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- 5. Health and Carein Ageing Societies A new international approach LIZ LLOYD AGEING AND THE LIFECOURSE
- 6. Health and Carein Ageing Societies A new international approach Liz Lloyd
- 7. First published inGreat Britain in 2012 by The Policy Press University of Bristol Fourth Floor Beacon House Queen’s Road Bristol BS8 1QU UK Tel +44 (0)117 331 4054 Fax +44 (0)117 331 4093 e-mail [email protected] www.policypress.co.uk North American office: The Policy Press c/o The University of Chicago Press 1427 East 60th Street Chicago, IL 60637, USA t: +1 773 702 7700 f: +1 773-702-9756 e:[email protected] www.press.uchicago.edu © The Policy Press 2012 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library. Library of Congress Cataloging-in-Publication Data A catalog record for this book has been requested. ISBN 978 1 86134 918 7 paperback ISBN 978 1 86134 919 4 hardcover The right of Liz Lloyd to be identified as author of this work has been asserted by her in accordance with the 1988 Copyright, Designs and Patents Act. All rights reserved: no part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise without the prior permission of The Policy Press. The statements and opinions contained within this publication are solely those of the author and not of The University of Bristol or The Policy Press. The University of Bristol and The Policy Press disclaim responsibility for any injury to persons or property resulting from any material published in this publication. The Policy Press works to counter discrimination on grounds of gender, race, disability, age and sexuality. Cover design by The Policy Press Front cover: image kindly supplied by istock Printed and bound in Great Britain by TJ International, Padstow The Policy Press uses environmentally responsible print partners
- 8. iii Contents List of abbreviationsiv Foreword by Judith Phillips v Acknowledgements vi one Introduction 1 two Patterns and trends in ageing and health 11 three Understanding health and care 27 four The policy process in health and care 47 five Healthy ageing: upstream actions to prevent illness 69 six Medicine, ageing and healthcare 89 seven Care for health in later life 111 eight Conclusion 131 References 141 Index 161
- 9. iv Health and carein ageing societies List of abbreviations ADL Activity of Daily Living DALY Disability Adjusted LifeYears GBD Global Burden of Disease GDP Gross Domestic Product IADL Instrumental Activity of Daily Living IFI international financial institution IMF International Monetary Fund INGO international non-governmental organisation MDGs Millennium Development Goals MIPAA Madrid International Plan of Action on Ageing NGO non-governmental organisation OECD Organisation for Economic and Social Development UNRISD United Nations Research Institute for Social Development WHO World Health Organization
- 10. v Foreword Judith Phillips A globalview of the complex relationship between health, care and ageing is provided in this refreshing approach to significant issues of later life.The book challenges a number of key assumptions of policy and practice,such as stereotypes of older people as a burden and drain on resources and society. It also questions the narrow and negative focus on healthcare in contrast to promoting positive health and well-being. Underpinning the discussion are frameworks to help the reader critique the processes involved in health and social care policies and the dominant discourses that have pervaded our thinking of how to address health and social care needs of an older population.An ethics of care approach and an understanding of the lifecourse are central to the reframing of these issues. This book captures the essence of the‘Ageing and the Lifecourse’series,based on critical gerontology and lifecourse perspectives. With renewed interest in mid and later life, the series ‘Ageing and the Lifecourse’ bridges the gaps in the literature as well as provides cutting-edge debate on new and traditional areas of ageing within a lifecourse perspective, while focusing on the social rather than the medical aspects of ageing. Such an approach will appeal to professionals as well as academics engaged in these debates at local, regional, national and global levels. It has considerable relevance to policy makers in health and social care, particularly at a time when,in many parts of the world,economic considerations are in the forefront of the debate on how to provide health and social care in ageing societies.
- 11. vi Health and carein ageing societies Acknowledgements Thanks are due to many people for the generous support they have given throughout the process of writing and producing this text. I am most grateful to Alison Shaw and the staff atThe Policy Press,who provided excellent support and guidance throughout, to Judith Phillips for her advice on developing the book and to the anonymous reviewer whose constructive comments were very helpful at the completion stage. I am equally grateful to my colleagues at the School for Policy Studies as well as to my friends and family who have provided unstinting support and encouragement.Particular thanks are due toAilsa Cameron,Marion Lovell-Jones, Randall Smith, and above all to Ed Cape.
- 12. 1 one Introduction Ageing,health and careare complex and contentious concepts and have become inextricably linked in policy debates around the world.Apocalyptic‘time-bomb’ messages continue to circulate,although they are now often accompanied by the more positive message that population ageing is a cause for celebration.The policy agenda on health and care in the context of ageing societies appears to have been settled and the task at hand is not to seek answers about the best way to respond so as much as to ensure compliance at local,national and international levels to a particular set of principles, consistent with a wider neoliberal economic agenda. Despite the economic crises of recent years,the neoliberal agenda remains firmly in place in the context of policies on health and care. TheWorld Health Organization estimates that by 2025,63% of all deaths in the world will be among the over-65s. In high-income countries, the 20th century saw greater increases in life expectancy than in the whole of previous history. According to the Global Forum for Health Research (www.globalforumhealth. org) almost 85% of deaths in high-income countries now occur after the age of 60,compared with 45% in low- to middle-income countries.Trends such as these might be seen as a cause for either celebration or deep anxiety, but in any case warrant serious attention so as to understand their impact on social and cultural life.In countries with established welfare states these trends have taxed the minds of policy makers over recent decades and,allowing for some variations,an agenda for health and care has emerged which has two overarching principles.The first of these is that a focus on the gap between life expectancy and healthy life expectancy is crucial.Accordingly, policies should be focused on the promotion of healthy and active ageing so that independence can continue for as long as possible in later life.The second is that governments should keep a tight rein on spending in health and social care so that when older people begin to fail in their attempts to maintain self-reliance and become dependent on others, the costs of caring for them are contained.These two principles permeate a range of policies at all levels, from the local to the global, and both of them generate a host of questions as to their viability, necessity and applicability in different contexts. Consistent with neoliberal economic policies, the tight rein on spending is widely regarded as meaning that the private,for-profit sector should replace the state as the primary provider of services,because of its perceived greater efficiency.The private sector is also central to the related policy discourse of consumerism, which entails the individualisation of services and the promotion of choice for older people as service users. In the context of globalisation, debates in one country or region reverberate around the world.Thus, care for older people in the affluent ‘global north’ relies to a large extent on a supply of cheap labour from the countries of
- 13. 2 Health and carein ageing societies the‘global south’.As populations in the global south are also ageing very rapidly, ethical questions arise about the impact of the migration of health and care workers on the countries of origin that can ill afford to lose them. One way of understanding how these principles became so firmly established in policy agendas is to analyse policies as processes,which are continuously taking place in the context of a globalised economy.A core focus of this book is on the ways in which conceptualisations of healthy ageing and the conditions of caring developed in high-income countries have found their way into global policies, despite socioeconomic inequalities and cultural and historical differences.There is a parallel policy discourse of rights,which is seen in the demands of older people for action on age discrimination and decent pensions, as well as in campaigns to improve healthcare and tackle global inequalities in health.There is an ongoing conflict between the idea of health as a human right and the idea of health as a commodity,with the latter currently in the ascendant but with the former being maintained by continuing strong commitment to the ideals of public health based on human rights (see,for example,Anderson 2006,Navarro 2007,Labonté 2008).Inequalities in health and in access to healthcare generate strong views and deeply held feelings. Sen (2004: 21), for example, commented:‘In any discussion of social equity and justice, illness and health must figure as a major concern’, while Anand (2004) argued that health is directly constitutive of a person’s well- being and that, as poor health constrains actions and choices, promoting good health is a matter of social justice. Indeed, some would argue that inequalities in health and healthcare are the ultimate expression of social injustice (Segall 2007). The unequal distribution of the spectacular gains in life expectancy that have occurred through the 20th century both within and between countries is an evident measure of global injustice.Yet,inequalities persist in spite of years of global declarations and policies to tackle them.In dominant global policy discourses,the cost of population ageing is arguably an overriding agenda that overshadows that of action on the injustice of inequalities.The policy process reflects inequalities in power and in the capacity to influence how and to what purpose issues are defined as they are.Analysis of the process of policies highlights how such policy debates are ‘framed’ and how priorities for action are established through contestation, negotiation and compromise.Contemporary debates on long-term care policies exemplify all three: for example the rights of unpaid carers to recognition; the rights of paid carers to decent working conditions and wages; and the rights of people who are cared for to determine the conditions of caring. Being about rights and resources and the relationship between them, these debates are both moral and political and often entail deep divergences and unresolved conflicts of interest between groups. Policies to promote healthy ageing are strongly individualistic and moral in tone, the personal responsibility of the individual to age in good health being ubiquitous in health promotion messages:to exercise more,to eat well and to cease smoking.There is nothing particularly new in this;these have been the stock-in- trade messages of health promotion for decades.However,linked with the rising
- 14. 3 Introduction numbers of olderpeople and anxieties over containing the cost of care, the moral message of healthy ageing is sharpened, so that even though the outcomes of a healthy life might be the enjoyment of a longer life, the primary purpose is to ensure that older people make minimum claims on the public purse. It follows also that this message generates questions concerning the rights to healthcare for those who do not succeed in maintaining their health, and already in some contexts consideration is being given to whether treatment decisions should be conditional on life-style changes,which assumes greater significance in the context of the overarching message about the cost of population ageing. The policy principle of containing the costs of care also generates questions concerning who should bear responsibility for meeting those costs, and once again the answer that emerges from policy circles is highly individualistic.Within developed welfare states, there has been a long-standing debate about whether long-term care costs should be pooled or borne by the individual, but in the context of population ageing at a time of dominant neoliberal economic policies the terms of the debate have been changed and the question increasingly is not whether but how and to what extent individuals should bear the cost.As Phillipson (2006) noted, the removal of the security of socialised forms of support has individualised risk so that ageing itself becomes a matter of risk.In turn,questions are raised about what will be the expectations on families to provide material and other forms of support. In contexts where little or no formal welfare state exists the costs of care have always been borne by the individuals and families, but there is increasing concern about the sustainability of these arrangements (Bedford 2010).Where nation-states have few or no resources the private sector is in a powerful position to dictate the terms of its involvement in health and social care. Looking after those who are unable to benefit is the job of the non- governmental organisations (NGOs). These moral and political questions are unavoidable in a discussion of health and care in ageing societies and demand a deeper analysis of policies than one that is focused merely on the viability of strategies on healthy ageing or fiscal policies to contain welfare expenditure. It requires a critical analysis of why it is that the policy agenda has been framed in the way described above.For example, as discussed in this text, despite evidence to the contrary, a simplistic model of dependency ratios continues to be used in policy making. In fact, the negative characterisation of dependence is a crucial element of policies on health and care, reflecting the dominance of the policy agendas of high-income countries on the rest of the world.Without doubt, in Western cultures dependence on the care of others entails a loss of citizen rights and heightens the risk of marginalisation from mainstream society.Yet, as is increasingly acknowledged in gerontology, the lifecourse usually ends in conditions of sickness and dependency, however successful individuals are at compressing the period of illness into as short a time as possible (Gilleard and Higgs 2000,Twigg 2006).Attention to our embodied selves calls into question the sustainability of policies that characterise the citizen as a disembodied, independent subject (Kittay et al 2005).
