Emma Dowling: Understanding the care crisis (ep346)
“I’m in favor of people being compassionate, and I think that’s a good thing. But the kind of change that we need is more than people simply changing their behavior—we have to actually change something structurally about the way that our economy and society are organized.”
In this episode, we welcome Emma Dowling, a sociologist at the University of Vienna in Austria. She has previously held academic positions in Britain and Germany. Her most recent work asks what our economy looks like when viewed from the perspective of care, charting the material conditions that shape its configurations. She is the author of The Care Crisis - What Caused It and How Can We End It? published with Verso Books.
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Transcript:
Note: *Our episodes are minimally edited. Please view them as open invitations to dive deeper into each resource and topic explored. This transcript has been edited for clarity.
Emma Dowling: I first became interested in the issue of care in the context of the UK, where I was based at the time. This was after the 2008 financial crisis wherein Britain was subjected to quite severe austerity measures: cuts to public services and funding for public services, particularly at the level of the municipality. There were cuts up to 60 percent, so municipalities and local councils couldn’t provide [the] adult social care services that they're responsible for.
I was interested in how austerity was having an effect in Britain in terms of people's access to the care that they needed, but also the increasingly difficult conditions under which people who were working in the care sector were trying to provide care and do their jobs. The other aspect of this was also to explore how cuts were increasing the amount of unpaid work that people were doing in the home, particularly that women were doing in the home in the context of the family and the household, and also volunteers as well in their community.
Looking at how austerity and cuts were impacting all these areas of care was the context. What I wanted to do was make the growing crisis here visible. The other thing I was interested in was looking at how care really isn't just one individual sector; it cuts across different areas of society. [Raising awareness about] areas of society that are crucial for life to be sustained [and] the caring that gets done as part of that. Showing this and making this visible was what I was interested in doing.
Kamea Chayne: When you said that care isn't just a sector, I feel the same about the idea of sustainability in that it's not a sector because it's really embedded within all aspects of society. It feels like a similar thing with care as well. There are so many crises we're faced with today. People talk about a mental health crisis, a socio-ecological crisis, the climate crisis, the financial crisis, and so on, although perhaps they're all part of this broader meta-crisis.
But as you note: "To speak of crisis – any crisis – is to join a litany of crisis lamentations that crowd the public sphere and make us numb to its urgency...Like inverted fairy dust, this despair has us all in a painful hiatus, not knowing how to impel change and unable to imagine a different future, let alone bring it about."
With this in mind, what is the significance of naming this care crisis? How do you see it relating to the multitude of other crises that people recognize?
Emma Dowling: That was something that I struggled with, particularly when [I] started out writing the book. The passage that you quote is from the introduction, where I was really trying to find a way into these issues. The way that I define the crisis in the book is the exhaustion of social care resources, both in terms of people's access to care, people not being able to get the care that they need, but also people who are doing care doing so under increasingly difficult conditions. All the while, inequality [is] growing... Calling it a crisis is, of course, not only reflecting reality in the real situation.
I begin the book by saying, “Open the papers and any day you have reports of the situation in the health sector, in the social care sector.” The sense of crisis is there—it's real. Of course, to call something a crisis is to draw attention to the urgency and the need for change, but also a question of what direction that change might go in. But at the same time...
To talk about crisis at a moment when there's so much talk about crisis is difficult.
There's an ambivalence there as well because all this talk about crisis can feel quite disempowering. I was grappling with that, in the context that crisis seems to have become such a normal state of affairs, but also one that feels quite disempowering because you don't have a sense of, “Ok, we're going somewhere positive. We have a sense of where we're going.” It's more a sense of, “Oh, we don't know what's happening, and things have gotten to a point where they can't continue the way that they are.”
As you say, at the moment, there seem to be crises in different areas. But for me, that's also an opening to think about how these crises are connected.
You mentioned sustainability. Thinking about ecological issues together with care is really important, but also thinking about how the economic model that we have, the capitalist model, has come up against limits. It tries to commodify care, tries to instrumentalize this whole area of care… and it's not working. The system is eating its tail and creating worse conditions and greater inequality. [It’s] the same with ecology. The idea of endless growth on a finite planet is a contradiction.
