Paid and unpaid work, quality of life, and physical and mental health of women who are family caregivers of people with long term chronic conditions

Résumé

Background In society today, the need to care for people at home is a growing reality. This care is mainly provided by family members, with a marked gender bias that stems from culturally rooted values; thus, women are the cornerstone of the system of informal care provision. Taking on the role of caregiver sometimes leads to the loss of paid work outside the home; moreover, the invisibility of the economic importance of caregiving is one of the factors perpetuating the economic and power relations underlying gender inequalities. The process by which a family member becomes a carer is progressive and can last for years, undermining the physical and psychological health of the person playing this role and often leading to social impoverishment and an irrevocable loss of quality of life. The main objective of this study was to investigate inequalities in health (physical, mental and health-related quality of life) arising from social causes, such as the relationship between occupational status, the discretionality of the role and the time dedicated to unpaid work, among family caregivers of dependent adults with chronic complex disease. Material and Methods Analytical, cross-sectional descriptive study, carried out in the province of Málaga (Spain), with a sample of 267 caregivers, to detect health inequalities arising from socioeconomic causes. Results Caregivers whom assume the informal care forced by circumstances spend less time in paid work activities (p=0.044; 95% CI 0.09 to 6.82). Caregivers with high educational attainment have more possibilities to be employed (OR: 1.06; 95% CI 1.06 to 1.10). A low social support perceived by caregivers increases the probability of leaving an employment to care (OR: 2.8; 95% CI 1.24 to 6.35). The 52.9% of caregivers of our study have a home net income under 1200 euros. Discussion The mass of family caregivers that, besides being a social good, are an irreplaceable economic value, estimated between 2.29% and 3.60% of Spanish GDP. In Andalusia, the estimated cost of annual informal care hours ranges from 5,266 to 8,721 million euros, being an unaffordable budget for our country's economy. In addition, we have to consider the eligibility of providing care as a modulator of health. In 2015, this threshold for a 4-member households stood at 16,283 euros (1,356 euros per month), which is higher than the average amount reported by more than half (52,9%) of the informal caregivers in our study, and constitutes a sign of alarm to consider caregivers as a potential group of risk of social exclusion. This situation produces an unacceptable oxymoron: those who are ensuring the well-being of vulnerable population, get themselves vulnerable for this reason, because the State, that gets benefits from their efforts, does not provide enough support for them. It could be stated that in family caregiving, “who comes near the vulnerable people, becomes vulnerable”. Conclusions This study enhances our understanding of the profile of informal carers, identifing health and economic inequalities and establishes a basis for new social and health policy measures to address the specific problems of this population.