Flesh and Stone Revisited: The Body Work Landscape of South Florida

by Carol Wolkowitz
University of Warwick

Sociological Research Online, 17 (2) 26

Received: 25 Apr 2012     Accepted: 2 May 2012    Published: 31 May 2012


This article seeks to demonstrate the value of producing still photographs as a way of comprehending the growth of the 'body work economy'. It documents the body work landscape of contemporary capitalism through exploring the ubiquity, appearance and scale of body work enterprises and employment in two localities of south Florida. It focuses on health, social care and other services for the ageing population of retirees in southeast Florida, as well as on tattooing and other body work services for younger, fashionable residents of and visitors to South Beach, Miami. The article sees the photographs of body work enterprises it deploys as a kind of ethnographic evidence, similar in status to quotations from a fieldwork diary or interviews, and suggests that they may help to pinpoint issues that require further analytical exploration, in this case the role of body work as a component of economic development and patterns of employment. The article goes on to explore the reasons for the growth of the body work economy in south Florida.

Keywords: Body Work, Body Work Economy, Ageing, Health Care, Social Care, Privatisation, Tattooing, South Florida, South Beach


1.1 This article seeks to demonstrate the value of visual methods, in this case the production of still photographs, for documenting the growth in what I and others term 'body work' (Twigg, et al. 2011; Wolkowitz 2006; Wolkowitz 2002). [1]It explores photographs of the emerging landscape of south Florida for evidence of the development of body work services, enterprises and employment, showing that paid work on others' bodies has become a crucial component of economic development and patterns of employment in south Florida. Interviews with local people help to indicate awareness of these developments amongst those involved in enterprise development and labour force training.

1.2 My title alludes to Richard Sennett's (1994) Flesh and Stone: The Body and the City in Western Civilization. Sennett considers the relation between human beings and the urban environment through six case studies of different ways in which city topographies have been constructed around changing notions of the human body. For instance, the creation of the Venice Ghetto was based on the perception of the Jewish body-- contagious, polluting and excessive—as requiring severe containment. In contrast, the design of eighteenth century Paris sought to encourage people's movement through the city. Sennett argues that Harvey's discovery of the circulation of blood around the human body led his contemporaries to create a city plan that envisioned people's circulation around the city as healthy and productive rather than as a sign of disorder.

1.3 The landscape of south Florida, I argue, is also marked by particular conceptions of the human body, and, in this case, of the kinds of work it requires: in other words, by a particular political economy of the body. Economic activity taking the human body as the immediate focus of more and more 'hands on' work is an increasing component of economic and cultural life in late capitalism, including the provision of health and social care, aesthetic services (hair styling, tattooing) and relaxing or pleasurable experiences (massage, sex work), as well as, although it is outside my concern in this article, protective and security services (airport security procedures, nightclub bouncers, burgeoning warehouse jails) (McDowell 2009; Twigg et al. 2011; Wolkowitz 2006; Wolkowitz 2002). The growth of paid body work, I show, plays itself out in a particularly vivid form in south Florida. If, as Edward Soja (1989) argues, the paradigmatic postindustrial city, Los Angeles, is 'where it all comes together', in so far as all the features of the postindustrial city are present, it seems that south Florida is surely paradigmatic of the explosion in body work, a place where so many kinds of body work 'come together' that we can begin to talk about a body work economy.

1.4 I begin by further elaborating the notion of body work and explaining the methodology underpinning the article. I then consider the provision of body work services in south Florida, focusing first on the visibility of services for ageing retirees in the town I call 'Atlantic Beach', on the southeast Florida coast, and the reasons for this growth. I then look at a range of body work services on offer to the younger population of residents and visitors to Miami, especially in the fashionable South Beach. Finally I discuss the value of the kinds of visual evidence I have presented.

The contemporary body work economy

2.1 Paid work that takes the human body as its immediate site of labour through touch or close proximity (Wolkowitz 2006) is the core activity of a range of body work sectors, with the particular tasks it involves, such as 'assessing, diagnosing, handling, treating, manipulating and monitoring bodies' (Twigg et al. 2011: 171), undertaken by particular occupational groups within them. Although there has been much sociological interest in the growth of body-oriented consumer culture (Featherstone 1991), the provision of body work services has been neglected as a feature of the landscape of the postindustrial city, which is usually seen to be dominated by high-tech, high-level financial, technological and knowledge-intensive services and cultural and leisure institutions (Gospodini 2006). While body work employment may feature in some of these, such as the knowledge-intensive hospital sector, the rapid growth of low-paid, low-tech services in the urban environment has been discussed much more rarely (but see McDowell and Dyson 2011; Sassen 2000).

2.2 Most researchers studying body work (e.g. Boris and Parreñas, eds 2010; Gimlin 2007; Kang 2010; McDowell 2009; Twigg 2000; Twigg et al. 2011; Wolkowitz 2011; Wolkowitz 2006), including myself, have focused on the relations between workers and their customers, clients and patients. The social relations of body work are variable and complex, shaped not only the relative social status of worker and consumer in the wider society but also by forms of expertise and organizational authority that specify a knowledge of the materiality of the body and its relation to the personhood that is present in that body. Moreover, the meanings attached to different kinds of corporeal interaction -- whether the work takes place on bodily surfaces or penetrates the body, whether it involves inflicting pain, whether it deals with the head or the 'nether regions' - also shape body work encounters (Wolkowitz 2002).

