Social Protection for the 21st century: towards a new politics of care

13 February 2023

Warnings that the UK is facing a ‘crisis of care’ are growing in volume. NHS wait times have reached a record high, and staff shortages across the social care workforce are predicted to rise to 500,000 by the end of 2030, as poor working conditions and the lowest wages of almost any sector in the UK make these careers increasingly unsustainable. The shortfall is being met by the most vulnerable, and over 350,000 people aged 16-25 in England and Wales now provide unpaid care to a loved one.

The new IGP working paper “Social protection for the 21st century: towards a new politics of care” unpicks the UK’s care crisis, using London’s tuberculosis (TB) rate as a case study. Henrietta L Moore and Alexandra Boothroyd argue that the crisis extends beyond health and social care: the UK is experiencing a breakdown of its social protection system, as the state fails to fulfil its duty of care.

The latest figures linking austerity measures introduced between 2010 and 2017 to 335,000 excess deaths highlight the breadth of this crisis. Care, like illness, is profoundly political, and is here understood according to Tronto and Fisher’s (1990) definition:

A working definition of care

‘Everything that we do to maintain, continue, and repair our ‘world’ so that we can live in it as well as possible. That world includes our bodies, our selves, and our environment, all of which we seek to interweave in a complex, life-sustaining web.’

The failure to invest both financial and social capital in care has critical implications for human lives; it is structural violence exerted through policy. Synthesising existing scholarship, Moore and Boothroyd contend that our current approach to care is flawed, and locate its problems on three interrelated levels: power, value, and scale. The paper argues that to act on all three levels, care must be redefined as a relational, interdependent, and multi-scalar phenomenon, and enacted across all areas of public policy.

Action of Power

Care is a relational term - Many indigenous knowledge frameworks offer the whole-systems thinking needed to address our current crisis of care. State-level and transnational efforts to recentre and redefine care must therefore recognise it as a relational term, taking meaning from different groups, across contexts. This approach is key to achieving epistemic justice and overcoming power imbalances in our current economy of care. New Zealand is one of very few national governments using indigenous conceptions of care and wellbeing to inform policy. The Treasury draws heavily on indigenous conceptualisations of care to inform its Te Tai Waiora wellbeing framework, addressing care as a relational term, with multiple, holistic definitions. The Maori understanding of wellbeing includes concepts such as manaakitanga (collective responsibility to care for others), kaitaiakitanga (guardianship) and kotahitanga (working in an aligned, coordinated way). These concepts have shaped the government’s Living Standards Framework, which helps to inform policy across the areas of health, housing, and environmental protection.

Action on Value

Care is as an inherently interdependent phenomenon - Dependence on care is not necessarily pathological: it is part of the human condition. Delivering good care at all stages of life promotes overall wellbeing, and is therefore of mutual benefit to us all. The Care Collective, a multi-disciplinary team of researchers from across the UK has argued for a radical redefinition of care, centred on interdependence. Dependence on care has often been pathologized, rather than

recognised as a basic part of the human condition. The Care Collective contend that defining care in this way frees us to move beyond traditional gendered and racialised divisions of labour, “since both the need to care and the need for care are understood and shared by all.” In a policy context, this redefinition means transforming the nation state: extending citizenship and rights based on the principle of care rather than birthplace and borders.

Action on Scale

Care is multi-scalar - Care, as a practice, is delivered on multiple levels: in families, communities, nation states, and across borders. State level care has historically been delivered through narrow, vertical interventions. We contend that the state’s duty of care must be expanded to include all areas of social policy, and must facilitate horizontal, community-led projects. This is key to addressing issues of both scale and power, broadly conceived. Cottam argues that rather than expanding standardised, national institutions like the NHS, we need to invest in a ‘web of care’, that implicates individuals and organisations on every level. Sustained investment in this model would help to overcome the mismatch between care needs and state/market structures: instilling care with necessary warmth and humanity, while also acting structurally. This amounts to broader reform of our welfare system.

IGP framework for care

The IGP framework for care goes a step beyond existing policy proposals, introducing a wholesystems approach. Redefining and enacting care as a relational, interdependent, and multi-scalar phenomenon ultimately means addressing it proactively, rather than reactively. Embedding care across all areas of policy, as standard, is key to ensuring equitable and sustainable livelihood security. The IGP contends that to reflect the challenges of the 21st century, we need a new form of social protection, underpinned by the analytical framework for care developed in this working paper. This can be achieved by the introduction of Universal Basic Services: an updated social protection system, fit for the 21st century.

You can read the working paper here.

Professor Henrietta L. Moore is the Founder and Director of the Institute for Global Prosperity (IGP).

Alexandra Boothroyd is a Research Associate at the Institute for Global Prosperity (IGP).

Photo: Ben White on Unsplash