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The next shift: the decline of the American Rust Belt industry and the rise of healthcare Gabriel Winnant

Harvard University Press, published in March 2021.

When we talk about the new economy, we tend to talk about technology. The reality is that the number of people employed by the technical department is relatively small.

The action is in eds and meds.

Thirty-four million people are engaged in education or health care services. The second largest category, wholesale and retail trade, employs about 20 million.

In the United States, the scale of the healthcare industry is almost unimaginable. Nearly one-fifth of all goods and services is used for medical care.

When we say that we have transitioned from manufacturing to a service economy, we are referring to healthcare and education.

There is no city that reflects the shift from manufacturing to services more than Pittsburgh, Pennsylvania.

Once dominated by the steel manufacturing industry, the two largest employers in Pittsburgh today are healthcare/insurance companies.

Pittsburgh is a typical Eds and Meds town. The football team should not be called the Steelers, but the potty team. (Or MRI, or more accurately, a nurse).

How did the transition from manufacturing to services, from steel to healthcare take place in Pittsburgh?

When the employment base shifts from making things to caring (and educating) people, can the rest of the country understand the benefits and costs of communities and workers?

exist Next shiftGabriel Winant, a historian at the University of Chicago, wrote a clear description of the causes and consequences of the decline of heavy industry and the birth of the medical industrial complex.

Winant delves into the economic, social, and cultural history of Pittsburgh to clarify the connection between the rise and fall of steel and the amazing growth of health care.

I didn’t fully understand until I read Next shift De-industrialization and medical growth are entangled. The rise of huge university-affiliated medical centers is closely related to the loss of manufacturing jobs.

Steel workers became the new high-profit hospital patients. As health care becomes more intensive, it is aging, unhealthy but well-insured (thanks to the union).

The hospital system expands on the dual basis of insurance (private and public) and mainly low-wage labor. Nursing care that was once performed at home in a single-income industrial economy has been transferred to hospitals, and nurses have filled essential but unsafe and low-paying positions.

Next shift It is essential reading for anyone who wants to understand the history and economic foundation of our modern healthcare industry.

This book also made me curious about the employment distribution in higher education. How many tertiary workers are made up of low-paid workers?

If Winant extended his analysis in Pittsburgh beyond hospitals and nursing homes, including colleges and universities, what would he find?

Readers interested in economic changes, urban history, race, class, gender, steel, healthcare, and Pittsburgh should consider Next shift On their reading list.

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