Using the Unions: Healthcare Struggles in Italy and Spain between Trade Unionism and Self-Organization

The healthcare sector has been profoundly impacted by global neoliberal restructuring which, in turn, has provoked campaigns of resistance from workers and users. Scholars' investigations of this resistance to have focused on unions' struggles in the workplace, user campaigns relating to access as well as instances of self-organized healthcare provision. This paper adopts a new focus – self-organized groups of healthcare workers and users which strategically use union resources. Our findings show how these groups, while emerging independently of unions and often framing unions critically, nonetheless rely on unions both in workplace-related struggles and campaigns regarding access to services. We identify three main purposes for which these groups use unions – expertise, institutional and legal resources, and publicity – and argue that these strategic uses are related to the phase of demobilisation in which social movements find themselves. As well as providing new insights into a distinctive feature of organizing within the healthcare sector, our research contributes to the literature on workers' self-organization and to labour revitalization studies by showing how and why self-organization and trade unionism interact

Protest in response to the commodification of healthcare in the era of the European Union’s new economic governance regime

In response to the 2008 financial crisis, the EU established a new economic governance (NEG) regime, which allowed the European Commission and Council to intervene to the financing and organisation of national healthcare services; as healthcare represents the single largest area of welfare state expenditure and service delivery. This thesis therefore addresses the following questions: 1) How have NEG policy prescriptions impacted the level of commodification of services and labour in Ireland and Madrid’s public health systems? 2) Since the beginning of the financial crisis in 2008, how have unions and social movement organisations active in these health systems politicised changes in public service provision and employment conditions? 3) How can we understand the choices of union and user groups organising in the sites of study regarding the scale at which they politicised policy changes related to the NEG regime and the scope of their demands? In turn, through a contextualised semantic content analysis of NEG policy prescriptions issued to the Spain and Ireland, this thesis first shows that EU executives have harnessed the NEG regime to promote the commodification of healthcare services and labour. Second, going beyond existing studies of NEG interventions in healthcare, the thesis then outlines the measures that the Irish and the Spanish central governments and the regional government of Madrid have adopted in line with these prescriptions and analyses their impact on healthcare services and labour. I show that the governments’ implementation of NEG prescriptions has institutionalised the underfunding of the health systems under study and promoted the corporatisation and privatisation of service delivery. Third, through a comprehensive protest event analysis of counter-mobilisations involving unions and user groups in the two health systems from September 2008 to March 2020, this thesis shows that the implementation of healthcare-related NEG prescriptions altered the movement landscape in each site of study – prompting trade unions and user groups to organise at higher scales and to broaden the scope of their demands. My study, however, also shows that resistance to commodification is a project and building powerful counter-movements takes time. Although the NEG regime was established relatively recently, this thesis shows that unions and user groups organising in the health systems have begun the work of constructing the oppositional networks necessary to challenge corporate and political leaders at the EU scale. My research on movement landscapes within these health systems will thus also serve future research by helping scholars to contextualise and understand counter-movements that may emerge in the forthcoming post-pandemic era of the NEG regime.European Research Counci

The ambiguous partnership: Elf Aquitaine and the French government 1976-1986.

This thesis explores the relationship of collaboration and conflict between France's state-owned oil group, the Societe Nationale Elf Aquitaine, and successive governments during the critical decade, 1976-1986, before wide-scale privatisation was initiated. The group's development reflects the broader trend in government - industry relations away from dirigisme to market economics by both senior managers and politicians alike. Created as an instrument of government with a "national interest" mission, the group was expected to work for and with governments. This partnership was conditioned by the international nature of the oil industry. Directly exposed to the impact of the oil crisis, the group suffered from the switch made in France from oil to nuclear energy as the main source of power. This development accelerated not only the diversification of the group's product range and multinationalisation of its activities but also modified its relations with government. It remained in public ownership, but became financially independent and acted increasingly like a private company. Governments were also affected by the economic crises of the 1970s, and by France's closer integration into Europe. While Elf maximised its profits, governments relied on the oil group's wealth. This confusing combination of dependence and governments' use of their powers of ownership produced many conflicts. Yet Elf's leaders could also exploit the state link through grand corps networks to achieve their own goals. These ambiguities were sharpened during the decade because Elf was shifting between two modes of relationship; an instrument of government enjoying privileged links with the state and an independent private multinational. Partial privatisation in 1986 somewhat resolved the contradictions but heralded new challenges. Under the impact of the Single Market programme and GATT agreements, French governments divested themselves of powers they could no longer exercise, French firms shifted partnership with the state to partnership with foreign firms and the development of each individual firm became subject to its performance in the market

The Irish Carnegie Community Engagement Classification Pilot: A critical analysis on culture and context from a community of practice approach