There are also ways in which these different crises come together around the question of the economy we have and the way that capitalism functions and the limits that we have there.
Kamea Chayne: Absolutely. When we dig deep enough underneath all these different crises or differences at the surface, I think that we often find that they share a lot of the same roots. When we think about the state of our world today, it's easy to jump to the conclusion that the crisis of care is about people's lack of compassion and lack of care for each other. That type of interpretation might lead people to believe that we just have to suck it up and be kinder, more compassionate, and loving towards everyone around us.
But your book “challenges the idea that people ever stopped caring. And that the deep and multi-faceted crises of our time cannot be solved by simply re-installing the virtues of empathy.” I'd be curious to hear you expand on this idea that compassion is so often mobilized as the fix to this crisis of care.
Emma Dowling: It's a tricky one. One of the things that motivated me in writing the book was precisely this increasing call for people to be more empathetic to one another. [The idea] that we need more compassion, that we live in a world that is dominated by people being selfish, this individualism, the atomization of society, and that these are all these real problems. To a certain extent, that's true.
[But] that doesn't mean that simply calling for more compassion will solve the problem.
There are a couple of issues there. The first is that people haven't stopped caring and didn't stop caring. We have to challenge this idea that we simply have a situation of selfishness and people not looking out for each other.
What we have is a situation where lots of people are caring and are doing the work of caring, but they are doing so under increasingly difficult conditions. Also, a lot of the time, it is precisely their sense of compassion, of empathy, of responsibility, either within the family context of responsibility for loved ones and relatives, or a sense of responsibility for the community, or a sense of responsibility in terms of public service with people who are working in the health sector or social work in other areas… that is drawn on to paper over the cracks, to keep things going under difficult conditions, precisely because people can't not care. And often it's the usual suspects—[mostly] women. [So] there are lots of people who are caring and often their work goes unnoticed, [which means] simply calling for more compassion is not sufficient.
The other thing is that there is precisely this ideological moment. For example, in the context of Britain after 2008, where we had so many cuts, there was also a call by the Prime Minister at the time, David Cameron, for a “big society,” for people to get involved in their local communities. This was presented as empowering: people getting involved in their communities. But at the same time, these cuts were happening, so there were fewer resources available for tax reforms [and] the lowering of corporation tax was happening. There was this redistribution of wealth upwards while at the same time, [they were] calling for people to get involved in creating a more compassionate society.
I wanted to draw attention to that problem. All of this is also based on something that the feminist movement has pointed out for a long time, that [the idea of the] “labor of love” is a mystification of things that women have done in the home and the family because of a sense of love. Behind that lies a whole lot of labor [that is] often also about economic dependency and these [historical conditions]. [I wanted to break this open and point] to the fact that...
The issues that we face have to do with structural conditions.
[It] has to do with the way that the economy is organized [and] the unequal distribution of work and resources. It's not simply an issue of individual behavior. Whereas I'm in favor of people being compassionate—I think that's a good thing—but I think we have to also not fall into the trap... The change that we need is more than people simply changing their behavior. We have to change something structurally, about the way that our economy and society are organized.
Kamea Chayne: I certainly do not doubt that people ever stopped caring, and at the same time, we’re also contextual creatures, and the circumstances we're in at any given moment also bring out different parts of the complex humans that we are. So, for example, maybe a sense of lack or insecurity or scarcity might lead people to behave more selfishly or define community and family more narrowly as well.
Emma Dowling: That’s a really good point as well, and that's something that I pick up in the book around this issue of self-care. That on the one hand, self-care can be a really good thing. But on the other hand, we can also criticize self-care in the ways that it becomes embedded in a well-being industry that is orientated towards consumption, [and] oriented towards people who have the financial resources to buy lots of products that will help them to self-care.
I think another aspect there is this idea of investing in yourself as human capital, that you can optimize and grow and reap the benefits of that financial logic. But of course, the backdrop to that is also “take care of yourself because no one else will.” In a world where for many people, life is becoming increasingly precarious, where we are very dependent on our ability to work to have an income, it becomes a very anxiety-producing situation. The fear of what will happen to me if I'm not able to work, what will happen to me if I don't have that income?
