ORIGINAL ARTICLE
DENDASCK, Carla Viana [1], COSTA, Rogério da [2]
DENDASCK, Carla Viana. COSTA, Rogério da. Inter-generational affections as a tool for social determinants of health: analysis of the film ‘The Intern’. Revista Científica Multidisciplinar Núcleo do Conhecimento. Year 08, Ed. 12, Vol. 01, pp. 77-91. December 2023. ISSN: 2448-0959, Acess link: https://www.nucleodoconhecimento.com.br/health/inter-generational-affections, DOI: 10.32749/nucleodoconhecimento.com.br/health/inter-generational-affections
ABSTRACT
The Social Determinants of Health (SDH) establish a new direction for understanding the health-disease process in contemporary societies, considering that individuals both affect and are affected by all contexts, situations, events, and the way they process and develop their cognitions. Factors such as environment, economic, social, and cultural life become direct contributors to health outcomes. Within this perspective, the World Health Organization (WHO) established a Commission in 2005 with the aim of not only consolidating these parameters but also producing scientific evidence, creating tools and policies for the implementation of SDH, and consequently promoting health equity. In this context, this study aims to analyze intergenerational affections present in the film “The Intern” as a potential tool within the SDH. Finally, it is suggested that this reflection may encourage the creation of intergenerational environments by various social, institutional, and governmental actors focusing on direct action for health equity.
Keywords: Social Determinants of Health, Generation, Intergenerational, Health Equity.
1. INTRODUCTION
In Western society, the understanding of the health-disease process has undergone various paradigms, producing theories and models that have been modified according to historical context and scientific advancements. These paradigms evolved from the mythical-religious model in Ancient Greece, passing through the miasmatic and biomedical models, until reaching the Social Determinants of Health (Backes et al., 2009).
Although there are still various definitions of Social Determinants of Health (SDH) in the literature, all agree on their essence—namely, that individuals are both affected by and affect everything around them. Consequently, the health-disease process represents a way in which they comprehend these influences. According to Buss and Pellegrini Filho (2007), all approaches converge on the fact that SDH cause health inequities.
The World Health Organization (WHO) defines SDH as:
As circunstâncias nas quais as pessoas nascem, crescem, trabalham, vivem, e envelhecem, e o amplo conjunto de forças e sistemas que moldam as condições da vida cotidiana. Essas forças e sistemas incluem sistemas e políticas econômicas, agendas de desenvolvimento, normas sociais, políticas sociais e sistemas políticos (OMS [s.d.]).
This understanding led to the creation of a World Commission on Social Determinants of Health (SDH) in 2005, with the goal of developing comprehensive policies, tools, and mechanisms to implement SDH in the pursuit of health equity. The Commission also organizes global conferences with the participation of government, social, and institutional actors to coordinate policies of shared responsibility and engagement of all stakeholders (Fiocruz, 2023).
Buss and Pellegrini Filho (2007) mention four levels of intervention in SDH: The first level addresses individual factors related to culture, lifestyle, and behavioral factors. The second corresponds to society and networks of relationships. The third level includes material and psychosocial policies, and finally, the fourth level consists of macro determinants such as market and labor macroeconomics, environmental protection, peace culture, sustainability, etc.
Thus, the proposal of this study, which aims to investigate how intergenerational affections can act as a tool within the Social Determinants of Health, is grounded in the second and third levels of intervention. It involves both networks of relationships (second level) and the creation of healthy work environments (third level). The analysis was conducted through the film “The Intern,” a dramatic comedy produced by Nancy Meyers and Suzanne Farwell, released in 2015, which explores various aspects of SDH impacting health, such as retirement, belonging, social relationships, depression, among other factors that directly affect the main character.
Ben Whittaker, portrayed by actor Robert De Niro, decides to return to professional life at the age of 70 after retiring and becoming a widower. He is hired by a fashion company that operates directly in the online environment, led by a young woman named Jules Ostin, played by Anne Hathaway. The technological and intergenerational environment presents various challenges for all involved, and as these challenges are overcome, a rich experience is created for both Ben Whittaker and Jules Ostin, ultimately contributing to an improvement in the quality of life and, consequently, health for both parties.
The comedy is primarily triggered by the behavioral differences between generations in the organizational environment. According to Santos et al. (2014), organizations have never had to deal with so many generations with such distinct characteristics living simultaneously. The generations that are most active in the contemporary corporate environment are the Baby Boomers, Generation X, and Generation Y. However, it is estimated that currently seven generations are coexisting (Novaes, 2018). Although the literature is controversial regarding the exact birth year range that classifies a generation, the general characteristics and environment remain the same, guiding behaviors, conduct, and values that are collectively shared, as will be observed in the following sections of this study.
