CAREGIVING: A FAR-REACHING PUBLIC HEALTH CONCERN

Abstract

Talley and Crews provide needed attention to family caregiving as a public health issue.1 Their description of caregiving in terms of the relationship between the elder care recipient and care provider is welcoming to this clinician and researcher. The urgency of caregiving is made more pressing by the passage of the Older Americans Act Amendments of 2000, which established the National Family Caregiver Support Program.2 Broadening the focus of caregiving—to include grandparents caring for children living with them and anyone caring for older persons—has magnified the implications of caregiving to encompass a range of traditional public health concerns, from child well-being to health promotion and access to care. In 2001, the California Department of Aging released a report that summarized findings from more than 180 journal articles into a systems-based framework.3 This model shaped caregiving into a life-course perspective of a family system for the benefit of local program planning. It treated caregiving as an interactional process marked by changes in social involvement, familial support, and well-being throughout the caregiving career, in addition to the changes in the clinical course of each disabling condition or the life demands of the caregivers. The model recognized many aspects of access to care as challenges that caregivers could face. It took into account not only the physical and financial barriers but also the less-well-researched areas influencing the perception of access, such as having knowledge about available services4 or working with clinicians who might not be able to build a therapeutic alliance with certain clients.5 The last domain within this model recognized inter- and intrapersonal resources of caregivers and the influences of caregivers’ values and beliefs, such as expectations about caregiving on the basis of gender, generational values, and ethnic or cultural background. Under the National Family Caregiver Support Program, the importance of caregiving as an emerging public health issue can be seen by observing how the events of caregiving over time may touch on more-traditional aspects of public health. A holistic view is needed to examine and manage family caregiving in a society that is becoming more ethnically and culturally diverse. The challenge for public health systems is to develop a strategy for reaching out to all Americans that is sensitive to the complexities of caregiving. Policies and programs targeting caregivers need to be meaningful and relevant to the targeted populations.