Economic Care Research Articles

The molecular pathology at Work: Metformin and Variability in Glycemic Control

The molecular pathology at Work: Metformin and Variability in Glycemic Control

Corporatisation and financialisation of social reproduction: Care homes and childcare in the United Kingdom

The ownership and financial strategies of companies providing care for children or older people have become an increasingly salient concern, in both research and policy, because of their implications for the quality and availability of care services, as well as working conditions. However, analysis has tended to be sector specific. This article provides the first comparison of ownership, business models and workforces across childcare and adult social care in the United Kingdom. It reveals growing convergence in terms of the dominance of large companies and their financial strategies, which can reward investors while undermining access to care and worsening working conditions for large, low-paid workforces. We conceptualise these developments in terms of corporatisation and the related process of financialisation. They are, we argue, underpinned by the political economy of low wages for care work, which we explain using feminist social reproduction theory – highlighting the devaluation of feminised and racialised caring labour. The article identifies the need for further research to account for differences between the sectors, to map the geographies and political economies of care, and to compare these processes internationally.

“Don't fuss at our staff”: A moral economy of volunteerism in South Carolina safety net clinics

In South Carolina, a state that has foregone Medicaid expansion, working poor residents often rely on safety net clinics for medical care. This care often occurs far from major hospitals, in different, inferior, spaces where limited services are provided in lesser circumstances. The temporary and conditional aid provided in these clinics is meant as a last resort, but often serves as the only source of care for many working poor patients, who must manage the effects of sustained precarity and protracted immiseration with conditional aid provided by volunteers. Here I explore the function that volunteering plays in regulating patients' utilization, and ability to contest, the quality of safety net care. Using ethnographic examples and interview data I show how the needs of patients—referred to in the clinics as “clients”—are managed and contained by a moral economy of volunteer care. These reciprocal obligations of debt and duty preclude working poor patients from making demands of, or lodging complaints against, the free clinics' staff, due to their capacity as volunteers, and leaves the state's safety net effectively unassailable to accusations of inefficacy or neglect. Consequently, patients must defer care, ignore episodes of maltreatment, and ration and share prescription medications, lest they be considered recusant or deemed not sufficiently appreciative of the volunteer staff dedicating their time to them. As a result of this moral economy, the plight of the state's uninsured working poor residents goes under-recognized as the safety net absorbs their cases, hiding the attritional nature of the ostensibly free care they receive and ration.

Statebuilding and the Modernisation of Welfare Governance in Russia

ABSTRACT This article examines challenges for effective statebuilding in relation to welfare governance in Russia. The focus is the contested role of non-state commercial actors in outsourcing reforms of welfare for older people. The findings suggest that authorities recognise the necessity of reforming the welfare system and its governance in line with international principles but face challenges for developing an effective mixed economy of care while bolstering statebuilding in the post-Soviet context. The article draws critical attention to the role of healthcare reform in statebuilding efforts and draws inferences for the public health governance and statebuilding nexus in a post-Soviet country.

Viral Interstitiality and Unlikely Resources: Gender and Labour in Turkish Public Theatre During the Covid-19 Pandemic

The growing literature on Covid-19 and theatre has demonstrated how the pandemic has intensified gendered precarities in theatrical labour.1 However, the pandemic has also provided feminist theatre makers with unexpected or unlikely resources, albeit with limitations. The Istanbul Municipal Theatre's (İstanbul Büyükşehir Belediyesi Şehir Tiyatroları or İBBŞT) production of Melek that premiered in 2020 is an indicative example of such rare and largely invisible cases of pandemic theatre. Critically engaging with the archives and repertoires of tuberculosis (TB) melodrama and the Turkish lives of the genre, Melek conducts an experiential mapping of the performativity of death and the porous borders between everyday performance and artistic performance. The production offered independent feminist theatre practitioners, who otherwise maintain a precarious existence in Turkey's theatre world, access to new spaces, resources and audiences. Combining archival with ethnographic research, I will demonstrate how, in the case of Melek, the intersections between actual and fictive viral contagion – what I define as viral interstitiality – constitute inclusive economies amidst the Covid-19 pandemic. In somatics, the interstitial is theorized and enacted as suspensions of static schisms that shape relational empowerment.2 Drawing upon this grasp of the interstitial as connective thresholds, viral interstitiality sheds light on the practices and the economies of care that emerge from the porous dynamism between the viral and the theatrical.

