This article explores care workers and working carers' experiences of work. It focuses on how both groups of workers experience pressures to adhere to an ideal, which this article argues, is centered on an emotional reaction of guilt. Through this ideal of a guilty worker, a "care ethic" is reconfigured to become a "work ethic." Drawing on 120 semistructured interviews with care workers, working carers, trade union officers, and care company managers, the article examines how guilt is experienced and constructed in the workplace, and how it becomes beneficial to the aims of the employing organization. The article links the construction and instrumentalization of guilt to Acker's analysis of the ideal worker and to the problematic discourse of the "heroism" of key workers during the Covid-19 pandemic. This discourse can reinforce the image of a sacrificial ideal worker; it implies that if workers do not take a sacrificial approach as part of their work and care ethics, they should feel guilty.
This article uses John Kelly’s mobilisation framework, with its foundational concept of injustice, to explore workers’ propensity towards unionism in England’s outsourced social care sector. Drawing on 60 interviews with union organisers and officers, care workers, support workers and care company managers, this research highlights the difficulties of union organising in the sector and explores theorisations of mobilising. The research contends that for mobilisation theory to provide insight into relationships between work and unionism, varieties of injustice and collectivism need to be contextualised. Paid care provision generates both employment-related injustices and care-related injustices, which lead to divergent collective identities and attitudes towards unions. An absence of a coherent entity for workers to attach blame to – within a context where private providers frequently remain reliant on state funding levels – affects whether injustice and collectivism progress to mobilisation and unionisation.
The Hospital, Brian Alexander's account of health care in Bryan, Ohio, is an emotionally and politically astute study. Alexander draws on more than two years of journalistic research, including extensive interviews, observation, analysis of documents, and investigations into the history of health care provision in the United States since the 1800s. Alexander notes that Bryan "wasn't much different from many other places . . . [i]t was a microcosm of America's sickness" (p. 248). Using Bryan as a microcosm, Alexander adeptly demonstrates how systems of health care impact the lives of individuals. The Hospital indicates an interplay of structure and agency by drawing connections between the struggles of Bryan residents and societal inequalities and profit imperatives.The text is broadly chronological, with three parts that cover "Autumn, 2018," "Winter/ Spring, 2018-2019," and "Winter/Spring/Summer, 2019-2020." However, the narrative surrounding the hospital itself is broken up by descriptions of the history of Bryan and of health care in America, by descriptions of neighboring hospitals, and by evocative detailing of the lives of hospital patients and employees. For example, the prologue introduces the reader to Phil Ennen, CEO of the hospital in 2018, to doctors, and to patients. Then the first chapter is more expansive. It details attempts to establish a hospital in Bryan, and the tensions in America between efforts to universalize and equalize health care and opposing efforts against any "socialization" of health. Initially, these shifts between the immediacy of concerns of Bryan residents and the broader picture of health care feel disorienting, but it is a skillful way of demonstrating that failings in health care systems have real effects. Alexander follows patients through their care as they suffer heart attacks, cancer, bereavements, amputations, all while navigating overwhelmingly convoluted health insurance systems and living on a financial knife edge. These emotive depictions of individuals' lives are perhaps the greatest achievement of the text. By taking this granular view, Alexander is able to demonstrate that the health of individuals in Bryan is inextricably connected to their employment, their accommodation, and their access to transport and to fresh food. Employment is significant here, particularly given that employers frequently have (often inadequate or inaccessible) health insurance systems. Beyond individual employment though, Alexander relates the "sickness" of inequality and failing health care to America's capitalist economy. He writes: "The modern American version of capitalism encouraged-even demanded-that employers extract the value from their employees while returning scraps to them and their communities" (p. 247). The health industry is like any other industry under this capitalist system: focused on its bottom line.The Hospital describes these pervasive issues within health care without applying any explicit theoretical lens. For example, Alexander uses distinctly Marxist terminolog...
Princeton economists Anne Case and Angus Deaton (Nobel Prize 2015) warn that deteriorating lives among the US working class generate ever more deaths of despair. These deaths from suicide, drug overdose and alcoholic liver disease threaten the success of the country. The fastest-growing causes of death, they are concentrated among whites without university degrees. The death rate from these causes tripled since the 1990s for those without degrees and didn't change for those with degrees. This growth caused overall US life expectancy, already low among industrial democracies, to decline for the first time in generations. Increasing deaths of despair and declining life expectancy are uniquely American, a sad exceptionalism.The deaths happen in the second half of a fifty-year decline in earnings for lesseducated Americans. Each cohort of entering workers without degrees experienced a decrease in real wages compared to those that came before. This fuels the growing education premium. Yet, inequality is, to the authors, an effect. Inequality and deaths of despair jointly result from the politics, power and social change destroying America's working class. The consequences are profound. Those without university degrees report being less happy, less healthy and in more daily pain. Marriage as an institution is failing. Labor force attachment is increasingly weak. Social organizations vanish, organized religion fades as political and social capital falls. These citizens increasingly "bowl alone." Large corporations from which they once gained belonging now contract out to firms providing no health insurance.The authors review other false explanations beside inequality. The timing is wrong for the great recession to be a root cause. They see no general moral failing of the less educated as declining wages combined with declining participation indicates a reduction in labour demand not in labour supply. While automation and trade certainly influence America's less educated, the authors view these as generating growth and increasing wealth. More importantly, both influence other developed democracies that have avoided deaths of despair. They recognize a less complete US social safety net failed to cushion the blow but do not see insufficient redistribution as the central problem.The central problem is unfairness. The authors give top billing for two villains: the American health care system and a government-run "protection racket" on its behalf. American health care is exorbitantly expensive, woefully inefficient and delivers poor public health compared with other industrial democracies. It vacuums up almost one dollar in five and per capita expenditures fly off the international chart. If the US
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