David Hill is still working as a rural GP (Tararua Health Group Dannevirke, New Zealand) at the age of 75 and is exploring an alternative model of ageing in which intellectual curiosity, creativity, and doctoral study remain central to later life.
[Read with Piazzolla’s Oblivion played on the bandoneón.]
At 75 years of age in New Zealand, I have to renew my driver’s licence. It would seem to be just a routine administrative act, but it carries a deeper meaning because it is not just about safety but about scrutiny and suspicion. A disturbing shift in status and a disruptive assault on my abilities.
This is not only about age. It is about disability … about how age, disability, gender, race, and class combine to determine who remains visible and who is quietly moved to the margins.
From one day to the next, lived experience becomes presumed decline. I am no longer simply a person who has driven for decades; I am ‘older’, ‘at risk’, less trusted. This is how erasure begins.
Ageism and ableism are embedded within broader systems of inequality. Intersectionality — the recognition that multiple social identities interact to produce compounded disadvantage — is essential to understanding this process.1 Without it, we mistake a single dimension for the whole and fail to see how invisibility is multiplied.
Oblivion as Structural Erasure
Oblivion here is not personal forgetfulness. It is structural and becomes embedded when systems are organised in ways that gradually design certain people out of participation.
No licence, and you lose more than mobility — you lose independence, spontaneity, and access to community. Similar exclusions occur across the built environment, workplaces, healthcare systems, and social services, all of which are frequently designed for a narrow conception of the ‘normal’ user.2 These are not neutral omissions. They are systemic exclusion.
Gender deepens this pattern. Women live longer than men, yet experience more years with disability, lower lifetime earnings, and by implication, exposure to poverty, by design, in older age.3 Disabled women, particularly those from indigenous or racialised communities, experience layered disadvantage arising from the intersection of gender, disability, and structural inequities rooted in colonisation and social stratification (Fredman, 2016).4
The result is not additive disadvantage, but multiplicative erasure.
Longevity, therefore, is not purely biological — it is socially produced.
Intersectionality: Mechanisms of Harm
Understanding this requires attention to mechanism, not just description.
1. Resource deprivation
Gendered labour patterns, interrupted employment, and disability-related costs reduce lifetime wealth. Lower socioeconomic status is strongly associated with worse health outcomes and reduced life expectancy.3
2. Healthcare exclusion and diagnostic overshadowing
Symptoms are often attributed to age or existing disability, leading to missed or delayed diagnoses — a phenomenon known as diagnostic overshadowing.5 Women and minority groups are particularly vulnerable to dismissal of symptoms especially pain, resulting in poorer outcomes.6
3. Social isolation and chronic stress
Social isolation increases risks of depression, cardiovascular disease, and cognitive decline.7 Chronic exposure to discrimination produces cumulative physiological stress — allostatic load — which accelerates disease processes.8
4. Violence and exploitation
Disabled women experience significantly higher rates of violence and abuse, with long-term consequences for physical and mental health.9
5. Policy and service design that normalises exclusion
Transport, housing, and digital systems are frequently structured around economically productive, able-bodied users. Those outside this model face barriers that increase dependency, reduce access to care, and hasten institutionalisation.2
These mechanisms interact dynamically. Poverty worsens health; poor health reduces opportunity; invisibility increases the likelihood of being deprioritised. Longevity, therefore, is not purely biological — it is socially produced. The COVID-19 pandemic exposed this and the fundamental truth: mortality is not distributed randomly. It reflects social structures, political choices, and institutional priorities.10-13
What the Evidence Shows
The empirical patterns are consistent:
• Women live longer, experience more years with disability and greater financial insecurity.3
• Older women are doubly marginalised, experiencing both ageism and sexism in healthcare and social systems.6
• Individuals at the intersection of multiple disadvantages (age × disability × race × gender) experience worse access to care, higher unmet need, and earlier mortality.4
• Internalised ageism and disability stigma are associated with poorer health behaviours, reduced recovery, and shorter life expectancy.14
Invisibility is not metaphorical. It is measurable, and it is consequential.
Astor Piazzolla’s Oblivion offers a striking analogue … The music does not simply mourn loss. It refuses erasure.
Piazzolla’s Oblivion: The Persistence of Presence
Astor Piazzolla’s Oblivion offers a striking analogue. Its phrases descend and dissolve, as if disappearing. Yet the melody does not vanish — it persists, insistently.
