IDEAS home Printed from
   My bibliography  Save this article

Demographic, health, and economic transitions and the future care burden


  • King, Elizabeth M.
  • Randolph, Hannah L.
  • Floro, Maria S.
  • Suh, Jooyeoun


The COVID-19 pandemic has caused millions of infections and deaths worldwide, forced schools to suspend classes, workers to work from home, many to lose their livelihoods, and countless businesses to close. Throughout this crisis, families have had to protect, comfort and care for their children, their elderly and other members. While the pandemic has greatly intensified family care responsibilities for families, unpaid care work has been a primary activity of families even in normal times. This paper estimates the future global need for caregiving, and the burden of that need that typically falls on families, especially women. It takes into account projected demographic shifts, health transitions, and economic changes in order to obtain an aggregate picture of the care need relative to the potential supply of caregiving in low-, middle- and high-income countries. This extensive margin of the future care burden, however, does not capture the weight of that burden unless the quantity and quality of care time per caregiver are taken into account. Adjusting for care time given per caregiver, the paper incorporates data from time-use surveys, illustrating this intensive margin of the care burden in three countries that have very different family and economic contexts—Ghana, Mongolia, and South Korea. Time-use surveys typically do not provide time data for paid care services, so the estimates depend only on the time intensity of family care. With this caveat, the paper estimates that the care need in 2030 would require the equivalent of one-fifth to two-fifths of the paid labor force, assuming 40 weekly workhours. Using the projected 2030 mean wage for care and social service workers to estimate the hypothetical wage bill for these unpaid caregivers if they were paid, we obtain a value equivalent to 16 to 32 percent of GDP in the three countries.

Suggested Citation

  • King, Elizabeth M. & Randolph, Hannah L. & Floro, Maria S. & Suh, Jooyeoun, 2021. "Demographic, health, and economic transitions and the future care burden," World Development, Elsevier, vol. 140(C).
  • Handle: RePEc:eee:wdevel:v:140:y:2021:i:c:s0305750x2030499x
    DOI: 10.1016/j.worlddev.2020.105371

