Something I wrote for school a while back...but I'm still thinking about a lot...

The Economic Crisis, Care Crisis, and Changing Dynamics of Gendered Work

Abstract:
Care work lies at the heart of all of society’s wealth. It is the work of nurturing, growing, teaching, healing, reassuring, bonding, and building healthy people and communities. Yet, traditionally unpaid or low-paid “women’s work”, care work is still devalued in our society. Despite many women gaining access to jobs traditionally held by men, this gendered inequality defines much of how we care for one another and are cared for. Changing dynamics in the economy are affecting the care economy in complex ways, which have ramifications on gender relations and work in the United States.

News of the current economic crisis in the United States is omnipresent in the media. Unemployment rates are rising, foreclosures on family dwellings are epidemic, and the poor and middle-class are quickly losing financial footing. According to “Get Sick, Get Out” (Robertson, 2008), 50 % of foreclosures are related to medical bills. Even as billions of dollars are being pumped into financial institutions to slow the financial decline, the crisis looms large in the lives of individuals and families, as a crisis of care.

Schools, public healthcare resources, daycares, food stamps and unemployment benefits are being defunded. While the United States cannot feasibly afford a decline in the health of its people, cuts to health resources continue. As unemployment grows, so does the population of uninsured people. With fewer people accessing formal healthcare resources, more are going without, turning to the people around them, or waiting until a crisis to go to the hospital (Rosen, 2007). Will the growing gap between the health needs of citizens and available resources be effectively absorbed by communities?

Conflict theory suggests that inequality of access to healthcare and health outcomes in our society reflect ingrained institutional power, and exclusion of marginalized groups from protections from harm and access to vital resources. The healthcare crisis in the United States has been growing for years, as an aging population drops out of the workforce and begins to use healthcare resources more intensively, as the current “nursing shortage” deepens, and as chronic health issues such as diabetes mellitus and cardiovascular diseases arise earlier and more frequently in the population.

Interestingly, the structure of privilege among healthcare workers reflects the same dynamics of inequality. Despite rising rates of physicians who are women, the majority of physicians are men, while the majority of supportive, more “care-intensive” workers are women. Physicians in the United States hold a high-status, high-paid position, while the supportive care positions typically do not hold such status. Since the 1970s, the profession of nursing has made a concerted effort at “professionalizing” by emphasizing technology in nursing, minimizing gendered dress and roles and promoting male involvement in nursing. While higher wages and status have resulted for nurses as a whole, the more “care oriented” aspects of nursing have remained feminized, while more technological aspects of nursing are seen as more masculine and often carry higher status (Lindsay, 2008). Further down the status ladder in care work, nurses’ aids often bear the brunt of very difficult care work and hard labor with low wages and little status.

The topic of changes in the care economy interests me, because as a working class woman in the United States, these changing dynamics of gendered work impact me in direct ways. Because of my privileged status as an educated white woman, I have the economic mobility and the choice to participate in traditionally feminized work, or to engage in historically male-dominated fields. My choice to study nursing has placed me in one of the higher-status care positions in society. It has also exposed me to the variety of intersecting crises present in patients’ lives and in the healthcare system.

The underground economy of informal labor epitomizes the deep crisis in care in general within our society. Many of the most marginal people in our society provide care for children, the aged, ill people, and the disabled, with little pay and few resources for care for themselves or their own families. Undocumented workers, new immigrants, and others with limited work options are filling widening gaps in the care economies of many postindustrial nations, doing the vital work of providing for those who need the assistance of others to meet their basic needs (McGregor, 2007).

Everyone needs care at certain points of life. Because of the devaluation of care work, many of those who provide care are also the least likely to receive care and support. A parent may be forced to work as a low-wage care provider instead of caring for his or her own children. One spouse caring for the other at the end of life may later have no care available to them.
In several care facilities that I have worked in, female and male migrants from African countries and other poorer, "peripheral" and "semi peripheral" economic regions of the world do much of the hands-on care work. They are some of the lowest-paid care providers in care facilities. The devaluation of care work persists even as it sheds its exclusive gender bias. And in its devaluation, it reinforces ethnic and class barriers.

