ジェンダー研究

第14号

2011

For Love or Money? Current Issues in the Economics of Care
Julie A. NELSON

ジュリー・A. ネルソン教授は、1986年にウィスコンシン大学マディソン校（米国）より経済学でPh.D. を取得。ブランダイス大学などで教鞭をとり、現在はマサチューセッツ大学経済学部准教授、およびタフツ大学グローバル開発環境研究所（Global Development and Environment Institute, Tufts University）シニア・リサーチ・フェローを務めている。
ネルソン教授は1990年代初期、新古典派経済学に対してジェンダー概念を積極的に導入することにより批判理論を展開したフェミニスト経済学者のひとりである。 国 際 フ ェ ミ ニ ス ト 経 済 学 会（International Association for Feminist Economics）の設立メンバーとして知られる。主流の経済学は客観的、論理的、自律的とイメージされる「合理的経済人」を軸とし発展してきたが、フェミニスト
経済学はこのモデルを規定する男性性／女性性という 2 元論に批判を行ってきた。ネルソン教授の著書としてEconomics for Humans（University of Chicago
Press, 2006）、Feminism, Objectivity, and Economics（Routledge, 1996）があり、共編書としてFeminist Economics Today: Beyond Economic Man（University of
Chicago Press, 2003）などがある。邦訳に、S・カレンバーグ他編著『経済学と知』（御茶の水書房、2007年）収録の「フェミニスト経済学――客観的、活動家
的、そしてポストモダンな？」（足立眞理子訳）がある。
本稿は、2011年 1 月 8 日に開催された国際シンポジウム「ケア・エコノミーの現在」（お茶の水女子大学ジェンダー研究センター主催）におけるネルソン教授の基調講演録である。内容は、Nancy Folbreとの共著 “For Love or Money—Or
Both? ”（Journal of Economic Perspectives, Fall 2000）を踏まえつつ、ケア労働の概念およびケア労働者の動機に関して、米国における近年の議論をもとに展開したものである。
4

4

4

Keywords：Care work, Economics, Gender, Motivation, Compensation

Introduction
What is “the economics of care”? One definition of care work points to those activities that involve extended personalized service to dependent individuals, including children, the sick, and the elderly. Childcare and nursing are prime examples. A somewhat broader definition also includes face-toface services that help to develop a person’s capabilities, including physical and mental health andcognitive skills, in ways that may be more short-term or intermittent. Under this definition, healthcare, education, and social services are also considered to be forms of care (England, Budig, and Fol-

Julie A. NELSONFor Love or Money? Current Issues in the Economics of Carebre, 2002). There is a general sense that “care activities” are of highest quality when accompanied by,
and motivated by, authentic emotional commitments, or “caring feelings.” 1 While most obvious in thecases of childcare and nursing, this is true even when the broader definition of care work is used. A
modern version of the Hippocratic Oath, for example, charges physicians to act with “warmth, sympathy, and understanding” (WGBH Educational Foundation, 2009). While many working in higher education may not consider themselves to be “carers” in the same sense as early childhood education professionals, they generally still resist the idea of replacing face-to-face, personalized, and motivational
interaction with their students with, for example, videotaped lectures. Taking economics to be, broadly speaking, the study of how societies organize themselves to provide for life and its flourishing, wemight label the “care economy” as comprised of caring activities, both paid and unpaid.
The first part of this essay explores developments in this “care economy” in the United States,
briefly reviewing historical changes in this sector. There is, however, a marked difference between
how we often think about care work, and how we often think about paid work in general. The former,
it is often thought, is simply “natural” and motivated “by love,” while the latter is often thought to require the development of more specific skills and to be primarily motivated “by money.” This oversimplified, dualistic conception, it will be argued, contributes to no end of problems in both the caresector and the economy at large.
One pressing current issue, within the care sector, is what has been called the “care penalty”—
the tendency for occupations that involve face-to-face healing and nurturing services to pay less thanother occupations, controlling for factors such as educational requirements (England, Budig, and Folbre, 2002). The existence of this penalty tends both to disadvantage the people who go into thesefields, and to create problems in the quality and size of the care labor force. The next two sections of
this paper, then, argue that work articulating the skills that care work requires and properly analyzing motivations for such work, as they relate to levels of compensation, is critically important. Such ananalysis should permit us to begin to make a more nuanced evaluation of the advantages and disadvantages of various ways of organizing care work. Lastly, it will be pointed out that these analyticaldevelopments in the economics of care can also give us insight into other important economic issues
that are not usually thought of as involving care work.

The Shift from Family to Market
The patterns of need for care are in the middle of a great transition, as analysis of birth rates
and life expectancies reveal. As illustrated in Figure 1a, in the 1950s in the United States there was ahigh number of children relative to prime-age adults. Currently, the U.S. population pyramid shows arelative bulge in prime-age adults relative to children and the elderly. But this is not expected to last,as the baby boomers move into old age. An even more extreme inversion of the traditional age pyramid is predicted for Japan, as shown in Figure 1b. These demographic changes indicate an increasing
importance of elder care.

ジェンダー研究

第14号

2011

Figure 1. The Changing Dependency Picture

Sources: For the United States, Shrestha and Heisler, 2009. For Japan, Statistics Bureau, DirectorGeneral for Policy Planning (Statistical Standards) and Statistical Research and Training Institute, 2010.

