Advertisement

Care Worker Migration and Global Health Equity: Thinking Ecologically

  • Lisa A. Eckenwiler
Chapter

Abstract

We read throughout the literature on health worker migration of ‘channels’, ‘flows’, a ‘cascade’. We hear calls for ‘sustainability’. These concepts, drawn from the discourse of ecology, entice with their imagery and vision of a better future. Yet the resources of ecological thinking call for closer attention. I intend to show that ecological epistemology provides rich conceptual resources for analysing and understanding this transnational flow of people and its implications, and in turn, generating more potent and ethically sound policy remedies.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. AARP (2005), International Forum on Long Term Care: Delivering Quality Care with a Global Workforce, Washington, 20 October 2005.Google Scholar
  2. Ahmad, O. B. (2005), ‘Managing Medical Migration from Poor Countries’, BMJ, 331, 43–5.CrossRefGoogle Scholar
  3. Aiken, L. (2007), ‘US Nurse Labor Market Dynamics Are Key to Global Nurse Sufficiency’, Health Services Research, 42(3), Part 2, 1299–320.CrossRefGoogle Scholar
  4. Asch, S. M., Kerr, E. A., Joan, K., Adams, J., Setodji, C. M., Malik, S., and McGlynn E. A. (2006), ‘Who Is at Greatest Risk for Receiving Poor Quality Health Care?’ New England Journal of Medicine, 354(11), 1147–56.CrossRefGoogle Scholar
  5. Bach, S. (2003), International Migration of Health Workers: Labour and Social Issues, Geneva: International Labour Office.Google Scholar
  6. Berliner, H. S. and Ginzberg, E. (2002), ‘Why This Hospital Nursing Shortage is Different’, JAMA, 288(21), 2742–4.CrossRefGoogle Scholar
  7. Brush, B. L., Sochalski, J., and Berger, A. M. (2004), ‘Imported Care: Recruiting Foreign Nurses to US Health Care Facilities’, Health Affairs, 23(3), 78–87.CrossRefGoogle Scholar
  8. Buchan, J., Parkin, T., and Sochalski, J. (2003), International Nurse Mobility: Trends and Policy Implications, Geneva: WHO.Google Scholar
  9. CARICOM/PAHO (2005), Report of the Caribbean Commission on Health and Development, St Lucia: CARICOM/PAHO.Google Scholar
  10. Castle, N. G. and Engberg. J. (2007), ‘The Influence of Staffing Characteristics on Quality of Care in Nursing Homes’, Health Services Research, 42(5), 1822–47.CrossRefGoogle Scholar
  11. Chen, L., Evans, T., Anand, S., Boufford, J., Brown, H., Chowdhury, M., Cueto, M., Dare, L., Dussault, G., Elzinga, G., Fee, E., Habte, D., Hanvoravongchai, P., Jacobs, M., Kurowski, C., Michael, S., Pablos-Mendez, A., Sewankambo, N., Solimano, G. and Stilwell, B. (2004), ‘Human Resources for Health: Overcoming the Crisis’, Lancet, 364, 1984–90.CrossRefGoogle Scholar
  12. Christakis, N. A. and Allison, P. D. (2006), ‘Mortality after the Hospitalization of a Spouse’, New England Journal of Medicine, 354(7), 719–30.CrossRefGoogle Scholar
  13. Code, L. (2006), Ecological Knowing: The Politics of Epistemic Location, Oxford: Oxford University Press.CrossRefGoogle Scholar
  14. Commission of the European Communities (2005), Communication from the Commission to the Council and the European Parliament: EU Strategy for Action on the Crisis in Human Resources for Health in Developing Countries, Brussels: COC.Google Scholar
  15. Crush, J., Pendelton, W., and Tevera, D. S. (2005), Degrees of Uncertainty: Students and the Brain Drain in Southern Africa, Pretoria: Africa Institute of South Africa.Google Scholar
  16. Dubois, C. A. and McKee, M. (2006), ‘Cross-National Comparisons of Human Resources for Health: What Can We Learn?’ Health Economics, Policy and Law, 1(1), 59–78.CrossRefGoogle Scholar
  17. Dumont, J. C., Martin, J. P., and Spielvogel, G. (2007), Women on the Move: The Neglected Gender Dimension of the Brain Drain (Discussion paper No. 2920), Bonn, Germany: Institute for the Study of Labor.Google Scholar
  18. Dumont, J. C. and Zurn, P. (2007), ‘Immigrant Health Workers in OECD Countries in the Broader Context of Highly Skilled Migration’, International Migration Outlook, Paris: OECD.Google Scholar
  19. Eckenwiler, L. A. (2009), ‘Careworker Migration and Transnational Justice’, Journal of Public Health Ethics, 2, 171–83.CrossRefGoogle Scholar