2.3 However, body work interactions are located not only within cultural expectations about the body and work but are also set within, shape, and are shaped by the economic relations and employment structures in which the micropolitics of the encounter are located. In the projected study from which this article draws I seek to use the example of body work in south Florida to explore the role of body work as a generator of local economic activity and to consider the ways in which particular economic, political and social contexts shape the meanings of the body and body work for both providers and recipients. The aim of this article is much narrower, seeking to document the ubiquity of body work enterprises and to begin to explore their role in the local economy.

2.4 Studying body work as an issue of economic growth is somewhat novel in Britain, especially in relation to health care, as compared to the US. Whereas in the UK health care has been provided by the state National Health Service and funded by the taxpayer, where health care is privatised, as in the US, the perception of health care provision as a profitable enterprise, rather than a cost, is more widespread. Health care institutions are more frequently analysed as central to the economic fortunes of metropolitan centres, and supplying health and life care services to the elderly analysed as a source of revenue for localities (Bartik and Erickcek 2007; Korcok 1987).

2.5 The potential economic contribution of health care, along with other kinds of body work, in generating investment and employment opportunities needs to be seen in the context of the now well-established 'offshoring' of manufacturing and sections of the service sector to lower wage economies abroad (Blinder 2009). In contrast, body work, which normally requires the co-presence of the provider and recipient of services, may provide welcome opportunities for domestic investment and employment, especially if investors can tap into funds generated outside the economic base of their own communities, for instance through tourism or through through state disbursements or insurance programmes. These may also make domestic body work markets attractive to foreign investors. It is hardly surprising, therefore, that there has been pressure to decrease the barriers to foreign investment and to open up opportunities for private capital in health, education and prison services in Europe. This construction of health care as a profitable market is now also encroaching on British health care policy (Player and Lees 2008), with overseas firms said to be queuing up for a slice of the action (Ramesh 2011).


3.1 This article draws mainly on hundreds of still digital photographs I took in December 2008, November 2009, February 2011 and January 2012, after over 25 years of visits to the region. Where it was not possible to ask people's permission to use photographs of them, I have slightly blurred the faces of some individuals who might otherwise be identifiable. I also draw on photographs by others, including especially Gary Monroe, a professor of Fine Art and Photography who has been documenting south Florida since the 1970s (Faculty Focus 2011).

3.2 The article builds on my long-standing interest in using still photographic images as a form of data (Knowles and Sweetman, eds 2004; Schwartz and Ryan, eds 2006). Their use is particularly appropriate for exploring the relevance of space and place for social processes (Halford 2008). While my photographs are intended to be mainly descriptive (Barrett 1986), none the less I recognise that landscape photography is as much about different ways of looking as picturing what is there, inviting the viewer to look in particular ways (Taylor 1994). Indeed, this is exactly why photography is such a useful vehicle for problematising aspects of the taken-for-granted environment. However, visual sociology has recognised from its outset the dangers of misrepresenting an environment through the publication of selective images (Becker 2002).

3.3 It has to be said that using photography to study body work is no easy matter, raising more than the usual ethical dilemmas. By definition body work involves an interaction between a worker and another person's body, and therefore normally takes place in privatised spaces which are closed to the visual sociologist; moreover, there are ethical problems in publically displaying photographs of patients, clients and customers when at their most vulnerable. Although there has been an explosion of television programmes that show embarrassing procedures, the people who have chosen to appear enjoy strong incentives. For instance, the individuals 'made-over' on the British television programme 10 Years Younger have often agreed to appear only in order to obtain expensive surgery they would otherwise be unable to afford (K. Throsby, personal communication). In addition, photography may compound our more general reluctance to make visible the bodily focus of many occupations. As Twigg et al. (2011) comment, working on the body has an ambiguous status: touching people's bodies borders on the erotic and often involves what is perceived as stigmatising 'dirty work'.

3.4 It is hardly surprising, therefore, that the publication of pictures of carers looking after nursing home residents, for instance, is rare, and in one case caused a storm of protest. In 2007, Kai Tiaki, the journal of a New Zealand nurses' organisation, published 40 pictures they saw as raising the profile of 'aged-care workers', claiming that the pictures of care work 'were more powerful than any written description of the relationship between caregivers and their patients' (Manchester 2007). Both carers and patients were named in picture captions, a way of insisting that neither care itself nor pictures of it are something to be ashamed of. Although an inquiry exonerated the magazine and the photographer, it concluded that those behind the project had been naïve (Manchester 2007). The public seems to assume that older people would naturally refuse to be pictured as so vulnerable and so old, and would not have done so if they had fully understood that the photographs would be published.

