Care Poverty and Unmet Needs edited by Teppo Kroger, Nicola Brimblecombe, Ricardo Rodrigues and Kirstein Rummery, brings together twenty-seven social policy researchers from across the Global North to analyse “care poverty” or inadequate social care provision. Though it would have benefited from including younger disabled voices, lived experience accounts and more focus on the Global South, this is a valuable and insightful resource that should prompt further research, writes Arlene Jackson.
A growing number of unmet needs
Comparing the social care crisis to the climate emergency, as the editors of Care Poverty and Unmet Needs: Inequalities in Theory and Practice do at the outset, might seem hyperbolic, but it is not. Increased life expectancy and a decrease in global birth rates has raised the ratio of those in need of support. Meanwhile, developed welfare states rely heavily on migrant labour from the Global South, exacerbating the issue of care inequalities in those countries. Recognising the impact of unsustainable care systems on care outcomes, theorised as “unmet needs”, the contributors propose “care poverty” as an analytical framework encompassing the structural, political and societal causes of care deprivation. The book offers theoretical and methodological tools for measuring care poverty, grounded in case studies from across the Global North, which offer empirical evidence on the prevalence and key determinants of unmet needs. The combination of the two exposes the giving and receiving of care as highly gendered and entangled with an individual’s socioeconomic status.
Kirstein Rummery reviews feminist theory which argues that to ‘free’ women from unpaid ‘informal care’ (given by an individual’s familial and social network), the distribution of care ought to be the responsibility of the state.
The gendered nature of care
The intersection of gender and care is first taken up in chapter two. Kirstein Rummery reviews feminist theory which argues that to “free” women from unpaid “informal care” (given by an individual’s familial and social network), the distribution of care ought to be the responsibility of the state. She compares such scholarship with the standpoint of disabled scholars and activists “who have fought long and hard to free themselves from the oppression, paternalism and segregation associated with state care” (17). Rummery concludes that if we reframe care poverty to be as politically charged as material poverty, care may be considered as a social right and therefore a public concern. However, this view is contested in proceeding chapters where gaps in “formal care” provision (state or market-based) are identified as being met by informal care given predominately by female relatives.
As a past Direct Payment recipient myself, I can testify that having a choice over who provided my care and when, and being able to pay my PAs well, was an empowering, ethically sound experience.
There is a middle ground between formal and informal care which arguably mitigates the gendered devaluation of caregiving. The Self-directed Support system or “Direct Payment” provides disabled people with a budget with which to organise and manage their own care, and enables service-users to pay their carers or personal assistants (PAs) a higher rate. It therefore opposes the profit-driven model offered by market-based providers. However, Rummery contends that as the care recipient takes on the responsibilities of the employer, for the state, the initiative is a “cost containment measure, rather than embracing the ideological emancipation of those who need care” (20-21). This is an area of the text where lived experience may have been instructive: as a past Direct Payment recipient myself, I can testify that having a choice over who provided my care and when, and being able to pay my PAs well, was an empowering, ethically sound experience.
Care poverty in developed welfare states
Systemic underfunding across state-provided care is felt both in the availability and continuity of care. The book illustrates this reality through empirical insights on care poverty, including those shown to persist in developed welfare states. In chapter twelve, Petra Ulmanen examines structural inadequacies in Sweden’s community care sector through the notion of “managerial care […] a family caregiving task involving handling contacts with health and social care services in order to make them meet the care needs at hand” (172). This chapter offers some welcome lived experience accounts. Participant interviews evidence “managerial care” as being not only entangled with gender norms, but also social class and socio-economic status: “cultural and social capital possessed by service users in terms of education, networks, skills and resources” (173) enabled relatives to better navigate the system.
Assisted dying as an existential threat
Of some concern is the centring of the emotional and physical labour experienced by caregivers. Although the authors are reflecting data on care that is theorised as a “burden”, this term is arguably problematic. Here, the concept of care poverty appears to diverge from sociological understandings of material poverty which recognise the ways in which those experiencing poverty can be stigmatised and shamed by public institutions and cultural attitudes. Indeed, disabled activists are vigilant to the implications of stigmatising rhetoric. For example, the political signalling surrounding cuts to disability benefits in the UK, which has undertones of eugenics, has mobilised disabled individuals and activists to campaign against assisted dying legislation. Despite Kroger et al’s analogy between the social care crisis and climate change, they do not attend to the “existential threat” of assisted dying to disabled people, who fear they may be pressured into ending their lives as either a cost-saving measure to society or their families.
Care as a universal social right
That end-of-life decisions may be influenced by financial concerns is potentially a crude definition of care poverty. Nevertheless, the authors’ synthesis of their theoretical, empirical and policy analysis shows how care poverty increases the risk of interdependence between care recipients and their carers, particularly when systemic issues leave both parties emotionally and financially vulnerable. The editors do advocate for care to be recognised as a universal social right, to address the privileging of care to those with either the funds to pay for it or the educational and class advantages to fight for it. To achieve this, Kroger et al argue that welfare states must reinvigorate welfare policies to ensure that they not only meet the continuing challenge an aging society presents, but do so in a way that enshrines basic human rights of dignity and respect. However, one can’t help but question where the political will to do so will come from. In the UK, successive governments have implemented increasingly stringent means testing measures which separate social care from a free-at-point-of-need NHS, and across the Global North, political policy continues to lean to the right which opposes social democracy.
A solid methodological foundation by which to advance research in this field by introducing ways to mobilise the concept of care poverty.
As the editors themselves conclude, the book raises more questions than it answers, and is therefore offered as a “blueprint” (198) for further scholarly research. However, they do construct a solid methodological foundation by which to advance research in this field by introducing ways to mobilise the concept of care poverty. Among these is the need to involve individuals with lived experience in further research through a combination of survey and qualitative methods, and to employ tools which distinguish subjective perceptions of unmet needs from objectively defined measurement of need. The book is a valuable resource for scholars, students and practitioners in the fields of health, social care, social policy, economics and public health research. It further offers insightful and interesting contributions to feminist theory in particular, and provoked this reader to reflect on her own experiences of care and caregiving, before seeking out related research from the Global South.
Note: This review gives the views of the author and not the position of the LSE Review of Books blog, nor of the London School of Economics and Political Science.
Main image: Nancy Beijersbergen on Shutterstock.
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