• Marcelo Vieta

Immigrant Women in Healthcare Support Roles in Times of COVID-19

Updated: Aug 3

By Isabelle Cascallar


Themes: Health, Work, Social Justice, Anti-Racism


How Capitalism Has Undervalued and Profited from the Labour of Minorities and Women with Devastating Impacts During the COVID-19 Crisis


All over the world, immigrants, people of colour, women and the poor are more exposed to the virus in their front-line worker roles. In this article I will explore how capitalism has undervalued and profited from the labour of minorities and women with devastating impacts during the COVID-19 crisis. Looking specifically at the supporting roles of immigrant women within the field of healthcare, we see how their existence at the lower end of the pay scale increases their risk of being exposed to COVID-19 and spreading it. Meanwhile, many do not have access to the support and resources needed to overcome sickness or unemployment. Focusing on the Canadian situation since the outbreak, I ultimately argue that better care for everyone could be achieved through mandatory paid sick leave for workers, fair pay, and job security which a unionized or cooperative environment could offer.

Impacts of Capitalism on the Female (Immigrant) Labour Force


According to labour economist Jim Stanford, work performed in the home amounts to over one third of all economic output (2008). Much of this work involves caring for family members, cooking, cleaning, and other household tasks, most of it typically done by women. This unpaid work is a critical part of the capitalist economic system which undervalues women’s contributions within the home and results in “[t]he inequality of men’s and women’s labour market experience reinforce[ing’], and … reinforced by, the inequality of their economic position within the home” (Stanford, 2008, p. 116). Also, while transferring more of their own work effort from the home to the paid labour market, women are still saddled with an unfair share of household duties when they get home from their paying jobs (Stanford, 2008).


Immigrant women are often doubly impacted. Firstly, their existence within the global division of labour from their lived experience of the market economy in the global South is often based on their household skills that include sewing and knitting, which provide cheap manufacturing labour often under appalling conditions (Mies, 1998). Secondly, when immigrating to richer nations in the global North, they also find themselves in low paying and precarious caregiver roles such as nannies or personal support workers. Mies asserts that: “The neoliberal policy of deregulation and flexibilization and of promoting the service sector is just another expression of the housewifization of labor” (1998, p. 13).


Neoliberal policies and practices are at the forefront of news on the COVID-19 related deaths in private long-term care homes in Ontario and all over the world, and this is directly related to the unsafe conditions of work in the caring and care home sector. Armstrong & Armstrong’s suggestion from 2006 is still relevant during our current crisis:


Business practices applied in both the for-profit and not-for-profit sectors are making women work harder, with fewer benefits, less satisfaction, fewer recognized skills, less job security and fewer choices about how to provide care and what care to provide. (2006, p. 34)


While some of the impacts on nurses have been accounted for and responded to, other women paid to provide care have received less attention and these women are disproportionately from visible minority and immigrant groups.


Roles of Immigrant Women in Healthcare and Exposure to COVID-19


Before the pandemic began there were reports in the news of long-term care homes being regularly understaffed, with high patient to support worker ratios, and unsafe working conditions (Armstrong & Armstrong, 2006; Luk, 2020). Part of the issue was related to the government enlisting private companies to manage long-term care homes, with limited public oversight, which resulted in the implementation of cost saving measures, ultimately at the expense of care workers’ and residents’ safety. One such measure was privileging part-time over full-time work to avoid paying employment benefits (Bouka & Bouka, 2020). This left many support workers with no other choice but to work at multiple sites to make ends meet. It is within this context that we learned COVID-19 was spread to multiple long-term care homes, having a devastating impact on both staff and patients. In an effort to prevent spreading the virus, the government legislated that support workers be employed at only one location. This has resulted in a loss of hours for many staff that require, at a minimum, full time hours to make ends meet (Luk, 2020).


