A theory of age exclusion through closure: ‘Chronological age’ to ‘clinical need’

In an approach, I term ‘age exclusion through closure,’ I describe the exclusion of older people, from the workforce, and from hospital-based continuing care in Britain. Nineteenth century socioeconomic changes—the introduction of workplace technology, social surveys, the New Poor Law, and workhouse isolation, culminated in workforce exclusion on the grounds of chronological age. In the 20th century, the Poor Law ‘therapy’/‘succour’ divide, was recast in the Welfare State ‘health’/‘social care’ divide. Socioeconomic changes—the rising cost of health care, demographic change, the development of geriatric medicine, and economic restructuring, have served to allocatively ration ‘continuing care’ at this interface through the criteria of ‘clinical need.’ To conclude, age has become forged to clinical need, to become a formidable force of exclusion and exploitation perpetuating Poor Law closure between those ‘able’ and ‘unable’ to work, and creating a consequent ‘process of subordination’ within Welfare State capitalism.