Picture 1. The only photograph still available of the 40 New Zealand photographs of care-giving activities (Senior Journal 2006)

3.5 It is partly because of the difficulty of accessing physically intimate interactions between worker and client, customer or patient that I started to experiment with recording places where body work goes on, rather than the work itself, by stopping to photograph any establishment that provided a body work service. I did this fairly systematically in South Beach, the southern sector of Miami Beach, and 'Atlantic Beach', where I trawled the public local roads stopping to photograph individual establishments and photographing around all the plazas and malls I passed. My photographing started out as a form of note-taking to document the prevalence of body work enterprises, but as I went on I became more aware of, and attempted to capture, not only the ubiquity of body work enterprises as a feature of the landscape, but also their size, self-presentation (modest, grand, welcoming, forbidding), the apparent seamlessness of their integration into the consumer services sector, and the explicitness of their focus on the body (for instance a beauty salon called 'Faces, Fingers and Toes'). However, I do not pretend that my images represent a full visual survey or inventory (as described by Suchar 2004) in either of the two main locales in which I took them. I discuss the validity of this data in the penultimate section below.

3.6 This visual data is supplemented by thirteen formal (and four informal) interviews conducted in November 2009, February 2011 and January 2012. The interviewees include hospital managers, health care practitioners and training staff; developers of care services; local academics; and five individuals working in local shops or as domiciliary carers. I approached these individuals through my local academic or personal contacts or by identifying them from publicly available websites. In many cases I had initially sought their help in obtaining interviews with workers in their sector, but when the meeting turned into a discussion of their organisation's operations, it became an unstructured interview in its own right. In other cases I approached shop proprietors 'on spec' or interviewed workers known to relations who live in Florida. Because of the small number of informants I have tried to disguise their identities and to avoid attributing some of the things they told me.

3.7 In order to give an indication of the variety of body work services concentrated in the south Florida region as a whole, in the rest of this article I consider two distinct body work landscapes. I view, first of all, the health, care and retail services for the ageing that dominate the districts of southeast Florida running northwards along the Atlantic Ocean coast from Miami. This landscape is epitomised by the locality I call 'Atlantic Beach'. I then consider, more briefly, the historically changing body work landscape of the beach resort of South Beach, part of the wider Miami-Dade county complex.

Body work for the ageing in 'Atlantic Beach'

4.1 The landscape of Atlantic Beach is dominated by enterprises of many kinds offering services for the elderly, of which health care provision is the most visible. Health care is by far the largest sector of the body work economy in western postindustrial societies. For instance, Cohen (2011:20) shows that about 65 per cent of the UK labour force in body work occupations, i.e. those with direct contact with customers', clients' or patients' bodies, are employed in a health or health-related occupation. But its expansion is particularly striking in Florida, where 18 of the 20 occupations projected to grow the fastest are health care-related (AWI 2011). Although the extent to which the proportion of the Florida state labour force holds health care occupations is about average for the US (BLS 2011a), particular health care occupations show a much higher or lower density, and this presumably reflects the age distribution of the population (discussed below) as well as a concentration of high-tech health care provision. For instance, a higher proportion of the Florida labour force is employed as 'Personal Care and Other Service Workers, All Other', and the proportion working as cardiovascular technologists and technicians, diagnostic medical sonographers and nuclear medical technologists is between two and two and half times higher than the US average. (On the other hand the proportion of paediatricians is only just a third of the American average [BLS 2011b]).

4.2 What pictures of services for the ageing show is not just the size of the body work sector but also the ubiquity, visibility and scale of individual enterprises and their integration into the wider consumer economy and local enterprise. Whether one turns west from Miami Airport to the gigantic hospitals of Miami (about which more later) or northeast to 'Atlantic Beach' and the coastal districts that have witnessed an influx of retirees from northern states and Canada, health care hits you in the eye. Interstate highway I-95 going north to the big retirement communities of incomers is lined with billboards (Pictures 2), many advertising the care offered by different hospitals and the employment they offer workers.

Picture 2. Examples of billboards along Interstate I-95

4.3 In Miami specialist health care services, at least, are concentrated in conventional hospitals, but in Atlantic Beach, where most of the older residents live in gated communities, both general and specialist medical doctors and medical testing services are often located at ground level, in plazas and malls that stretch along the arterial roads, enabling patients to walk in directly from their cars. I will illustrate this by looking at one road junction in Atlantic Beach, shown in a picture captured from Google's Street View and in the following pictures showing the buildings on its four corners.

Picture 3. Google Street View of a road junction in 'Atlantic Beach'

4.4 The pink-coloured plaza in the upper right hand corner of Picture 3, above, is comprised partly of the usual suburban household services outlets, which in this case includes carpet cleaning, financial advice offices, and private social work services, although these frequently relate to bodily health, like the pharmacy or provide cosmetic body work services for local seniors, like the salon (see Picture 4) whose elderly customers come mainly from a nearby gated community. But there is no cordon sanitaire, to make a bad pun, separating the provision of health care services and retail and other consumer services of various kinds.

Picture 4. First corner, showing a mixture of medical and other services

4.5 The second corner of the road junction is the water feature seen in Picture 3, but behind it is the local subsidiary of a multi-million dollar Midwest firm that runs personal care services within its own residential estates and provides assisted living and home care facilities more widely (Picture 5). It also offers consulting services to investors running housing estates who want to develop a home care business (Adler 2007). And behind these offices are further buildings, including the Intracoastal Cardiology Centre (Picture 6).

