Care in Europe

In postwar Europe, the “state” became politically and discursively constructed as responsible for the welfare of citizens, or at least for maintaining an economic and social context in which citizens could fare well. This compelled governments to prioritize efforts to meet fundamental thresholds of welfare in the areas of poverty, health, and children. This commitment was, and continues to be, crucial for European economic interests. For example, with governments stunned by the mortality rate of civilians and the destruction of property and infrastructure, postwar poverty relief—balancing incentives to workers with assistance to those in immediate need—was key to rebuilding national economies. This welfare capitalism rested upon an assumption of male full employment and, as such, both economic and social policies were geared toward the breadwinner model—assisting men returning from World War II to find employment and encouraging women to fulfill their domestic duties. Specifically, women needed to give birth to, and care for, children in order to replenish national populations and ensure healthy able-bodied workers/consumers for generations to come. More recently, this economic motivation has targeted the middle classes by constructing them as “stakeholders” in order to encourage commitment to current systems of welfare, such as state-funded health and education.

While many states articulated a postwar commitment to welfare provision, they did so with the assumption that most long-term-care needs would be met by the family. The family was the primary source of care for children and the elderly, and the normative parameters of family life were policed by the state and other service providers (see Barrett and McIntosh Reference Barrett and McIntosh1982; E. Wilson Reference Wilson1977). Arguably this remains the case. Faith-based agencies providing care buttress the state's dependency on the family by providing a values discourse that maintains the institutional importance of the heterosexual family. Their role increases as states rely more on care provision from the faith-based sector. The heteronormativity of care is well documented, as are assumptions about race that often accompanying such monolithic approaches to welfare (Evers, Lewis, and Riedel Reference Evers, Lewis and Riedel2005; HantraisReference Hantrais, Page and Baldock1994; Smith Reference Smith2007; Van Every Reference Van Every1995).Footnote ¹ While feminist and ethnic minorities have challenged the gender and racial assumptions of the family model employed and reinforced by welfare policy, it remains the case that European states rely extensively on the care provided by the heterosexual family.

What has changed significantly over that last 50 years is that the family model of normative welfare policy no longer maps easily onto the constructions of family in contemporary Europe. As a result of the dependency on one family model, welfare provision has been drastically affected by shifting cultural and demographic changes. A conundrum arises, then, concerning how to deliver on a postwar commitment to welfare despite financial pressure resulting from demographic, socioeconomic shifts (George Reference George1998; Huber and Stephens Reference Huber and Stephens2007; Pierson Reference Pierson and Pierson2001a, Reference Pierson and Pierson2001b ). For example, P. Taylor-Gooby (Reference Taylor-Gooby2004, 30) outlines the challenges for European welfare states thus:

F. Bettio and J. Plantenga note that “all European countries are currently trying to redefine and restructure the division of care responsibilities, seeking to establish a new balance among providers of care: the family, the market, and the state” (2004, 86).

Given the postwar welfare commitment and its evolution through demographic and cultural change, it is possible to identify moments of systemic stress, or a care crunch. In trying to address this care crunch, many European governments have adopted more neoliberal models of welfare and co-opted a range of care providers—faith-based and voluntary agencies, direct payments to extended family members caring for children or the elderly, and many going so far as to recognize same-sex partners and lesbian and gay parents.

Political economy of (hetero) care

With reference to political economy, the heterosexual nuclear family model reflects the foundation blocks of political theory (Bryson Reference Bryson2003; Patemen Reference Pateman1988; A. Wilson Reference Wilson and Wilson1994) as well as economic theory, particularly regarding male employment and women's unpaid labor. (See Cook, Roberts, and Waylen Reference Cook, Roberts and Waylen2000; Ferber and Nelson Reference Ferber and Nelson1993; Peterson Reference Peterson2002; Prügl Reference Prügl2002; Strober Reference Strober1994; for a reading of lesbian and gay economics, see Badgett Reference Badgett1995, Reference Badgett1997, Reference Badgett1998; Gluckman and Reed Reference Gluckman and Reed1997; Posner Reference Posner1992.) For example, Colin Danby (Reference Danby2007) explains the impact that heteronormativity has on economics, and Spike Peterson (Reference Peterson2003, 179) draws attention to the “deafening silence” about gender in studies of political economy.

