Health Care and Partnership Economics

An Interview with Riane Eisler by Kathy Malloch

Creative Nursing Journal Issue 2001:3

For this issue, we interview Riane Eisler, author of The Chalice and The Blade: Our History, Our Future, and a founder of the Center for Partnership Studies in Pacific Grove, California. A cultural historian and evolutionary theorist, she developed the concept of economic partnership, which values the informal contributions people make to society. Her latest book is Tomorrow's Children. Kathy Malloch, a member of the Creative Nursing Journal Editorial Board, conducted the interview.

Malloch: Tell us what partnership economics is, and how it applies to healthcare.

Eisler: First of all, I look at economics not in isolation from our overall lives. After all, the purpose of economics is supposed to be human welfare. And yet we rarely hear "caring" and "economics" in the same breath. That's very odd, given the fact that the purpose of economics is the management of the household — or in this case, the larger social global household — for the benefit of the people and the other creatures in that environment.

When looking at economics, we have to start with the basic question, What do we value? Take gold as an example. Why do we value gold? We can't eat it. All kinds of things glimmer more. But we have arbitrarily decided gold is valuable. So I started to question our economic system and why certain work is considered essential. In the scale of things, why do we give so little value to caregiving, something essential to human welfare and the maintenance of our planet's support system — which we are finding today we are not properly caring for.

In the course of my work, I developed a new lens for analyzing human society. Patterns and configurations emerged that I came to name "partnership" and "dominator" models.

I began to see that many aspects of society, including economics, have been structured in to conform to the dominator model. This is a system of top-down control, of rankings, where it is believed some people are born to be served and others to serve them. It is a system largely held together by abuse and violence, necessary to maintain dominance, be it man over woman, man over man, race over race, nation over nation and so on. I began to understand that we continue to operate in that dominator model because we inherited many of our values, habits, economic systems and institutions from earlier times that were more authoritarian and rigidly male dominated. Naturally, caring and empathy were not valued in this system because those values would destroy the system.

Malloch: If we value caring and empathy, we would not want to dominate others.

Eisler: Yes. But often we're told that what I call the dominator model is just human nature. When I embarked on what is now three decades of study of our past and present and the possibilities for our future, it was to explore whether there is really an alternative. I began to develop what I call the partnership-dominator continuum. At one end is a very rigid dominator model, with top-down rule, be it the family or the state. It involves rigid ranking of men over women, "superior" men over "inferior" men, lots of built-in violence, from child- and wife-abuse to warfare. On the other end of the spectrum is a different configuration with a very different system of values. It features political and economic democracy, and values both women and men, both halves of humanity. This system also values the work that in the dominator model is stereotypically associated with women — namely, caring and caregiving — whether it is done by women or men.

Empathy marks the partnership model. This model also lacks the high level of abuse and violence, because these aren't needed to maintain rankings of domination.

My argument is that we must contextualize economics in the larger social system. You can't just tack on caring or environmentally sustainable policies and still retain so many elements of the basic template and values of a dominator system.

Partnership economics goes way beyond the usual categories of politics, right versus left, religious and non-religious, or even pre- and post-industrial. It addresses the basic issue of what kind of activities and outcomes are most valued in the economic system.

As Marx wrote about the alienation of labor, the devaluation of work and the workers, I write about the alienation of caring and caregiving labor. It's the devaluation of the work typically associated with women (but devalued whether men or women do it.) I also have come to see that we cannot eradicate poverty and hunger, bring about high-quality partnership parenting and childcare, and move to a sustainable future without giving real value to this caregiving work.

Integrating the work of caring

Malloch: Is that what you think is happening — we're trying to insert caring into the economic model? How would you prefer to see efforts that value caring being integrated into the economic model?

Eisler: First, we have to change systems of accounting. When caregiving work is done inside the household it is not even included in calculations of economic productivity. On the other hand, those calculations of "productive work" include efforts that, instead of nurturing and enhancing life, take away life. Examples are the manufacturing and marketing of cigarettes, or weapons. Even cleaning up the messes that would not be made if we had economics that value caring in our environment. For example, we have policies that use taxpayer's money to bail out failed savings and loans, or clean up messes made by oil spills — instead of having rules that would discourage rather than reward uncaring and irresponsibility. We don't take into account the human, social and environmental costs of such things, which businesses can dismiss as externalities that you and I and everybody else pay for. And sometimes we pay for them with our health and our life.

