Interdependency and Care over the Lifecourse

Sophia Bowlby, Linda McKie, Susan Gregory, Isobel Macpherson

• Publisher: Routledge
• Year: 2010
• Print ISBN: 9780415434669
• eBook ISBN: 9781135281069
• Topic: Ciencias sociales
• Subtopic: Atención sanitaria

Interdependency and Care over the Lifecourse draws upon theories of time and space to consider how informal care is woven into the fabric of everyday lives and is shaped by social and economic inequalities and opportunities.

The book comprises three parts. The first explores contrasting social and economic contexts of informal care in different parts of the world. The second looks at different themes and dynamics of caring, using fictional vignettes of illness and health, child care, elderly care and communities of care. The book examines the significance to practices of care throughout the lifecourse of:

• understandings and expectations of care
• emotional exchanges involved in care
• memories and anticipations of giving and receiving care
• the social nature of the spaces and places in which care is carried out
• the practical time-space scheduling necessary to caring activities.

Finally the authors critically examine how the frameworks of caringscapes and carescapes might be used in research, policy and practice. A working example is provided.

This book will be of interest to students and researchers of care work, health and social care, geography, sociology of the family and social policy as well as those in business and policy communities trying to gain an understanding of how work and informal care interweave.

Part I

1
The Care Context

Introduction

In this chapter, we consider the geopolitical context within which contemporary care relationships take place. This context informs our conceptual framework on care and caring, which we have termed caringscapes. Individual care activities and experiences help to shape and are shaped by their socio-economic contexts. Trends in population, household and family composition, work and employment, income and benefits, health and illness and the funding, public policy, and provision of relevant services will have a particular impact on care. The ways in which we experience care reflects our age, gender, ethnicity, health and social status, and will be influenced by our beliefs and values about families and relationships, and hence by where and when we live. Thus, it is important to place the discussion of care and interdependence in the context of socio-economic, demographic and relevant care policy change. Living under different political regimes – in times of peace, unrest or conflict – the impact of natural and human-created disasters are all factors that have an effect on the care we give or experience (or not). Equally, changes and developments, for example, in infectious and chronic diseases, the environment and national economies, scientific knowledge and technological development, have a bearing on the shape and form of the care that we can expect to exchange.

Any framework for the analysis of care and caring must accommodate change because the interdependencies and contexts in which we live are ever-changing. In this chapter, we use statistical data to illustrate the geopolitical contexts of our three Geographical Zones. These are drawn from supranational, national and local sources, including NGOs, governments and academic centres. We are limited by what is recorded and how that is categorised, analysed, reported and debated: we highlight these issues where appropriate.

The intent of this chapter is to illuminate the varied and changing socio- economic and environmental contexts in which care relations take place. The chapter is divided into four main sections. We open with a consideration of continuities, change and context. The foundations of our data, and thus of our exploration of different care contexts, is outlined. In the third section, entitled Geographical Zones, data on our three comparative geopolitical zones is introduced: the European Union (EU) – old (15) and new (25) EU¹; USA; and Sub-Saharan Africa (S-SA).² We follow this with a section entitled ‘Care in Action’ in which we introduce the imaginary protagonist actors in our four People Scenarios. Each fictitious scenario illustrates care relations that are particularly relevant to a Geographical Zone. The chapter ends with a summary of data and issues that we will return to throughout the book.

Continuities, change and context

Social change is a broad term used to describe differences over time in social institutions, social behaviour and social relations. Change can be gradual, barely noticeable but, ultimately, revolutionary. For example, in Western societies, many people continue to spend much of their adult lives in partnerships but, over the last 100 years, expectations about partnerships have been changing subtly from the notion of ‘death do us part’ to the acceptance of partnership changes facilitated by separation and divorce, and from the legal arrangements of formal marriage to co-habiting.³ So, in the twenty-first century in most post-industrial societies, we are no longer surprised if people do not go through a marriage ceremony and, in many societies, there is much less stigma attached to not being married or not having married parents than in the past.

Change also can be relatively sudden with radical impacts, especially in the case of serious and life-threatening illness. For example, HIV/AIDS has resulted in dramatic changes in family and care relationships, particularly in S-SA. The rate of infection and death has taken many governments, non-governmental organisations and commentators by surprise. The implications are stark in countries where treatment is not routinely available, and poverty, limited knowledge, or lack of political will, leads to the early death of many of the adult population. As a consequence, culturally ‘normal’ care patterns are disrupted within and across families and societies.

