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When public welfare becomes dependent on charity

The Care Crisis. What Caused It and How Can We End It?
Forfatter: Emma Dowling
Forlag: Verso Books (Storbritannia)
CARE / : The UK is increasingly dependent on the efforts of volunteers to provide citizens with a minimum of care while public services are suffering from budget cuts and crises.


In the wake of the global financial crisis, welfare services and health services in Europe and the United States came under pressure with extensive austerity measures and restructuring, an example of an "obvious global care crisis", writes Emma Dowling.

The UK's challenge is an aging population, and consequently an increasing number of dementia patients in need of care and nursing. Expenditure cuts in the public sector and tight financial management have resulted in a shortage of resources and nursing homes. It affects the health services in general – including mental health services – and provides overworked health personnel, from doctors and nurses to caregivers.

The cuts have also depleted other services society needs, such as daycare, student support, unemployment benefits and disability benefits.

Emma Dowling has been researching how the private sector has invested in – and made money from – healthcare in the UK since the 1970s. According to Dowling, Margaret Thatcher's statement "it is not something called 'society' 'was not about individualism, but rather a call for" private and personal responsibility ". [It was not exactly what Thatcher said, but the press that wrote this. The quote reads: "… I will go and get a grant to cope with it!" 'I am homeless, the Government must house me!' and so they are casting their problems on society and who is society? There is no such thing! There are individual men and women and there are families and no government can do anything except through people and people look to themselves first. " red. note]

Care work involves social and emotional skills that can not be recalculated
to time units.

By neoliberal logic, care is understood as one individual moral obligation rather than as a public responsibility. This is the reason for the impoverishment of public social and health services, which in turn results in firefighting through private investment, which further exacerbates the care crisis.

Moral obligation

Dowling defines care as "all activities to create, change, maintain, contain and repair the world we live in, and the physical, emotional and intellectual capacity required to do so." Care is "central to society's reproduction" and part of a basic infrastructure that holds society together. Women perform "significantly more unpaid care work than men" and spend "3,3 times as much time as men on unpaid care".


Since the 1970s, Marxist feminists have looked at the economic value of society's reproduction. Women had entered the labor market long before that time, but it is still not so long ago that many women were dependent on the salary of the male breadwinner. For this reason, Marxist feminists have argued that unpaid reproductive work not only provides added value, but is also "within the wage relationship" (Federici, 2013).

Dowling analyzes the differences between "care" and "reproductive work" and argues that the latter is an economic category "used to describe the institutionalized distinction between productive and reproductive activities" in the capitalist economy, while the former is "an ethical social relationship based" on feelings of devotion and a sense of duty, which both demands and produces bonds that connect us to others ». Care work is not limited to the private sphere of the home; it is also "carried out in the context of the welfare state".

Production and reproduction

When the welfare state is on the rim, it is the women who first notice the consequences due to societal gender expectations. The author explains that when it comes to restructuring employment contracts for doctors working for the National Health Service [NHS, the UK Public Health Service, ed. Note], under the new working conditions, younger doctors will shift the responsibility for childcare to an informal or casual employee, who is most likely a «woman, of lower class and presumably with an immigrant background», which in turn shows a «mutual dependence between the spheres of production and reproduction ».

Cuts in public spending have resulted in bottom-up municipal coffers, which in turn are "accompanied by a rhetoric about the power of society" which grossly exploits the volunteers' efforts.

After the financial crisis in 2008, there was an increase in food banks, and there are now over 2000 in the UK. The food centers are dependent on "the compassion of the volunteers" and replace public welfare with charity and the desire of fellow human beings to help, while "strengthening the hierarchies between those who are blessed with time, abilities and opportunities to help others, and those who need help." . Furthermore, recipients of the kind of welfare suffer from the stigma that blames individuals for the situation they have ended up in, while the causal connections remain hidden.

There is an increase in a number of obsessive-compulsive disorders.

Large parts of public care and nursing services offered to adults depend on the labor force of immigrants, many of whom are employed by subcontractors who in some cases offer wages below the minimum wage.

The United Kingdom has been dependent on immigrants for care work since the NHS was established. At that time, the health care workforce was secured through citizens from common nations on the Indian subcontinent and the Caribbean. Today, the health care system is dependent on labor from the EU, especially Eastern European and Southern European countries, which in turn have also felt the consequences of the global financial crisis.

Self-care industry

The growing interest in the use of technology in home services involves not only the introduction of robots to perform labor-intensive tasks such as lifting a patient, but also the supervision and monitoring of time spent on each nursing task. Such technological solutions can help care workers with intensive tasks and allow information sharing about patients, but as Dowling warns, technology also changes the nature of the task itself: Care work involves social and emotional skills that cannot be converted into units of time.

The private sector has further permeated the care offer following restrictions in the health care system and implemented new business models through private-public cooperation. Dowling claims these are measures that exacerbate the crisis.

Tightening the economy is a management tool that creates "a mode of accumulation based on expectations, estimates and speculation about future gains or losses," writes Dowling. Financial instruments, such as Social Impact Bonds (SIB), were created to "finance societal innovation". The effect is calculated through the use of metric models and data analysis to guarantee goal achievements and return on capital.

If the goals are achieved "within the specified time", investors get their money back with an additional bonus. At the same time, when public social and health services are virtually non-existent, and individuals become responsible for the welfare of others through voluntary work, a self-care industry flourishes. In addition, there is an increase in a number of obsessive-compulsive disorders, such as a fixation on "clean food".

The Care Crisis paints a bleak picture of public health and social care in the UK, but reading this book during the current pandemic highlights the link between the welfare states' exhaustion following the global financial crisis and our inability to meet the covid-19 pandemic with good preparedness.

Patricia Sequeira Brás
Patricia Sequeira Brás
Patricia Sequeira Brás Teaches Portuguese Modern Cultures. The relationship between politics and cinema that motivated her doctoral work continues to shape her new research projects. Here Current Interests Include Representations of Crises in Cinema and Video; Explorations on film Viewership and political and Ethical Engagements; Communicative and Affect Capitalism. These interrogations are informed by work from an array of disciplinary fields within the humanities: film theory, philosophy, political theory and recent research in neuroscience.

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