Feminist political economies of care: Young people, masculinities and de-industrialisation in a former shipbuilding community

The paper explores how ideas of masculinity are currently configured in a former shipbuilding community. Derived from ethnographic research with 120 young people from three schools, the study makes a critical intervention into gender and work through a focus on masculinities and economies of caregiving. The paper contributes to emerging work on gender, work and care in four ways. First, highlighting a contingent relationship between local political economy, place and the production of masculinities. Second, demonstrating how the inclusion of young people’s perspectives and experiences of male caregiving extends existing feminist care geographies. Third, by exploring how care is gendered, ‘regendered’ and ‘degendered’ in young people’s accounts, prising open possibilities for ‘undoing’ patriarchal masculinities and reworking the gender order. Finally, it is argued that such practices may inspire new economic ontologies of care, pluralise masculinity and enhance the transformation of gender relations at local and global scales.

From wages for housework to self-care: feminist perspectives on the care economy

AbstractThis article argues that privatization of health care since the 1970s has created a paradox whereby a neoliberal discourse of ‘freedom of choice’ masks the fact that it is increasingly difficult to make good choices when it comes to caring for oneself and for one’s loved ones. Part one historicizes this paradox by examining the pioneering international feminist movement Wages for Housework. I argue that Wages for Housework offered a glimpse of a counter-model of state-renumerated care through its revolutionary demand that all houseworkers receive a government wage. At the same time, I call attention to limitations of the movement. Building on the insights of this case study, part two contends that the privatization and commodification of care – especially in the US and the UK in recent years—is fundamentally linked to the ‘responsibilization’ of female-identified subjects. To demonstrate this, I turn to the issue of self-care, arguing that the emergence of self-care as a lucrative twenty-first century market is an important consequence and indicator of this responsibilization. Specifically, I show how individual choice is recast as a societal obligation to assume a consumerist standpoint of ‘self-investment’ that, in itself, becomes a necessary precondition of the ‘right’ choice. I conclude by asserting that it is unjust to frame care—whether for oneself or for others—as a problem of individual responsibility and explore proposals for a ‘universal basic services’ model as the most equitable solution to the current care crisis.

Lectio præcursoria—Economies of care and politics of return: Sustaining life among injivas and their families in Bulawayo, Zimbabwe

A lectio præcursoria is a short presentation read out loud by a doctoral candidate at the start of a public thesis examination in Finland. It introduces the key points or central argument of the thesis in a way that should make the ensuing discussion between the examinee and the examiner apprehensible to the audience, many of whom may be unfamiliar with the candidate’s research or even anthropological research in general.

Understanding the Role of Public Transportation in Supporting the Care Economy in Washington, DC, USA

Women’s empowerment is a powerful engine for personal and societal economic development and well-being. Nevertheless, gender biases in physical infrastructure investments lead to negative consequences for women and children that reduce their empowerment and limit their economic benefits. Public fixed-route buses, such as those in Washington, DC, illustrate how physical transportation infrastructure has innate gender biases. These young residents likely depend on strollers to travel longer than a few blocks. The Washington Metropolitan Area Transit Authority (WMATA) runs the public transportation system in Washington, DC. In 2021, 7% of DC’s 720,000 residents were under five. WMATA maintains a fleet of approximately 1595 buses, 95% of which banned the onboarding of open strollers until recently. This ban directly limited the use of Metro buses for the caregivers of young children, primarily women. It also reduced the opportunities for these caregivers to participate in DC’s economic life. In neighborhoods dependent on buses for essential mobility, the stroller ban reduces employment, healthcare, social service, educational, and recreational offerings beyond walkable distances. This paper examines the publicly available discussions and actions that led to the updated stroller policy and offers opportunities for improving caregiver transit access in Washington, DC, and, by extension, other cities worldwide.