    Download full text from publisher

    File URL:
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL:
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    1. Robert C. Feenstra & Robert Inklaar & Marcel P. Timmer, 2015. "The Next Generation of the Penn World Table," American Economic Review, American Economic Association, vol. 105(10), pages 3150-3182, October.
    2. Lidia Farré & Yarine Fawaz & Libertad González Luna & Jennifer Graves, 2020. "How the covid-19 lockdown affected gender Inequality in paid and unpaid work in Spain," Economics Working Papers 1728, Department of Economics and Business, Universitat Pompeu Fabra.
    3. Adams-Prassl, Abi & Boneva, Teodora & Golin, Marta & Rauh, Christopher, 2020. "Inequality in the impact of the coronavirus shock: Evidence from real time surveys," Journal of Public Economics, Elsevier, vol. 189(C).
    4. OECD & World Bank & UN Environment, 2018. "Financing Climate Futures," World Bank Publications - Books, The World Bank Group, number 32517, December.
    5. Margaret Maurer-Fazio & Rachel Connelly & Lan Chen & Lixin Tang, 2011. "Childcare, Eldercare, and Labor Force Participation of Married Women in Urban China, 1982–2000," Journal of Human Resources, University of Wisconsin Press, vol. 46(2), pages 261-294.
    6. K. Bolin & B. Lindgren & P. Lundborg, 2008. "Informal and formal care among single‐living elderly in Europe," Health Economics, John Wiley & Sons, Ltd., vol. 17(3), pages 393-409, March.
    7. Lan Liu & Xiao-yuan Dong & Xiaoying Zheng, 2010. "Parental Care and Married Women's Labor Supply in Urban China," Feminist Economics, Taylor & Francis Journals, vol. 16(3), pages 169-192.
    8. Gema Zamarro, 2020. "Family labor participation and child care decisions: the role of grannies," SERIEs: Journal of the Spanish Economic Association, Springer;Spanish Economic Association, vol. 11(3), pages 287-312, September.
    9. Tilton, John E. & Crowson, Phillip C.F. & DeYoung, John H. & Eggert, Roderick G. & Ericsson, Magnus & Guzmán, Juan Ignacio & Humphreys, David & Lagos, Gustavo & Maxwell, Philip & Radetzki, Marian & Si, 2018. "Public policy and future mineral supplies," Resources Policy, Elsevier, vol. 57(C), pages 55-60.
    10. Yanagisawa, Satoko & Poudel, Krishna C. & Jimba, Masamine, 2010. "Sibling caregiving among children orphaned by AIDS: Synthesis of recent studies for policy implications," Health Policy, Elsevier, vol. 98(2-3), pages 121-130, December.
    11. Nguyen, Ha Trong & Connelly, Luke Brian, 2014. "The effect of unpaid caregiving intensity on labour force participation: Results from a multinomial endogenous treatment model," Social Science & Medicine, Elsevier, vol. 100(C), pages 115-122.
    12. Annika Meng, 2013. "Informal home care and labor-force participation of household members," Empirical Economics, Springer, vol. 44(2), pages 959-979, April.
    13. Jian-Huang She & Dan Grecu, 2018. "Neural Network for CVA: Learning Future Values," Papers 1811.08726,
    14. Compton, Janice & Pollak, Robert A., 2014. "Family proximity, childcare, and women’s labor force attachment," Journal of Urban Economics, Elsevier, vol. 79(C), pages 72-90.
    15. Dang, Hai-Anh H. & Viet Nguyen, Cuong, 2021. "Gender inequality during the COVID-19 pandemic: Income, expenditure, savings, and job loss," World Development, Elsevier, vol. 140(C).
    16. Bernard Berg & Werner Brouwer & Marc Koopmanschap, 2004. "Economic valuation of informal care," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 5(1), pages 36-45, February.
    17. Nancy Folbre & Jayoung Yoon, 2007. "What is child care? Lessons from time-use surveys of major English-speaking countries," Review of Economics of the Household, Springer, vol. 5(3), pages 223-248, September.
    18. Maria Sagrario Floro & Marjorie Miles, 2003. "Time use, work and overlapping activities: evidence from Australia," Cambridge Journal of Economics, Cambridge Political Economy Society, vol. 27(6), pages 881-904, November.
    19. Renske Hoefman & Job Exel & Werner Brouwer, 2013. "How to Include Informal Care in Economic Evaluations," PharmacoEconomics, Springer, vol. 31(12), pages 1105-1119, December.
    20. Jooyeoun Suh & Nancy Folbre, 2016. "Valuing Unpaid Child Care in the U.S.: A Prototype Satellite Account Using the American Time Use Survey," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 62(4), pages 668-684, December.
    21. Olivier Blanchard, 2018. "On the future of macroeconomic models," Oxford Review of Economic Policy, Oxford University Press and Oxford Review of Economic Policy Limited, vol. 34(1-2), pages 43-54.
    22. Pastore, Francesco, 2018. "New Education Models for the Future of Work Force," GLO Discussion Paper Series 267, Global Labor Organization (GLO).
    23. Li Da Xu & Eric L. Xu & Ling Li, 2018. "Industry 4.0: state of the art and future trends," International Journal of Production Research, Taylor & Francis Journals, vol. 56(8), pages 2941-2962, April.
    24. Christine S. M. Currie & Trivikram Dokka & John Harvey & Arne K. Strauss, 2018. "Future research directions in demand management," Journal of Revenue and Pricing Management, Palgrave Macmillan, vol. 17(6), pages 459-462, December.
    Full references (including those not matched with items on IDEAS)


    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.