So, I think there also is this issue of how anxiety and fear are also motivating a lot of ways in which people try to compensate for the situations that they find themselves in. You're right, we are complex human beings and it's not either, “You're a wonderful, bright, caring person,” or “You're not.” But it's also about understanding how society is organized to induce certain feelings.
Our economy is organized in a way to induce a sense of anxiety and worry.
Kamea Chayne: To take a step back and highlight the limitations of people simply becoming more loving and compassionate to address the care crisis, I think it's helpful to offer a little bit of a historical context to show how deep-rooted and large-scale the crisis is. You shared that the last 30 years have seen the proliferation of the global care chains. This isn't something we've talked about before on the show. Can you help us understand this phenomenon and how it ties into the broader extractive economy that the system of care exists within?
Emma Dowling: This is a term that was popularized by a sociologist in the United States, Arlie Hochschild, and has been taken on by others.
The debate here is really about what we might call a “care regime,” a broader question of how care and care work are distributed in society. [If we] look at countries like the United States or Britain and the situation after the Second World War, in that postwar context, the housewife and mother were quite a central figure in terms of being the person who does a lot of the unpaid care work within the home. In feminism, there is a so-called “social reproduction,” so reproducing labor power for the economy not only in terms of family but also all of the housework and the cleaning and the cooking and the emotional labor that goes into maintaining [the] relationships of the care work.
This was a more or less stable regime of a housewife who was in the home and then a male worker who would go out and earn the income would be the breadwinner in this model. Now, this was dominant. It was in many ways always premised also on racial divisions and a colonial context and so forth. But this stable regime starts to unravel for a variety of reasons, that have to do with women struggling against their position, but also their great entry into the labor market, particularly married women, who then work more.
Over a period from the late 70s into the 90s, we have a huge increase in female labor market participation, meaning that women are not available in the same way as they had been in the past, or a lot of the time, they had been doing double and triple shifts. But at the same time, what we also see is an increase in something that was already happening: other women coming in to take over this role and do this work, particularly with wealthier households who can afford to pay others.
We have other women who work as domestic workers, childminders, and so forth, and many of those women are migrant workers. So here we see that there is not much change to the current gendered division of labor in society overall, but there is an offloading onto other women who then often are working under underpaid or informal contexts that are precarious. There's an exploitation of the existing structural discrimination in the labor market there.
The issue with this idea of the chain is that these are women who have come from other countries and also have contexts at home where they might have caring responsibilities, or are then leaving contexts where there's the question of what happens to the people who need to be cared for there?
The other aspect of the chain is that other women from elsewhere might come into to fulfill that role. In the European context, there might be someone moving from Poland to Germany and there might be someone who comes from Ukraine to go into Poland. So there's a knock-on effect. So, for example, another sociologist, Rhacel Parreñas, talked about an international division of reproductive labor.
We have to take a broader lens than just the national context and look transnationally at this division of labor happening there and the inequalities that are generated.
Kamea Chayne: To go even deeper into care extractivism, your book looks at the relations of power that play profitability and care against one another, exposing the devastating impact of financialization and austerity. With that, you say, "Care needs to be shielded from the volatilities of financial markets, not be drawn deeper into them." What has the financialization of care looked like in practice for people who are not familiar? And what leads you to believe that there needs to be a decoupling of the care economy and the financial market?
Emma Dowling: Financialization is a term that always sounds rather abstract. Quite basically, it means an expansion of the logic of financial markets to more and more areas, the increasing importance of things such as shareholder value for companies, and new ways in which parts of society that before were not part of financial markets are drawn more and more in.
For example, something like the expansion of debt and people taking on more credit. In the context of care, something that we have seen in the U.K. and in other places [such as] the US is with the privatization of care, [with] things like care homes or home care, there is a situation where there are small providers that come in and run care homes for profit, maybe not for very much profit, as a small business. What has happened over time is that large corporations have bought up these businesses and become bigger chains oriented towards making a profit.
With that, also, there has been an expansion of things like private equity into care homes. One of the things that happened here is that private equity companies have business models that are based on things like leveraged buyouts. So, money will be borrowed, lots and lots of money will be borrowed to buy companies. But then the companies that are bought are loaded up with that debt. Then the operating business has to generate enough income and profit to then pay back those debts and also interest payments. So that's a way in which these companies become financialized.