The locations in which care is being provided are changing as well. 2 Women historically specialized in full-time home-making, when their families could afford it, so that households were long the
primary locations of care for young children and the elderly, and basic nursing services for the ill.
Wagman and Folbre (1996) constructed estimates of the total labor force of the United States, including both paid and unpaid workers. They assumed that women devoted about as much productive effort to paid and unpaid work combined as men did to paid work; that 85 percent of all women 16 andover were engaged in productive (paid or unpaid) work; and that those who did not have paying jobs
were full-time homemakers. The historical pattern of shifts in the use of women’s time that theyJulie A. NELSONFor Love or Money? Current Issues in the Economics of Carefound is presented in Table1. In 1870, about 40 percent of the entire productive labor force (paid andunpaid, male and female) was made up of full-time homemakers (Wagman and Folbre, 1996, p. 50).
Wagman and Folbre (1996) calculated that this percentage declined through 1930, while the relative
importance of paid employment among women increased. Applying Wagman and Folbre’s methodology to more recent statistics suggests that these declines continued up until 2000, with the biggest
change coming between 1960 and 1990. After 2000, the decline seems to have stopped (or very slightly reversed). By the year 2008, homemaking had declined substantially, but still involved 20 percent of
all workers, and 30 percent of all women workers.
Table 1. The Decline of Full-time Homemaking in the United States, 1870–2008

Homemakers as% of all women
workers

Women in paid
jobs as % of all
women workers

Homemakers as% of all workers

1870

70.2

29.8

40.1

1900

64.4

35.6

35.6

1930

59.7

40.3

34.1

1960

56.0

44.0

29.1

1990

32.7

67.3

22.0

2000

29.5

70.5

19.4 3

2008

30.0

70.0

20.0

Sources: For discussion of data for 1870–1930, see Wagman and Folbre (1996). For discussion of data for
1960–2000, see Folbre and Nelson (2000). Data for 2008 is from Statistical Abstract of the United States,
2010, Table 576.

Moving on to analysis of paid care work, many women entering wage employment moved into
industries that involve paid care for others. To illustrate this trend it is helpful to create a category of“professional care services” by combining the standard industrial classifications of “hospitals,” “health
Table 2. The Rise of Professional Care Service Industries(Employment by Industry as a Percentage of Total Employment)
Professional
Care Services

Domest ic a nd
Personal Services

Other Services

Agriculture,
Fishing, andForestry

Manufacturing,
Mechanical, andConstruction

1870

--

--

10.4

53.5

22.7

1900

4.0

9.3

16.7

37.6

30.1

1930

7.1

10.7

28.7

21.7

31.6

1960

11.9

6.6

40.7

9.4

31.4

1990

17.6

4.0

45.7

2.8

25.1

1998

19.2

3.4

52.1

2.7

22.7

2009

22.7

2.2

50.8

2.0

22.3

Sources: For discussion of data for 1870–1998, see Folbre and Nelson (2000). Data for 2009 is from the U.S.
Bureau of Labor Statistics, Employment and Earnings, January 2010, Table 18.

ジェンダー研究

第14号

2011

Figure 2. Numeric Change in Employment in Service Industries, 2008–2018 (projected)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, 2010–11 Edition, Chart 5

services except hospitals,” “educational services,” and “social services.” Table 2 puts U.S. employment
in this industrial category in the context of the overall labor market. In 1900, about 4 percent of all
workers were employed in professional care services. By 2009, over one-fifth of the paid labor force
was engaged in a professional care industry. Meanwhile, employment in “domestic and personal services” declined from 9.3 percent of the labor force in 1900 to 2.2 percent by 2009. 4 Clearly, the economic role of jobs that reflect the more skilled and emotionally complex dimensions of the traditional
homemakers’ role increased dramatically over the twentieth century. Today, hospitals and schools
should now count more in forming our image of wage employment than factories and construction
sites.
Professional care industries still employ women disproportionately to women’s share in the overall labor force. Of all women in paid employment, 36.1percent were employed in these industries in
2009; women constituted 47.3 percent of the paid labor force over age 16, but 77 percent of those employed in “hospitals,” 78.9 percent in “other health services,” 69.4 percent in “educational services,” and85 percent in “social services” (U.S. Bureau of Labor Statistics, 2010, Tables 12, 17, 18).
Professional care industries are also the growth industries of the future for the United States, asmeasured by employment projections. Primary and secondary sector employment is expected to continue to decline, while service industries are predicted to grow. Within service industries, “health careJulie A. NELSONFor Love or Money? Current Issues in the Economics of Careand social assistance” is projected by the Bureau of Labor Statistics to have the most expansion in
employment, while “educational services” is in third place among the growth industries, as shown in
Figure 2.

