The Uncaring Feedback Loop of the Care-Industrial Complex,
and Why Things Go On Like This
Patricia de Vries
Emma Dowling. 2021. The Care Crisis:What Caused
It and How Can We End It. London/New York: Verso
Books.
Review of
Care Work, Care Crisis, Austerity, Financialisation,
Marxist Feminism, Reproductive Labour, Care Fixes,
Privatisation, Neoliberalism, Inequality, Social
Reproduction
Keywords
https://doi.org/10.21827/krisis.42.1.38789
DOI
Krisis 42 (1):125-129.
Licence
This work is licensed under a Creative Commons
Attribution 4.0 License International License (CC
BY 4.0). © 2022 The author(s).
125
The Uncaring Feedback Loop of the Care-Industrial Complex,
and Why Things Go On Like This
Patricia de Vries
In The Care Crisis: What Caused It and How Can We End It (2021), Emma Dowling –
Assistant Professor of Sociology and Social Change at the University of Vienna – has
written a compassionate and lucid sociological account of the impact of decades of
government entrenchment, austerity, nancialisation, and marketisation on social and
health care infrastructures.
The Care Crisis focuses on the ongoing care crisis in Britain. Dowling argues that
the systematic underfunding of health and social care is long-standing and entrenched.
The retrenchment of the state’s material responsibility for social welfare resulted from
a state-driven social, political, and economic restructuring process that has generated
market relations in the care sector through social engineering. Dowling traces this “neo-
liberal reconguration of care” to the 1970s, when the British government opened the
door to the outsourcing of public services to corporations (Dowling 2021, 12). This
allowed the private sector to prot from social and health care services resulting in the
nancialisation and commodication of social and health care (10). Moreover, Dowling
invokes Margaret Thatcher’s infamous assertion, that “there is no such thing as society,” (9)
to argue that the “neoliberal reconguration” also framed “care as a private or personal
responsibility” — rather than a social and collectively funded responsibility (9).
The current care crisis is described by Dowling as a growing “gap” between care
needs and the recourses made available to meet them (6). More and more people are
unable to get the help they need, and those who provide care to others are “unable to do
so satisfactorily and under dignied conditions” (6). She delineates how under-resourced,
understaed, and undervalued care infrastructures have brought about a shortage of care
facilities, long waiting lists, fragmented community services, and major care decits.
The Care Crisis delineates the underlying rationale and impact of this growing
care gap. Each chapter starts with a short vignette, based on her eldwork, that gives
a glimpse into the oppressive conditions of care work provisions and the rationing of
care needs. Addressing paid care work, unpaid care work, and state-provision issues that
all play an interrelated part in the care gap, Dowling describes the consequences of a
care-industrial complex that operates on a reductive denition of care and imposes a mar-
ket-centred industry model to increase productivity and cost and time-eciency — in
short: protability — on fundamentally social, aective, relational, and time-consuming
labour. Prot is the end goal, whereas care is costly and often does not yield prot.
Adopting a Marxist feminist approach, and using demographics, statistics, and
interviews with people on both the frontlines and, to a lesser extent, the receiving end
of care in Britain, The Care Crisis argues that the underfunding of care is a by-product of
the undervaluing of social reproduction. Reproductive labour is all the usually unpaid
labour associated with women and the domestic sphere which makes productive labour
possible — think of giving birth and raising children, but also keeping a household
running or providing informal care to friends, neighbours, and relatives. For Dowling,
care work is an essential aspect of the labour of reproducing society (37). Care is an
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inherently “relational and aective” (45) form of work, comprising “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” (21). This
means that care is “central to the reproduction of society and thus one of its bedrocks,
part of a fundamental infrastructure that holds society together. Without care, life could
not be sustained” (21). Even though the spheres of production and reproduction “are
co-constitutive,” they are not considered equal (36). Reproductive work is still widely
considered non-work or unskilled work “warranting that it either not be paid at all or
paid very little” (36).
