Care, Caring and Social Policy in COVID-19 Times

If nothing else, the COVID-19 virus invites us to think big and reconsider our lives and our world. In this context, I want to suggest the benefits of thinking about the pandemic through the concept of care. From a social policy perspective, the field of care is demarcated by terms that are probably familiar to us, such as social care, long-term care, childcare. While such fields might be well-known, the concept of care is less so. It is most readily grasped by its reference to the conditions and efforts involved in requiring or providing care in a context of physical vulnerability or need. It is not so much medical need that is to the fore but rather what we might understand as ‘chronic care need’ (which may involve some medical intervention but is far more likely to require non-specialized, routine assistance). Young children and frail, ill or disabled adults are examples of relevant population sectors at the heart of care need just as mothers, other family members and those who are paid to provide care are centrally involved in the provision side. But the concept has a much broader application, connoting the human condition as one of interdependence and ubiquitous vulnerability. The broader notions of care encompass the manner in which we approach human relationships, our connectedness to our environment and our way of ‘being’ in the world. The pandemic has greatly increased the demand for inter-personal care and conditions such as ‘long COVID’ will leave us with a lot more chronic illness and other forms of vulnerability. This will mean a greater demand on us to provide hands-on care to those around us as well as requiring us to adopt a perspective that views care and caring as core to social and economic life.

In my article, which is oriented especially to examining care as a concern of welfare states, I first undertake a review of the literature, showcasing a rapidly growing body of work which sees care studied through multiple lenses. While different perspectives have developed the concept differently, most of the work has a sense of care as a domain of life and set of relationships that are often hidden and a likely source of disadvantage and inequality, especially for women. One of the points I make in my piece is of the need for a sharpened focus and clearer definition of the concept, especially for the purposes of social policy analysis. To my mind thinking through a care lens helps us to both analyse and explain  welfare state and other responses to the pandemic.

The second part of the article is oriented to definition and theorization. I start by defining care as a need lodged in human vulnerability and then problematize both the degree of public recognition of that need through welfare state policies and the resources that are forthcoming. I suggest that we can read relevant policy in terms of three registers:  actors and agency, resources, and ideas/values. The first enquires into who responds to the care need and in which setting (at home or in particular facilities); the second queries the resources required or committed (broadly defined to include material but also immaterial resources such as time) and the third suggests that we can study developments in terms of the values and ideas that they embody and promote.

This way of thinking has real application in the pandemic, especially if we regard it not only as a short-term shock but as a more long-term phenomenon that challenges how we live and the very purposes of social policy. The responses to COVID-19 – generalizing across countries – expose the strengths and weaknesses of the welfare state. Among the former are the stabilizing mechanisms that have allowed the systems of income support and job protection to reach much more widely, and in some countries to respond innovatively. Health apart, the service architecture has proved far less resilient. Right across countries lockdowns were applied to caring-related and educational services at a very rapid pace. Those services that had been built up, often in the name of a social investment perspective, were suddenly dispensable. Protections for young children and other sectors of the population with care-related needs were among the first casualties of the early response to the pandemic. While the longer-term welfare state settlement has still to be revealed, there is no question but that the pandemic has seen a return to a reliance on the family as the default position of welfare states. While the state will take some responsibility for their economic support, people will have to look to the family and informal relations for other aspects of their welfare, and especially to meet non-medical care need. So it has been largely the private agency of loved ones, wider family and neighbours that has been called on to meet chronic care need during the pandemic. In a repeat of another established pattern, once again medical care consumed the lion’s share of resources, confirming it as the most recognized and valued type of care and cementing divisions between medical and social care when we should be trying to integrate the two care systems. Another notable trend is for old gender patterns to re-emerge quite rapidly, with women especially undertaking the greater share of the privatized servicing involved in lockdowns all over the world. The typecasting of care as primarily women’s work was confirmed and women’s supposedly greater capacity to provide the necessary ‘love and labour’ reinforced.

Applying the lens of care brings with it theorization, and helps us to drill down to questions around ‘why’. In particular, the concept theorizes that those who need care and those who labour to provide it (regardless of whether they are paid or not and which sector they are located in) are systematically undervalued. Gender and other forms of inequality are perpetuated because this domain of life and type of situation (which is primarily associated with women and yet is actually universal) receives insufficient recognition, value and resources. In most countries of the EU, the long-term story is of a slow move from the informalization of care in familial, settings (especially care for ill and frail adults) to public support being forthcoming only in highly contingent circumstances. The pandemic did little or nothing to change this pattern, and even pressed the pause button on developments.

We can still hope that the Coronavirus offers us a ‘revolutionary moment’, mirroring William Beveridge’s conviction that a new welfare state was an opportunity for British society to rebuild and move forward from World War 2. What would a different vision look like? A fully scaled rethink is beyond this piece but a different future through the lens of care raises interesting possibilities.  First, we would have to change our understanding of what matters, moving beyond production-centred notions of value to treat vulnerability as normal and the provision of all types of care as a source of value deserving of public and private resources. If we wanted a counterpoint here, we need look no further than the philosophy of herd immunity, for it rests on a position that is essentially uncaring, asking us to accept that those who already have high levels of care need (apart from children) are should be sacrificed. Second, a care perspective highlights especially the role of services – perhaps even calling for a set of universal services (to accompany calls for a universal basic income). Thirdly, picking up on my earlier points about care as a wide perspective, we would have to turn the dial to our own behaviour and values, questioning to what extent we behave with an engaged ethical orientation to the welfare of others and our preparedness to take responsibility beyond our immediate circle. It is incontrovertible that the pandemic involves a contagion that originates in how we treat our environment and our tolerance for the widespread degradation of ecosystems. So we must find more sustainable ways in which we can ‘be’ with the world around us and develop both a critical and caring orientation towards our human and animal environments.

I am not denying that there are really complex issues involved but if there ever were a time to try and sort out these issues the time is now. Could we have a new welfare state and societal model organized around the concept of care as a universal need and exigency?

This blog post is based on an article published in the Journal of European Social Policy.

About the author

Mary Daly is Professor of Sociology and Social Policy at the Department of Social Policy and Intervention, University of Oxford.