In the case of care homes, what sometimes happens is there's a separation between the real estate of the care home and the operating business within. The operating business has to pay rents that increase over time to the private equity or the real estate managers who own the real estate. There's been research that looks at the ways in which actually wealth is extracted here, not just in the form of simple profits, but also financial wealth is extracted.
There has been research done in the U.K. on how money leaks out of the system in terms of what I mentioned… things like interest payments and payments of debt, but also management fees, consultants’ fees, etc. There's also research being done on issues like having very complex company structures where money is moved around, or tax [is avoided] through a circumstance of offshoring. There's a whole apparatus of wealth extraction. I explain these things in more detail in the book. I argue that...
There's an apparatus of wealth extraction that has been built around care that is taking much-needed resources out of the care sector and then making some people quite wealthy as a result, which is detrimental to the sector.
Another aspect of this is that [even] when companies are privatized and oriented towards the need to make profits, something like care is not very profitable. If you think about how caring is something that's an activity… it's very time-consuming, it's very labor-intensive. It's very difficult to make care more profitable. There are only so many people that someone can care for in a particular amount of time, and there's not much technology that you can deploy to generate greater productivity.
So often what happens when there are these attempts at making profits, it becomes a luxury market and people pay lots of money for their care services if they can afford them. But the other thing that often happens in this context of privatization is that to generate profits, [they] are also extracting wealth. This happens off the back of the workers in the industry: care workers who experience staff cuts, or cuts to their wages, or worsening of working conditions.
We need to think of different models here, that are not oriented towards profiting and certainly not towards financialization. And we need to think differently about how we provide care and what sorts of economic models we use here.
Kamea Chayne: I really want to stay on this for a little while because oftentimes, when people talk about how care is undervalued in our dominant economy—which is true—the conclusion is that the work of care should be paid more, and that I agree with as well. But what I'm stuck on is how we expand the care economy if resource and labor extraction are what fuel the engine of economic growth and monetary wealth generation in this current system.
So in other words, with the current profit incentives, it feels like to be able to value and pay more for care, we also simultaneously have to collectively extract and exploit more to be able to sustain care in that way. I wonder if this care economy you talk about really invites us to think about what it means to revitalize other forms of value beyond the representational value of the monetary currency, going beyond simply paying more for care.
Emma Dowling: That's a really good question, and in the way that you formulated that question, you also capture some of the difficulties and complexities of the issue.
Of course it's the case that care workers need more professional care work because people need to be paid better. They need to have better working conditions, better qualifications, better materials to do their jobs. More resources have to go into the whole area of care and caring and it's in its different forms and the different contexts where it takes place. Also, things like collective bargaining and trade unions [are needed] so that there's also an organized political voice and representation for care workers. So that’s one aspect.
But as you say, if it's simply oriented towards profit-making, then it seems like the solution is shortsighted. I'd say we have to maybe take the lens out a little bit and think more broadly. First of all, I would say...
This is not simply an issue of expanding marketization, because that's a dead end.
What we need to think about is the redistribution of wealth. Things like progressive taxation, greater corporation tax, curbing profit-making, maybe things like a wealth tax. It's thinking more holistically about how we generate wealth in society through our activities, at the moment, at least through work. But also, how is that wealth then distributed?
At the moment, we have a situation [where the] dominant idea is that the way to do all this is just to create more markets and then things become productive. That's a good thing, but we need to think more about the need for redistributing wealth, in terms of public infrastructures that are collectively maintained and paid for. We need to rethink public infrastructures and the distribution and redistribution of wealth. The inequality that we have at the moment is simply unacceptable and some people are amassing huge amounts of wealth that far exceeds anything that they could need. So, it's thinking in more structural, holistic terms.
But the other thing is thinking about the distribution of unpaid care work. Now, it's very necessary that we have more professional care workers and that they are well paid. But we also need more time to care for one another. We need to think about how we can integrate care more into our lives, our relationships, thinking beyond the nuclear family, and that very privatized model that often functions off the back of the exploitation of women's labor.
How could things look differently there? What might a redistribution look like? How could we shift away from this economic model in which we’re always working more and more?
