The division of labour in child health care: Poland and England & Wales compared

Abstract

The health of children is a matter of primary concern both to the state and to the individual, and the maintenance and restoration of that health are activities which take place both in the public domain and in the home. The recognition of the importance and interdependence of paid and unpaid labour is central to the conceptual framework of this study. It is a framework which views the division of labour in public and private domains not separately, but in terms of each other. This represents a break with classical sociological theories. Until feminists challenged the functionalist conception of the family as "natural" and unproblematic, these theories had been content with two discontinuous accounts of the division of labour: "one that it all began with Adam Smith and the other that it began with Adam and Eve" (Stacey, 1981: 172). That is one aspect of the approach. The other lies in the comparative nature of the study, dealing as it does with two countries: Poland and Britain (1). An endeavour of this kind is hedged in by difficulties both methodological and interpretive, yet the sociological method is essentially a comparative one. Inevitably, a comparison of countries with varying ideo-political and economic systems is fundamentally concerned with the effect of these differences on particular social processes. Although this is also true of the present enquiry, what it does not set out to do is to counterpoint a notion of capitalism with one of socialism, then to weigh up the merits of one over the other. This would be to assume that such a socialism exists and thereby to run the risk of subjecting evidence to what Gouldner (1980) has referred to as the self-normalising effect of theory. Rather, the conceptualisation of the division of labour described above allows, firstly, a comparison which is sensitive to issues of both class and gender and the relation between the two. In this way the enquiry encompasses the major structural divides of British society, and at the same time confronts two of the major claims of state-socialist society: that it seeks to reduce social inequalities in general and to eliminate sexual inequalities in particular. It also provides the opportunity to draw comparisons which go beyond an institutional analysis to the level of personal experience. In linking public policy to the intimate matter of health it allows us to follow Mills' enjoinder that we should "grasp history and biography and the relations between the two within society" (Mills, 1977:12). If vital in the study of a single society, how much more so is the sociological imagination for a comparison of two countries with conflicting social systems? This brief exposition of the conceptual background to the present study explains why an analysis of publicly provided health care in Poland and in Britain has been left to a single penultimate chapter. The initial task of the study was to establish a comparable notion of health and to examine the way in which this varies according to socio-economic group in each country. This is the subject of Chapter I and serves as a point of reference for what follows. Crucial to a comparison of health and health care is its location within a material context. Chapters II and III note overall differences in national disposable wealth and focus on the consequences of markedly different systems for the production and distribution of that wealth which are adopted in each country. These are viewed, in Chapter II in terms of the levels and patterns of female economic activity rates - including economic activity in private farming, and the inter-relationships between these and the division of labour within the family. Chapter III reviews the evidence concerning the extent of social inequality and poverty which has been generated by these wealth producing and distributing processes. Following a short analysis of the division of domestic labour in the two countries in Chapter IV, Chapter V presents a wide-ranging comparative account of social policies relevant to child health. Again, these policies may be classified as either (a) serving to accommodate the employment of women with what are understood to be their domestic responsibilities or (b) serving to mitigate or in some other way deal with the consequences of social inequality and poverty. The study culminates in Chapter VI with an examination of specific state intervention in the maintenance and restoration of child health, and conclusions emerging from the study as a whole are presented in Chapter VII. Two further points remain to be made. The first has to do with the nature of the source materials on which the thesis is based. These have been varied, and include the published writings of sociologists, medical sociologists, doctors and demographers in both Poland and Britain. Official statistics and legislative texts have been consulted where appropriate. In addition, the data would have been much depleted were it not for the availability of a variety of reports produced in Poland for intra-institutional consumption. These reports emanate from the Central Statistical Agency (GUS), the Central Planning Commission, the Research Institute attached to the Ministry of Labour, Wages and Social Security (IPiSS), the Institute of Mother and Child (IMiDz) and also include a large number commissioned by the Council for the Family (Rada d/s Rodziny), a group of specialists convened in 1978 by Edward Gierek, as part of his "familialisation" of social policy. Details of all of these are to be found in the bibliography. Finally, it is of some importance that the study is oriented towards a British readership. If greater weight has then been given to the Polish case, it is because a level of understanding of British arrangements has in places been assumed, the judgement having been that a proper comparison does not necessarily require a consistently even- handed approach, but that on the contrary, a fuller exposition of the less familiar is sometimes what is called for. Hopefully this judgement will be vindicated