First-person perspectives on the world of work
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The Future of Work Podcast

Episode 50
The care economy

Should we treat the care economy as an investment or a cost?

26 October 2023

The UN has designated 29 October as International Day of Care and Support. The decision was part of efforts to raise awareness of the crucial role of care work in society. Currently, around 380 million people work in the care sector, and projections are that this will increase significantly in future as demand for care services grows. But already, there is a shortage of care workers, and factors such as poor wages and conditions are a continuing problem. This opens the way for a potential care crisis.

A new ILO study suggests that greater investment in care services – notably childcare - could yield an impressive 3-to-1 return on investment (ROI) in terms of growth in Gross Domestic Product (GDP). It could also reduce the global gender pay gap and increase the proportion of women in paid employment. So, what needs to be done to get more decent jobs and working conditions into the care sector?




Hello, and welcome back to the ILO's Future of Work podcast.

I'm Sophy Fisher.

In this show, we'll be talking about the care sector

and why it is crucial to a future with decent work.

Worldwide, it's estimated that around 380 million people

work in care sectors.

Two-thirds of these are women.

These numbers are expected to grow, in particular,

in childcare and in care for the elderly.

It follows that there is great potential for the creation of jobs,

but the ILO has warned

that not only is there a current shortage of care workers,

but factors such as low wages, poor working conditions,

and a lack of protections and benefits mean

that the sector isn't attracting new workers.

This potentially sets us up for a global care crisis.

Earlier this year, the UN designated the 29th of October

as International Care and Support Day.

The purpose was to highlight

some of these issues and encourage solutions,

so we thought this would be a good opportunity

to try and do just that.

With me today are Christy Hoffman.

Christy is general secretary of the UNI Global Union.

Christy, welcome.

As I understand it, UNI is a trade union federation that represents

more than 20 million workers in service sectors.

Is that correct?

Yes. In 10 sectors of the economy.

Great. Okay.

Also with us is Laura Addati, who is a maternity protection

and work-family specialist at the ILO.

Laura, welcome to you too, and thank you very much for joining us.

Thank you, Sophy.

Let me come back to Christy, first of all,

and talk to us a little bit more about the workers that you represent.

I gave a quick sketch at the beginning about conditions in the sector.

Would you say that was about right?

Indeed, yes.

Low wages, poor working conditions, a lack of protections of benefits.

Is that pretty common?

I think you have to distinguish in terms of the various kinds of care,

and let me just be clear in terms of UNI.

We represent workers.

We're primarily in private sector, and we have some acute care work.

What I'd really like to talk

about today is more the problems in long-term care because I do think

that as distinct from acute care healthcare,

long-term care is where we'll see a huge amount of growth

both in the need for employment but also where we see

the real degradation of conditions.

It's not only low-paying conditions.

There is that, of course, but part of that is there's also staffing

shortages, which make it very, very hard work.

That's been a circular thing, the worse the conditions,

the more the staffing shortages, but we've seen that emerge

after the pandemic and during the pandemic for sure

in some of these long-term care arrangements.

Then the whole skew of non-standard,

as you would say, at the ILO arrangements,

short-term contracts or temporary agency contracts,

even zero-hours contracts

in some countries ranging to complete informality.

Then, of course, you see even volunteer work

in some really low-income countries.

I think those are the kinds of things

that give rise to the poor paying conditions,

is also the informality in long-term care

and home care in particular and in nursing homes

where I think you see some of that is missed sometimes

in some of the reporting about long-term care.

The conditions in nursing homes were so, so shameful during the pandemic,

how many nursing home workers died,

and the reality for those workers is something

that deserves a fair amount of attention, I would argue.

During the pandemic, there was a lot of focus

on the role and the value to society of care workers

and promises and talk about improving conditions.

From what you say, that didn't really convert

into anything practical.

Well, nothing happens just because they got applause.

Unfortunately, I think what's happening in terms of converting

into something practical is that these workers

are coming together in greater, greater numbers and demanding improvements.

We've seen strikes, we've seen organizing.

Certainly, in Switzerland,

there was a law passed that raised the minimum wages

for care workers to I think 20 francs.

There's a little bit--

20 francs an hour that would be presumably.

Yes. There's a little bit of improvement,

but not just by the good grace of the of the employers.

It's really been a fight.

Across the board, there hasn't been this like,

"Oh, we've realize care workers are so important,

let's increase their wages."

Not at all.Not at all.

They're mad, they're fed up,

and the staffing shortage becomes more and more acute,

which to some extent drives some improvement in wages.

In some of the lower-wage occupations,

you see a little bump up because there's this labor

shortage and staffing shortage in particular, but for the most part,

we need to organize these workers into unions.

They need to have collective bargaining.