…Because we need more income to buy the commodities and the commodified services that require us to work more and more in ways where the products of our work are, for the most part, being privatized. It's thinking about how the economy is organized and how this might be done differently to have it be democratized. What are different models of service provision, things like workers cooperatives? Also, at the level of the municipality, the very local level, could we think of new and different models for how we might provide and organize care? It really requires this bigger shift in thinking and certainly a fundamental redistribution of wealth and a different way of producing, working, and living together.
Kamea Chayne: There's so much to consider. Based on the market system, one of the fixes that has received a decent amount of investment is technological advancement to support the care system. I had raised similar concerns about the digitization of mental health care when speaking recently with Dr. Emma Bedor Hiland. But as you emphasize, technological developments bring up questions about the meaning of care.
What questions would you call on people to consider when techno-solutionism is propped up as a way we can grow the care economy and be able to provide care to more people? What may we lose through replacing care at a human-to-human level with more limiting modes of support from, say, automation and robotization?
Emma Dowling: One thing that has happened in the area of care work is electronic monitoring of home care workers who clock in and clock out when they are with someone in their home. One of the things that has happened is a more stringent delineation of the time that a care worker was spending doing “actual care” which is already, for the most part, done under duress and with not enough time.
But what happens, say, if they don't have enough time to do what they need to do in the time available to them? Then they might have to clock out and do this in their own time, or their travel time doesn't get paid for, because it's not considered to be “actual care.” When you think [about] the definition of a home-carer, they travel from home to home and care for people in their home, so that seems to be paradoxical in terms of what we would define as home care. That's one area where technology is used to surveil workers and squeeze more out of them and not pay for support for their working day.
Another aspect is this whole debate about robots and the use of technology in care, this promise of the solution to the care crisis lying in technologies that we can use to care for one another, whether this is in professional caring or whether this is about [caring for] our elders or older people living on their own who might need assistance or our relatives [who might] live farther away. That we can just deploy these assistive technologies, sensors, and all sorts of things in their houses and that can then replace the need for being closer.
Of course, the issue here is that’s not going to solve the problem. There are far too many people that are spending far too much time alone and isolated and disconnected from the socially effective community relations that they would need to be cared for well and to flourish.
The other issue is also [regarding] what we consider care work to be. A lot of the time, precisely because care work is considered to be very “low-skilled,” it doesn't have much value. It's something that everybody can do, what women do anyway. It's not seen also for the complexity of the activity that it requires. [It’s] not just supporting somebody with physical tasks, but it also requires emotional skill, intuitive skills, knowledge, and the ability to relate to someone to take time with them to understand what their needs are.
There's a whole array of complex emotional work involved there that often gets invisibilized when we conceive of caring as simply supporting people with physical tasks.
I think some of the ways in which technology gets deployed are on par with that, and syncs quite well with this idea of care being not a very complex activity. There are issues there about what is it that machines can do, and what aspects of caring that they cannot do. Not to mention the fact that precisely because caring is actually quite complex, you might have a technology that could be useful with one aspect, but not with others.
So you can have information communication technologies that are actually quite useful to help people to stay in touch with one another over a distance, but that doesn't replace the need for embodied, physical contact. In the same way, it could be very helpful to have technologies that help with things like lifting someone, but that doesn't replace the need for the human labor that is involved.
It's not about being anti-technology or pro-technology. It's more about thinking about the nuances of this, and the ways in which the dominant conceptions about what constitutes care work sit, sometimes quite uncomfortably, with this techno-optimism.
Kamea Chayne: On a related note, you share that it's also important to question the development of assistive technologies geared towards freeing up the time of those who would otherwise be undertaking care to participate in the labor market. I think this is critical because automation and digitization are often being pushed as the path forward as the way to improve our quality of life. After all, supposedly they would be able to free up more time so people can work less. It's not either-or, I'm sure assistive technologies have supported certain types of work to be safer and less labor-intensive, and so forth.
But again, it doesn't address why our system has become so energy and labor-intensive in the first place, and it doesn't address how we've transformed the human experience through the extractive economy, which orients us towards endless productivity. I wonder what more you might have to add to this as it pertains to thinking about the idea of technologies freeing up more time to make people's lives easier and therefore making our system more caring.
Emma Dowling: What I also stress in the book [is this]:
If technology ends up being deployed simply to enable us to be more available to the labor market, as opposed to being available to care for one another, then that's problematic.