With these interventions in mind, the political economy of care highlights how a care crunch has opened up possibilities for expanding normative definitions of the caring family. For example, N. Yeates (Reference Yeates2005, 227) notes in “a global political economy of care” that “care is an important analytical concept in social policy because of what its social organisation reveals about social formations and the nature of welfare states.” M. Daly and J. Lewis (2000, 284) understand care as the “interface of public authorities, especially the welfare state, and private agents.”Footnote ² They use social care to disentangle welfare state variations, change, and policy development in order to capture the “social and political economy within which it is embedded” (2000, 281–84). For Daly and Lewis (see their chart on p. 287), care is understood primarily as labor inherently connecting paid/unpaid, formal/informal welfare provision. Importantly, the state takes the lead in establishing and regulating boundaries of care, as well as the normative obligations of care. It is therefore within the remit of the state to perpetuate existing or significantly change norms of care. Care stretches across the public/private divide, with the state determining how costs are shared among individuals, families, and society. The political economy-of-care frame, therefore, can highlight points of systemic stress and moments of possibility that have given rise to inclusive lesbian and gay policies in many European countries (A. Wilson Reference Wilson, Annesley, Gains and Rummery2007a, Reference Wilson2007b).

On a macro level, European countries negotiating both Europeanization and globalization operate under restrictions on taxation, a competitive economic push to level welfare provisions, and a single currency. The European Union sets significant economic parameters for nation-states attempting to balance domestic budgets (Taylor-Gooby Reference Taylor-Gooby2005, 2). Any policies of “redistribution must be achieved through public expenditures rather than through the regulation of employment relations, and the costs of welfare have to be collected from the non-capital incomes and expenditures of the non-mobile population”; and it is within these economic constraints that national politicians can determine the overall size of welfare provision (Taylor-Gooby Reference Taylor-Gooby2004, 31; see Ferrera and Rhodes Reference Ferrera and Rhodes2000; Scharpf Reference Scharpf1999, Reference Scharpf1997; Scharpf and Schmidt Reference Scharpf and Schmidt2000). Marketization of care and subsidies, or payments for care, serves as an example of the impact of neoliberalism on welfare reforms (Daly Reference Daly2002).Footnote ³ Within budgetary assessment, the “domain of care” can be seen as more manipulable, porous, and less politically sensitive than, for example, changes to unemployment benefits (Daly and Lewis Reference Daly and Lewis2000, 294). Moreover, in answer to the pressures of globalization, nation-states may adopt more localized solutions to care provision that can perpetuate the normative role of faith-based agencies (see Yeates Reference Yeates, Manning and Shaw2000, Reference Yeates2002).

In order to negotiate these economic demands, states have attempted to adjust to, or at times control, the gender division within labor markets by focusing on care policies. During World War II, and continuing in postwar austerity, women have been constructed as a reserve army of labor, particularly in relation to welfare provision. “Women appear almost by accident and then vanish again” in Esping-Andersen's classic Three Worlds of Welfare Capitalism (Reference Esping-Andersen1990) because they are not central to the theoretical framework and seen only when necessitated by the discussion of statistics, namely, labor markets (Langan and Ostner Reference Langan, Ostner and Room1991, 130). Most experts agree that such an approach overlooks the fact that “men and women are gendered commodities with different experiences of the labor market resulting form their different relationship to family life” (Reference Taylor-Gooby1991, 131). Taylor-Gooby observes that “the gender division of care coincides with patterns of access to and status in paid employment that, despite national variations, deny women equal opportunities in this sphere” (Reference Dominelli1991, 101). Dominelli echoes that “treating these worlds as unconnected to each other enables non-feminist theories to ignore the contribution the domestic economy makes to sustaining and reproducing public welfare relationships” (Reference Dominelli1991, 9). Within welfare capitalism, the gender division of care labor, paid and unpaid, underpins welfare provision.

