Sirpa Wrede

Encountering Globalization: Professional Groups in an International Context

The market for professional services is increasingly international but comparisons have not been made between different professions nor on how state policies affect opportunities for mobility. This article considers three professions: engineers, physicians and psychologists and explores the similarities and differences in international labour market demand for occupations. It examines how state policies in four countries, Canada, Finland, France and the UK, aim to promote and control professional labour mobility and migration, and the differences across the three professions. Engineering is an international profession and the extent to which states encourage inward migration differs. Medicine is highly regulated in all four countries but inward migration of physicians varies depending on national policy. Psychologists are less mobile, and the extent of state sponsorship and regulation varies across countries. In all three professions, international organizations are a force encouraging global standards. The conclusion is that state policies reflect state interests and have a strong influence on patterns of mobility.

Social Service Professional or Market Expert? Maternity Care Relations under Neoliberal Healthcare Reform

Recent developments in the organization and practice of healthcare, driven by the introduction of (quasi-) markets and privatization, are altering traditional forms of professionalism found in high- and middle-income countries. Yet there remains debate about whether these neoliberal trends are universal or country specific, and whether they have any effect (positive or negative) on health service delivery. This article develops a comparative analysis that focuses on changes in maternity service systems in four countries in Northern Europe and the Americas with primarily publicly financed healthcare systems: the UK, Finland, Chile and Canada. The article begins with a discussion of the continuum of professional forms found in the post-Second World War period and their relationship to different kinds of welfare states. It then focuses on the impact of recent neoliberal reforms on the ideological projects of the medical and allied health professions in the four case examples. The results show that variation across time and place is mainly the result of structural/economic factors and that various forms of professional discourses are the result of the public/private ways that healthcare systems are organized. The article concludes with suggestions for further comparative sociological research.

Too Posh To Push? Comparative perspectives on maternal request caesarean sections in Canada, the US, the UK and Finland

Purpose – This chapter critically examines the purportedly growing phenomenon of Maternal Request Caesarean Sections (MRCS) and its relative contribution to the rising caesarean section (CS) rates. Methodology – We apply a decentred comparative methodological approach to this problem by drawing upon and comparatively examining empirical data from Canada, the US, the UK and Finland. Findings – We find that the general argument that has emerged within the obstetric community, evidenced in particular by a recent “State of the Science” conference, is that the reduced risks and benefits of MRCS are evenly balanced, thus ethically it could be seen as a valid choice for women. This approach, taken in particular in the North American context, negates the problematic nature of accurately measuring, and therefore assessing the importance of maternal request in addressing rising CS rates. Moreover, although some of the blame for rising CS rates has focused on MRCS, we argue that it has a relatively minor influence on rising rates. We show instead how rising CS rates can more appropriately be attributed to obstetrical policies and practices. Originality – In presenting this argument, we challenge some of the prevailing notions of consumerism in maternity care and its influence on the practice patterns of maternity care professionals. Practical implications – Our argument also calls into question how successful efforts to address MRCS will be in reducing CS rates given its relatively minor influence.

Unpacking gendered professional power in the welfare state

Purpose – Recent scholarship reveals the imagery of the professional as the “ideal citizen”. The linkage between professionalism and citizenship is here approached from the perspective of democratic social justice in order to examine the persistence of gendered inequalities in the health care system. The paper aims to examine the ideas framing professionalism, both in sociological theory and historically, asking what gendered hierarchies mean in modern health care systems, and why and how they persist in the conditions of liberal democracy.Design/methodology/approach – The question is approached through both sociological literature and an analysis of historical framings of professionalism; the Finnish health care system is employed as a case. The reason for keeping the discussion close to a specific case is that different professional fields, countries and historic contexts differ from each other in democratically relevant respects.Findings – Traditional sociological theory assumed that professional privi...

Born in the USA: Exceptionalism in Maternity Care Organisation Among High- Income Countries

In lay terms, childbirth is regarded as a purely biological event: what is more natural than birth and death? On the other hand, social scientists have long understood that ‘natural’ events are socially structured. In the case of birth, sociologists have examined the social and cultural shaping of its timing, outcome, and the organization of care throughout the perinatal period. Continuing in this tradition, we examine the peculiar social design of birth in the United States of America, contrasting this design with the ways birth is organised in Europe. We begin by showing how several key characteristics of the US health care system – including its inherent social inequality, its high level of medicalisation, and the substantial influence of private medical practice and insurance companies – influence the organization of maternity care there. We then explore how cultural characteristics of American society – its emphasis on individuality, the influence of moral conservatism in US politics, and the ease with which ordinary people take court action (the so-called ‘litigation culture’) – shape the delivery of care at birth. We conclude with a consideration of the implications of US maternity care exceptionalism for comparative sociological analysis.

