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5 Realizing Justice Globally in Long-term Care
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87 How can we move forward, having shifted the lens so that the focus is a bit less on individual agents and a bit more on their interdependence with others and need for certain kinds of habitats, places in which they can become and endure under conditions of equality? Who are the responsible agents and what are they to do? I have argued that an ecological approach reveals the injustice of current arrangements in long-term care—injustice that is structural in form, and experienced by the elderly, family members who coordinate and provide care, and members of the paid long-term care workforce, especially emigrants, as well as populations in source countries. The ecological approach suggests a way forward, toward establishing a new ethical norm for future policy and planning in long-term care and perhaps, too, efforts aimed at global health equity generally. Responsibility, on the view I have proposed, should be conceived as ethical place-making for ecological subjects; that is, making more equal the conditions for the becoming and duration of interdependent people in particular places. CHAPTER FIVE Realizing Justice Globally in Long-term Care 88 long-term care, globalization, and justice Assigning Responsibilities for Shared Health Governance Typically, in discussions of global justice, including discussions of global health equity, states are assumed to have primary responsibility ; that is, the “most direct and prior obligations” (Ruger 2006, 1001). Yet states’ limitations are many: some states do not have the capability to ensure justice, some lack the desire, and some states with the desire to be just are rendered more porous by neoliberal policies and programs and, so, are constrained in their capacities by the activities of other agents operating within them (O’Neill 2004, 246–47). Some argue that international lending bodies and transnational corporations now may have an even greater influence on health than governments and the World Health Organization (People’s Health Movement 2005). Transnational corporations, nongovernmental organizations, international lending bodies, and other global actors and institutions should therefore serve along with states as primary agents of justice. Indeed, all “dwelling [my emphasis] in this institutional and causal nexus,” and who thus constitute and are constituted by the people and places suffering injustice, are responsible (Young 2000, 224). This includes governments and global institutions, along with nongovernmental organizations, businesses, and foundations, as well as families and individuals. Addressing injustice in long-term care and global health requires collective action, or what we should call “shared health governance” (Ruger 2006, 1001), aimed at cultivating more equal conditions for those who need and those who provide long-term and other care to become and endure as they navigate and dwell in such places as homes, workplaces, long-term care institutions, and other care settings, within particular regions, communities, and the places between them, including, for some, immigration offices and borders. An agent’s position within the structural process and in the geography of long-term care help to determine the nature and extent of responsibilities. The social connection model of responsibility [54.227.136.157] Project MUSE (2024-03-19 09:36 GMT) Realizing Justice Globally in Long-term Care 89 enriched with ecological thinking’s demand for attention to the relational nature of identities and place offers a method: agents should examine their particular structural as well as geographical positioning and how they are situated in relation to those suffering injustice to determine their responsibilities and range of opportunities for contribution based on their scope of power, resources, and privilege.1 Agents like international bodies, states, domestic institutions, for-profit agents, and other collectivities can at most focus on the “positional and general” justice that people suffer and target those structural and geographic locations. We should think in terms of the responsibilities of U.S. employers to their employees; of U.S. policymakers to employers and employees and to the aging; and of U.S. health care corporations and institutions, the U.S. government , the World Bank and International Monetary Fund (IMF), source country governments (where functioning effectively), and for-profit recruiters, individually and collectively, to potential recruits and to the poor needing long-term and other varieties of care in source countries. In our personal interactions—for example, between high-income family members and the particular care workers supporting their loved ones; between particular employers and employees; and between individual recruiters and would-be migrant nurses—we can offer more finely tuned interventions aimed at justice. I elaborate on this...