I wouldn't be a sociologist if I didn't say that no technology is developed in a vacuum. It always depends on the social and economic and political and cultural relations and class relations and issues of race and gender, the sexual dimensions. All of that is relevant to what kinds of technologies are developed and how they're deployed. So if we don't address the fundamental issues of an economy that is oriented towards profitability and oriented towards putting people to work, then we're going to end up with the kind of technologies that perpetuate that, including the extractive dimensions in terms of resource depletion and ecological resource depletion. It's really about thinking about that differently.
Here we also come to this issue of productivity. A lot of the time, there is talk about the need to increase productivity. That's a good thing because it's labor-saving. In the context of an economy oriented towards capital accumulation, what that means is putting people to work more. [But] really, we need to go in a whole different direction. I do think that there could be technologies that help us free up our time. As I was saying before, there are some technologies that could help with care.
But it requires us to ask these much more fundamental questions about how the economy is organized and think about how that could be done differently. These are questions that have to come before the technology, rather than thinking that technologies and certainly the ones that exist at the moment could themselves be a solution.
Kamea Chayne: Yeah, absolutely, and especially with the current economic system geared towards endless economic growth with this increased perceived efficiency that might come with digitization and automation and so forth. I think what that overall does is it just accelerates extraction and the devastation of our planet and the exploitation of labor. So there's a lot to sit with there. Everything we just discussed here points to the reality that there is no simple fix, especially when the care crisis really calls for deep transformations of our society and how we even conceptualize value.
With this recognition, where does this leave us, and how can we help to nurture the growth and reorientation of the care economy, and are there any other calls to action you might have for us?
Emma Dowling: We've already addressed the issue of supporting the struggles of care workers, and I am sure people who listen to your program work and care themselves. Many of us are care workers and are involved in this work. But it's about supporting those struggles and making the political demands for investment in public, collective infrastructure.
Thinking about the issue of care shows us the limits of an individualist idea about care and shows us the limits of a system oriented towards markets.
Actually, collective infrastructures of care are more effective and are overall more efficient. [We need to] build a collective public infrastructure of care with a different model of production, a different distribution of wealth. We need to call for things like progressive taxation and investment, but also come up with new models where we're not pitted against one another.
Often those who are receiving care are pitted against those who are providing care because those receiving care go, “Oh, what about the cost of this? I need to keep the cost of this low.” So people are pitted against one another in that way. So how do we overcome that through different kinds of models of living and caring for one another in our communities [that] more collectively redistribute the care work? It's not always the usual suspects who are, for the most part, women who do this work. It's thinking across the whole spectrum of paid and unpaid care as a starting point for this.
Really having an honest conversation about how we need to attribute more resources and value to care [is needed]. But value is not simply a monetary issue. That value can also be different kinds of practices that push back against exploitation and push back against how our lives are dominated by being productive for capital.
*** CLOSING ***
Kamea Chayne: What's an impactful publication you follow or a book that's been really profound for you?
Emma Dowling: There's a book by Gabriel Winant called The Next Shift, where he looks in the context of the US about the rise of the health care sector in the Rust Belt, and he looks at Pittsburgh. I thought that was very inspiring and super interesting in terms of the kinds of challenges that we face right now.
Kamea Chayne: What is a personal motto, mantra, or practice you engage with to stay grounded?
Emma Dowling: For me, staying grounded means movement. I was thinking about this today, not just movement in the sense of social movements and being involved in social justice activism, but movement in terms of walking and dancing. Those are my practices of staying grounded. I love walking. But I also really love dancing, so movement is something that helps me to stay grounded.
Kamea Chayne: And what is your greatest source of inspiration right now?
Emma Dowling: My greatest source of inspiration right now is actually that people are having these conversations and that people are saying things can't continue in this way. I'm always super inspired by the students that I teach and the people around me who are asking all of these questions and who don't stop challenging the way that things are.
Kamea Chayne: Emma, thank you so much for sharing your wealth of knowledge and critical inquiry is here with us. What final words of wisdom do you have for us as green dreamers?
Emma Dowling: Let's do it. Let's create this world in which care is valued. It’s not so much a case of care being everything, but that there wouldn't be much without care.
