The Unseen Infrastructures of Care

Andrew Binet and Pritpal S Tamber

September 25, 2019

In some corners of the world, the idea that ‘community’ matters to health is taking hold. In my blog series, Communities Creating Health, published in Stanford Social Innovation Review and now an eBook, David Chavis and Kien Lee added some substance to the idea by offering a concrete definition of community – a set of relationships formed and maintained to meet common needs.

But, given that one of the most universal needs in life is the need for care, how well do we understand the pathway from a set of relationships to caring for one another? 

Today’s interviewee has been thinking about that. I first met Andrew Binet when he helped me put on my 2017 symposium, Community Agency & Health, while working at MIT’s Community Innovators’ Lab (CoLab). I caught up with Andrew to hear about where his thinking has got to, including his observation of ‘infrastructures of care’. 

Pritpal S Tamber: Hi Andrew. We’ll get to ‘infrastructures of care’ in a moment. I want you to start by sharing what you learned studying a massive regeneration programme in Toronto, Canada. 

Andrew Binet: Hi Pritpal. Yeah, so in 2005, the Toronto Community Housing Corporation (TCHC) began the redevelopment of Regent Park, Canada’s oldest and largest public housing estate. The redevelopment – still underway – is replacing the neighborhood’s post-war housing blocks with towering condominium-style buildings that mix public housing units with market-rate condominiums, a process that has involved the temporary relocation of roughly two thousand households. 

Pritpal: Wow, that’s big. 

Andrew: Absolutely. What’s more, Regent Park had for decades been a hub for social service organizations in downtown Toronto. I set out to study how those organizations weathered the rapid and drastic changes in the social, economic and built environment of the community, and how they helped their clientele do the same. What I found was that in the absence of adequate social planning by city agencies and the developer, these organizations: scrambled to orient and stabilize residents as their lives were disrupted; fought for space for the community to grieve about lost homes and maintain community ties; built political capacity and economic opportunity for Regent Park residents; and helped them negotiate structures and institutions of power.

Pritpal: What do you mean by structures and institutions of power? 

Andrew: By structures of power I mean durable social relationships – such as class – that determine how power works, and by institutions I am referring to stakeholders like the city agencies and real estate developers who had power over the process of redevelopment. For reasons to do with both the planning process itself and broader historical patterns of marginalization, residents didn’t have sufficient control over the planning process for the future of their community, which made the redevelopment all the more destabilizing. 

Pritpal: Interesting. So, how did that experience influence your thinking about ‘care’? 

Part of Regent Park, Toronto, in September 2012

Andrew: I spent a long time confused about what to call what I was witnessing. This group of under-resourced and over-worked social service organizations was constantly improvising to provide emotional and practical support to individuals and a community in a state of permanent upheaval. One day it occurred to me that the term ‘care’ described both how the social service providers were acting and what the outcomes of their actions were.

Pritpal: So, the term applies to both the process and the outcome? 

Andrew: Right. And I realized that this ‘care’ was playing a necessary – but un-planned-for – role mediating between TCHC’s plan and the complexity of individual lives to ensure that the redevelopment process was as livable as possible for those whose worlds were being rebuilt.

Pritpal: Does that make the hub of social service organizations an ‘infrastructure of care’? 

Andrew: I think it’s helpful to think about it that way. We typically think of infrastructure as physical networks facilitating the flow and distribution of goods, such as water or electricity, or people through space, such as roads. If we understand care to be an essential resource for health and wellbeing, then there is arguably much to gain from taking an infrastructural perspective on the networks that care is dependent on.

Pritpal: Gain in what sense?

Andrew: In the sense of applying the idea to urban planning and community development.

Pritpal: OK, I want you to explain that but first tell me what you mean by urban planning. 

Andrew: It’s an applied field focused on the transformation of the built environment of cities and communities. I say ‘applied’ because, similar to public health, we seek to apply knowledge from social scientific research to real-world contexts through interventions. 

Pritpal: OK, so how does an infrastructural perspective aid planning? 

Andrew: As planners, we need to think about how care, and the resources necessary for good care, are organized within and across cities and communities. These resources may include institutions like clinics, social service organizations, and food banks, but also include other elements of the material world like housing, transportation, schools, and amenities like parks. And so, we can ask how the ongoing evolution of the built environment shapes the provision and receipt of different forms of care, and how sites of and resources for giving and receiving care are organized in space.  

Pritpal: Got it. So, how might planners think about all of this? 

Andrew: I think there are three things for planners to consider. First, we have to learn how to see the infrastructure of care in the first place; it won’t always be recognizable in the same way that train tracks or a sewer system are. Second, we have to learn how to support this infrastructure. I think this begins with understanding all of the ways in which people are currently working to care for one another, and then figuring out how to materially support these efforts such that good care can be provided with minimal burden. And third, there’s the work of maintenance and repair. How can we help ensure the stability and function of these infrastructures over time so that the types of disruptions experienced in Regent Park do not threaten wellbeing? 