Referring to Marxist feminists like Silvia Federici, Dowling further explains
that care is fundamental to the historical organisation and development of the capitalist
system. Marxist feminists showed that creating surplus value in capitalist economies
happens on the backs of unpaid reproductive labour, which is predominantly carried
out by women in society.
As the 1970s feminist movement Wages for Housework argued, the home and
the community are sites of unpaid reproductive labour; hence, the home and the com-
munity are sites of wealth production and labour exploitation (33), and a key source
of capital accumulation (200). There is nothing natural about these conditions. Rather
they “are politically and economically — and hence historically — conditioned, with
all of the gendered, radicalised and classed implications of power relations” (38). Which
is to say, what constitutes acceptable care standards is a “profoundly, social, cultural and
political matter” (26).
The framework and analysis Dowling presents help to explain and critique the
conditions in which care work continues to be “one of the most undervalued and invis-
ibilised activities of all, while those who perform them are some of the most neglected
and unsupported people in our societies” (26). This should not surprise anyone living
in a capitalist, racialised, and patriarchal culture, given that women do most care work
and many of those women are migrants — this goes hand in hand with the devaluation
of care work. But it also helps us to understand that the care crisis she observes is a crisis
“for those in most need of care” (53).
As we all know, “in an unequal world, no crisis aects everyone equally. To
speak of a crisis is thus to ask the question, a crisis for whom?” (6). Dowling refers to
demographics and statistics to point to the larger systemic issues of the devaluation of
care work expressed in the uneven eect it has had on “lone women pensioners,” single
mothers, “Black and Minority Ethnic women,” refugees, children with disabilities, adults
with disabilities or complex mental health issues, jobseekers, the homeless, and those
dependent on benet payments (52).
To speak of a crisis is also to ask: who is picking up the tab for the neoliberal
restructuring of the care sector? Unsurprisingly, the disproportionate burden of care work
is placed upon women and migrant workers, both paid and unpaid. “Everywhere in the
world, without exception, women do signicantly more unpaid care work than men”
(24). “Women carry out 60 per cent more unpaid domestic and care work than men”
(77). Women make up the majority of paid care workers, too: care work “makes up 19.3
per cent of global female employment, and 6.6. per cent of global male employment” (25).
127
Part of the neoliberal doctrine of care is what Dowling calls “care xes,” which
“resolve nothing denitively but merely displace the crisis elsewhere” (15). In dierent
chapters, she discusses these “xes,” such as assistive technologies, gig work, outsourcing
and ooading of care, the mobilisation of and dependency on unpaid volunteer net-
works of community care, informal networks, and free labour of love from friends and
family, Social Impact Bonds (SIB), self-quantication, and the industry around self-care.
To pick just one from this list, more and more often, white and middle-class
people ooad care work onto others – think of nannies, babysitters, domestic workers,
and house cleaners. They are “often female, lower-class and quite probably with a
migration background” (74). Their conditions leave much to be desired: often below
minimum wage, informal, without social security, unemployment and sickness benets,
or pension savings. In this process of ooading care work, “chain reactions” emerge in
which women (and some men) from low-wage countries take on the care work of mid-
dle-class families at the expense of their care work, further entrenching social inequalities
(74). The resulting chain reactions change nothing in the unequal distribution of repro-
ductive labour, but merely replace one group of women and some men from the Global
North with another group of women and some men from the Global South.
The outsourcing and ooading of care are part of the so-called “management”
of the crisis in adult social care (105), which relies on the work of migrant women,
often employed by outsourcing companies that compensate below minimum wage. In
the chapter ‘A Perfect Storm,’ Dowling describes the perverse conditions of adult social
care provision, a “toxic mix” of “unequal distribution of societal responsibility; the lack
of value attributed to the work of caring; austerity and underfunding; and the failures
of privatisation and the consequences of marketisation and nancialisation” (105). This
is epitomised by care providers’ treatment of women and migrant care workers, the
elderly and vulnerable, and by the consequences of the uncritical use of monitoring and
assistance technology for the sake of protability. The very populations that “bear the
destructive consequences of nancialised capitalism” are being “recast as a cost to society
and a risk, to be managed using calculative instruments aimed at nancial returns” (165).