The excuse for not assigning monetary value to caregiving often is that it's hard to quantify activities such as caring for a child. But the truth is if we shift the way we think, it is very possible to quantify. The Scandinavian nations have shown us that. There are studies showing the real value of childcare, of healthcare, of all the work that in the old dominator model women were supposed to do for free in male-dominated households — work that was therefore given no visibility and no value, or at best very low value when it was done in the monetized or exchange economy.

And not only that, there are activities that you really can't quantify that are actually given high value in our society. For example, we can't really quantify the value of the stereotypically male activity of soldiers fighting and killing, but society invests a great deal of money in weapons, in training soldiers, in paying soldiers, in giving soldiers pensions. So what we're really talking about is valuing only what we are accustomed to giving value to.

There is movement toward measuring economic effectiveness not in terms of gross domestic product (GDP), but in terms of quality-of-life measures. GDP tells us very little, actually.

We did an interesting project at the Center for Partnership Studies on how the status of women is sometimes a much better predictor of a citizenry's quality of life than gross domestic product (GDP). The study is called "Women, Men and the Global Quality of Life." My co-researchers were my partner, the social psychologist David Loye, and a wonderful young sociologist by the name of Kari Norgaard. It's available from the center, and information on it is on our Web site (www.partnershipway.org). Using data from 89 nations, we separated two sets of measures — quality of life measures and measures of the status of women — even though there is of course some overlap. We found, as I said, that in some cases the status of women is a much better quality-of-life predictor than GDP. And a major reason is that a higher status of women means that there is a higher value given to activities and trades that are in dominator-thinking stereotypically associates with women, such as teaching and caring for children, the sick and elderly. For example, we found that Kuwait and France had about the same GDP, but Kuwait's infant-mortality rate is double that of France. Kuwait orients more to the dominator model. It is a monarchy and the status of women is low, to put it mildly. Kuwaiti women have no political participation, and the country's all-male legislature recently rejected a bill that would give women the right to vote.

Finland and Singapore also had about the same GDP, but again when you look at measures of quality of life, they are very different. Singapore is again a nation where women's status is much lower than in Finland. We did our study in time for the 1995 U.N. Conference on Women in Beijing. At the time, Singapore's economy was flourishing, but maternal mortality was twice as high in Singapore as in Finland.

So you begin to see the negative systemic effects of devaluing activities stereotypically associated with women, including caregiving. And that's the point: That the quality of life not only for women, but for everybody, is lower in those nations where there is an extreme devaluation of women, and with this, of caregiving activities. Coupled with a shortage of resources, that can have disastrous effects.

A New Measure of Productivity

Malloch: To capture the value of caregiving, or to change our accounting system, would there have to be an addition to the gross domestic product, or do you think we would need something completely different? What specific indicators would you add?

Eisler: In the longer term, we of course need different measures, measures that actually tell us about people's quality of life. But as long as we still have GDP, let's put it in there.

GDP is supposed to measure a society's productivity. As long as we measure a society's productivity in strict dollars-and-cents, market-economy terms and leave out the essential work of caring for children, the sick and the elderly in the informal economy, we have a very skewed picture of what really is economically productive and valuable.

The Scandinavian nations have much more political and economic democracy. This is not surprising because they orient more to the partnership configuration. For example, women comprise 35 to 40 percent of the Scandinavian legislatures. Here we've barely made 10 percent, and that's progress, right? The Scandinavian nations don't have huge gaps between haves and have-nots, and of course much more equal partnerships exist between women and men. That's why you get a higher valuing in the Scandinavian world of policies such as child care, healthcare, elderly care.

Malloch: How would you see us quantifying healthcare or caregiving roles into the gross domestic product?

