Engendering research on care and care work across different social contexts

The collaborative papers in this supplement grew out of an international workshop held at the University of Victoria in the spring of 2006. The workshop brought together students, academics and health care practitioners from Canada, the US and two Nordic countries (Finland and Iceland) interested in unpacking the complex interrelationships between gender and both equity and dignity in health care and health care work during the historical period referred to as neo-liberalism – a time of economic liberalism beginning in the 1970s and continuing through the 1990s. During the last two decades, a variety of neo-liberal reforms, including the creation of competitive markets, the deregulation of professional services and the privatization of others, have been carried out in varying degrees in countries around the globe. There remains a heated debate, in Canada and internationally, about the effectiveness of these reforms from the perspective of those receiving services, as well as those delivering them. The evidence is mounting that such macro-economic policies have been devastating for many lowand middle-income countries, where a small group is overserviced because they can afford to pay for health service out of pocket while the bulk of the population faces a “medical poverty trap”, unable to access health care for even basic conditions.1,2 This supplement explores the impact of neo-liberal reforms on those who deliver and receive health care in Canada, Finland and Iceland. In particular, the subsequent set of papers explores the dimensions of three central themes integral to an adequate understanding of how care work is performed across different health care settings: 1) the rules and practices that shape the performance of care work are crucial to understanding how it is gendered in both formal and informal settings; 2) the larger policy context in which care work and care delivery are organized is also gendered, highlighting how rural and urban contexts as well as national configurations of the welfare state shape the gendering of paid and unpaid intimate labour; 3) neo-liberal policy debates underway in Canada and other high-income countries that are focused on enhancing the efficiency and accountability of health and social care systems have taken needed attention away from other crucial policy agendas, including how to ensure dignity for both those who receive and those who provide health care. Below, we identify how each of the contributions to this supplement illuminates one or more of these themes. First, however, we provide a brief framework by which to understand the intersections among gender, care work and the struggle to ensure dignity in the workplace and high-quality services, especially for vulnerable and disadvantaged populations. Care work Care work is a subcategory of service work that is characterized by face-to-face service to individuals in an effort to enhance their capabilities and that either directly or indirectly maintains daily life.3,4 In Canada, paid care work – which for the most part falls within one of two overlapping categories of social care and health care – represented over 12% of employees in 2008 or approximately 1.8 million people, approximately 80% of whom are female.5 Women are generally over-represented in the health and social care sectors but are especially concentrated at the lower levels of these occupational hierarchies; they include ancillary and homecare workers with less prestige, lower incomes and precarious employment schedules.6,7 In fact, for some observers, much of the work that is done inside the health and social care sectors forms part of the “pink collar ghetto”: work that is feminized, underpaid and undervalued. Such work also tends to be racialized: women who are recent immigrants and women of colour without high levels of formal education (or whose credentials are unrecognized in Canada) are concentrated in jobs that are precarious and very poorly paid, especially in private sector sales and service jobs.8,9 A similar picture exists in the US as well.10 There is a sizeable literature documenting the various pathways along which the feminization and undervaluation of care work have gone hand in hand: of note is the devaluation thesis, which argues that because the activities associated with caring work are generally conflated with what are assumed to be universal and natural female characteristics, the skills and expertise associated with caring work go unrecognized.4,11 Similarly, other scholars have argued that the care sector relies, both implicitly and explicitly, on a highly gendered assumption that women who seek out caring work are motivated by altruistic orientations and the emotional rewards of this work.4,12,13 Implicit here is a second assumption – that aspects of work understood to motivate people in other sectors of the economy, such as wages and benefits or reasonable work hours, are secondary considerations for women engaged in care work. The result is that women health workers face a strong moral pressure to provide care services for low compensation and under poor working conditions.13,14 1. Professor, Department of Sociology, University of Victoria, Victoria, BC 2. Assistant Professor, Department of Sociology, University of Victoria, Victoria, BC Correspondence and reprint requests: Dr. Cecilia Benoit, Professor, Department of Sociology, University of Victoria, P.O. Box 3050, Victoria, BC V8W 3P5, Tel: 250-721-7578, Fax: 250-7216217, E-mail: cbenoit@uvic.ca. Acknowledgements: Special thanks to Leah Shumka, Kate Vallance, Adrienne Treloar and Kim Nuernberger for their assistance at various stages of the preparation of this supplement. Thanks as well to CJPH editorial staff for their advice along the way, and to anonymous reviewers for their helpful comments on earlier drafts. Finally, we acknowledge the monetary contribution of the MSFHR Women’s Health Research Network, CIHR Institutes of Gender and Health and Population and Public Health, the Social Sciences and Humanities Research Council, and the University of Victoria.

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