Conventional Economic Analysis: Love OR Money
Is care work work? In conventional economic thought, this may be doubted. In core Neoclassicaleconomic theory, which dominates much academic economics worldwide, work is thought of as creating “disutility”—that is, being unpleasant—and as usually requiring some amount of investment in“human capital” or skills. The main reason one works, then, is assumed to be personal financial gain.
Looking after someone—perhaps a child, or an elderly person—on the other hand, is often though ofas requiring no special skills and as intrinsically rewarding, especially if it is done at home.
The origin of this dualistic view of work versus care has many historical precedents, but one obvious source in Anglo-American contexts is the Victorian ideal of a family, with a male breadwinnerand a female homemaker. When, with industrialization, a general pattern of home-based industry was
replaced by the factory system in Anglo-American countries, an ideology grew up that strictly divided commerce from family life. A man was seen as a natural competitor in a dog-eat-dog world of selfinterested activity in markets, while a white, middle-class woman was idealized as the “angel in thehouse”—the embodiment of softer and more caring values. The Neoclassical school of economics, established during the Victorian period, not surprisingly, took on these values. Leaders of this school endorsed, for example, the idea that women’s wages should be kept low, to avoid tempting them to neglect their duty to build up a “true home” (Alfred Marshall, quoted in Pujol, 1984).
Taking “the economy” to be synonymous with markets, and aspiring to a masculine-biased imageof “rigor” in scientific thought, early Neoclassical economists, in fact, systematically excluded fromtheir consideration all parts of human activities, values, and motivations that contained a whiff of feminine “softness.” Economics adopted definitions and assumptions built entirely around the masculine-associated aspects of life listed in the left-hand column of Table 3.
Table 3. Conventional Economic Analysis

Economics

Not Economics

market

home

mind

body

reasonemotionautonomyinterdependence

self-interest

care and compassion

knowledge

virtuemasculine

feminineジェンダー研究

第14号

2011

In focusing economics on mental choices rather than bodily needs, for example, economists adopted the Cartesian dualism that regards “mind” as separate from and superior to “body.” Feminist economists argue that such an approach, far from being a sign of “rigor” and objectivity, is indicative of apronounced gender bias at both cognitive and social levels (Ferber and Nelson, 1993; Nelson 1996).

The Challenge to Conventional Analysis: Love AND Money
Are economies really characterized only by the elements in the left-hand column? Are self-interest and other-interest really so opposed? These questions are crucially important in analyzing the
economics of care, since the rise in paid caring forces us to think in terms that bridge this divide.
Some people fear that the entry of caring work into markets will leave it fundamentally demeaned
and corrupted, bereft of true compassion. This can occur at various points on the political spectrum:
many conservatives wish women to stay at home, while some left-leaning academics fear the commodification that they believe to be an intrinsic consequence of capitalism. Such views, however, simply buy into dualistic thinking, rather than challenging it. 5
Elsewhere I have proposed what I call a “gender-value compass” as a way to begin to think pastdualisms such as those in Table 3 (Nelson, 1996). Let us start with a simple example, that of economists’ aspiration to be “hard” scientists, eschewing acknowledgement of “soft” behaviors or forms ofanalysis. The aspiration to hardness comes from its association with strength, while softness is associated with weakness. Such a pattern of thought is not only dualistic, it is also hierarchical: the hard or
masculine-associated pole is thought of as superior to the soft or feminine-associated pole, as shown in
Figure 3.
＋
hard superior masculine

soft inferior feminine－
Figure 3. Stereotyped Gender and Valence

The gender-value compass breaks the associations of gender from the associations of value, as illustrated in Figure 4. “Hard” can also mean rigid, while “soft” can also mean “flexible.” Instead of an
opposition between hard and soft, this compass allows us to recognize aspects of complementarity.
Something that is both strong and flexible is, in fact, particularly resilient. On the other hand, aiming
for hardness without flexibility can be rigid, and ultimately brittle and weak.

Julie A. NELSONFor Love or Money? Current Issues in the Economics of Care

Positive
Masculine

Hard-strong

Soft-flexible

Hard-rigid

Soft-weakFeminine

Negative
Figure 4. A Gender-Value Compass

Now consider this compass applied to a topic of more relevance for the case at hand: the supposed opposition between self-interest and other-interest. In actual life, neither the extreme of being
entirely self-interested—that is, selfish—nor the extreme of being a self-effacing, co-dependent, physically exhausted doormat, bodes well for either personal health or good social relations. A healthycaregiver, for example, practices care and compassion from a base of self-respect and an adequate
practice of self-care. This is illustrated in Figure 5.
Positive
Masculine

Self-interested

Other-interested

Self-interested

Other-interested

ONLY

ONLY

Feminine

Negative
Figure 5. The Complementarity of Self- and Other-Interest

The purpose of the gender/value compass is not to impose a new form of rigidity on our thought,
but simply to help us break through old and outdated dualistic understandings. In particular, it canhelp us find hidden strengths that have been long hidden due to their association with supposed
weakness (and femininity). What has been hidden in care work that needs to be brought out in orderto facilitate our understanding of the increasing inadequacy of the old love versus money definitions of
economics? I suggest two major aspects that deserve our attention: the hidden skills of care work,and the complexity of human motivation.

Articulating Care
Standard economic arguments about “human capital” are often used to attempt to explain why
care work is relatively low paying. Economic theory says that jobs with low human capital requirements—that is, low requirements for education and skills—will tend to pay less, all else equal. But, applied to care work, this argument is fallacious: care work requires special and specific skills, though
ones which have been cloaked by invisibility by being associated with women and “naturally” arising
behavior.

