LETTERS TO THE EDITOR zyxwvutsrqpon 41. 42. 43. 44. 45. 46. 47. 48. 49. Weinstein MC, Schiff I. Cost-effectiveness of hormone replacement therapy in the menopause. Obstet zyxwvutsrq Gynecol Sumey Daniels N. Is the Oregon rationing plan fair?JAMA 1991; Dixon J, Welsch HG. Priority setting: lessons from Oregon. Lancet 1991; 337: 891-4. Hadorn DC. The Oregon priority-setting exercise: quality of life and public policy. Hactings Center Rep& 1991; (Supp): 11-16. Maynard A. Symposium proceedings: the ethics of resource allocation.JEpidemio1 Community Health 1990; 44: 187-90. Cranshaw R. Health care rationing [letter]. Science 1990; Calabresi G, Bobbitt P. Tragic zyxwvutsr choices. New York: Norton, 1978. Friedman DD. Comments on ‘rationing and publicity’. In: Agich GJ, Begley CE, editors. The zyxwvutsrqp pn’ce of health. Dordrecht: Reidel, 1986: 217-24. Rhoads S, editor. Valuing life: publicpolicy dilemmas. Boulder, Co: Westview Press, 1980. 1983; 38: 445-55. 265: 2232-5. 247: 662-3. LETTERS TO THE EDITOR 50. Winslow GR. Rationing and publicity. In: Agich GJ, Begley CE, editors. The pice of health. Dordrecht: Reidel, 1986: 199-2 16. 51. Carr-Hill RA. Allocating resources to health care: is the QALY (quality adjusted life year) a technical solution to a pol- itical problem? IntJ Health Sen, 1991; 21: 351-63. Mosteller F. Final panel: comments on the conference on advances in health status assessment. Med Care 1989; 27 53. Ware JE. Final panel: comments on the conference on advances in health status assessment. Med Care 1989; 27 52. (SUPP): S202-86. (SUPP): S286-90. 54. Carr-Hill RA. Social indicators for basic needs: who benefits from which numbers? In: Cole S, Lucas H, editors. Models, planning and basic needs. Oxford Pergamon Press, 1982. Mulkay M, Ashmore M, Pinch T. Measuring the quality of life: a sociological invention concerning the application of economics to health care. Sociology 1987; 21: 541-64. 55. Invisibility of carers In their article on the costs and experiences of caring for sick and disabled patients, Smith et al. claim that zyxwvu ‘ . . . there is no doubt that the physical, personal and emotional cost to the carer is priceless’.’ Despite the sentiment underscoring this remark I cannot let it go unchallenged. It is misleading because it results in a zero value being placed on informal care. The reluctance to place a value on the time spent by carers (or more accurately what they can do with that time) leads to what Waring describes as the invisi- bility of women’s work in caring.‘ If the value of the carer’s work remains invisible then the carers them- selves will remain invisible. Though carers are not exclusively women, women do bear a disproportion- ate amount of the burden for caring of older people. The trend towards shifting the cost of care from the public sector (nursing homes and hospitals) to private individuals (providing unpaid informal care) seems to be based on the assumption that home care is, and always will be, a cheaper alternative. This rests on the notion that unpaid labour inputs are ‘free’. To an economist nothing is ‘free’ if something has been forfeited to attain it. The time spent by carers could possibly have been spent on paid work or leisure time. A price can be placed on this paid work or leisure time forgone by using an appropriate market wage rate zyxwvuts as a proxy measure. Green, in costing informal care for older people in New Zealand, used wage rates for substitute labour appropriate for the task.3 Of course the opportunity cost of productive paid work or leisure time forgone will depend on the age, sex and occupational characteristics of the carers, the pool of unemployed with ‘carer’ skills as well as the dependence of the older person being cared for. Costing informal care is anything but straightfor- ward. However, evaluative studies that compare the substitutability of paid formal care for informal unpaid care must attempt to put a price on informal care. To omit a price compromises any conclusions made about the substitutability or cost of services. 286 AUSTRALIAN JOURNAL OF PUBLIC I sympathise with the authors; the methods for costing informal care are far from clear and are unlikely to incorporate the emotional aspects of caring. However, their assertion that the cost to the carer is priceless produces the perverse result that they are not valued at all. This can only perpetuate the invisibility of carers amongst some health policy makers. Glenn Salkeld Department of Public Health University of Sydney References 1. Smith, B, O’Malley S, Lawson J. Costs and experiences of caring for sick and disabled geriatric patients-Australian observations. zyxwv Aust J Public Health 1993; 17; 13 1-4. 2. Waring M. zyxwvut rf women counted. A zyxw new feminist economics. San Franciso: Harper and Row, 1988. 3. Green FT, Raper AC. The resource costs of community care of the dependent elderly. In: Selby-Smith C, editor. Economics and health: 1990. Proceedings of the Eleventh Australian Conference of Health Economists. Clayton, Victoria: Public Sector Management Institute, Monash University, 1991. Chemical hazards in the Melbourne metropolitan area Carlo, Sund and coworkers, in their recent papers, seek to dismiss the toxicological hazards of dioxins and the role of Nufarm in the emissions of dioxins to Werribee sewage farm.’.’ Close examination of these papers, however, reveals a number of omissions and inconsistencies and we would like to draw attention to the following points. The article by Sund et al. addresses the dioxin con- gener profiles in selected effluents and soils from urban and industrial sites in the area. They conclude that Nufarm’s effluent congener profile does not resemble the contamination profiles at Werribee or elsewhere and that Nufarm is therefore not a primary contributor to the contamination. Some concerns attach to the inconsistencies in the two tables of results (Tables 3 and 4), which report duplicate analy- HEALTH 1993 VOL. 17 NO. 3