Insiders and Outsiders in Health and Social Care

Recent research by Naomi Lightman (1) of the University of Toronto paints a stark picture of the earnings divide between health and social care professionals, and non-professionals working in the same sector, in English-speaking (read “liberal economy”) countries.

Lightman looked at the distribution of employment in health and social care in The USA, UK, Ireland, Australia, and Canada. (also Israel). She found that in all countries, those with the high-status jobs – mainly professionals – enjoy a wage “bonus” over comparable workers in other occupational sectors. They work mainly in the public and quasi-public sectors, although this varies somewhat by country. In Canada it is over 81%, 68% in the USA. These sectors are dominated by women. These are the insiders, protected by collective bargaining, public sector job security and a profession which has substantial control over who gets into it.

The outsiders are the non-professional care workers, still majority public and non-profit sector workers, but increasingly also private sector. These workers are also more likely to be women, and also more likely to be immigrants or temporary workers. They receive a wage “penalty” for their lack of protection or collective bargaining. They tend to be paid less than comparable workers in other sectors, about half of the overall average wage in the country. In other words poverty-level work. The author notes that the low status jobs have grown in tandem with the ageing society, and in an era when these liberal economy countries are trying to reduce government responsibility for care and transfer the costs to families or private insurance. She notes also that many of the outsiders – the low status workers, are trying to send money back to their own families in their countries of origin, making them highly vulnerable, precarious workers.

(1) Naomi Lightman, The “Migrant in the Market”, Migration and Care Work Across Six Liberal Welfare Regimes, Luxembourg Income Studies Working Paper No. 682, Nov 2016

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