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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Care is the foundation of organic life. But its fate in the economy is precarious and uncertain. The labour of care is arduous and underpaid. Yet without it health and vitality are impossible. Care itself ends up leading a curious dual life. In our hearts it’s honoured as an irreducible good. But in the market it’s treated as a second class citizen – barely recognised in the relentless rush for productivity and wealth.
How did we arrive in this dysfunctional place? And what can we do to change things? What would it mean to take health seriously as a societal goal? What would it take to adopt care as an organising principle in the economy?
Renowned ecological economist Tim Jackson sets out to tackle these questions in this timely and deeply personal book. His journey travels through the history of medicine, the economics of capitalism and the philosophical underpinnings of health. He unpacks the gender politics of care, revisits the birthplace of a universal dream and confronts the demons that prevent us from realising it.
Irreverent, insightful and profoundly inquisitive, The Care Economy offers a bold and accessible manifesto for a healthier and more humane society.
Also available as an audiobook, narrated by the author.
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Seitenzahl: 669
Veröffentlichungsjahr: 2025
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CONTENTS
Cover
Table of Contents
Praise for The Care Economy
Title Page
Copyright
Dedication
Prologue
Notes
1 The Road to Hell
The state of wellbeing
The invisible heart
Use the difficulty
Good intentions
The road to hell
Care’s nemesis
The book as a journey
Notes
2 Euphoria
Health as prosperity
The water cure
The problem of pain
Resurfacing
The poppy’s gift
Dopesick
Dangerous liaisons
Profit and loss
Notes
3 Vital Signs
98.6° Fahrenheit
Ice Mile
Inner morphine
The cathartic ocean
The wisdom of the body
The limits of wisdom
Notes
4 The Myth of Care
The birth of Rome
‘This is an act of care’
Symbolic health
Moralities of care
The myth of care
Gravity
Careful whispers
Notes
5 No Good Deed
Anniversary
The birthplace of a dream
Industrial homicide
‘We are going to Tredegar-ise you’
Fast forward
The causes of death
The burden of disease
The heritage
No good deed
Notes
6 Passerelle
Insult the guests
The Thinker
A degrowth explainer
Expansion vs extinction
This house believes
The good life
Postgrowth thinking
The Cinderella economy
The light within
Notes
7 Shoot the Messenger
The logic of care
Diabetes
Insulin wars
Type 2
Progress report
Deep learning
Profit and loss
Beyond humanitarianism
Notes
8 The Lost Generation
You are what you eat
Pure, white and deadly
Sisters of Mercy
Death in Scutari
Care as discipline
Conviviality
Serious people
Notes
9 Care in the Time of Cholera
Sweare Deep
Disease as a restorative process
The mirage of health
Natural hygiene
The Great Stink
A turn in the tide
Notes
10 Pathogenesis
Enter the germ, stage left
And the winner is …
And the truth is …
Terrain matters
The limits of medicine
Low tide
The robber barons
The blue pill
Notes
11 Death and the Maiden
Stonehenge
Asclepius and Hygeia
The long and winding road
The human condition
The frontline
Death of a dream
The economics of sculpture
The end of labour
Chasing productivity
Slow down
The cost disease
The Caduceus
Notes
12 Fuck the Patriarchy
Jamaica Inn
Battle of the sexes
My Cousin Rachel
Women and healing
Witches, midwives and nurses
Barbenheimer
Taylor’s version
The drop to the top
Bad men
Reactionary feminism
The roots of the patriarchy
The chalice and the blade
In a human voice
Of women and horses
Notes
13 Land’s End
The Mohegan
West by north
The symbolic self
The denial of death
Terror management
The collapse of care
The sacred canopy
The Charlotte
Capitalism as a disease
West by south
Notes
14 Jenga
Economy as care
The dangers of heaven
The mirage of health
The myth of care
The terrain matters
The careless economy
Baumol’s lesson
Structure and value
Value, culture and power
The patriarchy
No more sex war
Symbolic health
The state of wellbeing
Notes
15 The Red Pill
Care as a legacy
Care as a wishlist
Care as a principle
Care as prevention
Care as a postgrowth guide
Care as an investment
Care as an unpaid debt
Care as climate action
Care as freedom
Care as the red pill
Notes
Acknowledgements
References
Index
End User License Agreement
Guide
Cover
Table of Contents
Praise for The Care Economy
Title Page
Copyright
Dedication
Prologue
Begin Reading
Acknowledgments
References
Index
End User License Agreement
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Praise forThe Care Economy
‘A well-timed warning about the dire consequences of prioritizing wealth over health and sacrificing happiness for growth. Jackson takes his reader on a fascinating journey, peppered with entertaining characters and colourful stories. But his message is deeply serious – as persuasive as it is challenging. A “must-read” for anyone who cares about the future. A book that could change the world.’
Dr Michael Dixon CVO, OBE, FRCP (hon), FRCGP Chair of the College of Medicine
‘A profoundly insightful and personal book with a powerful message: a new economics guided by care for people and planet is urgently needed. I applaud Tim Jackson and this manifesto for a healthy and sustainable world.’
Riane Eisler, author of The Chalice and the Blade and The Real Wealth of Nations
‘The Care Economy rocks. Enjoy the rhythms of this compelling take-down of the dismal science and dance to the beat of new economic principles, joyfully explained. This music will stick in your head.’
Nancy Folbre, author of The Invisible Heart
‘The absence of “Care” as a primary purpose of economics limits the reach of policy. Tim Jackson shows not only what is missed by this, how policy must stretch to be inclusive, but also what gives us a better economics as a discipline and what might be a better economy.’
Michael D. Higgins, President of Ireland
‘Why do we sacrifice health for wealth? Why are we so careless with care? From the staggering rise of chronic disease to the dark persistence of gender-based violence, Tim Jackson’s sharp, uncompromising examination of capitalism’s failings is also a passionate call to arms. A manifesto for The Care Economy.’
