Care Policy Scorecard 2023 - Oxfam Canada

How Much Do We Care?

An Assessment of the Canadian Paid and Unpaid Care Policy Landscape

Acknowledgements

This report was written by Inez Hillel and Silas Xuereb (Vivic Research), with support from Amar Nijhawan and Ian Thomson (Oxfam Canada).

Founded in 2020, Vivic Research supports actors working toward systems change through economic and evidence-based research. Vivic is committed to a vision of a just society, where everyone has access to research, information, and data to participate in the decision-making processes that impact their lives. Vivic believes that when combined with public education and advocacy, research can be a tool for social change. To make this vision a reality, Vivic Research strives to collaborate with actors working towards systems change and confronting oppressive structures by providing alternatives to traditional economic and public policy research.

We would like to thank our expert Advisory Group for their invaluable support, guidance and active participation in our scoring process and validation workshop:

Pamela Uppal, Ontario Nonprofit Network

Katherine Scott, Canadian Center for Policy Alternatives

Bilan Arte, Canadian Labour Congress

Rae Vanille, Native Women’s Association of Canada

Chloe Carley, Native Women’s Association of Canada

Tiffany Walsh, Native Women’s Association of Canada

Dr. Ito Peng, University of Toronto

Dr. Sherri Klassen, University of Toronto

Morna Ballantyne, Child Care Now

Martha Friendly, Child Care Research and Resource Unit

Dr. Andréane Chenier, Canadian Union of Public Employees

Oxfam Canada acknowledges the historical and ongoing oppression and colonization of all Indigenous Peoples, cultures and lands in what we now know as Canada. We commit to acting in solidarity with First Nations, Inuit and Métis peoples in their struggles for self-determination and decolonization and in support of the Calls to Action of the Truth and Reconciliation Commission (2015) and the Calls for Justice of the National Inquiry on Missing and Murdered Indigenous Women and Girls (2019). Oxfam Canada’s offices are located on the unceded, unsurrendered traditional territories of the Anishinabe Algonquin peoples. We recognize the privilege of operating on lands that these peoples have nurtured since time immemorial. As settlers on these lands, we commit to walking in solidarity with our host nation and according to Oxfam’s values of equality, empowerment, solidarity, inclusiveness, accountability and courage.

June 2023

Oxfam Canada

39 McArthur Avenue, Ottawa, ON K1L 8L7 1 800 466 9326

info@oxfam.ca

www.oxfam.ca

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Cove photo: Dominik Lange / Unsplash

Photo: Helena Lopes / Unsplash

Executive summary

The COVID-19 pandemic exposed and exacerbated the crisis in care that has been brewing in Canada for many years. After decades of underfunded care services, underpaid care workers, increased reliance on racialized migrant women to perform care work, and inaction on rectifying the heavy and unequal care workload, care systems in Canada broke down under the social and economic stresses of COVID-19, and communities were left stranded with completely inadequate services. Today’s increased attention by governments and the public at large on the importance of care to our society and economy presents a unique opportunity to rethink how paid and unpaid care work are valued and how care systems can be strengthened to ensure quality care to those who need it.

This report applies Oxfam’s Care Policy Scorecard Tool to provide a comprehensive assessment of the current state of care-related policies in Canada. For too long, women have disproportionately provided care – unpaid in the household and underpaid in the economy – holding back efforts to close the gender gap. This assessment takes a holistic and rights-based approach to care, which recognizes that women’s unpaid care work increases when basic care services are inadequate or unaffordable and care workers do not have access to dignified work. Therefore, the assessment not only considers health care and child care policy, but other areas such as employment protections, immigration policy, and infrastructure investments, as they influence who provides care, how it is delivered, and who has access to care services. As such, the report looks at 21 indicators across eight policy areas to assess whether the right policies are in place at the federal level to provide an enabling environment for the provision of a wide spectrum of care services to ensure care work and workers are valued and care responsibilities are more equally shared within households and between families and the state. Ultimately, the provision of affordable, accessible and

quality care to those who need it requires a wholeof-government approach and this report provides an overview of what that would entail.

Overall, this report finds that existing federal care policies in Canada are strong in many areas. Recent federal investments in childcare, public transportation and long-term care are a step in the right direction to reduce and redistribute care work. These investments also provide models for how the federal government can take leadership and encourage provinces to invest in care.

However, the federal government still needs to address some of the major gaps in federal care related policy. For instance, failure to guarantee and provide access to clean drinking water on-reserve increases care work for women in many First Nations communities. Also, Canada has no federal initiatives to engage Canadians on shifting social norms around paid and unpaid care work, an important aspect to redistributing care work and ensuring care work is valued and adequately rewarded. As well, migrant workers in care sectors lack decent working conditions and labour rights protections, and in many cases cannot access care services themselves. Most importantly, much more progress is needed to ensure equitable access to care for marginalized groups, especially migrant, racialized and Indigenous peoples, and people with disabilities. Racism, ableism, sexism and other forms of systemic discrimination are embedded in Canada’s policy landscape but also in the ways care is delivered and accessed.

Supporting and redistributing unpaid care work will require investing in care-supporting infrastructure, ensuring equitable access to public care services, funding community-based options for care, enabling care-supporting workplaces and providing cash transfers to unpaid caregivers.

Based on the assessment, the following recommendations are made to build care enabling systems that provide more equitable and just access to care, reduce and redistribute women’s care responsibilities and reward care workers with decent working conditions and compensation:

1. Increase federal funding to expand non-profit and publicly managed early learning and child care, strengthen bilateral agreements with the provinces and territories and ensure accountability by the provinces and territories to meet the principles and targets set out in the federal framework, and develop a workforce strategy for child care workers that ensures adequate compensation and dignified working conditions.

2. Mandate provinces and territories to meet the new standards for long-term care, and support the development of public and community-based long-term care options.

3. Expand Canadian Medicare to include pharmacare, dentistry, vision, physical rehabilitation and mental health services, particularly for lowincome families and individuals.

4. Establish the Canada Disability Benefit to provide adequate levels of social protection and increase the child disability benefit to ensure all people with disabilities can access the care services they need, and ensure people with disabilities have community-based care options.

5. Raise parental benefit levels for the second caregiver to encourage further redistribution of care within households.

6. Establish a national food program in schools and provide cash transfers to all families experiencing food insecurity.

7. Increase investment in publicly constructed and operated public transportation services, especially in remote and rural communities, that take into account the particular needs of women.

8. Continue to invest in drinking water infrastructure in First Nations communities to end all drinking water advisories as soon as possible.

9. Ensure all Canadians have access to cellular and high-speed internet services, especially in rural and remote communities to enable access to a wider range of services.

10. Introduce policies that educate people about gender stereotypes and norms around care work. Currently, there are no national policies to fund education campaigns that pertain specifically to care work within Canada.

11. Develop a national strategy to recruit and retain care workers, considerate of global care chains, and ensure care workers are fairly compensated, have paid sick leave and enjoy dignified working conditions.

12. Immediately eliminate employerrestricted work visas for temporary foreign workers and provide all temporary foreign workers with permanent residency upon arrival.

13. Implement Employment Insurance reforms expanding access, particularly for precarious workers, and boosting the benefit rate, and implementing a permanent minimum weekly benefit.

14. Broaden access to the Canada Child Benefit for families with precarious status by repealing legislation tying eligibility to immigration status.

15. Ratify ILO Convention 189 on the rights of domestic workers.

While many of Canada’s care systems are delivered at the provincial or municipal levels, which are not assessed in this report, federal leadership is crucial to establishing national minimum standards, provide necessary investments and close policy gaps in federal jurisdiction. Beyond this report, it is hoped that the Care Policy Scorecard Tool can also be applied at the provincial and municipal levels to provide a more complete picture of the state of care policy in Canada.

