| The Invisible Infrastructure Beneath the Economy

| Dawn Carpenter

| America talks constantly about infrastructure. We debate roads, ports, semiconductor manufacturing, artificial intelligence, and energy grids as though the future of economic life depends entirely upon the built environment. Economic strength is usually described with this twentieth-century vocabulary.

Yet every day of the year, millions of Americans perform another kind of work that, while generally out of view, still qualifies as infrastructure. But without it, the formal economy would begin to fracture almost immediately.

A daughter coordinates medications for her aging father before logging into work. A grandfather provides childcare so his adult children can remain employed. A middle-aged employee leaves an important meeting early to care for a parent with dementia. A spouse quietly manages appointments, transportation, meals, insurance forms, and emotional support while absorbing a level of exhaustion that rarely appears in economic statistics.

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The surprising reality is that America may already rely upon one of the largest labor forces in the country while rarely recognizing it as labor at all. In 2025, an estimated 63 million Americans, roughly one in four adults, were providing ongoing care for a loved one. The economic value of unpaid family caregiving now exceeds $1 trillion annually, surpassing even total Medicaid spending.

For decades, caregiving was treated as a peripheral social issue. Today, that assumption no longer matches reality. The care economy has become foundational economic infrastructure shaping workforce participation, productivity, public health, and long-term societal resilience.

Why This Is Emerging Now

The reason this issue now feels unavoidable is that the United States is colliding with three historic forces simultaneously: longevity, demographic contraction, and institutional misalignment.

People are living longer, but often with more years of chronic illness and functional complexity. By 2034, adults over age 65 are projected to outnumber children in the United States for the first time in the nation’s history. At the same time, birth rates continue to decline, and families are shrinking while becoming more geographically dispersed.

Meanwhile, the modern workforce increasingly depends upon dual-income households operating at near maximum capacity. Many families no longer possess the hidden reserve of unpaid labor that twentieth-century institutions quietly assumed would always exist in the background. We modernized the workforce without modernizing the systems required to sustain human dependency across longer lives.

What was once episodic has become structural.

Caregiving is no longer a temporary disruption affecting a narrow slice of the population. It is becoming a continuous feature of modern adulthood, stretching across decades. Millions of Americans now find themselves simultaneously supporting children, aging parents, and their own financial survival, while attempting to maintain careers inside institutions designed for a different demographic era.

The economy increasingly resembles a power grid built for a small industrial town that is now attempting to support an entire modern city. The lights still turn on, but the strain beneath the surface is becoming impossible to ignore.

The Economy Runs on Human Maintenance

Research shows that workplaces designed around outdated assumptions about unlimited worker availability often collide with the realities of caregiving. The result is increased burnout, absenteeism, workforce exits, and significant productivity losses among workers attempting to navigate systems never built for an aging society. One study found caregiving-related strain reduced work productivity by roughly one-third among affected workers.

Yet much of our economic language still treats caregiving as though it exists outside the productive economy rather than beneath it.

This mismatch reveals a deeper misunderstanding about what economies actually are. An economy is not merely a system of production. It is a system for sustaining human life across time. Markets do not function independently of human dependency. They rest upon it.

The modern economy often behaves like an elaborate theater production in which policymakers, executives, and investors focus almost exclusively on the actors illuminated on stage while ignoring the hidden rigging and backstage crews making the performance possible. Caregiving is that backstage system. Invisible when functioning properly. Catastrophic when neglected.

Caregiving preserves human capability. It enables workforce participation, stabilizes households during periods of vulnerability, protects long-term health, and supports economic mobility across generations. In many cases, it serves as the shock absorber preventing social fragmentation from becoming economic collapse.

An economy that exhausts caregivers is not maximizing productivity. It is undermining the human conditions that make long-term contribution possible.

Treating Care as Economic Strategy

The challenge now is not simply recognizing caregiving as valuable. It is redesigning institutions around the reality that care has become central economic infrastructure.

Employers will increasingly need to stop treating caregiving as a private inconvenience unrelated to economic performance. Flexible work arrangements, caregiver leave policies, eldercare support systems, and long-term workforce planning are productivity strategies rather than merely employee benefits.

Many workplace models still complacently assume a twentieth-century household structure supported by invisible unpaid labor that no longer exists at sufficient scale.

Healthcare systems must also evolve beyond episodic treatment models toward sustaining lifetime functional capacity. In an aging society, health itself functions as an economic variable shaping labor force participation, resilience, and long-term financial security.

Policymakers face a similar reckoning. Caregiving capacity is now directly tied to labor supply, economic growth, public health expenditures, and social cohesion. Care is no longer a soft social issue sitting downstream from the economy. It is upstream from it.

The societies that thrive in the decades ahead will not simply be those that innovate fastest. They will be those that recognize that care itself is productive capacity. Because beneath every functioning economy lies a quieter form of infrastructure: the daily human labor of helping one another remain alive, capable, connected, and dignified across time.

That work was never peripheral. It was the foundation all along.

Dr. Dawn Carpenter is Director, Financial Longevity, at the Milken Institute. This essay builds upon themes explored in Dr. Dawn Carpenter’s Milken Institute report, The Longevity Equation: How Healthspan and Wealthspan Intersect, which examines how health, wealth, and institutional design increasingly shape one another across longer lives. Additional writing can be found on her Substack, The Financial Ethicist.