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By Kate Moynihan
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Everyone depends on care. We need it when we are young, when we are sick, when we live with disability, and as we grow older. Yet much of the care that allows people to remain independent, work, learn, and participate in their communities is still treated as a private family responsibility.
That assumption has economic consequences.
In 2023, an estimated 748 million people were outside the global labor force because of care responsibilities, according to the International Labour Organization (ILO), and of those, 708 million were women. The ILO has also emphasized that a well-functioning care economy supports families, strengthens the workforce, and enhances productivity.
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These figures should change the way we think about economic policy. Care is often discussed as a matter of family policy, health policy, or social services. However, its consequences extend much further.
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The True Cost of Vision Impairment
When people cannot access the care they need, someone else frequently absorbs the responsibility. That may mean a parent leaving work to care for a child, an adult accompanying an aging relative to appointments, or a family member taking over everyday tasks that someone can no longer safely perform alone.
The economic costs can be substantial. Unaddressed vision impairment provides one clear example. The World Health Organization (WHO) estimates that at least one billion people have vision impairment that could have been prevented or remains unaddressed.
The annual global productivity loss associated with vision impairment is estimated at $411 billion, in purchasing-power-parity terms. WHO also identifies availability, affordability, and awareness as major factors determining whether people receive appropriate eye care.
The productivity figure is important, but it does not capture the full economic effect.
When a Health Care Need Becomes Caregiving Responsibility
Consider an older person who cannot see well enough to shop independently, prepare food safely, or travel to a local market. A family member may begin providing transportation or managing daily tasks.
What begins as a health need can become a caregiving responsibility, creating costs for households that conventional economic measures may never record. The same pattern appears across all forms of care.
When affordable childcare is unavailable, parents can struggle to maintain employment. When long-term care is inaccessible, families may provide support themselves. When basic health services are too expensive, too distant, or poorly understood, conditions that could have been addressed early can create greater demands later.
Recognizing the Problem as One of Infrastructure
The problem is global, even though its expression varies by country. In underserved communities across lower-income countries, families may face barriers including distance, cost, limited providers, or even just a lack of awareness that effective solutions are available.
People still want to work, children still need to learn, and older adults still want to remain independent. When essential care is inaccessible, those goals become harder to sustain.
This is why I believe care should be understood as economic infrastructure.
We readily recognize roads, electricity, and digital networks as infrastructure because they allow people and businesses to function. Care creates a similar foundation. It helps people remain healthy, independent, educated, and able to participate in economic life.
Building a Framework to Deliver Proven Care
My experience in global health has made this particularly clear to me. Working with underserved communities has shown me that access is rarely determined simply by whether a solution exists. It depends on whether people can reach it, afford it, understand it, and continue receiving appropriate support.
Eye care illustrates this well. Many common causes of vision impairment have established and cost-effective interventions, yet access remains deeply uneven. WHO reports that two out of three people in low-income countries who need eyeglasses do not have access to them.
The challenge, then, is building systems capable of delivering proven care to the people who need it. That requires investment.
Governments should incorporate essential care into economic planning by investing in community-based services, reducing financial barriers, strengthening local workforces, and improving public awareness.
Employers can provide caregiver benefits, flexible working arrangements, and practical support that helps employees remain economically active. Public-private partnerships can extend services into communities where traditional delivery models have struggled.
Technology can help as well. Digital tools can connect patients with providers, improve coordination, and identify communities facing unmet needs. They should make care easier to reach and navigate while preserving the human relationships that make care effective.
A Shared Economic Priority
We also need better economic measurement. The ILO defines the care economy as encompassing paid and unpaid work across households, public institutions, private organizations, and communities. Its contribution reaches far beyond the transactions captured by conventional economic measures.
If we measure only the hours someone spends in paid employment, we miss many of the conditions that make those hours possible.
A stronger economic framework would recognize the value created when people can remain independent, when parents can stay employed, when caregivers receive support, and when preventable health problems are addressed before they become long-term dependencies.
The solution requires governments, employers, investors, technology companies, and communities to treat care as a shared economic priority. Investment in access and affordability can strengthen households, support workforce participation, and help people remain engaged in their communities.
A productive economy depends on people being able to participate. That participation depends partly on whether societies have built systems that support health, independence, and family stability.
Care is one of those systems.
It is time to make it visible, invest in it, and recognize its place within the economic infrastructure of every community. When people can access the care they need, they have a greater opportunity to contribute fully, families are better positioned to remain resilient, and economies are better equipped to grow.
Kate Moynihan is the CEO and executive director of Seva Foundation, where she leads global efforts to expand access to sustainable eye care systems in underserved communities. She is based in Oakland, California.
The views expressed in this article are the writer's own.
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