The World Health Organization (WHO) designated 2021 as the International Year of Health and Care Workers to recognize the commitment of health and care workers in their fight against the COVID-19 pandemic. The decision was, in part, to raise awareness of the crucial role of health and care workers. That same year, the 74th World Health Assembly requested WHO to develop a “global health and care worker compact” (“the Compact”). The Compact was meant to provide a succinct compilation of international legal instruments’ guidelines, obligations, and other commitments to best protect health and care workers and safeguard their rights. While the Compact is an essential tool for upholding the rights of health and care workers and empowering advocates to bring about change, a significant challenge exists in defining care workers in law and policy.
The Compact itself defines care workers broadly — encompassing those who provide direct personal care services at home, in health care, or residential settings. This can range from health care assistants; workers who provide direct personal care at various institutions such as hospitals, clinics, and residential nursing care facilities; and workers who provide care at homes, including routine assistance with activities of daily living to persons who are in need of such care due to effects of aging, illness, injury, or other physical or mental conditions. The International Labor Organization (ILO), the other major multi-lateral body that focuses on care workers, classifies care workers based on where they work. While the defined scope might be similar, the ILO differentiates between institution-based and home-based personal care workers.
Care worker definitions also vary dramatically in academic research and legislation. Research on care workers usually combines health and care workers as one or exclusively focuses on a certain group or a segment of care workers, such as a social worker or home-based care worker. A PubMed search of care workers produced results of studies that focused either on healthcare workers that included health workers and care workers or on specific groups of care workers such as social workers, community health workers, or home-based care workers.
Definitions on who constitutes a care worker vary substantially in national laws as well. For example, Luxembourg’s labor code differentiates between care workers working in institutions and domestic service personnel. Conversely, Benin uses the term “household employees” under its labor code while referencing protection against occupational hazards. Nicaragua, on the other hand, uses the term “home workers” under the labor code.
These wide-ranging definitions, across international and domestic legal paradigms, result in a major challenge when advocating for care worker rights. Often laws and policies on minimum wage, working hours, parental leave, and workplace discrimination cover employees in formal employment, excluding those who work in the informal sector. Notably, domestic workers make up a considerable segment of care workers and are often outside of the purview of social protection laws and policies. ILO data suggests that domestic workers account for 18% of care workers. Since domestic workers often are part of the informal economy, those who work as care workers often have little to no social protection or other benefits afforded to other formal workers in the health sector. Currently, over two billion of all workers globally are informally employed, which includes 90% of all employment in developing countries. ILO data also projected an increase in poverty levels among informal workers from 18 to 74% post-pandemic.
Care workers are also the most vulnerable during a health crisis, as there is an increase in demand for care services with no corresponding increase in adequate protections — including both social protection and protections against occupational hazards. A study by UN Women in 2020 showed an increase in unpaid domestic work during the COVID-19 pandemic in Pakistan, Bangladesh, and Maldives, with a much higher rate among women. In the United States and United Kingdom, many workers lost paid jobs during the same period. The ILO also recognized that care workers across the world remain at-risk due to a void of essential protections and benefits, including fair remuneration and exposure to physical, mental, and sexual harm. Often, vulnerable populations share a disproportionate burden of care work, placing them at higher risk. Globally, a majority of care workers are women, and often people of color and migrants.
In times of crises, countries increasingly rely more on migrant workers as care workers. For example, the Thai government employed many migrants as care workers during the pandemic. They took on various roles, including contact-tracing and awareness activities, especially among migrant communities. However, migrant workers often have little to no protection, such as vaccines and personal protective equipment. What is more, they often lack of access to adequate social protections due to their nationality. Currently, a handful of countries, such as Thailand and Brazil, offer the same healthcare access to undocumented migrants as they do for citizens. Thailand provides access to health care at public facilities and reduces out-of-pocket expenditure for migrants and their dependents substantially through its program. A 2007 report by ILO showed migrant workers in Thailand accounted for 5% of all labor forces in the country. Providing healthcare access to migrants or including them under universal health coverage, as Thailand does, can provide better protection to migrant care workers. The rights of care workers are intrinsically tied to the rights of other marginalized and disadvantaged groups. It is essential to adopt an inclusive term for care workers that includes workers in both the formal and informal sectors, domestic and other home-based workers, and migrants, while evaluating and addressing laws and policies that can provide them with essential social protections, such as minimum wage, affordable healthcare, and protections from workplace hazards. Adopting an inclusive term or definition can help care workers realize their rights and empower civil society organizations and others to hold governments accountable for fulfilling their legal obligations and commitments