- 15. 4 Health and carein ageing societies In this text, which draws on literature from a range of disciplines, the critical analysis of these complex issues is framed by the theoretical frameworks on care developed by feminist ethicists (Tronto 1993, Sevenhuijsen 1998, Kittay et al 2005, Held 2006).There are variations within this school of thought, but all take it as a fundamental principle that dependence and a need for care must be understood as characteristics inherent within the human condition, not as aberrations. Feminist ethicists argue that in Western cultures the social nature of human life has been eclipsed by a preoccupation with individual autonomy and independence. Rejection of the characterisation of humans as essentially self- sufficient and independent underpins the whole body of work in the ethics of care and is encapsulated in the observation that in order to achieve independence and autonomy human beings must first be cared for.At the heart of this perspective and in common with other philosophical schools of thought is the emphasis placed on the centrality of human beings’social nature.It is argued that this is not the outcome of relationships between individuals but that, on the contrary, what connects us to others is prior to our individuality, not consequent upon it. For example,Mahon and Robinson (2011a) argued that an emphasis on the isolated, self-reliant,autonomous individual does not adequately reflect the social realities in most communities around the world. Instead, they proposed a ‘relational autonomy’, which holds that ultimately autonomy is achieved in and through relationships. It is important to stress that feminist ethicists argue not against the idea of individual autonomy, but for recognition that it is mutually constitutive (Mahon and Robinson 2011b:181). The focus on autonomy is particularly relevant in the context of ageing.The loss of autonomy,in the sense of individual rational thought and behaviour, is associated with cognitive impairment; but at a broader level a loss of autonomy, in the sense of individual self-sufficiency, frequently goes hand-in-hand with declining health and an increase in reliance on others for support and care.The value of an ethics of care perspective is that it does not differentiate between old (dependent) and young (independent) but sees dependency as inherent within the entire lifecourse and thus overcomes the tendency to regard older people as ‘the other’. A second fundamental principle within the feminist ethics of care is the critique of the dichotomy between public and private domains of life and the place of care. Feminist ethicists argue that care has been devalued and, being antithetical to the dominant model of autonomy, has been excluded from the public sphere and confined to the private sphere.Indeed,Tronto (1993) argues that it is the very centrality of care to human life that has led to its devaluation within contemporary political life and its containment behind doors in the private sphere of the family or institution because it poses such a threat to contemporary ideas about autonomy. It would be reasonable to ask at this point why, if care has been confined to the private sphere,it holds such a central place in the global policy agenda in relation to ageing populations.From a feminist ethics of care perspective,the answer to this question is evident in the way that policies are framed by dichotomous thinking about public and private spheres of care.The preoccupation of policy makers is
- 16. 5 Introduction with the economicsof care provision and the organisation and management of care services.What is less evident in policy debates is attention to the practices of care, which are regarded as the business of the private domain, preferably within the family, where care is assumed to come naturally.The privacy surrounding family care practices extends to institutional and home-based care practices also, and there is an evident lack of public awareness or regulation of care practices in most parts of the world. Indeed, it is often when a scandal emerges about cruel or inhuman behaviour that public attention turns to institutional care practices, and even then it is usually short lived. There is an especially serious lack of understanding of how practices of care are perceived from the point of view of those older people who are on the receiving end. Even where a ‘service-user perspective’is sought,there is a tendency to engage in discussion with proxies,in the form of representative organisations and carers’groups.As Kittay et al (2005) argued, the private–public distinction can itself be seen as a product of denial about the inevitability of human dependency. The ethics of care is central to international perspectives on ageing health and care for a number of interrelated reasons.The first of these concerns the core principle concerning the interdependence of human beings.This insight opens up a different way of understanding health and well-being as the outcome of social relationships.This applies not only at the micro-level of care relationships but also at the global level. Global patterns of interdependency, as explored further in Chapter Seven, are shaped by gender relations, colonial histories and contemporary socioeconomic inequalities. For example, the idea of ‘global care chains’ (Yeates 2004) describes the way in which migration patterns have developed to meet the need for care workers in relatively affluent countries,with far-reaching consequences for labour relations and ideas about citizenship rights. The migration of mainly women care workers from poorer parts of the world to more affluent countries of North America and Europe to take up low-paid jobs in health and social services has,as Mahon and Robinson argued,‘translated the unequal relations of personal interdependency into the unequal relations of transnational interdependency’ (2011a: 25). Second, the ethics of care exposes the limitations of liberal individualism seen in marketised models of health and welfare at a global level.Its challenge is based on its rejection of the currently dominant idealised version of the autonomous rational individual. Held (2006) argued that while individualism is relevant to citizenship, it is not all that citizenship is about.The extension of markets into health and welfare services has reinforced the idea that contractual relationships between self-interested strangers of equal standing are the desired form within public services.However,Held raised the question of what this means in services such as healthcare, where people who are ill may be far removed from the assumptions that underlie the contractual model of relationships.As argued, old age commonly entails a loss of self-reliance and increased dependency on others, and this places older people in a particularly invidious position within markets. Held’s observation also reflects the principle that ethics should be grounded in
- 17. 6 Health and carein ageing societies people’s experiences – the‘real world’,as opposed to the abstract world of market relations. Third, the ethics of care offers a valuable critique of dichotomous thinking between justice and care. In the context of social policies, justice is widely regarded as the moral framework for public life, while care is seen as the moral framework of private life. How these two relate to each other is the subject of much debate and, as pointed out above, the divide between public and private domains is problematic.There is now more widespread acceptance of the need for the principles of justice to apply in the private world of family relationships. For example, the abuse of older people within the family is, at least in principle, regarded as unacceptable.An ethic of justice demands that the rights of people enshrined in the UN Declaration of Human Rights,to a life that is free of cruel, inhuman or degrading treatment, must be upheld and that public bodies have a responsibility to attend to this.Indeed,theWorld Health Organization supported the Toronto Declaration on the Global Prevention of Elder Abuse (WHO 2002c).Yet it is known that the abuse of older people continues to be prevalent throughout the world and that authorities fail to pay adequate attention to it.To understand why this is so draws attention to the need for an ethic of care to apply to the public domain. Feminist ethicists argue that the encapsulation of rights in abstract form – such as in the Toronto Declaration – runs the risk that they end up remaining as lofty ideals with little impact in practice.The reason for this is that the moral agenda of rights and justice is conceptualised as separate from and above the world of politics (Tronto 1993) and this conceptual differentiation obfuscates the way in which political considerations influence and shape the moral agenda, both in the abstract and in reality.The exercise of power within the political sphere has a profound influence on the setting of moral agendas and statements concerning the rights of individuals. Hence, the language of policies is highly moral in tone, but policies in practice become subsumed into political agendas where the management of resources is the primary rationale. It follows that rights are not immutable but are always contingent and always to be defended.Thus,while declarations and overarching policy aims are valuable for articulating public standards they cannot be relied upon as a basis for tackling the abuse of power.An ethics of care approach to dealing with the abuse of older people would start not from a reliance on declarations (although these might be strategically invoked) but first and foremost from an understanding of the experiences of people involved in abusive relationships – both the abused and the abuser – so that political action and choices about appropriate interventions and resource allocation could be better informed.The ethics of care is thus a form of political ethics, in which an enriched notion of social justice can be achieved through awareness of social practices and the ways in which these are influenced by power.To paraphrase Held:the justice motive is about fairness and equity;the care motive sees that needs are met. A final reason why the ethics of care is of central importance to this text concerns its epistemological insights that are of particular relevance to understanding how
