The Consequences of Collective Neglect

We are suffering from a pandemic of collective neglect, in a large part due to secret inflation since 2010.

This is the second in a three-part series of long essays about what’s wrong with the world… Thank you all for following along, and thank you for letting me know what you think!

-Rob

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How do you take care of a newborn baby? The baby, it turns out, will teach you: do the wrong thing and the baby screams her head off; do the right thing and the baby’s face lights up in a smile. Ah, that’s it, keep doing that. 

Actually, in my experience, children continue this teaching technique even as they grow up. The same bright smiles when you’re doing it right, but the screaming is (usually) replaced by powerful, soul-crushing sulks when you’re doing it wrong.

In this way I’ve learned the most important lesson about how to take care of someone: pay attention to them for a while. Really, fully. Not half-attention while also reading, or while thinking through some work question. Not paying attention for a few seconds until the immediate problem is solved, then turning away. 

Newborns, and children, and really anyone, are often in need of this: someone to be fully present to their needs, both practical and emotional, or just to keep them company. These fully-present hours may be the foundational activity, the core, of what we call “care”. 

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In the previous essay I claimed that we are victims of a secret inflation that has compounded over the last decade, an inflation that has made us all poorer than we realize. In this post I want to convince you that one of the major consequences has been a severe and worsening underinvestment in taking care of people in most of the Western World. This lack of care – in a word, neglect – has its own set of consequences, the same consequences that are witnessed in any individual victim of neglect: degradation of self-esteem, a breakdown in trust in others, increase in drugs and alcohol addiction, and aggression. 

As a society we are experiencing these problems on a widespread basis and it has gotten much worse since 2010 – in a large part due to secret inflation. We are suffering from a pandemic of collective neglect, because we are not properly taking care of ourselves and each other.

1. Our societies have a collective care budget

To start this thought process, imagine all the time and resources that are spent taking care of people in a society. The hours taking care of our households, the cleaning and cooking. The hours of attention given to newborns, children, the sick and the elderly. The hours spent by doctors, nurses and specialists tending to our health, plus the budgets for the facilities and tools they use. The hours teaching people in our education systems, plus the budgets for the school buildings and materials. 

Imagine all of that added together. Imagine quantifying it all, government-funded, privately-funded, and un-funded, all the hours and the related expenses. Imagine combining the expenses that are typically categorized as parts of healthcare, education, and social welfare, but are all about taking care of people in one way or another.  

Let’s call the sum of all that our collective care budget. 

Before it decreased massively this past decade, it was already too low.

2. The underinvestment in care was already extreme to begin with (= a feminist critique of capitalism)

We had already been spending too little time taking care of ourselves back in 2010, at least in most places in the world. 

And the main reason is because capitalism has traditionally been… hmm, what word is the opposite of “feminist”? … capitalism has traditionally been masculinist, patriarchal.

In the previous essay about inflation, I explained that our dollars and euros are fictions that represent all the “value” in the world. That value includes all of our labor, our work-time, which is represented in capitalism by our salaries. Everything is translated into money.

And of course the massive oversight of this system, traditionally, is women’s labor, which was generally taken for granted, not compensated or even represented by money, made invisible to the system. I mean women’s labor in the traditional historical sense, the kind of work that was usually done by women in previous generations: the maintenance of a house, the feeding of people, and most of all, the taking care of people. Taking care of children, of husbands, of sick relatives, of elderly parents. Countless hours of fully-given attention.

Gender roles changed gradually over decades, and then more quickly after the feminist revolutions of the 1970’s. As things changed, new generations of women took jobs out of the house, jobs with salaries in the classic capitalist mold. To be clear, this was – and still is – a great thing for women and a great thing for society overall. But one obvious consequence is that fewer hours were being spent taking care of people, because those millions of women stopped working in their households (for zero pay, of course), where their primary job was taking care of people.

Even though some of the new salaries that women were earning out-of-the-house were now being re-dedicated to care work (paying nannies, for instance), the consequences were stark. As women entered the workforce, the disappearance of invisible-care-work represented a massive, enormous decrease in our overall collective care.

Some countries adjusted to this change by spending more money on public care to compensate for the “lost” care work of women in private households, work that was previously invisible to the capitalist system. This spending took multiple forms: publicly-funded daycares for children, childcare allowances for working parents, higher budgets for school, afterschool programs, more public healthcare spending to take care of the sick, publicly funded assisted-living facilities for the elderly. Paid parental leave, too, and paid sick leave, and paid family leave to take care of sick or elderly relatives. 

