Unpaid carer inequalities: a public health concern

Abstract The number of unpaid carers is rising globally and is anticipated to grow given predictions on life expectancy, morbidities and limitations on care alternatives. The estimated number in England is 5.5 million. Significant international evidence exists of potential negative impact on employment, health and wellbeing which have individual and societal consequences. This presents a major public health concern, especially as much of the experience and health consequences remain a largely hidden issue. Drawing on two doctoral studies undertaken in the UK we expose the potential for significant health and social inequalities to be experienced by unpaid carers and offer models to enhance understanding and potentially more effective responses. The presenting author provided supervision and continues to research the topic. Both studies were set in a translational paradigm to maximise timely utility. The experiences of the participants were privileged while attempting to ensure that the clinical, education and policy potential of the research was incorporated. Study participants were care givers for family members with life limiting illnesses, principally cancers and dementia. Qualitative methodologies were employed in both studies; one drawing significantly on realist approaches and the other on grounded theory. There is generally a lack of consensus concerning when and how carers can best be supported. Although some support interventions were valued there are some fundamental tensions in service models which limit their potential. Specifically the centrality of the relationship is needs to be acknowledged and nurtured. Often, professionals often predominately draw on a medical model as the default intervention position when attempt to tackle carers’ health inequalities. These findings suggest that greater attention should be afforded to the potential of social coping strategies to create a more enabling rather than burden dominated perspective. Key messages unpaid (family)carers are at risk of being exposed to a range of health inequalities which can have individual and societal consequences. Interventions that acknowledge the relationship and draw on social dimensions may off coping may offer effective ways forward.