Page 279 - The ISA Handbook in Contemporary Sociology

9781412934633-Chap-17 1/10/09 10:19 AM Page 250

17

Conflict, Competition and

Cooperation in the Social

Division of Health Care

Paul Leduc Browne

Health care in contemporary societies more heavily on the institutions, organizations
encompasses a vast and complex set of prac- and practices in health care. The question
tices, organizations and institutions. As arises: in systems of health care dominated
inescapable as birth, illness and death, it rep- by ideological conflict, centralized command
resents on average about one-tenth of the structures and economic competition, what is
GDP of Western European and North the place and fate of care, as a cooperative
American states today, and is thus a very sig- form of practice and organization?
nificant source of employment, innovation Care has become ever more salient in
and economic competitiveness. It has also recent years as a key concept of sociological
become an ever more central field of political and political theory (Armstrong, 2004; Daly
conflict, as welfare states in transition and Lewis, 2000; Fink, 2004; Hankivsky,
are torn between competing social forces, 2004; Kittay, 1999). There has been much
values and models. As engines of economic attention to aspects of care (e.g., emotional
redistribution (Evans, 1999), public health labour) in fields relevant to the sociology of
insurance systems have been the target of health care, such as management studies,
campaigns warning of the fiscal crisis of the gerontology or women’s studies. But it
state and promoting tax cuts and privatization seems marginal – or at the very least taken
(Browne, 2000; Sen, 2003). Major industries for granted, not discussed – in debates about
in fields, such as construction, manufactur- the political economy of health care (as
ing, information technologies, biotechnol- pointed out also by Daly and Lewis, 2000).
ogy, pharmaceuticals, financial services and A basic idea in much of the literature
personal services have grown up in and on care is that the latter is the first and
around health care and compete for the enor- foremost work (e.g., Armstrong and Kits,
mous profits to be realized therein. These 2003; Bolton, 2000; Bolton, 2005; Browne,
economic and political changes impinge ever 2003; Daly and Lewis, 2000; Fink, 2004;