Care work is indispensable - YET THE CARE ECONOMY

Across Canada and around the world, daily tasks, like cooking, cleaning, laundry, family planning, child rearing, eldercare and caring for people with disabilities, keep our society running –and are disproportionally done by women. Burnout among paid care workers has spiked since the onset of the pandemic, and many workers are leaving the sector due to low wages and strain on their mental health1. The health care sector is struggling to meet the needs of a population impacted by ongoing COVID-19 infections and an enormous backlog of surgeries and procedures caused by COVID lockdowns. At the same time, the soaring cost of living is making it harder for households to afford basic essentials and is requiring workers to put in long working hours, often at more than one job2 For hundreds of thousands of women in Canada, there is no escape from the constant of care work.

The care economy refers to all care work that takes place in institutional settings (whether public, private, or non-profit), households and communities and includes all forms of paid and unpaid reproductive labour3. Unpaid care work includes the provision of unpaid direct care for children, young people, older people and people with disabilities, and unpaid indirect care, like cooking, cleaning and other related activities. In 2022, 52% of women over the age of 15 provided paid or unpaid care compared to 42% of men4. Within the household, women report spending 3.9 hours per day providing unpaid care compared to men who report spending 2.4 hours per day.5

When done for profit or compensation, those same caregiving roles are referred to as paid care work, which includes but is not limited to domestic workers, personal support workers, health care workers and child care workers.

IN CANADA IS BEING PUSHED TO ITS LIMITS.

In the paid labour market, women account for 75% of care workers in Canada.6

Many of the women who work in the paid care economy are underpaid, (im)migrant and racialized workers working in homes and institutions.7

The gendered division of household labour and the prevalence of low-wage and precarious care work can be traced back to oppressive structures that devalue women’s labour and constrain their economic opportunities.8 In order to challenge the systems that produce these negative and unequal outcomes for the people who provide care, we must first recognize the role of capitalism and neoliberalism as the economic and political systems that create the conditions under which the care economy operates.9 Strong actions by governments are needed to transform the current conditions of care with bold policies tackling the root of the current crisis. Major investments in care infrastructure and communities and an overhaul of immigration law are needed. Equally necessary are concerted efforts

to address and change the prevalent norm that care is undervalued “women’s” work, so it’s equally distributed between men and women, and from the household to the state.

This report assesses the strengths and weaknesses of federal care policy in Canada.10 The results show whether federal policies related to care have been adopted, funded and implemented, and the extent to which they have had a transformative effect on the intersections of inequality. Valuing paid and unpaid care workers and redistributing the unequal care workload between women, men and gender diverse people will require reforms to all these policies, guided by a whole-ofgovernment approach. The increased attention currently aimed at care presents a unique opportunity to rethink how paid and unpaid care work, and care systems generally, function in Canada.

Photo: Kelly Sikkema / Unsplash

methodology

Why a Care Policy Scorecard?

The Care Policy Scorecard was launched by Oxfam in 2021 and was developed collaboratively between organizations and individuals working on the care agenda at the regional, national and global levels.11 COVID-19 highlighted how important care is for our society and our economy, while also demonstrating just how fragile the care sector is. Despite the magnitude of these issues, care has not been adequately taken up by public policies globally. Furthermore, as unpaid care work and, to a large extent, paid care work remain relatively less recognized as public policy issues, an instrument was needed to highlight care work as a responsibility of policy makers and set out what that responsibility entails.

When the Scorecard was conceptualized, there was no global instrument that tracks and measures government progress against key care policies areas through a practical tool – despite a growing body of literature that addresses unpaid and paid care work in different contexts. There are a small number of existing global gender-related scorecards and indexes that include metrics on unpaid and/or paid care and domestic work,

Care Policy Scorecard applied

For this report, the Scorecard was adapted to analyze the Canadian context. When this tool was being adapted for and applied in the Canadian context, despite the volume of care policies developed and applied at the municipal and provincial levels of government, the scope was limited to the analysis of federal care policies. This limitation was justifiable because of the federal government’s leadership role in creating an enabling environment for care across the country. Therefore, only federal legislation, policies and programs were scored.

Many indicators in the scorecard fall largely under provincial jurisdiction, but some of these indicators still have significant scope for federal action and funding (e.g., public transportation) and thus were retained. Other indicators with no significant federal role, including sanitation services and labour law, were excluded. Although the federal government has jurisdiction over labour law for federally regulated workers, this group

such as the Gender Inequality Index and Women Peace and Security Index; however, there is no in-depth and holistic measurement of care policy responses. 12

To outline the key components of a care-enabling public policy environment, the Scorecard draws on the work of feminist and development economists and the International Labour Organization’s 5R framework. This means being able to recognize, reduce and redistribute unpaid care work, adequately reward paid care work and represent care workers in collective bargaining and social dialogue. In addition to this framework, the Scorecard is accompanied by a set of policy indicators and questions that can be used to assess, monitor and evaluate progress systematically and holistically across relevant public policy areas. Recognizing that contextually specific conditions for care need to be understood before applying overarching policies or solutions, the Scorecard is intended to be a tool for advocacy research that can be adapted to multiple contexts by its users.13

includes few, if any, care workers and thus was less relevant to this report.

Two indicators were removed from the assessment: timeand energy-saving equipment, and technologies and caresensitive public works programs. They were not deemed as relevant to the Canadian and Global North context; these indicators are more salient in collecting information about care policies in the Global South.

Canada does have an informal economy. (1.7 million Canadians in the labour force pre-pandemic were engaged in gig economy arrangements; about half these arrangements were for supplemental income, the rest were the person’s sole source of income.)14 Canada’s “underground economy” was valued at 2.7% of the GDP ($68.5 billion) in 2021, with residential construction being the largest contributor.

in Canada

While prominent, in the context of this report – Canada’s informal economy is smaller in magnitude compared to other countries – therefore the emphasis on “informally employed workers” in several assessment criteria was replaced with an emphasis on a broader scope of marginalized groups, including especially First Nations, Inuit and Métis Peoples and migrant workers.

These modifications resulted in a scorecard with 21 indicators in eight policy areas. Each indicator is assessed based on 12 to 22 criteria, each given a score of 1, 0.5 or 0. The sum of the scores for each indicator’s criteria is divided by the number of criteria to provide an overall percentage score for each indicator. The percentage scores are then converted to a degree of transformation, a score from 0 to 5 that reflects the degree to which the federal policy in that area is transformative for care.

The criteria were mostly assessed by reviewing federal policies, legislation and regulations. Most criteria could be assessed objectively, and this report provides an explanation and source(s) for the score. However, other criteria involved a significant amount of judgement.

For these criteria, the report established specific methods for interpreting the criterion and applied them consistently across indicators. Crucial to this process was consultation and validation workshops with an expert Advisory Group15 consisting of members from advocacy, labour and non-profit organizations in Canada who work in policy areas specific to care. In addition to providing ongoing research support – all final scores were reviewed by this group. Oxfam Canada will continue working with experts and advocates to conduct similar scorecard reports assessing provincial and municipal care policies in Canada to gain a holistic picture of the care policy needs across the countries.

Finally, one of the cross-cutting assessment criteria of this Scorecard measured the extent to which care policies had been developed in consultation with paid care workers and/or women’s rights organizations. This information was often not publicly available, so researchers surveyed representatives from 16 feminist organizations. This criteria was scored a “1” if at least one representative had been consulted and their input had been taken into account to some extent.

Canada has made significant progress on care-related policies over the past decade, but federal leadership is still lacking in many areas. Little has been done to spur the transformation of gender norms, and many policies have had disproportionate consequences for marginalized groups.