2. INTERGENERATIONAL AFFECTION AS A TOOL WITHIN THE SOCIAL DETERMINANTS OF HEALTH (SDH)
In the first scene of the movie, while a group of people is practicing yoga, Ben’s voice is heard in the background. Before introducing himself, he begins with the phrase: ‘Freud used to say: Love and work. Work and love. That’s what matters.’ This opening not only highlights the value that work holds for the character, who is currently 70 years old and belongs to the Baby Boomer generation. According to Santos et al., (2014), this is a post-war generation that, while operating in an environment of economic recovery, experienced the early impacts of globalization and capitalism, with one of its main characteristics being commitment and love for work.
Even though it’s a post-war generation, Max Weber (2004) had already anticipated that this would be a natural development for the capitalist and high-production drive that the United States was implementing. As a result, what became evident was a generation entirely inclined towards results and work. According to Santos et al., (2014, p.31), ‘members of this group are known for ‘wearing the company’s shirt.”
For the World Health Organization, despite the increase in life expectancy, challenges for healthy aging with quality of life are still significant for most countries. According to WHO (2005), most pathologies affecting the elderly are associated with the biopsychosocial factors also outlined in the SDH.
In Brazil, in 2005, the ‘Healthy Brazil’ project was launched with the aim of promoting healthier ways of living according to life stages, with a special focus on aging (Brazil, 2005). Among the actions already taken are policies to encourage return to work. Because, as highlighted by the character Ben, ‘feeling useful’ is crucial for this generation. In this sense, it is important to note that when talking about policies, reference is not only made to government policies but also to social policies. These often emerge subjectively in the adoption of sustainable behaviors for social well-being, which in this case would be society’s empathy for the inclusion of people from different categories. An example is the inclusion of seniors in the job market.
It was precisely through an inclusion policy that the character Ben, along with other seniors, was hired by the startup company founded by the character Jules Ostin, belonging to Generation Y. According to Rudge et al. (2017), this generation comprises those born between 1978 and 1990, many of whom are inclined towards significant leadership and innovations, always seeming to exude a sense of urgency and being little inclined to understand routines and processes, constantly seeking to break paradigms and achieve immediate results.
According to Tapscott (2009), these characteristics influence working life as a whole, such as the desire for remuneration linked to their respective performances. Moreover, consumption characteristics would be linked to immediacy and trends, replacing the need to build large assets, such as properties or houses, with the consumption of sensations and experiences, such as travel or dinners.
It should also be mentioned that Generation Y experienced the transition from an analog to an extremely digital and globalized world, where patterns, including cultural ones, no longer belonged to a specific group or geolocated space but became shared and often hybridized (Cordeiro, 2012).
This transition from one generation to another, bringing the viewer into the current context, is introduced by the scene cut that separates Ben’s introduction from the narrative’s shift to the contemporary context. The effects of this transition can be clarified by Deleuze (2018, p.13):
[…] O movimento não se confunde com o espaço percorrido. O espaço percorrido é passado, o movimento é presente, é o ato de percorrer. O espaço percorrido é divisível, e até infinitamente divisível, enquanto o movimento é iThe sound of keyboards, the background music chosen, scenes demonstrating the breaking of social paradigms, and engagement in the digital world compose the characteristics presented by the character Jules, introduced in the very first scene cut, even before her appearance. This technological context inevitably influences the health and disease processes of this generation, translating into a set of social experiences and interactions that tend to lead to pathologic features, to a greater or lesser extent (Costa Junior and Couto, 2015).
According to Rudge et al. (2017), Generation Y was the first to be considered entirely disruptive compared to previous generations, which followed patterns with fewer paradigm shifts, always seeking to break with any historically grounded or established concepts. However, while society managed to break many traditionalist boundaries, the lack of a solid foundation in a liquid society brought some challenges in terms of health, especially mental health.
In 2021, the Ministry of Health issued a technical report proposing a plan to address various Chronic Non-Communicable Diseases (NCDs) in Brazil, with the aim of implementing a series of actions between 2021 and 2030. According to the Ministry of Health, in 2019, 54.7% of deaths in Brazil were caused by NCDs, marking a reverse scenario in epidemiological attention as it was previously. Most of these diseases are linked to alcohol consumption, lack of physical exercise, obesity, nutritional factors, and mental health issues such as anxiety and depression (Brazil, 2021).
Alves (2011) points out that the confluence of intergenerational contexts and rapid changes in the status quo of beliefs and attitudes has become a promising field for the development of psychological disorders, such as anxiety and depression.