Some countries compensated for the reduction following the 1970’s feminist revolutions with increased public spending, some did not. The US is among the worst offenders in undercompensating. France was better, but the overall decrease in care budget was still dramatic.

And by the way, in the meantime over these past fifty years, lifespans were increasing rapidly, so even more care was needed than ever before, as society decreased its overall investment. 

3. After 2010, our collective care budgets went down

Then the financial crisis of 2008/9 came along, and interest rates went to zero, and a few things happened to our collective care budgets.

First, there was a terribly complex thing called the European Debt Crisis around 2010, and someone had the awful idea that the way to react was via government austerity, which meant that governments across Europe started cutting their public care budgets.

Second, there is the secret inflation that made us all poorer over the past decade and consequently decreased the affordability of care and education in the private markets. Our increasing poverty didn’t decrease our purchasing-power for stuff (ie, “consumer goods”), because better technology and offshore labor decreased the cost of producing that stuff. But the price of care did not go down. One hour of attention was still one hour of attention, and no technology or foreign factory can change that. 

So over the past decade, prices of care and education in the private markets have skyrocketed, and more and more people are priced out. People just can’t afford private daycare anymore, or private schools, or a home health aide for an older parent, or a visit to the doctor outside our insurance networks. At least, that is, the 90%+ of people whose wages have not gone up with the secret inflation.

Third, there is the effect of secret inflation on our public budgets. Even for those budgets in Europe that were not slashed by austerity – for example, primary school expenses per-student were generally not cut by austerity – even those budgets effectively went down because of secret inflation, because ten thousand euros per student is just worth less in 2022 than it was in 2012. I think that’s why teacher salaries are perceived as so alarmingly low these days in European countries, even though they are similar to what they were a decade ago and have technically increased with the “official” inflation numbers. That’s why public hospital budgets in Europe are so low that most countries have declared national emergencies.

These care and education sectors are the big losers in the secret inflation of the past decade.

4. In the meantime, productivity is the same as it always was, or maybe worse

I won’t dwell on this for long, because others have written about it more convincingly and eloquently than I can – but the same technology that has decreased costs in other sectors has been increasingly applied to care work over the past decade (including healthcare and education) to disastrous effect. Attempts to increase productivity with better tech has probably had the opposite impact, actually decreasing productivity by adding an administrative burden to care-workers’ time, and it has also probably decreased the quality of care. 

Care work does not follow the same logic as manufacturing or office work. One hour of attention from a caregiver has a certain worth, and there is no way to get that value with less time spent – because the time spent is the whole point, it is the value itself. There is also value to continuity, to having the same caretaker spend time with the same person. If there’s any productivity to be had, it’s via a long-term relationship being formed. But modern approaches with technology usually take the opposite approach, cycling people through different caregivers or teachers in this misguided attempt to get more from less.

The impact of information technology has not only missed the care sectors, it has hurt them.

5. Hence the Crisis of Care

All of what I’ve just described has been called a “Crisis of Care” in many countries. Much has been written about it, but I especially recommend Labours of Love, a beautifully-written and powerfully-convincing book from 2020 about the Crisis of Care in the UK that is relevant in the US and France as well (and from which the feminist critique in this article is largely inspired.) The author, Madeleine Bunting, mentions government austerity as a cause, but not the secret inflation that I think explains a big part of it as well.

We were already underinvesting in our collective care, not spending enough time taking care of ourselves. And in the past decade-or-so, the problem has gotten much, much worse.

This crisis is difficult to measure, because the overall collective care budget I’ve described is never actually measured, and would be extremely difficult to measure if anyone tried. It is not a monetary measure, just the sum of all our spending. (The US healthcare system is proof that it is possible to spend lots of money for very little actual care.) Measuring the number of fully-present hours might be better, but hard to capture. Measuring the quality of care is a thorny topic and the subject of thousands of researchers. All this lack of measurability make the crisis very hard to navigate.

The lack of care has a direct consequence, of course, and it explains a lot about the world we’re living in.

6. The consequences of neglect

A lack of care is called neglect, when we fail to attend to the needs of someone. 

Neglect can be extreme, like when we don’t feed someone who depends on us, or never change a child’s diaper. Or it can be less extreme, but still harmful, like when we don’t have time to talk to a child about a fight they had in school. When we leave a sick person alone with no moral support. When a child is stuck in a classroom with 30 other kids and one teacher and no one can pay attention to their specific needs. 

We can even neglect ourselves, leaving our house a mess, perpetually picking up fast-food instead of taking the time to cook a healthy meal, and never making the time for the physical activity or exercise our bodies need.