Glocalising Care in the Nordic Countries

* E-mail: sirpa.wrede@helsinki.fi This Special Issue examines the position of migrant-background care workers in Nordic care work regimes. The issue takes part in a research dialogue that is emerging between researchers coming from two main fields: migration studies and research on migrants in the labour markets, and the scholarship on care work in the context of changing welfare-state arrangements in the Nordic countries. The special contribution of this Special Issue is to introduce the concept of glocalisation which provides an analytical link to the two, previously mentioned largely separate strands of literature on migrant-background care workers. Deriving from macro-sociological debates where it was introduced to emphasise the cultural dynamics of globalisation (Robertson 1995, Roudometof 2005), the concept here calls attention to the role of globalisation in the changing Nordic care regimes, but not as a deterministic force that transforms the different local regimes according to one model that reflects globalisation. Instead, this cultural interpretation of globalisation calls for the need to pay attention both to the role of non-local globalising discourses and to the emerging local arrangements in which the non-local discourses are interpreted for the specific contexts of the local regime. Our aim is not to emphasise the unavoidability of convergence or to celebrate divergence. Instead the glocalisation argument calls attention to the fact that the characteristics of the social embeddedness of care work regimes are not fixed. In this vein, we argue that the impact of globalisation on care work regimes may be best understood if we consider glocalisation as a dynamic mix of convergence and divergence (Saltman 1997). Accordingly, care work organisation needs to be examined in specific localities, taking into consideration both the travel of ideas and the activities of the people with whom they travel, the reshaping of practices and the experiences of people affected. In the following, we approach the issue of migrant-background care workers in the context of glocalising care work regimes from the perspective of the two research fields mentioned above. The two research fields provide two different perspectives about how the position of migrant care workers has evolved: one focusing on the care work regime and the other focusing on international migration and movement of people. The attention lies on how unique historic constellations play into the particularities of glocalisation. In the context of on-going societal transformations involving neoliberal reforms and long-term demographic developments, Nordic care regimes suffer a particularly severe deficit of care labour at the same time as the Nordic region constitutes an increasingly attractive region in the context of global mobilities. In the final part of this introduction we present the articles in this issue that describe what happens when new people enter a care work regime that is itself undergoing transformation.

Nursing: Globalization of a Female-gendered Profession

Governments, health managers and the general public in high-income countries invoke nurses as a central resource for achieving health political aims (Davies, 2007). This is hardly surprising, as nurses are the largest group of workers holding formal qualifications in healthcare. In OECD countries nurses usually outnumber doctors three to one (OECD, 2008: 14–15). Recent research suggests, however, that even though policies in high-income countries recognize nurses as important healthcare workers, the quality of nursing work from the point of view of the nurses as workers has been neglected. Recent health reforms have pushed for cuts in healthcare spending, resulting in deteriorating working conditions for nurses (Folbre, 2006). Neoliberal economic restructuring has emerged as a global force that has steered nation-states to explicitly create and reinforce the redistribution and internationalization of care work, including nursing (Misra et al., 2006). For instance, recent research evidence from the United States, the country that employs the largest number of foreign nurses, demonstrates that dissatisfaction with the nursing workplace is the key reason cited by nurses working outside of nursing employment (Black et al., 2008).

Introduction: Street-Level Engagements

During the last decade, new research approaches to global migration have highlighted the multifaceted ways in which structural inequalities and subordination impinge upon the possibilities to substantive citizenship (Fraser 2009; Nordberg 2006; Olwig 2011; Tully 2000). By shifting the focus from migrants themselves to reciprocal processes of interaction, the complex macro–micro relationship between recognition, redistribution, representation and a sense of belonging becomes visible. Scholars, particularly drawing on governance perspectives, have effectively shown how the political-cultural framework morally constructs and disciplines migrants (Lippert & Pyykkönen 2012; Geiger & Pécoud 2013). The categories produced for the purposes of governance are ordered along intersectional social divisions such as gender, race, class and sexuality (Anthias 2013). Recognising the insights of such previous research, the specific aim of this special issue of the Nordic Journal of Migration Research is to bring to the forefront new, empirically grounded understandings of policies and practices of migrant citizenisation in the restructuring welfare state. The individual contributions have been produced in different scholarly contexts: social work, social policy, sociology, education and ethnic and migration studies. A multidisciplinary approach to citizenship proved particularly fruitful for grasping the complex and multifaceted nature of contemporary citizenship. Accordingly, introducing the notion of citizenisation, we develop it from a top-down understanding (cf Tully 2005) to the interplay between migrants’ negotiations and acts of citizenship (Isin & Nielsen 2008) and the normative practices of (welfare) state incorporation played out in street-level encounters. We understand acts of citizenship as a broad category of engagements. The notion of the street-level was introduced by Michael Lipsky (1980) to identify the specific character of this type of institutional encounters between bureaucrats and service users. In this issue, we find that street-level encounters constitute sites of fundamental importance for citizenisation, referring simultaneously to formal institutional encounters in the Lipskyan sense, to semi-formal institutional encounters and to the myriad forms of everyday encounters with fellow members of society. In the Nordic welfare state contexts at the street-level, migrant citizenisation practices are typically featured by extensive interaction with the local welfare state: mainstream social and welfare services as well as specific integration plans, language training and citizenship training (Fernandes 2013; Hagelund 2010; Keskinen et al 2012). The neoliberalisation of what once were perceived as mature welfare states has not only implied a move towards a fragmented and increasingly marketised model of service provision, but also a redefinition of the social contract with a stronger emphasis on the duties and responsibilities of individual citizens (see also Carmel et al 2011; Schierup & Ålund 2011). Accordingly, there is a call for research that empirically examines the implications of the reconfigurations occurring at the nexus of state policies, street-level encounters and the individual. The special issue takes as its starting point the way migrants socially engage/disengage with the street-level welfare state. This analytic lens that has not previously been discussed in the literature vis-à-vis migrant citizenisation draws on the understanding that migrants lose the social status they had in the country of origin. In the country of destination, the category of being a migrant is often a stigmatised category, regardless of the individual background and reasons for migration. Hence, the common denominator for people who have migrated is the experience of renegotiating subjectivities and social status positions (Wrede & Nordberg, 2010). Thinking about migrancy as a social category (Wrede 2010, 12–14, Näre 2014) in this way, we follow the lead of Bryan S. Turner (1989) who developed Received 23 February 2015; Accepted 25 March 2015

