emotional labour: body work

Emotional labour/body work: The caring labours of migrants in the UK’sNational Health Service

S. Dyer *, L. McDowell, A. BatnitzkySchool of Geography, Oxford University Centre for the Environment, South Parks Road, Oxford OX1 3QY, United Kingdom

a r t i c l e i n f o

Article history:Received 1 November 2007Received in revised form 21 July 2008

Keywords:Service sector employmentCareMigrationEmotional labourBody workGreater London

a b s t r a c t

The provision of care is an increasingly pressing issue in the Global North. With an ageing population andpolicies encouraging women into the labour market, there is a growing need for workers to undertakepaid caring. This poses important and urgent questions about the social organisation of labour markets.Care work typically is low paid and undertaken in precarious, informal, or temporary situations. Manyposts are filled by economic migrants, raising concerns about a care deficit in sending countries. In thispaper we examine the ‘caring work’ undertaken by migrant workers in a West London Hospital. Weemploy a twofold characterisation of caring work. Like other bottom-end service sector work, this workis characterised by the face-to-face ‘emotional labour’. However, it also requires ‘body work’: close andoften intimate physical contact between carers and those they care for. We argue that both of theseaspects are important in understanding how caring work is constructed as poorly regarded and low paid.We show how these features play out in particular ways for migrant workers employed in such caringwork.

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1. Introduction

Care is a fundamental requirement of the human condition. Atdifferent points in our lives we require varying amounts of supportfrom others. When we are young or ill and often when we are oldwe need the care of others ‘more urgently and more completely’than usual (Kittay et al., 2005, p. 433). Despite its universal andessential nature, care has often been theoretically neglected andsocially undervalued. Human dependency has been described asthe elephant in the room, the aspect of life actively ignored in mostpolitical, economic, and moral models of life (Gilligan, 1997; Folbreand Nelson, 2000; Kittay et al., 2005; Lawson, 2007). However, inrecent years an ageing population and more women entering thelabour market have brought the provision of care onto the politicalagenda (Anderson, 2000; McDowell et al., 2005; Freud, 2007). Cur-rent government thinking reinforces contemporary trends for care,and other social reproductive functions, to be increasingly pro-vided by the market. Where once the home was the realm of famil-ial caring duties undertaken for ‘love’, increasingly care is boughtand sold as a commodified product. This shift poses importantand pressing questions about the social organisation of care mar-kets, the implications for workers employed in this work, and forthose whom they care for.

Employment in ‘caring work’, by which we mean paid work thatinvolves the care of others, is routinely poorly paid and is oftenundertaken on a temporary or informal basis (England, 2005). Suchconditions and the resultant concentration of those with littleautonomy in the labour market are symptomatic of bottom-endservice work (Leidner, 1991; Gray, 2004; McDowell et al., 2007).Gendered assumptions about the emotional labour required byface-to-face work play an important role in the devaluing and fem-inising of this work (Hochschild, 1983; Kerfoot and Korczynski,2005) However, in caring work these constructions are exacer-bated by wider symbolic associations and hierarchies that comeinto play when jobs involve work on the bodies of others (Wolko-witz, 2002, 2006). Describing the mechanisms through which thiswork is devalued serves to demonstrate that such outcomes areneither ‘natural’ nor inevitable.

The care labour market now operates at a global scale, with agreat deal of care work being undertaken by migrant workers (Mis-ra, 2003). While the traditional image of a migrant worker is ayoung single man, the increasing demand in the Global North forpeople to undertake caring work has led to a rising feminisationof economic migration (Kofman et al., 2005; Vertovec, 2006). Manymigrant women are employed in advanced industrial economies asdomestic workers caring for homes and families (England and Sti-ell, 1997; Yeoh et al., 1999; Anderson, 2000). Many others are em-ployed in more professionalised caring occupations as nurses andnannies (Pratt, 1999; Hochschild, 2000; Yeates, 2004; Brush andVasupuram, 2006). The concentration of migrant women in low

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* Corresponding author.E-mail address: [email protected] (S. Dyer).

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paid caring work signals the double jeopardy faced in the labourmarket by workers who are both female and migrants (at timescompounded by also being of black and minority ethnicity(BME)) (Adib and Guerrier, 2003; Browne and Misra, 2003). How-ever, this segmentation also poses challenges for men who eitherfind themselves effectively excluded from this area of work or stig-matised by undertaking such ‘women’s work’ (McGregor, 2007;Batnitzky et al., in press).

In this paper we explore the provision of paid care through thelens of migrant workers’ experiences in the UK’s National HealthService (NHS). We argue that through multiple mechanisms thiswork, and indeed these workers, is devalued. While we do notwant to re-inscribe already entrenched dualisms of mind/body ormind/emotion, we discuss, in turn, the aspects of this work as‘emotional labour’ and ‘body work’. We begin by unpacking the no-tion of caring as a particular type of labour, the gendered nature ofwhich persists in the transition from familial duty to the commod-ified realm.

2. Caring work: the commodification of care

Whether or not it is undertaken as a commodified exchange,care is marked by its associations with the familial and the femi-nine. Paid caring work is constructed as ‘women’s work’ (Novarra,1980) and is often symbolically organised as if it were in the un-paid domestic sphere (Glenn, 1992; James, 1992). These associa-tions construct care as symbolically outside the economic.Feminist economists have argued that a significant factor in theinadequate recognition of this work is an assumed dichotomy be-tween love and money (England and Folbre, 1999; Folbre, 2002).The social good produced by good care is not captured and turnedto profits and thus societies ‘free ride’ on the care provided by oth-ers. Workers are seen as having a ‘special vocation’ involving in-nate skills and (quasi-religious) devotion, thus contributing tothe low status and poor pay of this work. Economists, therefore ar-gue that one cause of the pay penalty in caring work is the intrinsicvalue of performing caring work. The ‘soft’ rewards of caring act aspartial compensation for low pay (England, 2005). It is arguedthose involved in caring work are less likely to engage in certaintypes of industrial action, such as strikes, because of feelings ofduty for their charges: the ‘prisoner of love’ dilemma (Folbre andNelson, 2000).

Empirical research shows that carers themselves adopt a frame-work that mirrors the love–money dichotomy. Workers have beenshown to emphasise a distinction between work and non-work,with care classed as non-work. Describing gynaecology nurses’commitment to the ‘femaleness’ of their work, Bolton (2005, p.173) explains how the nurses she interviewed sought to ‘‘confirmthe underlying expectation that nursing is a vocation, involvingaltruism and an overwhelming drive to ‘care’ for people, ratherthan offering a career involving choice and skills.” Bolton showshow these constructions are double-edged, for while they providea strong professional identify and self-esteem in the face of others’perceptions of gynaecological nursing as ‘dirty work’, they contrib-ute to the devaluing of this work and attribution of this as un-skilled and naturally female. In research examining nursing inhospices James (1992) identifies a distinction made by nurses be-tween physical tasks, such as administering medication, and care.She argues that ‘‘. . .the framework of physical labour also becamethe justification and explanation of paid work. Having been sittingtalking to a patient a nurse would say ‘I must go and do some worknow’, meaning physical tasks” (James, 1992, p. 497). This framingwas used, in part, to construct boundaries by staff. No nurses,she says, would feel comfortable complaining that they were re-quired to care ‘too much’ whereas they did feel able to complain

about being given too many tasks to carry out. However, these con-structions by workers reproduce the assumptions which devaluetheir labour.

