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SOCIAL DIVISION OF HEALTH CARE 251

Himmelweit, 1999; James, 1989, 1992; moves from the abstract to the concrete and
Maheu and Bien-Aimé, 1996; Twigg, 2000). factors in the distinctions established by the
A rich and expanding body of research has social division of labour. The initial discus-
shown how understanding care as labour, sion of care may at first strike the reader as
and labour as care, sheds light on the com- too general; however, subsequent stages of
plexity, fertility and specificity of both the argument will disclose the value of this
concepts, broadening and deepening their approach from the standpoint of analysis and
understanding. critique.
How does health care as a set of public and My argument will unfold in four sections.
private enterprises relate to health services as Health care today resembles a vast and hetero-
care? The answer resides first in the concep- geneous collection of services and practices,
tualization of care as complex, collective such as surgery, laboratory work and insur-
labour, in which the building of specific ance. In my view, it is possible to subsume
types of cooperative and dialogical relation- them all under the concept of care, but this
ships is both a condition and a desired out- means departing from common-sense under-
come; and second in an analysis of the ways standings of what it is. My first section will
in which forms of conflict and competition abstract from the relations of production and
generated by the social division of health situations in which care occurs in order to
care today reify care and lead to the exploita- construct a concept of care as a specific com-
tion of care work. 1 plex, collective form of labour. This will set
This chapter carries forward the discussion the stage for a second section discussing
of care as labour by highlighting the key role some general aspects of today’s social divi-
of this concept in bridging the various litera- sion of care, in particular the relationship
tures on care – those which deal with conflict between the logics of exchange, redistribu-
and competition over power, status and tion and reciprocity. In the third section, my
resources in a political economy perspective, attention will bear on the fragmentation and
and those which stress cooperation, emotion reification of care work, and on the segmen-
and giving in an anthropological or social tation of those who care by gender, class,
work approach. In developing this analysis, status (notably professional status) and by
this chapter draws mainly on North economic logic (exchange, redistribution,
American, British and French sources from a reciprocity). In today’s world, care is gen-
variety of disciplines and relies mostly on dered in a number of ways. Several aspects
empirical studies conducted in Canada and of care (body work, emotion work) tend to be
Québec. It contributes to the literature on socially constructed as ‘women’s work’, not
care in its effort to mediate analyses of care just in the sense that the majority of care-
at different spatial scales and different levels givers (including remunerated professional
of abstraction. In seeking thus to generate a and non-professional workers in the health
more totalizing concept of care, the chapter care system) are women, not just in the sense
moves from the abstract to the concrete, from that these activities are construed as of lesser
care in general to the dynamics of the social value because women do them, and not just
relations of health care stemming from the in the sense that men who do them may con-
division of labour. The most abstract level sequently lose status, but also in the sense
specifies the nature of care as a process of that it is believed to be in the nature of
physical, emotional and intellectual work, women to do them, to the point that these
but does not yet explicate the relations of activities are no longer really counted
production under which this work takes as work, but simply as the way women are.
place. That is done at subsequent levels of the A certain kind of gendering in practice and
analysis. The reader will note that the meaning ideology results in the reification, devalua-
of the concept of care shifts as the argument tion and occlusion of care (Hochschild,