Quantification of factors influencing differences in the Case Mix Index and their significance for health systems sustainability

Case Mix Index (CMI) represents a standard indicator of hospital disease seriousness at both the national and international level. CMI is structured to compute hospital payments and not to follow up disease seriousness. It is considerably related to the data accuracy as well as patients’ medical records. The main aim of the study was to quantify the factors influencing the differences in CMI depending on the types of healthcare facilities, their geographical location, as well as the procedural aspects within the Slovak healthcare system. We use data published by the Institute for Economic and Social Reforms, which continuously surveys the quality and outputs of healthcare provided in the Slovak Republic. The data comes from multiple datasets that are issued by healthcare authorities and stakeholders is the Slovak Republic such as insurance companies, the Ministry of Health of the Slovak Republic, the Ministry of Finance of the Slovak Republic, healthcare facilities, the National Health Information Centre etc. Regression analysis indicates that the positive impact on the Case Mix Index is possessed by the Operating experience of doctors and Overall inpatients satisfaction; whilst the negative impact on Case Mix Index values is documented for variables Total rehospitalisation within 30 d, Intensive care unit mortality, Economy, and Transparency.

Professioni nella Care economy e occupazione: evidenze su dati amministrativi

The paper analyses the evolution of hiring in the care economy professions. To this end, a dataset is used that merges information from sample and administrative sources on labour market flows and occupations. Empirical analyses show that over the period 2012-2021 there was an increase in hiring in the care economy sector, albeit with a cyclical dynamic mainly linked to the Covid-19 emergency. However, these occupations are associated with a penalty in terms of work intensity compared to the average for other occupations. Finally, in care economy professions, there is a reduction in gender inequality when measured by the average number of days worked during the year

“Care Drain” from East to West: The Narrative of Romanian Women Migrant Working in the Italian Domestic Care Sector

This study employs a qualitative methodology to investigate the implications of Romanian women’s migration to Italy for employment in the domestic care sector. The research is based on in‐depth interviews conducted face to face with 20 Romanian women who have resided in Italy for over a decade, with the aim of capturing the details of their long‐term integration processes. These interviews, conducted in 2022, specifically focus on the participants’ lived experiences of migration and adaptation within the Italian context. Findings reveal that economic motivations are a primary driver intertwined with aspirations for personal and familial advancement. However, the research also highlights the challenges faced by these women, including precarious employment conditions, emotional strain due to family separation, and complexities of integration within the host society. Social networks and transnational ties emerge as crucial factors influencing both the decision to migrate and the subsequent adaptation process. The analysis underscores the duality inherent in care work migration: While it bolsters the Italian care economy and offers economic opportunities for the migrants, it simultaneously exposes them to vulnerabilities such as job insecurity and potential exploitation. By investigating this migration of care workers, the research contributes to the field of welfare economics by clarifying the economic ramifications of gendered occupational segregation and migration status. Furthermore, it advocates for implementing inclusive labour market practices and policies that prioritize the well‐being of migrant care workers and facilitate their successful integration into host societies.

Creating a User-Inventor Community: How Disabled People Innovated and Marketed Disability in Early Nineteenth-Century America.

Early nineteenth-century America's robust trade in medical and health care products is richly documented, yet many scholars have overlooked just what role people with impairments played in that industry as inventors and retailers, forming relationships with clients based on their shared experiences of disability. A study of newspaper advertisements, patents, organizational records, medical accounts, and objects suggests that many impaired and formerly impaired producers marketed products to impaired consumers, creating an organic and unselfconscious network of disabled people who made, sold, and bought knowledge and devices about and for disability. Recovering this world of disabled inventors, retailers, and their clients reveals how disability fueled innovation in early nineteenth-century America, expanding scholarly understandings of who participated in and profited from the burgeoning medical and health care economy. This study also suggests that the market was an early venue of disability community where people came together around their common bond.

