DieterBirnbacher
WhoCaresforWhat?DeterminantsofPreparationforOldAge
AcrosstheLifeCourse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
KlausRothermund
AgeCategoriesinSocialSecuritySystems. . . . . . . . . . . . . . . . . . . . . . . 25
StefanHuster
LifeCourseandSocialParticipation:(NotOnly)aQuestion
ofFairness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
PeterDabrock
FairParticipationforAgingEmployeesattheWorkplace. . . . . . . . . . . 45
MathildeNiehaus
BecomingMotivatedandCompetenttoPerformHealth-Enhancing
Behaviors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
RalfSchwarzer
AutonomyandCareintheLawoftheHumanBiography. . . . . . . . . . . 63
ReinhardDamm
TheExtraYears:CreatingMoreOpportunitiesforWomen
andMenbyRedistributing(Working)Time. . . .. . . . . .. . . . .. . . . . .. 87
JuttaAllmendingerandEllenvondenDriesch
HealthLiteracyinEurope:TheConcept,ItsImpactandApplication. . 99
KristineSørensen
PatientInvolvementinHealthCare:Conceptualisation,Measurement,
UptakeandFutureImprovement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
OliverGröne
ix
How Fair Is the German Old-Age Pension
System?
DieterBirnbacher
1 Introduction
Inthetwenty-firstcentury,thedemandforsocialjusticeisanincreasinglyuniversal
demand for the organisation of societies. This demand is a more or less natural
development from liberal civil right. If civil rights that were hard-fought by the
Enlightenment, such as the right of freedom of opinion, freedom of association,
freedom of religion and free development of one’s personality, are to become
effective under real social conditions, more is required than a legal guarantee of
theserights.Alsorequiredisthelegalguaranteeofthemeansformakinguseofthese
freedoms.“Creatingeffectiveness”ofcivillibertiesrequiressocialrightsthatensure
thateveryonehasatleasttheminimumresourcesrequiredtoutiliseinconcretothe
rightsgrantedinabstracto.
The further development of civil liberties into social rights that “make them
effective” is a world historic process. It is shown in the historical sequence of
politicalconstitutions,thecataloguesofhumanrightsandnotleastinthehistorically
changing understandings of the ethical-political basic concept of human dignity.
WhileforthosewhopioneeredtheconceptofhumandignityduringtheEnlighten-
ment focused on liberties and other defensive rights, in the nineteenth century,
particularlythroughthelabourmovements,theideaofhumandignitywasenriched
withsocialrights,suchastherighttominimumsubsistenceandhealthcareandthe
righttohumaneworkingandlivingconditions.
Therefore, it is no coincidence that “social justice” has become one of the most
frequentlyusedpoliticalslogans,nextto“freedom”and“equality”.Assuch,itstands
together with these others in a certain suspicion of being used as an empty phrase,
D.Birnbacher(*)
Heinrich-Heine-UniversitätDüsseldorf,InstitutfürPhilosophie,Düsseldorf,Germany
e-mail:[email protected]
©TheAuthor(s),underexclusivelicensetoSpringerNatureSwitzerlandAG2022 1
B.Schmitz-Luhn,C.Woopen(eds.),JusticeovertheCourseofLife,Schriftenzu
GesundheitundGesellschaft-StudiesonHealthandSociety1,
https://doi.org/10.1007/978-3-030-86449-1_1