Understanding the mechanisms structuring caring labour mar-kets requires an analysis of care itself. Although part of our every-day lives, care is analytically difficult to define. A complex notion, itrefers both to activities, such as feeding and bathing, and to feel-ings, such as empathy, sympathy, and love as well as those of sor-row, grief, and anxiety (Folbre and Nelson, 2000). In recent yearsscholars have tended to characterise caring work as relational workthat involves the nurture of others (England and Folbre, 1999).However, Duffy (2005) argues that doing so reproduces class andracial hierarchies by excluding those undertaking lower paid andlower-status work – primarily women of colour. She argues insteadfor a definition of caring work as reproductive work or ‘‘the workthat is necessary to ensure the daily maintenance and ongoingreproduction of the labour force” (Duffy, 2005, p. 70). This defini-tion includes non-relational and non-nurturant work such as foodpreparation and cleaning. While she is able to show with analysisof the 2000 US census how BME women are excluded by narrowerdefinitions, her thesis poses an important question about the ex-tent to which cleaners, for example, can be described as caringworkers. This is an argument that qualitative research can usefullycontribute to. While our analysis of caring work includes consider-ation of the emotional and the relational, in our research weadopted an open sampling frame – any migrant worker in the hos-pital – in order to prevent prejudging which workers are caringworkers and to prevent re-inscribing gendered and racialised hier-archies of care.

In the context of a hospice James (1992) describes caring workas being defined by ‘‘care = organisation + physical labour + emo-tional labour”. While she is right in identifying these elements ofcare, we argue that her definition is insufficient. Care also involvesskills, ‘rational’ labour, and ‘body work’ and takes place within so-cial and political contexts, which as much as organisational ones,shape its structure and meaning (Conradson, 2003). Thus we beginour characterisation of caring work with an analysis of the emo-tional labour it requires but go on to assess the role of ‘body work’it involves.

2.1. Caring as emotional labour

In common with work in other areas of the service sector,employment relations in the NHS are structured by a three-wayrelationship between employees, managers, and the ‘customer’(Wolkowitz, 2002, p. 502). This structure has been termed a ‘cus-tomer-orientated bureaucracy’ to capture the ways in which work-ers are governed through the standardising disciplining of abureaucratic organisation and also by the demands of a presentcustomer (Korczynski, 2001; Kerfoot and Korczynski, 2005). Theembodied attributes and gendered performances of workers areparticularly important in customer-orientated bureaucracies asworkers become responsible for resolving the intrinsic tensionsof how their work is organised (Forseth, 2005). The toil and skillsinvolved in undertaking such emotional labour go unrecognised(c.f. Payne, 2006) and this work is naturalised as an effortlessexpression of femininity (Hochschild, 1983; Krumal and Geddes,2000; Hampson and Junor, 2005). In the healthcare sector thisplays out as women choose (and are chosen for) caring work overother jobs and co-construct gender and work identities (Halford,2003; Bolton, 2005), whilst patients and their families engage withhealthcare workers in the context of gendered understandings ofcare.

The neo-liberalisation of much welfare provision is an impor-tant context shaping the costs of emotional labour for many caringworkers. As Wolkowitz (2002) observes both ‘pulls’ of the

S. Dyer et al. / Geoforum 39 (2008) 2030–2038 2031

‘customer-orientated bureaucracy’ dynamic have been heightenedin British and North American healthcare work due to reorganisa-tion and increasing privatisation (England and Ward, 2007). Work-ers might experience more demanding ‘customers’ who are lessdeferential than ‘patients’ were (Rogers et al., 1999) and they doso within an environment of rationalised managerialism (Mohan,1995; Clarke and Newman, 1997; Twigg, 2000a). Clarke (1999, p.49) argues that welfare provision is increasingly ‘‘structuredaround an internal calculus of efficiencies (inputs and outputs)and an external calculus of competitive positioning within a fieldof market relations.” In this context the provision of care has beenrationalised to a series of tasks which fails to account for the rela-tional and context specific nature of caring. The rationalisation ofcare further hides the emotional labour workers perform by notincluding it within these tasks. This exacerbates the devaluing ofemotional labour, as witnessed in the wider service sector, but alsomeans that workers undertake tasks and form relationships out-side what they are remunerated for. As ‘prisoners of love’, or atleast of professional identity or human decency, workers continueto perform emotional labour and care beyond the rationalisedschedules of bureaucracies that employ them.

2.2. Caring as ‘body work’ – dirty work

A further important factor in the organisation of the caring la-bour market is its association with the human body. The humanbody, particularly when ill, old, or diseased, unsettles the modernWestern emphasis on rational autonomy and thus needs to be fun-damental to our conceptions of justice (Young, 1990). Althoughthere are some exceptions, such as psychoanalysis and counselling,most caring work takes the customer’s body as its immediate siteof labour (Wolkowitz, 2002). Moreover, this work performed onthe bodies of others is often undertaken using the worker’s ownbody as a primary vehicle (Jervis, 2001, p. 94). In a culture whichesteems the cerebral over the physical, the autonomous abovethe dependent, and the disciplined over the uncontrolled/able;‘body work’ (Gubrium, 1975; Wolkowitz, 2002, 2006) is markedby the ‘intimate, messy contact’ (Wolkowitz, 2002, p. 497) it in-volves. Wolkowitz (2002, p. 501) argues in order to understandthe structuring of body work labour markets we must move be-yond distinctions of manual and mental labour. The structures ofgender, class, and race segmentation in these labour markets, sheargues, are organised by attitudes to the body, to different partsof the body, and to different states of the body. As caring work inthe British economy is increasingly being undertaken by migrantworkers, we must also add migration status segmentation to thestructures at play in these labour markets. Following Wolkowitz(2002, p. 499) we believe scholars need to be explicit in ‘‘recogniz-ing, and therefore attempting to deal with, the centrality of bodywork to post industrial national and global economies”.

