Gender and East Asian Welfare States: from Confucianism to Gender Equality

How can we understand the gender logic underpinning the welfare states/systems of East Asia? Does the comparative literature, which has largely been concerned with western Welfare states, whether in The Three Worlds of Welfare Capitalism (Esping-Andersen 1990), or in gender-based analysis of the male breadwinner model (Lewis 1992, 2001, 2006), have anything to offer in understanding the gender assumptions underpinning East Asian welfare states? Are the welfare systems of East Asian countries distinctive, with Confucian assumptions hidden beneath the surface commitment to gender equality? We will use the (mainly western) comparative literature, but argue that Confucian influences remain important, with strong assumptions of family, market and voluntary sector responsibility rather than state responsibility, strong expectations of women’s obligations, without compensating rights, a hierarchy of gender and age, and a highly distinctive, vertical family structure, in which women are subject to parents-in-law. In rapidly changing economies, these social characteristics are changing too. But they still put powerful pressures on women to conform to expectations about care, while weakening their rights to security and support. Nowhere do welfare states’ promises bring gender equality in practice. Even in Scandinavian countries women earn less, care more, and have less power than men. We shall compare East Asian countries (Japan, Korea, Taiwan where possible) with some Western ones, to argue that some major comparative data (e.g. OECD) show the extreme situation of women in these countries. Some fine new qualitative studies give us a close insight into the experience of mothers, including lone and married mothers, which help us to understand how far the gender assumptions of welfare states are from Scandinavia’s dual earner model. There are signs of change in society as well as in economy, and room for optimism that women’s involvement in social movements and academic enquiry may be challenging Confucian gender hierarchies.

Reconfiguring or reproducing intra-professional boundaries? Specialist expertise, generalist knowledge and the ‘modernization’ of the medical workforce

Efforts to ‘modernize’ the clinical workforce of the English National Health Service have sought to reconfigure the responsibilities of professional groups in pursuit of more effective, joined-up service provision. Such efforts have met resistance from professions eager to protect their jurisdictions, deploying legitimacy claims familiar from the insights of the sociology of professions. Yet to date few studies of professional boundaries have grounded these insights in the specific context of policy challenges to the inter- and intra-professional division of labour, in relation the medical profession and other health-related occupations. In this paper we address this gap by considering the experience of newly instituted general practitioners (family physicians) with a special interest (GPSIs) in genetics, introduced to improve genetics knowledge and practice in primary care. Using qualitative data from four comparative case studies, we discuss how an established intra-professional division of labour within medicine—between clinical geneticists and GPs—was opened, negotiated and reclosed in these sites. We discuss the contrasting attitudes towards the nature of genetics knowledge and its application of GPSIs and geneticists, and how these were used to advance conflicting visions of what the nascent GPSI role should involve. In particular, we show how the claims to knowledge of geneticists and GPSIs interacted with wider policy pressures to produce a rather more conservative redistribution of power and responsibility across the intra-professional boundary than the rhetoric of modernization might suggest.