Picture 5. Life Care

Picture 6. Intracoastal Cardiology Center

4.6 The third corner is at first sight a fairly downmarket supermarket and shopping plaza (Picture 7). But set back behind it is a medical plaza housing doctors' and dentists' offices (Picture 8).

Picture 7. Many of the lunchtime customers wear medical green or blue uniforms, and seem to have stepped out from local doctors' offices.

Picture 8. A second, identical building can just be seen in the top left picture, above.

4.7 The fourth corner lot has not yet been built on, but at its edge, set back behind trees, is a day care and activity centre for people suffering from Alzheimer's (Picture 9).

Picture 9. Lots Of Love (or Laugh Out Loud?)

4.8 While photographs of this road junction illustrate the density of health care enterprise, it is the professional plazas that most vividly demonstrate the advertisement of body work as body work. The tall lettering on medical practitioners' premises focuses one's attention on parts of the body and the things that can go wrong with them. Picture 10, for instance, shows a number of different health care services in just one of the medical plazas in Atlantic Beach serving residents and visiting 'snowbirds' who winter there (for another example see Picture 30, below).

Picture 10

4.9 Moreover, as the numbers of retirees in Florida grows, both the gated communities and the medical plazas and hospitals that precede them are moving further into the agricultural hinterland. Picture 11, for instance, shows a nearly completed new hospital located in an area where new, gated communities are being built, although in the main still devoted to fruit production and plant nurseries.

Picture 11. This hospital, still under construction, has been designed to double its number of beds in the years ahead.

Services for older residents: growth and visibility

5.1 What underpins this growth and visibility of health and social care as a component of economic life? I consider first the most obvious of three factors, the presence of populations providing a potential market for body work services. Geographers have hitherto tended to assume that within industrialised countries health and personal care employment is relatively evenly dispersed, varying only with the size of the local population, in comparison with, for instance, heavy industry and manufacturing, which are historically concentrated in particular regions, or financial services, which are located in affluent major cities (McDowell 2009: 16-17). However, the mobilities of recent years may make this picture of evenly dispersed demand for health and personal services somewhat dated. What we have in south Florida is a particular 'elderscape' (Katz 2005) in which the exceptionally high proportion of older people provides a market for the provision of particular goods and services by local, national and multi-national entrepreneurs.

5.2 But that is not the whole story. As I will go on to discuss, there are also two less obvious factors. First is the financial resources and state support that ageing bodies bring with them, and which enable private entrepreneurs to turn elders' needs into potential profits. Economists used to say that the accumulation of profit in the service sector is limited, since people taking in each other's washing does not increase the total wealth of a locality, in the way that manufacturing exports or the exploitation of novel intellectual property would do. However, this neglects the role in economic development of attracting a new, migrant consumer class, or the development of new financial and other instruments that make enterprises providing for a growing elderly population viable. These benefits will be all the greater if a third factor, the presence of a cheap and 'appropriate' labour force, is also in place.

The body work target population

5.3 While planners may worry that the number of older people in Florida will lead to a crisis in long-term care provision (Katz 2005), at the local level the presence of body work enterprises in every mall would seem to contribute to the development of the local economy. As of the 2000 census Florida was still the leading retirement destination in the US (McHugh 2003), although the proportion of migrant retirees to Florida is declining relative to other destinations (Longino and Bradley 2004). Migrant retirees are concentrated in three counties of southeast Florida (where Atlantic Beach is located) and the Charlotte County area on the West Coast. Florida gains from the $3.5 billion of income transfer retired people bring with them, in the form of savings with which to purchase their homes and their income from investments, private and state pensions and social security; up to 12,000 homes a year were being constructed for these newcomers (Longino and Bradley 2004: 4).

Picture 12. Showing the lunchtime crowd in a local restaurant

5.4 Whether snowbirds or permanently settled, the largely Jewish retirees of 'Atlantic Beach' are a sizable community. Sixty-two percent of the Jewish population of 47,000 (out of a total population of about 67,000) are over 65 (Sheskin and Dashefsky 2010). For many south Florida has been part of their frame of reference for years. For instance, Sam and Ina Cooperman (family friends of mine, who gave their permission for me to use the photographs in Picture 13, which Sam carries in his wallet) honeymooned in Miami Beach soon after the end of the Second World War. Now well into their eighties, and still very much in love, Mr Cooperman tells me that they have re-visited Miami Beach on their wedding anniversary several times, so that he could photograph his wife in the same spots as he had when they were first married. Picture 14 shows the view from the back window of a flat in their gated community, more upmarket and longer established than many, where the residences are surrounded by a golf course.

Picture 13

Picture 14. View from the rear window of a flat on a condo estate in south Florida

5.5 However, the dependence of particular Florida local economies on a continuing stream of retirees also makes them vulnerable. The recession following the 2008 banking crisis has hit Florida exceptionally badly, due to its dependence on real estate, construction and, in Miami, finance. Moreover, recession across Northeast and Midwest United States means that some retirees, now unable to sell their homes in the Northeast, have been unable to move permanently to Florida as they had planned. Local entrepreneurs, therefore, do not depend entirely on local patients but seek new paying customers or new ways of serving their needs.