Among the 21 indicators assessed in the Scorecard, the majority scored a 2 or 3 on the degree of transformation scale. This indicates that federal policy exists in these areas but that they are doing little to transform gender norms and the unequal distribution of care work, to value care work, or to eliminate gender inequality. Four indicators received a 4, indicating that policies are moderately transformative. No policies were transformative to a great extent. One indicator scored a one because the policy is under development, and three indicators from Section 3 scored a 0, indicating that there are no federal policies in these areas.

The full scoring data across all indicators (including the references and sources) was organized in a separate Excel file. While not included in this report, it can be accessed by request through Oxfam Canada.

When this tool was being adapted for and applied in the Canadian context, the scope was limited to the analysis of federal care policies

POLICY SCORECARD A tool for assessing country progress towards an enabling policy environment on

UNPAID CARE WORK POLICY FRAMEWORK

Policies assessed

Safe Drinking Water for First Nations Act (repealed)

2030 Emissions Reduction Plan: Canada’s Next Steps for Clean Air and a Strong Economy

None

Permanent Public Transit Fund

Description

The federal government has jurisdiction over piped water on federal lands and First Nations reserves. This section scores policies around the provision of piped water in Indigenous communities.

There is no federal policy for the provision of household electricity, this falls under provincial jurisdiction. However, there is some federal funding for household electricity under the Emissions Reduction Plan.

There is no national policy for sanitation services (we focused on rubbish collection but the same applies for bathrooms, municipal waste).

There is dedicated federal funding for public transportation through the permanent public transit fund, although the allocation of these funds is still under consultation.

Canada Health Act

Multilateral Early Learning and Childcare Framework, 2021 Budget

None

Disability Tax Credit, Canada Disability Benefit Act

Canada Pension Plan, Old Age Security, Guaranteed Income Supplement

Canada Child Benefit

Pan-Canadian School Food Policy consultations

Canada Labour Code

EI Maternity and Parental benefits

Canada Labour Code

Government of Canada policy on Workplace Daycare Centres

Canadian Charter of Rights and Freedoms, Canadian Human Rights Act

Provision of public healthcare services is under provincial jurisdiction but the federal government funds public healthcare services through the Canada Health Transfer.

The federal government has entered into agreements with each province to provide funding to reduce childcare fees and increase childcare capacity.

There is no national policy for long-term care.

There is no comprehensive national policy to provide care services to people with additional care needs. The new Canada Disability Benefit may help people with additional care needs pay for care services.

The combination of the CPP, GIS and OAS ensure most seniors can live in dignity.

The Canada Child Benefit supports low-income families but is not large enough to lift families in deep poverty out of poverty and is not universally accessible.

The federal government has started to develop a national school food policy but it has not been completed.

Under the Canada Labour Code, federally regulated employees now have access to 10 days of paid sick leave per year.

Workers have access to paid parental leave through the Employment Insurance System.

The Canada Labour Code outlines that federally regulated workers can request flexible working arrangements but employers are not obligated to oblige them.

There is no national policy regarding onsite childcare. We evaluated the Workplace Day Care Centres policy which applies only to federal government employees.

Policies developed under the CHRA, which apply to federally regulated employers, outline that employers have a duty to accommodate breastfeeding at work. Discrimination due to breastfeeding has been interpreted as sexbased discrimination under the Charter of Rights and Freedoms.

Figure 1. Count of indicators by their degree of transformation.

CARE POLICY SCORECARD A tool for assessing country progress towards an enabling policy environment on care

SECTION 2 PAID CARE WORK

Policies assessed

Federal minimum wage policy

Pay Equity Act

Canada Labour Code

Employment Insurance Act

Canada Labour Code

Description

The federal minimum wage only applies to federally regulated workers. Most paid care workers fall under provincial legislation.

The Pay Equity Act establishes that federally regulated workers must take proactive steps to achieve pay equity.

The Canada Labour Code establishes standard working hours for federally regulated employees.

Employment insurance is available to an increasingly limited subset of workers.

The Canada Labour Code and Canada Labour Standards Regulations govern when children can work in federally regulated workplaces. Most of Canada’s work on child labour, including Bill S-211, is focused on child labour in foreign supply chains for goods imported into Canada.

Canada Occupational Health and Safety Regulations

Workplace Violence and Harassment Regulations

Canada Labour Code

The Canada Occupational Health and Safety Regulations (enabled under the Canada Labour Code Part II) apply to federally regulated workers.

These regulations apply to federally regulated workers but give precedence to employers’ opinions.

Workplace inspections largely fall under the responsibility of employers and employees can file labour standards complaints with the ESDC Labour Program.

Immigration and Refugee Protection Regulations, Temporary Foreign Worker program

Migrant workers are not adequately protected under existing regulations and their rights are limited by employer-tied worker permits and a lack of paths to permanent residency.

Canada Labour Code

The Canada Labour Code Part I establishes the right to join unions for workers in federally regulated workplaces.

Figure 1. Count of indicators by their degree of transformation.

Policy exists and is transformative to a limited extent 3

Policy exists and is transformative to a very limited extent 2

Policy exists but is not transformative 1

Policy does not exist 0

Figure

Count of indicators by their degree of transformation.

Policies assessed

Description

None

There is no government policy on gender stereotypes in advertising. Industry groups have created policies that prohibit gender stereotypes in advertising and media that are administered on a self-regulating basis.

There is no national policy to raise awareness about care work or shift gender norms around care work.

None

There is no national education policy to address gender stereotypes.

The Department of Finance is currently developing a Quality of Life framework to measure wellbeing. Quality of Life

Statistics Canada Time Use Survey

Statistics Canada conducts a time use survey every 5-6 years.

Many indicators have a common assessment criteria. Assessment criteria are separated into several categories, including accessibility & reach, budget & administration, design & impact, legislation & ratification and regulation & monitoring. Summarizing the scores by category provides an understanding of federal policy strengths and weaknesses across indicators. The strongest scores were achieved in budget & administration and regulation & monitoring. Policies scored particularly well on assessment criteria related to having a specific government department to oversee the policy, having clear mechanisms to address complaints and having an adequate financial and human resources to implement the policy.

However, policies scored worse on accessibility & reach and design & impact. Criteria that required services to be universally and affordably accessible for and to actually reach (rather than simply be accessible on paper) structurally marginalized populations fared the most poorly. Although the policies exist and can be implemented effectively, they do not prioritize

marginalized populations, and when they do, the implementation of the policy may not result in real accessibility in practice.

The gap between what is on paper and what is happening in the real world is significant in policy making and analysis. While this report provides a holistic review of what exists and does not exist, in-depth qualitative research on the experience of living through and navigating care systems was not a part of this exercise. This point is important because many assessment criteria were related to the content of policies and regulations without considering how the policies are implemented and experienced by people on a day-to-day basis.

Canadian Code of Advertising Standards, CAB Equitable Portrayal Code

Care Policy

Further research, stories and public material is crucial to understand the lived realities of navigating care systems in policies in Canada from an intersectional lens. For example, the Canada Health Act, which receives a favourable score, stipulates that to receive full transfer payments to fund health care from the federal government, provinces must “provide for insured health services on uniform terms” for all residents of the province.16 However, in practice, we know that marginalized groups, especially Indigenous peoples, face a wide range of barriers to accessing health care services, including discrimination in the health care system, long wait lists and having to travel long distances to access care.17 In this instance, the accessibility of care services in practice is very different from the accessibility of care services on paper.

While these scores (see the accompanying Scorecard for the full criteria and scores for each indicator) are indicative of the state of care policy in Canada, we acknowledge that no single number can reflect the full impact of federal policies on care recipients and paid and unpaid care workers. This report aims to explain the scores assigned to each indicator, but also to explain the differentiated impacts of federal policies on marginalized groups, including especially racialized and Indigenous women and migrant care workers.