Stephanie Kelton, author of The Deficit Myth
‘We are taken on a tour of everything that makes, breaks and takes care. Yes, care, this word that has been denuded so much in today’s thoughtless culture by soppiness, shallowness and exploitation. Tim Jackson cuts through much of the cant about care to show why a care-full society is the good society and how that requires infrastructure. With many personal details and his wondrous but lightly worn erudition, he shows that unless we restructure the economy and how we live to deliver deep care, society will be taken by brutal forces into ever starker divisions. I’d like all politicians to read this brilliant book.’
Tim Lang, Emeritus Professor of Food Policy City & St George’s, University of London
‘What is care, anyway? Care is Misery. Care is Cure. And therein lies the rub and our salvation. Because care is half of homo sapiens, half of us. The justice ethic, and the care ethic; the male rubic, and the female rubric. It’s our burden and our legacy. Tim Jackson has plumbed the depths of economics, psychology, philosophy and spirituality to confront us with that which we can’t ignore – we were born to care, and when we choose not to, we kill ourselves, our children and our planet.’
Robert Lustig MD, MSL, neuroendocrinologist author of The Hacking of the American Mind and Metabolical
‘If you want to understand why it’s high time to reframe the whole concept of care (and you should), then start here. Drawing insights from literature, politics, psychology, philosophy, biology, feminism, pop culture and more, every chapter of The Care Economy surprises, provokes and illuminates. Profoundly radical and ultimately practical, it is also that rare thing for a book from an economist – a clear and gripping read.’
Sue Pritchard, Chief Executive, Food, Farming and Countryside Commission
‘If you ever doubted what truly matters in life, you need doubt no more. Prosperity, equity and harmony between people and planet are all about health, not wealth; about care, not growth. Tim Jackson takes us on a remarkable journey, exploring how to reshape the global economy, making his case with compassion, honesty and analytical force.’
Johan Rockström, Professor of Earth System Science, University of Potsdam author of Breaking Boundaries (now a Netflix documentary)
‘A forthright and original book. Jackson encourages his readers to think afresh about their own well-being – and that of humanity and the planet.’
Matthew Taylor, Chief Executive, NHS Confederation
‘Is there such a thing as poetic economics? A postgrowth page-turner? Everyone who dreams of a better world should read this compelling account of how a care economy could replace our current capitalistic, growth-addicted system.’
Joan Tronto, author of The Caring Democracy and Who Cares?
‘In this deeply personal book, Tim Jackson takes readers on a wonderful journey into the possibilities for an economy of care, offering a unique take on the potential for modern economic practices to be transformed into something more humane, universal and healthy for people and planet.’
Remco van de Pas, International Institute for Global Health, UN University
The Care Economy
Tim Jackson
polity
Copyright © Tim Jackson 2025
The right of Tim Jackson to be identified as Author of this Work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988.
First published in 2025 by Polity Press
Polity Press65 Bridge StreetCambridge CB2 1UR, UK
Polity Press111 River StreetHoboken, NJ 07030, USA
All rights reserved. Except for the quotation of short passages for the purpose of criticism and review, no part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publisher.
ISBN-13: 978-1-5095-5430-0
A catalogue record for this book is available from the British Library.
Library of Congress Control Number: 2024942690
The publisher has used its best endeavours to ensure that the URLs for external websites referred to in this book are correct and active at the time of going to press. However, the publisher has no responsibility for the websites and can make no guarantee that a site will remain live or that the content is or will remain appropriate.
Every effort has been made to trace all copyright holders, but if any have been overlooked the publisher will be pleased to include any necessary credits in any subsequent reprint or edition.
For further information on Polity, visit our website:politybooks.com
Dedication
To the memory of Valerie Marjory Sylvia Haywood 1931–2018
Prologue
‘What was I made for?’
Billie Eilish, 2023
In the beginning there was Chaos. The earth was without form and void. And darkness was upon the face of the deep.
After a while it got lonely there. So Chaos allowed Terra to form herself. Terra was the mother of Saturn and the grandmother of Jupiter. She was the mother of everything. In Roman mythology at least. And in Greek too, where she was called Gaia. But that’s another story. Or the same story in a different language. As most things are.
At any rate, thanks to Terra, there was soon a whole family of gods and goddesses running around on Mount Olympus. Mostly they spent their time squabbling over power. As families invariably do. Which drove Terra crazy and quite frankly wore her out.
So whenever she could she took to hanging out with her friend the goddess Care. By the time of this story, as often as not, you’d find them chilling together down by the river. And while Terra was taking an afternoon nap, Care sat happily beside her, absent-mindedly playing around in the mud.
Many aeons later the psychologist Carl Jung did something similar. He swore it helped him think. Neuroscience now confirms it. Unfocused playful activity stimulates the parasympathetic nervous system, which encourages the body to rest and digest. And yes. It can aid the creative process too. So all in all it’s a good thing.
Back then Care seemed to know all this instinctively. Probably because, at that point, there was less to remember. So fewer things had been forgotten. Since then we’ve largely forgotten almost everything. It’s amazing how much it’s possible to forget when you try to remember so much. But then again, without all that forgetting there wouldn’t be much need for learning. Or books, come to think of it. So what would we all do then? Right?
Anyway. This is all backstory. Here’s the frontstory.
One day, during her post-prandial creative downtime, Care finds that she’s managed to sculpt something strange and unusual out of the mud: a small, lifeless figurine that looks a bit like her.
‘Wow,’ she thinks. ‘Wouldn’t it be cool if she could move and talk and write books and stuff?’ But not having the power to breathe life into clay, she decides to ask Jupiter to do it for her.
Now the big man is a scary dude. Even though he’s just a grandkid. Son of Saturn. Grandson of Terra. A third-generation god. Or fourth if you count Chaos. But he also happens to be in charge of the sky. And of thunder. Which gives him the right to be kickass bad. Apparently.
