CHRISTINE MILLIGAN. Lancaster University, UK. Care in the field of health is widely defined as the provision of practical or emotional sup- port to those who ...
Geographies of Care CHRISTINE MILLIGAN Lancaster University, UK
Care in the field of health is widely defined as the provision of practical or emotional support to those who would otherwise be unable to undertake activities of daily life due to physical or mental disability, illness, injury, or an age-related condition. The inclusion of emotional support in this definition is important, as long-running feminist debate has challenged unidirectional definitions of care that center solely around observable labor. Rather, care is seen to entail a complex network of actors and actions with multidirectional flows of activity and connections. It is also viewed as being relational, in that it involves an ongoing responsibility and commitment to the recipients of care (Tronto 1993). How that care is manifested in practice is linked to the different social and politicaleconomic belief systems that shape rights and responsibilities with regard to care. These can operate at the level of both the individual and wider society. The geography of care acknowledges, but goes beyond such social, economic, and political concerns. It recognizes that care is structured and practiced in spatial ways, so focuses on the interrelationships between people, places, and care. Care and care relationships are thus interpreted through their location in, and contribution to, the shaping of the multiple sites within which care occurs (Milligan and Wiles 2010). It emphasizes not only the complexity and richness of that spatiality, but also its impact on the health and well-being of those involved in both the giving and receiving of care. Much informal
(or family) care, for example, takes place within the home, where it is, by and large, neither visible nor measurable. A geographical lens can thus focus on how care reshapes the nature of home, and vice versa, and how this is experienced by actors enrolled within the care network. Of course care is not confined to the home; it also takes place within and across a range of other physical and virtual settings, such as care homes, hospitals, extra care settings, day centers, and centers concerned with the delivery of telecare and other forms of virtual care practices. Advances in technology from the Internet to mobile and wi-fi technologies also support remote care, such that even those living at significant distances from each other are able to engage in both physical and emotional care. The geography of care thus stretches from highly localized to global settings and can occur in both public and private spheres. Critically, this approach recognizes not only that where care occurs plays an important role in people’s physical and emotional experiences of care, but also that any shift in the place of care can transform the very nature of those places. Those working around geographies of care have articulated these interrelationships in a number of ways. One early focus looked at the spatial impact of differing welfare regimes on rights and responsibilities to care. Here geographers have considered how shifts in political and ideological thinking about care are spatially manifest. One particular body of work has addressed the shift from institutional to community care and its impact on “new” sites of care located within the domestic home and its immediate environs. In many neoliberal countries this shift has been seen to bring new actors into the care network, including the voluntary and community
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2 sectors. This work has revealed the emergence of new spaces of care across the city and community, including the, sometimes surprising, social spaces that enable caring interactions – from community drop-in centers to homeless shelters (e.g., Conradson 2003; Cloke, May, and Johnsen 2010). But it has also drawn attention to the spatial and temporal unevenness and inequities of care which are, at least in part, the outcome of a shifting politics of place which can be seen to be eroding situated traditions of care. A second strand of work has drawn attention to the individual space–time trajectories through which care is performed and received (McKie, Gregory, and Bowlby 2002), including the ways in which shifting responsibilities for care, and the commodification of care, impacts both socially and spatially on the lives of informal (family) caregivers as well as paid care workers. But geographical work on care and the home has also drawn attention to the shifting boundaries between public and private as the giving and receiving of care has become increasingly focused around the home. Although Julia Twigg is not a geographer by discipline, her inherently spatial book, Bathing – The Body and Community Care (2000), gives a clear illustration of the entanglements of power and dependency, formal and informal care that occur within the home, and how this acts to shape and reshape even the most public and private spaces of the home. This focus on the home has also lead to a third body of work, which has taken as its focus the body as a site of care and production, drawing attention to the spaces and practices that facilitate care of the body (e.g., Dyck et al. 2005). More recently, work in the geography of care has addressed the emotional terrain within which care takes place and which underpins care and care interactions. The
relationships between emotions, care, and specific settings have been both explicitly and implicitly documented – drawing attention to the interrelationships between place, affect, and care as well as the spatiocultural aspects of emotionally inflected practices of care (e.g., Milligan 2005; Atkinson et al. 2010). Embedded in much of this engagement with emotion and the spatiality of care is, of course, a feminist ethics of care which challenges conventional distinctions between public space – seen as the realm of politics and justice – and private space, which is more commonly associated with emotion, care, and welfare. Work in this vein has sought to adopt an inclusive approach to care and justice by refusing to partition the two, instead emphasizing the acts and structures of caring that stretch across public and private spheres and seeking ways to connect the individuals, communities, and institutions that shape care (see Staeheli and Brown 2003). The geography of care can thus be seen to encompass the institutional, the domestic, the familial, the community, the public, the voluntary, and the private, as well as transitions within and between them. Its concern is with the complex relationships and multiple sites within which care is performed and experienced – from the micro-scale of the body and the home to the macro- (cross-national) scale and various local, regional, and national levels in between. In doing so, it takes cognizance of issues of distance and proximity in the giving and receiving of care and the collapsing of distance through technological advance. SEE ALSO: Aging and Health Geography; Geographies of Gender and Health; Geographies of Health Care Access; Health Geography; Voluntary Care
3 REFERENCES Atkinson, S., Macnaughton, J., Saunders, C., and Evans, M. 2010. “Cool Intimacies of Care for Contemporary Clinical Practice.” Lancet 376: 1732–1733. Cloke, P., May, J., Johnsen, S. 2010. Swept Up Lives? Re-Envisioning the Homeless City. Oxford, UK: Wiley-Blackwell. Conradson, D. 2003. “Spaces of Care in the City: The Place of a Community Drop-In Centre.” Social & Cultural Geography 4: 507–525. Dyck, I., Kontos, P., Angus, J., and McKeever, P. 2005. “The Home as a Site for Long-Term Care: Meanings and Management of Bodies and Spaces.” Health & Place 11(2): 173–185. McKie, L., Gregory, S., and Bowlby, S. 2002. “Shadow Times: The Temporal and Spatial Frameworks and Experiences of Caring and Working.” Sociology 36: 897–924.
Milligan, C., and Wiles, J. 2010. “Landscapes of Care.” Progress in Human Geography 36(6): 736–775. Milligan, C. 2005. “From Home to ’Home’: Situating Emotions Within the Caregiving Experience.” Environment and Planning A 37(12): 2105–2120. Staeheli, L., and Brown, M. 2003. “Where Has Welfare Gone? Introductory Remarks on the Geographies of Care and Welfare.” Environment and Planning A 35: 771–777. Tronto, J. 1993. Moral Boundaries: A Political Argument for an Ethic of Care. New York: Routledge. Twigg, J. 2000. Bathing - The Body and Community Care. London: Routledge.
FURTHER READING Milligan C. 2009: There’s No Place Like Home: Place and Care in an Ageing Society. Farnham, UK: Ashgate.