Table 1. Average scores for main assessment criteria categories.

The Context of Care in Canada

The Scorecard findings demonstrate that people living in Canada do not have equal access to care and do not have equal access to the resources needed to receive care, both as workers and within their homes and communities. Policymaking allows the government to provide quality care to those who need it, protect care workers employed in the paid labour force as well as remove structural barriers preventing households and communities from sharing the care workload equally.

At its core, the care environment in Canada is shaped by capitalism, neoliberalism, racism, ableism, sexism and other forms of systemic discrimination. Care decisions made under these systems of oppression produce unequal outcomes. The recommendations put forward in this report seek to challenge elements of these systems to ensure that access to care is equitable throughout society and that the federal government is rising to the task of meeting the care needs of everyone living in Canada now and in the future. To better understand the gaps that this report identifies, the analysis is anchored by a brief summary of some of the ways these systems operate.

Capitalism’s neoliberal agenda of privatization and austerity started in the 1980s and continues to this day, prioritizing profits over the provision of quality care services and care-supporting infrastructure. Decades of research show that for-profit service delivery is associated with substandard care and higher user fees, with negative consequences for the people receiving care and the workers providing it.18 Care-supporting infrastructure is increasingly built and maintained by private companies through public-private partnerships,

such as those encouraged by the Canada Infrastructure Bank.19 Only 5 of the 16 policies assessed against this criterion around infrastructure in the Scorecard are primarily (over 80%) government funded and administered. Some care services, such as long-term care homes, are already predominantly privately owned, while others, like health care services in Ontario, are moving toward privatization.20 Mortality rates in private long-term care homes were 25% higher than in publicly owned homes in Ontario during the pandemic.21

Normalized sexist, patriarchal and racist worldviews have solidified the view that care work, especially household labour, is “women’s work.” Despite its essential nature, care work remains highly gendered, overlooked and undervalued. Statistics Canada estimates that the economic value of unpaid household care work in Canada is between $516.9bn and $860.2bn or between 25.2% and 37.2% of Canada’s GDP, which is more than the contribution of the manufacturing, wholesale and retail industries combined. Since women have less status, care work is seen as unskilled and less valuable than other employment, and therefore not worthy of living wages and decent working conditions. Due to insufficient wages and the devaluation of care work, many workers do not consider this type of work desirable, leaving the care sector in a constant recruitment and retention crisis and overrepresented of migrant and racialized women care workers. This coupled with racist immigration policies pushes these women to provide valuable care work often under threat of deportation.

Before the report examines each policy and indicator individually, this section aims to briefly outline the context of care in Canada and its position within the global economic system.

Since paid care work is disproportionately performed by immigrant and racialized workers, care policy must be understood within the broader international context. As more women enter the paid labour force in Canada, the increasing need for care workers is filled by racialized immigrant women.22 Many of these workers come to Canada without their families due to strict immigration and visa requirements, leaving care gaps in their home countries. This process, referred to as global care chains, highlights the importance of broad and intersectional analysis that not only considers the Canadian context but the impact that national policies in Canada can have around the world and for those who are providing care.23 For example, in an attempt to address the nursing shortage in Canada – federal and provincial governments have been actively recruiting foreign-trained nurses from the Global South.24 This situation not only demonstrates government inability to train and retain the health-care staff they need, it poses a risk of depleting a supply of health-care workers in the Global South and worsening already fragile healthcare systems.

The relationship between capitalism and care work is complex, as it is both the driving force behind creating a demand for paid care work and the supply of care workers in Global South countries who have few alternatives in their own context.25 In this Scorecard, only one indicator focuses on migrant workers’ rights; however, we considered whether services and benefits were inclusive of migrant workers when scoring criteria on accessibility and reach. Many benefits, including the Canada child Benefit and Old Age Security are not available to many migrant workers despite them paying taxes, which makes Canadian policies exploitative of workers coming from the Global South to fill essential labour shortages. Ensuring that migrant workers are cared for requires valuing care work by transforming social norms, paying fair wages and providing access to employment benefits, coupled with fundamental changes to immigration policy that do not perceive the Global South as a supplier of cheap labour but rather that prioritize pathways to citizenship as a right and reward for the contributions migrant workers make to Canada’s economy and society.

Although Canada scores well in terms of the provision of care services, understanding the ways systemic racism and ableism operate can help explain why marginalized groups do not receive the same care as other groups in health care and education settings. Throughout Canada’s colonial history and in the present, the health care, education and social service sectors have been sites of violence for marginalized persons. For example, the child welfare system and Residential School system have been used to disrupt Indigenous families and communities and resulted in the deaths of thousands of Indigenous children. 26

Photo: Mulyadi / Unsplash

Today, multiple reports document the ways stigma and discrimination impact the care received by Black and Indigenous patients in hospitals and other health care settings.27,28 Psychiatric institutions have been and continue to be sites of violence for people with mental illness.29 These are all examples of ways that care infrastructure has been used to the detriment of marginalized groups. Racism and ableism have produced care infrastructure that favours removing, isolating and institutionalizing people rather than supporting them or ensuring their communities are well-resourced to meet their care needs.30 Therefore, while this report recommends investing in publicly funded care services, it also recognizes the historical failures of federal care policies in Canada and suggests offering alternatives to institutionalized care by funding community-based care alternatives.

The federal government must invest in public care services and infrastructure to ensure that care is valued, accessible and affordable to all and to reduce barriers to community-based care networks. In areas that fall within provincial jurisdiction, the federal government can adopt a leadership role by tying funding for provinces to federal standards. This approach has already been applied to expand early learning and child care in the past year. Budget 2021 included an historic investment of $30bn over five years to build a Canada-wide early learning and child care (ELCC) system. In less than a year, bilateral agreements were signed with all 13 provinces and territories, and clear plans have been laid out to deliver affordable, inclusive and high-quality child care within the next five years. While there is room for improvement, these agreements set targets for increases in child care spaces and lower fees, while also promising better wages and training opportunities for the child care workforce Families across Canada have already begun to see significantly reduced child care fees, and the government is closer to achieving its goal of $10-a-day child care by 2026. In December 2022, Nunavut became the first jurisdiction to achieve $10-a-day child care under the Canada-wide system.

Transforming gender roles and promoting gender equality requires addressing discriminatory social norms. Entrenched social norms prevent the equal distribution of care responsibilities between men and women – and to value care work (paid and unpaid), these biases must be addressed. In addition to playing a leadership role in the policy sphere by regulating life-saving care policies and enforcing standards for the provinces to adhere to, the federal government can undertake the important role of shifting social norms and expectations around care work through public campaigns, interventions and the media.

Section 1 UNPAID CARE WORK

Section 1 includes indicators that redistribute unpaid care work from individuals (mostly women) to governments and other organizations and that provide compensation or other forms of support for care work that is typically unpaid. It also includes indicators that reduce the care workload through physical infrastructure. Table 2 lists the indicators in Section 1 and their associated degrees of transformation.

CARE SERVICES MUST BE UNIVERSAL AND AFFORDABLE

The public health care system, which falls under provincial jurisdiction, but is federally funded through the Canada Health Act, is free and widely accessible. However, decades of underfunding, combined with the strain that the COVID-19 pandemic placed on the system has pushed it beyond its capacity. Long wait times mean that many people do not receive the care they need, and those who can afford it seek health care from private service providers. Instead of investing more in public health care, some provinces are moving towards privatization of services despite private care often yielding worse outcomes and exacerbating inequality.33

Canada scores high on access to public health care services, but the lower scores on care services for older people and people with additional care needs reflect gaps in care services.