Producing market growth

5.6 It is important to recognise that the south Florida body work sector depends not simply on the presence of an ageing population, but on the state disbursements that ageing bodies carry, for instance the entitlement of over 65s not only to Medicare, but also to direct access to specialist doctors (Stevens 2008). Another example is the growth in Assisted Living Facilities, which have only recently become viable as accommodation for the low-income elderly. A developer of assisted living and day care facilities told me that

In Florida and the other sunbelt states the luxury condo market has crashed, so (real estate) developers are looking for new opportunities... Yes, there are already upmarket assisted living facilities, which have luxuries, swimming pools, landscaped grounds, but that market is saturated. But even in the assisted living sector there are fewer rich seniors than elderly poor. So the market is in the low income.

5.7 He went on to say that providing viable assisted living facilities for low-income residents depends mainly on putting together 'different streams of money'. Having obtained new legislation that allows Medicare to cover nursing assistance to people living in their own apartments, rather than only those in nursing homes, the care industry can combine this financial input with the rent support payments prospective low-income residents already receive, their social security and their coverage for medical care. The buildings can be bought for almost nothing, he says, as they are derelict social housing in need of renewal (for which redevelopment grants are also available). A well-managed enterprise also depends on accepting the right mix of bodies in the same facility, so that for instance, there are not too many wheelchairs to fit round the dining tables.

5.8 The identification of a reliable market subsidised by the state is also crucial for the local retail sector. Picture 15 shows a shop that rents and sells appliances and other items, funded mainly by Medicare, to enable disabled people—in this region mainly the frail elderly—to live at home.

Picture 15. Kin Care shares its shopping plaza with a doctor specialising in varicose vein surgery (also funded by Medicare), a hair institute for thinning hair and baldness and a podiatrist, as well as the usual mall outlets - florist's shop, pizza restaurant, dry cleaners, discount jewellers and a small cinema with heavily discounted rates for seniors.

5.9 The potential profitability of body work enterprises, and why, was articulated almost explicitly by one local entrepreneur who had bought a comfort shoe shop (Picture 16) for his wife to run. Using IT jargon he describes the shop as a 'high touch' operation, meaning that it offers a very high level of customer contact and service, at least 30 minutes per customer. He explained that he had been looking to invest in a retail business that was recession-proof and one where the products could not be bought more cheaply or more easily on the Internet. Comfort shoes fit the bill on all counts: whereas he had observed that upmarket fashion shoe shops had been going out of business in the recession, Medicare will refund people with diabetes for the purchase of two pairs of special shoes per year, so that they do not get blisters that can become infected. Moreover, like other kinds of body work, buying comfort shoes requires not only the co-presence of salesperson and customers but is high touch in another sense: the customers' feet have to be properly measured and individually fitted out with inserts, especially for diabetics.

Picture 16. Other shop fronts in the same small plaza, besides a bank, dry cleaners and Chinese restaurant, display signs for Rheumatology, Pharmacy, Hearing Center, Chiropractor, Podiatry, and Dentist. There is also an international gym franchise unit that houses a Rehabilitation Centre, also a branch of a larger company.

5.10 Some health care providers, however, have begun to look outside their local populations in developing their market. Anticipating some of the information on body work in Miami I will present later, the webpage link below shows part of a broader campaign initiated by the Miami-Dade Chamber of Commerce called 'Branding Miami as a Healthcare Destination', a joint campaign by local hospitals to attract more patients from Central America and the Caribbean.

Picture 17. The Miami-Dade Chamber of Commerce has sought to stimulate cooperative developments among local health care providers since late 1990s (Karp 2008).

5.11 The Chamber of Commerce Healthcare Committee hosts bi-monthly forums to educate members on various aspects of state Medicaid and federal Medicare reform, changes to insurance coverage, etc. and runs a Health Career Resource Expo for Employers and Transitioning Workforce (Greater Miami Chamber of Commerce 2011), but its main project is marketing patient care to patients coming from abroad. Within Florida, the Orlando area already has the lead in the development of biotechnology and medical research facilities, so Miami's health sector marketing concentrates on patient care. One of those involved in these efforts told me,

People say to me, 'How can we boost Miami, we don't specialize in anything. Detroit had cars, Seattle had computers, Houston has space and technology'. I tell them, 'We do specialise, we specialise in health, and especially patient care, and we can advertise that'.

5.12 She thinks that the hospitals can all benefit by strengthening their common links with international insurance companies like BUPA and overseas doctors. With Miami only 2 hours away from anywhere in the Caribbean they can even provide emergency treatment for the victims of violent trauma, building on the well-known expertise of one of the Miami hospitals in this area. Examples like this suggest that the growth and profitability of body work enterprises in health and social care is not simply a response to local needs, but requires the development of an effective market.

