The Care Crisis* What Caused It and How Can We End It?

by Emma Dowling, Verso, 2021

Reviewed by Amber Parkes

“As a homecare worker in the 1970s, you’d usually have three hours to light a fire, help someone up in the morning, get them dressed and make breakfast; in the 1980s, you’d have just one and a half hours. Today, you’d likely have around 15 minutes.”

In The Care Crisis: What Caused It and How Can We End It?, Emma Dowling uses this as just one example to illustrate the global care crisis. Emma Dowling’s central premise is compelling and timely. With the ‘toxic cocktail of recession and austerity’ (p. 1) as the backdrop, she casts a critical eye over the unholy alliance of neoliberalism and austerity, and their impacts on social and economic inequality in the UK. Our attention is drawn to how, in the wake of austerity, the state is offloading more of the costs and responsibility for paid and unpaid care on to households and communities, with those who can least afford it bearing the brunt. She explains how increasing numbers of volunteers (often women), grandparents, and even children are stepping in to care for people and run food banks and volunteer in hospitals – effectively subsidising the welfare system where local authorities aren’t providing the necessary care services.

Emma Dowling clearly documents how we have landed in this ‘perfect storm’, where care is not valued though our care needs are increasing exponentially. In locating the ‘eye of the storm’, she evidences how increasing privatisation, outsourcing, and financialisation are driving the chronic underfunding, zero-hour contracts, low pay, and high turnover that now characterise the UK care sector. We are taken through an enlightening and in-depth interrogation of ‘market fixes’ to the care crisis – such as Social Impact Bonds, where care outcomes become profit margins for private investors. One of her core points is that care work is an intensely ‘relational and affective act’ (p. 137), and therefore doesn’t benefit from ‘market efficiencies’ such as outsourcing or mechanisation that other sectors do. We are reminded here that, contrary to current capitalist discourse, care work is about more than producing a healthy workforce.

Importantly, in addition to the more familiar gendered dimensions of care work, Emma Dowling digs into the many ways in which the care crisis is deeply racialised and classist. In the chapter ‘Who Cares’, we look more closely at who exactly the responsibility for caring falls on, today. Here, Emma Dowling makes links to historical class and labour struggles in Britain that today sees an over-representation of Black and Minority Ethnic people in care work, and the ‘offloading’ of poorly paid and precarious care jobs on to migrant workers. It’s clear we are all in the same storm, but we are not all on the same boat.

Emma Dowling also has plenty to say about the self-care and wellness industries, bringing a fresh perspective to their relationship to the care crises. Interrogating the idea of ‘caring capitalism’, she makes nuanced arguments for how the multi-million-dollar self-care and wellness industries are based on an individualist and private – rather than collective and public – responsibility to feel well. In this sense, she explains, although often sold as an antidote to burnout, these industries are in fact often symptoms of, rather than solutions to, society’s care deficit.

The Care Crisis makes a substantive contribution to the feminist and political scholarship on the global care crisis, albeit with a UK focus. Emma Dowling spent several years researching this book and interviewing 20 carers, meaning that beyond the statistics we are given insight into the lived experiences of caregivers and recipients. This approach makes the book engaging and relatable, lightening what could have otherwise been a fact-heavy read. Usefully, each chapter is also divided into bite-sized sections, making it digestible for those less familiar with the topic. Aimed at a generalist audience, the book may have a UK focus but offers insights that stretch well beyond national borders.

The majority of the book sets out the problem, with the first two-thirds focusing on the cause of the care crisis, and most of the last third on ‘fixes’ – which Emma Dowling adeptly demonstrates are not actually fixing the structural causes of the care crisis, but rather plastering over the symptoms. Nestled within the last ten pages of the conclusion are what Emma Dowling sees as the real solutions to achieve the structural transformation needed to address the care crisis. First and foremost, she explains, this requires improving the status of care: recognising its value to society, the economy, and humankind by investing more time, money, and attention to it.

This final section on how to end the care crisis is especially needed to give hope to people, like me, who often feel despair at the current state of the care system. I would have appreciated more space dedicated to the solutions, including examples from around the world of where promising solutions have been successfully adopted. Hawaii’s Feminist Economic Recovery Plan for COVID-19 that centres care, New Zealand’s progressive ‘wellbeing budget’, or the influential US National Domestic Workers Alliance are rays of light amid the grey skies, and I would have valued the inclusion of these, or similar, inspiring examples in the book.

Though ‘the shadow of COVID-19’ is mentioned on the book’s cover, most examples and statistics inside are pre-pandemic, specifically from the 2008 economic crisis and its fallout. This makes the content feel slightly dated. Even allowing for publishing timelines, not including more contemporary analysis of the effects of COVID-19 feels remiss, considering how issues of care, inequality, and neoliberalism have come to the fore during the pandemic. Emma Dowling’s nuanced critiques about the care crisis are even more relevant now, so not having her thoughts on the implications of COVID-19 feels like a missed opportunity.

Nevertheless, the book achieves its goal of documenting the causes of the care crisis. In doing so, it provides a clarion call for us to build an economy that puts care at its centre and strives for wellbeing, social justice, and human rights for all. In Emma Dowling’s own words (p. 8), ‘the current care crisis … does not demand a return to a better past, but rather a struggle for a better future’.