Commentators, activists and scholars alike have been warning of a deepening ‘care crisis’ for some time now. Today, as we grimly mark the one-year anniversary of a global pandemic, these warnings seem terrifyingly prescient. The UK’s resource-starved health and social care systems have, after all, been a major contributing factor to the country’s high Covid-19 infection and death rate.
But what do we mean exactly when we speak about a crisis of care writ large? And what are the factors that have brought us to such a state? Emma Dowling’s The Care Crisis: What Caused It and How Can We End It? not only addresses these urgent questions, situating her analysis within the UK context, but she also outlines what we can – and must – do to create an alternative and more caring future. Her book is accessible, rigorous, and thoughtful. It seamlessly weaves theory, statistics and on-the-ground experiences in order to generate a convincing analysis of how and why care has been devalued and increasingly exploited in contemporary Britain.
Much of the book’s analytic power derives from its clarity and thoroughness. Given the overdetermined nature of ‘care’ – as well as its overuse during the Covid-19 pandemic – Dowling is careful to define the term. Indeed, drawing on the work of feminist scholars Joan Tronto and Nancy Folbre, she categorizes ‘all the supporting activities that take place to make, remake maintain, contain, and repair the world we live in and the physical, emotional and intellectual capacities required to do so’ as care (p. 21). Care is consequently not reduced to care work or care workers – as often occurs in current discussions and media representations—but is understood as all of the practices and resources that allow human beings to live materially secure and meaningful lives. The insistence on an expanded notion of care is a very welcome contribution to on-going feminist debates.
The care crisis, in turn, is understood as the growing gap between care needs and the resources made available to meet them. Dowling offers a comprehensive overview of the symptoms of this crisis in the UK as well as narratives from those working on the frontline of social and health care, underscoring the misery and devastation the crisis has wrought: from a growing elderly population without access to adequate care facilities through the underpaid, overworked and undervalued social care workers to the ever-diminishing resources to support society’s most vulnerable populations, such as children with disabilities. And, as Dowling emphasizes, the care crisis is profoundly gendered as well as inflected with racial and class inequalities, with women carrying out 60% more unpaid domestic and care work than men in aggregate terms.
Importantly, Dowling also clearly distinguishes between ‘social reproduction’ and ‘care’. There has been a resurgence of both social reproduction theory and theories of care in recent years, while scholars tend to invoke one or the other term depending on their theoretical commitments. Yet, Dowling keeps both terms in sight, underscoring the usefulness of each to describe different aspects of the care crisis. Social reproduction refers to a functional economic category, which identifies the institutional separation between productive and reproductive activities and encompasses reproductive activities and their arrangement within capitalist societies. Care, by contrast, is a social relation, characterized by relational, affective, and emotional dimensions. As Dowling puts it, ‘Care (work) is an ethical social relationship, both requiring and producing sympathetic attachments’ (p. 38). Care work can thus be understood as one crucial aspect of the labour of social reproduction, even as it is irreducible to it.
This distinction is useful and compelling. Moreover, it helps us understand how, under neoliberal capitalism, care work practices are economized. By breaking care work into repetitive and standardized tasks, leaving little time or space for any affective and relational dimensions, ‘productivity’ increases as does profit for employers. This rationalizing of care enables both the increased outsourcing of care work, since it becomes quantifiable, as well as justifies the categorization of this work as unskilled. In a sense, by extracting all affective aspects from care work, this process renders the distinction between social reproduction and care in the realm of paid labour unintelligible. It also clearly exacerbates the crisis of care, since human flourishing depends on all those non-quantifiable and ‘more fragile dimensions of care—love, concern, regard, attention, affection’ (p. 46).
This leads to another key conceptual intervention: the notion of ‘care fixes’, which describes how financialized capitalism attempts to manage its internal contradictions through short-term solutions that merely displace the crisis and serve to further privatize care. Rationalizing and quantifying care work is one such care fix, since it not only enables the increased financialization of social care by transforming it into a marketized service, but also devolves the emotional and affective dimensions of care onto family members – mostly women – and communities. The burgeoning self-care industry is another salient example. These short-term care fixes encourage individual solutions to structural injustices – whilst also opening up new markets for profit.
Dowling ultimately and very convincingly argues that the current care crisis in Britain cannot simply be understood as a cocktail of recession and austerity following the financial crash of 2008. Rather, it is the result of the devastating ways in which care has been disaggregated, privatized, outsourced and financialized over the past fifteen years. This, in turn, also means there is no quick fix to the care crisis.
Indeed, the only way to truly solve the crisis is by a radical transformation on all levels: in our common sense, social norms, and economic and social care infrastructures. It will require ‘rethinking care in the household, the workplace and beyond … Truly valuing care means having time for unpaid caring in our everyday lives and publicly funding a care infrastructure with well-paid care work’ (p. 195). It means a radical redistribution of care so that it is shared in an egalitarian manner. Expanding Dowling’s insights even further, it means replacing profit with care as the main organizing principle of life, including the non-human and the planetary.
And if ever there was a time when this kind of radical agenda could become prescient, it is in the midst of a global pandemic which has laid bare – tragically but also dramatically – our mutual inter dependencies and that the need for care is front and centre of not only human survival but for all human, non-human, and planetary thriving.