In the wake of all the COVID-19 related deaths in long-term care homes, it has also become increasingly evident that immigrant women in healthcare suffer from a lack support and resources. Amongst other immigrants, Filipina women are highly represented in care giving roles, for both children and the elderly. Without recognition of foreign credentials and often without financial support, it is difficult for them to move out of these low paying and precarious roles (Luk, 2020). Under such circumstances, workers from other countries will continue to work multiple low-wage jobs to piece together a living and expose themselves and others to health risks.


Support and Resources Needed to Overcome Sickness or Unemployment


While research on immigration seems to support the viewpoint that it is a good, even a necessary thing for Canada, especially economically, there are other factors to consider which relate to the overall quality of life of immigrants. Although, generally immigrants fare better in Canada than for example in a country such as the United States where various social structures and safety nets are not in place, such as universal healthcare, barriers remain (Zuberi, 2006). Systemic racism can prevent racialized people from accessing services within a universal healthcare system (Timothy, 2020). Even with the support of family resources and working as many jobs as possible, many live on the edge of poverty in neighbourhoods with a low quality of life, isolated from mainstream society and opportunities to well-paying jobs. They also often lack access to extended health insurance and preventative medical care (Zuberi, 2006). Such differences become critical when unforeseen events such as medical emergencies or poor health become very costly expenses on minimum wage or less, which can be the only jobs that newly arrived immigrants are able to secure (Zuberi, 2006). Women are also often in the unpaid role of caregiver at home when family members become sick.


Part of the adverse employment effect that the COVID-19 labor market shock had on immigrant employment relates to the fact that immigrants are less likely to be employed in jobs that can be done remotely. They thus suffered disproportionally as the economic lockdown allowed other workers with the skills and resources to work from home (Borjas & Cassidy, 2020). Employing mostly immigrant women and racialized people, those in care, service, or health support work – deemed “essential” by Canadian provincial and federal governments, cannot stay safely home and, as previously noted, they are compelled to keep working their often precarious and part-time jobs, mostly without benefits and at times in settings with high risk of infection. For those who do not have benefits, the decision of whether to go to work while sick is made based on whether they can afford to miss a shift. Such a decision can have harmful impacts, especially during a pandemic where contracting and spreading COVID-19 could result in death, particularly for long term care home residents.


Further Options From a Unionized or Cooperative Environment


Options such as unions or alternate organizational models such as cooperatives can help protect immigrant female support workers in healthcare and guarantee them access to stable employment and fair compensation in roles that do not require them to hold down more than one job, as well as paid sick leave. The collective power of workers can have a big influence on employers: “Although the female-dominated workforce once did much of the labour as unpaid trainees or as very low-paid employees, the unionization of almost all the women employed in hospitals has significantly improved both pay and conditions of work” (Armstrong & Armstrong, 2006, p. 4). When employees can band together and voice their demands collectively it typically results in higher wages, better benefits and more of a say in how they work and their conditions of work (Glasbeek, 2020). In addition to unionizing, employees of long-term care homes and patients could also benefit from a more cooperative structure of care delivery.


For instance, there can be many benefits to cooperative living for the elderly, including the ability to stay active and benefit from a community atmosphere. An improvement in the service of care would be ensured by personal support staff that are worker-members of an employee-centred organization that is committed to meeting their needs, such as a worker cooperative, while at the same time striving to meet community need and adhere to cooperative values and principles.


If we think about the need for business firms to operate in a manner that does not have them externalizing costs such as worker health and safety, community erosion or environmental damage, the co- operative business model, with its focus on meeting member and community needs as opposed to maximizing returns to shareholders, is in principle a better model. (Webb & Cheney, 2014, p. 84)