Urgensi Pelindungan Pekerja Rumah Tangga Sebagai Pengakuan Atas Kerja Perawatan di Indonesia

Domestic workers (DWs) are in a very vulnerable position. However, the problems faced by domestic workers have not yet become a mainstream discourse, let alone transformed into public policies that provide legal protection for them. In the absence of a legal framework that can be used to claim their rights, domestic workers are one of the most vulnerable groups of workers to discrimination, violence, and exploitation. In Indonesia, advocacy for a law to protect domestic workers has been ongoing for almost two decades. However, to date, the law has not been materialised, even though the Indonesian government, when hosting the G20, advocated for the recognition of the care economy. This article aims to discuss the PPRT Bill using the 5 R’s framework (recognition, reduction, redistribution, reward, and representation) developed by the ILO. This article assesses that the PPRT Bill is generally in line with the 5R’s framework, but it still needs strengthening in several aspects, especially issues of pay, benefits, and the right to unionise.

A Study of the Construction of Smart Healthy Elderly Care City: An Aspect of Foshan City, Guangdong Province

The smart healthy elderly care city takes the integration of healthy elderly care resources with information technology as its basic feature, and innovates the healthy elderly care service model to accurately serve the elderly. In recent years, all parts of the country have gradually promoted the construction of smart, healthy and elderly care cities, which have achieved good results, but also face many problems. In order to evaluate the current situation of the construction of smart healthy elderly care cities, the author has built a smart healthy elderly care city evaluation index system based on the research results and standards of smart city and healthy elderly care city evaluation index system. The evaluation index system of smart health care city involves five fields, including smart health care infrastructure, smart health care environment, smart health care economy and smart health care services, which can comprehensively and systematically reflect the construction of smart health care city. Taking Foshan City, Guangdong Province as an example, this paper empirically analyzes the current situation and problems of the construction of a smart healthy elderly care city using the data from 2020-2021, and then puts forward high-quality development strategies for the construction of a smart healthy elderly care city in Foshan.

Aiming for equity in care provision

Since the introduction of the triple aim for health quality improvement around 2008 the suggested multi-layered approach to quality improvement has gained ground. The idea is that when working for quality improvement in the health and care sector one needs to have several aims in sight at the same time. Originally the three aims singled out were: enhancing patient experience, improving population health, and reducing costs. These were then expanded to include an additional goal of improving the work life of health care providers (the quadruple aim). Now, the last addition to the idea is a new layer; namely equity (the quintuple aim). 
 This presentation addresses the discussion on how to work towards the newly added aim on equity. In Scandinavia and elsewhere in Europe we are moving towards more integrated care, but also more complex care economies consisting of an increasing number of private and public providers that in various ways depend also on domestic agents. Indeed, the ongoing transformations of care work holds in it several potential routes for change when it comes to equity, and it is of vital importance we keep our gaze on these issues to ensure a desired outcome. 
 From gender research it has been pointed out that research addressing inequality and equity in (care) work, often remain on an individual micro level, when instead we need to lift our gaze to culture and social structure to get the whole picture. To meet this challenge the concept of gender regimes can be helpful; it points to the variation in the political and organizational contexts in which care work institutions are founded and embedded. The presentation will explore weather this approach, in combination with a look towards care economy as a societal field going across domestic, public and private spheres, can allow for a conceptual discussion on how we can succeed in increasing awareness of equity and inclusion in health care improvement work.

