Rethinking unequal exchange: The global integration of nursing labour markets (2012)

Update: An April 28, 2013 New Yorker article about migrant labourers is entitled “Hidden from view.”

Rethinking unequal exchange: The global integration of nursing labour markets (2012) deals with research related to migrant workers.

The author is Salimah Valiani, Associate Researcher with the Centre for the Study of Education and Work, University of Toronto.

Chapter 5, which I looked at first, is entitled “The global integration of the nursing markets – The Philippines instance.”

Specialists of Philippine migration

Building upon the work of specialists of Philippine migration Graziano Battistella, James Tyner, Robyn Rodriguez and others, Valiani outlines (p. 93) the steps whereby the Philippines state emerged as the leading international exporter of labour.

Among other things, Valiani describes why a labour export policy was adopted by the Philippine state starting in the 1970s and not before.

She posits (p. 93) that the policy is “the outcome of contradictions arising from the trade relations shaped under colonialism, severely unequal land distribution, and weighty U.S. political influence.”

Valiani  notes that her explanation, rooted in what she describes as a world historical political economy analysis, differs from those of post-structural analysts who argue that external debt servicing serves as the primary motivation for the labor export policy of the Philippine state.

She refers, in this context,  to the arguments of Robyn Rodriguez (2010) who emphasizes the role of the state in creating demand for migrant Filipino labor in a range of sectors and occupations.

She notes that exports-oriented labor force development is a key element of restructuring in the capitalist world economy. States such as Indonesia, India, Bangladesh, and Vietnam are described, in this context, as “redefining economic development to include the generation of foreign exchange through the exportation of temporary migrant workers – especially female migrants, who tend to remit larger sums with more consistency” (p. 125).

Why does the march of science cost so much?

Chapter 3, “Global integration – the U.S. American instance,” addresses the questions of: What led to the restructuring of the U.S. nursing labour market? How did the restructuring occur? What key social agents were involved?

Valiani argues that the rise in use of medical technology starting in the 1940s led to rising hospital costs through to the 1980s. Around 1990, she argues, hospital administrators began to reduce hospital costs by restructuring of nursing work.

She notes (p. 41) that hospital labour market changes can be viewed as “part of the contradictory outcomes of monopoly capital, of which the medical and diagnostic industry is demonstrated to be one instance.”

Among the topics addressed in the chapter is: Why does the march of science cost so much? Valiani speaks of  monopoly capital as a key element driving up health care expenditures.

In developing her narrative, Valiani notes that Paul Kalb, writing in the 1990s,  highlighted that most drugs and medical devices in the United States are assessed for safety and efficacy, but most medical and surgical procedures are not formally evaluated at all.

I would note that this situation may have changed since 1990, to the extent that evidence-based practice is implemented in the American health care system.

Valiani concludes that the monopoly structures of production of medical technology and pharmaceuticals account for a significant part of the increase in US health expenditures in the second half of the 1900s.

The Canadian experience

In Chapter 4, “Global integration of nursing labor markets – the Canadian instance,” Valiani  concludes that the Canadian instance differs from the U.S. American instance  in various ways (p. 91):

“Unlike in the United States, cost-cutting in the area of nursing labour has been and continues to be effective in reducing hospital expenditures, a strategy adopted virtually from the beginning of publicly funded healthcare. Though unionization of nurses in Canada began earlier than in the United States, the gains, in terms of both salary and working conditions, have been relatively greater in the United States.”

Conclusion of the book

The book’s final chapter concludes (p. 149)  that “the global integration of nursing labor markets and the interrelated global integration of domestic care labor markets appear to be leading to a world-stratified distribution of caring labor, based on exports-oriented production of caring labor and some countries of the world.  This has the potential to concentrate crucial caring labor in the social reproduction of a dwindling fraction of world society, moving world society as a whole further away from the goal of human development.”


I like this book because it offers a possibly more comprehensive overview of topics related to migrant workers than can be covered in a newspaper article or similar text. The book also ties in with my interest in colonialism and the related topic of military history.


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