ジェンダー研究

第14号

2011

Consider, for example, the case of Registered Nurses, who are nurses with, typically, at least twoto three years of university education. 6 Traditionally, in many countries, nursing has been identified
with a “virtue script” (Gordon and Nelson, 2006) which emphasizes nurses’ compassionate interest in
the well-being of their patients. As nursing has become more scientifically and technologically complex, at least partial recognition of formally acquired knowledge and expertise of RNs has been granted. Some of the most important nursing skills, however, have remained largely invisible, while others
are under-respected and under-rewarded.
Recall that according to Table 3 and Figure 3, in conventional analysis (masculine) mind has been
elevated above (feminine) body, and (masculine) knowledge above (feminine) virtue. Consider Table 4,
which lays out four mutually complementary and essential broad skill categories for nursing care in agrid defined by these mind/body and knowledge/virtue dualisms. The theory presented in the previous section predicts that aspects of care that fall on the more respected “mind” and “knowledge” sidesof this dualism will be more socially recognized and financially rewarded in cultures dominated byCartesian thinking, than those on the denigrated sides. And this is what we found.
Table 4. Articulating Some Broad Skill Categories for Nursing Care

Knowledge

VirtueMind

Body

Nurses use medical, scientific, andtechnical knowledge acquired
through specialized education in diagnosing, 7 treating, and educating
patients.

Through direct, repeated, and often
tactile interactions with patients,
nurses gain important “local” and individualized knowledge about theirpatients’ physical, mental, and emotional states.

Nurses help patients and their families by providing personalized counseling and encouragement, often
demonstrating compassion and providing emotional comfort.

Nurses assist vulnerable patientswith bodily processes. Althoughthese activities often expose nurses
to risks and bodily stress as well as
unpleasant sights, sounds, and smells,
nurses accomplish these in waysthat maintain their patients’ dignity.

Source: Adams and Nelson, 2009.

As described in Table 4, the mind-knowledge aspects are those that emphasize mental knowing,of the sorts that nurses primarily achieve through formal education. Recognition that nursing requires
such skills is rather mixed: while the more-informed commentaries on contemporary nursing take this
into account, there is evidence that the image of nurses as mere pleasant “pillow-fluffers” still exists,
to some extent, in the public mind. The emphasis on mind-knowledge, we can note, also appears in
distinctions made among physicians’ medical specialties. Specialties such as surgery or cardiac care,which emphasize extended training and are particularly amenable to technological innovation, are often perceived as more skilled than specialties such as primary care, family practice, internal medicine,
pediatrics, or gerontology, where face-to-face relationships form a greater part of the work. They areJulie A. NELSONFor Love or Money? Current Issues in the Economics of Carealso more financially remunerative. Table 5 notes that mind-knowledge aspects are sometimes recognized as necessary to nursing, and, following the human capital model, are generally, when recognized, financially rewarded.
Table 5. Social Recognition and Financial Rewards in Nursing

Mind

Body

Knowledge

Recognition: mixed
Reward: yes

Recognition: no
Reward: no

VirtueRecognition: yes
Reward: no

Recognition: mixed
Reward: minimal

Source: Adams and Nelson, 2009.

In Table 4, virtue-mind aspects are described as those that emphasize compassion, but without
the inclusion of any physical aspects of care. This somewhat sanitized and ethereal aspect of nursing(when considered on its own) is socially recognized via the “virtue script.” However, as has been notedby feminist scholars investigating the phenomenon of “emotional labor” (e.g. Steinberg, 1999), the valueof such capacities is largely overlooked when it comes to determining the appropriate monetary compensation for the work.
The top right-hand cell in Table 4 lays out the heart of what may be the most drastically underarticulated aspect of not only nursing care but other sorts of extended care work as well: body-knowledge. Good nurses, along with good parents, childcare workers, teachers of young children, social
workers, primary care physicians, and others involved in care require repeated occasions of bodily copresence to build up a knowledge base. They need to “get to know” the physical, mental, and emotional
states of their charges or clients, and need to see how these change over time. As one nurse has put
it, “You evaluate patients by working with them. What happens when you ask them to put their arm
out? Did they seem to understand you? Are they paying attention? Are they restless?” (quoted in
Weinberg, 2006: 37). This is not something that can be done quickly, impersonally, and at a distancebut rather requires sustained engagement, a relationship of trust, and often physical contact. Similarly,
in childcare work, research in early care and education has found that attention, responsiveness, andphysical warmth provided by trusted caregivers are not merely sentimental niceties. These physicaland relational factors are, instead, absolutely vital, at a neurological level, to the social, emotional, andcognitive development of growing children.
Unfortunately, when people try articulating this aspect of care against a background of strongly
Cartesian thought focused on autonomy, these sorts of relational skills are missed. To an unattuned
observer, hours of uneventful “checking on” an elderly person or “baby-sitting” a child may not seem
like activity at all. The astute and life-preserving work of the acutely observant people in human services often, in fact, seems to be considered little different from attending to inanimate objects. Workers in the United States who care for children and parking-lot attendants—who watch parked cars—

10

ジェンダー研究

第14号

2011

currently both make median wages of about $9.25 per hour (U.S. BLS 2009). Body-knowledge skills, as
noted in Table 5, are neither recognized nor rewarded.
The last cell in Table 4 is body-virtue. With physical work strongly stigmatized relative to mental
work, hands-on care for challenged, heavy-to-move, and perhaps smelly or otherwise unattractive bodies gets very little respect. It may be considered a “virtue” aspect in a sort of Mother Theresa, selfsacrificing way. Even within the nursing profession, nursing recruiting literature tends to downplay
the physical demands. In the United States, this work is often shifted, when possible, from more educated, predominately white native-born RNs onto low-paid and minimally trained (although often quite
competent and caring) nursing aides, who disproportionately come from immigrant and minority racial groups. Such an organization of work, however, while reducing labor costs, also reinforces amind/body hierarchical dualism, reinforces racial and immigrant status divisions, and reduces—perhaps to zero—the sorts of occasions that would allow the more highly educated medical personnel tobuild relationships and gain the important body-knowledge they need to do their jobs.
As the populations of industrialized countries age, the recognition of the full scope of caring work
becomes even more urgent. Gerontology (medical care of the elderly) tends to be a relatively disrespected field, directed as it is to deteriorating bodies and to the social and emotional adaptations aging
requires. There are no heroics here, no cures, and not a great deal of scope for the sorts of mindknowledge biotech breakthroughs that bring prestige. Unless we want our increasing numbers of elderly citizens to get the same treatment as parked cars, it is time to more strongly articulate what itis that real care requires.