There needs to be obviously more public investment into care.

That's a big part of it.

It all needs to come together

as a package because we can invest in care and deliver bad jobs,

and this isn't really what we want.

If the agenda is a better world, a better care.

In addition, we want gender equality.

As you point out, these jobs are two-thirds women,

I think more than that in domestic and home care.

I think it's over 90% women.

I might be wrong about that number,

but then when we see this as a way to look at,

as a lens for gender equality,

it's not only about creating good care jobs,

but it's also about creating the conditions through

which women who do all the unpaid care

or the large majority can actually enter

the labor movement if there aren't good care options.

It's really part of a complete quilt of here

is what we need to do to address gender inequality as well.

Yes. I wanted to talk to you about this issue of gender

in the care sector and the fact that it is female-dominated

because there have been other area of research which has shown

that when you have a sector that is female-dominated,

the wages and the conditions tend to go down.

The inverse happens when you get more men into the sector,

the wages and conditions tend to improve.

Is this something, do you think, that policies can actually help with?

For sure.

Look at even on the legal front, we just saw a big case brought

by a UK affiliate GMB against the differential in pay.

Not so much two people working at the same job,

but between a care worker and someone

with similar skills in a male-dominated occupation.

There was a big lawsuit brought in New Zealand on the same issue,

and they won big improvements for care workers using a legal tool.

Now, I don't know if we need to do that everywhere.

I think it's a really powerful message.

We also see the difference between long-term and acute care.

The OECD put out a report showing that comparable workers would earn

€24 an hour in acute care to €15 an hour in long-term care.

That's even the same worker, comparable occupations.

There's a big difference there as well.

On the gender equality issue,

we do see some legal cases pumping up and succeeding,

and that actually has the impact of lifting

up the wages for care workers, but I think on the policy side,

it could be addressed as well.

Absolutely. They're having to do that in New Zealand

because the case had such a big impact.

Laura, let me bring you in here because the issue of gender equality

in the care sector is also something that you've been looking at, I think.

Yes. This new international day for care and support

really emphasizes the need for the substantial investments

in the care economy and to build this care

and support system that are robust, resilient, and gender transformative.

Gender transformative,

it means ensuring that the jobs that are created are of good quality.

As we heard from Christy, they need to be formal, they need to be safe,

free from violence and harassment.

We know that so many women and other workers

face violence and harassment in care occupations.

Also, we need to offer adequate wages

and equal pay for work of equal value.

That's extremely important.

Offer social and labor protection training and accreditation.

Is not because women are over-represented in these jobs

that should not see these jobs

as skilled that need a reward and value.

Right. Now you've been looking, I think,

at care as it relates to childcare, which, of course,

is the other major sector Christy's been talking about,

long-term elder care and care in homes.

What were the basic things that you found relating to childcare?

The new brief that has been published

in October '23 focuses on the benefits

of investing in transformative childcare policies.

When we talk about investing in care and support systems,

we are also looking at all those care policies that include maternity,

paternity, parental leave, childcare services,

long-term care services

that staff with quality care jobs.

At the ILO, we have dedicated our efforts in creating a robust evidence case

and an investment case to guide governments, workers,

and employers in formulating and financing transformative care policies.

We have launched ILO care policy

investment simulator that is an online tool

that really wishes to empower users

to advocate for transformative investments,

bringing the arguments that would allow social dialogue

around care policies and bring

the evidence that these are not costs or investments and we need

public solutions for tackling the growing care challenges.

The brief highlights that investing

in transformative care policy packages

could generate almost 300 million jobs by 2035.

When we look specifically at childcare policies,

we find that every dollar invested in closing childcare policy gaps

could result in an average increase

of $3.76 in global GDP by 2035.

We find that these benefits are present everywhere independent

from regional and income diversity.

There are also important gender equality advantages

for the simulations based on this new tool show

that also women's employment rates could increase

from the 2019 average of 46%

to a simulated 56% by '35,

so important reduction in gender inequality in employment,

but also global gender gaps in monthly earnings

could be reduced from the 2019 average

of 20% to 8% in 2035.

This alone, of course, won't resolve the whole issue of gender

inequality in the labor market but really point

to the urgency of prioritizing investments

that can really bring meaningful societal transformation.

If I understand you correctly,

what you're saying is that for every dollar spent

on additional childcare

between the ages of when the child is born

and when it can start full-time education,

for every dollar that is spent on that,

the potential economic return is $3.70.

Exactly. Precisely.

In addition to that, there are benefits of reducing

the gender pay gap because you're allowing women to get

back into the workforce and increasing

the amount of actual women in the workforce.

Exactly. Also, creating good quality care jobs.

It's all the direct jobs.

That's the key, isn't it?