Progress has been made to expand access to public early learning and child care in the past two years with the adoption of a national framework.31 The Multilateral Early Learning and Childcare Framework has many strengths, including an emphasis on non-profit providers, inclusion and affordability. Furthermore, a separate framework was developed collaboratively with Indigenous partners for First Nations, Inuit and Métis children. However, in practice, there are observed differences between how provinces are implementing the framework. For example, some provinces have committed to only funding the creation of new non-profit child care spaces while Ontario and Alberta have committed to funding both non-profit and for-profit child care spaces.32

Furthermore, the public health care system is far from providing comprehensive care. One in five adults in Canada does not have any drug coverage, resulting in individuals paying out of pocket or choosing to skip or delay taking prescribed medications.34 Coverage for mental health care, physiotherapy and addiction treatment services is patchy and many are still required to rely on private health insurance or go without care. The federal government demonstrated its willingness to expand health care in the 2023 federal budget by investing in dental coverage for uninsured Canadians under 18 and

persons with disabilities in 2023, and all uninsured Canadians with an annual family income of less than $90,000 by 2025.35 This type of bold government action provides a framework for further expansions, such as pharmacare.

Not all groups in Canada have equal access to the health care system. Undocumented people in Canada cannot safely access the public system as the Canada Health Act only mandates the provision of health care to insured persons, who by definition must have legal status.36 On top, systemic racism in health care is a direct barrier to seeking care, particularly for

Table 2. Degrees of transformation (DoT) for indicators related to unpaid care work.

Black and Indigenous individuals who report anticipating negative treatment when seeking health care.37 Furthermore, individuals report being denied care and being provided inadequate care based on stigma and discrimination surrounding substance use, mental illness and chronic pain.

Long-term care homes are another site where COVID-19 revealed a crisis of care – death rates in Ontario for older adults were 13 times higher in long-term care homes than in the community during the COVID-19 pandemic.38 The government has not advanced or prioritized their goal of providing access to safe and high-quality long-term care for vulnerable seniors and people with disabilities with the urgency necessary. In January 2023, the federal government finally unveiled new national standards for long-term care, after a three-year consultation process. Many advocates were disappointed to learn the standards would not be mandatory and raised concerns

about the absence of sustainable funding, enforcement and accountability mechanisms. There was also no information in the standards on the role of ownership or the need to end for-profit long-term care, which has been shown to deliver inferior outcomes across a variety of measures including staffing, resident experience, injuries and quality of care.39

While the high death rates in private care homes relative to municipally owned homes suggest that major investments are needed to expand the provision of public long-term care, it is critical to consider the limitations of those demands. Disability justice advocates have advocated for the deinstitutionalization of long-term care, which refers to investing in community-based alternatives to ensure people with additional care needs are not being removed and isolated from their communities.40

Access to care services for people with disabilities largely falls under provincial jurisdiction. This results in a wide range of policies providing different levels of benefits and services to people with disabilities across Canada.41 Rather than guaranteeing access to services, federal and provincial governments have largely taken the approach of providing cash benefits to people with disabilities far short of the levels needed. Federal assistance takes the form of the disability tax credit. It is a non-refundable tax credit however, meaning that only people with disabilities who have tax owing can benefit, leaving out people with the lowest incomes.

The Canada Disability Benefit Act, which is set to come into force this year, will create the first federal income supplement for persons with disabilities in Canada. The details of the benefit, however, are not laid out in the Act, leaving it to regulations to define the amount and eligibility criteria.42 The federal government must live up to its promise of “nothing about us without us” and meaningfully engage the disability community in the development of the program.43

Photo: Matheus Ferrero / Unsplash

Taken together, women receive more from the public pension system than men. However, this does not nearly compensate for the gap in private retirement income between men and women: men earn 18% more total retirement income than women and more senior women have low income than senior men. These inequalities are even larger for racialized women, who bear a disproportionate amount of the care workload. Retired racialized women receive only 63 cents for every dollar a retired non-racialized man receives.46

These inequalities stem, in part, from the failure to value care work through compensation. While the OAS and GIS make some progress by compensating seniors regardless of their previous engagement in paid work, they do little to transform gender norms or recognize the underlying inequity around payment, employment and care responsibilities across gendered lines.

The Canada Child Benefit (CCB) provides cash transfers to parents with income below a certain threshold. This compensates for the care work involved in raising a child and pays for the additional real costs incurred. The CCB has lifted a significant number of families out of poverty, although its value is insufficient for families facing the deepest poverty.47 This is a step towards valuing the care work involved in raising children, which is disproportionately done by mothers.

Canada’s public pensions and cash transfers related to care score relatively well. The public pension system, including the Canada Pension Plan (CPP), Old Age Security (OAS) and Guaranteed Income Supplement (GIS), provides income to seniors in Canada. In reality, the pension system is a combination of two very distinct systems that have very distinct implications for women and care workers. The CPP is a contributory system that provides income to those who paid into it while they were working. Because men are more likely to work in the paid workforce and women are more likely to engage in unpaid care work, men receive more CPP payments than women. The gender pay gap therefore directly translates into a gender gap between CPP payments to men and women workers. In Canada, women working full time and part time make 89 cents for every dollar that men make, and racialized women make on average only 59.3% of white men’s earnings.44 The gender pay gap is directly connected to other economy-related gender gaps – including fields of study and work, career advancement opportunities and time allotted to unpaid care and domestic work. In 2020, men received about 17% more than women in CPP payments.45 On the other hand, GIS and OAS are noncontributory and paid to legal residents in Canada over the age of 65 whose income is below a certain threshold. Women receive more OAS and GIS payments than men because their income from other sources is lower.

CARERELATED BENEFITS MUST BE ACCESSIBLE TO ALL

In Canada, racialized women working full time and part time make on average only 59.3% of white men’s earnings

Both of these care-supporting transfers, however, leave many marginalized groups behind. The CCB is only available to people with legal status who have resided in Canada for at least 18 months and who file taxes. The auditor general estimated that more than 3-4% of eligible families do not receive the CCB.48 This is in addition to all the undocumented and temporary residents who are ineligible for the CCB. Temporary residents and those who do not file their tax returns are at increased risk for poverty and are most in need of support to care for their children.49 OAS is only available to seniors with legal status who have lived in Canada for at least 10 years since the age of 18, and only at a reduced rate for those who have lived in Canada for less than 40 years since the age of 18. Both of these examples demonstrate that access to care-supporting transfers in Canada is limited for people with precarious immigration status.

The third indicator in this policy area is school meals or food vouchers. Canada currently has neither of these programs, making it the only G7 country without a national school meal program.50 A national school lunch program would redistribute unpaid care work from individuals, predominantly women, to the government and provide direct care to children who receive inadequate nutrition. Although Canada has begun consultations to develop a national school food policy,51 advocates have noted that this will not solve the underlying problems of food insecurity and inadequate nutrition for children in Canada, and especially those in remote communities.52 Children who do not receive adequate meals at school likely also do not receive adequate meals at home, and 1 in 5 children live in a household that experiences food insecurity.53 Direct cash transfers to low-income households could additionally be used to combat food insecurity among children. Building on the CCB, a policy where Canada scores well, could be a model for a national food program.54

WORKPLACES MUST OFFER CARESUPPORTING BENEFITS

Care-supporting workplace benefits, such as paid parental and sick leave, are one way that some of the costs associated with care work can be redistributed from individuals, especially women, to employers and the government. Canada scores relatively well in terms of offering care-supporting workplace benefits; however, there is a patchwork of policies at the provincial level. Federal policies mandating the provision of many workplace benefits, such as paid sick leave and flexible work, are only available for federally regulated workers. This is an example of an area where the federal government could take leadership by adopting best practices in federally regulated workplaces and encouraging provinces to follow.

