Framing Work Injury and Sickness in a Changing Welfare State: A Closer look at Organizational Inequalities within the Public Sector
While different forms of regulating and privatizing functions traditionally carried out by the welfare state are introduced, adopted or dismissed, the consequences of changes – longer sick leaves and/or exiting the work force - for those charged with administrating social services is treated as a necessary negative by-product of welfare state changes and hidden in a myriad of statistics. Yet as the welfare state continually tries to justify itself to citizens through economically forced repackaging of slimmed-down social policy, public employees are experiencing a type of “strategic violence” to their professional identity. Work processes become compartmentalized and job security precarious.
Simultaneously, the process of de-professionalizing workers within the public sector, particularly teachers and nurses, opens the public service labor market for a buffer group of teacher class assistants, corridor guards or nurses aids with lower professional qualifications, lower pay and usually with a non-Swedish ethnic background. This creates a paradox where, on the one hand, the welfare state, as an institution, is charged with implementing policies that level life chances and reduce inequality. And, on the other hand, the welfare state as employer, is marginalizing service professions, primarily held by women, and introducing low wage jobs into schools and health institutions that increase precarious employment.
Both processes of de-professionalization and use of a “buffer level” of low wage jobs within the public sector can be considered macro-level processes. Both processes produce micro-level inequalities. A careful analysis of micro-level accounts of processes at work within schools and health institutions together with macro level statistics of changing employment and series interviews with individual public employees provides the empirical base of the paper. Public schools and health institutions as organizations accommodate and mediate between introduced macro level changes and micro level consequences. The accounts show how it is that gender, race and class inequality is produced and sustained at a micro-level for both the middle-class teacher and nurse as well as for the temporary employed non-skilled lower-class assistant or nursing aid.
The paper introduces a theoretical analysis that combines a) an explanation of de-professionalization techniques as a method of welfare management control used to weed out undesirable workers and to create uncertainty of the authority of welfare professionals with b) the introduction of new categories of low wage precarious workers. The theoretical framework starts with post New Public Management governance where colleagues use tools of de-professionalization against each other. Additionally, as changes in the role of a professional expand to other non-professional services so too does the felt need for additional “hands” at school and in health care. More adults in the classroom or more aids in emergency room are gradually seen as a necessity in both schools and health institutions as protective buffers against what is more and more interpreted as disruptive elements.
The method used in this paper involves an analysis of a large number of accounts over a three-year period (2012-2014) written by employees and submitted by employers to work environment authorities. Swedish law requires an employer to file a report whenever an employee is of the opinion that his/her injury or sickness is related to work. Formally, the reports are used by the Swedish National Work Environment Authorities to produce aggregate statistics about work place safety. However, each filed report although formally submitted by employer is written by the employee and contains a detailed account of what happened including descriptions of why the injury or sickness occurred. The accounts reveal employees methods by which workers frame injury (n= 820) and sickness (N=396). The paper examines the situation of employees in contact professions within the public sector, particularly teachers at primary schools but also nurses at hospitals. The paper unravels the similarities and differences in how women and men frame their situation in the same occupational environment and shows that injury mostly is involved in cases reported from “buffer” employees. Stress sicknesses such as mental exhaustion, apathy and despair are more likely reported by employees, teachers and nurses, with training as a professional. Structural organizational changes as experienced by employees are related in the accounts as descriptions of the psychosocial organization of the work place. The accounts run outside given page limits and in over 40% of filed reported sickness, the employee attaches an even more intense and longer description of everyday life at work and events leading up to a reported sickness. The empirical part of the paper also includes macro statistics of changes in employment in Sweden during the last twenty years.
The analysis of framing injuries and sicknesses throws a new light on work place environment and suggests why women flee work places dominated by women employees and bossed by politicians. By placing the cultural framing of injury and sickness within changes in the public sector, the paper reveals how cultural patterns are produced, reproduced and interact with structural changes in the organization of work and the work place. But it is not only cultural patterns of exclusion that are produced and revealed in the accounts of organization of work but also the creation of inequality within professions, gender, class and ethnicity.
Although the unique research on individual accounts depicts processes at work in Sweden, the paper also points out that similar processes can be seen at work in the teaching profession in other countries, for example, in the United States.