Critical to Care: The Invisible Women in Health Services

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Who counts as a health care worker? The question of where we draw the line between health care workers and non-health care workers is not merely a matter of academic nicety or a debate without consequences for care. It is a central issue for policy development because the definition often results in a division among workers in ways that undermine care.

Critical to Care uses a wide range of evidence to reveal the contributions that those who provide personal care, who cook, clean, keep records, and do laundry make to health services. As a result of current reforms, these workers are increasingly treated as peripheral even though the research on what determines health demonstrates that their work is essential. The authors stress the invisibility and undervaluing of 'women's work' as well as the importance of context in understanding how this work is defined and treated.

Through a gendered analysis, Critical to Care establishes a basis for discussing research, policy, and other actions in relation to the work of thousands of marginalized women and men every day.

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Product Details

  • ISBN-13: 9780802093332
  • Publisher: University of Toronto Press, Scholarly Publishing Division
  • Publication date: 6/28/2008
  • Pages: 176
  • Product dimensions: 6.23 (w) x 9.24 (h) x 0.78 (d)

Meet the Author

Pat Armstrong is a Distinguished Research Professor of Sociology and Women’s Studies at York University and co-author of Critical to Care: The Invisible Woman in Health Services.

Hugh Armstrong is a professor in the School of Social Work and the Institute of Political Economy at Carleton University

Krista Scott-Dixon is a research associate at the Institute for Work and Health in Toronto.

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Table of Contents

List of Figures and Tables     ix
Acknowledgments     xi
Introduction     3
Critical to Care: Invisible and Undervalued     4
Counting the Work and the Workers     6
Determining Who Counts     7
Identifying Contributions to Care     8
Making Gender Matters Visible     9
Exposing Health Hazards at Work     9
Establishing the Context: Further Explanations     10
Developing Options     11
Building on the Past, Moving to the Future     12
Counting the Work and the Workers     14
Clerical Work     19
Assisting Occupations in Health Care     36
Visiting Homemakers, Housekeepers, and Related Occupations     42
Cleaning/Housekeeping, Laundry, and Food Services     44
Security Work     52
Managers     52
Unpaid Ancillary Work     56
The Composite Picture     59
Determining Who Counts     62
Feminist Political Economy     63
The Determinants of Health     66
Identifying Contributions to Care     75
The Specificity of Health Care     75
The Origins of Ancillary Work     82
Conclusions     87
Making Gender Matters Visible     88
Women's Care Work     88
Skills and Care     91
Defining Skills     92
Gender Skills     93
Health Care Skills     96
Regulation and Training     103
Resistance     105
Moving into the Labour Force     105
Unions and Professions     109
Women's Individual Responses     116
Conclusions     119
Exposing Health Hazards at Work     121
Infection and Respiratory Diseases     123
Lifting, Bending, Twisting, and Musculoskeletal Injuries     124
Chemicals, Needles, and Cuts     126
Lack of Employment Security and Control     127
Workplace Organization     130
Workplace Violence, Bullying, Sexual Harassment, and Racism     135
Lack of Respect     138
Conclusions     138
Challenging the Construction of Ancillary Work     140
International Contexts and Trends     140
Rising Health Care Expenditures     140
New Public Management     143
Health Care as an Opportunity for Profit     146
Global Markets and Workers     150
The Health Policy Context in Canada     152
Public Health Care in Canada     153
Privatization     156
Integration and Teamwork     160
Evidence-Based Decision Making     162
Accountability     164
Public Health     167
Regionalization and Decentralization     168
Conclusions     169
Developing Options     170
Implications for Policy, Research, and Action     171
First, We Need an Active State     172
Second, We Need Better Management     175
Third, We Need to Promote Unions and Other Forms of Collective Organization     177
Fourth, We Need More and Better Research     180
Conclusions     181
A Guide to Canadian Data on Ancillary Workers in the Health Care Sector     183
Introduction: Interpret Data with Care!     183
Methodology and General Overview     184
Notes on the Labour Force Survey     185
Notes on Census Data     185
Defining Ancillary Occupations in Health Care     186
The Importance of Industry     189
Form of Employment     191
Immigrant and Visible Minority Status      193
References     195
Index     219
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