Compensation and the Issue of “Intrinsic Rewards”
Another reason, besides a presumed lack of skill requirements, that is often used to justify relatively low wages for care work is the idea that the work is intrinsically motivated. This is the ideathat people want to do it because they find it pleasant, are moved to do it by emotions of love and attachment, or feel that it is socially valuable. This argument plays out two ways, the first of which has
to do with the economic theory of “compensating wage differentials” and the second with what I willcall the “protection” argument. 8Compensating Wage Differentials
The economic theory of compensating wage differentials says that jobs with better working conditions should, all else (such as education requirements) equal, tend to pay less. Childcare workers, forexample, are sometimes said to “take part of their pay” in hugs, while health care workers benefit
from the “warm feeling” that they get from helping someone in need. Assuming they have choices,such workers have presumably—according to this theory—made rational, free choices to decline higher paid jobs in favor of ones with lower –pay –plus –intrinsic rewards.
But some people really enjoy using mathematics on their job. So engineering and finance salaries

11Julie A. NELSONFor Love or Money? Current Issues in the Economics of Careare low because of the intrinsic rewards? Some people enjoy giving orders. Does the theory of compensating wage differentials explain why managers are low paid? Clearly, there is something notquite right with this argument, since engineering, finance, and management are relatively highly paid
occupations.
The key to understanding what is going on is to realize that, within the theory of compensating
wage differentials, whether pay in an occupation as a whole is high or low depends on the preferencesof the marginal worker—that is, the last worker hired. When demand for workers in a certain field ishigh, so that wages in the occupation are bid upwards, workers can get both intrinsic benefits andhigh pay. In Figure 6, the supply curve shows the number of people who are willing to provide laborto a particular occupation at different levels of wages. The horizontal “wage elsewhere” line represents what they could make if they took their skills to a different market (that is, to other jobs requiring a similar level of skills). The people represented by the part of the supply curve that lies below
this line like some characteristic of this particular occupation enough to take something of a wage
sacrifice in order to work in it. If demand is low, this occupation will pay less than other jobs, andpeople who choose it will have to take “part of their pay” in intrinsic benefits. If demand is high, however, this occupation will pay more than other jobs, and many workers will enjoy both a wage premium and intrinsic benefits.

Figure 6. Compensating Wage Differential vs. Wage PremiumThis suggests that it is not so much a qualitative difference in motivation that depresses wages
in care work, but a depressed level of effective demand arising from an inadequate devotion of resources to the care sector. The occupations of nursing, teaching, and childcare in the United States
tend to suffer from labor shortages. Given patterns of depressed pay, depressed respect, and/or shortstaffing, they also suffer from high rates of labor turnover—with resulting harmful effects on patients,
students, and young children. The theory of compensating wage differentials in no way justifies starving these sectors of the resources that would keep good workers on the job.

12

ジェンダー研究

第14号

2011

The “Protection” Argument
Ideally, care work should make a recipient feel authentically “cared for”—that is, nurtured, recognized and valued as an individual, emotionally supported, empathetically connected, or, in shorthand,
loved. Many worry that, to the extent a worker might take a care job “just for the money,” she or hewill leave out these important interpersonal dimensions, and instead do the work impersonally andeven callously. While this concern is valid, it is, unfortunately, often expressed as a desire to “protect”
care work from the presumably corrupting influence of money.
Consider two examples from recent, peer-reviewed economics journals. In “The economics of vocation, or ‘why is a badly paid nurse a good nurse,’” Anthony Heyes (2005) argues that since nursing
is a “vocation,” “increasing wages reduces the quality of applicants attracted.” In “Selfish bakers, caring nurses? A model of work motivation,” Kjell Arne Brekke and Karine Nyborg (2010) argue that“nurses’ wages must be kept strictly lower than bakers’ income” to prevent unmotivated people(shirkers) from becoming nurses. These articles both assume that competence in caring is largely amatter of having the correct, loving motivation, and that the quality of care cannot be directly monitored. They conclude that a low wage is necessary to assure that only properly altruistic people will
be willing to take the job.
There are two central problems with the protection argument. The first is that it often draws on
only selected findings from behavioral economics and the study of human motivation. Economists (andothers) who make the protection argument often cite the research finding that, in some cases, extrinsic motivators such as monetary rewards can “crowd out” or reduce a person’s level of intrinsic motivation. The example often given of this is a study in which paying for blood was associated with a decrease in blood donations. What is missed, however, is that the context of the payments matters: thecrowding-out effect is associated with payments that are perceived by the recipient to be controlling—that is, as a means for someone else to manipulate one’s own actions. When, on the other hand,monetary payments are perceived of as acknowledging of a person’s own efforts and character, withina relationship of trust, they can “crowd-in” or encourage intrinsic motivations (Frey 1997; Fehr andFalk 2002). Care workers, in fact, often interpret the low pay they receive as indicating a lack of suchacknowledgment of the social importance of their work, which may encourage them to leave the field.
The larger behavioral literature suggests that increased financial support could increase, not decrease,care workers’ intrinsic motivations.
Secondly, the “protection” argument seriously neglects the role of non-selfish factors in determining a worker’s reactions to wage offers. Implicit in the “protection” analysis cited above is the ideathat the further up one moves on the supply curve for caring work (that is, the higher the wage offer
must be to get a person to take the job), the more selfish are the worker’s motivations. This is shownin Figure 7.