THE ROLE OF SOCIAL ENTERPRISE ORGANIZATIONS IN SUPPORTING FAMILY CARERS OF OLDER PEOPLE LIVING WITH DEMENTIA

Abstract This paper aims to present findings from a primary qualitative study that explored the role of social enterprise organisations (SEOs) in delivering co-produced support for family carers of older people living with dementia (PLWD). Defined in the UK, as businesses with a social or environmental purpose, SEOs are increasingly recognised as occupying a unique space in the landscape of adult social care delivery. In Wales, devolved legislation requires public bodies to collaborate with SEOs - this provision is intended to create a mixed economy of care with co-produced user-led services. To date, however, there is little firm evidence of SEOs delivering co-produced care solutions within the policy framework in Wales, which can be understood to be particularly permissive of SEO involvement, or of how the sector is involved in the delivery of support for family carers of older PLWD. Findings gathered through five focus groups with a purposive sample of family carers, and SEO care providers in South Wales, show how co-produced family carer support programmes are navigated and enacted, as well as how the individual agency of service providers, PLWD, and their carers are involved in these processes. Adopting an ethics of care approach, and utilising reflexive thematic analysis, key themes identified include competition between and within organisations, parochialism, capacity, and organisational barriers. This study highlights implications for policy and practice related to the rhetoric of co-produced support services for family carers, SEOs’ views on delivering that support, and family carers’ experiences of navigating and receiving SEO-delivered services.

Converging economies of care? Immigrant women workers across 17 countries and four care regimes.

This study analyses 17 care economies using 2016 Luxembourg Income Study data to contribute to extant debate regarding the ongoing utility of care regimes as a classificatory schema for cross-national comparison. Examining similarities and differences in the provision of low-status work in health, education, social work, and domestic services - the 'care economy' - the data reveal devaluation of the labour done by immigrant women care workers, net of national and regime-level variation. In addition, numerous similarities across liberal, corporatist, social democratic, and central and eastern European care regimes emerge, in terms of the overrepresentation of immigrant women in low status care work, and the disproportionate financial penalties these workers incur. Together, findings suggest that notwithstanding national and policy-specific differences, there has been considerable convergence across economies of care towards a 'migrant in the market' model of employment. Such large-scale evidence of this trend calls into question the ongoing efficacy of care regimes for national comparisons of migrant care work under conditions of neoliberal globalization.

Unnamed, not unskilled: Toward a new labor history of pharmacy.

By recovering the dependent, often enslaved, laborers who helped to make European medicines commercially available in the New England colonies, this article offers a new history of early American pharmaceutical knowledge and production. It does so by considering the life and labor of an unnamed, enslaved assistant who was said to make tinctures, elixirs, and other common remedies in a 1758 letter between two business partners, Silvester Gardiner, a successful surgeon and apothecary in Boston, Massachusetts, and William Jepson, his former apprentice, in Hartford, Connecticut. Using strategies from slavery and critical archive studies, as well as from social history and the history of medicine, this article emphasizes the materiality and embodiment of pharmaceutical production and follows fragmentary evidence beyond the business archive to reverse the systemic erasure of enslaved and indentured laborers from the records of eighteenth-century manufacturers of medicines. The medicine trades of men like Gardiner and Jepson appear more reliant upon dependent laborers - named and unnamed - who not only performed rote tasks but brought their experience and judgment to their labors as well. Their contributions could be obviously medical (preparing remedies) or more ambiguous (stoking fires, shipping goods), but these actions together constituted early modern pharmacy, enabled the expansion of the transatlantic medicine trade, and laid the foundations for the more self-sufficient and industrialized pharmacy that developed in the nineteenth century. Centering the skill and knowledge among subordinated laborers in one facet of an emergent transatlantic care economy affirms the entanglement of slavery and science and underscores the necessity of asking new questions of old sources.

Confronting Loneliness with Devotion

Abstract Today, the practice of religion is strongly influenced by digitalisation, in not only everyday life but also liminal situations such as dying. Apps, social networks, and virtual church services offer believers opportunities for participation when their mobility is impaired due to ageing and severe illness. This short-term ethnography explores Bible (e-)reading and (religious) encounters in a palliative care unit of a Swiss hospital, drawing on in-depth interviews, participant observation, and documentary photography. Using the case of a devout Protestant, who was chosen as a case study from a sample of 12 terminally ill patients, I will investigate 1) the existential issues involved in the dying process, 2) how Bible (e-)reading alleviates these issues, and 3) the networks and encounters with which the practice is connected. The results show that anticipation of death in conjunction with personality and social issues bestow a complex emotional tone on the Christian’s end-of-life journey. Bible reading, performed both through mobile mediation and face-to-face with companions, is an avenue through which to gain strength and hope in this difficult situation. Another important finding is that the devotional practice involves an exchange of gifts, which transposes the practice into a moral economy of compassion and care.