It is precisely within this life context that the character Jules is presented. Despite being a successful businesswoman, she struggles to effectively handle her marriage or the criticisms of shareholders regarding her approach to business. She finds herself in the midst of an existential crisis trying to save her marriage while also needing to share the management of the company she founded. Ben’s arrival at the company proves to be entirely awkward in the treatment and misunderstanding directed towards the elderly interns, starting with standard questions from interviewers without consideration for context, such as: ‘How do you see yourself in ten years?’ – ‘Why did people use phone books and not Google?’
Despite the distinct professional environment from his roots, Ben takes an uncommitted approach to embrace the new environment and tries to act with subtlety and understanding, often appreciating this labor movement, as, in the end, what mattered to him was feeling productive and active, innate characteristics of his generation.
Ben is assigned to work with Jules, who always multitasks, rides a bike inside the company to attend dozens of micro-meetings a day, and is constantly ultra-connected and overloaded. Lipovetsky (2007) notes that this overload is associated with hedonistic values, where individuals have such high self-esteem that they tend to consider themselves irreplaceable. However, they are revealed to be the most vulnerable when facing disappointments, often lacking emotional intelligence and developing deep conflicts in everyday situations since their environment is mostly formed by virtual social relationships.
According to Azevedo (2016), the health impacts of this exposure mainly occur due to mental stress, including issues such as: a) Headache; b) Muscle pains; c) Difficulty relaxing and sleeping at night; d) Anxiety; e) Depression; f) Obsessive-compulsive disorder (OCD); g) Distress; h) Difficulty concentrating; i) Chronic fatigue; j) Increased alcohol and drug consumption; l) Dysphoria and mood swings; m) Cardiovascular changes; n) Respiratory rhythm changes; o) Fear reactions; p) Mental confusion and dissociative symptoms; q) Increased risk of eating disorders; r) Sleep disturbances/restless sleep.
Throughout the plot, most of these symptoms belong to the world of the protagonist Jules as she faces everyday situations and demonstrates an inability to deal healthily with interactions. However, the approach of intern Ben, through intergenerational coexistence, especially in attention and care in relationships, emerges as a paradigm shift and a foundation for both sides. Ben, after witnessing Jules’ driver drinking on the job, intervenes and ends up becoming Jules’ driver, thus getting closer to her family. Initially, Ben is taken aback as he understands that Jules’ husband plays the role of a ‘stay-at-home dad’ and is responsible for tasks that, in his time, were traditionally associated with women. On the other hand, he begins to admire Jules’ effort to handle this leadership role, which was previously exclusively assigned to men, creating an admiration for Jules’ performance.
The shared living situations between the characters, especially in the way they see the world and conceive their respective views, lead to a mutual feeling of esteem and affection starting to emerge. The bonds of shared experiences begin to break many preconceptions of both characters, allowing them to embrace ‘new possibilities.’ Jules is going through a crisis both at work and in her family, while Ben is relearning to live and break habits. For example, welcoming a coworker to spend time in his home or starting a relationship with the company masseuse, Fina (a character portrayed by Rene Russo).
At work, Jules’ inability to relate to people and her extremely busy schedule seeking rapid company growth lead shareholders to see a certain threat in her management. They request that she find a more experienced CEO to take over. Jules’ modus operandi aligns with the perception of Comazzetto et al.; (2016, p.47) when commenting on the characteristics of Generation Y in the workplace: ‘they are relational workers, immersed in flows of all kinds, with an intelligence associated with the collective, constantly producing new figures of subjectivity.’
Despite initially resisting upon learning that her husband was cheating on her, Jules begins to consider hiring a CEO so she can dedicate herself to her family and try to save her marriage. The fear of being alone and the perception that it is much more difficult for women to find a partner lead Jules to retrieve feelings and behaviors that belonged to past generations, directly affecting her mental state and self-confidence (Perrone et al., 2012). The resistance in the way she deals with and accepts criticism, as well as the search for the reason behind human nature in her actions, is evident in how Jules tries to handle the circumstances, being trapped in the significance that work has in her life and the paths her marriage is taking. As Comazzetto et al.:
A resistência e a criação caminham juntas, e este é paradoxo que demanda uma nova ação das empresas. A recusa de uma relação de trabalho e que pode ser melhor definida como a recusa da alienação da vida é parte fundamental para o investimento pessoal na inovação e desenvolvimento para a nova geração (Comazzetto et al., 2016, 148)
Despite not sharing her suffering with anyone, Ben’s approach causes him to witness her husband’s betrayal at a certain moment, greatly empathizing with Jules. She, upon confiding that she knows about her husband’s betrayal and is considering stepping down from the company presidency as a result, seeks wise words from Ben to guide her. At the end of the film, the character finds reinforcement in her friend’s only direct words, providing her with support for decision-making regarding the company and her husband, who ultimately confesses his infidelity and regrets his actions. Jules accepts these apologies, aiming for a fresh start in her family and business.