This is the paradox of those subject to intersectional marginalisation. Society may script them for disappearance, but they endure — not by accident, but by necessity.
What appears as fragility is also resistance. What appears as slowing is also depth. What repeats is not redundancy, but testimony. The music does not simply mourn loss. It refuses erasure.
The Toll: When Invisibility Becomes Biology
The consequences are not evenly distributed:
• Social exclusion increases depression, cardiovascular disease, and cognitive decline.7
• Disabled and older women are more likely to experience unmet healthcare needs and financial strain.2
• Chronic discrimination elevates allostatic load, accelerating the onset of disease.8
Invisibility becomes embodied. It becomes physiology. It becomes earlier death.
Ageing and disability are not, in themselves, erasure. They are transitions into different forms of presence … Oblivion is not inevitable.
Refusing Oblivion: Structural Change
If erasure is structural, so must be the response.
Material redistribution
Income security, disability cost support, and retirement systems must reflect real life courses, including caregiving and disability.
Universal design and accommodation
Accessibility must be foundational. Systems should be designed for diversity, not retrofitted after exclusion.
Healthcare reform
Clinicians must recognise diagnostic bias and provide culturally safe, gender-aware, disability-competent care. More fundamentally, healthcare must move from episodic, reactive models to a contextual, longitudinal understanding of health — recognising that health trajectories are shaped by cumulative exposures across the life course.3
Enforcement of anti-discrimination law
Protections must operate across intersecting identities, with outcomes — not intentions — monitored.
Cultural revaluation
Ageing and disability must be reframed as sources of knowledge and contribution. Indigenous and relational worldviews offer alternative models that centre continuity, interdependence, and meaning.15
Data that reveals inequity
Outcomes must be disaggregated across age, gender, disability, ethnicity, and socioeconomic status. Without this, inequity remains structurally invisible.
The Final Note
Oblivion teaches us something essential: even as the melody fades, it persists.
Ageing and disability are not, in themselves, erasure. They are transitions into different forms of presence. The tragedy is not decline. It is society’s refusal to recognise and reorganise around difference. Oblivion is not inevitable. It is designed and constructed, and what is constructed can be dismantled —not quietly, but structurally, and together.
What appears to be concern for safety or efficiency can become a mechanism through which some lives are valued and others rendered progressively less visible.
Michel Foucault, whose intellectual journey was itself diverse and not diminished by time, moving from analyses of madness and institutions to questions of ethics, selfhood, and human freedom, offers an immersive way of understanding oblivion. In his earlier work, particularly Discipline and Punish, he described how modern institutions classify, observe, measure, and normalise individuals (Foucault, 1977).16 Power does not operate only through prohibition; it operates by defining what counts as normal.
Ageing and disability therefore become more than biological states. They become deviations from socially constructed norms of productivity, independence, efficiency, and control. Yet age rarely acts alone. It intersects with disability, gender, ethnicity, and socioeconomic status, creating multiple layers of surveillance, classification, and exclusion. What appears to be concern for safety or efficiency can become a mechanism through which some lives are valued and others rendered progressively less visible.
… ageing and disability need not represent decline. They can become opportunities for what Foucault described as an ‘aesthetics of existence’: the deliberate creation of a meaningful life outside dominant expectation.
The routine requirement to renew a driver’s licence at age 75 illustrates this process. Whatever its practical justification, it carries symbolic weight. The experienced driver becomes a subject of surveillance. Capability is no longer assumed but questioned. The issue is not simply transport. It is membership of the category of the competent citizen.
Foucault would recognise this as part of a wider process through which institutions distinguish the normal from the abnormal, the productive from the dependent, and the visible from the invisible.
But the power of these classifications depends upon a prior assumption: that there exists such a thing as a ‘normal’ body against which all others can be measured. As Lennard J. Davis argues, normality is not a natural fact but a historical and statistical invention that emerged alongside modern industrial and bureaucratic societies (Davis, 2013).17 Once normality becomes the benchmark, ageing, disability, and other forms of difference are increasingly understood as deviation rather than variation.
In Foucault’s later work, Technologies of the self, he shifted attention from how people are governed to how they govern themselves.18 Rather than accepting identities imposed by institutions, individuals can engage in what he called ‘technologies of the self’ — practices through which people consciously shape their own lives.