13

Julie A. NELSONFor Love or Money? Current Issues in the Economics of Care

Figure 7. Bad Pay Attracts Altruists?

But after the Heyes (2005) article on “vocation” and my response articles co-authored with Nancy
Folbre (Folbre and Nelson 2006) on pay for nurses were published, a number of nurses joined a discussion of them on a nursing blog. One nurse wrote: “I AM called to nursing. … I am also a motherthat has three children who LOVE to eat.” (“Bindy” quoted on allnurses.com 2006; emphasis in original.) 9 Caring people who have high family financial responsibilities require a high wage, and it makes
them no less caring. Also, people who would be competent at caring would also likely be competentat a variety of other jobs. They will reasonably weigh the opportunity cost (that is, lost wages fromalternative occupations) of entering a caring job, and choose alternative employment if that cost is too
great. High wages, then, are necessary to make it possible for many caring (feeling) people to care (activity). People at the low end of the supply curve may not be so much unselfish people, as people withlow responsibilities (such as young workers who may need to change jobs as their family financial responsibilities grow) and minimal skills. A more likely supply curve is shown in Figure 8.

Figure 8: A Good Wage Allows Caring (Feeling) People to Care (Activity)14

ジェンダー研究

第14号

2011

A third point is a bit more technical. The key assumption in the models created by Heyes andBrekke and Nyborg does not, in fact, have anything to do with the issue of care. Rather, the key assumption is that the quality of nursing or the effort put into nursing is somehow less observable thanin other occupations. This forces reliance on a second-best way to monitor quality—in this case, using
self-selection based on offering a lower wage. Oddly, however, an older literature in economics on “efficiency wages” has long proposed a different—and opposite— solution. If an employer pays a worker
more than the worker can get elsewhere, this literature suggests, the higher wage will inspire better
performance motivated by loyalty to the firm (and/or an increased fear of being fired). It is quite adramatic example of the dualisms between male/female, and self-interest/altruism, that the proposedsolution to unobservable quality for workers in general, no doubt pictured as male, is to pay more,while the solution proposed for nurses, no doubt pictured as predominantly female, is to pay less!

Advantages and Disadvantages of the Private-to-Public Move
One obvious benefit of creating more public and marketed alternatives to family care is thegreater freedom it allows for women, who were traditionally expected to do the bulk of such work, irrespective of their own individual variations of interest and talent. In taking the burden of care offparticular women, who had been assigned to it by status considerations, the increasingly for-pay provision of care could contribute to the costs of care being more widely and equitably distributed. The
provision of care could in some ways be accomplished more effectively because of advantages of specialization. A traditional at-home caregiver is a generalist, and unlikely to have the child-development
knowledge of a preschool teacher, the medical skills of a gerontologist, the counseling skills of a
trained social worker, and so on. Shifting at least some aspects and intensities of caregiving to thosewith specialized training and experience (and who receive the pay that rewards their investment inskill) should raise the quality of care. Even the relative impersonality of paid care may sometimes beperceived as an advantage. Senior citizens in the United States, for example, sometimes express apreference for being cared for by a paid “outsider” rather than a family member, because this enhances their feeling of independence. Finally, as care work comes to be recognized as a type of work, rather than as a naturally occurring phenomenon that can be taken for granted, more attention may be
paid to what constitutes care quality.
On the other hand, reliance on more public sources for the provision of care does not guarantee ahigh quality of care, without attention to the actual institutional structures through which the care isprovided. While economic theory assumes that people can make informed choices and refuse unsatisfactory services, many direct recipients of services—children, the very ill, and the very elderly—are
not in fact in control of decisions about their care. Even working age adults may find it difficult tomonitor care quality—for example, when choosing a doctor for themselves or a childcare center for
their child. Some of these problems might be ameliorated by better regulation of the locations inwhich care is provided, and through the sorts of workplace management techniques (such as regular

15

Julie A. NELSONFor Love or Money? Current Issues in the Economics of Careevaluations, and compensation structures that “crowd in” intrinsic motivations) that encourage quality.
The level of financial resources devoted to marketed and state-supported care is also a crucial issue. When care is done for pay, but under conditions of low pay, excessive work loads, and high worker turnover, workers suffer, and the quality of care suffers. Nancy Folbre (1994) has pointed out that
quality care is in many ways a “public good,” creating important externalities that cannot always be
captured in individual transactions. For example, many people share in the benefits when children arebrought up to be responsible, skilled, and loving adults who treat each other with courtesy and respect. When nurses do a good job, patients’ families and employers benefit. It is well-known, however,that in the absence of collective coordination, the existence of “free riders” will cause markets to supply less than optimal levels of public goods. This suggests that substantial public financial support, notmerely reliance on market provision, is necessary for quality care. Decent pay and reasonable workloads are also necessary for the benefit of the workers themselves: the possible advantages of the
movement of much care work out of the home would be much diminished, if it came to be suppliedlargely by an underclass of exploited workers.