According to Leite and França (2016), the coexistence between different generations is beneficial, especially as a rich conduit for emotional solidarity and the meeting of emotional skills. If older individuals can provide wiser experiences and views on certain subjects, younger ones can, through affection, promote the breaking of prejudices that were previously inherited from previous generations, providing them with a new way of understanding the world. Thus, intergenerational coexistence is a two-way street in the process of teaching and learning models and possibilities of living from one generation to another. Leite and França’s (2016) study conducted in an intergenerational university environment demonstrated that intergenerational exchange is beneficial for both sides, favoring the character, health, and citizenship of the involved individuals.
Although most studies tend to investigate the benefits of intergenerational coexistence focused on the elderly, as Santos et al. (2023) point out, what we can observe in the depicted story is that the benefits of this coexistence will be felt by all the actors involved. In each of the generations, as well as in individual life experiences, there will be positive and negative aspects, and intergenerational human coexistence can provide support for better living and facing situations, ensuring a better quality of life for everyone involved.
3. FINAL CONSIDERATIONS
Despite the understanding of health-disease processes having gone through many moments in Western history, directly influencing the mechanistic way in which doctors and researchers viewed levels of attention and care, the understanding that Social Determinants of Health (SDH) directly influence the health-disease process brings new perspectives to the way of caring for humans and promoting health.
Much more than treatment actions or medication, SDHs aim to establish preventive mechanisms for health to be established in society in an integral way. Acting on triggers that precede disease, thus going in the opposite direction of the biomedical model, seeing the individual as a result of the factors surrounding them.
Intergenerational coexistence can promote quality of life for all involved in relationships. However, for this coexistence to be beneficial and achieve its objectives, it is necessary for the parties involved to be willing to share their experiences, without the cultural resistance that Western generations have established.
In the film, it was possible to observe some interesting aspects in this regard. The resistance of the character Jules, for example, who initially considered that Ben’s character had nothing to add and ultimately became his best friend and a great support. To overcome the barriers in the union of these two characters, some concurrent actions were necessary. The first of these was the implementation of an inclusive policy that allowed the company to hire retirees, enabling them to return to work and feel useful. It became clear that these specific policies must be targeted so that this coexistence can be fostered. Initially, the policy should benefit the quality of life of retirees who, due to feelings of uselessness, as well as various age-related situations, tend to develop various pathologies, including mental ones. However, it was observed that life experience and commitment tend to promote intergenerational aspects in organizations that proved necessary for both sides.
The second situation was the willingness of one side to “break down the barriers of prejudice” and extract the best from the coexistence. In the case of the film, this role was played by the older character, but it is understood that it could have been developed by either side, thus establishing the beginning of a coexistence capable of promoting quality of life and health for all involved.
The reflections brought in this material help foster new understandings and policies in the importance of looking at intergenerational coexistence to generate a healthier, fairer, and more equitable society.
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APPENDIX – FOOTNOTE
3. It is important to clarify at this point that the appropriation of the terminology ‘affection(s)’ and ‘affected’ is being adopted within the framework of the philosopher Baruch Spinoza’s theory of affects. In other words, affections are considered as the body being affected by the world. We are bodies that relate to other bodies when we undergo their affections. When we are affected by other bodies, our power either increases or decreases.
[1] Ph.D. in Psychology and Clinical Psychoanalysis. Currently pursuing a Ph.D. in Communication and Semiotics at the Pontifical Catholic University of São Paulo (PUC/SP). Holds a Master’s degree in Religious Sciences from the Mackenzie Presbyterian University. Also has a Master’s degree in Clinical Psychoanalysis. Completed undergraduate degrees in Biological Sciences and Theology. With over 15 years of experience in Scientific Methodology (Research Methods), providing guidance for the Scientific Production of Master’s and Ph.D. students. Specializes in Market Research and Health-related Research. ORCID: https://orcid.org/0000-0003-2952-4337. Lattes: http://lattes.cnpq.br/2008995647080248.
[2] Ph.D. in History of Philosophy (Université Paris IV – Sorbonne); Master’s in Philosophy (USP); Systems Engineering (UERJ). ORCID: https://orcid.org/0000-0002-6807-4263. Currículo Lattes: http://lattes.cnpq.br/4983570722211746.
Submitted: November 13, 2023.
Approved: November 22, 2023.
