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SOCIAL DIVISION OF HEALTH CARE 257

male medical professionals. The domination condition is time for body work, emotion
of professional elites and bureaucratic proce- work, dialogue – for listening. ‘Time is a gift
dures provoked a grassroots backlash that of self, even when it is remunerated; it blazes
took the form of interest in alternative the path of reflexivity (between care givers
medicine and therapies, as well as of community- and recipients and each for her/himself) and
based movements to bring workers and users of the space to be taken’ (Gagnon et al.,
together in egalitarian, cooperative or asso- 2000: 155). Because the building of trust is
ciational organizations (see the radical grass- such an essential part of care, continuity is
roots initiatives that were at the origins of one of its key features (Himmelweit, 1999:
Québec’s Centres locaux de services commu- 35). Time is money, according to the old
nautaires – CLSCs). More recently, the intro- cliché. Private wealth can purchase time –
duction of the new public management in and therefore the opportunity for ‘labour’ to
health care (Browne, 2000) has brought with become ‘work’ in Radin’s and Himmelweit’s
it an emphasis on the use of market mecha- terms – for a price. (On time and care, see
nisms – in particular competition – to effect Browne, 2003; Gagnon et al., 2000; Twigg,
efficiencies: separating purchaser from 2000.) Few people can afford this, though. In
provider; contracting out; introducing fees; the public sector, time has grown scarce and
enhancing efficiency through the standardi- expensive, as cutbacks have become the
zation of practices; improving relations with imperative of every ministry and program.
the ‘customer’ through the ‘personalization’ Although there are considerable expenditures
of services, that is., the introduction of care- on supplies and equipment in health care (for
like elements, such as aspects of co-production, figures see Browne, 2000), wages make up a
emotional labour and so on (Bellemare, significant portion of the costs. Reducing the
1999; Ughetto et al., 2002). latter has therefore meant finding ways of
Standardization of many aspects of care is economizing on the expenditure of labour
quite another matter, however, because of their power, that is, reducing the time available to
‘product complexity’ and ‘consumer complex- health care users. The clock time of capital
ity’, as John Baldock (1997: 82) has suggested. and the state is in contradiction with the
Because emotion and body work is often process time of care. As Julia Twigg puts it,
inseparable from the concrete relationship the ‘needs of the body cannot be saved up and
between the individuals it joins (Himmelweit, dealt with once a week’ (Twigg, 2000:
1999: 29), care is inextricably bound up with 100–101; also Davies, 1994).
‘individual differences, varying from person to The time of care can be related to the kind
person and across time and space’ (Baldock, of social relationship it is. David Graeber
1997: 83), making it poorly suited to standard- (2001) usefully shows how giving can take
ization (Laville and Nyssens, 2001: 11–12; different forms, which may themselves be
Leys, 2001). In the rationalization of the mass highly gendered, pulling either in the direc-
production of health services, whether in the tion of open-ended or closed relationships.
hospital or the home, those aspects of care In the latter, actors weigh their gifts much
which are most easily standardized, which more carefully and tend to await reciprocal
have greatest prestige or which have greatest gifts before giving again. In the former,
clout have been given priority (Campbell, actors give continually without expectation
2000). The emotion work of building care rela- of reciprocal gestures and without any
tionships has tended to be marginalized and thought as to whether such gestures have
occluded, because it is not standardizable, been forthcoming – behaviour characteristic
because it is time-consuming and expensive, of a relationship of care. Each of these forms
and because of its gendered nature. of giving can become corrupted. Closed rela-
Because care consists in the collective tionships can ‘degenerate into outright com-
work of building relationships, its essential petition’ or barter; open-ended giving, of the