There are experiences of worker-run and -controlled health cooperatives from around the world, and in Canada, as well. Marcelo Vieta has recently documented a case of a mostly women-run cooperative health clinic in the Argentine city of Córdoba, Cooperativa Salud Junín. People often form cooperatives because they seek a better or fair outcome to a market situation they regard as unfair or unjust (Vieta, 2020). An economic crisis to the extent that Argentina experienced in the late 1990s and early 2000s, where the neoliberal economy collapsed and where owners of workplaces would declare bankruptcy, often illegally, motivated workers in hundreds of workplaces to eventually taken them over and convert them to cooperatives. For the Salud Junín workers, the former owners of the private clinic had them “…asset strip the firm, fire workers, and, in the process, carve out an exit strategy for themselves rather than protect the livelihood of the clinic’s staff and the wellbeing of its patients” (Vieta, 2020, p. 84). While this may not be the current reality in Canada, the failure of the existing structure of long-term care to provide adequate service and protection for both support workers and those in need of care during the pandemic has resulted in many deaths and there is a current call to either nationalize health care facilities, or convert them to non-profits (Alaniz & Cruz Ferre, 2020). And there is already a precedence of converting SMEs to cooperatives in Canada (CoopConvert, 2020), and even in the health sector as in, for instance, several ambulance services in Quebec converting to cooperatives in the 1980s and 1990s and still making up a fair portion of its paramedic services. Nova Scotia’s Careforce home care delivery services is another example of a cooperative conversion led by the mostly immigrant women that could be replicated throughout Canada.


Parting Thoughts


We see how capitalism has undervalued and profited from the labour of minorities and women with devastating impacts during the COVID-19 crisis. Immigrant women in healthcare support roles exist at the low end of the pay scale which has increased their risk of being exposed to COVID-19 and spreading it. Meanwhile, many do not have access to the support and resources needed to overcome sickness or unemployment. Better care for everyone could be achieved through mandatory paid sick leave for workers, fair pay, and job security which a unionized or cooperative environment could offer. It is time that the workers who provide these services – disproportionately female, racialized, new immigrants, and low paid – are recognized and fairly compensated for the critical roles they play within our society.


Other contacts for Isabelle Cascallar: https://www.linkedin.com/in/isabelle-cascallar-9a439a125/


Resources

Alaniz, M. & Cruz Ferre, J. (2020). We Need To Nationalize Health Care Now! Popular Resistance.Org (April 14).


Armstrong, P., & Armstrong H. (2006). Women, privatization and health care reform. National Network on Environments and Women's Health. Toronto, Ontario: York University.


Borjas, G. J., & Cassidy, H. (2020). The Adverse Effect of the COVID-19 Labor Market Shock on Immigrant Employment. Bonn, Germany: IZA - Institute of Labor Economics.


Bouka, A., & Bouka, Y. (2020). Canada’s Covid-19 blind spots on race, immigration and labour. Policy Options: The Coronavirus Pandemic: Canada’s Response special feature. (May 19)


Glasbeek, Harry. (2020). The Anti-Union Virus Inside the Emergency Powers: Lessons for Workers. The Bullet. (Apr. 26).


Luk, Vivian. (2020). How Filipino-Canadian care aides are disproportionately affected by the COVID-19 pandemic. CBC. (May 31).


Mies, Maria (1998) Globalization of the Economy and Women’s Work in a Sustainable Society, Gender, Technology and Development, 2:1, 3-37.


Stanford, Jim. (2008). Economics for Everyone: A Short Guide to the Economics of Capitalism. London: Pluto.


Timothy, Roberta. (2020). Coronavirus is not the great equalizer—Race Matters. The Conversation Canada. (Apr. 6).


Vieta, Marcelo. (2020). Workers’ Self-Management in Argentina: Contesting Neo-liberalism by Occupying Companies, Creating Cooperatives, and Recuperating Autogestión. Leiden: Brill.


Webb, Tom & George Cheney. (2014). Ch. 5, Worker Owned-and-Governed Co-operatives and the Wider Cooperative Movement: Challenges and Opportunities Within and Beyond the Global Economic Crisis. In M. Parker, G. Cheney, V. Fournier, & C. Land (Eds.), The Routledge Companion to Alternative Organization. London: Routledge (pp. 64-88).


Zuberi, Dan (2006) Differences That Matter: Social Policy and the Working Poor in the United States and Canada. Ithaca, New York: Cornell University Press.