This article provides a reflective critique of the process undertaken to pilot the Carnegie Community Engagement Framework in Ireland between 2015 and 2016. Of particular interest to the authors is the cultural specificity of employing a US-centric self-assessment data capturing tool in a heterogeneous Irish context. Taking the reader through from conception of the idea to its execution and post-pilot reflections, we examine the cultural appropriateness and translatability of the tool to Irish higher education. To frame the discussion of the process, we employ the concept of a community of practice, as defined by Wenger (1998). This was adopted to promote a culture of collaboration in an ever-growing neoliberal system that promotes competition between institutions, rather than facilitating their co-construction of knowledge. In the analysis, we demonstrate how forming this community of practice allowed for a cohesive assessment of the challenges and opportunities that arose through the pilot process. This was particularly important since each participating institution had different motivations for engaging with the pilot. Reflecting with some distance, we consider the value that comes from operating as a community of practice, as well as some shortcomings that we identified as specific to this pilot

Using the Unions: Healthcare Struggles in Italy and Spain between Trade Unionism and Self-Organization

The healthcare sector has been profoundly impacted by global neoliberal restructuring which, in turn, has provoked campaigns of resistance from workers and users. Scholars' investigations of this resistance to have focused on unions' struggles in the workplace, user campaigns relating to access as well as instances of self-organized healthcare provision. This paper adopts a new focus – self-organized groups of healthcare workers and users which strategically use union resources. Our findings show how these groups, while emerging independently of unions and often framing unions critically, nonetheless rely on unions both in workplace-related struggles and campaigns regarding access to services. We identify three main purposes for which these groups use unions – expertise, institutional and legal resources, and publicity – and argue that these strategic uses are related to the phase of demobilisation in which social movements find themselves. As well as providing new insights into a distinctive feature of organizing within the healthcare sector, our research contributes to the literature on workers' self-organization and to labour revitalization studies by showing how and why self-organization and trade unionism interact.European Research Counci

The creation of a healthy eating motivation score and its association with food choice and physical activity in a cross sectional sample of Irish adults

BackgroundThis study aimed to develop a healthy eating motivation score and to determine if dietary, lifestyle and activity behaviours vary across levels of motivation to eat a healthy diet with a view to informing health promotion interventions.MethodsA cross-sectional survey of food intake, physical activity, lifestyles and food choice attitudes was conducted in a nationally representative sample of 1262 adults in the Republic of Ireland aged 18 years and over.ResultsIncreasing score for health motivation was significantly and positively related to healthy eating and exercise. Women, increasing age, normal BMI, regular exercise and increasing intakes of fruit and vegetables were associated with a higher odds ratio (OR) for having a high healthy eating motivation score. However, despite a high motivation score only 31 % of consumers in the strong motivation group achieved the recommendations for daily fruit and vegetable consumption, while 57 % achieved the fat recommendation. A higher intake of calorie dense foods from the top shelf of the food pyramid and increased time spent watching T.V. was associated with a decreased OR for positive motivation towards healthy eating.ConclusionsHealthy eating promotions directed at women and older adults should focus on supporting people’s motivations to attain a healthy diet by addressing issues such as dietary self-control and self-regulation. For men and younger adults, healthy eating promotions will need to address the issues underlying their weak attitudes towards healthy eating

Lessons from inter-disciplinary collaboration to mitigate SARS-CoV-2 transmission in schools, Ireland, 2020/2021, to inform health systems and multisectoral recovery

IntroductionSchool closures associated with the COVID-19 pandemic resulted in the loss of educational and social supports for up to 1,000,000 students in Ireland and disproportionately affected students from lower socio-economic backgrounds. For the 2020/2021 school year, multisectoral and interdisciplinary “Schools Teams” were established within Public Health departments to maintain in-person education by minimizing transmission of SARS-CoV-2 in schools. This study aimed to describe this model and explore the experiences of Schools Team members in the East of Ireland to identify factors that influenced effective working that can be sustained in the context of health systems and multisectoral recovery.MethodsSchools Teams were comprised of multidisciplinary staff from regional Public Health departments and redeployed staff from the Education sector. Governance rested with Public Health departments. All staff operated to nationally agreed protocols following training. The experiences of the East Schools Team members were explored through an online survey and semi-structured interviews.ResultsThe survey response rate was 53/70 (75.7%). Participants reported clear channels of communication within the team (44, 83.0%), feeling comfortable in their role following training (43, 82.7%) and a positive team culture (51, 96.2%) as key facilitators of effective inter-disciplinary working. Insufficient administrative support and mixed messaging to schools were identified as barriers to efficient team collaboration.DiscussionThe Schools Team model illustrates the potential for multisectoral partnerships to effectively address complex public health priorities and contribute toward health system resilience to health threats. By recognizing and leveraging the ability of allied sectors such as the education sector, to contribute to public health goals, countries can move toward the kind of whole-of-government approach to health recognized as key to health system resilience. The strong links between the education and public health sectors developed through this collaboration could be extended and strengthened to more effectively pursue public health priorities in school settings. More broadly, mechanisms to support multisectoral working should be developed, expanding beyond reactive interventions to proactively address key health priorities and build resilience across health systems and communities. Such collaborations would promote healthier populations by promoting and encouraging a public health perspective among other sectors and embedding “health in all policies”