Eisler: You gave me a very good example, of the nurse who spent two hours, rather than 45 minutes, on an admission assessment. In other words, she spent time listening, caring. The benefits of this work were quantifiable, as you said because the patient received the care she wanted, she avoided unnecessary procedures and the hospital saved money. This is quantifiable; it's just that we're not focusing on caregiving as being economically productive. Trust me, when people start focusing on the real value of this work, they'll come up with thousands of ways to measure it.

Malloch: How do you see the increasing number of men in nursing making a difference in the visibility of our work?

Eisler: I see it as part of the partnership movement. In the old dominator model, masculinity is defined as not being like a women and certainly not doing a woman's work. If you are like a women, you are a sissy. So as we begin to move toward the equal valuing of women and men, men can express their full humanity, including their capacity for caring and caregiving.

At the same time, women are not so hamstrung about being assertive in the partnership model. In the dominator model, if a woman is assertive, she's pushy, but if a man is assertive, that's wonderful. Or if a women is being very logical then she's not being feminine. But it's really nonsense, because both women and men have these capacities. In today's system that values men and work associated with men more than women and work associated with women, as more men enter a profession, the value of that work rises; the more women in a profession, the lower the value.

This has become frighteningly clear: We have to examine what we truly value. We have to consider the basic issue of devaluing the female half of humanity and anything stereotypically associated with us.

Economic Inventions

Malloch: Could you talk a little bit about your views of "economic invention"?

Eisler: Everything in an economic system is an economic invention. Banks are an example. An economic invention is developed for a particular goal. Some economic inventions are more on the dominator side. Slavery was an economic invention that supported the dominator model.

On the other hand, when you start moving toward the partnership model, you see laws that require safety in work places. That's an economic invention. Laws prohibiting child labor are economic inventions. Parental leave — now that is an economic invention that actually gives some visibility to caring and caregiving work. Scandinavia and most other industrialized nations have paid parental leave. Why? Because it's a tremendously important community investment, if you will, in the human capital of our society. We hear so much about the need for high quality human capital in a post-industrial society, but we rarely invest in it.

Malloch: The Family Medical Leave Act is an economic invention.

Eisler: Yes, it is one on the partnership end of the continuum.

Structural policies that require cutbacks in social services here or in the developing world are dominator economic inventions. They require deadening of empathy, and they place much more of the burden again on women. After all, it's usually women who start the soup kitchens, or quit their education in order to take another job. They're the ones who take care of the child or elderly person as best they can if no good healthcare is available. It's a transfer of economic costs to those who are most vulnerable, most devalued, in the system.

Malloch: The visibility is really the key.

Eisler: Absolutely. And because people don't see the economic, social and human consequences of not valuing this work, we continue with these bizarre economics rules and measurements. Measurements of activities that actually kill people, rather than those that help care for people, nurture us, help us be healthy.

A Broader View for Change
Malloch: I want to say to my colleagues, the women executives and nurses in healthcare, that we need to do something about getting the value of human caring in an economic language. Would you use the economic invention as that vehicle?

Eisler: I would not use that as a vehicle right now, I would start with something closer to home. First of all, I would say that focusing on the pay scale for nursing is too narrow to really have the systemic effect that we need. If nursing associations took a role in raising the value of caring and caregiving in the entire human relations spectrum, not only that one profession, then we could begin to change the value system. We have to make caring more visible, but not only in nursing.

For example, we know that if children don't get proper nutrition when they're little, if they're abused, if they don't get what I call partnership parenting and care, they are going to be physically or emotionally unhealthy. Again: Changing this requires giving value to caring and caregiving. But look at where our social and fiscal priorities still are. Our elected officials are talking about eliminating school breakfasts in a time of affluence. What does that tell you about dominator values and the mentality of public officials? It is women's work to feed the children, right?

Malloch: And the human caring value hasn't been translated into the economic model for other people to understand.

Eisler: Well, that is a big part of it. But beyond that, we need to broaden the measures of what is productive. I'm proposing that nursing associations can make a major contribution by bringing out these systemic connections. To focus not only on higher pay for nursing care, but a re-examination of the value of caring and caregiving work in the market economy. We pay more to a parking lot attendant, the person to whom we entrust our automobile, than to the person to whom we entrust the care of our child. We require that parking lot attendant to learn to drive, but we don't require childcare workers to learn about the stages of child development, about the harm that hitting and shaming a child can cause. We pay them less, and we require less of our childcare workers because we don't value "women's work."

