The history of friendship and the underlying benefits of strong mutual relationships have been debated for many centuries. From the earliest philosophers to modern day cognitive scientists friendship is seen as a conduit for both good health and happiness. To Aristotle friendship was viewed as the art of holding up a mirror to each other’s souls and it is through this reciprocal mirroring that we can improve our individual self.

This improvement of the self, as highlighted in a recent study from the University of Virginia, lies in our capacity to be more emphatic towards people that are closely related to us. “The correlation between self and friend was remarkably similar,” Coan said. “The finding shows the brain’s remarkable capacity to model self to others; that people close to us become a part of ourselves, and that is not just metaphor or poetry, it’s very real. Literally we are under threat when a friend is under threat. But not so when a stranger is under threat.”

This study, viewed through the lens of health and social care provision in Ireland highlights the vital role friendship plays in supporting our existing healthcare infrastructure. The country has a rich history as a friendly and empathic society, one example of which is highlighted in Global AgeWatch Index, which ranks Ireland with one of the highest rates of social connectedness among older people at 95%. Much of this connectedness is due to strong local communities, volunteer groups and also the network of carers in our society.

The Census of Population defines a ‘carer’ as someone who: “provides regular, unpaid personal help for a friend or family member with a long-term illness, health problem or disability (including problems which are due to old age). Personal help includes help with basic tasks such as feeding and dressing”.

There is a continuing upward trend in the number of family carers. In Census 2002, 148,754 people indicated that they provided unpaid care. By 2006, the total number of carers aged 15 and over was 160,917, growing to 182,884 in 2011. This represents a 13.7% increase over that last five-year period alone. The most recent census showed that 4.1% of the total population was providing unpaid assistance to others in April 2011.

When met with adequate supports and not overburdened by unrealistic expectations the life of a carer can be both enriching and rewarding. In situations where support mechanisms are not in place, many carers report a life of stress with the pressures of caring for a loved one taking a toll on their mental, physical and emotional wellbeing. Risk factors to health and the emotional wellbeing of carers can be difficult to map empirically, but one clear metric is that of the benefits to the economy that carers provide.

Some not-for-profit groups have estimated this value of caring to be in the region of €4 billion per year. This figure, calculated from Census 2011 data, has increased significantly since the 2006 estimate which stood at €2.5 billion. Calculations are based on the rate of €25 per hour, which is the average cost of home help provided through the HSE. This means that, on average, a full-time family carer saves the state €62,000 per year. According to 2012 Carer’s Allowance rates, a family carer aged 66 caring for one person would receive €12,525 per annum. It could therefore be argued that family carers’ contribution to society is equivalent to one-third of the total annual cost of the HSE (c. €13 billion) and five times what family carers cost the Department of Social Protection in income supports (c. €850 million)

From an economic standpoint the demographics leave us facing a lot of unknown challenges:

  • The ageing population is expected to advance more rapidly in the Republic of Ireland in the years 2006-2021 with a 69% increase in population aged 65 and over and an 82% increase in population aged 80 and over.
  • The number of people aged 65+ using residential long-term care will rise by 12,270 in the Republic, which is an increase of 59% since 2006. In the North, the rise will be 4,270 (+45%).
  • An additional 23,670 older people in the Republic will use formal home care (+57%). The extra demand for care from statutory providers in the North will be 4,200 (+37%).
  • Demand for all-day/daily informal home care by people aged 65+ with disabilities will expand by 23,500 in the Republic (+57%) and the demand for informal care generally by 11,000 in the North (+26%).
  • 2,833 extra people will require residential or formal home care each year in the Republic and 565 in the North. The numbers requiring formal residential or home care will increase further if informal carers are unable to provide the same rate of care as in 2006, which would require all-day/daily care for an additional 1,565 people each year in the Republic and 730 in the North.

It is clear from the figures above that we are facing into an unprecedented set of challenges relating to health and social care provision in Ireland. When these challenges are pitched alongside those of climate change, endless wars and the ongoing refugee crisis the world is confronted with rather a daunting scenario.

To face up to these challenges we need to consider alternative models for the provision of health and social care. The Amicitia project is the development of one such alternative. Amicitia, latin for friendship, believes that the spirit of egalitarianism and reciprocity exists within us all but it has often become lost in the challenging economy we exist in today. By collaborating and working together towards new solutions we can design alternatives and we can create a better, healthier, society.