From this perspective, ageing and disability need not represent decline. They can become opportunities for what Foucault described as an ‘aesthetics of existence’: the deliberate creation of a meaningful life outside dominant expectation.
The tragedy of ageism is therefore not simply exclusion from work, transport, or public life. It is the assumption that a person whose body changes has less value to contribute. The question, then, is not whether older and disabled people remain useful. It is why usefulness has become the primary measure of human worth.
It has been great to be reminded by Foucault that institutions do not simply manage difference; they design the norms by which difference is judged. Whether through colonial classifications of race, enforced poverty, capitalist valuations of productivity, or contemporary assumptions about ageing and disability, the consequence is often the same: those who fall outside the norm risk becoming progressively less visible.
The ageing voice is not necessarily rejected; it simply becomes easier not to hear … That is the essence of oblivion. Not disappearance but being rendered progressively silent.
As I write this, I am aware of another irony. I recently contacted the editor of a medical journal to ask whether there might be interest in an essay on ageing. I was told the team would consider it and respond. No response came. Perhaps there is a mundane explanation. Most silences do.
Yet ageism and disability rarely announce themselves openly. It seldom arrives as hostility. More often it appears as delay, omission, non-response, and the gradual withdrawal of attention. The ageing voice is not necessarily rejected; it simply becomes easier not to hear.
That is the essence of oblivion. Not disappearance but being rendered progressively silent.
References
- Crenshaw, K. Demarginalizing the intersection of race and sex. A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics. University of Chicago Legal Forum, 1989; 1989(1): 139–167.
- World Health Organization. Global report on ageism. WHO, 2021.
- Marmot M, Allen J, Boyce T, et al. Health equity in England: The Marmot review 10 years on. Institute of Health Equity, 2020.
- Fredman S. Intersectional discrimination in EU gender equality and non-discrimination law. European Commission, 2016.
- Jones S, Howard L, Thornicroft G. Diagnostic overshadowing. Acta Psychiatr Scand 2008; 118(3): 169–171.
- Samulowitz A, Gremyr I, Eriksson E, Hensing G. “Brave men” and “emotional women”: A theory-guided literature review on gender bias in health care and gendered norms towards patients with chronic pain. Pain Res Manag 2018; 2018: 6358624.
- Holt-Lunstad J, Smith TB, Baker M, et al. Loneliness and social isolation as risk factors for mortality. Perspectives Psychol Sci 2015; 10(2): 227–237.
- McEwen BS, Wingfield JC. The concept of allostasis in biology and biomedicine. Hormones & Behavior 2003; 43(1): 2–15.
- Hughes, K, Bellis MA, Jones L, et al. Prevalence and risk of violence against adults with disabilities: a systematic review and meta-analysis of observational studies. Lancet 2012; 379(9826): 1621–1629.
- Steyn N, Binny RN, Hannah K, et al. Estimated inequities in COVID-19 infection fatality rates by ethnicity for Aotearoa New Zealand. N Z Med J 2020; 133(1521): 28–39.
- Ministry of Health NZ. COVID-19 mortality in Aotearoa New Zealand: Inequities in risk. Ministry of Health NZ, 2022.
- Social Care Working Group. The association between the discharge of patients from hospitals and COVID in care homes. A Consensus statement from the Social Care Working Group to SAGE. Scientific Advisory Group for Emergencies, UK Government, 2022.
- Dutey-Magni PF, Williams H, Jhass A, et al. COVID-19 infection and attributable mortality in UK care homes: Cohort study using active surveillance and electronic records. (March-June 2020). Age Ageing 2021; 50(4): 1019–1028.
- Levy, B. Stereotype embodiment: A psychosocial approach to aging. Curr Dir Psychol Sci 2009; 18(6): 332–336.
- Durie M. Whaiora: Māori health development (2nd edn). Oxford University Press, 1998.
- Foucault, M. Discipline and punish: The birth of the prison. Pantheon Books, 1977.
- Davis LJ. The end of normal: identity in a biocultural era. University of Michigan Press, 2013.
- Foucault M. Technologies of the self. In: LH Martin, H Gutman, PH Hutton (eds), Technologies of the self: A seminar with Michel Foucault (pp. 16–49). University of Massachusetts Press, 1988.
Photo by Facu Montanaro on Unsplash