  20. Fang, Z. Z. (2007). ‘Potential of China in Global Nurse Migration’, Health Services Research, 42(3), Part 2, 1419–28.CrossRefGoogle Scholar
  21. Fleming, K. C., Evans, J. M., and Chutka, D. S. (2003), ‘Caregiver and Clinician Shortages in an Aging Nation’, Mayo Clinic Proceedings, 78(8), 1026–40.CrossRefGoogle Scholar
  22. Folbre, N. (1999), ‘The Invisible Heart: Care and the Global Economy’, in Human Development Report, New York: United Nations Development Programme.Google Scholar
  23. Genosko, G. (2009), ‘Subjectivity and Art in Guattari’s The Three Ecologies’, in B. Herzogenrath (Ed.), Deleuze/Guattari and Ecology, New York: Palgrave Macmillan, pp. 102–15.Google Scholar
  24. Go, S. (2003), ‘Recent Trends in Migration Movements and Policies: The Movement of Filipino Professionals and Managers’, in Migration and the Labour Market in Asia, Paris: OECD.Google Scholar
  25. Gross, J. (2006), ‘As Parents Age, Baby Boomers and Businesses Struggle to Cope’, New York Times (25 March).Google Scholar
  26. Grosz, E. (1995), ‘Space, Time, and Bodies’, in E. Grosz (Ed.), Space, Time, and Perversion: Essays on the Politics of Bodies, New York: Routledge.Google Scholar
  27. Grosz, E. (1999), ‘Thinking the New: Of Futures Yet Unthought’, in E. Grosz (Ed.), Becomings: Explorations in Time, Memory, and Futures, Ithaca: Cornell University Press.Google Scholar
  28. Hochschild, A. (2000), ‘Global Care Chains and Emotional Surplus Value’, in W. Hutton and A. Giddens (Eds), On the Edge: Living with Global Capitalism, London: Jonathan Cape, pp. 130–46.Google Scholar
  29. Institute of Ecosystem Studies (n.d.), ‘Defining Ecology’, http://www.ecostudies.org/definition_ecology.html [accessed 6 June 2009].
  30. Institute of Medicine (IOM) (2004), Keeping Patients Safe: Transforming the Work Environment of Nurses, Washington: National Academies Press.Google Scholar
  31. INSTRAW (2007), ‘Feminization of Migration’, www.un-instraw.org [accessed 23 May 2009].
  32. International Council of Nurses (2006), The Global Nursing Shortage: Priority Areas for Intervention, Geneva: ICN.Google Scholar
  33. International Longevity Center and Schmieding Foundation (2006), Caregiving in America, New York: International Longevity Center.Google Scholar
  34. International Organization for Migration (2005), World Migration 2005: Costs and Benefits of International Migration, Geneva: International Organization for Migration.Google Scholar
  35. Jones, A. (2008), ‘A Silent but Mighty River: The Costs of Women’s Economic Migration’, Signs, 33(4), 761–9.CrossRefGoogle Scholar
  36. Kapur, D. (2003) ‘Remittances: The New Development Mantra?’, Paper presented at the G-24 Technical Group Meeting, Harvard University with The Center for Global Development, Cambridge, 25 August.Google Scholar
  37. Khadria, B. (2007), ‘International Nurse Recruitment in India’, Health Services Research, 42(3), 1429–36.CrossRefGoogle Scholar
  38. Kingma, M. (2006), Nurses on the Move: Migration and the Global Health Care Economy, Ithaca: ILR Press.Google Scholar
  39. Kingsland, S. (1995), Modeling Nature: Episodes in the History of Population Ecology, Chicago: University of Chicago Press.Google Scholar
  40. Kittay, E. F. (2001), ‘A Feminist Public Ethic of Care Meets the New Communitarian Family Policy’, Ethics, 111(3), 523–47.CrossRefGoogle Scholar
  41. Kramarow, E. J., Lubitz, J., Lentzner, H., and Gorina, Y. (2007), ‘Trends in the Health of Older Americans, 1970–2005’, Health Affairs 26(5), 1417–25.CrossRefGoogle Scholar
  42. Krieger, N. (2001), ‘A Glossary of Social Epidemiology’, Journal of Epidemiology and Community Health, 55, 693–700.CrossRefGoogle Scholar
  43. Krieger, N. (2008), ‘Ladders, Pyramids and Champagne: The Iconography of Health Inequities’, Journal of Epidemiology and Community Health, 62, 1098–104.CrossRefGoogle Scholar
  44. Kuehn, B. M. (2007), ‘Global Shortage of Health Workers, Brain Drain, Stress Developing Countries’, JAMA, 298(16), 1853–5.CrossRefGoogle Scholar
  45. Labonte, R. and Schrecker, T. (on behalf of the Global Knowledge Network) (2006), Globalization and Social Determinants of Health: Analytic and Strategic Review Paper, http://www.who.int/social_determinants/resources/globalization. pdf [accessed 22 May 2009].
