Conceptualizing the Social and Political Context of the Health Workforce: Health Professions, the State, and Its Gender Dimensions

Abstract

This paper attempts to address the theoretical vacuum that exists within the growing literature on the sufficiency and stability of the health workforce that has dominated health policy agendas worldwide. Conceptualizing the context of the health workforce, and the relationship between health professions and the state more specifically, draws upon critical areas of social theory and health. The sociology of professions literature, and its focus on professional projects, point to the important role that the state plays as an audience for social closure strategies, those that seek resources to the exclusion of others. Depicting the state in this manner, however, does not enable us to explain why some state-directed strategies are successful whereas others are not. An expanded analysis of the state, its interests and the efficacy of the strategies directed toward it is augmented with reference to health policy literature. I present a model which attempts to integrate the conceptualization of the state in the health professions and policy literatures as a means to better understand the context of the relations between the state and the health professions. The specific gender dimensions of this relationship are then explored through a consideration of female health professional projects and the role of women vis-à-vis the state.

South African community health workers' pursuit of occupational security

“…These varying examples illustrate how governments may serve either to promote or undermine formal recognition of care workers (Bourgeault, 2017;Khulman, 2013). Differences in public health policies in diverse country settings illustrate the importance of contextual studies of feminized care occupations, particularly in the Global South, to understand internal professional dynamics and the role of external, state, and non-state actors in the legitimation of nascent occupations.…”

“…Scholarship on women‐dominated health occupations in the Global North and South identifies the opportunities created by public policy and legislation for professional closure, thereby restricting entry into the workgroup to those who are suitably qualified. This research emphasizes how the state is a pivotal actor in either creating opportunities for or against the development of occupational closure (Bourgeault, 2017; Kuhlmann, 2013; Witz, 1992). Incorporating analysis of profession‐state relations in the Global South brings consideration of state functions and competence into play (Chorev & Schrank, 2017; Jin, 2017; van de Ruit, 2017).…”

Introduction

“…However, in these contributions, the state is treated as an abstract, complex phenomenon, and little interest is paid to its specifics. In contrast, we consider the state to be an actor in medicalization and psychologization processes as well as to provide a context that impacts these processes depending on its specific institutional configuration (Bourgeault, 2017). Adding such an institutional perspective of the state provides a tool for better understanding how and why medicalization and psychologization vary across countries and over time (Olafsdottir & Beckfield, 2011).…”

The More Doctors Program in Brazil under the perspective of the public policies cycle: argument for debate based on the analysis of Heider Pinto and colleagues

“…In order to speak of circumstances, we need to understand the feasibility of fulfilling policy cycles. Basically, it is about opening the governing action's "black box," understanding that decisions made throughout policy cycles result from the momentary structure and organization of groups of interest 3 . These groups include wider political communities (political parties and multiple social organization movements with political purposes), as well as professions, market, international regulation instances and, obviously, universities.…”