During the current economic crisis, historically male-dominated working-class jobs such as in building trades and production have been disappearing at the highest rate, leaving an increasing number of women as the primary wage earner in families. Because these historically male dominated jobs were seen as primary wage-earner jobs, they often came with health insurance and other supports, while fewer of the female-dominated jobs carry these benefits. Thus the impact on families and gender relations is complex: the symbolic importance of women being the primary wage earner is matched with greater vulnerability of many families to poverty and illness. The pressure on many women to both earn wages and care for dependents or community members is increased. And women are not being given more benefits or resources with which to fill these roles. In fact, it is documented that women still receive less resources in support of the care work that they do, than men receive when they do similar work (Bywaters, 1998).
Because of the loss of many formerly male-dominated jobs, it is likely that competition for the remaining jobs will increase and more men will seek work in female-dominated work. While women should seek work and pay parity with men, I think workers must avoid the conclusion that I’ve heard in some newscasts that women are starting to achieve some sense of equality in the job market. It is not a success when both men and women are underpaid for doing important work.

In settling for less, we are left with the dilemma of "who will care for the caregivers"? The question of how marginalized and exploited workers, and women in an increasingly unsupportive economy receive the care they need is a crucial one. The crisis is visible enough already to have sparked national debate about the structure and function of our healthcare system.
There are policy suggestions on how to mitigate the care crisis, which propose healthcare reform or restructuring. There are several different types of proposals including a proposal that requires all people to have insurance, and proposals for a single-payer, universal healthcare system. Out of the currently proposed healthcare options, I believe the latter would provide more universal, continuous, and affordable care. Because it would create a single unified health system, it would close gaps in health disparities that are due to unequal access among classes, races, and genders in our society. In addition, the single-payer system would take out the interest of insurance corporations from making profit-driven decisions in cases where people’s health hangs in the balance.

However, without a complete revolution in the prioritization of care in our society, I believe the care crisis will persist regardless of the structure of our healthcare system. It is only by addressing the underlying dynamics of the exploitation and marginalization of care work, and those who do it, that our society could transform from one of failing health to one built on life affirming values of inclusion, nurturance, and health. In separating the provision of healthcare from a corporate profit motive or utilitarian focus on merely maintaining the ability of a person to work, our society may start developing an understanding of healthcare as a human right, and health as a holistic pursuit of protection from risk and access to all necessary resources. With a comprehensive change in priorities, we should have no problem finding enough money in the budget to eliminate dire scarcity for all those seeking support.

In addition to the federal policy proposals, other healthcare initiatives attempt to fill the gaps in care in our communities. There are religious institutions that provide care as charity. There are also non-profit organizations and community empowerment groups that have broached this work.

The concept of community organizing around care is very interesting to me. The concept that everyone has the right to healthcare makes the provision of that care everyone’s responsibility. Care becomes central to the community, and care providers are no longer isolated. This motivates responsive, relevant care. There are some historical examples of groups such as the Black Panthers and the Young Lords who created or occupied clinics in order to create community-focused care for communities that were underserved and exploited by the sociopolitical system (Gonzalez, 1995). There are also contemporary examples, arising from acute disaster such as Common Ground clinic in New Orleans (a grassroots clinic organized in the aftermath of Hurricane Katrina to fill the immediate health needs of residents); and those arising from the slow boil of the everyday care crisis (such as community clinics that are abounding and networking across the country). While these efforts to build socially just health and care support strcutures are still small, to me they provide a living example of how communities can make care a central ethic, and to provide care universally in ways that do not minimize the experiences and needs of communities and of carers.

References:

Bywaters, Paul; Harris, Allison “Supporting Carers: Is Practice Still Sexist?” Health and Social Care in the Community (1998) 6:6
Gonzalez, Juan “Lincoln Emancipation Hospital Takeover in ’70 Made Medical History” The Nation (1995) July 18 ed.
Lindsay, Sally “The Care-Tech Link: An Examination of Gender, Care, and Technical Work in Healthcare Labor” Gender, Work & Organization (2008) 15:4
McGregor, JoAnn “Joining the British Bottom Cleaners: Migrants in the UK Care Industry” Journal of Ethnic and Migration Studies (2007) 33:5
Robertson, Christopher; Egelhof, Richard & Hoke, Michael "Get Sick, Get Out: The Medical Causes of Home Foreclosures" Health Matrix 18 (2008): 65-105.
Rosen, Ruth “ The Care Crisis” The Nation (2007): March 12th ed.