Neglect has been studied in children, and the consequences documented. (These studies are not fun to read, I don’t recommend it.) I listed the major consequences that are mentioned in most studies at the beginning of this essay: degradation of self-esteem, an inability to trust others, increasing dependency on drugs and alcohol, and aggression.

I think these same problems are playing out across our entire societies among children and adults and everyone in between. Increasing polarization, decrease in mutual trust and social ties, increasing isolation: there are plenty of studies that show the shocking rise of these problems in France, the US, and many other countries since 2010. Drug and alcohol abuse is rising. It makes sense to me that these are the symptoms of neglect, the result of not taking care of ourselves and each other, made worse by secret inflation.

As we invest less in our collective care budgets, and consequently become less trustful of one another, we are even less inclined to support increases in public spending. It’s a classic vicious cycle. Some rare countries, like the Nordics, have the opposite phenomenon, a virtuous cycle: they invest heavily in public care, so people tend to be more social and trustful, and are more inclined to continue voting for high public care budgets. 

The US is clearly in a vicious cycle. France seems to be somewhere in the middle.

Many have written about the phenomenon of deaths of despair in the US. One of the big reasons the overall life expectancy is dropping in the US is because every year, hundreds of thousands of people die from behavior that is driven by despair, like drug and alcohol overdoses, diseases and conditions caused by drug and alcohol addiction, or suicides. The people writing about this phenomenon usually blame the economic system. They say that despair comes from the feeling that your living conditions are worse than previous generations, and it will be even worse for your children. Not just poverty, but the feeling that increasing poverty in the future is inevitable.

I wonder if the lack of care is the bigger cause. Even if people were poor and had dim economic prospects, if they were properly being cared for, if their kids were being educated with enough resources, if we stopped neglecting them, perhaps their despair would not be so suicidal.

7. The bifurcation of two care systems

In this context, two care systems are emerging in France, the US, and many other countries. Those who can afford it – those whose salaries are most connected to the financial markets, and secret inflation – are using a private care system made up of dedicated nannies, private schools with high tuitions, private concierge doctors, domestic labor and health aides. The prices within this private care system are rising with both the official and secret inflations, and the use of technology or new kinds of productivity-enhancing systems tend to be low or nonexistent. Note the schools in Silicon Valley, popular among the families of executives at tech companies, that cost $30k-$50k per year and promise an environment free of screens.

Those who cannot afford this private system – at least 90% of the population – are stuck with the publicly-funded systems that have low and decreasing effective budgets (because they are not indexed to the true inflation), and relatively high use of efforts to increase productivity (that usually have the opposite effect). 

And in one of the maddening hypocrisies of our modern world, those people who are in charge of the public systems – the senators and ministers who decide their budgets, the executives who run the institutions – are usually wealthy enough to use the private care system for themselves and their own families. This is not always the case, of course, and it is worse in the US than in France due to cultural constraints. But still.

The public system is in need of significantly more resources, but it’s also in need of reform: changes in the way education and healthcare are planned and delivered, as I’ve written about in the past regarding early-childhood education. However reform is nearly impossible in an environment of low and shrinking budgets. In that kind of context, people inside the system tend to protect what they have and are more resistant to change than usual; when there are too few resources to begin with, the risk of having your resources stolen is too high. Reform is always easier in an environment of plenty.

So perhaps the problems in the education and healthcare system are unsolvable today because budgets are too low, the people responsible are not experiencing the problems first-hand, and all of that because of some decisions the central banks made a decade ago. Perhaps.

8. Then along comes the pandemic

With a society under-cared for and suffering from neglect, and public systems of care failing to adapt, along comes the pandemic and lock-down in our homes.

For some, the lock-down made the neglect even worse. Adolescents who were already not getting enough attention now got even less, with parents busy at work (remote or on the front-lines), teachers intermediated by zoom, and their friends locked in other houses. Mental health professionals today talk about a massive mental-health crisis among teens.

For some, the lock-down allowed more time, finally, to take care of themselves and their families. People who had been working too much and seeing their kids too little were suddenly at home, either on paid-leave (in France, at least), or fired, or working remotely without much pressure. And many of them realized how deeply they had been neglecting themselves and their families, and how nourishing it felt to have real time for care. 

So in the wake of the pandemic we see the parallel and opposite trends of a ballooning mental health problem and school systems in panic, and at the same time the Great Resignation and a whole segment of the population who is ready to work less, homeschool their kids, or permanently work remotely.

I believe this is one of the reasons that the 4-day work week is proving so necessary and effective. In today’s world of underinvestment in care, we all need that extra day to take care of ourselves.

In the next post I’ll write about the other major consequence of secret inflation, which is a big shift in the power-equilibrium among governments, the masses, and the oligarchs.