Gender and maternal healthcare

This chapter addresses some key issues in maternal healthcare which have resonance in the international arena. In many middle and high-income countries, a key policy focus is on addressing disparities or inequities in healthcare recently highlighted by the revisiting of work on the social determinants of health by the WHO (CSDH, 2008). The report argues that social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices. The social determinants of health are seen as mostly responsible for health inequities — the unfair and avoidable differences in health status seen within and between countries, with ongoing debate about the effective contribution that health services can make to mitigate the impact the these social determinants on health and well-being.

Street-Level Engagements

During the last decade, new research approaches to global migration have highlighted the multifaceted ways in which structural inequalities and subordination impinge upon the possibilities to substantive citizenship (Fraser 2009; Nordberg 2006; Olwig 2011; Tully 2000). By shifting the focus from migrants themselves to reciprocal processes of interaction, the complex macro–micro relationship between recognition, redistribution, representation and a sense of belonging becomes visible. Scholars, particularly drawing on governance perspectives, have effectively shown how the political-cultural framework morally constructs and disciplines migrants (Lippert & Pyykkönen 2012; Geiger & Pécoud 2013). The categories produced for the purposes of governance are ordered along intersectional social divisions such as gender, race, class and sexuality (Anthias 2013). Recognising the insights of such previous research, the specific aim of this special issue of the Nordic Journal of Migration Research is to bring to the forefront new, empirically grounded understandings of policies and practices of migrant citizenisation in the restructuring welfare state. The individual contributions have been produced in different scholarly contexts: social work, social policy, sociology, education and ethnic and migration studies. A multidisciplinary approach to citizenship proved particularly fruitful for grasping the complex and multifaceted nature of contemporary citizenship. Accordingly, introducing the notion of citizenisation, we develop it from a top-down understanding (cf Tully 2005) to the interplay between migrants’ negotiations and acts of citizenship (Isin & Nielsen 2008) and the normative practices of (welfare) state incorporation played out in street-level encounters. We understand acts of citizenship as a broad category of engagements. The notion of the street-level was introduced by Michael Lipsky (1980) to identify the specific character of this type of institutional encounters between bureaucrats and service users. In this issue, we find that street-level encounters constitute sites of fundamental importance for citizenisation, referring simultaneously to formal institutional encounters in the Lipskyan sense, to semi-formal institutional encounters and to the myriad forms of everyday encounters with fellow members of society. In the Nordic welfare state contexts at the street-level, migrant citizenisation practices are typically featured by extensive interaction with the local welfare state: mainstream social and welfare services as well as specific integration plans, language training and citizenship training (Fernandes 2013; Hagelund 2010; Keskinen et al 2012). The neoliberalisation of what once were perceived as mature welfare states has not only implied a move towards a fragmented and increasingly marketised model of service provision, but also a redefinition of the social contract with a stronger emphasis on the duties and responsibilities of individual citizens (see also Carmel et al 2011; Schierup & Ålund 2011). Accordingly, there is a call for research that empirically examines the implications of the reconfigurations occurring at the nexus of state policies, street-level encounters and the individual. The special issue takes as its starting point the way migrants socially engage/disengage with the street-level welfare state. This analytic lens that has not previously been discussed in the literature vis-à-vis migrant citizenisation draws on the understanding that migrants lose the social status they had in the country of origin. In the country of destination, the category of being a migrant is often a stigmatised category, regardless of the individual background and reasons for migration. Hence, the common denominator for people who have migrated is the experience of renegotiating subjectivities and social status positions (Wrede & Nordberg, 2010). Thinking about migrancy as a social category (Wrede 2010, 12–14, Näre 2014) in this way, we follow the lead of Bryan S. Turner (1989) who developed Received 23 February 2015; Accepted 25 March 2015