Higher status occupations ‘dematerialise’ their work on thebody through distancing techniques. These encompass the use ofinstruments and frameworks of scientific or professional knowl-edge. These higher status and better paid occupations deal withthe bounded body ‘‘leaving lower-status ones to deal with whatis rejected, left over, spills out and pollutes” (Wolkowitz 2002, p.501). Moreover, lower-status body work often involves caring forold or diseased bodies that cause so much dis-ease in contempo-rary Western societies; loathsome or feared bodies (Young, 1990;Jervis, 2001) or ones which are simply ignored (Twigg, 2000b).Work on the unbounded body is written as of hierarchically lowlyand symbolically dirty (Hughes, 1951; Brody, 2006). However,body work has also been described as ‘ambivalent work’ (Twigg,2000b, p. 391). Certainly, for many undertaking such work it is.In nursing, for example, there is a tension between an emphasison the value of embodied nursing skills which draw on the profes-

sion’s heritage and contemporary theoretical re-consideration ofthe (phenomenological) body (Lupton, 1994; Bolton, 2005), andan increasing (medical) professionalisation of nursing which stres-ses distancing techniques (Philpin, 1999).

Undertaking ‘dirty work’ represents a challenge to workers be-yond low pay, for the symbolic associations that contribute to thestructuring of body work as being of low worth attach themselvesto the workers (Hughes, 1951). In a sense, those involved in dirtywork become constructed as ‘dirty workers’. Ashforth and Kreiner(1999) identify three axes of dirty work: the social, physical, andmoral. Much caring body work is best characterised as sociallystigmatised, although some is also physically dirty work involvingthe ‘unbounded body’. Research has shown that people experiencedirty work as posing a challenge to their identity and self worth(McGregor, 2007). Workers undertake a number of strategies to at-tempt to mitigate the issue, including the use of humour, formingstrong collective identities, and emphasising the dignity of earninga wage (Bolton, 2005; Stacey, 2005; Kreiner et al., 2006).

The ability to construct migrants as ‘other’ plays an importantrole in the construction of their work. The writing of anthropologistMary Douglas (1966) has shown how notions of dirt rest on cate-gories of ‘matter out of place’. What is out of place is potentiallypolluting. As a common construction of migrants is ‘people out ofplace’ it is hardly surprising that a position of low autonomy inthe labour market intersects with low socio-symbolic status to re-sult in an over-representation of migrants in these positions (Adiband Guerrier, 2003; Misra, 2003). These workers handle distastefultasks which are necessary for the functioning of society (Ashforthand Kreiner, 1999, p. 416). Rather than being rewarded for under-taking such essential work, they are stigmatised by it. Notions ofpollution here play an important role in enforcing inequality inthe labour market (Jervis, 2001, p. 89). As Wolkowitz (2002, p.501) argues, ‘‘the worker is employed as much to carry dirt’s stig-ma as to labour”.

2.3. Caring as work for migrants

Historically care has been seen as women’s work. However, it isconstructed as such where gender intersects with race and class(amongst other categories) to construct a hierarchy of carers. Anintersectional understanding of gender resists essentialist formula-tions and allows the complex lived realities of gender relations tobe explored (Adib and Guerrier, 2003; Browne and Misra, 2003;Valentine, 2007). Caring work and productive labour are relational.The entry of white middle class women into the labour market de-pends on other women undertaking the caring they themselvesonce provided within their homes (Glenn, 1992; Browne and Mis-ra, 2003). This includes, most obviously, childcare but also care forthe old and ill. In healthcare a gendered and racialised hierarchyexists, with male doctors ranked above white female nurses whoin turn are superior to BME women working as nurses’ aides (US)or health care assistants (HCAs) (UK) (Glenn, 1992). Differentnationalities are naturalised in different roles, for example the fig-ure of the Filipina nurse (Brush and Vasupuram, 2006). Migrantmen describe being feminised through undertaking ‘women’swork’ (McIlwaine et al., 2006; McGregor, 2007). A US ethnographerwho attended nurse aides training described the emphasis placedon deference to those in authority, on not asking questions, anddoing what one is told. He quotes a woman from Jamaica observing‘‘I can’t figure out whether they’re trying to teach us to be a nurse’saides or black women” (Diamond, 1988, discussed in Glenn, 1992,p. 23).

Power relations are further entrenched by the willingness of theGlobal North (and countries such as Saudi Arabia and UEA) to ac-tively recruit caring workers from poorer parts of the world (Agu-stin, 2003). In what has been termed a ‘care drain’ (Kittay et al.,

2032 S. Dyer et al. / Geoforum 39 (2008) 2030–2038

2005, p. 405), the North staffs its hospitals and care homes withdoctors, nurses, and carers from abroad creating a ‘care deficit’ inthe sending countries as parents leave children with friends andfamily in order to migrate and societies (often devastated by pov-erty and disease) are left without doctors, nurses, and other work-ers. Scholars have highlighted the post-colonial implications ofthese relationships. Brush and Vasupuram (2006) have argued thatnurses, among other workers, are ‘produced’ as an export productby some nations in the same way that crops such as sugar and teawere previously. Similarly, Hochschild (2003) has argued that theGlobal North is extracting ‘love’ from the South in much the waythat colonial powers used to extract raw materials. Certainly,receiving states are implicated in the working conditions of theseworkers, creating the conditions for exploitation by, for example,allowing some workers in to the country on visas that tie themto particular employers (Huang and Yeoh, 1996; Anderson, 2000;Ruhs and Anderson, 2006). We turn now to a case study in orderto demonstrate the connections between ‘emotional labour’ and‘body work’ in the organisation and devaluing of the caring workcarried out by migrant workers in a Greater London hospital.

3. Research methods

This paper draws on the experiences of migrant workers en-gaged in caring work in a West London NHS hospital. We call thehospital West Central Hospital (WCH) for the sake of confidential-ity. These workers represent a subset of caring workers and theirexperiences are shaped by, amongst other factors, the organisationthey are employed by. Hospitals are large organisations, in com-parison with most care homes for example. Their role is primarilyto provide medical care to patients who are generally resident foronly a few days, if at all. Thus these workers’ experiences will bedifferent from those working in other settings and we would wel-come the development of the analytic framework used here to ac-count for those. In our analysis we identified themes emergingfrom the data (in the light of the literature reviewed above). Quo-tations in the texts are illustrative of these themes.

As we have argued, care is a complex notion and caring work isorganised by entrenched hierarchies. Our aim in interviewingworkers across the occupational spectrum is to cut across the hier-archies of care and capture the ways gendered assumptions andsymbolic associations organise caring work within the hospital(James, 1992; Twigg, 2000b). We interviewed 60 non-British-bornworkers employed at the hospital. These workers were recruitedthrough an advert in the staff newsletter, posters in staff areas,and snowballing techniques. We told potential interviewees thatwe were interested in talking to them about their experiences ofbeing a migrant worker in the hospital and provided them withan information sheet approved by the hospital’s research ethicscommittee. Recruitment through snowballing combined with mi-grant workers’ over-representation in particular jobs (for example,as discussed below, geriatric nursing) means our sample is not sta-tistically representative of the hospital workforce. The interviewsfollowed a semi-structured format through which we exploreddecisions to migrate, experiences of migration, work biography,and everyday working lives. Our interviewees originated from 30countries and had a range of migration experiences, from very re-cent migrants to those with British citizenship who had lived in theUK for decades. Some workers had trained as healthcare profes-sionals in their country of birth as a ‘ticket abroad’ while othershad migrated and taken jobs in the NHS out of utility. Fourteenof our informants were men, reflecting women’s over-representa-tion in the NHS’s workforce. Informants are identified by pseud-onyms, their job, gender, and country of birth. Our aim in thispaper is not to unpack migration per se, but following Conradson,

(2003, pp. 451–452), we are ‘‘interested in the spaces, practicesand experiences that emerge through and within relations of care”.