The body work labour force

5.13 Finally, a body work economy requires a labour force, which in south Florida is ethnically diverse, mainly low paid and non-unionised. Body work is labour-intensive, and with most types of workers able to work on only one body at a time opportunities for firms to profit from raising the productivity of labour are relatively limited (Cohen 2011). According to one report, revenue per worker in US nursing care homes is only about $58,000 (Hoovers 2011), as compared to estimates from the same source that range from $170,000 per Wal-Mart employee to General Electric's $436,000 (with oil companies said to generate over $2 million per worker (Harnish 2006). Hence employers have to look for ways to keep wage costs down, for instance by being able to access a labour force with few alternative sources of employment. (Other possibilities include the intensification of labour, which may carry a high cost for both recipients and for workers [Lopez 2006] or the replacement of better paid, more highly qualified workers with those who command a lower hourly wage, for instance nursing assistants and physician assistants, both of which are amongst the fastest growing occupations in Florida.)

5.14 The south Florida body work labour force in health and personal care (as well as in other kinds of body work) is extremely diverse. There is long-standing African American population in both Miami-Dade and the coastal counties to the northeast, but much of labour force are migrants themselves or come from families of relatively recent migrants. Many members of Cuban families who settled in the 1960s or before have joined the professions, along with Jewish professionals from out of state, who seem to think of moving to Florida themselves in middle age, with their eye on the weather and their own future retirements. There are also a large number of recent immigrants from the Caribbean and Central and South America, especially following the earthquake in Haiti. Hence even if the body work sector can neither increase productivity nor export production overseas it can take advantage of lower wage rates offered by 'third world' labour at home.

5.15 The racialisation of body work employment is frequently commented upon by academic investigators (Glenn 1996; Kang 2010; McDowell 2009), with some arguing that the racialisation of care work intersects with the low status and stigmatising nature of the work itself (Anderson 2000). Black women form the backbone of the body work labour force in domiciliary care services, and their situation is unenviable. For instance, Lorraine (not shown) has been working as a home carer for 13 years. After leaving her lower middle-class family in Jamaica, where she had run a clothes stall, she found that if she became a care worker she could start earning immediately, and 'that is the only reason', she says, that she went into this line of work. For the past 5 years she has been combining full-time care work with studying for an associate degree at a local community college, and eventually she hopes to become a maths teacher.

Picture 18. Wheelchair-accessible local beauty spot

5.16 When I asked about the advantages and disadvantages of the work she immediately listed the disadvantages, her outrage at the lack of dignity palpable. She says that the main disadvantage of the work is how badly people treat you, especially racism and sexual harassment. 'It's not just the colour of your skin', she says. 'Some people ask for skinny girls - no fat girls -- some patients ask for a sexy girl…I have a man now, he told the agency "Do not send me a girl who is not attractive".' When I asked Lorraine how he could get away with this, she answered, 'He says he's paying…' She says that the care agency she works for claims to be unable to do anything about sexual harassment by male patients because it is caused by their mental state.

5.17 More novel is the extent to which people are now turning to body work as a source of employment who would not have considered it before. During the recession, health and personal care has been one of the few areas to hold up. Lorraine's husband, for instance, after 8 months unemployment, has been forced to accept work as a home carer, something she feels is an affront to his masculine pride (for an account of the co-construction of gender and care work, see Widding Isaksen 2002).

5.18 Similarly, people who have lost their jobs in the finance sector or cosmetic services, such as barbering, are now looking to the health sector as a more secure career by retraining as nurses or allied health care technicians at privately owned colleges. Tuition fees at one expanding college are between $13,000 and $46,000 per year, depending on the specialism, but 70-80% graduates manage to obtain work afterwards in the health care sector. Even so, they are currently often only able to obtain temporary or sessional work, because people already in the full-time, permanent jobs who might wish to leave for other kinds of work cannot do so. This is a good reminder that the growth of the health care sector is dependent on other factors, including continuing public willingness to support Medicare and Medicaid at current levels, the overall buoyancy of the local economy, and, in Florida, on real estate and property continuing to expand.

Picture 19. A dummy patient and disarticulated arms used by students to practise taking blood pressure and other procedures

Developing new varieties of body work: the attractions of Miami Beach

6.1 Although in south Florida, as elsewhere, body work is dominated by the health care sector, what makes it an example of a body work economy is the presence of other thriving body work sectors that provide different kinds of body work for different markets. The largely urban county of Miami-Dade illustrates the historically changing nature of body work, which in the now fashionable South Beach section of Miami Beach has moved from the low-profit provision of housing and care for failing elderly people of modest means to the supply of services for different bodies and bodily desires. Nijman (2010) calls Miami 'the mistress of the Americas', evoking the seductiveness of the city and its history of body culture – in other words, a city whose expansion has centred on the mobile economy of desire (Bauman 1998) on which the postindustrial consumer economy is said to be based.

Picture 20. Celebrate your body. A gym and spa in South Beach

6.2 Body work has been a feature of the Miami Beach economy for several generations, but its character has changed as new markets have been fostered. Miami Beach developed as a vacation resort mainly between the 1920s and the US's entry into the second world war. From the late 1960s it declined precipitously as vacationers went elsewhere. The hotels in a city previously known for its spectacle of 'idleness, luxury and sex' (Lejeune 2009) gradually became apartments and nursing homes for increasingly elderly, mainly Jewish, full-time residents who had gone there as retirees. With a preponderance of the very frail it acquired the nickname of 'God's waiting room' (Nijman 2010).