Change can even turn the social conventions of caring upside down: for example, in many industrialised countries, a growing number of grandparents are now actively caring for grandchildren in lieu of childcare facilities that are either too expensive or too inconvenient. In Africa, grandparents are extending their caring role in the face of the HIV/AIDS crisis. In both places, grandparents are increasing their involvement at a time of their life when they might have expected to be recipients of care from the family. However, the delivery of care within a family context can also present challenges, create tensions and even lead to abuse. Indeed, for many people, friendships and community ties offer alternative, and sometimes preferred, forms of security and continuity.

Many commentators argue that change in economies, and the ways people live their lives, have never been faster and more complex (Davis and Meyer 1999). There are, however, continuities as well as change. An obvious continuity is the continued and strong association of all forms of care with women and femininities, despite an increase in men taking part in formal and informal types of care in many countries (Himmelweit and Land 2008, Williams 2004). Presumptions about the centrality of family relationships to informal care also remain strong and it is not uncommon for families to provide practical, financial and emotional support. And for many, friendships and community ties offer forms of security and continuity.

Continuity and change are rarely mutually exclusive and, as we progress through the lifecourse, we may well find ourselves dealing with both concurrently. This has created a need to employ coping strategies or ‘care contingencies’ in which people anticipate and manage care crises and gaps. One obvious example is the need to reconcile child-rearing and paid employment – a process of reconciliation that is both evolving and gendered. Although most children continue to be brought up in a kin-based context, the implications of the need, and desire, for paid work for both women and men, has resulted in parents juggling various methods of caring for (that is, practical activities) and caring about (psychological dimensions) their off-spring. For many people, this involves a combination of informal care by family members and friends and formal, paid nursery, childminders and school care, and the utilisation of fast-growing technologies, such as mobile phones and email. This example of ‘care contingencies’ is familiar to northern European and postindustrial societies and is becoming a familiar feature of developing economies in Asia. Therefore, in many ways the experiences of combining caring and working presents similar challenges across the world today. Limited resources lead to gendered compromises; women still dominate in formal and informal care, with attempts to involve men moving forward slowly, reflecting different ‘care’ cultures, care policies and varying economic circumstances.

Different histories of change and continuities in social and economic relationships have led to distinctively different contexts for care in different parts of the world. In particular, the degree to which and the ways in which the state is able or willing to support the welfare of its members through the supply of formal care services and through guaranteeing the physical and social conditions that make care possible, varies. The work of Esping-Andersen (1993) on welfare state regimes has stimulated a wide range of research on the different ways in which market, state and family relate to one another in the provision of welfare in prosperous, capitalist societies. Esping-Andersen’s original suggestion of three ideal-types of welfare state regime – liberal, conservative and social-democratic have been modified and extended (Arts and Gelissen 2002).

A vigorous feminist critique of Esping-Andersen’s original ideas has drawn attention to the significance of the family to analyses of the provision of welfare and care and the importance of examining the ways in which women from different ethnic groups are or are not incorporated into the labour market. In particular, the critical importance of the gendered division of caring and domestic work has been highlighted and attention drawn to the ways in which the state can facilitate or undermine different routes to improving equality between women and men of different ethnicities in both the labour market and the home (Lewis 1992, Orloff 1996, Lewis 1997). Research by Morrisens and Sainsbury (2005) examined data from the Luxembourg Income Study for the UK, the USA, Germany, France, Denmark and Sweden. Noting that comparative welfare state research has devoted little attention to the social rights of migrants or to ethnic and racial dimensions, the analysis shows that there are major disparities between how migrant and citizen households fare in welfare states. When migrants are incorporated into the analysis, intra-regime variations stand out in the case of the liberal and social-democratic countries. Discrepancies widen still further for migrants of colour. Given the development of migration across the EU, such findings are of concern.