Unsurprisingly, then, cultural and demographic shifts have brought on stress to this system of gendered welfare provision. These include the increasing number of women in employment, lower fertility rates, changes in family structures, and the migration of workers away from localized familial care. As Daly and Lewis note, “the demographic and financial factors have acted as pressures increasing the demand for care whereas the social factors, in particular changing norms about family and kin responsibilities and the role of women, have contributed to a transformation of the conditions under which care has been traditionally organized. . . . [A]ll of these together have acted to effectively decrease the supply of care at a time when demand is rising” (2000, 288). As a result, most European countries are experiencing a crisis of care (Hochschild Reference Hochschild1995), reflecting the fact that “family resources for caring are shrinking as are the resources (funds and commitment) available to and for public services” (Daly and Lewis Reference Daly and Lewis2000, 289). For example, demand for elder care is rising, with the proportion of older people in the European population rising from 12% in 1980 to projections of 25% in 2030, while the percentage of women—traditional providers of care—joining the labor force is increasing (Taylor-Gooby Reference Taylor-Gooby2004, 35).

Daly and Lewis link this reliance on the family directly to the historic role of Christian concepts of family solidarity, built around a readiness to care and the way in which these are embedded in social programs throughout Europe that encourage the supply of, if not also the demand for, family caring (2000, 290). Significant cultural changes, alongside more women in employment, challenge the assumption of family readiness, or ability, to provide care. For example, Daly (Reference Daly2005) calls attention to changes in family forms, with more people living alone, a downward trend in marriages,Footnote ⁴ increasing variations in the composition of households, more lone parents, the rise in two-income families, and competing demands between couples without children/partnerhood and those with/parenthood.Footnote ⁵ Sociological research (for example, Lewis Reference Lewis2003; Silva and Smart Reference Silva and Smart1999; Smart and Neale Reference Smart and Neale1999) documents increasing evidence of alternative family models. While there is a significant lack of national or European-wide statistics, recognition of lesbian and gay couples and their children in the media, economic inclusion, and social attitudes are other examples of seismic cultural shifts in understanding of “family” (see Purdam et al. Reference Purdam, Wilson, Afkhami and Olsen2008).

Certainly one response to this care crunch is further welfare retrenchment supported by neoliberal understandings of individual responsibility. However, given the continuing high degree of commitment to welfare provision across European countries, the emergence of an American-style residual model is unlikely (Ferrera Reference Ferrera1993; Svallfors Reference Svallfors1997; Taylor-Gooby Reference Taylor-Gooby2002). Of course, care strategies are intertwined with national identities, and differences between countries reflect the complexities of national party-political compromises (Alber Reference Alber1995; see Bettio and Plantenga Reference Bettio and Plantenga2004). Taylor-Gooby argues that public attitudes remain favorable toward welfare, thus limiting the capacity of politicians to cut back. This commitment reinforces a “politics of viscosity and path-dependency” (2004, 32). Furthermore, he adds that despite European welfare states facing drastic challenges, “attitude survey data typically demonstrates a high measure of enthusiasm for state welfare” (2004, 32).

What can be said about this period of challenge, or care crunch, is that it has offered significant scope for change. Birgit Pfau-Effinger (Reference Pfau-Effinger2004) maintains that moments of weak integration between social values and institutions are moments in which modernization of gender arrangements occur. When the possibility of change arises, it is important to have organizations that can capitalize on discrepancies between institutions and shifting values in order to forge new arrangements. A care crunch sets the scene for a revision of normative gender arrangements, and depending on the ability to take advantage of moments of systemic stress, one result might be greater incorporation of lesbian and gay citizens as equal carers.