He’s already put his old dad (Saturn) out to pasture and become the top god. Top dog. The CEO of deities. And in fact he’s destined to stay that way until Christianity comes along and knocks him off his perch.
But strangely Jupiter has always had a soft spot for Care. So when she asks him to breathe life into the figurine he smiles fondly.
‘Yes of course, my dear,’ he says. And then pauses. ‘Provided …’
(Beware the patriarchy. There’s always a ‘provided’.)
‘Provided what?’ says Care.
‘Well, I’m the one that’s breathing life into him,’ says Jupiter.
‘She’s not a him,’ says Care. ‘She’s a her.’
‘So I get naming rights.’
‘No way!’ retorts Care.
‘No breath then,’ snaps Jupiter. And he turns to go.
‘No, wait. Wait!’ Care calls after him. ‘Terra! Terra! Make him wait! Don’t let him go!’
‘What now?’ sighs Terra, dragging herself out of sleep. Could they really never get along without her? Just for a moment? But she calls Jupiter back anyway. Because she too has a soft spot for Care. And when Care explains what’s going on Terra says:
‘Who gave you the mud?’
‘Um. You did?’
‘I did?’
‘You said I could play with it.’
‘Then she should have my name,’ decides Terra.
‘See!’ says Care to Jupiter. ‘I told you she’s a she.’
‘Give that thing to me,’ snarls Jupiter, grabbing the figurine. ‘I’ll breathe some fire into it for you.’ And he puffs violently into the figurine’s clay mouth.
‘Not fire,’ cries Care. ‘Life!’
‘Done.’ Jupiter laughs. ‘Hello little me,’ he says.
‘It’s not all about you!’ says Care, snatching the drowsy figurine away from him.
‘My breath. My name,’ says Jupiter.
‘Not gonna happen.’
And seeing they’re not going to stop, Terra suggests they ask Saturn, who by a stroke of good fortune happens to be passing by.
Now Saturn is a cool dude. God of almost everything that matters, like agriculture and time and having parties. He’s also a mature, well-balanced judge of people and situations. Just the sort of leader who gets rolled over in favour of a Machiavellian bully. But not for the first time, faced with something tricky to navigate, Saturn comes up trumps.
‘Her body belongs to Terra because you’re the one that donated the mud,’ he tells his mum. ‘You can have it back when she dies.’
‘Her spirit belongs to Jupiter because you’re the one that breathed life into her,’ he tells his son. ‘You can have it back when she dies.’
‘And what about me?’ cries Care, looking pretty dismayed at how this is all going.
‘You, my dear, get to look after her as best you can for as long as you both shall live.’
‘Really?!’
‘To have and to hold.’
‘To the end of time!’
‘In sickness and in health.’
‘I’m so happy!’
‘Til Death shall tear you cruelly asunder.’
‘Thank you, Saturn! Thank you!’ says Care.
And with that they all go about their business. Which is to say that Terra settles down for a nap, Jupiter goes off to stir up a storm somewhere and Saturn plods on home to tend his vines. And that’s when it occurs to Care.
‘Hey wait. Wait!’ she cries. ‘We didn’t give her a name!’
But they’ve left already. Or gone to sleep. Out of earshot. On to the next.
‘Oh dear,’ says Care. ‘Oh well,’ she says.
And then she turns to the little figurine, who is now blinking and looking at the world around her in wonder and astonishment. What am I doing here? What was I made for?
‘What’s your name, little thing?’ Care asks her sweetly.
‘Barbie,’ says the figurine. ‘My name is Barbie.’
The Myth of Care (a long time) after Gaius Julius Hyginus
Notes
p. xiii
‘What was I made for?’: This is the title of Billie Eilish and Finneas O’Connell’s single from the soundtrack of the 2023 movie
Barbie.
p. xiii
The Myth of Care (a long time after) Gaius Julius Hyginus: This version of the Roman Myth of Care is adapted from the one first recorded by the historian Gaius Julius Hyginus around the second century CE (Scott Smith and Trzaskoma 2007, pp. 166–7). Evidently, I’ve taken some liberties. For example, there is no Roman equivalent of the Greek god Chaos. And so far as we know the first human being wasn’t named after Barbie. Or vice versa.
1The Road to Hell
‘The road to hell is paved with good intentions.’
Anon
My task was simple. Or so I thought. I sat down to write this book just as the world was emerging from the coronavirus pandemic, confident it wouldn’t take long. I had a strong narrative and a clear backstory. The characters were already familiar to me. And, to be honest, the concept of the book is pretty simple to convey.
There are two central ideas. They are connected to each other in fairly obvious ways. The first is that human prosperity, properly considered, is primarily about health rather than wealth. The second is that, in consequence, the economy should concern itself first and foremost with care, in all its forms, rather than with relentless growth, as it does at the moment.
That’s pretty much it.
My journey towards these two ideas began a long time ago. Possibly even in childhood. More recently, it came from thinking about the nature of human prosperity. And in particular from thinking about what prosperity can possibly mean when we’re living on a lonely rock in the middle of nowhere, hurtling through the universe at a million miles per hour.
What can it mean for us to live well on a small blue (finite) planet?
Deceptively simple. It doesn’t take long to see that it’s actually a complex question. To answer it you probably need some psychology. Some sociology perhaps. And a little history wouldn’t go amiss. You also need some economics, of course. As my title suggests. The Care Economy is in part at least a book about the economy.
That’s not to say it’s full of statistics or equations. For me, that’s not what economics is. Sometimes, of course, you have to get your hands dirty with data. And every now and then a little conceptual analysis is definitely in order. But first and foremost, I see economics as a lens through which to understand how we organize society in pursuit of our common wellbeing. It’s the study of answers to my ‘deceptively simple’ question.
That question also demands some attention to philosophy. In the old days that used to be taken for granted. Economics was part philosophy from the outset. Later, economists created a sophisticated discipline that not many people could understand. Quite often not even economists. And that, to my mind, is a recipe for disaster. Not knowing how to organize society or, worse still, appointing a small number of people to tell you (in a language you don’t speak) how best to do it for you – that’s a catastrophe waiting to happen. Something to be avoided. At all costs.