4. Caring work undertaken by migrants in a West Londonhospital

We now turn to the caring work undertaken by migrant work-ers in WCH. Having shown how bottom-end service sector work isdevalued and feminised through constructions of emotional la-bour, we begin by considering migrants’ experiences of undertak-ing emotional work.

4.1. Emotional labour

In this section we describe three aspects of emotional labour.First, we describe the specific contexts in which migrant workersfind themselves performing emotional labour in, what we term ‘cul-tures of emotional labour’. Secondly, we describe the caring workthat is hidden by rationalised healthcare regimes, before turningto the intense nature of the emotional labour of caring bodywork.

4.1.1. Cultures of emotional labourTurner and Stets (2006) have suggested that undertaking emo-

tional labour can be particularly stressful for migrant workers. Muchcommunication of emotion rests on culturally bounded subtletieswhich people must relearn when they migrate. Workers who are re-quired to undertake emotional labour must contend with subtle butimportantly different norms and expectations. Given the numbersof migrant workers employed in bottom-end service sector workwhich requires emotional labour the relationship between such la-bour and migration is woefully under-theorised (Dyer et al., in press).

In our conversations with migrant nurses we found evidence ofcountry-specific professional cultures and identities. Nursestrained abroad expressed surprise at the way nursing in the UKdownplayed the importance of ‘attitude’ or emotional engagement.Joy explained how nursing in the UK is constructed as involving‘knowledge and skills’, to the exclusion of ‘attitude’. She explainedwhat she meant by attitude:

Attitude is how you approach the patient, how you feelyou’re working. But here [in the UK] it is only skills andknowledge. Attitude [is] how you interact with the patientor like when you communicate to the patient, how is yourfacial expression? How is your body language? (Joy, nurse,female, Philippines)

She felt that the emphasis on knowledge and skills neglected animportant aspect of nursing:

[It is also important to] be pleasant with my words, differ-ently, be transparent, be trustworthy, establish thepatient–nurse relationship. Attitude is most for me. Theskills are there, the knowledge is there but if you’ve got anegative attitude, that can affect your thinking and youremotions, and your [way of] doing things.

The emphasis on ‘knowledge and skills’ is a response by the UKnursing profession to the lack of recognition of emotional labouror ‘attitude’. However, it serves as evidence of differences en-trenched within the professionalised work of nursing. A differentialvaluing of this particular aspect of their work is one cultural differ-ence nurses must work within.

The context in which emotional labour is performed isimportant in shaping the workers’ experience of emotional


labour (Kang, 2003; Seymour and Sandiford, 2005). Differentprofessional constructions of the emotional labour of caringis one such context. Another is a neo-liberal organisationalmanagerialism. It is to this we now turn.

4.1.2. Prisoners of ‘love’: filling the shortfallAs discussed above, the neo-liberalisation of healthcare entails a

rationalisation of caring to a series of tasks. However, care by itsvery nature is highly context dependent and involves respondingto the needs of the cared-for. In ‘customer-orientated bureaucra-cies’ it is frontline workers who must resolve these tensions intheir interactions with those they care for. In this sense, workersperform the ‘hidden’ work which enables rationalisations to (ap-pear to) work. For example, workers described responding to theneeds of patients without families:

Some people they haven’t got a family and like myself I wasgiving more care to the people who haven’t anyone, becausethey don’t have a visitor, they don’t have anyone lookingafter, doing right thing, because some people come in andcheck, you know? But some people haven’t got that and thatI think in myself [I] was saying, you know, make more effortand we do the care, because I will do this and we will talk tothem. That can be hard, it was emotionally, it was very emo-tional. (Habiba, health care assistant, female, Somalia)

Such work is ‘hidden’ because it is not formally recorded or rewarded.Often the gaps workers fill are those left by the organisation and

its ‘rational’ differentiation of tasks. A cleaner described taking thetime to talk to people on the wards that she is cleaning:

I love to help old people as well. Yeah, I have a pity for oldpeople, so I go there and I’ll make them breakfast and tidythe ward, like mop and clean the sink and going in theirroom, clean anything, check toilets, soap and stuff, so I’mused to it. . .I like caring, sometimes I go there and I singfor them. (Amber, cleaner, female, Jamaica)

Amber’s description of her working day highlights the importanceof not assuming a narrow definition of caring work. As a cleaner,Amber is not obviously employed in caring work. However, herworking day is spent in close proximity to patients and she finds‘soft’ (i.e. non-monetary) rewards in caring for patients. Expressingsimilar sentiments, Krzysztof, a Polish porter, describes acting as atranslator to newly arrived Polish immigrants who are in hospital:

A lot of Polish will come to the hospital, it is growing, so I cansee that I’m useful, some of them don’t speak English at all,they are really distressed and a new place, everything is new,different. (Krzysztof, porter, male, Poland)

Our findings provide support for Duffy’s (2005) argument for theuse of wider definitions of caring work. The emotional labour re-quired by bottom-end service work is less visible than in other moreobviously nuturant caring work and many migrant and BME work-ers are found undertaking this work. However, this is more than acontingent relationship. It is precisely because workers with lowautonomy in the labour market undertake this work that their car-ing work remains hidden. Cleaners, porters, and HCAs are the work-ers who are paid the least and experience the most precariousworking conditions (Datta et al., 2006). They are employed to cleanfloors, empty bins, move patients around, wash patients. However,such a list of tasks does not capture the lived reality of their workingday. Because workers are ‘customer facing’ they must manage pa-tients’ (and their families’) needs and expectations. As demon-strated by Habiba, Amber, and Krzyszof, sometimes workers will

respond by providing care. At other times workers will not providecare but they must manage the emotions that such a denial willprovoke in themselves and patients (Solari, 2006). The caring workthese workers perform, as ‘prisoners of love’, out of feelings of duty,empathy, or human decency is hidden but is necessary to the func-tioning of the healthcare system.

