That’s not an occupation…..

I recently had a very interesting discussion with a journal editor about a paper I would very much like to see published. The paper presents the findings from a study that utilised a workplace intervention for people who are at risk of burnout. Their work is very much on the frontline, and requires a skill set, knowledge and a quality of workplace performance that ensures that the people they ‘work with’, are able to remain in their own homes. The findings from the study are interesting and encouraging. The ‘intervention’ demonstrated a sustainable improvement in mental wellbeing. Given that the work of this ‘workforce’ remains largely hidden, it also raised the significance not only of the contribution this workforce makes to the health and wellbeing of people in our communities, it importantly asks us to think about what happens when this workforce is overwhelmed and can no longer provide a service.
Interestingly the work that this workforce performs is one that sits between health and social care, in fact, without the work of this workforce, health and social care provision across the globe would be in serious difficulty to meet demands.
The paper was rejected for publication, not because the editor considered the science used in the study weak, but because the editor did not consider the work performed by these workers as fitting the traditional notion of what amounts to work.
I invite you to read the rejection response below:

“we consider “work” and “occupational health” to refer to the activities and/or health of those who hold a paid job”. Primarily working to earn a livelihood is conceptually different from caring, household activities, or leisure activities. In the latter type of activities there is usually always some sort of personal choice or intrinsic motivation to continue these activities – one engages in such activities because they are fun, personally important, etc. Stated differently, one could also decide to quit with these activities, although I acknowledge that this may often be difficult. However, engaging in paid work is never only due to intrinsic motives, but also – and sometimes to a very large degree – to extrinsic motives: most people would not engage in paid work if they were not paid for it. Thus, even if paid and unpaid work involve more or less similar activities, conceptually they are different, and this may affect the psychological processes involved.”

Now I don’t know about you but people who work as carers, the informal, often unpaid kind, who do their work 24/7, who perform often complex tasks that qualified experienced health care staff provide, who assist with social care needs, and administration…have a broad yet defined work role. They have a place of work, they have people they look after. The editor who rejected the paper points out conceptually that a carer who works without pay, and a person who works with pay are different, so the psychological processes that may affect each may be different. Call me old fashioned but isn’t this a starting point for exploration in research? Isn’t this where we put forward a hypothesis and test it!

Asside from any academic nose pulling here, there really is a bigger principle at stake which reflects the value we place on the work that carers provide. It appears that the only thing that sets them apart from their colleagues who work in formal health and social care roles relates to pay, and by not being paid, the editor of this journal deemed that their conditions of work and occupational health should remain ignored.

There is an emerging international narrative regarding the status of informal carers and a growing realisation that, given the demands placed upon health and social care services across the globe, we need to find ways in which to support and develop their occupational health. Accepting that informal caring amounts to an ‘occupation’ is perhaps one of the stumbling blocks we have to overcome, but by doing so, this allows us to consider ways in which to ensure informal carers are supported to endure what essentially amount to ‘front line service roles’. Provision of support to informal carers, differs from country to country, with some countries ensuring carers have the benefit of legal rights , and while global numbers of informal carers is not known, they are likely to be in the billions. The reliance on informal caring is likely to rise , yet the broader picture tells us that the availability of people to fulfil the caring role may be diminishing because of the changing demographic in relation to proximity of family members, and existing demands of formal paid roles.

It is timely for us to examine the role of informal carers, and consider what may be done in terms of sustainable support.