It's not just gating the jobs, is they have to be good jobs.

Exactly. They need to be trained jobs, they need to be well-paid jobs,

there should be enough workers.

What we see, we've heard from Christy, is that living in some countries,

the results of years of underinvestment in care sectors,

and in other countries, financing choices that are based on market logics

are really creating an exodus of care professionals,

providers are struggling

to hire quality trained care professionals,

and we all suffer when carers are not recognized

and empowered to deliver for our loved ones.


Christy, one of the things that Laura has mentioned in what she was saying

is not just the creation of jobs but the creation of good formal jobs,

which, of course, come with protections and, of course,

with paying taxes back to governments.

To what extent do you think that

in the long-term care sector where your members work

that it's the conditions of the jobs

that are as important or even more important

than the actual wages themselves?

To what extent are the conditions?

Is it an issue of conditions as much as money?

No, I think money is really important.

I think that the conditions drive the money to some extent.

When you're talking about such low wages,

really a small difference can be transformative

for some low-wage workers.

I don't want to take money out of the table, but I do think

that when you're not in a formal relationship,

when you don't have a standard employment relationship,

it's much harder to make more money.

I think, and it's certainly much harder to organize.

When you look at domestic care workers caring for the elderly,

the push to formalize those relationships

has been really transformative to ensure that those workers

are both able to come together in unions because they have an employer.

They're able to negotiate higher wages,

but also, of course, improve their conditions.

I want to come back to the point about training because I do think that

it's proven that when we have workers who move out of informality

and come into a different kind of employment

relationship and they are able to get

some certification and some upskilling,

it really benefits the clients as well as the worker.

Because the worker has more skills,

they're able to negotiate being in a position to get higher wages,

but the client's also getting better care.

I think there's a win-win for everyone.

Training is very important in terms of the care economy.

Yes, of course, conditions matter, but pay is absolutely essential.

People need a living wage.

Yes. I think your point about training

is well taken because anybody who has seen

a care worker in action will know that it's actually a skilled job.

Let me ask you, this International Day of Care and Support

that the UN created this year, do you think that's going to be a help?

How do you think it's going to affect the industry?

I think it's terrific that we're having

this opportunity to pay attention to these people

who are so essential to every one of us

who hasn't had a mother or child who needed care.

I do think that it's important as a moment

where we can do things like we're doing today.

We're having a podcast or we're issuing

reports or we'll be able to celebrate

the victories that we've seen over the past year,

in particular of workers coming together to negotiate better conditions.

Putting a spotlight on these workers who live for so long in the shadows,

we just expect that we're going to be able to find

some migrant worker or low-wage worker.

There's just, "Oh, well, we'll be able to find someone

to come in and take care of the grandmother."

Actually, the reality is we need to upgrade the industry.

We need to put more attention onto it.

We need to make sure that all workers in the care sector are getting

both a relationship through which they can come together,

negotiate good collective agreements, and have decent work all around.

That, I agree with Laura's comments about it's got to be safe work,

it has to be regular schedule.

Scheduling is really, really difficult for care workers.

Often if you're moving from one client to another,

you don't get paid for the time

in between your spending time with the client.

The travel time, that's a big issue for care workers who are negotiating

with their employers is how to treat that transportation time.

We have seen some really good models emerge.

I know in the ILO's report from last year,

you talked about the SEIU and AFSCME,

the big project they've done in the state of California

to formalize the home care workers there,

and what a transformation that has made for the lives

of those many, many thousands of care workers.

We've seen this year in the Czech Republic,

where nursing homes are

very poorly represented by unions in general,

but some of our affiliate got one of the first collective agreements

for 1,500 employees in 32 care homes

across the country with substantial wage increases.

We have to celebrate these victories.

The SEIU model, I point that out that that's some time ago,

but I think it's a good model that others can follow.

I think the Czech Republic example

is important to see these private sector nursing

home care workers coming together in countries

where unions have very low density, especially in the care industry,

and that they were able to come together

and create a new model for themselves.

Laura, just finally, the ILO, as you mentioned,

has launched this new care policy investment

simulator and the care policy portal.

How do you hope those will be used?

The care policy investment simulator

and portal are important tools for empowering

governments, workers, employers,

and other key stakeholders in making informed decisions.

We really have the tools out there.

We need the policy commitment,

the political commitment of states and workers

and employers that have the responsibility to deliver care.

This day really reminds us the importance to invest in our carers.

Great. Thank you, Laura and Christy.

Thank you very much for that.

It's a good note to leave it on.

Unfortunately, that's all we've got time for in this podcast.

Thank you to you both for joining us,

and thank you also to you, our listeners,

for giving us your time and attention.

I hope you'll join us again soon for another Future of Work podcast,

but for now, goodbye.