Unpaid carers: a silent workforce
Authors: None The Lancet Public Health
Journal: The Lancet Public Health (2024)

Millions of people worldwide provide care for family members requiring support informally and without payment—they represent around 20% of the population in the UK and Canada, and 5% in Japan and Finland, according the 2021 International Alliance of Carer Organisation's Global State of Caring report. In this issue of The Lancet Public Health, two Articles investigated the impact of providing informal care on the health of caregivers. Ludmila Fleitas Alfonzo and colleagues' longitudinal study of young Australian carers, aged 15–25 years, spanning over 20 years, found poorer mental health for caregivers compared with non-caregivers, particularly when an intense amount of caregiving was provided. Rebecca Lacey and colleagues used data from the UK Household Longitudinal Study, from 2009 to 2020, and found increased psychological distress in the transition to caregiving for every age analysed, from age 16 years to age 65 years, and increased distress with the number of hours dedicated to caregiving per week. The authors noted that psychological distress for women becoming caregivers in early and mid-adulthood was higher compared with female non-caregivers and persisted for several years. Both Fleitas Alfonzo and colleagues' and Lacey and colleagues' studies found differences in the burden of caring by age and identified younger people as being at particular risk of negative health outcomes. For young and young adult carers, caring happens alongside other major life events and obligations, such as education, first employment, or parenting, which could exacerbate the impacts. Apart from carer characteristics, other contexts might influence outcomes. Both studies described experiences prior to COVID-19 that might have further deteriorated health during the pandemic through reducing social contact outside the household or increasing care needs due to changes in service provision. Moreover, unpaid carers do not represent a homogeneous population and policies need to take their background and personal circumstances into account. For instance, interventions such as a right to additional days off work for caring responsibilities only help people who are in work, and policies are needed for those in education for example. A recent umbrella review on the effectiveness of interventions developed to mitigate negative health outcomes among carers highlights the need for more robust evidence to develop tailored interventions. Another important consideration is the disproportionate burden of unpaid care carried out by women and the potentially increased burden for women caregivers. Jennifer Ervin and colleagues reported that for employed women, unpaid labour was negatively associated with mental health. Unpaid care work in women is an important factor contributing to gender gaps in labour outcomes, linked to lower wages, labour force participation, and job quality, as highlighted by the OECD development center. Caring does not only affect health but also the socioeconomic determinants of health. The Lancet Commission on Women and Health powerfully stressed how women's contribution to health care remains underappreciated and there are very few gender-sensitive policies to enable them to integrate their social and occupational role and express their full potential. How can we ensure health equity for unpaid carers? First, it is essential to acknowledge the social and economic value of the contribution provided by unpaid caregivers as co-producers of health services and to raise awareness of the health issues and inequality linked to the caring role among the general public and health-care professionals. This should facilitate the reconciliation of employment, more flexible working arrangements, and adequate remuneration for their efforts. Furthermore, governments should work towards a proactive identification of individuals providing informal care and monitor their health status, acknowledging their increased risk of worse health outcomes. Health professionals are well positioned for the early identification of caregivers in need of support. The need for caregivers is expected to grow due to increases in longevity. It is unsustainable for the health-care sector to rely more and more on unpaid carers when they themselves become at risk of experiencing poorer health outcomes. It is more than time to recognise and reward the contribution of unpaid caregivers to society by implementing policies that include financial rewards and avoid disadvantages in work and education for caregivers to combat avoidable health inequities. Mental and physical health changes around transitions into unpaid caregiving in the UK: a longitudinal, propensity score analysisOur findings highlight the importance of early identification of and support for caregivers, including younger caregivers. This is important to break the cycle of caregiving and future care need. Health services staff, including general practitioners and hospital discharge teams, are well positioned for early identification of caregivers. We also encourage particular support for the mental health of caregivers and particularly those who become caregivers at a younger age. Full-Text PDF Open AccessThe effect of informal caring on mental health among adolescents and young adults in Australia: a population-based longitudinal studyOur findings suggest potential mental health effects of informal care in young people, particularly when providing an intense amount of caregiving. Reducing young caring loads could be a possible avenue for intervention. Full-Text PDF Open Access