So The Care Economy is a book about the economy for people who aren’t necessarily economists. It’s for people who don’t even like economics as much as for those who do. It’s for people who hated economics at school, like I did, as well as those who loved it. It’s a book for people who feel that economics has nothing to do with them as well as those who realize that it probably does and feel it might be a good idea to know a bit more about it.
In short you need no qualifications to read this book. Because you need no qualifications to care about the care economy. You just need to care. Which, of course, doesn’t apply to everyone. But in all probability those people who don’t didn’t bother picking up this book in the first place. And if they did, I guess they can always change their mind.
It’s also worth saying that you don’t need to be an expert in care either. If we take prosperity as health seriously, I’m going to argue, our job is not just to delve into specific sectors of the economy which we happen to label with the word ‘care’. The care economy isn’t a standalone sector. It isn’t some desirable cherry on the top of the economic cake. I’m saying something different here. I’m saying this. Because prosperity is primarily about health, the economy should always and everywhere be about care. In talking about the care economy, I’m talking about economy as care. That’s my case.
The state of wellbeing
It stands to reason I’ll need to define some terms. First up, I’ll need to be clear what I mean by health and what I mean by care. But it’s relatively easy to come up with some working definitions for both those concepts.
Fortunately, the World Health Organization (WHO) has done a pretty good job already. Back in 1948 when it was founded, it defined health as ‘a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’. Maybe today we’d want to include planetary wellbeing in that list. It’s difficult to imagine how we could achieve the rest of those things on a sick planet. But aside from that, it’s a definition that’s definitely stood the test of time. As a starting point, that’s good enough for me.
When it comes to care, it’s a little trickier. But I’ve always been drawn to a framing of care by the US writers Berenice Fisher and Joan Tronto. They define care as ‘an activity that includes everything we do to maintain, continue and repair our “world” so that we can live in it as well as possible’. That seems broad enough to me to include all – or at least many – of the things we mean when we talk about care.
Care for the young. Care for the elderly. Care for the sick and the faint of heart. Care for our family. Care for our community. Care for our home. Care for the material conditions of life itself. And, of course, it would definitely include care for the planet that sustains us. Care for the climate. Care for the soil. Care for the oceans. Care for our ‘world’.
When we get down to details, these initial definitions may need some adjustment. Particularly if we want to do justice to the specific dynamics of health or to the singular qualities of care. Dimensions that I’ll have to unfold further if I want to bring you along with me. But for now they work. They’re definitely good enough for me to give you a sense of what I’m aiming at.
In one sense they make my thesis self-evident. Perhaps even tautological. If care is about maintaining and continuing a state of wellbeing, then of course the economy should be all about care. What else would it be doing? On the other hand, it’s clearly a long way from what the economy actually is doing. Most of the time at least. So there’s definitely some scope for inquiry.
Aside from that my case is simple. Let’s say straightforward. Nothing is ever entirely simple. It all seemed very manageable. The book was already in sight. I agreed a deadline with my editor. I negotiated a short retreat from my day job. And at the end of 2021 my partner Linda and I decided to rent a small cottage in rural Wales where I would catch up on reading and make a start on writing. Three things happened more or less simultaneously.
The invisible heart
The first and perhaps most predictable thing, obvious if I’d thought about it for a moment or two, was that I found myself marooned in a foreign country without a valid passport. I’m not talking about Wales. That’s still a part of the British Isles. For the moment at least. This particular stranding was metaphorical.
The Care Economy was a good title. Short, simple and to the point. It seemed like a suitably inclusive label under which to pursue my project. But my reading immediately reinforced something blindingly obvious. It wasn’t my label. It wasn’t my country. The terrain had already been charted extensively by pioneers who came before me. And almost exclusively those pioneers were women.
It was women who’d highlighted the essential nature of care. Women who’d pointed out the poor treatment of carers. Women who’d developed an entire discipline of feminist economics premised on the importance of care to human life.
That’s not remotely surprising. To this day most of what we refer to as care work is carried out by women. So inevitably it was women who’d largely concerned themselves with understanding care, with exploring its challenges and with exposing its fundamentally gendered nature.
I’m not saying we should take that division of labour for granted. I don’t believe we should. But amongst economists I’d say the gender bias is even more pronounced. Male economists have concerned themselves endlessly with economic efficiency. With productivity. With technology. With investment. And in particular with economic growth. Reams and reams have been written about economic growth.
These male economists have also spent a lot of time praising Adam Smith’s ‘invisible hand’. That’s the mythical force which claims to translate narrow selfish interest into the common good through the magic of market-based mechanisms. But they’ve left woefully unexplored what the US feminist economist Nancy Folbre has called the ‘invisible heart’ of society. Even today that heart is kept beating largely through the underpaid or unpaid labour of women. It would be totally meaningless to write anything about the care economy without recognizing this fundamental truth.
I’d known that all along. At an intellectual level. But I hadn’t really understood what it might mean until I immersed myself in the landscape. What it meant for the project. Or for me personally, as a proponent of something I wanted to call the care economy. Or even, I suppose, as a man.
I hadn’t even started writing. I could see the reviews. I could write them myself. ‘White male economist mansplains care.’ Terrific. Just what the doctor ordered. But I only had myself to blame. I’d wandered into the land of the invisible heart in my big male economist boots. With the very best of intentions, for sure. But without stopping to check my footwear.
On the other hand, I realized, I’d been steeped in this division from a very early age. To some extent we all are. There’s no avoiding it. Maybe it’s relevant to the perspective I take. But that doesn’t invalidate the case. Let’s acknowledge that at the outset. But prosperity as health still makes for a powerful proposition. Economy as care is the obvious corollary to that. If the care economy feels gendered, that’s probably because it is. So why should being a man trip me up?
