Rethinking Unequal Exchange: The Global Integration of Nursing Labour Markets by Salimah Valiani (review)

Female international migration constitutes almost 50 per cent of all migrants, notwithstanding that a large proportion of female migration remains invisible due to undocumented flows of workers in the sex trade and other female-dominated occupations. Most contemporary analyses are based on a conception of “push and pull.” According to this approach, the basis of international labour migration flow depends on a “demand pull” in receiving countries of migrants due to domestic labour shortages and a “supply push” due to unemployment, low wages, etc. in sending countries. Valiani criticizes these approaches because they are not able to explain why most contemporary workers are migrating on a temporary, legally limited time basis. According to the author, policies in the countries of destination restrict the entry of labour through temporary contracts which meet specific demands for labour, but keep social and economic costs for the receiving country to a minimum.

Using a mix of socialist feminist, traditional Marxist, and world system/world historical theoretical approaches, Valiani postulates that temporary migration must be analyzed as part of the restructuring process of a capitalist world economy and as an indicator of the emergence of a global integration of labour markets. She focuses on the increasing rates of temporary migrations of nursing labour to countries of the global North and tries to explain them from a historical perspective what accounts for the increased use of this kind of labour.

Valiani uses this structural approach to demonstrate how a minority of countries that she sees as forming the core of the world system are historically produced and reproduced, and how the global majority remain peripheral. The capitalist world economy developed, according to Valiani’s theoretical assumptions, out of the territorial conquests by European states. This global economy is characterized by systemic cycles of accumulation, with the present de -fined as the fourth (US) cycle. Since the 1970s this cycle has seen discontinuous changes because economic development has reached its limits and thus has been subject to a radical restructuring and reorganization. Therefore, the increasing temporary labour migration in this cycle can be described, among its other aspects, as a re-intensified exploitation of female caring labour. Reconstructing the historical processes in three countries – the US, Canada, and the Philippines - her analysis tries to empirically trace the different impulses for the global integration of the nursing labour markets. She chose the US and Canada because they were the first countries of the global North to import temporary migrant nurses in large numbers, and the Philippines was the first country to provide a steady supply of these nurses. The processes in these three countries were, according to Valiani, of extreme importance because they set in motion the global integration of nursing labour markets.

The US, the world’s largest importer of internationally-trained nursing labour, began to import large numbers of temporary migrant nurses in the early 1990s in order to cut costs in their health care system, although Valiani contends that, in reality, it was the producers of medical technology and pharmaceuticals who contributed significantly to increasing costs faced by US hospitals. These producers perceived the introduction of employer-based health insurance coverage and state health care programs as new opportunities for capitalist accumulation. Unable to contradict the monopoly of producers of medical technology, the US state facilitated the increasing use of female temporary migrant workers as part of its cost-cutting strategy, a model later followed by other countries of the global North. Nursing work was thus reorganized and trade union and workers’ rights were replaced by flexible labour policies.

The Canadian example differs from the American because Canada is simultaneously one of the suppliers of nurses for the US labour market and a receiving countries for temporary migrant nursing labour. According to the author, a persistent undervaluing of female caring labour underlies the structural conditions of the movement of temporary migrant nursing labour in and out of Canada. Ongoing public funding constraint was one manifestation of...