Daly and Lewis note that “welfare states are increasingly redefining what is offered as a public service, who might qualify for cash assistance in respect of care, and how much care must remain in the private familial or private market sectors” (2005, 291). States still hold the reins and are gendered institutions and producers of “regulatory values,” particularly when it comes to question of what, who, and how much care will be provided (Elson Reference Elson, Cook, Roberts and Waylen2000; see Prügl Reference Prügl2002). In the face of marketization and globalization, the state “is not just some passive monolith adjusting and adapting as its environment dictates” (Daly and Lewis, Reference Daly and Lewis2000, 296). Ruth Lister details key features of the social investment state, including the redistribution of opportunity to promote social inclusion rather than income to promote equality and the adaptation of individuals and society to enhance global competitiveness (Reference Lister2003 p. 437).Footnote ⁶ This is a relevant description of state interventions negotiating a care crunch. Such an active state constructs responses to economic necessities at least partially by redefining values around care provision. Vying for power within this process are groups with varied interests in state redistribution and market principles. States may find that resulting tensions place a wedge between different groups. Undoubtedly, redefining the family to include lesbian and gay citizens as caregivers is one such wedge issue.

Who Cares?

The centrality of gendered heteronormativity in health and social care debates is a common theme in feminist political analysis. But such concerns seem distanced in the American same-sex marriage discourse of justice, equality, or rights. For example, Obama's assertion that gay and lesbian citizens deserve to visit “the person they love in a hospital” is not just an appeal to moral intuitions about love and care; it is an appeal to the pragmatics of care provision. And it is in the formal and informal delivery of care that faith-based institutions continue to offer a pragmatic solution—ones that perpetuates their social and political power.

For centuries, the Christian church has played a central role in care provision in the United States and Europe. Yet much of the care discourse, particularly in terms of health and social care, focuses on state strategies for welfare, and this “obscures the roles played by smaller, but important, care providers such as churches, private charities, or companies” (Bettio and Plantenga Reference Bettio and Plantenga2004, 86). In exploring the confines of the Sacred and Secular, P. Norris and R. Inglehart (Reference Norris and Inglehart2004) offer a compelling account of the relationship between religiosity and welfare provision. When individuals feel economically secure, their religiosity begins to wane. In postindustrialized countries, the welfare state offers tangible security, and it is in these countries, particularly Western Europe, that secularization is most obvious: “The growth of the welfare state in industrialized nations insures large sectors of the public against the worst risks of ill health and old age, penury and destitution, while private insurance schemes, the work of non-profit charitable foundations and access to financial resources have transformed security in postindustrial nations, and also reduced the vital role of religion in people's lives” (Norris and Inglehart Reference Norris and Inglehart2004, 108). However, with residual welfare programs and an emphasis on personal responsibility, the United States “has greater income inequality than any other advanced industrial democracy” (p. 108). The outcome of less security in individual well-being and “mistrust of big government, limiting the role of public services and the welfare state for basic matters such as healthcare covering all the working population,” is a high level of religiosity (p. 108). This relationship among the provision of care, religion, and heteronormativity is key to understanding the role of Christian values in American politics, and in the sociopolitical positioning of lesbians and gay citizens in the United States. Employing Norris and Inglehart's understanding of the relationship between security and religiosity, one can understand that a state may continue to rely upon the church and the heterosexual family to provide care until a care crunch forces it to consider other possibilities—for example, extending the definition of family to include lesbian and gay caregivers.

Given the historic role of marriage as a symbol of women's oppression, one feminist response to the same-sex marriage debate is that health and social care policies should not be configured around such limited notions of intimacy. Employing a political economy of care frame highlights possibilities for capitalizing on discrepancies among institutions, demographics, and shifting values in order to forge new arrangements. Those benefiting from current allocations of health and social care have a clear investment in maintaining the current U.S. care mix of individualism and heterosexual familial and faith-based care. And undoubtedly in America, Christian churches have a fairly unregulated and disproportionate investment in care provision. Because of that, it is unsurprising that they want to protect such an investment. Same-sex marriage challenges that investment and political clout by expanding the pool of possible caregivers. A care crunch may open up possibilities for renegotiating gender arrangements, more recognition, and inclusion of lesbian and gay caregivers, or maybe even open up the possibility of moving beyond the limits of marriage as the primary structure for ensuring care.