Larger Lessons from Care WorkAs we have seen, paid care work challenges the old Victorian division between work as a masculine, competitive, self-interested pursuit, and care as a feminine, compassionate, virtuous one. I hopethe discussion above has persuaded you that that thinking in those terms is now passé and even dangerous, when applied to issues of caring labor. I would like to end, however, by making a couple ofpoints that go beyond the care work discussion, as it has so far been framed. These may be provocative.
Consider the behavior of corporations, and particularly the behavior of, and compensation of, corporate chief executive officers. The dualist ideology that says that business is about the unfetteredpursuit of self-interest has become so predominant in the United States that many mistakenly believethat profit-maximization is mandated by law, or is an inviolable mechanism of capitalist economic systems (Nelson, 2010). Those who, on the other hand, still believe that businesses are social citizens,with corresponding ethical responsibilities, are in a minority and must fight an uphill battle to beheard. The idea that self-interested CEOs, mostly males, will only look out for the interest of the corporation if they are paid huge performance-tied bonuses has led to a rapid increase in the value ofCEO compensation packages in the United States in recent decades. Note, however, the contrast between this theory and the argument presented above that said that nurses, mostly females, will only
look out for the interests of their patients if they are paid particularly low amounts. Why not, instead,
write an article about “Why a badly paid CEO is a good CEO?” Presumably, only the CEOs who werewilling to put the corporations’ interests first would then take the job. The recent financial crisis, if
nothing else, should lead us to question whether the idea of an ethics-free business sector is really so
viable after all.

16

ジェンダー研究

第14号

2011

Much of my work has also looked at the behavior of economists, and our professional attitude towards ethics. The idea that knowledge is somehow separable from care has come to the fore in recent discussions of the economics of climate change. The argument has been made that, purely on objective and scientific grounds, it is optimal for the United States to not immediately engage in serious
mitigation policies. That this view very likely consigns both citizens of poorer nations and those in future generations to extreme hardship goes unacknowledged.
I raise these points because I think it is tempting to study care work, in the sense of face-to-face
intimate care for individuals, in isolation, and emphasize its differences from other kinds of work.
What I would like to suggest, instead, is that in our contemporary global and densely interconnectedworld, in which the actions of each of us impact others, all work involves, in an even larger sense of“care,” caring responsibilities. All work, to be done properly, and in the service of not only ourselves
but also the common good, requires a sensitivity to interdependence, attention to virtue, and the expression of our compassion. That we do not recognize this, and in fact often may do our other sorts ofwork in ways that are directly harmful rather than caring, is not due to some fundamental differencein the nature of the occupations. Rather, it is due to our currently abominably low ethical standards
for economic behavior.

Conclusion
The shift of much caring activity from family to markets represents an enormous social change.
Markets on their own are unlikely to provide the particular volume and quality of “real” care that society desires for children, the sick, and the elderly, or guarantee the sorts of relationships that makeeducation, social, and health services most effective. The increasing intertwining of “love” and “money”
brings the necessity—and the opportunity—for innovative research and action. The actual skills involved in care work need to become better articulated, and myths about the motivations for careneed to be dismantled. Issues of market structure, work environments, incentive schemes, regulatory
requirements, and, most importantly, adequate financial support for care cannot be neglected. This istrue not only for the sorts of face-to-face care on which this essay has largely focused, but also in the
more general sense in which our work, in whatever area, connects us to each other.
(Julie A. Nelson, Associate Professor, Department of Economics
University of Massachusetts, Boston)

Notes
1

The distinctions between care as an activity and care as a motivation have been discussed by Joan Tronto (1987), KariWærness (1984), Susan Himmelweit (1996), and Nancy Folbre and Thomas Weisskopf (1998).

2This analysis draws from and updates Folbre and Nelson (2000).

3

The figure for homemakers as a percent of all workers in 2000 corrects a typographical error that appeared in Folbre and17

Julie A. NELSONFor Love or Money? Current Issues in the Economics of Care

Nelson (2000).
4

Employment of workers as maids and in-home childcare providers, while it exists in the U.S., is not as prominent a part of
the U.S. economy as it is elsewhere. Government statistics for 2000, for example, suggest that only 0.4% of native born

workers, and 1.8% of foreign born workers, work in private household service occupations in the U.S. (Mosisa 2002, Table 8).
5

For more on this, see Folbre and Nelson (2000), Nelson (2006a,b).

6

This section draws heavily on Adams and Nelson (2009).

7

The term “diagnosis” here refers to nursing diagnosis as distinct from medical diagnosis.

8This section draws on Folbre and Nelson (2006) and Nelson (1999, 2001).

9

Other nurses were quick to point out that nursing requires competence as well as good intentions; nurses can concentrateon their jobs better when they aren’t worried about bus fare; and higher wages bring in a larger pool of people for employers
to choose from (allnurses.com 2006).