And if it does, then too bad. I’ve been flat on my face before. Not long ago actually. Quite literally.
Use the difficulty
Shortly before that trip to Wales, we assumed the care of a small black-and-white cat. Just for a few weeks, while his owner was away. At first he hid behind the sofa. Resolutely. Very slowly, he gathered enough courage to emerge into the light of day. Usually unannounced. And occasionally at breakneck speed.
It was on one of those occasions that I caught a brief flash of white from the corner of my eye and then saw the floor rising up to meet me. In an instinctive effort not to step on the kitten, I fell awkwardly and smashed my foot against a doorpost. The cat was fine. Long gone. The doorpost was fine as well. The foot definitely wasn’t.
A broken toe is not the end of the world. I know. It’s not even the beginning of the end of the world. Most fractures heal in six to eight weeks. Although sometimes the tissue injuries can linger on. Like this time. And their failure to heal can sometimes be a sign that something else isn’t quite right. Like this time. Over the next year or so the pain in my toe became a pain in my foot and then a much more severe pain in my hip. At one point I had pain down the entire right-hand side of my body. Not obviously conducive to good writing.
The actor Michael Caine has a story for just this sort of circumstance. When he was young he was rehearsing a scene which involved him coming onstage through a doorway into the middle of an argument between a married couple. On one occasion the actor playing the husband had managed to knock over a chair which now blocked Caine’s entrance. Poking his head round the door, the young actor asked the director what he was supposed to do.
‘Use the difficulty,’ came the reply.
‘What do you mean?’ said Caine.
‘Use the difficulty,’ said the director. ‘If it’s a comedy, fall over it. If it’s a drama, pick it up and smash it.’ And I guess if it’s a book about the care economy, take a good hard look and see if you can figure out what it’s doing there in the middle of your writing plans. This particular chair was there to remind me of some inconvenient truths about my own health. And some hard facts about the care economy. Amongst them, for sure, was a disconcerting lesson about the relationship between care and time.
Care disrupts time. It throws our plans out of the window. Challenges emerge without warning. Tasks change and evolve. Time stops making sense. Care belongs ‘in the world of kairos time,’ as the social innovator Hilary Cottam has pointed out. It belongs to a time that’s measured by flow and connection. It’s different from ‘chronos time’, which is measured in minutes and deadlines. In the logic of care, writes the philosopher Annemarie Mol, ‘time twists and turns’. In that sense it’s a lot like writing. A place where the clocks move slower. Or faster. Or backwards. And sometimes not at all.
I’ve always found that insight fascinating. But I might not have dwelt on it if it weren’t for the chair. The cat. The toe. What I’m saying is, the book definitely has a different shape to the one I imagined when I set out to write it. A bit like my toe, I guess, which has a pronounced kink in it even to this day.
Champagne problems, I hear you mutter. And you might be right. Worse things happen at sea. Much, much worse, as it turns out. Barely two months after my accident, everything changed again. For all of us. And for the entire context of this book.
Good intentions
In the winter of 2021, when we set off for Wales, the world was still living in the shadow of the pandemic. Omicron and Delta were less deadly than earlier variants. But even so they reminded us of the fragility of human health. Of the centrality of care to our lives. And of the value to society of our carers. We would change, after the pandemic, because we understood at last what really matters. Some of these lessons would surely find their way into government policy.
The US government signalled its intentions early. The Biden administration first introduced its ambitious ‘Build Back Better’ Bill in April 2021. It would spend a massive $3.5 trillion on the task of post-pandemic recovery. The money would be used to improve public infrastructure, to fight climate change and to extend the reach of vital care services to more and more people. It would be paid for in part by higher taxes on corporations and on the rich. Its vision was to create a better society for everyone when the storm of the coronavirus was finally over.
The Bill passed the House of Representatives in November 2021. But it was famously derailed in the Senate when a lone Democrat refused to support it. Senator Joe Manchin argued that it was too expensive. The country couldn’t afford to pay for it, he said. It was useless to point out that they couldn’t afford not to. Attempts to thrash out a compromise failed. And by the early months of 2022, negotiations had more or less stalled. That’s the point at which world events took on a different and more sinister hue. Out of the Covid frying pan. Into the military-industrial complex.
Early on the morning of 24 February 2022, Russia invaded Ukraine, escalating a conflict that had been playing out on the edge of Europe – and on the edge of political attention – for most of the previous decade. By the time we were listening to the news, early on that Tuesday morning, Russian troops were within sight of the Ukrainian capital. Commentators were anticipating an early capitulation by Volodymyr Zelensky’s government. Tanks would be rolling through the centre of Kyiv before sundown, they said.
Six million refugees and more than half a million casualties later, those early predictions looked naïve. Laughable even, if it weren’t all so tragic. No one had taken account of the fierce resistance of a besieged nation. Nor had they anticipated the resolve of NATO to arm a country it considered an ally against a country it deemed a foe. This was not just about Ukraine, we were told. It was about democracy. It was about freedom. It was a battle for the soul of Europe. It was a struggle for the spirit of the West. NATO allies would do whatever it took to save the free world from autocracy. Even if it meant pushing Build Back Better into the long grass.
One thing it clearly took was money. In the first two years or so of the war the West committed over $400 billion to Ukraine in military and financial aid. That’s more than the entire national income of the besieged country. They comforted (or convinced) themselves that this was worth the pain by pointing out that Russia had lost as much or more in military expenditure and the destruction of financial capital. Approaching $1 trillion in total. All for the want of diplomacy. And yet even these sums were dwarfed by the knock-on effects on the global economy.
Sanctions on Russia pushed the price of oil and gas to an all-time high. The cost of living began to go through the roof. Ordinary household budgets were caught in the crossfire. Governments were caught in the headlights. Their playbook had been drawn from a different economic era. A place where cheap money could solve big problems. That trick had definitely come in handy through the pandemic. But now things were different. With heavy debt, low growth, rising inflation and high interest rates, a sense of panic was setting in. ‘Stagflation’ was not what we needed. But suddenly we were staring down its barrel. A new reality had dawned.
