The care economy is the system of paid and unpaid labour, services and relationships to meet the physical, emotional and social needs of those who need care. Despite its essential role in the market economy, care work remains invisible, under-recognised and undervalued.
Care encompasses direct assistance with basic daily activities (such as feeding, dressing and bathing) and chores (for instance, cleaning, cooking and laundry). Care recipients increasingly shift from young children to adults who have difficulties carrying out daily activities as they age.
Care work is mainly provided by unpaid family members – mostly women – worldwide. This household division of labour enables households to participate in market economies.
As societies age, household size shrinks partly due to falling birth rates and changing family structures. Unpaid care may be provided by children, friends, neighbours and community volunteers, and those who themselves need care, such as a spouse at an advanced age, supplemented by paid in-home care work (for example, home care workers and domestic workers).
Care work may also be provided in nursing homes and other facilities, often characterised by low wages, unsafe work environments and limited work-related benefits, compounded by race, gender and immigration status.
Economic value of unpaid family care
The economic value of unpaid family care is estimated to be trillions of dollars globally. Unpaid care may account for 10% to over 40% of a country’s gross domestic product.
Some countries consider the economic value of unpaid family care in national policies and national accounts that track income, spending and production.
Measuring and estimating. National time-use surveys track the value of unpaid family care in dozens of countries.
Incorporating unpaid care into official government reports of national total economic activity. Specific efforts include establishing household satellite accounts using time-use surveys to measure unpaid care work alongside GDP, without changing the core market-based GDP calculation.
Public policies to support unpaid family caregivers. Policies can 1) directly recognise unpaid family caregivers and support them financially (using, for example, stipends or caregiver tax credits), 2) reduce care burden (through public infrastructure development and subsidised care services), and 3) redistribute family care more equitably (with paid family and medical leave, for instance, or flexible work arrangements).
A country that is excellent in measurement or accounting may be trailing in public policies. For example, the United States leads the world in the statistical tracking of time spent on unpaid family care but remains one of the few countries without national paid leave policies. Several countries have established national long-term care insurance (including Germany, Japan and the Netherlands) or universal public systems (as in Sweden, Denmark and Norway) to support family caregivers and help pay for long-term care.
Pathways for integrating care
Care work is an essential foundation for market economies in ageing societies. Political will is needed to integrate care work into social and economic systems. Recommendations on how to do so include:
Develop long-term public policies to support unpaid or underpaid care work, implement them, and continuously improve them. Go beyond statistical tracking.
Build health promotion and prevention into care work. For example, build physical activity and healthy eating into care work to promote healthy ageing in those who provide care as well as those who receive care.
Empower care work with technology appropriate for the needs of care providers and recipients. Artificial intelligence and robots are unlikely to replace humans to perform care work in the foreseeable future, but we should consider how AI applications could support or supplement caregivers’ work.
Social norms about caregiving are strong but can shift as older generations are replaced by younger generations with different values, beliefs and behaviour. Cultural lag is the period of friction when older norms persist in parts of social and economic systems. We should critically assess the intended or unintended impact of evolving national policies (such as immigration) on unpaid or paid care providers.
Make the invisible visible
Care work and related social norms are often invisible as are health promotion and prevention efforts. We must make the invisible visible and enact policies to support care work in social and economic systems.
