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SOCIAL DIVISION OF HEALTH CARE 261

privatization advocates of public anxiety 2 To be sure, emotion work is also an instrument
over the time of care, that is, both its timeli- of manipulation in the private and public spheres. The
Managed Heart analyzes two extreme examples of
ness and duration, as waiting for treatment
the colonization of this faculty in the capitalist econ-
appears to lengthen, while hospital stays and omy, in one case (flight attendants) with a view to
contact time with healt hcare professionals seducing customers, in the other (bill collectors) with
seem to get ever shorter. Another conse- a view to bullying them. However, I shall reserve dis-
quence has been the enormous pressure felt cussion of these dynamics for the following section.
3 In Quebec, and increasingly in Canada, the
by physicians, nurses and other caregivers in
social economy is defined as those forms of non-
recent years as a result of budget cuts, mas- statutory collective enterprise (e.g., associations and
sive restructuring, work speed-ups, and the cooperatives), which exist primarily to serve their
introduction of new management strategies. members or the community, rather than simply to
In Canada, nurses responded with unprece- maximize profits or generate financial returns; which
are governed democratically by their members, with
dented union militancy (Briskin, 2006). At
involvement by their workers and the users of their
the same time, many have left the profession, services; which stand for the primacy of persons and
while recruitment of new nurses has been labour over capital in the distribution of their sur-
insufficient. A huge labour shortage threatens pluses and revenues; and which promote the values
Canada’s health care system. The popular and of participation, empowerment and collective
responsibility. (This definition is adapted from those
ideological perception is of health care sys-
used by the Canadian Social Economy Hub
tems in crisis because of soaring costs. The (www.socialeconomynetwork.ca) and Québec’s
analysis here suggests that health care sys- Chantier de l’économie sociale (www.chantier.qc.ca).)
tems are experiencing a deeper crisis rooted 4 Sharon Bolton (2005) usefully distinguishes
in the way their societies allocate and between different aspects of emotion management in
the workplace. Pecuniary emotion management, as
manage time – a process increasingly dictated
the type of emotional labour required of employees in
by the imperatives of capital accumulation – commercial settings (e.g., Hochschild’s flight atten-
and in the way this fragments the cooperative dants who must always appear cheerful and pleasant),
relations of care by pitting caregivers and differs in her view from prescriptive emotion manage-
users, producers and consumers, employers ment, the sort of emotion work that professionals
such as lawyers, physicians and nurses are trained to
and employees, managers and workers, pro-
accomplish in order to cope with the stresses of their
fessionals and patients, waged workers and jobs. These both differ from philanthropic emotion
volunteers against each other in relations of management, which Bolton defines as the gift of emo-
competition and conflict. tion work with no expectation of a return. Bolton
(2000) shows that nurses take pride and pleasure in
this kind of emotion work; therefore, she does not
view it as alienating. My point here is not that it is
NOTES alienating as such, for it is not, but rather that the
specific character of the gift relationship must be ana-
lyzed, both as it appears in itself in a given situation
1 It was only as I was finishing this chapter that I and as it is mediated with other forms of relations of
came across Daly and Lewis’s article, ‘The Concept of production. Bolton presents the different aspects of
Social Care and the Analysis of Contemporary emotion management as though they could coexist as
Welfare States’ (2000). Daly and Lewis also make the separate things, without exploring their mediations.
case for analyzing care as labour, viewing it holisti- Labour process theory, which Bolton commends,
cally beyond the fragmentation brought about by the would suggest, however, that one form is likely to be
division of labour, examining the social relations of hegemonic and the others subordinate.
wealth and power entailed by the social division
of care, and taking into account not only the public
and private sectors, but also the third sector, as well
as the informal and domestic economies. Although REFERENCES
my starting point is Marxist theory and my object
health care, while their starting point is feminist
theory and their object what they call social care, Armstrong, Pat (2004) ‘Thinking It Through:
there is much in common between their approach Women, Work, and Caring in the New
and mine. Millennium’, in Karen R. Grant, Carol