Good intentions for the post-pandemic era were fading fast. Build Back Better was transformed into a much leaner, much meaner, much more keenly focused fiscal instrument. Worth only a third of the original Bill, the Inflation Reduction Act was eventually signed into law in August 2022. Its revised focus was on curbing inflation, investing in domestic energy production and reducing the federal government deficit. These were the new priorities of the day. Care for people and planet would have to wait. We had stumbled, as Chris Rea says in his 1989 rock classic, on the road to hell.
The road to hell
Things change. Of course they change. But this wasn’t just about change. It certainly wasn’t just about new and more punishing economic conditions. Something else was going on. The very idea of care was at risk of seeming facile, facetious even, in the face of the brutality and insecurity unleashed by war. An irrelevant luxury at best. A fatal distraction at worst.
That sense was reinforced when Hamas militants crossed into Israel on 7 October 2023. At least a thousand people were killed and around two hundred and fifty people were taken hostage. But the carnage that day was quickly dwarfed by the scale and ferocity of the retaliation. Israeli forces bombed Gaza relentlessly, reducing much of the strip to rubble. More than a million people were displaced. Tens of thousands of civilians died. Almost half the initial casualties were children. At one point a child was dying in the Gaza strip every ten minutes, according to UN observers.
It should have been a moment for global leadership. For western politicians to support the calls for a ceasefire. To broker peace. To step back from the brink of instability. Instead they condoned and facilitated military aid to Israel just as they did in Ukraine. And instead of diplomacy they began to ramp up the rhetoric of war. Defence budgets had been declining since the end of the Cold War. But the hawks could sense their moment. The tragedy on the ground was brushed aside. The clamour for military spending was cacophonous.
And soon it was joined by calls to reintroduce some form of draft. Compulsory military service for young men and women. We’re living in an increasingly unstable world, came the almost universal refrain. From the European Union. From the US. From the UK. From NATO. That this instability was one in which our own politicians were complicit seemed to pass them by. It felt like we were being primed, gas-lighted and emotionally blackmailed into a world where war and violence are inevitable.
It was all so patently the very opposite of care. Violence carries away all reason. Vengeance begets vengeance. Rage begets rage. In the space of a year the world had been dragged ruthlessly out of its long Covid daze. Lockdown was over. Solidarity was a delusion. Rose-tinted dreams of a better world would have to wait. It was time to get real. And reality had a distinctly violent face.
I felt as though we were living in a world where the sanctity of health and the ethos of care were vague shadows from another life. The last vestiges of a dream we once had, fading like the morning mist in the harsh light of day. And as for my project of positioning care as an organizing feature of the post-pandemic economy, it lay, temporarily at least, in ruins.
Care’s nemesis
And then, at some point, I recalled a BBC Radio 4 show I’d listened to back in February 2022. It was the afternoon of the day Russia invaded Ukraine. A panel of experts was discussing how the West should deal with Putin now that the ‘inevitable’ had happened. Much of the discussion was predictable. Arm Ukraine. Counter force with force. Weaken Russia. Remove Putin from power. Do whatever it takes. Not much recognition of the patent failure of the West to exercise diplomacy for over thirty years. Or of NATO’s broken promises to Russia not to expand eastwards.
But there was one contribution from Mary Kaldor, director of the Conflict Research Programme at the London School of Economics, which took me by surprise. She called out what was happening as a manifestation of ‘toxic masculinity’. Not just as an isolated act of aggression by an autocratic Russian President. But as a phenomenon that had taken hold of society, exemplified in our leaders, even in the West, for decades. Perhaps longer. A phenomenon perpetuated through a male propensity for violence whose ultimate expression is always war.
I went back and listened to it again. I noticed how quickly Kaldor was shut down by the other (male) participants on the panel. They hated it. They couldn’t countenance the idea that something systemic was going on. Some co-dependency between Putin and the West. Something inherently masculine. On this day we were all supposed to roundly condemn the enemy. Not question our own culpability. I hated it too. I hated the idea that my own gender is mired in toxicity. But the more I thought about her comment, the harder it became for me to ignore it.
It reminded me of something I had read in Kathleen Lynch’s Care and Capitalism – one of many excellent and fierce feminist critiques of the marginalization of care in modern society. There was one particular point she’d made which struck home with me forcefully. If we want to reposition care in society, she argued, we have to understand its nemesis: war and violence. ‘To ignore violence when speaking about love, care and solidarity,’ she said, ‘is to ignore what lives in their shadows.’
And in understanding violence, we can’t avoid the realization that it’s primarily enacted by men. And that it’s most often enacted on women. Reports of systematic sexual violence have emerged from almost every war in history, including the conflicts in Ukraine and the Middle East. The casual sacrifice of women and girls in Gaza hospitals reached appalling levels in the first few months of the Israeli assault.
I started to feel that the eclipse of care by violence in the aftermath of the pandemic was not an accident. It wasn’t just a question of bad timing. It wasn’t a historical inconvenience. It was part of a pattern that repeated itself. Over and over again. It was like the swing of a pendulum. A tension that haunts civilization. A conflict with deep social and cultural roots. Played out continually. Throughout history. Across society. And perhaps even inside the human psyche.
There’s obviously an aspect to that conflict which is gendered through and through. But there’s also something which transcends the simplicity of gender binaries. Something that forces us to confront fundamental aspects of human nature and of social behaviour. Something which holds a spotlight up to the values we claim to hold dear. Something that calls into question the hopes and the visions that we cling to. And it started to change my understanding of the care economy. And of my task in writing about it.
As I began to find my bearings on the road to hell, it slowly dawned on me. There is still a need to articulate prosperity as health. Still a reason to articulate economy as care. But my assignment is not so much to point out the blindingly obvious as to ask why the blindingly obvious doesn’t happen. Over and over again.