- 18. 7 Introduction care is conceptualisedwithin policy processes,at national and international levels. In Chapter Four of this text is a discussion of the way in which concerns are taken up by governments and international bodies in the first place, what happens to these issues once they are on the agenda and,importantly,what difference is made by policy actions.The models of health and care that have come to dominate the policy process are woefully inadequate as a knowledge base, to the detriment of older people.To take just one example, the presentation of ‘dependency ratios’ and the impact of ageing populations on these gives no recognition at all of the value of unpaid care, which in all contexts constitutes the majority of care provided and in many contexts is all the care there is.The crucially important level of care provided by grandparents to children orphaned by HIV/AIDS in sub-Saharan Africa is just one example. Nevertheless, despite their major role as care providers,older people are characterised as a drain on resources by reference to chronological age in a rather rough and ready way.There is a pressing need for a fuller understanding of people’s experiences of ageing to be articulated within policies. How the book is organised Within the confines of this book, the approach taken is to critically analyse the policy developments that flow from the overarching principles set out above and to focus on their implications for the interrelationship between ageing, health and care. As an interdisciplinary endeavour, the book is informed by a broad literature and the next three chapters explore a range of important strands in the knowledge base. Chapter Two looks at the contemporary patterns and trends in population ageing, life expectancy, mortality and morbidity.This discussion highlights significant issues at the level of individual ageing, including the extension of the lifecourse. It provides a discussion of the range of perspectives on the difference between life expectancy and healthy life expectancy,which has come to be such a powerful discourse in policies. It also focuses on the nature of ageing at the population level and the contentious issue of dependency ratios. Important within this discussion also is the significance of global inequalities in health, how these are perceived in the context of ageing populations worldwide and how they influence policy agendas. In ChapterThree different conceptualisations of health and care are examined by reference to social and epidemiological research. The critique developed throughout this text, that policies reflect an over-narrow perspective on both health and care, is underlined by this discussion. The richness and variety of ways of understanding health, illness and care set out in this chapter stands in stark contrast to the impoverished view of all three found in policies. Of crucial importance to debates on health and care is an understanding of the lifecourse, as analysed in both epidemiology and gerontology, and the relationship between the third and fourth ages.A brief explanation of these terms would be helpful at this point: the idea of the third age, generally ascribed to Laslett (1989), is that
- 19. 8 Health and carein ageing societies during the latter part of the 20th century a new stage in the lifecourse emerged, which offered opportunities for independence and personal development for the relatively healthy and financially secure cohorts of people in the years following retirement from paid employment. These opportunities can be understood as consequent on prevailing social conditions, such as retirement pensions and the availability of leisure and educational opportunities.However,at the point where older people’s health begins to decline and they become dependent on others,the third age gives way to a fourth age,when the stark reality of mortality is evident. Chapter Four goes on to examine in more detail the policy process. In this chapter the focus turns again to global concerns, as it is at the global level that the inconnectedness of policies and practices on health and care can be best appreciated. Policy is presented as a process, involving the exercise of power by different ‘actors’ in the form of national, international and transnational organisations.Of central importance is the relationship between different levels of policy making.This chapter also focuses on the point raised above concerning the tensions between the moral and political agendas.In the context of global health concerns, the roles of the World Health Organization (WHO) and the World Bank and the relationship between these provide a means of understanding how policy agendas become established.Policies reflect cultural values,and discussion of values within policies on health and care in the context of ageing societies inevitably raises questions concerning the distribution of resources.The capabilities approach,which has influenced policies at a global level,is examined critically in relation to its implications for ageing. The following three chapters are organised around different aspects of health and care and how these feature in policies.They follow a model of health promotion that has been in circulation for some years, known as the ‘tertiary prevention model’ (Ashton and Seymour 1988). In its original form the model held that illness could be prevented at three levels: primary, secondary and tertiary. It is also used in a more positive sense to argue that health can be promoted at these three levels and that is the approach taken. At the primary level,which is the focus of Chapter Five,are actions to promote health‘upstream’.That is,actions to prevent illness from occurring and to promote positive health and well-being.At the primary level,policy actions are the business of health promotion.These include a whole raft of measures, including those on environmental health, income security and education that pay attention to the socioeconomic determinants of health.However,as is discussed,although upstream actions have a strong ethical base and are widely regarded as the way to tackle inequalities in health,in practice the approach of health promotion has been the subject of criticism for failing to uphold the principles on which it was founded, having become preoccupied with individual behaviour rather than socioeconomic determinants of health.In the context of ageing,health-promoting practices at the primary level tend to reflect third age interests and identities, and here the focus is on promoting active ageing at the individual level.However,policies on active ageing are open to criticism for the way in which they have become shaped by
- 20. 9 Introduction broader economic imperativesto reduce demand on healthcare, which have led to a narrow and limited understanding of health and activity in old age. At the secondary level, as discussed in Chapter Six, are actions to restore health through healthcare interventions. The secondary level of health promotion is arguably more important in later life than at other periods of the lifecourse.This is illustrated by reference to particular health conditions that are associated with later life and the growth in prevalence of long-term illness.The growth in long- term conditions poses a challenge to politicians and healthcare providers as well as to the traditional relationship between doctor and patient, all of which have implications for older people as users of healthcare services.The role of medicine in later life is strongly influenced by globalisation and the practices of transnational pharmaceutical and healthcare corporations,which have influenced international agendas in healthcare as well as the provision of healthcare at the local level.A discussion of secondary-level prevention also inevitably entails a focus on debates concerning the medicalisation of old age and the role of medicine in shaping experiences of ageing and in extending life expectancy. At the tertiary level are actions that promote health even in the context of incurable and terminal illness. These are the subject of Chapter Seven. The relevance of this level to later life is obvious: not only are chronic diseases more prevalent in later life, but the picture of mortality described at the beginning of this chapter highlights how death is more and more concentrated in old age.The tertiary level is not only about maintaining health.As Bernard (2000) argued, the word‘maintain’can be seen to have negative connotations,suggesting that all that can be done is to prevent unnecessary complications, but a broader perspective on health demonstrates the potential for health promotion, including in the context of life-threatening disease, when palliative care is needed. Palliative care can be health promoting, by paying attention to physical, psychological, social and spiritual needs.This chapter also examines the ways in which care has been developed in the context of policies for older people who might be regarded as in the fourth age, with associated loss of capacity for self-care.The development of care services once again draws attention to the significance of global agendas and the ways in which policies on care provision overlap with policies on employment, migration and trade. The three levels should be understood as interacting. For example, health is valued more highly when under threat, since it is the onset of illness conditions that frequently prompts people to make the changes in their life-styles that promote better health.Hence people receiving secondary-level interventions are likely to be more receptive to primary-level prevention messages. The model is useful in pointing to the potential of health-promotion messages for all – not only the not-yet-sick or the recently recovered. It therefore helps to overcome the tendency to take a polarised view of prevention, treatment and care. Care is frequently assumed to be of relevance only as action to relieve the suffering, discomfort and disabilities associated with disease, and particularly so in the context of chronic, long-standing and incurable disease. But there are
- 21. 10 Health and carein ageing societies compelling reasons for understanding the ethics of care as relevant to the whole range of health-related policies and practices. It is hoped that this book provides a contribution to developing such an understanding.
