Demographic, health, and economic transitions and the future care burden

Abstract

The COVID-19 pandemic has caused millions of infections and deaths worldwide, forced schools to suspend classes, workers to work from home, many to lose their livelihoods, and countless businesses to close. Throughout this crisis, families have had to protect, comfort and care for their children, their elderly and other members. While the pandemic has greatly intensified family care responsibilities for families, unpaid care work has been a primary activity of families even in normal times. This paper estimates the future global need for caregiving, and the burden of that need that typically falls on families, especially women. It takes into account projected demographic shifts, health transitions, and economic changes in order to obtain an aggregate picture of the care need relative to the potential supply of caregiving in low-, middle- and high-income countries. This extensive margin of the future care burden, however, does not capture the weight of that burden unless the quantity and quality of care time per caregiver are taken into account. Adjusting for care time given per caregiver, the paper incorporates data from time-use surveys, illustrating this intensive margin of the care burden in three countries that have very different family and economic contexts-Ghana, Mongolia, and South Korea. Time-use surveys typically do not provide time data for paid care services, so the estimates depend only on the time intensity of family care. With this caveat, the paper estimates that the care need in 2030 would require the equivalent of one-fifth to two-fifths of the paid labor force, assuming 40 weekly workhours. Using the projected 2030 mean wage for care and social service workers to estimate the hypothetical wage bill for these unpaid caregivers if they were paid, we obtain a value equivalent to 16 to 32 percent of GDP in the three countries.

Keywords: Care dependency ratios; Care economy; Extensive margin of care need; Global care burden; Time-use data; Unpaid household caregiving.

Fig. 1

Total fertility rate, by country income group and region, 1990–2035. Data source: UN World Population Prospects, 2019 revision (United Nations, 2019a).

Fig. 2

Age-gender population pyramids, 2015 and 2030, by country income group. Data source: UN World Population Prospects, 2019 revision (United Nations, 2019a).

Fig. 3

Labor force participation rate of populations aged 65 and over, 1990–2030. Data source: ILOSTAT modelled estimates of the labor force participation by age and sex, 2019 revision (ILO, 2019).

Fig. 4

Average global women’s labor force participation, 1960–2017. Data source: ILOSTAT modelled estimates of labor force participation by age and sex, 2019 revision (ILO, 2019).

Fig. 5

Average life expectancy at birth in years, by country income group and region, 1990–2030. Data source: UN World Population Prospects, 2019 revision (United Nations, 2019a).

Fig. 6

Years lost due to communicable and noncommunicable diseases (rate of YLDs as a proportion of population). Notes: YLD is the number of years that a person lives with disability. Data source: Authors' calculations using data from IHME Global Burden of Disease Study, 2017 revision (Global Burden of Disease Collaborative Network, 2018).

Fig. 7

Estimated wage cost of unpaid caregivers if they were paid, as a percent of GDP. Notes: Estimates are calculated by multiplying the estimated total number of unpaid care workers using a 40-hour work week (Table 5) by the average wage for human health and social work. To get 2030 estimates, the average wage for human health and social work is projected forward using the average annual real growth rate of all wages for each country from 2008-2017 (15.2%, 8.3%, and 1.2% for Ghana, Mongolia, and South Korea, respectively) (ILO, 2018b). Data sources: Authors’ calculations using mean nominal monthly earnings of employees by sex and economic activity in the ILO’s Harmonized Series (ILO, 2019); World Development Indicators (World Bank Group, 2020); Projected Real Gross Domestic Product (GDP) and Growth Rates of GDP for Baseline Countries/Regions (in billion 2010 US dollars) for 2011-2031 (United States Department of Agriculture, 2020b); Global Wage Report 2018/19 (ILO, 2019).