The book as a journey
Almost without me noticing it, The Care Economy had turned into something different. When I compare the book you’re reading now against my original intentions, I’m filled with a sense of astonishment at the creative process. Your children are not your children, the poet Kahlil Gibran once said. They come through you but they are not of you. I suppose you can say the same about books. About this book certainly.
It starts in roughly the place I imagined I would. I explore our conceptions and misconceptions about what health is (Chapter 2). And what it’s not. I tease out the differences between health, the pursuit of pleasure and the avoidance of pain. Those differences are vital in being able to convey what I mean when I talk about prosperity as health.
And then I begin to develop what will turn out to be two critical themes. One concerns health as a process of adaptation (Chapter 3). The other portrays care as a restorative force (Chapter 4). These are important elaborations on the definitions of health and of care with which we set out in this chapter. But they are both absolutely vital in understanding the care economy.
At this point I happened to visit the town of Tredegar, in Wales, the birthplace of Britain’s National Health Service (Chapter 5). It wasn’t foreseen originally. Which illustrates perfectly what I was saying about writing. But that visit was powerful. It gave me an insight into what happens when the principle of care meets the harsh light of the economy.
I expand on that theme in the next few chapters. By probing the relationship between care and my own previous work on post-growth economics (Chapter 6). By examining the pressures placed on healthcare by the changing global burden of disease (Chapter 7). And by exploring the forces which have given rise to those changes (Chapter 8).
So far so good. The book was maybe slightly off track. But not a lot. And then it decided to take on a life and direction of its own. I think that happened for a couple of reasons. The first was that I began to find myself caught up in it not only as an observer but also as a subject. Not just through gender. Not just through history. But also through the ramifications of that seemingly innocuous fall which tripped me up at the outset. The second was that I began to go down a rabbit hole. That’s always a danger when you’re deep in a writing project. And you always have the option to shake it off. Or wriggle your way back out again. Whatever the metaphor ought to be. Sometimes, though, you just can’t get the scent of a mystery out of your nostrils. Particularly when, as in my case, the whole thing had become deeply personal.
So then there’s nothing for it. Down you go. Tearing at the veils of history. Unravelling the threads of the past. Trying to figure out, in this case, what had happened to medicine itself that we find ourselves now so far from home with an overburdened healthcare system and an unpayable healthcare bill. Particularly when the insights that could have saved us from this fate were already well known, not just decades but centuries ago.
You might say that’s all academic. You might ask what use it is to dwell on arguments that are lost in the mists of the past. But one of the things I learned in this section of the book (Chapters 9 and 10) is that they’re not just lost in the past. Those insights are still not listened to. Worse. They’ve been expunged deliberately from the canon of knowledge. They are still demonized as quackery. Or relegated to the background in favour of principles and practices which owe most of their authority to commercial interests. And have little or nothing to do with health.
But history is obviously not the only thing we need if we’re to understand the predicament we’re in. And at this point in the book I made a renewed effort to take back control. I knew I must explore the economic structures which consistently lock out care (Chapter 11). And I was absolutely determined to come back and do justice to the question of gender and violence (Chapters 12 and 13) which I’ve already hinted at here.
By now I was feeling increasingly that the whole thing would benefit from some kind of overall synthesis. Something you could read as a stand-alone piece if you wanted to. Something that would pull the threads of my argument together (Chapter 14). And once I’d done that, I realized too that I couldn’t get away without at least some kind of response to the resounding question: what on earth can we do about it? Chapter 15 responds to that daunting task.
I don’t remember when it first occurred to me to ground the whole thing in the places I encountered along the way. The case I’m making in the book is a generic one. It travels intellectually over several millennia and across several continents. The arguments are clearly anchored to a western perspective but they draw on insights from cultures from east and west. They are as relevant to the economies of the South as they are to those of the North.
But you can’t write convincingly from the abstract. Particularly when the intellectual territory shifts and swirls around you. So I began to allow the physical geography of my own journey to enter the writing process. At one level this book can almost be read as a travelogue. Place. Politics. Personal health. Literature. The history and sociology of ideas. All these things began to weave themselves into its narrative arc.
And I think it was their presence on the journey that finally made me realize something crucial. The deep currents of violence and the dark shadow of war may still be wreaking their tragedies on the world. And the leadership we so desperately need may be retreating further and further from the shores of any meaningful diplomacy. But this was not the wrong time to be writing about the care economy. It was precisely the right one.
Notes
p. 1
‘The road to hell’: Attributed to various people, most definitively Samuel Johnson: Pell 1857, p. 89.
p.1
The nature of human prosperity: This is the guiding question for the Centre for the Understanding of Sustainable Prosperity, which I’ve had the privilege to lead for almost a decade now:
https://www.cusp.ac.uk
.
p.2
Definition of health: WHO 1948. Though its progressive nature is now taken as read, the definition has its roots in the socialized medicine of the Soviet Union and its adoption involved a careful process of negotiation in an era where the US was fearful of communist interests: Larsen 2021.
p.3
Fisher and Tronto’s definition of care: Tronto 1993, p. 103, emphasis added; see also Fisher and Tronto 1990.
p.4
‘invisible heart’: Folbre 2001.
p.6
Hilary Cottam on
chronos
and
kairos
: Cottam 2021, p. 26; see also:
https://theapeiron.co.uk/understanding-how-the-ancient-greeks-viewed-time-will-make-your-life-richer-510e8b003ff
.
p.6
Annemarie Mol – time’s twists and turns: Mol 2008, pp. 62–3.
p.6
Build Back Better, $3.5 trillion:
https://www.politico.com/news/2021/07/13/democrats-spending-plan-biden-agenda-499593
; see also:
https://www.whitehouse.gov/build-back-better/
; and:
https://www.commonwealthfund.org/blog/2022/history-balance-promise-build-back-better
.
p.7
Build Back Better stalled:
https://www.forbes.com/advisor/personal-finance/build-back-better-plan-dead/
.
