The Pains of Health Care Privatization

Guess who does the cooking and cleaning in BC hospitals and nursing homes?

If you answered “mostly women,” you would be right. It’s not exactly news that service jobs in Canada are usually done by women. In the Lower Mainland, many of the cleaners and food service workers in our health facilities are immigrant women from Asia and other countries of the south. Most have children at home and are also supporting family members overseas.

But BC health facilities have changed dramatically in one respect: many cooking and cleaning jobs have become nightmares. The culprit is privatization. Since 2003, about 8,500 public sector jobs have been terminated and the work contracted out to three of the world’s largest trans-national service corporations, offering less than 60% the previous pay. A new study, The Pains of Privatization, reports on in-depth interviews with 24 workers now employed by private firms, and documents the reality of these newly privatized jobs: low pay, meagre benefits, heavy workloads, poor training, frequent injuries, family stress, and no job security.

Contracting out has created a modern-day sweatshop system that relies on immigrant women of colour and exploits their vulnerability in Canadian society. The majority of immigrant women in our study have post-secondary credentials that qualify them for much better-paying jobs, yet systemic barriers against foreign-trained professionals prevent them from exercising their talents.

How bad is the picture? A privatized health support job is virtually synonymous with poverty: more than 75% of our study participants — and 100% of those with children — have incomes below Statistics Canada’s 2003 low-income line. Their sick time is minimal and they have no pension plan. “It's not much, only $10.50 an hour for working so hard,” says a 52-year-old Filipina cleaner who works the night shift at a hospital. Before privatization, the same job earned over $18 an hour with full benefits, pension, and job security.

A 47-year-old Indian-born woman, the sole support for her two daughters, is earning $1,426 per month at her hospital cleaning job. Her family income is about 44% below the poverty line.

Over 40% of our participants held at least one other job to make ends meet. Over half are sending money abroad to their parents, grandparents, nieces, and nephews. They are determined to honour these family commitments, though they can ill afford to do so.

Financial distress is only part of the story. Working conditions under privatization are unacceptably harsh. Almost all participants say their workload is exhausting. Many deal with unpredictable assignments, under-staffing, and isolation. They often feel too rushed to work safely and take shortcuts that put them at risk for serious injury. Fear of getting fired prompts some workers to skip meals and breaks. “The contractor pushes us to do too much,” said a woman cleaner. “It’s abusive.”

Pain, illness, and injury are common. Over 80% of our participants say their physical health is adversely affected by the job. They describe overwhelming fatigue, soft-tissue pain, numbness, headaches, and other ailments. Their emotional and spiritual well-being is also in decline. They talk about feeling depressed, anxious, powerless, and angry. “Every day, I feel like I'm going downhill,” says one worker.

These conditions have repercussions for family life. “My husband usually cooks and takes the kids to the park because I'm so tired,” says a hospital cleaner. Workers have little time for their kids and grandchildren. The financial squeeze has forced several to drop their own or their children’s educational plans. Vacations, family outings, and music lessons are cancelled.

The quality of patient care is also compromised. Our participants describe inadequate training and supervision, and improper cleaning (including of rooms with antibiotic-resistant infections). Excessive workloads eliminate time for human contact with patients, and in some facilities the company actually prohibits talking to patients.

Why would anyone put up with these substandard wages and working conditions? The answer lies in some harsh Canadian truths. Unemployment rates for immigrants are much higher than for non-immigrants. In 2001 an immigrant woman between 25 and 54 years old with a university degree was about four times more likely to be unemployed than her Canadian-born counterpart.

The companies that create these sweatshop conditions take advantage of the situation. Our study shows how immigrant workers are at the mercy of institutionalized racism and sexism. A Filipino woman in our study, a single mom who lost her public sector job to contracting out, summed up the situation: “If I don’t do this job, I won’t be able to raise my son and give him encouragement to move on to a good life.  . . . I just keep telling myself, ‘You have no choice, no choice, no choice.’”

She may have no choice, but as a society we do. At the very least we should open our eyes to the unhealthy and unjust consequences of privatizing health support jobs.

Nancy Pollak, Jane Stinson and Marcy Cohen are co-authors of The Pains of Privatization: How Contracting Out Hurts Health Support Workers, Their Families, and Health Care