- 22. 11 two Patterns and trendsin ageing and health Introduction The UNWorld Population Ageing Report for 2009 stressed the implications of population ageing for the viability of intergenerational support systems and the sustainability of social security and healthcare systems (UN 2010a).These concerns are amplified in countries where the speed at which population ageing occurs is greatest,many of which are countries where social security and healthcare systems are least well developed.The significance of the trends is enormous.In this chapter the focus is on the data on life expectancy and on mortality and morbidity rates, and on the implications of these as a basis for policy making on health and care. It sets the scene for the discussion in subsequent chapters. Since policies both influence and are influenced by the data, a critical approach is necessary which questions approaches to information gathering and interpretation as well as analysing the basis on which policy priorities are established. The production of information on ageing, health and care is influenced by a range of factors: practical, methodological, conceptual and political. Studies of global inequalities in health, for example, are often based on comparisons between regional groupings of countries,which have traditionally been organised in these ways, based on preconceived ideas about their comparability that are derived in part from colonial histories (Day et al 2008).Within these regional groupings there are significant variations between countries in patterns of health, which highlight the important of political and cultural contexts as well as broad measures of socioeconomic status. International comparisons are open to question also because of the scale of difference in population size, which, as pointed out by Lloyd-Sherlock (2010),presents a distorted picture.National-level data also obscures inequalities within countries and, in some cases, the extent of inequalities calls into question the value of the national data. For example, in India,as Mini (2009) pointed out,between different states the patterns and trends in mortality and morbidity vary enormously.In the state of Kerala the figures are more comparable to those in high-income countries than to other Indian states. Inequalities in health between ethnic groups are also masked by national-level data.Another example is Australia, where the health and life expectancy of the Aboriginal people is more akin to that found in low-income countries than to the non-Aboriginal Australian population. Further challenges emerge over the multiple meanings of age. As discussed, crude calculations of dependency ratios based on a population’s age structure have
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- 24. "Camp Two iswest of here," muttered the boy. "I guess the men were part of Slue Foot's crew, and he went over to the camp with 'em." Darkness prevented him from noting that the trail that led to the westward was a clumsier trail than Saginaw would have made, or he never would have dismissed the matter so lightly from his mind. As it was, he continued upon his course for Camp One, where he arrived nearly an hour later to find the camp in a turmoil. The boy hastened, unnoticed, to the edge of a crowd of men that encircled Frenchy Lamar, who talked as fast as he could in an almost unintelligible jargon, which he punctuated with shrugs, and wild- flung motions of his arms. "Oui, dat be'n w'en de las' of de Camp Two tote teams be'n pass 'bout de half hour. We com' 'long by de place w'er de road she twis' 'roun an' slant down de steep ravine. Woof! Rat on de trail stan' de leetle black bear, an', Sacre! Ma leaders git so scare dey stan' oop on de hine leg lak dey gon for dance. Dey keek, dey jomp, dey plonge, an', Voila! Dem wheelers git crazy too. I'm got ma han' full, an' plenty mor', too, an' de nex' t'ing I'm fin' out dey jomp de wagon oop on de beeg stomp an' she teep ovaire so queek lak you kin say Jac Robinshon. Crack! Ma reach she brek in two an' ma front ax' she git jerk loose from de wagon an' de nex' t'ing I'm drag by de lines
- 25. 'cross de creekso fas' dat tear ma coat, ma shirt, ma pants mos' lak de ribbon. I'm bomp ma head, an' lose ma cap, an' scratch ma face, but by gar, I'm hang holt de lines, an' by-m-by dem horse dey git tire to haul me roun' by de mout', and dey stan' still a minute on top de odder side. I'm look back an', Sacre! Hurley is lay on de groun' an' de boss I. W. W. is hit heem on de head wit' de gon. De res' is cuttin' loose deir han's. I'm yell on dem to queet poun' on de boss head, wit de rifle, an' de nex' t'ing I'm know: Zing! de bullet com' so clos' eet mak de win' on ma face, an' de nex' t'ing, Zing! Dat bullet she sting de horse an' I'm just got tam to jomp oop on de front ax', an' de horses start out lak she got far business away from here queek. Dey ron so fas' I'm got to hol' on wit' ma han's, wit' ma feet! Dem horses ron so fas' lak de train, dem wheels jomp feefty feet high, an' dey only com' on de groun' 'bout once every half a mile an' den I'm git poun', an' bomp, an' rattle, 'til I'm so black lak de, w'at you call, de niggaire! "De neares' doctaire, she down to Birch Lak'. I'm leave ma team een de store-keeper stable, an' Ol' Man Niles she say de train don' stop no mor' today, so I can't go to Birch Lak' 'til mornin'. I t'ink, by gar, I'm mak' de train stop, so I'm push de beeg log on de track an' lay on ma belly in de weeds, an' pret' soon de train com' long an' she see de beeg log an' she stop queek, an' dey all ron opp front an' I'm climb on an' tak' de seat in de smokaire. De train go 'long w'en dey git de log shov' off, an' de conductaire, he com' long an' seen me sit dere. 'We're you git on dis train?' she say, an' I'm tell heem I'm git on to Dogfish, w'en de train stop. 'I'm goin' to Birch Lak' for git de doctaire for man w'at git keel,' I'm say, an' he say de train don' stop to Birch Lak', neider. She t'rough train, an' we'n we git to de firs' stop, she gon' for hav' me arres'. I ain' say no mor' an' I'm look out de window, an' de conductaire she go an' set down in de back of de car. De train she gon' ver' fas' an' by-m-by she com' to de breege, an' Birch Lak' is wan half mile. "I'm travel on de car before, an' I'm see dem stop de train mor' as once to put off de lumbaire-jack w'en dey git to fightin' Voila! I'm jomp oop on ma feet ver' queek an' pull two, t'ree tam on de leetle
- 26. rope, an' delas' tam I'm pull so hard she bre'k in two. De train she stop so queek she mak' fellers bomp 'roun' in de seat, an' de conductaire she so mad she lak to bus', an' she holler ver' mooch, an' com' ronnin' down de middle. She ain' ver' beeg man, an' I'm reach down queek, de nex' t'ing she know she light on de head in de middle w'ere four fellers is playin' cards. Den, I'm ron an' jomp off de car an' fin' de doctaire. Dat gittin' dark, now, an' she startin' to snow, an' de doctaire she say we can't go to Dogfish 'til mornin', day ain' no mor' train. I'm see de han' car down by de track, but de doctaire she say we ain' can tak' dat for 'cause we git arres'. But I'm laugh on heem, an' I'm say I'm tak' dat han' car, 'cause I'm got to git arres' anyhow—but firs' dey got to ketch—eh? So I'm tak' a rock an' bus' de lock an' we lif' her on de track an' com' to Dogfish. Ol' Man Niles she tak' hees team an' gon' oop an' got Hurley an' de cookee, an' breeng heem to de store. De doctaire she feex de boss oop, an' she say eef eet ain' for dat cookee stay 'roun' an' mak' de blood quit comin', Hurley she would be dead befor' we com' long. Dis mornin' I'm tak' ma team an' Ol Man Niles's wagon an' com' to de camp. Hurley she won' go to de hospital, lak de doctaire say, so de doctaire she com' 'long. Eet tak' me all day long, de snow she so d'ep, an' by gar——" Connie left in the middle of the Frenchman's discourse and hurried into the office. In his bunk, with his head swathed in bandages, lay Hurley. The doctor stood beside the stove and watched Steve feed the injured man gruel from a spoon. The big boss opened his eyes as the boy entered. He smiled faintly, and with ever so slight a motion of his head indicated Steve: "An' I said they wasn't the worth of a lath in his hide," he muttered and nodded weakly as Connie crossed swiftly to the boy's side and shook his hand. Hurley's voice dropped almost to a whisper: "I'll be laid up fer a couple of days. Tell Saginaw to—keep—things—goin'." "I'll tell him," answered Connie, grimly, and, as the boss's eyes closed, stepped to his own bunk and, catching up the service revolver from beneath the blankets, hurried from the room.
