A Dialectical Simplicity approach to health and care
1. Introduction: Care as the Fabric of Life
Care is not a niche issue. It is not soft, secondary, or sentimental. It is foundational. Without care, nothing else works—no economy, no family, no democracy. From the moment we are born to the moment we die, we depend on the care of others. Yet in policy, in budgets, and too often in culture, care is overlooked, undervalued, and underpaid.
Dialectical Simplicity calls for a radical revaluation of care—not only as a service, but as an ethic, a structure, and a political priority.
2. Who Cares? And Who Gets Paid For It?
Globally, the majority of care work—whether raising children, supporting disabled people, or tending to the elderly—is done by women. Much of it is unpaid. Where care is paid, it is often low-waged, casualised, and emotionally demanding. In Aotearoa New Zealand, care and support workers (including those in aged care and disability services) are disproportionately women, Māori, and Pasifika【1】.
Many of these workers earn little more than the legal minimum wage. A 2023 report from the New Zealand Council of Trade Unions noted that even after the Equal Pay settlement of 2017, care workers still face rising living costs, short staffing, and inadequate funding models that treat their work as an expense rather than an investment【2】.
This is not simply an economic problem. It is a moral and political one. When the people who provide the most essential human support are paid the least, something is deeply wrong with our values.
3. Quality of Care: More Than a Metric
Care is not a widget. It cannot be mass-produced, standardised, or measured purely by outputs. Yet modern public services have increasingly adopted managerial logics from the corporate world: KPIs, targets, dashboards. While some measurement is necessary, too much reduces care to checklists.
Good care requires:
- Time: to listen, to notice, to build trust.
- Continuity: relationships, not just tasks.
- Judgement: knowing when to bend the rules for the right reasons.
- Presence: being with someone, not just doing something for them.
Zen traditions speak of right attention—a full presence that is non-instrumental. Applied to care, this means seeing the person in front of you as more than a diagnosis or a schedule. It is a kind of relational awareness. No dashboard can capture that.
The philosopher Joan Tronto argues that quality care involves “attentiveness, responsibility, competence, responsiveness, and solidarity.”【3】These are human, not transactional, qualities.
4. The Economics of Care
Funding for health and care is often treated as a cost to be contained. But what if we treated it as core infrastructure—just as vital as roads or energy?
Keynesian economics teaches us that public spending in times of underemployment and social need is not a drain—it is a stimulus. Investment in care creates jobs, boosts household incomes, and enhances long-term wellbeing. Studies show that care work creates more employment per dollar than construction or tech【4】.
And yet governments frequently underfund care. In New Zealand, the recent 2025 Budget proposed changes to procurement rules that risk removing Living Wage guarantees from government contractors, directly threatening the income of thousands of aged care, disability, and cleaning workers【5】.
This is not fiscal responsibility. It is a false economy. The long-term costs of neglect—hospital admissions, burnout, poverty, and isolation—are far higher.
5. Care Work Is Climate Work
Care is also ecological. A society that values care is one that values repair, maintenance, and regeneration—over extraction, speed, and profit.
When we care for the elderly, the ill, the land, or each other, we slow down. We adapt. We listen. These are the very qualities we need to survive the climate crisis. As feminist political theorist Berenice Fisher puts it, “Care is the work that maintains, continues, and repairs our world.”【6】
Investment in low-carbon, high-impact sectors like care is one of the fastest ways to create green jobs without carbon footprints. Building more hospitals, expanding in-home care, and supporting families to care for one another are acts of climate mitigation as well as justice.
6. Revaluing Care Through Structure
We must stop expecting individuals to carry the burdens of broken systems. While personal virtue is admirable, it is not structural change. To revalue care, we must rewire how society allocates its time, money, and prestige.
That means:
- Universal public healthcare, fully funded and free at the point of use.
- Sector-wide pay equity settlements that are costed and enforced.
- Secure hours, proper training, and career pathways for all care workers.
- State investment in aged care, disability support, and mental health as essential services, not market commodities.
- Care leave and parenting policies that recognise the realities of life, not just economic efficiency.
The 2017 Equal Pay Settlement in New Zealand was a landmark, but it only covered a portion of the sector. Successive governments have stalled on expanding it. Without constant pressure, gains are eroded.
7. A Culture of Mutual Care
The revaluation of care is not only about funding—it is about culture. Capitalist modernity has long idealised independence: the self-made man, the lone entrepreneur, the rugged survivor. But this is a myth. Everyone depends on someone.
We must build a culture that recognises interdependence as strength. That honours carers and the cared-for. That treats vulnerability not as weakness, but as part of being human.
During COVID-19, we clapped for essential workers. But clapping is not payment. Clapping is not a safe roster. If we truly value care, we must show it in policy, pay, and practice.
8. Conclusion: The Care We Owe Each Other
Dialectical Simplicity teaches that the most valuable things in life are not the most profitable. Care is one of them.
To care well requires time, attention, and support. It is not efficient. It is not cheap. But it is essential. In valuing care, we begin to repair not only our systems, but our sense of what matters.
We live in a world of fraying connections. Reweaving them begins here: in the hands that hold us.
References
- Statistics NZ. (2024). Women and Work: Occupational Breakdown by Sector.
- NZCTU. (2023). Care Workers: Still Waiting for Justice.
- Tronto, J. (2013). Caring Democracy.
- De Henau, J. & Himmelweit, S. (2020). A Care-Led Recovery from Coronavirus. Women’s Budget Group UK.
- NZ Government Procurement (2025). Proposed Rule Changes and Living Wage Review.
- Fisher, B. & Tronto, J. (1990). Toward a Feminist Theory of Caring.