We Need a New Economic Category
Think about caregiving less as a bundle of services and more as a web of relationships that encourage human flourishing.
Care work has long been indispensable and invaluable. Indispensable: It is the work that makes all other work possible. Invaluable, quite literally: Our society is incapable of valuing it properly.
The sector of the American economy devoted to care—of children and the elderly and people with disabilities—is valued at $648 billion. That’s larger than the U.S. pharmaceutical industry. And yet most individual caregivers are criminally underpaid. That’s because caregiving is viewed either as a “labor of love,” in which case it can never be priced without destroying its essence, or as a service so basic that anyone can do it, in which case it is priced lower than dog walking or waitressing.
Recognizing the true value and potential of care, socially as well as economically, depends on a different understanding of what care actually is: not a service but a relationship that depends on human connection. It is the essence of what Jamie Merisotis, the president of the nonprofit Lumina Foundation, calls “human work”: the “work only people can do.” This makes it all the more essential in an age when workers face the threat of being replaced by machines.
When we use the word in an economic sense, care is a bundle of services: feeding, dressing, bathing, toileting, and assisting. Robots could perform all of those functions; in countries such as Japan, sometimes they already do. But that work is best described as caretaking, comparable to what the caretaker of a property provides by watering a garden or fixing a gate.
What transforms those services into caregiving, the support we want for ourselves and for those we love, is the existence of a relationship between the person providing care and the person being cared for. Not just any relationship, but one that is affectionate, or at least considerate and respectful. Most human beings cannot thrive without connection to others, a point underlined by the depression and declining mental capacities of many seniors who have been isolated during the pandemic.
The best care goes further. The goal is not simply to provide comfort or sustenance, but to enable and empower, to develop or maintain the capabilities of another human being. All parents or other caregivers of young children, for instance, know that bath time, mealtime, or even time on the changing table is scaffolding for talking, playing, or teaching: igniting young minds and shaping young brains. At the other end of life, good care consists of enabling an older person to have what the doctor and writer Atul Gawande calls his or her “best possible day”—the best day possible under the circumstances of a particular illness or condition.
Extend the idea of developing or maintaining human abilities beyond childhood and old age, and an entire vista of care jobs opens up. Call it the “care-plus economy.” It is generating all sorts of new jobs. Coaching, for instance, is a rapidly expanding career category, and not just on sports fields. There are life coaches, career coaches, and health and education coaches who guide people through social services. These are all jobs that enable others to perform at their best.
Education is a care-plus job. Lelac Almagor, a fourth-grade teacher, wrote in an essay for The New York Times, “I’m not ashamed to say that child care is at the heart of the work I do. I teach children reading and writing, yes, but I also watch over them, remind them to be kind and stay safe, plan games and activities to help them grow.”
The number of community health workers, a job category pioneered in poorer countries, is increasing in the United States. The jobs have different titles, but their core function is to connect people to the health system. The Baltimore Health Corps, for example, tackled both the health and economic crises created by the pandemic by hiring nearly 300 unemployed or furloughed community members as contact tracers, care coordinators, or administrative staff.
Academic advisers once confined their role to signing off on students’ course selections, but today they have become crucial to keeping students in college and helping them make the most of their experience. Technology has made a big difference, as it will in other care-plus jobs. In explaining Georgia State University’s successful retention of first-generation college students, Vice Provost Timothy Renick points to advising powered by predictive analytics. By monitoring students closely, the advising office gains information about when they are most likely to be discouraged and think about dropping out, and hence when personal interventions can be most effective.
The next frontier of the care-plus economy will be an explosion of mental-health jobs. Traditional therapy with a high price tag cannot meet Americans’ needs. But peer counselors, behavioral-health coaches, and technology-enabled support systems are filling the gap. Crisis Text Line, for instance, analyzes data to learn when depressed people are most likely to act on suicidal thoughts and how best to stop them.
One of us, Hilary, has worked in Britain to expand caregiving networks. In 2007 she co-designed a program called Circle, which is part social club, part concierge service. Members pay a small monthly fee, and in return get access to fun activities and practical support from members and helpers in the community. More than 10,000 people have participated, and evaluations show that members feel less lonely and more capable. The program has also reduced the money spent on formal services; Circle members are less likely, for example, to be readmitted to the hospital.
The mutual-aid societies that mushroomed into existence across the United States during the pandemic reflect the same philosophy. The core of a mutual-aid network is the principle of “solidarity not charity”: a group of community members coming together on an equal basis for the common good. These societies draw on a long tradition of “collective care” developed by African American, Indigenous, and immigrant groups as far back as the 18th century.
President Joe Biden has proposed spending $400 billion on home- and community-based care. Such support is crucial not only for the people being cared for, but for the professionals who provide that care—overwhelmingly Black and brown women, many of whom work for below minimum wage and receive few if any benefits. Suppose, however, that these workers were part of a new social sector based on community care, in which government and nonprofit organizations partnered to feed, house, treat, educate, or employ community members in part by embedding them in networks that would meet their needs in the round. Creating this sector will require not only a mix of government, private, and philanthropic funding, but also a new social contract about what we owe one another and what we should expect from the government.
Care jobs help humans flourish, and, properly understood and compensated, they can power a growing sector of the economy, strengthen our society, and increase our well-being. Goods are things that people buy and own; services are functions that people pay for. Relationships require two people and a connection between them. We don’t really have an economic category for that, but we should.