Paid parental leave, offered through the Employment Insurance (EI) program, is the only policy in this area that is uniformly available across Canada, however accessibility gaps remain. An incentive to share parental leave between both parents was introduced in 2019, but much more could be done to redistribute care work between men and women. In 2021, women were still three times more likely to access parental leave than men due to the fact that benefit levels for the second caregiver are much lower.55 Furthermore, parents must work a certain number of hours before being eligible for the benefits. Due to labour market discrimination, workers from marginalized groups are more likely to work part time in short-term contracts.56 Accumulating enough hours or staying in one position long enough to qualify for benefits can be difficult.

One area of particular need for federal leadership is access to paid sick days. The COVID-19 pandemic exposed the devastating consequences of workers going to work sick and putting their colleagues at risk. The income precarity that many workers felt made unpaid time off unaffordable. In the care economy, it is particularly critical because sick workers risk infecting people receiving care who may be particularly vulnerable.

Federally regulated workers currently have access to 10 paid sick days and three days of paid personal leave, which, among other reasons, can be used to care for sick family members or dependents. This is a relatively new policy, only introduced last year. Access to paid leave to care for sick family members is especially important from an equity standpoint, as women are more likely than men

to miss work to care for family members.57 However, most workers fall under provincial jurisdiction, where only BC, PEI and Quebec offer permanently accessible paid sick days.58 Without paid leave available through every type of employment, workers facing financial stress or juggling multiple responsibilities will likely be unable to prioritize their health and the health of those with whom they regularly interact, both at home and in the workplace.

The COVID-19 pandemic also revealed the importance of flexible working conditions as a step towards greater gender equality.59 Federal policy should be strengthened to allow federally regulated workers flexibility in their work hours and location so that workers with care responsibilities are supported.

THE FEDERAL GOVERNMENT MUST STEP UP TO FUND CARESUPPORTING INFRASTRUCTURE

The construction and maintenance of physical infrastructure that supports care work largely falls under provincial jurisdiction in Canada. Nonetheless, the federal government has jurisdiction over some care-supporting infrastructure and can fund further investment in other areas.

Safe drinking water infrastructure is relevant to care policy because the failure to provide it results in a larger unpaid care workload, which disproportionately falls on women. In a context where safe drinking water is unavailable, the task of collecting it, using it for washing and cooking, and ensuring others have access to water for consumption can take hours in a week. The federal government has jurisdiction over federal lands and shared responsibility in First Nations communities. It has been well documented that the federal government has failed to live up to its responsibilities to ensure access to safe drinking water in First Nations communities. As of February 2023, there were 28 First Nations communities with long-term drinking water advisories and over 20 First Nations communities with short-term drinking water advisories.60 This points to a dire need for the federal government to provide care, while also promoting Indigenous self-determination, rights and control of land and resources.

The federal government faced a lawsuit regarding its failure to provide safe drinking water to First Nations communities between 1995 and 2021; it settled for $8bn.61 It has also committed to introducing new legislation to protect access to drinking water for First Nations communities after it repealed the previous Safe Drinking Water for First Nations Act following criticism that the Act infringed upon Indigenous communities’ rights and did not provide adequate funding to maintain water systems. While they have addressed safe drinking water in some communities, Once again, however, the federal government has failed to introduce the new legislation.

Internet infrastructure, in addition to access to electricity, is critical to ensure access to care services and lessen care workloads. The federal government has failed to provide cellular and internet services to Indigenous communities, especially Inuit communities. Although 91% of households have access to high-speed internet in Canada, only 59.5% of households in rural and remote communities and 42.9% of households in First Nation reserves have the same access.62 Access to these services has become essential to communications, education and safety. One of the recommendations of the 2019 Missing and Murdered Indigenous Women and Girls final report was “remote communities must be ensured access to reliable high-speed Internet as a right.”63 The federal government has committed $8bn in funding to increase access to cellular services and high-speed internet but must ensure that affordable access for Indigenous and remote communities is prioritized.

Access to public transportation is crucial to support and facilitate both paid and unpaid care work. Women are more likely to use public transportation than men, in part due to disparities in caregiving responsibilities, income and employment. Federal funding for public transportation should be used to ensure public transportation systems take into account the needs of the women and care workers who use them.64

The federal government has committed some funding to improve public transportation infrastructure. This funding, allocated through a permanent public transit fund, aims to make public transit “accessible regardless of factors such as age, ability, race, gender, or income.”65 To date, however, there is no explanation of how this will be achieved. Marginalized groups face barriers to accessing public transportation including unaffordable fares, unavailable service and safety concerns.66 The currently allocated funding, which focuses on funding infrastructure, will be insufficient to support municipalities with operating costs, which would be necessary to reduce or eliminate fares and alleviate safety concerns. Also, public transport is non-existent in rural and remote communities.

Only 59.5% of households in rural and remote communities and 42.9% of households in First Nation reserves have have access to high-speed internet in Canada

Photo: Luke Jones / Unsplash

Photo: Kevin Fouillet

Section 2 PAID CARE WORK

The laws and policies that guarantee the right to dignified work for care workers fall predominantly under provincial jurisdiction. Policies such as minimum wage, working hours and workplace health and safety regulations are all decided at the provincial level. Only federally regulated workers, which include few if any care workers, fall under the jurisdiction of federal labour law. Therefore, we limited the section of the scorecard related to paid care work conditions to federal policies that impact care workers across Canada. The two indicators that we retained tell an important story: the discrimination against migrant care workers and their vulnerability to violence in their workplaces are an outcome of Canadian immigration policies. At the same time, too little is being done to protect precarious care workers through the existing EI program.

IMMIGRATION REFORM IS A VITAL COMPONENT OF CARE

Canada’s policies to ensure equal rights and protections for migrant care workers score low. In Canada, there are 25,000 migrant care workers, many of whom are racialized women.67 As of 2019, 9.8% of all employees in private households were temporary foreign workers, despite only accounting for 2.9% of total employment.68 Many care workers can only access temporary work permits which provide few rights and protections and often do not offer accessible and timely pathways to permanent residency or citizenship.

One of the many ways Canadian immigration laws create precarity is by issuing employer-restricted work permits to migrant workers.69 For these workers, leaving an abusive employer means risking deportation and extending the timeframe before they can apply for permanent residency and family reunification. The threats of becoming undocumented or being deported add considerable stress to the lives of migrant care workers and violate their right to a safe work environment.

A survey of migrant care workers exposed the even more precarious employment conditions for migrant care workers who live in their employers’ homes. During the pandemic, live-in care workers who lost their employment also lost their homes, and those who remained employed reported an increase in working hours and unpaid wages and an intensification of employer control over their movements, among many other cases of abuse.

Currently, the Home Child Care Provider Pilot and Home Support Worker Pilot issue occupation-restricted work permits and pre-screen family members for permanent residency eligibility to attempt to minimize family separation and reduce worker abuse. Despite these policy changes, reports have shown that the complexity of the program and strict rules have made accessing permanent residency through these pilots even more difficult than in previous schemes.

The harmful impacts of Canada’s restrictive immigration laws have lasting consequences, and immigration reform must be combined with initiatives to remedy the harms that have been caused. 90% of workers admitted to

Canada through the Live-in Caregiver Program (housed within the Temporary Foreign Worker Program) which ran from 1992 to 2014 were from the Philippines. The temporary work permits did not allow care workers to migrate with their families, an example of the creation of global care chains. Today, data shows significant downward intergenerational social mobility for Filipino youth in Canada, and points to extended periods of familial separation under the Live-in Caregiver Program as one of the causes.

The devaluation of care work, which is typically viewed as women’s work, has led to a reliance on migrant workers in the care economy. This labour is both gendered and racialized, with immigrant women making up 31% of all nurse aides, orderlies and patient service associates in 2016, compared to only 13% of all workers. Twentysix percent of workers in those occupations were Black women, six times more than among all workers, and 25.6% were Filipino women, five times more than among all workers. Employers leverage the devaluation of care work to maintain low wages, limit employment security and avoid improving working conditions.