6.3 Beginning in the late 1970s the hotels in a square mile of south Miami Beach began to be developed as a design-driven mecca for yuppies, including a large gay contingent. When I went on an architectural tour in 1985 run by the Miami Design Preservation League, we were taken into a hotel building in which very aged people had been wheeled out to sit in the sunny courtyard while the lobby was being restored to its Art Deco glory and the exterior of the scaffolded building was painted in the vivid pastel colours that became the signature motif of the new South Beach. We were told that the new owners were undertaking the rehabilitation of the building with the older residents still in situ, so that they would not be disturbed in their last years (this is also mentioned by Raley et al. 1994), but that the building would reopen as a hotel as soon as it was empty.

6.4 The Cardozo Hotel, shown below in about 1979, before its redevelopment, was the first of the new hotels to be renovated (Raley et al. 1994), while Picture 22 shows some Miami Beach residents of a similar hotel in the same period. The Cardozo was bought for redevelopment by one of the sons of Barbara Capitman, who is generally credited with saving the architectural heritage of South Beach by spearheading a campaign to get it listed on the Register of Historic Districts - another example of the dependence of body work development on state policies and disbursements of various kinds. All of the potential developers of the new tourist market recognised that for any one hotel to be a success (and, as the first, the Cardozo went through several bankruptcies) it had to be part of a wider distinctive, creative environment (Posner, 2009). A visit by Andy Warhol in 1980 and an advertisement for Calvin Klein's perfume Obsession in 1985 were early markers in the changing fortunes of Miami Beach's image (MDPL 2011).

Picture 21. Cardozo Hotel, c. 1979. Reproduced from Raley, et al. 1994, p. 96. Courtesy of A.J. Millas and the Miami Design Preservation League.

Picture 22. Elderly women seated on porch. Reproduced from Raley, 1996, p. 26. Courtesy of the photographer, Gary Monroe. Further photographs of Florida from the 1970s onwards by Gary Monroe can be accessed online at <http://www.garymonroe.net/default.html>

6.5 The redeveloped Cardozo Hotel, seen in Picture 23, below, is associated with different, more glamorous bodies than before its reincarnation. Within a few years of its initial redevelopment developers were bringing celebrities and other beautiful people to Miami to launch nightclubs and other venues that would create a demand for hotel rooms, and, in turn, attract the investors they needed for their hotel and other building projects (Posner 2009). By 2009, when the photograph on the right, below, was published as part of a double spread advertisement in a fashion magazine, the chair in which the model is sitting would be immediately recognisable as one of the seats along the beachfront promenade opposite the Cardozo.

Picture 23. (left) The Cardozo Hotel in 2010. (right) Vogue magazine, 2009 (Reproduced courtesy of the Paul & Joe Press Office).

Picture 24. New South Beach bodies. The Miami Beach Yellow Pages (2011b) lists 140 entries for salon waxing in Miami Beach and 2991 for the Miami area.

6.6 Bodies like those above need services such as waxing, tanning and other body work that the former elderly residents did not require. They might be models working in the large number of fashion modelling agencies -- there are 28 modelling agencies in Miami Beach alone, according to the online Miami Beach Yellow Pages (2011a) and many of the NYC agencies have branches there (Irene Marie 2009; Splashlight Miami 2011).

6.7 The most visible of the new body work services in South Beach sectors is tattooing, which has exploded in part due to the US television programme Miami Ink, which is set in a tattoo parlour in South Beach. According to one of my informants, many vacationers see getting a tattoo as an essential part of their holiday experience.

Picture 25. One commercial website gives Miami Beach the accolade of the most tattoo-friendly city in America. 'Averaging about 24 shops per 100,000 people, Miami Beach is dense with ink. (Guess being able to sunbathe nude near one of the vainest cities in the country didn't quite do it for them — or maybe they just want works of art to display while they soak up the sun in the buff.)' (Today n.d.)

6.8 Other body work services that 'celebrate the body', the slogan of a local gym (Picture 20), are available to both visitors and the local population, which sees the hedonistic culture and heightened body awareness as important features of local life styles. One interviewee told me, for instance, that her 16-year-old son thinks nothing of having a massage as a way to relax.

Picture 26. Exercise Group, South Beach, FL 1978 Courtesy of Gary Monroe

6.9 Bodily maintenance exercise is not new to Miami Beach, as seen in the picture of an exuberant exercise group by Gary Monroe in the 1970s (Picture 11). Nowadays, though, in addition to individuals exercising on the seafront, much extended to other age groups out running or skating, body work services often involve more intensive disciplinary regimes and focused instruction, including Pilates. (Miami is host to the headquarters of the national Pilates Method Alliance and has 76 Pilates studios.)

