As I look at health and the health care system today there is key component that is supporting health and supporting the health system and yet its value and impact has not always been recognized until more recent years. This is the role of caregiving.
Sinha (2013) indicates that “caregiving by family and friends is often integral to maintaining the health and well-being of Canadians living with chronic health conditions, disabilities or aging needs (p.4)”. Tally & Crews (2007) suggest that “caregiving has become an issue that affects the quality of life for millions of individuals and demands attention from every community (p. 224)”.
According to the Statistics Canada report Portrait of Caregiving 2012, an estimated 8.1 million Canadians aged 15 years and older provided care to a chronically ill, disabled, or aging family member or friend in the past 12 months (Sinha, 2013, p. 4).
Tally & Crews (2007) ponder the question about the public health implications of caregiving, highlighting the challenges of the role and the impacts to the health of the caregiver of prolonged caregiving. Tally & Crew (2007) also recognize that it is important to understand who the caregivers are, recognize the differences in vulnerability that might exist amongst individual caregivers and they articulate the need for a response.
The social ecological model (SEM) provides a lens through which one could begin to understand caregiving. By applying the concepts of individual, interpersonal, organizational, community and policy, one can begin to understand the multilevel influences on health (CDC, 2015). I was not able to find a specific reference that had applied SEM to caregiving so I created a chart below to provide a brief overview of the factors to consider.
In addition, here are brief high level examples for each level of influence.
The individual factors of the caregiver are important to understand. When one looks at the list of factors there are several factors that will come together to influence the health of the caregiver. One example would be gender and income. Tally & Crew (2007) note that “in the past, the overwhelming majority of caregivers were women who were not employed outside the home (p. 224)”. Today, some of those factors have shifted with women making up 50% of the workforce (Tally & Crew, 2007) and in Canada, Sinha(2013) reports that women represent 54% of the caregivers. Sinha (2013) also indicates that "60% of caregivers are in paid employment and that at times providing care resulted in disruptions to work and a reduction in paid work hours with an impact on household income (p. 15)".
At an interpersonal level cultural context impacts the caregiving role. American Psychological Association (2018) reports that rates of caregiving vary by ethnicity and that cultural perspectives of caregiving differ across ethnic groups and impact caregiver experiences.
At an organizational level there are system designs and policies that exist that influence the caregiver. This could include how the health system interfaces with the caregiver role including communication and scheduling of appointments. This could also apply to employer policies related to approving time off from work for the caregiver to fulfill caregiving activities such as accompanying person to medical appointments.
At a community level, the physical environment can have impacts on the caregiving role. The availability and accessibility of the community infrastructure including access to parks, recreation and retail environments, can impact the caregiver and the ease of completing their caregiving activities.
At a policy level, the role of caregiving has gained recognition over the past number of years. There are examples within federal policy for financial supports in the form of tax credits and policy for employment benefits that supported leave from work (The Change Foundation, 2016).
References
American Psychological Association (2018) Cultural Diversity and Caregiving Retrieved from http://www.apa.org/pi/about/publications/caregivers/faq/cultural-diversity.aspx
Bronfenbrenner,U. (1977) Toward an experimental ecology of human development. American Psychologist, 32(7), 513-531 Retrieved from http://psycnet.apa.org/fulltext/1978-06857-001.pdf
CDC (2015) Social Ecological Model Retrieved from https://www.cdc.gov/cancer/nbccedp/sem.htm
Sinha, M.(2013) Portrait of Caregivers, 2012. Statistics Canada Catalogue no. 89652X − 00. Ottawa: Minister of IndustryRetrieved from https://www150.statcan.gc.ca/n1/pub/89-652-x/89-652-x2013001-eng.htm
Tally, R. & Crews, J (2007) Framing the public health of caregiving. American Journal of Public Health. 97 (2) 224-228. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1781412/
The Change Foundation (2016) Legislations Supporting Family Caregivers in Canadian Jurisdictions and selected International Jurisdictions. Retrieved from http://www.changefoundation.ca/caregiver-resource-hub/legislation-supporting-caregivers/