Table 3. Degrees of transformation (DoT) for indicators related to paid care work.

The precarity of workers’ immigration status, coupled with limited demand for these jobs, limits their ability to bargain for better working conditions. There is a direct correlation between the working conditions of care workers and the quality of care service users receive.

This means that protecting paid care workers and improving their working conditions will also improve experiences for service users.

Migrant care workers also have difficulty accessing benefits, such as the Canada Child Benefit and EI. During the COVID-19 pandemic, a third of respondents surveyed for the Behind Closed Doors report on migrant care workers reported having difficulty accessing EI or the Canada Emergency Response Benefit. Not only migrant workers experience problems with EI; only 38% of unemployed people have access to EI.

Workers in health care and social assistance, where women are overrepresented, are less likely to access

EI than workers in goods-producing industries, like construction, where men are overrepresented, due to the EI program’s restrictive requirements. Workers who work part-time, which is more common for women, especially those with caregiving responsibilities, are less likely to meet the eligibility criteria for EI. The EI program must be reformed so that it values all types of work, including paid and unpaid care work, which is disproportionately performed by racialized and Indigenous women.

In other policy areas that fall under provincial jurisdiction, the federal government can support paid care workers by tying transfer payments to adequate employment standards and by establishing best practices for labour rights for federally regulated workers. Canada is also in a position to ratify ILO Convention 189 on the rights of domestic workers, which in turn would result in the integration of laws to support and protect domestic work in provincial labour codes.

Photo: Jason Leung / Unsplash

Section 3 SOCIAL NORMS AND MEASUREMENT FRAMEWORKS

Canada has done little to explicitly combat gender stereotypes and norms around care work. The federal government should be commended for converting Status of Women Canada into a full government department, Women and Gender Equality Canada. The incorporation of gender-based analysis plus (GBA+) into the budgeting process has also been a welcome development. However, there are no explicit government policies aimed at increasing awareness of gender norms and care work through education or public campaigns, nor aimed at preventing the proliferation of gender stereotypes in advertising. Combating gender stereotypes and norms, which is essential to eliminating gender inequality, is not listed in the mandate of Women and Gender Equality Canada, nor any other government department.78

CARE AND GENDER NORMS MUST BE TACKLED EXPLICITLY

Gender stereotypes and norms around care work are contributing factors to gender inequality and gender-based violence. Gender norms that portray women as caretakers contribute to unequal participation in the workforce and higher pay in jobs typically occupied by men, leading to the gender pay gap. Gender-based violence is often used to reinforce the power differences and maintain the gender hierarchies that are learned early in our patriarchal society. Establishing explicit education policies to help children identify and unlearn gender stereotypes would help transform this patriarchal system. Educational policy is a provincial responsibility in Canada, but federal leadership could be shown by developing curricula to combat gender stereotypes and tying transfer payments to provincial implementation plans.

In addition to supporting other government departments to ensure their policies do not promote gender inequality, Women and Gender Equality Canada also works with community organizations to combat harmful gender stereotypes. However, an explicit mandate to address gender stereotypes, especially around care work, and a commitment to coordinate action at scale through education policy and public awareness campaigns could have transformational effects.

Although there is no federal policy to address gender stereotypes in advertising and media, industry bodies have set up self-regulating standards. The Canadian Code of Advertising Standards prohibits discrimination based on sex and gender identity and the media’s Equitable Portrayal Code prohibits “unduly negative stereotypical material” with regard to gender.79 These efforts by industry groups are commendable, however, they exist to fill a gap left by the federal government’s lack of

regulation. These industry bodies have little power to reprimand actors who publish ads or media containing harmful stereotypes and investigations are only conducted in response to public complaints. Deciding what media and ads are acceptable should be a matter of democratic deliberation, not a decision made by industry groups.

Understanding the gendered division of care work is not possible without high-quality data. Statistics Canada has conducted a time-use survey that allows for the estimation of time spent doing paid and unpaid care work every five to seven years since 1986. This is an invaluable resource for understanding the gendered division of care in Canada. Unfortunately, the most recent wave of this survey, conducted in 2015, did not collect sufficient data for racialized groups and Indigenous peoples to allow for an examination of the care workload for racialized or Indigenous women.80

2. Degrees of transformation (DoT) for indicators related to unpaid care work.

Although it is not yet complete, the Department of Finance and Statistics Canada are working together to develop a national measurement framework to monitor progress toward improving well-being.81 This work is encouraging and should be developed with an intersectional lens and an emphasis on valuing care work and other aspects of well-being missing from typical statistics. The draft set of indicators does include time use although it is not clear whether the gendered and racialized division of the care workload will be explicitly considered.

Canada has endeavoured to establish itself as a feminist leader in applying intersectional analysis to its policy development by requiring that all federal departments apply GBA+ to government policy. Unfortunately, the

implementation of GBA+ has left much to be desired. It has been critiqued for narrowing the goals of feminist movements and for failing to fully integrate an intersectional approach.82 Even if one accepts the limitations of the government’s GBA+ approach, the Auditor General concluded that the ”government does not know whether its use of GBA+ is achieving better gender equality outcomes.”83 In sum, although the federal government has made progress on collecting data around care work and gender inequality, there is still a long way to go to improve disaggregated data collection for groups experiencing intersecting axes of marginalization and to use this data to inform policy development and evaluation.

Photo: Nappy / Unsplash

Photo: Javier Allegue Barros / Unsplash

RECOMMENDATIONS

Creating a society that values paid and unpaid care work will require fundamental changes. Care policy is not limited to health care and child care policy. Care work can be valued through reforming the immigration system, investing in public transportation that is designed to meet women’s needs, supporting community-based care for people with disabilities, or ensuring all residents have access to paid sick leave. To create a society that truly values care, a whole of government approach will be needed.

To ensure a whole of government approach, the government should establish a national care economy commission tasked with designing and implementing a holistic strategy that recognizes care as a human right, combats gender norms surrounding care work and builds a robust system to provide child, disability, health and elder care. The right to care could be modeled after Uruguay’s national Care Act which establishes a right to care services, provides training to caregivers and explicitly aims at balancing the care workload between women and men.

The ability to provide and receive care must be available to all people living in Canada. This means that policies must prioritize the provision and receipt of care for groups who have typically been failed by care systems. This especially includes Indigenous peoples who have suffered from Canada’s colonial education, child care and health care policies.

To ensure a whole of government approach, the government should establish a national care economy commission.

Photo: Danie Franco / Unsplash

Indigenous women, in particular, have been especially harmed by these policies and are subject to discrimination. The phenomenon of Missing and Murdered Indigenous Women and Girls reflects an abject failure on the part of the federal government to care for Indigenous women.

Black and racialized people have also been failed by care systems through the prevalence of systemic racism and discrimination. The federal government must take concrete steps to eliminate racism and discrimination from care systems to uphold racialized peoples’ right to care. Special attention must also be paid to those without legal status who do not have access to many care services and care-related benefits in Canada. A right to care for those without legal status would involve regularizing their immigration status upon arrival.

The federal government must also make it a priority to combat gender norms around care work. Currently, no federal department has the mandate to transform gender norms around care or educate people about gender stereotypes. Without intentional action, gender norms around care will continue to persist, women will continue to bear a disproportionate amount of the care workload, and the gender pay gap will not be closed. The federal government should mandate Women and Gender Equality Canada to educate Canadians about discrepancies in the provision of care in Canada and the stereotypes that contribute to these discrepancies through public awareness campaigns and to work with provinces to develop school curricula.

Without intentional action, gender norms around care will continue to persist, women will continue to bear a disproportionate amount of the care workload and the gender pay gap will not be closed.

