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BEDREHELSE-Bedre helse og livskvalitet

Inequalities in informal caregiving over the adult life course in Europe: social participation, health and the influence of Covid-19

Alternative title: Ulikheter i uformell omsorgsarbeid i livsløpet til voksner i Europa: sosial deltakelse, helse og påvirkningen av Covid-

Awarded: NOK 2.5 mill.

EUROCARE is a European study on inequalities in informal care from a life course perspective. Increased life expectancy means more chronic diseases and a greater need for care in older people. Across most of Europe, care is provided informally by the family. Both the parental generation and the younger generation have children later in life. Therefore, more people in these generations provide care to parents and their own children at the same time. It is known from smaller cross-sectional studies that women provide more care than men, and that those with low education and low income provide more care than those with high income. Traditional values, religiosity, and gender equality, and personality traits such as agreeableness and conscientiousness as linked to caregiving. Prolonger care can lead to reduced working hours, wages, wealth, and pensions. It can also cause distress and reduced psychosocial well-being. The consequences likely depend on life stage and risk and protective factors such as social support. We will use several Norwegian and European long-term studies to shed light on these growing societal problem. We will investigate whether social inequalities, gender, and personality affect education, work participation, income, and wealth of younger, middle-aged, and older caregivers. In addition, we will examine whether social inequality and gender affect the psychological consequences of providing care for the quality of life, family conflicts, and mental health in different generations. Grøtting et al. recently published an economic paper on health consequences of informal caregiving. While providing informal care may come at a cost to caregivers in terms of their own health, evidence of causal effects of care responsibilities on health is limited, especially for long-term outcomes. In this paper, the authors estimate short and long-term effects of a formal care expansion for the elderly on the health of their middle-aged daughters. They exploit a reform in the federal funding of formal care for Norwegian municipalities that caused a greater expansion of home care provision in municipalities that initially had lower coverage rates. They find that expanding formal care reduced sickness absence in the short run, primarily due to reduced absences related to musculoskeletal and psychological disorders. The reduction in sickness absence is concentrated among workers with little work flexibility (e.g., shift workers), whereas there are no effects for workers with more flexible jobs. The authors were unable to detect effects on long-term health and healthcare utilization outcomes. The results imply that sickness absence uptake could be hiding a need for more flexibility around work for people with caregiving responsibilities. Hansen et al. examine the prevalence and micro- and macro-level predictors of exclusion from social relations among older adults (60+) using two waves of data obtained four years apart across 14 European countries in the Survey of Health, Ageing and Retirement in Europe (SHARE). The authors examine four indicators of objective and subjective social isolation and tie these to potential barriers and predictors of social participation and integration on individual (e.g., caregiving responsibility) and national macro level (e.g., public health expenditure). Findings reveal a northwest to southeast gradient, with the highest social connection found in the stronger welfare states of Northwest Europe. This pattern is especially pronounced among women, reflecting better living conditions but also the cultural and institutional frameworks which may reduce caregiver burden and facilitate combining caregiving with paid work and other engagements. The project also two ongoing scientific articles which are to be submitted early 2023. Hynek et al. explore the prevalence and health effects of informal caregiving in a migrant perspective. Using largescale data from the Public Health Surveys we will explore how different types and levels of care relate to various aspects of physical and mental health among different according to migrant background. Hansen et al. use the covid-subsample of the same survey to explore and compare trajectories of psychosocial well-being (loneliness, subjective well-being, distress) among caregivers and non-caregivers before and during different stages of the pandemic. Project researchers have extensively disseminated findings from Eurocare and related research projects in various forum (media, conferences, meetings, etc.). We have had meetings with non-academic partners in the international consortium (incl. the Norwegian partner Pårørendealliansen). The last meeting was a digital meeting held in Feb 2022, and the next will be a hybrid meeting held in Barcelona in Feb 2023. Despite delays regarding hiring and access to data there has been much activity in the project and we are on schedule vis-à-vis the publication plan.

EUROCARE is a European study about inequalities in caregiving from a life course perspective. Increased longevity has led to a higher need for care for older people. Across most of Europe, the most care is provided informally by families, friends, or neighbors. Smaller family sizes, divorce, and women’s paid work diminish the pool of informal carers. Delayed childbearing in parents means more young adults with old parents or grandparents requiring care and more carers providing care to parents and children simultaneously. Women are more likely to provide care, provide care for a long time, and care more intensively than men. Gender inequality in care providers is greater in countries that rely on a family-based model. Also, caring itself acts as an inequality, limiting financial and social resources. Caring leads to reduced working hours, salaries, and pension entitlements, and poorer mental and physical health. Research so far has been largely cross-sectional or addressed caring for groups with specific diseases. Besides, younger carers are often overlooked in policy and research. Younger caregiving occurs at a time when young adults aim at completing education, finding jobs, and forming long-term relationships. We will harness Europe’s longitudinal population data, as well as the methodological and substantive experience in a multidisciplinary team of European academic and non-academic partners to examine inequities in employment, social participation, and health between carers and non-carers at different life stages. Comparisons will be made across European countries, focusing on those providing care during young adulthood and mid-and later life. Finally, we include a specific research objective and work package focused on working closely with our non-academic partners to translate our results into policy recommendations.

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BEDREHELSE-Bedre helse og livskvalitet