Picture 27. Morning exercise on the South Beach ocean front

6.10 However, despite the current image of South Beach as a place for vital, fit bodies to preen themselves, buses in Miami Beach sport advertisements, in Spanish, for health care (see Picture 28) and the town's biggest employer is the Mount Sinai Medical Centre, started in 1946 by Jewish doctors who were not allowed to practice at existing hospital at the time. Even larger medical centres in the wider Miami area are Jackson Memorial, a publicly funded hospital that became known for training US army doctors in dealing with violence-related trauma, and the huge, not-for-profit private hospital group Baptist Health, which with 13,700 employees in 2010 was the largest private employer in Miami-Dade (Miami Job Market 2009).

Picture 28. Advertisement on local Miami Beach bus (Picture courtesy of Jeff Greenberg/Alamy)

Picture 29. Jackson Memorial Hospital, Miami, with 1550 beds, is the third largest public hospital (and the third largest teaching hospital) in the US. The Jackson Health System, of which it is a major component, employs about 10,000 people. <http://en.wikipedia.org/wiki/Jackson_Memorial_Hospital http://www.jhsmiami.org/body.cfm?id=9253>


7.1 One question the sceptical reader may ask is if the apparent visibility of body work enterprise as a feature of the landscape of Miami Beach or Atlantic Beach (or the highway between them) is a valid indicator of either the incidence of body work enterprises or their economic or social significance. My photographs do not pretend to be a random or strictly representative sample, although some of the statistical evidence supports my argument about the importance of body work occupations in Florida, especially those serving ageing patients and clients. However, the visual evidence is even better at showing the clustering of body work enterprises within sub-regional localities where older people have settled, which is not necessarily captured by, for instance, comparisons between US states, each of which covers a much larger and more diverse area. It may also be better at capturing the density of enterprises in which most workers are self-employed, like the tattoo sector, and which may therefore be under-represented in labour force statistics.

7.2 However, my use of still photographs is not really meant to provide the kind of evidence that one might get from random sampling. Rather, the strength of using still photographs is that they give a vivid picture of how body work as a social phenomenon is changing in its appearance and scale. The photographs also capture the ways that enterprises represent themselves to the public and to prospective clients and patients. As evidence pictures therefore provide a sense of the setting that parallels the ethnographer's use of quotations from their interviews, informal conversations or fieldwork diary, inviting a more pointed interrogation than a general discussion makes possible. Like ethnographic data of a more usual sort, photographs and other visual evidence also permit the reader/ viewer some leverage in assessing or modifying an author's interpretations.

7.3 However, the interview data is also necessary. Visual observation of the landscape may provide pointers to the existence of underlying social or economic processes, like the real estate agents' roadside signs I saw recently, this time on the southwest coast of Florida, advertising vacant lots zoned for 'Office or Medical Use'. But the processes themselves still need to be investigated through other sources, including publicly available documents as well as interviews. Moreover, the difficulties in using visual methods to study body work interactions that are screened from public view means that were one to seek to document the body work encounter itself one could not stop at the front door, and would need to adopt much more conventional research methods.


8.1 Like Sennett (1994), but in a different way, I have tried to document how the relation between the human body and its environment is currently expressed in the topography of two particular localities. My attempt to visually document the body work landscape of south Florida documents the ubiquity and clustering of body work provision, while information from interview respondents suggests that they perceive body work (without naming it as such) to operate as an economic driver of the local economy, and not simply as an ad hoc response to local needs.

8.2 Halford (2008: 925) suggests that

From the moment we encounter a workplace – in person, in visual representations, or in the imagination – the location and architecture of the building are implicated in how we understand the organisation and the work that goes on within it.

8.3 The images of body work enterprises are a good example of this, as they capture not only the ubiquity of body work enterprises, but also, as in Picture 30, below, the size of the buildings, their often grandiose architectural styles and the gigantic lettering announcing their specialties. The pictures show, to my mind, how the commodification of the body is now normalised, or, as Harvey (1998) says in another context, is adopted as a strategy of capital accumulation. In south Florida we see sectors of the capitalist economy which target the body and its various parts very explicitly, but at the same time ones which must also respect local residents' and visitors' sensibilities. The distinctiveness of these buildings lies partly in how they fit into the landscape: they must advertise their presence rather than hide in obscure office buildings or clinics, where painful bodily ills or procedures are more usually hidden away. Thinking in particular of 'Atlantic Beach', it seems that whether an establishment offers pain management, urology or rheumatology, by promising wellness it inevitably also risks reminding passers-by of their physical vulnerability. Both problem and cure must be announced within the built environment in such a way that they do not undermine the life-affirming image of revitalisation on which the retirement colonies (and the local property market) is based. Indeed, because the buildings flatter their clientele we almost forget to notice that instead of validating retired seniors' active input into their communities, they construct them as consumers of health care and other body work services. The pictures therefore help to document not only the role of body work in the economy but also the changing place of body work in the process of 'growing old in contemporary capitalist society' (Kemp 2008).

Picture 30. Some of the establishments in a new Atlantic Beach professional plaza


1Thanks are due to Tony Elger, Phil Mizen and an anonymous reviewer for helpful comments on a previous draft; to the photographers and others who gave permission to reproduce images; and to the interviewees and those who helped to put me in touch with them, including support from individuals at Florida International University. I am also much indebted to Martyn Partridge for many discussions of this material as well as for help with design and layout.


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