This article presents the results of a qualitative study of 72 workers in regional Victoria, Australia. Against the background of the growing casualization of the workforce it demonstrates the impact on the health and well-being of these workers, focusing on the intersection between psychosocial working conditions and health. In particular it focuses on the detrimental impact on workers’ sense of self-efficacy and self-esteem. It emphasizes how the job insecurity characteristic of non-standard work extends beyond the fear of job loss to involve uncertainty over the scheduling of work, with debilitating consequences for workers’ autonomy, self-efficacy and control over their lives. Additionally, it is argued that the exclusion of these workers from paid leave and other entitlements in the workplace confers a lower social status on these workers that is corrosive of their self-esteem. It is these key socio-psychological mechanisms that provide the link between insecure work and workers’ health.
This article examines the development of general practice in the latter half of the 20th century, documenting the issues of concern to both the profession and the state. General practice developed hand in hand with the welfare state in Australia. As the structural changes associated with restructuring of the welfare state have advanced, so have the fortunes of general practice declined, despite significant attempts in the 1970s and 1980s to "save" general practice by both the profession and the state. These structural changes have operated on two fronts, the economic and the cultural. On the economic, changes to the employment of general practitioners clearly indicate ongoing proletarianization, particularly in a changing environment of labor-capital relations. At the cultural level, development of the self-help and the women's movements and the elective affinity of these groups with the individualism of the new right are leading to deprofessionalization. The author advances this argument in a review of general practice over the last 40 years and in a case study of community health services. Theoretically he argues for a combination of the proletarianization and the deprofessionalization theses.
Over the past decade, the Australian hospital sector has undergone a massive economic and administrative reorganization with ramifications for both the private and the public sectors. Changes such as privatization, deregulation, and the entry of foreign capital into the hospital sector are occurring in the hospital systems of many countries, including Australia, the United States, and the United Kingdom. These developments are radically transforming the hospital sector, altering established relationships between the state, the medical profession, the consumer, and the corporate investor, and raising important questions about the future of hospital services in regard to equity, accessibility, and quality.
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