References
Adams, Valerie and Julie A. Nelson. 2009. “The Economics of Nursing: Articulating Care.” Feminist Economics 15(4): 3-29.
allnurses.com. 2006. “Does Better Pay = Better Care?” Retrieved 9/7, 2006, from www.allnurses.com.
Brekke, Kjell Arne and Karine Nyborg. 2010. “Selfish bakers, caring nurses? A model of work motivation.” Journal of Economic
Behavior & Organization 75(3): 377-394.
England, Paula and Nancy Folbre. 1998. “The Cost of Caring.” The Annals of the American Academy of Political and Social
Science 561, 39-51.
England, Paula, Michelle Budig, and Nancy Folbre. 2002. “Wages of Virtue: The Relative Pay of Care Work.” Social Problems
49(4): 455-473.
Fehr, Ernst and Armin Falk. 2002. “Psychological Foundations of Incentives.” European Economic Review 46: 687-724.
Ferber, Marianne A. and Julie A. Nelson, eds. 1993. Beyond Economic Man: Feminist Theory and Economics. Chicago:
University of Chicago Press.
Folbre, Nancy. 1994. Who Pays for the Kids? Gender and the Structures of Constraint. London, Routledge.
Folbre, Nancy and Julie A Nelson. 2000. “For Love or Money —Or Both?” Journal of Economic Perspectives 14(4): 123-140.
Folbre, Nancy and Julie A. Nelson. 2006. “Why a Well-Paid Nurse is a Better Nurse.” Nursing Economics 24(3): 127-130.
Folbre, Nancy and Thomas Weisskopf. 1998. “Did Father Know Best? Families, Markets, and the Supply of Caring Labor.” In
Economics, Values and Organization. Avner Ben-Ner and Louis Putterman, eds. NY: Cambridge Univ. Press, 171-205.
Frey, Bruno S. 1997. Not Just for the Money: An Economic Theory of Personal Motivation. Cheltenham, U.K. and Lyme, N.H.:
Elgar.
Gordon, Suzanne and Sioban Nelson. 2006. Moving Beyond the Virtue Script in Nursing: Creating a Knowledge-Based Identity
for Nurses. The Complexities of Care: Nursing Reconsidered. S. Nelson and S. Gordon. Ithaca, NY, Cornell University Press:
13-29.
Heyes, Anthony. 2005. “The Economics of Vocation or ‘Why is a Badly Paid Nurse a Good Nurse’?” Journal of Health Economics
24(3): 561-569.
Himmelweit, Susan. 1996. Conceptualising Caring. Paper presented at the International Association for Feminist Economics
Conference, Washington D.C., July 1996.
Mosisa, Abraham T. 2002. “The role of foreign-born workers in the U. S. economy.” Monthly Labor Review 125(5): 3-14.
Nelson, Julie A. 1996. Feminism, Objectivity, and Economics. London: Routledge.
Nelson, Julie A. 1999. “Of Markets and Martyrs: Is it OK to Pay Well for Care?” Feminist Economics 5: 3, 1-17.
Nelson, Julie A. 2001. Why are Early Education and Care Wages So Low? A Critical Guide to Common Explanations. The
Foundation for Child Development Working Paper Series.
Nelson, Julie A. 2006a. “Can We Talk? Feminist Economists in Dialogue with Social Theorists.” Signs: Journal of Women in
Culture and Society 31(4): 1052-1074.

18

ジェンダー研究

第14号

2011

Nelson, Julie A. 2006b. Economics for Humans. Chicago, University of Chicago Press.
Nelson, Julie A. 2010. “Does Profit-Seeking Rule Out Love? Evidence (or Not) from Economics and Law.” Global Development
and Environment Institute Working Paper No. 10-06.
Pujol, Michele. “Gender and Class in Marshall’s Principles of Economics. CJE 1984, 8(3), 217-234.
Shrestha Laura B. and Elayne J. Heisler. 2009. The Changing Demographic Profile of the United States. Washington D.C.:
Congressional Research Service.
Statistics Bureau, Director-General for Policy Planning (Statistical Standards) and Statistical Research and Training Institute.
2010. Statistical Handbook of Japan 2010. http://www.stat.go.jp/english/data/handbook/c02cont.htm, accessed 11/15/10.
Steinberg, Ronnie J. 1999. “Emotional Labor in Job Evaluation: Redesigning Compensation Practices.” Annals of the American
Academy of Political and Social Science 561(1): 143-157.
Tronto, Joan. 1987. “Beyond Gender Difference to a Theory of Care.” Signs: Journal of Women in Culture and Society 12:4,
644-663.
U.S. Bureau of Labor Statistics. 2009. Occupational Employment and Wages, May 2009. Tables 39-9011 and 53-6021.
U.S. Bureau of Labor Statistics. 2010. Employment and Earnings, January 2010.
Wærness, Kari. 1984. “Caring as Women’s Work in the Welfare State,” in Patriarchy in a Welfare Society. Harriet Holter, ed.
Oslo: Universitetsforlaget, 67-87.
Wagman, Barnet, and Nancy Folbre. 1996. “Household Services and Economic Growth in the United States, 1870–1930,”
Feminist Economics 2:1 (Spring), 43-66.
Weinberg, Dana Beth. 2006. When Little Things Are Big Things: The Importance of Relationships for Nurses’ Professional
Practice. The Complexities of Care: Nursing Reconsidered. S. Nelson and S. Gordon. Ithaca, NY, Cornell University Press:
30-43.
WGBH Educational Foundation. 2009. “The Hippocratic Oath: Modern Verson.” Nova: Doctor’s Diaries Retrieved 12/11/2010,
from http://www.pbs.org/wgbh/nova/doctors/oath_modern.html.

19