4.1.3. Intense emotional labour of body workWorking in the context of a hospital shapes the demands on

workers and the coping strategies available to them. The intensityof the emotions encountered arises from the centrality of the hu-man body, in particular damaged or needy bodies, in the hospital.Workers describe the intense emotions entailed by their workinglives. Habiba, the HCA quoted above, who used to work in an oldpeople’s home, used the term ‘hard work’ to describe the emotionalinvolvement she has with people at work. She went on to say:

I saw someone die with the civil war. I haven’t seen someonedying naturally and that was hardest. I was heartbrokenbecause the home, the nursing home the old people weredying a lot, you could see two or three people dying in oneday and so [I was] heartbroken, you know. Sometimes you’reso attached with someone and then you know and it was sohard for me. (Habiba, HCA, female, Somalia)

The emotional labour undertaken by workers can be intense. Somepeople we spoke to described not being able to cope with such dif-ficult emotional situations. In an example of a worker refusing toprovide emotional labour, Parnel explains:

The. . .how should I say, the most difficult situation that I can’tmanage is if the patient is. . .if they’re dead and I need to informthe family, I can’t manage that. . .I can’t say because. . .that dayssometimes I call the doctor or I call the senior sister. . .it’s reallydifficult to say that. (Parnal, nurse, female, India)

A working life that involves such emotions clearly extends beyond‘service with a smile’. The human body, particularly in it vulnerableand needy states, is a source of much anxiety, embarrassment, andfear. Undertaking emotional labour in a context where illness anddeath are the stuff of the everyday raises particular challenges forworkers.

4.2. Caring work: body work

In this section we examine how the ‘body work’ requirement ofcaring work structures the hierarchical relationships at work andthe construction of this as work suitable for migrants. We drawout four aspects of undertaking caring body work. First, we de-scribe how hierarchies at work rely on being able to mark distancefrom the bodies of patients. Secondly, we show how many migrantworkers find body work difficult because of cultural understand-ings that its proper location is in the familial realm. Thirdly, we de-scribe the associations workers feel are made between beingmigrants and dirty work. Finally, we examine the difficulty in fit-ting this work in to the schedules of modern healthcare. Thisneo-liberal organisation makes body work particularly undesirablefor workers.

4.2.1. Hierarchies of workWorkers at WCH described a hierarchy of work in the hospital

where doctors occupy the most prestigious positions, nurses themiddle ones, and HCA and cleaners1 the bottom ones. We argue,

1 Following Twigg (2000a) we include cleaners in the category of body workers, c.f.Isaksen (2002).


in part, that this hierarchy reflects deeply held ideas about caringbody work and an equation that is made between ‘dirty work’ andthe workers that undertake it.

Dress codes and uniforms in the hospital play a role in markingwhich workers are involved in body work. Naresh described howcertain clothes are associated with doctors:

I never come to the hospital without a tie. . .yes, obviouslypeople do recognise you if you have the stethoscope. It chan-ges. . .they realise that you’re a doctor. If you don’t have astethoscope they say ‘‘who are you?”, then I have to tellthem I’m a doctor. (Naresh, doctor, male, India)

Wearing a stethoscope is a literal display of the distancing techniquesavailable to doctors. This display and wearing a tie, a piece of clothingassociated with white collar work, signals to others that this individ-ual is not involved in messy or unbounded caring body work.

The increasing (medical) professionalisation of nursing includesnot wearing a uniform. Senior nurses, for example those working innurse-led clinics, such as Daniela, also wear ‘outdoor clothes’:

I’m dressed as the doctor. I think patients associate outdoorclothes with doctors and stethoscope. I think many of themare not familiar with the fact that nurses are examiningpatients now. (Daniela, nurse, female, Malta)

The association of ‘smart’ office wear distances the worker from thecaring body work of feeding and washing. It links to the boundedinteraction of ‘examining patients’. The two roles are constructedas mutually exclusive and relational. The body worker is the ‘assis-tant’ to the superior professional.

The implications of undertaking body work can be seen mostacutely for nurses for whom there is a tension between distancingand embracing but redefining such work (Ashforth and Kreiner,1999). Nurses’ descriptions of the hospital hierarchy exhibited anambivalence towards body work. Catherine, for example, said shethought patients and their families can be quite rude to nurses be-cause they see them just as the ‘doctors’ helpers’. She described pa-tients’ relatives doubting what she told them and demanding totalk a doctor. She disputed this construction of nursing, seeing her-self as a medical professional just as doctors are. However, sheused the notion of ‘dirty work’ to stress her superiority to HCAs:

There’s the health care assistants, they’re doing feeding,washing. It’s like an assistant to the nurse, you know, thedirty work. (Catherine, nurse, female, Philippines)

Work on the bodies of others, feeding and washing, is read as me-nial and ‘dirty’. In some senses, Catherine’s ability to delegate bodywork to another secures her professional status. However, as we de-scribe below, nurses themselves do undertake body work.

4.2.2. Cultures of body workTo the surprise of nurses trained abroad, nursing in the UK does

often involve body work. In the countries where they had beenworking previously (the Philippines and India) nursing involvedmedical rather than caring duties. Joy described nursing in theUK as ‘the complete opposite’ of the Philippines. Discussing arriv-ing in the UK, Catherine explained:

I didn’t realise that you have to wash the body and every-thing. Back home we don’t do it, washing patients. We don’treally do it. It’s a relative doing it. (Catherine, nurse, female,Philippines)

Those nurses trained in India and the Philippines expressed a differ-ent cultural understanding of caring body work. Such work isthought to be a duty of relatives and as belonging in the domesticand familial domain. This disjuncture in conceptualisations has

been shown to increase the stigma of undertaking such work forpay. Discussing Zimbabwean expatriates working in care homes.McGregor (2007, p. 808) observes:

Most felt that care for the elderly should be a family matterand was part of the duty children had towards their parents,and should not be commodified. They were highly critical ofthe way British society treated its elders: many thought thatfamilies who put old people in homes were abdicating theirmoral responsibility by ‘discarding’ or ‘dumping’ their par-ents; that the elderly should be looked after in their children’shomes by relatives out of love, not put in an institution andcared for by people they did not know, working for money.

There are echoes of these conceptions in some of the sentiments ofnurses described below, of themselves and their elderly chargesbeing ‘dumped’. Workers’ own cultural expectations about theproper context of body work (a familial one) and moral judgementabout the treatment in the UK of the elderly further stigmatise thiswork in their eyes.

