The Culture and Politics of Health Care Work. Ithaca and London: ILR Press (an imprint of Cornell University Press), 2023. xi, 182 pp. (B&W photos.) US$47.00, cloth; US$31.00, ebook. ISBN 9781501768040.
Robots could be said to have helped “save” Japan following its devastating defeat in the Pacific War. As its failures of technology were partially blamed for the country’s military losses, Japan invested heavily in revamping its technological armament for the economic recovery to follow. With such innovations as its “just-in-time” delivery system, postwar Japan achieved double-digit economic growth through the high output of productive workers alongside high-tech machines. Embracing industrial robots, Japanese factories deployed more than anywhere else in the world by the 1980s (and ten times the rate in the United States). As an economic power friendly to robots, Japan became globally known as a “robotopia” (Frederik L. Schodt, Inside the Robot Kingdom: Japan, Mechatronics, and the Coming Robotopia, Tokyo: Kodansha International, 1988).
In the fascinating story told here by James Wright, robots have been far less successful in handling the current crisis facing Japan of a rapidly aging population requiring care. With one in three Japanese now over the age of 65, a life expectancy of 85, and the ratio of those working age to elderly closing quickly (from 1 to 4 in 2000 due to be near parity in 2050 when 40 percent of the population is predicted to be over 65), the matter of carework is pressing. But the kind of labor needed here is quite different from what fueled the industrial apparatus of postwar Japan. And what reproduced those workers—a social unit of nuclear families with homes cared for by women—is now drying up: a product itself of the investments made by “Japan Inc.” in the second half of the twentieth century. While a robust welfare system was instituted in the 1970s (and supplemented by a generous long-term care insurance system for the elderly in 2000), the increasing emphasis placed on the market in Japan has commodified the delivery of care at a time when there is a huge crunch in both facilities and laborers to carry it out. This is the problem—a crisis as much of capitalism as of care—that Wright so astutely analyzes in this wonderful book.
Rather than a human solution (such as opening up the country to immigrants, as have other countries facing a labor shortage in care or other areas), the Japanese government has sought a technological one by supporting a number of state and corporate initiatives to develop robotic technology for elderly care. Wright focuses on one of these and the world’s largest to date. Part of then-Prime Minister Abe’s Robot Revolution Initiative of 2015, and overseen by AIST (National Institute of Advanced Industrial Science and Technology) under METI (Ministry of Economy, Trade, and Industry), this was the Project for the Development and Promotion and Introduction of Robot Care Devices, aka the Robot Care Project. Doing fieldwork between 2016 and 2020, Wright studied both those designing the robots (at the AIST research lab) and would-be users of them (in a nursing home in Kanagawa Prefecture during the time it did six-week trials with three different care robots). As Wright shows, the dissonance between the two of these couldn’t be more striking. At AIST, where engineers and programmers worked to develop safe and effective robotics devices, the emphasis was on distilling categories of need/care based on statistics of ADL (activities of daily life in elderly care) that would be implemented by regulatory measures that would encourage commercial, and not just public, production of care robots. The atmosphere here was silent; the work one of algorithms and abstraction; and the input of careworkers not solicited at all. At Sakura (the nursing home), by contrast, things were constantly bustling with the everydayness of routines and the flow through them that care workers choreographed with the “users” of the facility. Taking us into the intimacy of the scene here, Wright breaks down the ADL of elderly care as it actually takes place in the context of this publicly funded nursing home, by minimally paid workers tending to the elderly, almost all of whom have some dementia or physical disability.
In superb ethnography done with its director (Mr. K.), staff members, and a number of the elderly, Wright tracks the trial-runs that were conducted at Sakura with three different care robots: Hug (a lifting robot), Paro (a seal pup used as a therapeutic communication device), and Pepper (a cute humanoid robot deployed to assist with recreation). Though these robotic care devices were all intended to save careworkers’ time by substituting or reducing their labor, Mr. K. decides at the end that none have adequately done so. But Wright gives us an even more stunning finding with this. While some of the elderly didn’t mind, or actively welcomed, their robotic encounters (particularly with the cuddly Paro), it was the staff who objected on the grounds that these machines interfered with the “personal touch” they should be giving their charges. This was true even with Hug, a device that could help with the 400 lifts workers average per day that incur back problems in 58 percent of them. But when lifting becomes mechanized, it threatens “the ethical basis of care.” And Wright reports that workers identify the human slowness of the care given the elderly as a primary reason for liking the work, and the “homeyness” of the workplace. This despite the fact that the job is low-paid and socially devalued.
Just as Sakura decides against adopting care robots, a 2019 study done of the over 9,000 eldercare facilities in Japan showed that only about 10 percent had introduced care robots of any kind (134). Noting that the actual usage is probably lower, Wright concludes that care robots have not proven to be the solution to Japan’s aging problem and crisis of eldercare. Besides not being popular with staff and increasing rather than reducing their work, care robots are expensive—and not cost-effective for many facilities. This then leaves the problem of care scarcity—insufficient workers to provide the work of care to a rising population of elderly—unsolved. This is a problem that more and more countries will be facing as the trend towards longer life expectancy and aging populations increases across the world. Wright ends less plaintively than critically compassionate—about the need for a new balance between productivity and care. Speaking of Japan, but also beyond, he urges that we listen carefully to what the care workers at Sakura have told him—about the need for a humanistic elder-care that doesn’t deskill, devalue, or dehumanize either those being cared for or those doing the carework. If Japan could come up with a prototype for this, that would be a major feat. But, as Wright has persuasively argued, care robots have not yet been designed to do this. Robots Won’t Save Japan is a forceful book on a timely subject that is tightly argued, well-researched, and compellingly written from beginning to end. On the interface between care and technology, this is both riveting and humbling.
Anne Allison
Duke University, Durham