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    An economy of abandonment

    HEALTHCARE: Is reinstalling empathy the only fix to society's current crisis of caring.

    The Care Crisis
    Author: Emma Dowling
    Publisher: Verso Books, UK

    The restructuring of welfare states in Europe and North America as the result of the imposition of austerity measures following the Global Financial Crisis is ‘one facet of a manifest global care crisis’. Britain today faces an ageing population, and subsequently, an increasing number of dementia patients with care needs. The cuts on public spending resulted in a shortage of resources and care facilities, affecting health care services in general, including resources to mental health services and exhausting health care providers, including doctors, nurses and carers. Cuts have also depleted the social provision of ‘nursery schools’, ‘education maintenance allowances’, unemployment and disability benefits, ‘community services’, and the means to address the ‘needs of migrants fleeing war’ in the last decade.

    Emma Dowling
    Emma Dowling

    In her first book, Emma Dowling propounds a compelling and well-researched argument that traces the ways in which the private and financialised sector was given the opportunity to invest and profit from social and health care provision since the 1970s in Britain. According to Dowling, Margaret Thatcher’s infamous statement that there is ‘no such thing as society’ is less about individualism as such, but instead a petition for ‘private and personal responsibility.’ Under a neoliberal logic, care is understood as an individual moral obligation rather than a social and therefore collective, even public responsibility. This is the reasoning behind the depletion of public provision of social and health care, resulting in the implementation of a series of ‘care fixes’ through private investment that aggravates even further the care crisis.

    Under a neoliberal logic, care is understood as an individual moral obligation rather than a social and therefore collective, even public responsibility

    Dowling defines care ‘as 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.’ This means that care is ‘central to the reproduction of society’ and ‘part of a fundamental infrastructure that holds society together’. Women perform ‘significantly more unpaid care work than men’, spending ‘3.3 times as much time as men on unpaid care.’ Because of this, since the 1970s, Marxist feminists have long considered the economic value of social reproduction. Women have entered the labour market long before that time but until recently, many women were dependent on the salary of the male breadwinner; therefore, Marxist feminists have long argued that unpaid reproductive labour not only produces surplus value but is also not ‘outside the wage relation’. For Dowling, ‘care work is one aspect of labour reproduction’. Grappling with the difference between ‘care’ and ‘reproductive labour’, she argues that the latter is an economic category ‘used to describe the institutionalised separation between productive and reproductive activities’ within the capitalist economy, whilst the former ‘is an ethical social relationship based on both feelings of affection and a sense of service, both requiring and producing sympathetic attachments with bonds that tie us to others’. Care work is not confined to the private and unpaid sphere of the home; it is also ‘carried out in the context of the welfare state’. Yet, when the welfare state is depleted, women are the first to bear the brunt due to societal gender expectations.

    When social services are depleted by austerity measures, the criticism often falls on the providers rather than on the systemic conditions that prevent social and health care provision in the first place. As Dowling argues, austerity is a way of ‘governing in the future perfect’ thus shaping ‘a mode of accumulation based on expectations, projections and speculation of future gains or losses’. In Britain, cuts on public spending also resulted in the creation of the new Universal Credit rollout that over-simplifies the way benefits and credit taxes are attributed, restricting ‘eligibility criteria’. When local authorities are also depleted of public funding and prevented to provide social care, the most vulnerable are then left to their own devices. This depletion was ‘accompanied by a rhetoric of community empowerment’ that preys upon voluntary and community care work. On the other hand, social welfare recipients suffer from a stigma that blames individuals in order to conceal the systemic nature of their predicament.

    When local authorities are also depleted of public funding and prevented to provide social care, the most vulnerable are then left to their own devices.

    Dowling also demonstrates that cuts on public funding means that someone always ends up paying the bill. Regarding the restructuring of employment contracts of junior doctors working for the NHS, the author expounds that those who would be more affected by these new contracts were the ones with caring responsibilities. Under these new conditions, junior doctors would have to offload childcare responsibilities to an informal or casual labourer, who most likely would be a ‘female, lower class and quite probably with a migration background’, evidencing in turn ‘the interdependence of the spheres of production and reproduction’.

    Following the Financial Crisis in 2008, food banks also mushroomed, ‘there are now over 2,000 food banks’ in Britain . According to the Trussell Trust, 30 per cent of food bank users have an income. On the other hand, bank foods ‘rely on the compassion of volunteers’, replacing social welfare with charity and good will while at the same time, ‘reinforcing hierarchies between those blessed with the time, means and inclination to help others, and those with need of help’.

    In Britain, much of the ‘adult social care’ provision relies on the work of migrants, many of who are employed by outsourcing companies that offer in some cases salaries below the minimum wage. Since the establishment of the NHS, Britain has relied on migration to perform care work. In the 1950s, the health care work force was secure by citizens of Commonwealth nations in the Indian subcontinent and the Caribbean. Today, in Britain, recruitment of care workers relies heavily on migration from the European Union, in particular East European but also South European countries, such as, Portugal, which have suffered their own predicament after the Global Financial Crisis.

    Today, in Britain, recruitment of care workers relies heavily on migration from the European Union, in particular East European but also South European countries

    There has been a gradual interest in the investment and use of technology in home care provision, which involves not only the creation of robots for the execution of labour intensive tasks such as lifting a patient but also the supervision of workers and the monitorisation of the time spend in each task. These ‘technofixes’ might help ‘information sharing among care workers’ and the relief of labouring intensive tasks, but as Dowling warns ‘technology never replaces a task’, it also informs and transforms the nature of the task itself. Technology is not only used against workers to monitor their tasks, but care work also involves social and affective skills that cannot be compartmentalised in units of time.

    In the context of austerity, the private sector has permeated even further social and care provision, implementing new business models through private-public partnerships. For Dowling, these are ‘care fixes’ that augment the crisis. As prevention is thought as an option to address the care crisis, a series of financial instruments like Social Impact Bonds (SIB) are used to ‘fund social innovation and are part of the broader social enterprise turn.’ SIBs are ‘issued to generate private finance’ in order to intervene in society. If each ‘intervention achieves its targets within the designated time’, investors receive their money with an additional premium. Social impact is predicted through the employment of metric models and data analysis to guarantee target achievements as well as capital return. In addition, when social and health care public services are depleted, and individuals made responsible for their wellbeing, a self-care industry flourishes and a plethora of compulsive-obsessive disorders emerge, such as, clean eating.

    In conclusion, Today, in Britain, recruitment of care workers relies heavily on migration from the European Union, in particular East European but also South European countries offers a grim picture of the health and social care public provision in Britain. Dowling argues that the Global Financial Crisis was then a ‘catalyst’ to the care crisis yet in the context of our current situation, her book also renders visible an obvious correlation between the depletion of the welfare states since 2008 and the Western World’s inability to respond accordingly to the Covid-19 pandemic.

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    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. Her 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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