4.2.3. Dirty work/ersHospital body work by its very nature deals with the un-

bounded body and is often messy and dirty. Workers describedthe difficulties of cleaning people and, in particular, those involvedin cleaning human waste. Amber, a cleaner, described the experi-ences of cleaning the public areas of the hospital:

I do all the toilets and sometimes it gets me mad because themental health people as well come over, then we have pee onthe ground, there’s sick on the ground, they willvomit,. . .there was blood all over the place. . .my job forme! I have to do it, sometimes there’s poo on the ground,you have to take it up and you have to clean it. It’s my job isn’tit? [laughing] Sometimes it makes me sick. [laughing] Beforeyou eat and before you do anything, you wash and then youuse a (alcohol) gel. (Amber, cleaner, female, Jamaica)

Joy, a nurse, echoes Amber’s feelings:

[Is there anything I don’t like about my job?] Yes, waste,handling waste, body waste, that’s the only thing. Some-times it feels that. . .even though we’re used to it but thereare times that where probably we’re going to end up notfeeling very well but you’re still capable of working, andsometimes I’ve felt that, only in rare occasions but most ofthe time because we’re used to it, we can look at it, but ifit’s too much like all splattered on the floor, sometimes justwaste, I’m only a human being, sometimes I get sick withwaste. (Joy, nurse, female, Philippines)

Joy’s plea that she is ‘only human’ is telling. Working as a nurse shehas to undertake tasks that transgress social codes of behaviour.However, rather than being compensated for unpleasant work orrewarded for socially useful work, her work is devalued by associa-tion with ‘dirt’.

Workers felt that they, as migrants, were employed to under-take ‘dirty work’ that British-born workers are not prepared todo. Hafid describe the view of people in his home country:

In Morocco they said ‘‘listen, if you go to Europe, like adomestic or sweeping the roads or what ever, you will finda job quickly [snaps his fingers] because the English people,they don’t want to do this type of job”. So they give them toforeigners. (Hafid, cleaning supervisor, male, Moroccan)


Carla, another cleaning supervisor, echoed his comments: ‘‘They(British-born workers) don’t want to do it.”. Commenting on thework of cleaners, a doctor made a similar observation:

It’s not a nice, it’s not a fun job, it’s hard work and it’s longhours and I suspect folk who do have other options, will takeit and other people will say ‘‘I’d rather not do the job” but Ialways find it interesting that foreigners will find some workto do, not that I’m casting aspersions on anyone, I’m just think-ing most of the cleaning staff, I can’t actually think of anyother. . .there’s one lady I know who’s British-born, the restare all from overseas. (Eileen, doctor, female, South Africa)

Migrant workers are typically recruited for posts that are hard to filland so nurses moving to the UK found themselves working in low-er-status specialisms, such as geriatrics, regardless of their trainingor expertise. Asked what she felt on arriving in the UK Catherine de-scribes a disappointing experience:

Because they throw me in South side where the old buildingis. They would shuffle the staff and they put me to [elderly]Ward which is like. . .it’s not permanent and they’re throw-ing patients, mostly like having mental problems or reallywaiting for a nursing home and everything, and it’s really,for one, it’s not really good conditions of where it is, it’s anold building down there, it’s not happy to work with becauseall patients are complaining, ‘‘what is this style of work?”,it’s like a ship going to the. . .you know? (Catherine, nurse,female, Philippines)

She was expecting a ‘beautiful hospital’ but felt ‘dumped’ in wardsin bad conditions working with patients who no one else wanted towork with.

Workers employed a number of strategies to mitigate such anidentification. The most common was stressing the dignity of earn-ing a living and supporting their families. Asked what she likedabout her job, Joy answered:

I like it, it’s tiresome but I like it because I just learnt to like. Ijust learnt to like it. I don’t know the specific reason, I can’tthink of a specific reason why I like it, I just learnt to like andlove my job. Probably because this is my source of incomeand I don’t know other job except nursing. (Joy, nurse,female, Philippines)

Similarly Amber says:

I feel proud of my uniform because it gives me my food so Idon’t hide my uniform, I pick up my uniform, anywhere inthe NHS I feel so proud. (Amber, cleaner, female, Jamaica)

Other workers stressed the satisfaction they gained from caring forpeople. Habiba, who would have trained as a doctor but was pre-vented from doing so by civil war, said:

The best thing about my job is, when the person is very sickand getting better and going home that’s my, I feel good tosee, we did something and that person is going home, youknow that’s my best thing. (Habiba, HCA, female, Somalia)

Similarly, Iresh, a nurse, describes committed and fulfillingcaring work:

The best thing? Yeah. . .I think care of patients. I can befriendly with them. I do help as much as I can. The doctors,they only [have contact with patients] for some time, they

only are doing doctors’ rounds. I know. . .I get to. . .I knowthem completely, I talk to them and they know what is hap-pening. (Iresh, nurse, female, India)

Workers derive self-respect from a variety of sources; from theirability to support their family, humour, and stressing the valueand fulfilling nature of their work (Ashforth and Kreiner, 1999; Kre-iner et al., 2006). This, though, is undertaken within the context of asociety and an organisation which poorly remunerates this work.These migrant workers undertaking ‘dirty work’ in the NHS feelstigmatised within the workplace by their work and associationsmade between their status as migrants and the work that is appro-priate for them.

4.2.4. Caring body work as non-routineBody work might seem to be an aspect of caring work amena-

ble to the rationalisation of neo-liberal healthcare. Meeting phys-ical needs, such as feeding and bathing, seems to break down intotasks in a way that emotional labour just does not. However, ourinformants highlighted how non-routinisable the tasks of bodywork such as feeding and bathing are. The people in hospitalneed, in Kittay et al. (2005, p. 433) words care ‘‘more urgentlyand more completely” than usual (some more than others). Fit-ting such care into a schedule of discrete tasks is problematicfor workers.

Many of the workers we spoke to organised their working life inorder to avoid the stress of undertaking strictly timetabled bodywork. Being low in a hierarchy often involves having little auton-omy or control over the organisation of their working day. This isparticularly stressful for workers because it is they themselves,not their managers, who come face-to-face with their ‘clients’.The people we spoke to described changing shifts or wards in anattempt to avoid difficult-to-schedule body work. Joy, for example,described working night shifts because it did not involve washingpatients:

Oh dear, if you have to thoroughly wash, it takes about 15–30 min, it depends on how, you know, how dirty they are;how difficult (they are) to move. Because sometimes when,after washing them, they poo again. I have to go back againand wash them. (Joy, nurse, female, Philippines)

In another example, Habiba, a health care assistant, explained thatshe prefers working on a surgery ward because she can plan hertime:

(You know) exactly what’s coming and what you’re doing allthe time. You’ve got a list. You’re doing everything in a par-ticular hour and you know who needs this and who needsthat. But (in other wards) most of them is elderly, they havefell down and broken leg, broken and they can’t stand up atall and it’s not. You have to, you need someone, a nurse to bewith them all the time. (Habiba, HCA, female, Somalia)

Within a rationalised and bureaucratic system of delivering health-care unpredictability makes body work stressful for the workers.The workers we spoke to described, where possible, organising theirworking lives so as to avoid body work. This is work that is poorlypaid and understood as lowly. We can conjecture that such work isstressful for workers in part because it is work on the bodies of hu-mans, and that it is also work with people. As such workers are re-quired to simultaneously undertake emotional labour. When anincontinent patient needs washing again not only is the worker’sschedule disrupted but they must manage their feelings of stress/annoyance/anger and disgust as well as the patient’s embarrass-ment or shame.


