As the populations of Europe, North America, and East Asia age rapidly, their shrinking workforces cannot possibly provide enough caregivers (nurses, home health aides, hospital attendants) for their own elderly. By 2050, almost 30% of Europeans will be over 65. Europe will have just 1.5 workers per retiree—down from 2.7 in 2022. Meanwhile, the African workforce is growing: by 2050, nearly a quarter of the world’s working-age population will be from Africa, and many will seek employment in other regions. This demographic transformation requires an honest assessment of several issues: future care needs in the Global North, the need to improve conditions for caregivers, and the positive, mutually beneficial impacts that could come from African workers filling these roles.
Yet political leaders are not confronting the crisis or even being honest with the public. In North America and Europe, there is little discussion of increased investment in the care system. Meanwhile, immigration debates remain trapped in denial, with politicians on all sides selling a fantasy. They promise their aging voters a future of closed borders while ignoring the need to staff the nursing homes, hospitals, and home care services those voters will desperately need. Their rhetoric ignores the clear reality: unless they make unprecedented investments in the caregiving profession and make caregiving a far more attractive option for their own workforces—something they are clearly not prepared to do—the only way to meet the care needs of their aging populations is through immigration.
In fact, we will need both investment and immigration, but the shortage of workers in the Global North means that immigration must be a big part of the mix. Many of the immigrants who could fill caregiving positions will come from Africa, because soon nearly one worker out of every four will be African. Compounding pressures—including unemployment, corruption, and climate change—are already pushing many Africans to migrate.
To welcome these immigrants into the care professions, we need a saner, more humane, more just immigration system. We must also address the deficiencies—and historic inequities—of our caregiving system: understaffing, low wages, and poor working conditions. As just one example of understaffing, a recent report by the Joseph Rowntree Foundation showed that the vacancy rate for care workers in the United Kingdom is 3 times that for workers in other low-paid sectors, such as retail. In the process, we must also confront thorny ethical issues about the nature of care, the causes of immigration, and what solidarity must entail in a globalized care economy.
These challenges exemplify the weakness of our current international order. While policy frameworks exist to create a fair and humane care economy, there’s little evidence of the political will to implement them. The United Nations system, which should be the venue for critical global action on this issue, is growing weaker and more ineffective by the day.
When nurses are overworked, patient mortality rises. When personal care workers are rushed, the elderly lose the attentive care they deserve.
The stakes couldn’t be higher. A caregiving system with good working conditions is a moral imperative. It is also the only way to ensure high-quality care. As the International Labour Organization warns, poor working conditions for care workers, particularly understaffing, lead to substandard care. When nurses are overworked, patient mortality rises. When personal care workers are rushed, the elderly lose the attentive care they deserve. If we bring more immigrants to the Global North without addressing poor working conditions, we risk perpetuating them. The quality of life for millions of elderly citizens in the Global North will depend directly on how we treat those who care for them.
We must be clear-eyed about additional challenges. Our society does not respect caregiving; the focus is largely on economic returns rather than quality or human dignity. Establishing protections for workers—to ensure fair wages, decent working conditions, and pathways to stability—is crucial, but it is still not enough. We must imagine and build a future in which care itself is valued and integrated into all stages of life—child care, elder care, and disability care.
In addition, a more rational immigration policy does not address the reasons so many Africans want to emigrate in the first place: unemployment, poor economic prospects, and instability. Africa’s youth should be a lifeline for Africa, not for the aging societies of the Global North. Today, many young Africans say they want to seek work outside of the continent. We should support their aspirations. But we must also support African efforts to make life better for its young people in their home countries.
Political leaders need to start telling hard truths: Europe and North America’s future quality of life depends on welcoming workers from Africa and other parts of the Global South and treating them justly and humanely.
Still, as we tackle these long-term challenges, we need to be realistic about the current demographic situation. We don’t have a quarter of a century to get this right. Political leaders need to start telling hard truths: Europe and North America’s future quality of life depends on welcoming workers from Africa and other parts of the Global South and treating them justly and humanely. We need to invest in and revalue the care work done by all, regardless of who they are or where they come from—a shift that would make the care professions more attractive to both native workers and immigrants.
We need immigration policies—and rhetoric—that create clear, dignified pathways for care workers. We need international action to protect workers’ rights while ensuring that sending countries benefit from this migration. We need to invest in training and integration that prepare both receiving societies and incoming workers for this transition.
The alternative—maintaining our current head-in-the-sand approach—guarantees a future crisis where elderly populations receive inadequate care or inhabit a dystopia of care provided by robots and AI. Meanwhile, young Africans will lack economic opportunities, all but ensuring unrest and instability in their home countries. All of us deserve better.
This isn’t about charity. It’s about recognizing our mutual interdependence and shared futures. The elderly European who needs assistance with daily living and the young African seeking meaningful employment are part of the same global story. The sooner we start writing that story together, guided by honesty, human dignity, solidarity, and justice, the better off we’ll all be.
Joe Waters is the Co-Founder and CEO of Capita.
Blessing Adesiyan is the Founder and Chief Care Officer of Caring Africa.