- 27. Connie Morgan wasa boy that experience and training had taught to think quickly. When he left the office it was with the idea of heading a posse of lumberjacks in the capture of the three I. W. W.'s, for from the moment he heard of their escape the boy realized that these were the three men who had intercepted Saginaw Ed on his return from Willow River. His one thought was to rescue the captive, for well he knew that, having Saginaw in their power, the thugs would stop at nothing in venting their hatred upon the helpless man. As he hurried toward the crowd in front of the men's camp his brain worked rapidly. Fifty men in the woods at night would make fifty times as much noise as one man. Then again, what would the men do if they should catch the three? The boy paused for a moment at the corner of the oat house. There was only one answer to that question. The answer had been plain even before the added outrage of the attack upon Hurley—and Hurley was liked by his men. Stronger than ever became the boy's determination to have the I. W. W.'s dealt with by the law. There must be no posse. His mind swung to the other alternative. If he went alone he could follow swiftly and silently. The odds would be three against one—but the three had only one gun between them. He fingered the butt of his revolver confidently. "I can wing the man with the gun, and then cover the others," he muttered, "and besides, I'll have all the advantage of knowing what I'm up against while they think they're safe. Dan McKeever was strong for that. I guess I'll go it alone." Having arrived at this decision the boy crossed the clearing to the men's camp where he singled out Swede Larson from the edge of the crowd. "Saginaw and I've got some special work to do," he whispered; "you keep the men going 'til we get back." Without waiting for a reply, he hastened to the oat house, fastened on his snow-shoes, and slipped into the timber. It was no hardship, even in the darkness, for him to follow the snow-shoe trail, and to the point where the others had left it his progress was rapid. The snow had stopped falling, and great rifts appeared in the wind-driven clouds. Without hesitation Connie
- 28. swung into thetrail of the four men. He reasoned that they would not travel far because when they had intercepted Saginaw there could not have been more than two or three hours of daylight left. The boy followed swiftly along the trail, pausing frequently to listen, and as he walked he puzzled over the fact that the men had returned to the vicinity of the camp, when obviously they should have made for the railway and placed as much distance as possible between themselves and the scene of their crimes. He dismissed the thought of their being lost, for all three were woodsmen. Why, then, had they returned? Suddenly he halted and shrank into the shelter of a windfall. Upon the branches of the pine trees some distance ahead his eye caught the faint reflection of a fire. Very cautiously he left the trail and, circling among the trees, approached the light from the opposite direction. Nearer and nearer he crept until he could distinctly see the faces of the four men. Crouching behind a thick tree trunk, he could see that the men had no blankets, and that they huddled close about the fire. He could see Saginaw with his hands tied, seated between two of the others. Suddenly, beyond the fire, apparently upon the back trail of the men, a twig snapped. Instantly one of the three leaped up, rifle in hand, and disappeared in the woods. Connie waited in breathless suspense. Had Swede Larson followed him? Or had someone else taken up the trail? In a few moments the man returned and, taking Saginaw by the arm, jerked him roughly to his feet and, still gripping the rifle, hurried him into the woods away from the trail. They passed close to Connie, and the boy thanked his lucky star that he had circled to the north instead of the south, or they would have immediately blundered onto his trail. A short distance further on, and just out of sight of the camp fire, they halted, and the man gave a low whistle. Instantly another man stepped into the circle of the firelight—a man bearing upon his back a heavily laden pack surmounted by several pairs of folded blankets. He tossed the pack into the snow and greeted the two men who remained at the fire with a grin. Then he produced a short black pipe, and, as he
- 29. stooped to pickup a brand from the fire, Connie stared at him in open-mouthed amazement. The newcomer was the boss of Camp Two!
- 30. W CHAPTER XI CONNIE FINDSAN ALLY HER'S Pierce?" asked Slue Foot Magee, as he glanced down upon the two figures that crouched close about the little fire. "He went on ahead to hunt a place to camp. We waited to pack the stuff," lied the man, nodding toward the pack sack that the boss of Camp Two had deposited in the snow. "I sure was surprised when Sam, here, popped out of the woods an' told me ye'd got away an' needed blankets an' grub. Wha'd ye do to Hurley? An' how come ye didn't hit fer the railroad an' make yer git-away?" "We beat Hurley up a-plenty so'st he won't be in no hurry to take no I. W. W.'s nowheres ag'in. An' as fer hittin' fer the railroad, it's too cold fer to ride the rods or the bumpers, an' we hain't got a dollar between us. You'll have to stake us fer the git-away." Slue Foot frowned: "I hain't got a cent, neither. Come into the woods on credick—an' hain't draw'd none." "That's a fine mess we're in!" exclaimed the leader angrily. "How fer d' ye figger we're a-goin' to git on what little grub ye fetched in that pack? An' wher' we goin' to—bein' as we're broke? We hit back fer you 'cause we know'd ye stood strong in the organization an' we had a right to think ye'd see us through." "I'll see ye through!" growled Slue Foot, impatiently. "But I can't give ye nawthin' I hain't got, kin I?" He stood for a few moments
- 31. staring into thefire, apparently in deep thought. "I've got it!" he exclaimed. "The Syndicate's got a camp 'bout ten mile north of here on Willer River. They're short handed an' the boss'll hire anything he kin git. Seen him in town 'fore I come out, an' he wanted to hire me, but I was already hired to Hurley—got a boss's job, too, an' that's better'n what I'd got out of him. If youse fellers hadn't of be'n in such a hurry to pull somethin' an' had of waited 'til I come, ye wouldn't of botched the job an' got caught." "Is that so!" flared the leader. "I s'pose we'd ort to know'd ye was goin' to be hired on this job! An' I s'pose our instructions is not to pull no rough stuff onless you're along to see it's done right!" "They hain't nawthin' in standin' 'round argerin'," interrupted Slue Foot. "What I was a-goin' on to say is that youse better hike on up to Willer River an' git ye a job. There's grub enough in the pack to last ye twict that fer." "Wher'll we tell the boss we come from? 'Taint in reason we'd hit that fer into the woods huntin' a job." "Tell him ye got sore on me an' quit. If they's any questions asked I'll back ye up." The leader of the I. W. W.'s looked at Sam, and Sam looked at the leader. They were in a quandary. For reasons of their own they had not told Slue Foot that they had picked up Saginaw—and with Saginaw on their hands, how were they going to follow out the boss's suggestion? Behind his big tree, Connie Morgan had been an interested listener. He knew why the men stared blankly at each other, and chuckled to himself at their predicament. "What's to hinder someone from Camp One a-trailin' us up there?" suggested Sam. "Trailin' ye! How they goin' to trail ye? It was a-snowin' clean up to the time ye got to Camp Two, an' if any one sees yer tracks around there I'll say I sent some men up that way fer somethin'. An' besides," he continued, glancing upward where the clouds that had thinned into flying scuds had thickened again, obliterating the stars,
- 32. "this storm hain'tover yet. It'll be snowin' ag'in 'fore long an' ye won't leave no more trail'n a canoe. Anyways, that's the best way I kin think of. If you've got a better one go to it—I've done all I kin fer ye." There was finality in Slue Foot's voice as he drew on his mittens, and turned from the fire. "So long, an' good luck to ye." "So long," was the rather surly rejoinder. "If that's the best we kin do, I s'pose we gotta do it. Mebbe if it starts snowin' we're all right, an' if we make it, we'll be safer up there than what we would down along the railroad, anyways. They won't be no one a-huntin' us in the woods." "Sure they won't," agreed Slue Foot, as he passed from sight into the timber. The two beside the fire sat in silence until the sound of Slue Foot's footsteps was swallowed up in the distance. Then Sam spoke: "What we goin' to do with this here Saginaw?" he asked. The leader glanced skyward. "It's startin' to snow—" he leered and, stopping abruptly, rose to his feet. "Wait till we git Pierce in here." Producing some pieces of rope from his pocket, he grinned. "Lucky I fetched these along when I cut 'em off my hands. We'll give him a chanct to see how it feels to be tied up onct." The man stepped into the timber and a few minutes later returned accompanied by Pierce, to whom they immediately began to relate what had passed between them and the boss of Camp Two. The moment they seated themselves about the fire, Connie slipped from his hiding place behind the tree and stole noiselessly toward the spot where the men had left Saginaw. Snow was falling furiously now, adding the bewildering effect of its whirling flakes to the intense blackness of the woods. Removing his snow-shoes to avoid leaving a wide, flat trail, the boy stepped into the tracks of the two who had returned to the fire and, a few moments later, was bending over a dark form that sat motionless with its back against the trunk of a tree. "It's me, Saginaw," he whispered, as the keen edge of his knife blade severed the ropes that bound the man's hands and feet.
- 33. "WHAT IN THENAME OF TIME BE YOU DOIN' HERE?" EXCLAIMED SAGINAW. The man thrust his face close to Connie's in the darkness. "What in the name of time be you doin' here?" he exclaimed. "Sh-sh-sh," whispered the boy. "Come on, we've got to get away in a hurry. There's no tellin' how soon those fellows will finish their powwow." "What do you mean—git away? When we git away from here we take them birds along, er my name ain't Saginaw Ed! On top of tryin' to burn up the camp they've up an' murdered Hurley, an' they'd of done the like by me, if they'd be'n give time to!" "We'll get them, later. I know where they're going. What we've got to do is to beat it. Step in my tracks so they won't know there were two of us. They'll think you cut yourself loose and they won't try to follow in the dark, especially if the storm holds." "But them hounds has got my rackets." "I've got mine, and when we get away from here I'll put 'em on and break trail for you."