Imagine, Talk, Mobilize

Malloch: Do you have any recommendations for healthcare professionals on how to make caring work more visible?

Eisler: I think there are things you can do at a number of levels, Kathy. The first is that every one of us can be what I call a partnership educator or ambassador. In your conversations with people, talk about these issues. We have materials on our Web site, on www.partnershipway.org. There is an interview with me on partnership economics, and now we have this interview. Hand it to people and ask them to think about what life would be like if our economic system really valued caring and caregiving, whether it's done by women or men, whether it's in the formal or informal economy. What would happen if we really focused on learning how to be good caregivers of life — of self, others and of our mother earth. This is what I've proposed in my new book, Tomorrow's Children. If we made caregiving part of our education, what would happen? I believe we would move much more rapidly toward the kind of life that we so want for ourselves and our children.

A second step is to change education to give more visibility and value to caring and caregiving work. One problem is that we still have such a male-centered curriculum today. It has to be a gender-balanced curriculum, with kids grow up giving value to the partnership model and taking gender equity for granted.

A third step for healthcare professionals to make their work more visible is to work with the nurses associations. Get those leaders to think in broader terms, rather than just improving the pay, benefits and working conditions for nurses. I'm not saying nurses shouldn't do that. But they can broaden the scope to help society understand that this problem is not specific to nursing. It is a much larger problem that has to do with economic systems devaluing the caring work stereotypically associated with women. Deal with those larger policy issues, become active in seeing that we change our economic measurements globally. To make this work visible and give it adequate value, look at what the Scandinavians have done. They have refused in some of their measures to just take the market value for the work. They have factored in the kind of things that you have started to do in your work, Kathy.

Then: Lobby politicians, educate them, challenge them to give value to the work that makes for that caring. If elected officials call themselves advocates for children, yet they don't give any real value to that work in their economic policies, call them on that. Our so-called welfare reform is a classic example of this. I agree the welfare system needed reform because it was still the old model of the male head-of-household — though in this case, it was the male head of government — giving a small allowance to the woman to feed and clothe the child. But the old welfare system, just like the "reformed" one, gave no value to the work of caring for children. Instead, with the welfare reform that occurred, we told everyone to go to work, to get outside jobs, regardless of whether they had small children at home. Why? Because parenting is invisible. If people choose the training, education and support to get a job, that is good, it's very important. But we didn't give people choices: "If you want to stay home and do a good job of taking care of your child, you can, and we will give you support." We also never offered support, for example in forming cooperatives where parents can really become exemplars of everything from child nutrition to non-violent child rearing.

Malloch: Child-rearing would become a recognized profession.

Eisler: Absolutely. But it takes organized, deliberate support for it. Nursing and other professions can do this — and we can get many men to become allies, too.

Malloch: It would be so interesting for the American Nurses Association to take this on as a mission rather than the labor union approach that sometimes gets far too much attention.

Eisler: The old union approach is very short-sighted. I'm not saying unions are unnecessary: They are essential. Just look at the sweat shops all over the world because the workers are not unionized. But my point is we are not used to thinking systemically. As a systems philosopher in sciences, that is my life's work.

Malloch: Well, nursing needs to take a good look at our profession because that's what we're really trying to do — challenge what we do, examine the value of our work and see how we can create a better future. This is particularly true in view of the information age, in which we're finding things are very different.

Eisler: Yes. If the Web sites of these nursing associations featured articles on giving value to caring and caregiving and what the human social and economic and political implications are, that would be an incredible resource. It could start changing politics so that elected officials could no longer evade these issues. We need to define the issues that we want to talk about. And since the mass media are difficult, let's do it through our Web sites and conferences. Let's make alliances with other professional organizations — teachers, childcare workers. Let's become a potent social, political and economic force.

Malloch: Well, I thank you, Riane. You have given us some incredible food for thought. We certainly have work to do don't we?

Eisler: Yes, and it's exciting work.