Supporting and redistributing unpaid care work

Supporting and redistributing unpaid care work involves investing in care-supporting infrastructure, ensuring equitable access to public care services, funding community-based options for care, enabling care-supporting workplaces and providing cash transfers to unpaid caregivers. We recommend the federal government do the following to support and redistribute unpaid care work:

1. Increase federal funding to expand non-profit and publicly owned early learning and child care, strengthen bilateral agreements with the provinces and territories and ensure accountability by the provinces and territories to meet the principles and targets set out in the federal framework, and develop a workforce strategy for child care workers that ensures adequate compensation and dignified working conditions

2. Mandate provinces and territories to meet the new standards for long-term care, and support the development of public and community-based longterm care options

3. Expand Canadian Medicare to include pharmacare, dentistry, vision, physical rehabilitation and mental health services, particularly for low income families and individuals.

4. Establish the Canada Disability Benefit to provide adequate levels of social protection and increase the children’s disability benefit to ensure all people with disabilities can access the care services they need and ensure people with disabilities have communitybased care options

5. Raise parental benefit levels for the second caregiver to encourage further redistribution of care within households.

6. Establish a national food program in schools and provide cash transfers to all families experiencing food insecurity

7. Increase investment in publicly constructed and operated public transportation services, especially in remote and rural communities, that take into account the particular needs of women

8. Continue to invest in drinking water infrastructure in First Nations communities to end all drinking water advisories immediately

9. Ensure all Canadians have access to cellular and high-speed internet services, especially in rural and remote communities

10. Introduce policies that educate people about gender stereotypes and norms around care work. Currently, there are no national policies to fund education campaigns that pertain specifically to care work within Canada.

Supporting paid care workers

The federal government also has a significant role to play in protecting paid care workers, who are disproportionately racialized and immigrant women. Even though labour rights largely fall under provincial jurisdiction, there are many actions the federal government can take to improve the working conditions of paid care workers:

1. Develop a national strategy to recruit and retain care workers, considerate of global care chains, and ensure care workers are fairly compensated, have paid sick leave and enjoy dignified working conditions

2. Immediately eliminate employer-restricted work visas for temporary foreign workers and provide all temporary foreign workers with permanent residency upon arrival

3. Implement Employment Insurance reforms expanding access, particularly for precarious workers, and boosting the benefit rate, and implementing a permanent minimum weekly benefit

4. Broaden access to the Canada Child Benefit for families with precarious status by repealing legislation tying eligibility to immigration status

5. Ratify ILO Convention 189 on the rights of domestic workers

1. A. Ali, et al. (2022). The Burnout Crisis: A Call to Invest in ECE and Child and Youth Workers. Retrieved 3 May 2023, from https://cccf-fcsge.ca/wp-content/uploads/2022/09/The-BurnoutCrisis-EN.pdf

2. S. Uppal. (2023). Rising prices and the impact on the most financially vulnerable: A profile of those in the bottom family income quintile. Retrieved 3 May 2023, from https://www150.statcan. gc.ca/n1/pub/75-006-x/2023001/article/00002-eng.htm

3. The Care Economy Knowledge Hub. Retrieved from https://www.the-care-economy-knowledge-hub.org/

4. Statistics Canada. (2022, 8 November). More than half of women provide care to children and care-dependent adults in Canada, 2022. Retrieved 3 May 2023, from https://www150.statcan. gc.ca/n1/en/daily-quotidien/221108/dq221108b-eng.pdf?st=5ySXhYeX

5. Canadian Women’s Foundation, Canadian Centre for Policy Alternatives, Ontario Nonprofit Network, and F. Faraday. (2020). Resetting Normal: Women, Decent Work and Canada’s Fractured Care Economy. Retrieved 3 May 2023, from https://canadianwomen.org/wp-content/uploads/2020/07/ResettingNormal-Women-Decent-Work-and-Care-EN.pdf

6. Statistics Canada. (2022). Study: women working in paid care occupations. Retrieved 3 May 2023, from https://www150.statcan.gc.ca/n1/daily-quotidien/220125/dq220125a-eng.htm

7. The Care Economy. Retrieved 7 April 2023, from https://thecareeconomy.ca/

8. G. Chang. (2016). Disposable Domestics: Immigrant Women Workers in the Global Economy. Chicago: Haymarket Books.

9. Ibid.

10. A.P. Butt, et al. (2021). Care Policy Scorecard: A tool for assessing country progress towards an enabling policy environment on care. Retrieved 3 May 2023, from https://policy-practice. oxfam.org/resources/care-policy-scorecard-a-tool-for-assessing-country-progress-towards-an-enabling-621287/

11. Oxfam, International Center for Research on Women (ICRW) Asia, International Domestic Workers Federation, Africa Leadership Forum, UK Women’s Budget Group, Ciudadanía Bolivia, Padare Men’s Forum Zimbabwe, the Ugandan Women’s Network and Youth Alive! Kenya.

12. Ibid.

13. Ibid.

14. The Changing Nature of Work. Retrieved from https://www.statcan.gc.ca/o1/en/plus/249-changing-nature-work

15. Please see the acknowledgements page for information about the Advisory Group

16. Canada Health Act, RSC, 1985, c C-6

17. National Collaborating Centre for Indigenous Health. (2019). Access to health services as a social determinant of First Nations, Inuit and Métis health. Retrieved 3 May 2023, from https:// www.nccih.ca/docs/determinants/FS-AccessHealthServicesSDOH-2019-EN.pdf

18. Ontario Nonprofit Network. (n.d.). Not For Sale: The Case for Nonprofit Ownership and Operation of Community Infrastructure. Retrieved 4 March 2023, from https://theonn.ca/publication/notfor-sale-the-case-for-nonprofit-ownership-and-operation-of-community-infrastructure/

19. Penner, D. (2020). Public-private partnerships have no place in Canada’s pandemic recovery. The Council of Canadians. https://canadians.org/analysis/public-private-partnerships-haveno-place-canadas-post-covid-just-recovery/

20. Canadian Doctors for Medicare. (n.d.). Myth: «Privatization» can help everyone access health care. https://www.canadiandoctorsformedicare.ca/myth_privatization

21. N. Akhtar-Danesh, et al. (2022). COVID-19 excess mortality among long-term care residents in Ontario, Canada. PLoS One, 17(1).

22. H. Walia. (2021). Border and Rule: Global Migration, Capitalism, and the Rise of Racist Nationalism. Chicago: Haymarket Books.

23. J. Fudge. (2011). Global Care Chains, Employment Agencies and the Conundrum of Jurisdiction: Decent Work for Domestic Workers in Canada. Canadian Journal of Women and the Law. 23(1), 235–64.

24. L.McQuillan. (2022, November 20). Canada’s push to ‘poach’ nurses from abroad fuels fears of shortages in developing countries. CBC News.

25. H. Walia. (2021). Border and Rule: Global Migration, Capitalism, and the Rise of Racist Nationalism. Chicago: Haymarket Books.

26. National Centre for Truth and Reconciliation, Memorial. Retrieved from https://nctr.ca/memorial/

27. B. Gunn. (n.d.). Ignored to Death: Systemic Racism in the Canadian Healthcare System. Retrieved 7 April 2023, from https://www.ohchr.org/sites/default/files/Documents/Issues/IPeoples/ EMRIP/Health/UniversityManitoba.pdf

28. L. Gebremikael, et al. (2022). Afrocentric approaches to disrupting anti-Black racism in health care and promoting Black health in Canada. Canadian Medical Association Journal, 194(42), E1448–E1450.

29. N. Kanani. (2011). Race and Madness: Locating the Experiences of Racialized People With Psychiatric Histories in Canada and the United States. Critical Disability Discourses, 3.

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endnotes