- 34. "Look a here,you give me yer gun an' I'll go in an' clean up on them desperadoes. I'll show 'em if the I. W. W.'s is goin' to run the woods! I'll——" "Come on! I tell you we can get 'em whenever we want 'em——" "I'll never want 'em no worse'n I do right now." "Hurley's all right, I saw him a little while ago." "They said they——" "I don't care what they said. Hurley's down in the office, right now. Come on, and when we put a few miles behind us, I'll tell you all you want to know." "You'll tell a-plenty, then," growled Saginaw, only half convinced. "An' here's another thing—if you're double crossin' me, you're a-goin' to wish you never seen the woods." The boy's only answer was a laugh, and he led, swiftly as the intense darkness would permit, into the woods. They had gone but a short distance when he stopped and put on his rackets. After that progress was faster, and Saginaw Ed, mushing along behind, wondered at the accuracy with which the boy held his course in the blackness and the whirling snow. A couple of hours later, Connie halted in the shelter of a thick windfall. "We can rest up for a while, now," he said, "and I'll tell you some of things you want to know." "Where do you figger we're at?" asked Saginaw, regarding the boy shrewdly. "We're just off the tote road between the two camps," answered the boy without hesitation. A moment of silence followed the words and when he spoke the voice of Saginaw sounded hard: "I've be'n in the woods all my life, an' it would of bothered me to hit straight fer camp on a night like this. They's somethin' wrong here somewheres, kid—an' the time's come fer a showdown. I don't git you, at all! You be'n passin' yerself off fer a greener. Ever sence you went out an' got that deer I've know'd you wasn't—but I figgered it worn't none of my business. Then when you out-figgered them hounds—that worn't no greener's
- 35. job, an' Iknow'd that—but, I figgered you was all to the good. But things has happened sence, that ain't all to the good—by a long shot. You've got some explainin' to do, an' seein' we're so clost to camp, we better go on to the office an' do it around the stove." "We wouldn't get much chance to powwow in the office tonight. Hurley's there, and the doctor, and Steve, and Lon Camden." "The doctor?" "Yes, those fellows beat Hurley up pretty bad, but he's coming along all right. Steve stayed by him, and the doctor said it saved his life." "You don't mean that sneakin' cookee that throw'd in with the I. W. W.?" "Yup." "Well, I'll be doggoned! But, them bein' in the office don't alter the case none. We might's well have things open an' above board." Connie leaned forward and placed his hand on the man's arm. "What I've got to say, I want to say to you, and to no one else. I wanted to play the game alone, but while I was trailing you down from Willow River, I decided I'd have to let you in on it." "You know'd I follered you up there?" "Of course I knew it. Didn't I help you string that racket?" Saginaw shook his head in resignation. "We might's well have it out right here," he said. "I don't git you. First off, you figger how to catch them jaspers with the goods an' lock 'em up. Then you throw in with Slue Foot. Then you hike up to the Syndicate camp an' is thicker'n thieves with the boss. Then you pop up in a blizzard in the middle of the night an' cut me loose. Then you turn 'round an' let them hounds go when we could of nailed 'em where they set— seems like you've bit off quite a contract to make all them things jibe. Go ahead an' spit 'er out—an' believe me, it'll be an earful! First, though, you tell me where them I. W. W.'s is goin' an' how you know. If I ain't satisfied, I'm a-goin' to hit right back an' git 'em while the gittin's good."
- 36. "They're going upto work for the Syndicate in the Willow River Camp." "Know'd they was loose an' slipped up to git 'em a job, did you?" asked Saginaw sarcastically. Connie grinned. "No. But there's a big job ahead of you and me this winter—to save the timber and clear Hurley's name." "What do you know about Hurley an' the timber?" "Not as much as I will by spring. But I do know that we lost $14,000 on this job last winter. You see, I'm one of the owners." "One of the owners!" Saginaw exclaimed incredulously. "Yes. I've got the papers here to prove it. You couldn't read 'em in the dark, so you'll have to take my word for it 'til we get where you can read 'em. Waseche Bill is my partner and we live in Ten Bow, Alaska. Soon after Hurley's report reached us, showing the loss, a letter came from Mike Gillum, saying that Hurley was in the pay of the Syndicate——" "He's a liar!" cried Saginaw wrathfully shaking his mittened fist in Connie's face. "I've know'd Hurley, man an' boy, an' they never was a squarer feller ever swung an axe. Who is this here Mike Gillum? Lead me to him! I'll tell him to his face he's a liar, an' then I'll prove it by givin' him the doggonest lickin' he ever got—an' I don't care if he's big as a meetin' house door, neither!" "Wait a minute, Saginaw, and listen. I know Hurley's square. But I didn't know it until I got acquainted with him. I came clear down from Alaska to catch him with the goods, and that's why I hired out to him. But, Mike Gillum is square, too. He's boss of the Syndicate camp on Willow River. A clerk in the Syndicate office told him that the Syndicate was paying Hurley, and Mike wrote to Waseche Bill. He's a friend of Waseche's—used to prospect in Alaska——" "I don't care if he used to prospeck in heaven! He's a liar if he says Hurley ever double crossed any one!" "Hold on, I think I've got an idea of what's going on here and it will be up to us to prove it. The man that's doing the double crossing
- 37. is Slue FootMagee. I didn't like his looks from the minute I first saw him. Then he began to hint that there were ways a forty-dollar-a- month clerk could double his wages, and when I pretended to fall in with his scheme he said that when they begin laying 'em down he'll show me how to shade the cut. And more than that, he said he had something big he'd let me in on later, provided I kept my eyes and ears open to what went on in the office." "An' you say you an' yer pardner owns this here timber?" "That's just what I said." "Then Slue Foot's ondertook to show you a couple of schemes where you kin steal consider'ble money off yerself?" Connie laughed. "That's it, exactly." Saginaw Ed remained silent for several moments. "Pervidin' you kin show them papers, an' from what I've saw of you, I ain't none surprised if you kin, how come it that yer pardner sent a kid like you way down here on what any one ort to know would turn out to be a rough job anyways you look at it?" "He didn't send me—I came. He wanted to come himself, but at that time we thought it was Hurley we were after, and Hurley knows Waseche so he could never have found out anything, even if he had come down. And besides, I've had quite a lot of experience in jobs like this. I served a year with the Mounted." "The Mounted! You don't mean the Canady Mounted Police!" "Yes, I do." There was another long silence, then the voice of Saginaw rumbled almost plaintively through the dark, "Say, kid, you ain't never be'n President, have you?" Connie snickered. "No, I've never been President. And if there's nothing else you want to know right now, let's hit the hay. We've both done some man's size mushing today." "You spoke a word, kid," answered Saginaw, rising to his feet; "I wouldn't put no crookedness whatever past Slue Foot. But that didn't give this here Gillum no license to blackguard Hurley in no letter."
- 38. "Has Hurley everworked for the Syndicate?" asked Connie. "No, he ain't. I know every job he's had in Minnesoty an' Westconsin. Then he went out West to Idyho, or Montany, or somewheres, an' this here's the first job he's had sence he come back." "What I've been thinking is that Slue Foot has passed himself off to the Syndicate as Hurley. They know that Hurley is boss of this camp, but they don't know him by sight. It's a risky thing to do, but I believe Slue Foot has done it." "Well, jumpin' Jerushelam! D'you s'pose he'd of dared?" "That's what we've got to find out—and we've got to do it alone. You know Hurley better than I do, and you know that he's hot- headed, and you know that if he suspected Slue Foot of doing that, he couldn't wait to get the evidence so we could get him with the goods. He'd just naturally sail into him and beat him to a pulp." Saginaw chuckled. "Yes, an' then he'd squeeze the juice out of the pulp to finish off with. I guess yer right, kid. It's up to me an' you. But how'd you know them I. W. W.'s is headin' fer Willer River?" "Because I heard Slue Foot tell them to." "Slue Foot!" "Yes, I forgot to tell you that Slue Foot is an I. W. W., too. I didn't know it myself 'til tonight. You see, when I got back to camp and found that Hurley's prisoners had made a get-away, I knew right then why you had turned off the back trail from Willow River. I knew they'd treat you like they did Hurley, or worse, so I hit the trail." "Wasn't they no one else handy you could of brung along?" asked Saginaw, drily. "The whole camp would have jumped at the chance—and you know it! And you know what they'd have done when they caught 'em. I knew I could travel faster and make less noise than a big gang, and I knew I could handle the job when I got there. I had slipped up and was watching when Pierce took you into the timber. He did that because they heard someone coming. It was Slue Foot,
- 39. and he brought'em a grub stake and some blankets. They knew he was an I. W. W., and they'd managed to slip him the word that they were loose. They wanted him to stake them to some money, too, but Slue Foot said he didn't have any, and told them to get a job up on Willow River. He told them they'd be safer there than they would anywhere down along the railroad." "Yes, but how'd you know they'll go there?" "They can't go any place else," laughed the boy. "They're broke, and they've only got a little bit of grub." "When we goin' up an' git 'em?" persisted Saginaw. "We'll let the sheriff do that for us, then the whole thing will be according to law." "I guess that's right," assented the man, as the two swung down the tote road. "We'd better roll in in the men's camp," suggested Connie, as they reached the clearing. A little square of light from the office window showed dimly through the whirling snow, and, approaching noiselessly, the two peeked in. Mounded blankets covered the sleeping forms of the doctor and Lon Camden; Hurley's bandaged head was visible upon his coarse pillow, and beside him sat Steve, wide awake, with the bottles of medicine within easy reach. "Half past one!" exclaimed Saginaw, glancing at the little clock. "By jiminetty, kid, it's time we was to bed!"