Why does care continue to be undervalued in this way? Dowling argues that
legitimacy and justication are partly achieved “through a denial of the structural
reasons people need welfare in the rst place” (70), and partly a result of what she
calls a “displacement eect” (162). Dowling borrows this concept from Stuart Hall,
who coined it in the 1970s in the context of the criminalisation of young black men.
The displacement eect recasts symptoms of the structural crisis as causes, leaving the
systemic problems of the crisis unaddressed (162).
According to Dowling, the causes of the care crisis are “growing poverty and
inequality” (92), underfunding and the “privatising of gains and socialising of risks” (163).
Yet social care recipients suer from the social stigma that blames and shames them for
their care needs, while political, economic, and social inequalities disappear from view.
Depleted public funding, privatisation, and the logic of business models ensnare social
and health care infrastructures at their roots (139). Care becomes commodied, and
access to it is more and more dependent on what people can aord, leaving the most
vulnerable to their own (limited) devices, and deepening care decits and inequalities.
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This creates an uncaring feedback loop.
How can we break out of this self-reinforcing loop? Chief among the possible
remedies for the care crisis Dowling explores in the nal chapters of her book is the
need for “transforming the social, economic and political structures that create social
disadvantage” (156). This necessary “transformation of the structural conditions for
care” will only happen if care has “a dierent status” and is organised “as a social and
material practice — at the level of institutions and the everyday” (193). This requires
“allocating more time, money and social capacities” and “elevating its undervalued
political and ethical status” (195). More concretely, she proposes to “denancialise care,”
to democratise it, and liberate it from free trade agreements (196). Care work, she
argues, should be “better paid, with better working conditions, better training, more
resources and improved technological support that enables better caring” (197). It also
needs to “be met with public investment in infrastructures such as childcare, education,
healthcare, eldercare, and community service” (199) and by the redistribution of care
delivery through creating collectively owned forms of care provision. The care crisis,
Dowling contends, demands a “struggle for a better future” (8). This struggle requires
reclaiming “the means to care from the prerogatives of protability” (206).
Dowling’s call is urgent in an ongoing global pandemic and a mammoth task for
capitalist systems that care about prot above anything else. I don’t think many people
on the left would disagree with Dowling’s astute analysis. But can her suggestions for
repair and reform succeed in getting a foot in the door?
Under capitalism, valuation is expressed in money and prot, but does this
mean that money is part of the solution for reversing the underlying political deci-
sions, measures, and infrastructures that have led to this worrying care crisis? Dowling’s
proposals raise the question: can one reform an infrastructure that was parasitic from the
get-go and never worked to begin with? Phrased dierently: what are the implications
if indeed care and capitalism are fundamentally at odds with each other? How can we
extricate care from the credo that time is money?
More pragmatically: How could we incentivise – or reverse engineer – states,
corporate investors, and care providers to take the material and social responsibility
to help reduce poverty and social and health inequality, without exploiting (migrant)
women? The World Health Organisation estimates a projected shortfall of 18
millionhealthworkersby 2030, mostly in low- and lower-middle-income countries,
but every country will be aected. In The Netherlands, new projections predict a
shortage of 135,000 care workers by 2030, particularly in hospitals and nursing homes.
It is easy to predict who will be aected the most. What changes are needed to make
women and migrant workers less vulnerable to parasites — what factors aect the
host-parasite relationship? How do we elevate its status and the conditions of care
work? To throw the cat among the pigeons: what about a men’s quota regulation in paid
care work: enforced, inalienable quotas to mitigate gender, class, and ethnic disparities
and accelerate the achievement of balanced participation in paid care work? We need
to start somewhere.
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Patricia de Vries works as research professor at the
Gerrit Rietveld Academy. She has published in Big
Data & Society, Rhizomes, nY, De Reactor, Press & Fold,
Amsterdam Book Review, and has written on art and
philosophy for the art gallery MU in Eindhoven,
Centraal Museum in Utrecht, Maxxi Museum
in Rome, and the digital art center Chronus in
Shanghai.
Biography
