A Caring Society?

As the anthropologists McKechnie and Kohn (1999) have argued, care is a concept currently coming to the fore in many contemporary debates, pushed on not just by the increasingly public character of care and the clash of its apparently altruistic values with consumerism and market-based efficiency, but also by medical and ethical debates linked to new technologies for diagnosis and intervention. What is understood by the term, its characteristics and the ideals it embodies is not fixed, but is currently being (re)constructed and refashioned, constantly fought over by various protagonists who seek to claim its mantle for their cause. But as the increasingly common cross-referral between perspectives suggests, there is also evidence of convergence around common themes, as the concept of care is defined and redefined to justify the claims and counter-claims made of it.

One of the key problems faced by women as they entered the workforce in increasing and unprecedented numbers in the late twentieth century concerned the way in which neither employers nor public life more generally took account of issues of care. Beyond the immediate need to develop practical solutions, it was apparent that the dominant value systems in public life were blind to the issues of responsibility for the lives of others which women experienced in the home and which still kept many there. One of the approaches developed by feminist researchers and theorists to tackle this was to present care and caring as a distinct set of moral principles and as an alternative to the existing system of male privilege and impersonal standards that dominated public life. Following the work of Carol Gilligan, the ideal of caring as such a moral standard for the world became known as the ethic of car.

The Canadian researcher on care and caring labour, Sheila Neysmith, observed that the debate about the ethic of care has been conducted in highly theoretical terms in ways that have mostly seemed quite separate from, even irrelevant to, the real-life politics involved in the restructuring of care work experienced in welfare services, in health care and in the home (Neysmith, 2000: 7). But there is an alternative approach to theories and research about care in which those involved have explicitly sought to be relevant, to engage with the issues faced by ordinary people in their daily lives, to advocate for policies and practical interventions that will improve the life of those who depend on care and those responsible for providing care. The applied approach, examined in this chapter, looks at care as an activity, a form of work or practice. The theoretical ideas produced are quite deliberately political and strategic, intended to be directly applicable to the struggles around social policy.

The view that we are facing a crisis in the capacity to provide care for the ageing population in the twenty-first century is widespread. A background paper prepared by the National Health Policy Forum (NHPF) in Washington for the benefit of federal health policy-makers, for example, sets out the facts and well-known arguments: The number of elderly with activity limitations will more than double, from 8.5 million to 21 million by 2030. By 2050, over 25 million elderly will be limited in their activities and need assistance…Beginning in 2025, the number of persons aged 65 and older will exceed the number of women aged 25 54. Moreover, due to greater opportunities for education and workforce participation by women over the past four decades, fewer new workers are entering the long-term care workforce. In the past, women had many fewer avenues of employment; today, work opportunities less difficult and better-paying than long-term care are abundant.

As women have turned their backs on unpaid domestic work in favour of employment and careers outside the home, the employment conditions encountered in increasingly deregulated systems of paid employment have emerged as major threats to the capacity of the family and friends to provide care. With employment more competitive and insecure than at any time since the Great Depression of the 1930s, the level of work in almost every field has intensified, affecting the lives of both women and men and severely compromising the caring capacity of families.

In a now famous formulation, C. Wright Mills (1959) saw sociology’s subject matter as the ‘intersection of history and biography’. Yet most research until recently placed the emphasis on questions of history, or social structure, with relatively little attention being given to the issues that might be considered biographical. The rise of feminism, the recognition of the importance of sexuality for social life and the dramatic transformation of personal and domestic life in the closing stages of the twentieth century have forced social analysts to pay greater attention to issues linked to self, identity and the significance of the actions of individuals. Attention to these more biographical issues has had a very significant impact on contemporary social theory, opening up new ways of thinking about social life that are of direct relevance to any attempt to understand care. In this chapter, therefore, I focus on three of the main themes to emerge from this new work – the themes of the body, individualization and the transformation of personal life.

For most of the twentieth century, including the period in which the welfare state was developing, care was primarily a private matter, a responsibility of the family with or without help purchased through the market. The state intervened only in critical cases such as child protection or long-term institutional care of the aged, assuming responsibility in cases in which the alternatives were demonstrably inadequate or were held to have failed (Fine, 1999a). In consequence, informal and formal care operated in a more or less self-contained fashion, as alternatives, with care recipients who were unable to rely on informal support at home typically being forced to accept complete reliance on formal provisions. Families who wished to continue responsibility for care after it was assumed by the state, or by a self-contained private organization such as a nursing home or orphanage, were considered as interfering and their involvement typically discouraged.