5. Conclusion

In this paper we have argued that caring work is devaluedthrough multiple mechanisms. We have employed a twofold char-acterisation of caring work in order to describe and thus de-natu-ralise the devaluation of caring work and its association withfemininity. We have shown how it suffers, like much customer-fac-ing service sector work, through the lack of recognition of emo-tional labour. We have argued that this plays out in particularways when the emotional labour is of the intensity required byhealthcare work, and when the organisational context of manage-rialism rationalises care to a series of tasks. Further, we have ar-gued that caring work is devalued by the associations betweenbody work and dirty work. Rather than being rewarded for under-taking socially necessary and difficult work, workers are stigma-tised by the work they undertake.

The strategy of not presupposing which workers undertake car-ing work has been shown to be valuable for cutting across hierar-chies of care. We have shown that caring work in hospitals isundertaken by cleaners and porters as well as by nurses, by thosenot expected, as well as those expected, to provide ‘care’. Our aimis not to romanticise this work or these workers. Certainly, theseworkers can and do refuse to meet the demands and needs of pa-tients and their families. However, the examples of a porter provid-ing translation for newly arrived Polish migrants or a cleanertaking the time to chat with elderly patients as she cleans the warddemonstrate the extent to which emotional labour is hidden byhospital hierarchies and illustrate what it means for workers tobe a ‘prisoner of love’. These peoples’ experiences are importantin highlighting how workers respond to managerialist organisa-tional contexts. The workers we spoke to described, where possi-ble, choosing to work the shifts most amenable to arationalisation of care: night shifts or on wards requiring the leastbody work.

We began this paper by observing that care has been theoreti-cally neglected and socially undervalued. This has been possiblebecause historically, using the economist’s terminology, there hasbeen a surplus of care. Society has been organised in such a waythat care was provided within familial and domestic relationshipsand so the costs were hidden. However, it is becoming increasinglydifficult to ignore questions about care when a care deficit is cre-ated by more men and women working for wages in advancedindustrial economies, and by aging societies. Our aim here hasbeen to use this moment to challenge the devaluation of careand caring workers. Among the problems facing the world in the21st century, the provision of care – a seemingly mundane prob-lem – is of huge significance. It is not one that scientific innova-tions will resolve but is instead an issue about labour relations,gender and discrimination, and, ultimately, about social justicefor both the workers who perform such valuable labour and theircharges.

Acknowledgements

We would like to thank all of the workers at WCH who tooktime to talk to us, to acknowledge the support of the ESRC grantnumber RES 225 25 2001. We would also like to Yasmin Gunarat-nam and those who refereed the paper for their thoughtful com-ments on earlier drafts of this paper.

References

Adib, A., Guerrier, Y., 2003. The interlocking of gender with nationality, race,ethnicity and class: the narratives of women in hotel work. Gender Work andOrganization 10, 413–432.

Agustin, L.M., 2003. A migrant world of services. Social Politics 10, 377–396.

Anderson, B., 2000. Doing the Dirty Work? The Global Politics of Domestic Labour.Zed Books, London.

Ashforth, B., Kreiner, G., 1999. ‘How can you do it?’: dirty work and the challenge ofconstructing positive identity. Academy of Management Review 24, 413–434.

Batnitzky, A., Dyer, S., McDowell, L., in press. Flexible masculinities: the workinglives and gendered identities of male migrants in London. Journal of Ethnic andMigration Studies.

Bolton, S.C., 2005. Women’s work, dirty work: the gynaecology nurse as ‘‘other”.Gender Work and Organization 12, 169–186.

Brody, A., 2006. The cleaners you aren’t meant to see: order, hygiene and everydaypolitics in a Bangkok shopping mall. Antipode 38, 534–556.

Browne, I., Misra, J., 2003. The intersection of gender and race in the labor market.Annual Review of Sociology 29, 487–513.

Brush, B.L., Vasupuram, R., 2006. Nurses, nannies and caring work: importation,visibility and marketability. Nursing Inquiry 13, 181–185.

Clarke, J., 1999. Whose business? Social welfare and managerial calculation. In:Purdy, M., Banks, D. (Eds.), Health and Exclusion. Routledge, London and NewYork, pp. 45–61.

Clarke, J., Newman, J., 1997. The Managerial State. Power, Politics and Ideology inthe Remaking of Social Welfare. Sage, London, Thousand Oaks, New Delhi.

Conradson, D., 2003. Geographies of care: spaces, practices, experiences. Social andCultural Geography 4, 451–454.

Datta, K., McIlwaine, C., Evans, Y., Herbert, J., May, J., Wills, J., 2006. Work, Care andLife Among Low-Paid Migrant Workers in London: Towards a Migrant Ethic ofCare. Department of Geography Queen Mary, University of London, London.

Douglas, M., 1966. Purity and Danger an Analysis of the Concepts of Pollution andTaboo. ARK Paperbacks, London.

Duffy, M., 2005. Reproducing labor inequalities – challenges for feministsconceptualizing care at the intersections of gender, race, and class. Genderand Society 19, 66–82.

Dyer, S., McDowell, L., Batnitzky, A., in press. The impact of migration on thegendering of service work: the case of a West London hotel. Gender, Work andOrganization.

England, P., 2005. Emerging theories of care work. Annual Review of Sociology 31,381–399.

England, P., Folbre, N., 1999. The cost of caring. The Annals of the AmericanAcademy of Political and Social Science 561, 39–51.

England, K., Stiell, B., 1997. ’’They think you’re as stupid as your English is’’:constructing foreign domestic workers in Toronto. Environment and Planning A29, 195–215.

England, K., Ward, K., 2007. Neoliberalization: Networks, States, Peoples. Blackwell,London.

Folbre, N., 2002. The Invisible Heart: Economics and Family Values. The New Press,New York.

Folbre, N., Nelson, J.A., 2000. For love or money – or both? Journal of EconomicPerspectives 14, 123–140.

Forseth, U., 2005. Gender matters? Exploring how gender is negotiated in serviceencounters. Gender Work and Organization 12, 440–459.

Freud, D., 2007. Reducing dependency increasing opportunity options for the futureof welfare to work. Department for Work and Pensions, London.

Gilligan, C., 1997. In a different voice: women’s conception of self and morality. In:Meyers, D.T. (Ed.), Feminist Social Thought: A Reader. Routledge, New York andLondon, pp. 547–582.

Glenn, E.N., 1992. From servitude to service work – historical continuities in theracial division of paid reproductive labor. Signs 18, 1–43.

Gray, M., 2004. The social construction of the service sector: institutional structuresand labour market outcomes. Geoforum 35, 23–34.