Pritpal: You said, “the ways in which people are currently working to care for one another”. That makes me think that you’re seeing care as more than clinics and social service organizations. 

Andrew: Yes. My conception of care draws heavily on work by feminist political theorists, such as Joan Tronto, who defined care as: “an activity that includes everything that we do to maintain, continue and repair our world so that we can live in it as well as possible. That world includes our bodies, ourselves, and our environment, all of which we seek to interweave in a complex, life-sustaining web.” 

Pritpal: I’m hopelessly out of my depth with this question but does the fact that this is feminist political theory imply that care is a female role? 

A redeveloped part of Regent Park, Toronto, in 2010

Andrew: Well, historically, the vast majority of care work has been performed by women. In the 1980s, psychologists like Carol Gilligan argued that caring was an element of a uniquely female morality. Tronto’s view was that, while care had traditionally been associated with, and provided by, women, labeling it as ‘feminine’ risked cementing gendered inequities in how care work is organized and valued within society and preventing a deeper understanding of how pervasive care is in everyday life. As a result, Tronto sought to offer a definition of care centered on interdependency. 

Pritpal: Fascinating stuff. Going back to Tronto’s definition of care, though, I’m intrigued by the term ‘maintain, continue and repair’. There’s something very active about it. 

Andrew: Absolutely. Care is a process. And I would also add that care is ubiquitous, without assuming that all care is good care (it’s not) or that everyone has equal access to good care (they don’t) or the resources to provide good care (again, they don’t). 

Pritpal: Active. Ubiquitous. Not necessarily good. Not necessarily equal. 

Andrew: Yes, and the dynamism of this understanding of care is crucial to planning. Like I said, planning is an applied field. An infrastructural perspective helps us consider how the ongoing activity of care is organized and influenced by the built environment of cities, how the infrastructure of care can be built and expanded, and how it may need to be repaired or maintained over time and as circumstances change. 

Pritpal: Fascinating stuff. So, are planners embracing this idea of infrastructure of care?  

Andrew: I think we’re on our way. As urban planners become more familiar with insights from social epidemiology, we’re understanding just how important social relationships are for health, and we know how much social relationships are shaped by the built environment. But we have further to go in terms of thinking about care as something that is shaped by planning, and treating care as something that planners are responsible for. Care is so important not only to health and well-being, but also livability, which is a central value in planning. Moreover, as I saw in Regent Park, care plays an enormous role in determining how interventions conceived on paper play out in practice and in the lives of the people we are accountable to. 

Pritpal: So, how might you make your perspective available to fellow planners?  

Andrew: Well, just as planning is an applied field, it’s also interdisciplinary, and there are decades of insights from fields ranging from political economy to medical anthropology that could be productively introduced to planning scholarship, education, and practice. I hope to play a part in that. Similarly, I plan to center care in my own research about the relationship between health and place. And, finally, I’m beginning to think about how to build tools that might help planners and other community stakeholders inventory or assess the infrastructure of care in communities where they work and evaluate how it might be impacted by changes in the built environment or other planning and community development interventions. 

Pritpal: That all sounds both ambitious and important. Thanks for making the time to share your thinking with us.

Andrew: Thank you for extending the invitation!

What strikes me about Andrew’s insights are their depth. I think most of us would intuitively agree that how people are organized and interact matter to whether or how they can care for each other. But Andrew has taken that observation and given it shape. What’s more, his motivation for giving it shape is so that it can be applied to changes in the real world. For me, that’s a key difference between know-all academics that observe and publish, and people like Andrew that observe and then try to make tools to bring those observations to the service of humankind. We need more Andrews.

The photo behind the title is by Lance Anderson on Unsplash.

Andrew Binet

PhD Student at Dept. of Urban Studies and Planning, MIT | Website
I am a third-year PhD student in the Department of Urban Studies and Planning at MIT where my research sits at the intersection of urban planning and public health. I am especially interested in how changes in the built environment shape relations of care and social reproduction. For four years, I have been involved in the Healthy Neighborhoods Study, a longitudinal Participatory Action Research (PAR) project exploring the links between neighborhood development and health in nine rapidly-changing communities across the Boston metropolitan area. Prior to starting my PhD, I worked as a community health planning consultant for healthcare providers and labor unions in Boston and New York City.

Pritpal S Tamber

Independent Writer, Researcher & Consultant | pritpal@pstamber.com

I'm an independent writer, researcher and consultant focussing on community health and medical information. I'm a former physician, medical editor and medical publisher, and also the former Physician Editor of TEDMED. I began my career at The BMJ. For more information, see the About page.

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