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1 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 ©TheEditor(s)(ifapplicable)andTheAuthor(s),underexclusivelicensetoSpringerNatureSwitzerland AG2022 Thisworkissubjecttocopyright.AllrightsaresolelyandexclusivelylicensedbythePublisher,whether thewholeorpartofthematerialisconcerned,specificallytherightsoftranslation,reprinting,reuseof illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similarordissimilarmethodologynowknownorhereafterdeveloped. Theuseofgeneraldescriptivenames,registerednames,trademarks,servicemarks,etc.inthispublication doesnotimply,evenintheabsenceofaspecificstatement,thatsuchnamesareexemptfromtherelevant protectivelawsandregulationsandthereforefreeforgeneraluse. The publisher, the authors, and the editorsare safeto assume that the adviceand informationin this bookarebelievedtobetrueandaccurateatthedateofpublication.Neitherthepublishernortheauthorsor theeditorsgiveawarranty,expressedorimplied,withrespecttothematerialcontainedhereinorforany errorsoromissionsthatmayhavebeenmade.Thepublisherremainsneutralwithregardtojurisdictional claimsinpublishedmapsandinstitutionalaffiliations. ThisSpringerimprintispublishedbytheregisteredcompanySpringerNatureSwitzerlandAG. Theregisteredcompanyaddressis:Gewerbestrasse11,6330Cham,Switzerland 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