    Cited by:

    1. André Cieplinski & Simone D'Alessandro & Chandni Dwarkasing & Pietro Guarnieri, 2022. "Narrowing women’s time and income gaps: an assessment of the synergies between working time reduction and universal income schemes," Working Papers 250, Department of Economics, SOAS University of London, UK, revised Apr 2022.
    2. Víctor-Raúl López-Ruiz & José Luis Alfaro-Navarro & Nuria Huete-Alcocer & Domingo Nevado-Peña, 2022. "Psychological and Social Vulnerability in Spaniards’ Quality of Life in the Face of COVID-19: Age and Gender Results," IJERPH, MDPI, vol. 19(16), pages 1-16, August.
    3. Karolina Hoffmann & Dorota Kopciuch & Aleksandra Bońka & Michał Michalak & Wiesław Bryl & Krzysztof Kus & Elżbieta Nowakowska & Tomasz Zaprutko & Piotr Ratajczak & Anna Paczkowska, 2023. "The Mental Health of Poles during the COVID-19 Pandemic," IJERPH, MDPI, vol. 20(3), pages 1-16, January.
    4. Ourania Tzoraki & Svetlana Dimitrova & Marin Barzakov & Saad Yaseen & Vasilis Gavalas & Hani Harb & Abas Haidari & Brian P. Cahill & Alexandra Ćulibrk & Ekaterini Nikolarea & Eleni Andrianopulu & Miro, 2021. "The Impact of the COVID-19 Pandemic on the Working Conditions, Employment, Career Development and Well-Being of Refugee Researchers," Societies, MDPI, vol. 11(3), pages 1-13, July.
    5. Ruttana Phetsitong & Patama Vapattanawong & Rosie Mayston & Martin Prince & Kia-Chong Chua, 2022. "In Caring for Older People in Low- and Middle-Income Countries, Do Older Caregivers Have a High Level of Care Burden and Psychological Morbidity Compared to Younger Caregivers?," IJERPH, MDPI, vol. 19(24), pages 1-12, December.
    6. Yunjie Luo & Yoko Sato, 2021. "Health-Related Quality of Life and Risk Factors among Chinese Women in Japan Following the COVID-19 Outbreak," IJERPH, MDPI, vol. 18(16), pages 1-13, August.
    7. Maria Dosil-Santamaria & Naiara Ozamiz-Etxebarria & Nahia Idoiaga Mondragon & Hiram Reyes-Sosa & Javier Santabárbara, 2022. "Emotional State of Mexican University Students in the COVID-19 Pandemic," IJERPH, MDPI, vol. 19(4), pages 1-11, February.
    8. Aleem, Majid & Sufyan, Muhammad & Ameer, Irfan & Mustak, Mekhail, 2023. "Remote work and the COVID-19 pandemic: An artificial intelligence-based topic modeling and a future agenda," Journal of Business Research, Elsevier, vol. 154(C).
    9. Cieplinski, André & D'Alessandro, Simone & Dwarkasing, Chandni & Guarnieri, Pietro, 2023. "Narrowing women’s time and income gaps: An assessment of the synergies between working time reduction and universal income schemes," World Development, Elsevier, vol. 167(C).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Lusi Liao & Sasiwimon Warunsiri Paweenawat, 2022. "Alternative boomerang kids, intergenerational co-residence, and maternal labor supply," Review of Economics of the Household, Springer, vol. 20(2), pages 609-634, June.
    2. Fukai, Taiyo & Ikeda, Masato & Kawaguchi, Daiji & Yamaguchi, Shintaro, 2023. "COVID-19 and the employment gender gap in Japan," Journal of the Japanese and International Economies, Elsevier, vol. 68(C).
    3. Ke Shen & Ping Yan & Yi Zeng, 2016. "Coresidence with elderly parents and female labor supply in China," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 35(23), pages 645-670.
    4. Valentina Rivera & Francisca Castro, 2021. "Between Social Protests and a Global Pandemic: Working Transitions under the Economic Effects of COVID-19," Social Sciences, MDPI, vol. 10(4), pages 1-21, April.
    5. Kugler, Maurice & Viollaz, Mariana & Duque, Daniel & Gaddis, Isis & Newhouse, David & Palacios-Lopez, Amparo & Weber, Michael, 2023. "How did the COVID-19 crisis affect different types of workers in the developing world?," World Development, Elsevier, vol. 170(C).