Research on welfare state regimes has largely been concerned with the ‘developed’ countries of the West. A new literature analysing welfare provision in ‘developing’ countries offers further insights. For example, Gough et al. (2004) have examined the processes through which welfare and personal and family security are maintained – or not maintained – in the Southern hemisphere. They highlight the role of ‘community’ as well as family, market and state in these processes and focus on the issue of insecurity in situations in which an established and legitimate state and well-functioning labour and financial markets do not exist. Thus they identify three broad global ‘ideal types’ of welfare regime – welfare state regimes (characteristic of prosperous capitalist countries); informal security regimes (characteristic of many parts of Latin America and Asia); and insecurity regimes (characteristic of many African countries). In the latter, where the state is weak, they suggest that global actors such as transnational corporations and supranational bodies and NGOs have become highly influential; at the same time, local patrons, for example, local religious leaders, community elders or tribal leaders, are also powerful, resulting in a precarious livelihood and security situation for many people. In such situations, the state will be of limited relevance to the conditions in which care takes place. However, this research makes only limited reference to gendered differences in access to the labour market, and in care access and provision. A wide range of other research on care in the Global South has emphasised the importance of gender, age and ethnicity in structuring labour market access and informal caring practices in different places (Parrenas 2005). For our purposes, the value of the research on welfare regimes is to re-emphasise both the importance of the socio-economic and political contexts in shaping the practices and possibilities of informal care, and the importance of gendered formal and informal care work to welfare regimes. The concept of ‘welfare regime’ is to be welcomed insofar as it puts both formal and informal care centre-stage and focuses analysis on identifying the situations in which such care work can prosper alongside moves to enhance social equality. In the remaining parts of this chapter, we focus on our three Geographical Zones and draw out the significance of their varied socio-economic and political contexts for informal care. However, before we detail the differences between our Zones, we discuss the problems of finding appropriate data on care and care contexts.

The data foundations

Statistical data can provide evidence of continuities and change in care contexts and practices. Despite limitations in what is collected, commentators and planners concerned with social and economic trends take these data sources seriously. In most countries, the major source of data is the census, generally conducted every decade, and supplemented by regular surveys on particular topics. Governments, supranational organisations and NGOs may influence and debate the contents of such censuses and surveys so that the particular interests of these powerful groups affect their content. When it comes to the documentation of care, a key driving force is the use, and anticipated need for, formal care services. For example, data often are collected on paid care workers (e.g. nurses, teachers, social workers), but collecting direct information on who provides informal care varies. For example, direct questions may be asked within surveys/census (such as, for example the annual household surveys conducted in the nations of the UK) or household composition is used as a proxy to make presumptions about informal care-giving. The major presumptions are that spouses care for each other, especially in old age and that parents care for children. Thus, much informal care (such as that of friends and neighbours and relatives living outside the home) and unpaid work fails to be documented. Nevertheless, informal care is assumed to be available for many and this presumed resource is taken into account in the resourcing and organisation of policies and formal services. For example, it is assumed that families and friends are available to facilitate convalescence at home, allowing governments and health services to provide limited access to rehabilitation and convalescence services (Sevenhuijsen, 1998).

Box 1.1 shows a résumé of a report on trends in unpaid caring in the UK. Drawing on the census of 2001, the House of Commons Work and Pensions Committee (2008) explored patterns, gaps in data, and implications for future policy and service provision. These trends are not dis-similar to those in many post-industrial countries and illuminate a heavy dependence by formal health and social care services on the provision of informal care. This report also illustrates another key point – namely, that data collection concentrates on informal care provided for those with a recognised illness or disability, be that physical or mental. Childcare is generally documented in analyses of women’s participation in labour markets, re-emphasising assumptions about the ‘natural’ relationship between women and childcare. Further, care that provides support for those experiencing, for example, bereavement, threat of job loss, or financial or relationship breakdown is valued by those who receive it, but rarely documented.

Attempts to compare care between countries are particularly fraught. Definitions of formal and informal care differ across state boundaries, and the use of common questions in national surveys to aid international comparison remains rare. Supra national organisations, including the United Nations, World Bank, Office of Economic Co-operation and Development, and European Union do run cross-national surveys but the content of these reflect particular political and conceptual interests, often how formal and informal care is moulded around paid employment. Translation into different languages adds a conceptual layer to the practical issues of undertaking cross-national comparisons. Furthermore, notions of care and what forms of care are formal or informal varies markedly. For example, in many Nordic countries, state-run services provide much more care for the elderly and sick than in the UK or Germany. These contrasts are born of different histories, cultures and welfare systems.

Our search for national and international data revealed many examples of the ways in which the provision of information can obscure, as well as illustr...

Table of contents

• Relationships and Resources
• Contents
• Illustrations
• Acknowledgements
• Introduction
• Part I
• Part II
• Part III
• Bibliography
• Index