Gubrium, J., 1975. Living and Dying at Murray Manor. St. Martin’s Press, New York.Halford, S., 2003. Gender and organisational restructuring in the National Health

Service: performance, identity and politics. Antipode 35, 286–308.Hampson, I., Junor, A., 2005. Invisible work, invisible skills: interactive customer

service as articulation work. New Technology Work and Employment 20, 166–181.

Hochschild, A., 1983. The managed heart. Commercialization of human feeling.University of California Press, Berkley, CA.

Hochschild, A., 2000. The nanny chain. American Prospect 11, 32–36.Hochschild, A., 2003. The commercialization of intimate life. University of California

Press, Berkley, CA.Huang, S., Yeoh, B.S.A., 1996. Ties that bind: state policy and migrant female

domestic helpers in Singapore. Geoforum 27, 479–493.Hughes, E.C., 1951. Work and the self. In: Rohrer, J.H., Sherif, M. (Eds.), Social

Psychology at the Crossroads. Harper & Brothers, New York, pp. 313–323.Isaksen, L.W., 2002. Toward a sociology of (gendered) disgust: images of bodily

decay and the social organization of care work. Journal of Family Issues 23, 791–811.

James, N., 1992. Care = organization + physical labor + emotional labor. Sociology ofHealth and Illness 14, 488–509.

Jervis, L.L., 2001. The pollution of incontinence and the dirty work of caregiving in aUS nursing home. Medical Anthropology Quarterly 15, 84–99.

Kang, M., 2003. The managed hand – the commercialization of bodies andemotions in Korean immigrant-owned nail salons. Gender and Society 17,820–839.

Kerfoot, D., Korczynski, M., 2005. Gender and service: new directions for the studyof ‘front-line’ service work. Gender, Work and Organization 12, 387–399.

Kittay, E.F., Jennings, B., Wasunna, A.A., 2005. Dependency, difference and the globalethic of longterm care. Journal of Political Philosophy 13, 443–469.


Kofman, E., Raghuram, P., Merefield, M., 2005. Gendered migrations. Towardsgender sensitive policies in the UK (Asylum and Migration Working Paper 6).Institute for Public Policy Research, London.

Korczynski, M., 2001. The contradictions of service work: the call centre ascustomer orientated bureaucracy. In: Sturdy, A., Grugulis, I., Wilmott, H. (Eds.),Customer Service: Empowerment and Entrapment. Palgrave Macmillan,Basingstoke.

Kreiner, G.E., Ashforth, B.E., Sluss, D.M., 2006. Identity dynamics in occupationaldirty work: integrating social identity and system justification perspectives.Organization Science 17, 619–636.

Krumal, S., Geddes, D., 2000. Exploring the dimensions of emotional labour. Theheart of Hochschild’s work. Management Communication Quarterly McQ 14, 8–49.

Lawson, V., 2007. Geographies of care and responsibility. Annals of the Associationof American Geographers 97, 1–11.

Leidner, R., 1991. Serving Hamburgers and selling insurance - gender, work, andidentity in interactive service jobs. Gender & Society 5, 154–177.

Lupton, D., 1994. Medicine as Culture: Illness Disease and the Body in WesternSocieties. Sage Publication, London.

McDowell, L., Ray, K., Perrons, D., Fagan, C., Ward, K., 2005. Women’s paid work andmoral economies of care. Social and Cultural Geography 6, 219–235.

McDowell, L., Batnitzky, A., Dyer, S., 2007. Division, Segmentation, andInterpellation: The Embodied Labors of Migrant Workers in a Greater LondonHotel. Economic Geography 83, 1–25.

McGregor, J., 2007. Joining the BBC (British Bottom Cleaners): ZimbabweanMigrants and the UK Care Industry. Journal of Ethnic and Migration Studies33, 801–824.

McIlwaine, C., Datta, K., Evans, Y., Herbert, J., May, J., Wills, J., 2006. Gender andEthnicity: Low-Paid Migrant Workers in London. Department of GeographyQueen Mary, University of London, London.

Misra, J., 2003. Caring about care. Feminist Studies 29, 387–401.Mohan, J., 1995. Post-Fordism and Welfare – An Analysis of Change in the British

Health Sector. Environment and Planning A 27, 1555–1576.Novarra, V., 1980. Men’s Work, Women’s Work. Marion Boyars, London.Payne, J., 2006. Emotional Labour and Skill: A Re-appraisal (Skope Issues paper 10).

University of Warwick, Warwick.

Philpin, S.M., 1999. The impact of ‘Project 2000’ educational reforms on theoccupational socialization of nurses: an exploratory study. Journal of AdvancedNursing 29, 1326–1331.

Pratt, G., 1999. From registered nurse to registered nanny: Discursive geographics ofFilipina domestic workers in Vancouver, BC. Economic Geography 75, 215–236.

Rogers, A., Hassell, K., Nicolaas, G., 1999. Demanding Patients? Analysing the Use ofPrimary Care. Open University Press, Buckinham, Philadelpia.

Ruhs, M., Anderson, B., 2006. Semi-compliance in the migrant labour market(working paper no. 30). Centre on Migration, Policy and Society. University ofOxford, Oxford.

Seymour, D., Sandiford, P., 2005. Learning emotion rules in service organizations:socialization and training in the UK public-house sector. Work Employment andSociety 19, 547–564.

Solari, C., 2006. Professionals and saints – How immigrant careworkers negotiategender identities at work. Gender and Society 20, 301–331.

Stacey, C.L., 2005. Finding dignity in dirty work: the constraints and rewards of low-wage home care labour. Sociology of Health and Illness 27, 831–854.

Turner, J.H., Stets, J.E., 2006. Sociological theories of human emotions. AnnualReview of Sociology 32, 25–52.

Twigg, J., 2000a. Bathing the Body and Community Care. Routledge, London andNew York.

Twigg, J., 2000b. Carework as a Form of Bodywork. Ageing and Society 20, 389–411.Valentine, G., 2007. Theorizing and researching intersectionality: a challenge for

feminist geography. The Professional Geographer 59, 10–21.Vertovec, S., 2006. The emergence of super-diversity in Britain (working paper no.

25). Centre on Migration, Policy and Society. University of Oxford, Oxford.Wolkowitz, C., 2002. The social relations of body work. Work Employment and

Society 16, 497–510.Wolkowitz, C., 2006. Bodies at Work. Sage, London.Yeates, N., 2004. A dialogue with ‘global care chain’ analysis: nurse migration in the

Irish context. Feminist Review, 79–95.Yeoh, B.S.A., Huang, S., Gonzalez, J., 1999. Migrant female domestic workers:

debating the economic, social and political impacts in Singapore. InternationalMigration Review 33, 114–136.

Young, I.M., 1990. Justice and the Politics of Difference. Princeton University Press,Princeton, New Jersey.


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