- 40. I CHAPTER XII SHADING THECUT T was nine o'clock the following morning when Connie was awakened by someone bending over him. It was Saginaw, and the boy noticed that his cap and mackinaw were powdered with snow. "Still snowing, eh? Why didn't you wake me up before?" "It's 'bout quit, an' as fer wakin' you up," he grinned, "I didn't hardly dast to. If I was the owner of an outfit an' any doggone lumberjack woke me up 'fore I was good an' ready I'd fire him." "Oh, you want to see my papers, do you?" grinned Connie. "Well, I might take a squint at 'em. But that ain't what I come fer. The boss is a whole lot better, an' the doctor's a-goin' back. What I want to know is, why can't he swear out them warrants ag'in them three I. W. W.'s an' have it over with? I didn't say nothin' to Hurley 'bout them bein' located, er he'd of riz up an' be'n half ways to Willer River by now." "Sure, he can swear out the warrants! I'll slip over to the office and get their names out of the time book, and while I'm gone you might look over these." The boy selected several papers from a waterproof wallet which he drew from an inner pocket and passed them over to Saginaw, then he finished dressing and hurried over to the office. Hurley was asleep, and, copying the names from the book, Connie returned to the men's camp.
- 41. "You're the goodsall right," said Saginaw, admiringly, as he handed back the papers. "From now on I'm with you 'til the last gap, as the feller says. You've got more right down nerve than I ever know'd a kid could have, an' you've got the head on you to back it. Yer good enough fer me—you say the word, an' I go the limit." He stuck out his hand, which Connie gripped strongly. "You didn't have to tell me that, Saginaw," answered the boy, gravely, "if you had, you would never have had the chance." Saginaw Ed removed his hat and scratched his head thoughtfully. "That there'll strike through 'bout dinner time, I guess. But I suspicion what you mean, an'—I'm obliged." "Here are the names for the doctor—better tell him to swear out warrants both for arson and for attempted murder." "Yes, sir," answered Saginaw, respectfully. "Yes, what!" The man grinned sheepishly. "Why—I guess—bein' I was talkin' to the owner——" "Look here, Saginaw," interrupted the boy, wrathfully, "you just forget this 'owner' business, and don't you start 'siring' me! What do you want to do—give this whole thing away? Up where I live they don't call a man 'sir' just because he happens to have a little more dust than somebody else. It ain't the 'Misters' and the 'Sirs' that are the big men up there; it's the 'Bills' and the 'Jacks' and the 'Scotties' and the 'Petes'—men that would get out and mush a hundred miles to carry grub to a scurvy camp instead of sitting around the stove and hiring someone else to do it—men that have gouged gravel and stayed with the game, bucking the hardest winters in the world, sometimes with only half enough to eat—men with millions, and men that don't own the tools they work with! My own father was one of 'em. 'The unluckiest man in Alaska,' they called him! He never made a strike, but you bet he was a man! There isn't a man that knew him, from Skagway to Candle, and from Candle to Dawson and beyond, that isn't proud to call him friend. Sam Morgan they call him —and they don't put any 'Mister' in front of it, either!"
- 42. Saginaw Ed noddedslowly, and once more he seized the boy's hand in a mighty grip. "I git you, kid. I know they's a lot of good men up in your country—but, somehow, I've got a hunch they kind of overlooked a bet when they're callin' your pa onlucky." He took the slip of paper upon which Connie had written the names. At the door he turned. "We begin layin' 'em down today," he said. "Shouldn't wonder an' what Slue Foot'll be down 'fore very long fer to give you yer first lesson." "Hurley will think I'm a dandy, showing up at ten o'clock in the morning." "Never you mind that," said Saginaw; "I fixed that part up all right—told him you was up 'til after one o'clock helpin' me git things strung out fer to begin work today." Connie bolted a hasty breakfast, and, as he made his way from the cook's camp to the office, sounds came from the woods beyond the clearing—the voices of men calling loudly to each other as they worked, the ring of axes, and the long crash of falling trees. The winter's real work had begun, and Connie smiled grimly as he thought of the cauldron of plot and counter-plot that was seething behind the scenes in the peaceful logging camp. The boy found Hurley much improved, although still weak from the effects of the terrible beating he had received at the hands of the escaped prisoners. The big boss fumed and fretted at his enforced inactivity, and bewailed the fact that he had given the doctor his word that he would stay in his bunk for at least two days longer. "An' ut's partly yer fault, wid yer talk av th' law—an' partly mine fer listenin' to yez," he complained fiercely, in rich brogue, as Connie sat at his desk. The boy's shoulders drooped slightly under the rebuke, but he answered nothing. Suddenly Hurley propped himself up on his elbow. "Phy don't yez tell me Oi'm a big liar?" he roared. "Ye was right, an' Oi know ut. Don't pay no heed to me, kid. Oi've got a grouch fer lettin' them shpalpeens git away. Furst Oi was thryin' to lay ut on Frinchy, an' him the bist teamster in th' woods! Ut's loike a sp'ilt b'y Oi am, thryin' to blame somewan f'r what c'udn't be helped at all. Ut was an accident all togither, an' a piece
- 43. av bad luck—an'there's an end to ut. Bring me over yer book, now, an' Oi'll show ye about kaypin' thim logs." "PHY DON'T YEZ TELL ME OI'M A BIG LIAR?" HE ROARED. Connie soon learned the simple process of bookkeeping, and hardly had he finished when the door opened and Slue Foot Magee entered. "Well, well! They sure beat ye up bad, boss. I heerd about it on my way down. I'd like to lay hands on them crooks, an' I bet they'd think twict before they beat another man up! But yer a fightin' man, Hurley; they must of got ye foul." "Foul is the word. When the wagon tipped over my head hit a tree an' that's the last I remember 'til I come to an' the boy, Steve, was bathin' my head with snow an' tyin' up my cuts with strips of his shirt." "Too bad," condoled Slue Foot, shaking his head sympathetically; "an' they got plumb away?" "Sure they did. It wasn't so far to the railroad, an' the snow fallin' to cover their tracks. But, Oi'll lay holt av 'em sometime!" he cried, relapsing into his brogue. "An' whin Oi do, law er no law, Oi'll bust 'em woide open clane to their dirty gizzards!" "Sure ye will!" soothed Slue Foot. "But, it's better ye don't go worryin' about it now. They're miles away, chances is, mixed up with a hundred like 'em in some town er nother. I started the cuttin' this
- 44. mornin'. I'm workin'to the north boundary, an' then swing back from the river." Hurley nodded: "That's right. We want to make as good a showin' as we kin this year, Slue Foot. Keep 'em on the jump, but don't crowd 'em too hard." Slue Foot turned to Connie: "An' now, if ye hain't got nawthin' better to do than set there an' beaver that pencil, ye kin come on up to Camp Two an' I'll give ye the names of the men." "If you didn't have anything better to do than hike down here, why didn't you stick a list of the names in your pocket?" flashed the boy, who had found it hard to sit and listen to the words of the double-dealing boss of Camp Two. "Kind of sassy, hain't ye?" sneered Slue Foot. "We'll take that out of ye, 'fore yer hair turns grey. D'ye ever walk on rackets?" "Some," answered Connie. "I guess I can manage to make it." Slue Foot went out, and Hurley motioned the boy to his side. "Don't pay no heed to his growlin' an' grumblin', it was born in him," he whispered. "I'll show him one of these days I ain't afraid of him," answered the boy, so quickly that Hurley laughed. "Hurry along, then," he said. "An' if ye git back in time I've a notion to send ye out after a pa'tridge. Saginaw says yer quite some sport with a rifle." "That's the way to work it, kid," commended Slue Foot, as Connie bent over the fastenings of his snow-shoes. "I'll growl an' you sass every time we're ketched together. 'Twasn't that I'd of made ye hike way up to my camp jest fer to copy them names, but the time's came fer to begin to git lined up on shadin' the cut, an' we jest nachelly had to git away from the office. Anyways it won't hurt none to git a good trail broke between the camps." "There ain't any chance of getting caught at this graft, is there?" asked the boy.
