|Ten good reasons for measuring unpaid work in health care|
1. Measurement is an essential part of knowledge. Although not all knowledge is quantifiable, the search for quantification requires prior analysis that sheds light on strengths and weaknesses in the theory and bolsters researchers’ capacity to perform analysis and synthesis.
2. Measurement facilitates the ability to make comparisons over time, at the geographical level, and among social groups. Such progress requires scientific discussion and agreements.
3. Measurement is an essential tool in concealing and evaluating the “invisible” limited resources and setting priorities, which helps prevent the shift of costs to the most vulnerable social sectors. The health of the population and the healthcare system affects production and development sustainability, and distributive equity. It is important to promote and maintain good health standards, with a particular focus on fighting diseases and disabilities, responsibilities which demand significant efforts from individuals, the state, and numerous social and political entities.
4. Unremunerated work in healthcare, assumed mainly by women and low-income sectors, affects the entire population directly or indirectly, regardless of gender, social class, ethnicity, rural or urban status, and geographic location. Its effects are unequal and segmented, rather than uniform, and it undermines the social protection of patients and caregivers alike (induced poverty, lost employment, social precariousness, lack of access to contributory pension systems, etc.).5. Unremunerated work in healthcare is mainly an concern within the health sector, however its impact cuts across all sectors, affecting the education, labor, culture, transportation, food, housing, safety, development, and other sectors and influenced, in turn, by their activities. Therefore, health policy must be coordinated with the rest of public policy and with private health systems.
6. Significant changes are occurring in the demand and supply for care in the area of unremunerated work in health worldwide, particularly in Latin America. Changes in the demand are provoked mainly from changes in demographics (more elderly people) and household composition (more single-person households, single-parent families, divorce, and blended families). At the same time, changes in supply stem from the shrinking proportion of potential and actual caregivers per care recipient, women’s increased entry into the workforce, and other social changes. 7. Health is good safeguarded by a state that is governed by the rule of law; how it is addressed is not an individual, rather an institutional, social, and political matter. Measurement and opinion making are key tools for transforming theoretical policy principles into applied, recognized, and enforceable rights.
8. Unremunerated health care has repercussions at local and international levels. When potential caregivers emigrate, it affects caregiver availability and leads to the displacement of specific populations (to provide remunerated care for patients and dependent people in other countries), with the consequent financial transfers (remittances) and changes in formal and informal social protection systems.9. Several monographs published in Spain estimate that the time spent on unremunerated care represents 88% of the total time devoted to health care, an impressive proportion. In cases of the advanced degenerative diseases common in the aging populations (Alzheimer’s disease, for example), unremunerated care is estimated to represent 99% of the overall time spent on patient care.
10. Finally, measuring unremunerated work in health is a political commitment made by the vast majority of the governments, which, at the Fourth World Conference on Women held in Beijing in 1995, accepted the United Nations proposal to reform National Accounts Systems in order to rescue unremunerated work from invisibility and take all sector policies into account, including health policies.María-Ángeles Durán, “La economía invisible y las desigualdades de género. La importancia de medir y valorar el trabajo no remunerado”, Pan American Health Organization, 2008.
Regional Office for the Americas of the World Health Organization