    6. Fiaschi, Davide & Tealdi, Cristina, 2023. "The attachment of adult women to the Italian labour market in the shadow of COVID-19," Labour Economics, Elsevier, vol. 83(C).
    7. Fukai, Taiyo & Ikeda, Masato & Kawaguchi, Daiji & Yamaguchi, Shintaro, 2021. "COVID-19 and the Employment Gender Gap," IZA Discussion Papers 14711, Institute of Labor Economics (IZA).
    8. Scott, Douglas & Freund, Richard & Favara, Marta & Porter, Catherine & Sanchez, Alan, 2021. "Unpacking the Post-lockdown Employment Recovery of Young Women in the Global South," IZA Discussion Papers 14829, Institute of Labor Economics (IZA).
    9. Fiaschi, Davide & Tealdi, Cristina, 2022. "Scarring Effects of the COVID-19 Pandemic on the Italian Labour Market," IZA Discussion Papers 15102, Institute of Labor Economics (IZA).
    10. Sara Grubanov-Boskovic & Spyridon Spyratos & Stefano Maria Iacus & Umberto Minora & Francesco Sermi, 2021. "Monitoring COVID-19-induced gender differences in teleworking rates using Mobile Network Data," Papers 2111.09442,, revised Nov 2021.
    11. Gema Zamarro & María J. Prados, 2021. "Gender differences in couples’ division of childcare, work and mental health during COVID-19," Review of Economics of the Household, Springer, vol. 19(1), pages 11-40, March.
    12. Juan Oliva-Moreno & Luz María Peña-Longobardo & Leticia García-Mochón & María del Río Lozano & Isabel Mosquera Metcalfe & María del Mar García-Calvente, 2019. "The economic value of time of informal care and its determinants (The CUIDARSE Study)," PLOS ONE, Public Library of Science, vol. 14(5), pages 1-15, May.
    13. Bauer, Jan Michael & Sousa-Poza, Alfonso, 2015. "Impacts of Informal Caregiving on Caregiver Employment, Health, and Family," IZA Discussion Papers 8851, Institute of Labor Economics (IZA).
    14. Janina Reinkowski, 2014. "Empirical Essays in the Economics of Ageing and the Economics of Innovation," ifo Beiträge zur Wirtschaftsforschung, ifo Institute - Leibniz Institute for Economic Research at the University of Munich, number 53.
    15. Huamin Chai & Rui Fu & Peter C. Coyte, 2021. "Unpaid Caregiving and Labor Force Participation among Chinese Middle-Aged Adults," IJERPH, MDPI, vol. 18(2), pages 1-25, January.
    16. Claudia Hupkau & Barbara Petrongolo, 2020. "Work, Care and Gender during the COVID‐19 Crisis," Fiscal Studies, John Wiley & Sons, vol. 41(3), pages 623-651, September.
    17. Jung, Haeil & Kim, Jun Hyung & Hong, Gihyeon, 2023. "Impacts of the COVID-19 crisis on single-person households in South Korea," Journal of Asian Economics, Elsevier, vol. 84(C).
    18. Elena Ellmeier & Melanie Koch & Thomas Scheiber, 2023. "Saving behavior along the income distribution during the COVID-19 pandemic," Focus on European Economic Integration, Oesterreichische Nationalbank (Austrian Central Bank), issue Q1/23, pages 7-21.
    19. Heger, Dörte & Korfhage, Thorben, 2017. "Does the negative effect of caregiving on work persist over time?," Ruhr Economic Papers 703, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.

    More about this item


    Global care burden; Extensive margin of care need; Unpaid household caregiving; Care economy; Time-use data; Care dependency ratios;
    All these keywords.

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • J1 - Labor and Demographic Economics - - Demographic Economics
    • O1 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development


    Access and download statistics


    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:wdevel:v:140:y:2021:i:c:s0305750x2030499x. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.