Manchin resistance:
https://www.newyorker.com/news/our-columnists/joe-manchin-kills-the-build-back-better-bill
.
p.7
Casualties in Ukraine:
https://www.nytimes.com/2023/08/18/us/politics/ukraine-russia-war-casualties.html
.
p.7
Western financial aid to Ukraine: This totalled $403 billion between January 2022 and April 2024: see:
https://www.ifw-kiel.de/publications/ukraine-support-tracker-data-20758/
.
p.7
Costs to Russia: Shatz and Reach 2023.
p.7
Stagflation: This is a combination of inflation and economic stagnation – the slowing down of economic growth:
https://www.worldbank.org/en/news/press-release/2022/06/07/stagflation-risk-rises-amid-sharp-slowdown-in-growth-energy-markets
.
p.8
7 October casualties:
https://web.archive.org/web/20231217222630/https://www.france24.com/en/live-news/20231215-israel-social-security-data-reveals-true-picture-of-oct-7-deaths
.
Some of these were from friendly fire:
https://apnews.com/article/israel-hamas-hostages-investigation-friendly-fire-3b6fdd4592957340b32a8ee71505b8e9
.
Casualties in Gaza:
https://en.wikipedia.org/wiki/Timeline_of_the_Israel%E2%80%93Hamas_war
.
p.8
One child dies every ten minutes:
https://www.aa.com.tr/en/middle-east/who-says-1-child-killed-every-10-minutes-in-gaza/3073714
.
p.9
Broken promises: See, for example:
https://www.jeffsachs.org/newspaper-articles/wgtgma5kj69pbpndjr4wf6aayhrszm
; see also Sachs’s evidence to the UN:
https://www.youtube.com/watch?v=wm4qLWc_Co0
.
p.9
Mary Kaldor on toxic masculinity:
PM
, BBC Radio 4, 24 February 2022.
p.9
‘To ignore violence’: Lynch 2022, p. 9; see also pp. 173ff.
p.10
Conflict-related sexual violence:
https://georgetownsecuritystudiesreview.org/2023/11/15/the-burden-women-bear-israel-hamas-war-sheds-light-on-conflict-related-sexual-violence-experienced-by-israeli-palestinian-women/
; see also:
https://news.un.org/en/story/2023/09/1141417
.
p.10
Kahlil Gibran: Gibran 1923, p. 21: ‘On Children’.
2Euphoria
‘Life reveals itself in pain.’
Boris Groys, 2022
I’m sitting in the waiting room of the Minor Injuries Unit at the Llandrindod Wells Memorial Hospital. Not a soul in sight. It’s cold outside. Snowing lightly as it has been for a few days now. But comfortingly warm inside. The old building creaks a little, the way old buildings do. Aside from that it’s so damn quiet I’m not even sure I’m in the right place.
It reminds me of somewhere. But I can’t place it. Perhaps the hospital where, as a kid, I took my first job, mopping blood off the floors of the operating theatre at the end of each working day. Or maybe the local cottage hospital where my mother once worked as a physio. Either way, it’s something old school. Something from a bygone age. But it’s January 2022. So what the heck? Maybe nobody gets minor injuries in mid-Wales anymore. Or perhaps it’s a post-Covid thing, I think to myself. There were clear instructions online to phone ahead before attending. I’m glad I did.
Expecting to have to wait a while, I take out my notebook. I’ve been asked to write a programme note for the launch of an extraordinary film installation by the German artist and film-maker Julian Rosefeldt. His subject matter is the dystopian nature of capitalism. But he calls his film Euphoria.
If you happen to be Gen Z, that title will immediately remind you of Sam Levinson’s controversial and critically acclaimed HBO series of the same name. No offence to the millennials, Gen X and the boomers. You may well have come across it too. If you have, your reaction was probably to be scared witless for the world your kids are living in. Like I was. But then I’m not exactly the target demographic.
Euphoria the series follows a group of American high-school students as they ‘navigate love and friendships in a world of drugs, sex, trauma and social media’. The show’s first season was a runaway success when it hit the screen in 2019. It made instant stars of its young stars, except of course Zendaya, who was already a star. But her role as Rue certainly cemented her status as ‘a cultural icon in the making’. It also won her a couple of Emmys and a Golden Globe Award.
In stories and films, and even in real life, euphoria carries a sense of excitement. Something that lifts our lives and our loves above the everyday. Something light and almost transcendent. But quite often it also conveys dangerous overtones, as though being truly happy must always carry a price. Which of course it sometimes does.
That sense of seductive danger is probably why psychiatrists define euphoria not just as happiness or wellbeing, but as an ‘exaggerated’ sense of elation. One that is groundless, disproportionate to its cause or inappropriate to real events. None of which sounds particularly healthy.
But here’s the thing I’ve just discovered. In its original meaning the word was derived from the Greek eu- (εὔ), which means well, and phoros (φορος), which just means bearing or carrying. Euphoria described a condition of ‘bearing well’ or very simply ‘being healthy’. Not even something as nebulous as happiness then, but health pure and simple. It was used by doctors as early as the seventeenth century to refer to good outcomes from clinical treatments. To describe a situation where their patients were responding well to medical intervention. The opposite of dysphoria. When things were obviously going downhill.
So is euphoria really just another way of thinking about health? Is health what Rue is chasing? Or is euphoria an exaggerated form of health? What would that even mean? Surely you’re either healthy or you’re not. I’m trying to decide if any of this is remotely useful in defining prosperity as health when suddenly the door opens and a woman pokes her head round.
‘Are you the man that fell over a cat?’
Very funny.
I give what I hope is a wry smile and limp after her to the X-ray room. The images confirm that, yes, the toe is broken and, no, there is nothing much to be done about it. By that time the news has gone viral. Or the equivalent of viral in a deserted old hospital in the middle of rural Wales.