- 45. "Naw; that is,'tain't one chanct in a thousan'. Course, it stan's to reason if a man's playin' fer big stakes he's got to take a chanct. Say, where'd you learn to walk on rackets? You said you hadn't never be'n in the woods before." "I said I'd never worked in the woods—I've hunted some." The talk drifted to other things as the two plodded along the tote road, but once within the little office at Camp Two, Slue Foot plunged immediately into his scheme. "It's like this: The sawyers gits paid by the piece—the more they cut, the more pay they git. The logs is scaled after they're on the skidways. Each pair of sawyers has their mark they put on the logs they cut, an' the scaler puts down every day what each pair lays down. Then every night he turns in the report to you, an' you copy it in the log book. The total cut has got to come out right—the scaler knows all the time how many feet is banked on the rollways. I've got three pair of sawyers that's new to the game, an' they hain't a-goin' to cut as much as the rest. The scaler won't never look at your books, 'cause it hain't none of his funeral if the men don't git what's a-comin' to 'em. He keeps his own tally of the total cut. Same with the walkin' boss—that's Hurley. All he cares is to make a big showin'. He'll have an eye on the total cut, an' he'll leave it to Saginaw an' me to see that the men gits what's comin' to 'em in our own camps. Now, what you got to do is to shade a little off each pair of sawyers' cut an' add it onto what's turned in fer them three pair I told you about. Then, in the spring, when these birds cashes their vouchers in town, I'm right there to collect the overage." "But," objected Connie, "won't the others set up a howl? Surely, they will know that these men are not cutting as much as they are." "How they goin' to find out what vouchers them six turns in? They hain't a-goin' to show no one their vouchers." "But, won't the others know they're being credited with a short cut?" "That's where you come in. You got to take off so little that they won't notice it. Sawyers only knows about how much they got
- 46. comin'. They onlyguess at the cut. A little offen each one comes to quite a bit by spring." "But, what if these men that get the overage credited to 'em refuse to come across?" Slue Foot grinned evilly: "I'll give 'em a little bonus fer the use of their names," he said. "But, they hain't a-goin' to refuse to kick in. I've got their number. They hain't a one of the hull six of 'em that I hain't got somethin' on, an' they know it." "All right," said Connie, as he arose to go. "I'm on. And don't forget that you promised to let me in on something bigger, later on." "I won't fergit. It looks from here like me an' you had a good thing." An hour later Connie once more entered the office at Camp One. Steve sat beside Hurley, and Saginaw Ed stood warming himself with his back to the stove. "Back ag'in," greeted the big boss. "How about it, ye too tired to swing out into the brush with the rifle? Seems like they wouldn't nothin' in the world taste so good as a nice fat pa'tridge. An' you tell the cook if he dries it up when he roasts it, he better have his turkey packed an' handy to grab." "I'm not tired at all," smiled Connie, as he took Saginaw's rifle from the wall. "It's too bad those fellows swiped your gun, but I guess I can manage to pop off a couple of heads with this." "You'd better run along with him, Steve," said Hurley, as he noted that the other boy eyed Connie wistfully. "The walk'll do ye good. Ye hain't hardly stretched a leg sense I got hurt. The kid don't mind, do ye, kid?" "You bet I don't!" exclaimed Connie heartily. "Come on, Steve, we'll tree a bunch of 'em and then take turns popping their heads off." As the two boys made their way across the clearing, Hurley raised himself on his elbow, and stared after them through the
- 47. window: "Say, Saginaw,"he said, "d'ye know there's a doggone smart kid." "Who?" asked the other, as he spat indifferently into the wood box. "Why, this here Connie. Fer a greener, I never see his beat." "Yeh," answered Saginaw, drily, his eyes also upon the retreating backs, "he's middlin' smart, all right. Quite some of a kid—fer a greener."
- 48. "H CHAPTER XIII SAGINAW EDHUNTS A CLUE ELLO!" cried Saginaw Ed, as he stared in surprise at a wide, flat trail in the snow. The exclamation brought Connie Morgan to his side. The two were hunting partridges and rabbits, and their wanderings had carried them to the extreme western edge of the timber tract, several miles distant from the camps that were located upon the Dogfish River, which formed its eastern boundary. Despite the fact that the work of both camps was in full swing, these two found frequent opportunity to slip out into the timber for a few hours' hunt, which answered the twofold purpose of giving them a chance to perfect their plans for the undoing of Slue Foot Magee, and providing a welcome addition to the salt meat bill of fare. "Wonder who's be'n along here? 'Tain't no one from the camps— them's Injun snow-shoes. An' they ain't no one got a right to hunt here, neither. Hurley posted the hull trac' account of not wantin' no permiscu's shootin' goin' on with the men workin' in the timber. Them tracks is middlin' fresh, too." "Made yesterday," opined Connie, as he examined the trail closely. "Travelling slow, and following his own back trail." Saginaw nodded approval. "Yup," he agreed. "An', bein' as he was travellin' slow, he must of went quite a little piece. He wasn't carryin' no pack." "Travelling light," corroborated the boy. "And he went up and came back the same day."
- 49. "Bein' as heheaded north and come back from there, it ain't goin' to do us no hurt to kind of find out if he's hangin' 'round clost by. They ain't nothing north of us, in a day's walk an' back, except the Syndicate's Willer River camp. An', spite of yer stickin' up fer him, I don't trust that there Mike Gillum, nor no one else that would claim Hurley throw'd in with the Syndicate." The man struck into the trail, and Connie followed. They had covered scarcely half a mile when Saginaw once more halted in surprise. "Well, I'll be doggoned if there ain't a dugout! An' onless I'm quite a bit off my reckonin', it's inside our line." For several moments the two scrutinized the structure, which was half cabin, half dugout. From the side of a steep bank the log front of the little building protruded into the ravine. Smoke curled lazily from a stovepipe that stuck up through the snow-covered roof. The single window was heavily frosted, and a deep path had been shovelled through a huge drift that reached nearly to the top of the door. The trail the two had been following began and ended at that door, and without hesitation they approached and knocked loudly. The door opened, and in the dark oblong of the interior stood the grotesque figure of a little old man. A pair of bright, watery eyes regarded them from above a tangle of grey beard, and long grey hair curled from beneath a cap of muskrat skin from which the fur was worn in irregular patches. "Phwat d'yez want?" he whined, in a voice cracked and thin. "Is ut about me money?"
- 50. "PHWAT D'YEZ WANT?"HE WHINED. "Yer money?" asked Saginaw. "We don't know nothin' about no money. We're from the log camps over on Dogfish. What we want to know is what ye're doin' here?" "Doin' here!" exclaimed the little old man. "Oi'm livin' here, that's what Oi'm doin'—jest like Oi've done f'r fifteen year. Come on in av ye want to palaver. Oi'm owld an' like to freeze standin' here in th' dure, an' if ye won't come in, g'wan away, an' bad cess to yez f'r not bringin' me back me money." Saginaw glanced at Connie and touched his forehead significantly. As they stepped into the stuffy interior, the old man closed the door and fastened it with an oak bar. Little light filtered through the heavily frosted window, and in the semi-darkness the two found difficulty picking their way amid the litter of traps, nets, and firewood that covered the floor. The little room boasted no chair,
- 51. but, seating himselfupon an upturned keg, the owner motioned his visitors to the bunk that was built along the wall within easy reach of the little cast iron cooking stove that served also to heat the room. "Ye say ye've lived here for fifteen years?" asked Saginaw, as he drew off his heavy mittens. "Oi have thot." "Ye wasn't here last winter." "Thot's whut Oi'm afther tellin' yez. Last winter I wuz to the city." "This here shack looks like it's old, all right," admitted Saginaw. "Funny no one run acrost it last winter." "Ut snowed airly," cut in the little man, "an' if they ain't no wan here to dig her out, she'd drift plumb under on th' furst wind." "Who are you?" asked Connie. "And what do you do for a living? And what did you mean about your money?" "Who sh'd Oi be but Dinny O'Sullivan? 'An' phwat do Oi do fer a livin'?' sez ye. 'Til last winter Oi worked f'r Timothy McClusky, thot owned this trac' an' w'd died befoor he'd av sold ut to th' Syndicate. Good wages, he paid me, an' Oi kep' off th' timber thayves, an' put out foires, an' what not. An' Oi thrapped an' fished betoimes an' Oi made me a livin'. Thin, McClusky sold th' timber. 'Ye betther come on back wid me, Dinny,' sez he. 'Back to the owld sod. Ut's rich Oi'll be over there, Dinny, an' Oi'll see ye'll niver want.' "But, ut's foorty year an' more since Oi come to Amurica, an' Oi'd be a stranger back yon. 'Oi'll stay,' Oi sez, 'f'r Oi've got used to th' woods, an' whin they cut down th' timber, Oi'll move on till somewheres they ain't cut.' 'Ut's hatin' Oi am to lave yez behind, Dinny,' sez he, 'but, Oi won't lave ye poor, fer ye've served me well,' an' wid thot, he puts his hand in his pocket loike, an' pulls out some bills, an' he hands 'em to me. 'Put 'em by f'r a rainy day, Dinny,' he sez, an' thin he wuz gone. Oi come insoide an' barred th' dure, an' Oi counted th' money in me hand. Tin bills they wuz, all bright an' new an' clane, an' aich bill wuz foive hunder' dollars. 'Twas more
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