industry & reform
“ Access to care is essential and markets have failed to provide acceptable solutions .
Caring about care
Why it is vital we properly recognise the care economy .
By Michael Fine
Fixing aged care is set to be a key priority of the new government under Prime Minister Anthony Albanese . So is a more affordable and improved system of child care , reform of the NDIS , and strengthening Medicare and the health care system . What binds these issues together is their recognition as part of the ‘ care economy ’.
Data on the size and significance of the care economy can be alarming . Reflecting the huge growth in the provision of formal services in these fields since the 1960s , there has been a continuing rise in employment in aged and child care , disability and health care .
Employment in the ‘ health care and social assistance ’ sector , as the ABS calls it , has been the most rapidly growing form of work and is now the largest field of employment in Australia and in comparable countries .
Most workers in the care economy are women . Wages are low in comparison with those in comparable fields , and employment conditions are increasingly precarious . Income growth and career prospects lag well behind most other areas . No wonder there are staff shortages .
Much care continues to be provided by women and men , working in their own homes , families and neighbourhoods without pay . They work as family carers , volunteers and members of a wide range of non-profit community organisations .
But the meaning of the term is not really captured by simply adding up all the statistics . The point of identifying care as an economy that is essential to the functioning of the modern world is to recognise that in a global market system , the complexity of the way that care is produced , exchanged and used can no longer just be ignored or taken for granted . Nor can it be understood simply as just another specialised sector of the larger economy .
Instead , recognition of the care economy draws attention to the unique way that care is produced , distributed and used . It serves to meet fundamental needs in a manner that shapes and reshapes the lives that all people lead . It is both a product of the system of our market society , and a force that in turn helps shape the families , communities and nations in which we live .
Recognising the care economy in this way is comparable to the acknowledgement of climate change and the environment . Both are foundations on which the world as we know it depends .
Meanwhile , the ongoing policy failures in aged care and problems with childcare , disability and health care have typically been regarded as essentially local . But problems in the care economy are experienced internationally and require a longer-term , global perspective alongside one that focuses on national policies and local solutions . There is also much to be learned from the experience of other countries .
It is often argued , correctly in my view , that these problems are an expression of gender-based discrimination leading to the disadvantage and unequal treatment of women . In Australia , for example , national governments over the past decade have promoted the virtues of employment in traditionally male dominated industries such as mining , while presiding over deteriorating wages , staff ratios and employment conditions in aged care and childcare .
But the care economy perspective also helps identify other factors involved .
In contrast to many other areas of the economy where production costs have fallen , care services are delivered on-site , at the point of consumption and continue to be produced almost entirely by people working one-to-one . Not surprisingly , the overall proportion of GDP spent on costs of care have risen .
Attempts to drive the costs of care down have focused on reducing the core costs , ie wage costs . Is it any wonder that these career-killing strategies have not attracted sufficient highly qualified staff ?
While markets have been promoted as a solution to all problems , the care economy , internationally as well as in Australia , would not exist without government funding , support by non-profit community groups and unpaid family care .
This mix came about because access to care is essential and markets have failed to provide acceptable solutions for the majority of citizens . We should not forget how these foundations need to be maintained and improved , not abolished .
Drawing attention to the way that care operates as a social investment and not just a cost , can lift debate about care , both paid and unpaid , and help create hope for a better future . ■
Michael Fine is Honorary Professor in the School of Social Sciences at Macquarie University .
12 | nursingreview . com . au