  46. Leutz, W. N. (2007), ‘Immigration and the Elderly: Foreign-Born Workers in Long-Term Care’, Immigration Policy in Focus, 5(12), 1–11.Google Scholar
  47. Lipson, D. and Regan, C. (2004), Health Insurance Coverage for Direct Care Workers: Riding Out the Storm, Washington: Better Jobs Better Care.Google Scholar
  48. Lorenzo, F. M., Galvez-Tan, J., Icamina, K., and Javier, L. (2007), ‘Nurse Migration from a Source Country Perspective: Philippine Country Case Study’, Health Services Research, 42(3), 1406–18.CrossRefGoogle Scholar
  49. Lowell, B. and Findlay, A. (2002), ‘Migration of Highly Skilled Persons from Developing Countries: Impact and Policy Responses — Synthesis Report’ (International Migration Papers, No. 44), Geneva: ILO.Google Scholar
  50. Marmot, M. (2000), ‘Inequalities in Health: Causes and Policy Implications’, in A. R. Tarlov and R. F. St Peter (Eds), The Society and Population Health Reader, vol. 2: A State and Community Perspective, New York: New Press, 239–309.Google Scholar
  51. Martineau, T., Decker, K., and Bundred, P. (2002), Briefing Note on International Migration of Health Professionals: Leveling the Playing Field for Developing Country Health Systems, Liverpool: Liverpool School of Tropical Medicine.Google Scholar
  52. May, J. H., Bazzoli, G. J., and Gerland, A. M. (2006), ‘Hospitals’ Responses to Nurse Staffing Shortages’, Health Affairs, 25(4), 316–23.CrossRefGoogle Scholar
  53. Meghani, Z. and Eckenwiler, L. (2009), ‘Care for the Caregivers?: Transnational Justice and Undocumented Non-Citizen Care Workers’, International Journal of Feminist Approaches to Bioethics, 2(1), 77–101.CrossRefGoogle Scholar
  54. MetLife Mature Market Institute (2006), The MetLife Caregiving Cost Study Productivity Losses to US Businesses, www.caregiving.org/data/Caregiver% 20Cost%20Study.pdf [accessed 10 December 2008].
  55. Narasimhan, V., Brown, H., Pablos-Mendez, A., Adams, O., Dussault, G., Elzinga, G., Nordstrom, A., Habte, D., Jacobs, M., Sewankambo, N., Solimano, G., Wibulpolprasert, S., Evans, T., and Chen, L. (2004), ‘Responding to the Global Human Resources Crisis’, The Lancet, 363, 1469–72.CrossRefGoogle Scholar
  56. National Clearinghouse on the Direct Care Workforce (2006), ‘Who Are Direct Care Workers?’ http://www.directcareclearinghouse.org/download/NCDCW%20Fact%20Sheet-1.pdf [accessed 15 July 2008].
  57. Ncayiyana, D. (1999), ‘Doctor Migration Is a Universal Phenomenon’, South African Medical Journal, 89, 1107.Google Scholar
  58. Newcomer, R. and Scherzer, T. (2006), ‘Who Counts? On (Not) Counting Occupational Injuries in Home Care’, paper presented at the American Public Health Association Annual Meeting, Boston, 7 November.Google Scholar
  59. Nussbaum, M. C. (1995), Poetic Justice: The Literary Imagination and Public Life, Boston: Beacon Press.Google Scholar
  60. Nussbaum, M. C. (2006), Frontiers of Justice: Disability, Nationality, Species Membership, Cambridge: Harvard University Press.Google Scholar
  61. OECD (2008), ‘International Mobility of Health Workers: Interdependency and Ethical Challenges’, in The Looming Crisis in the Health Workforce: How Can OECD Countries Respond?, Paris: OECD.CrossRefGoogle Scholar
  62. O’Neill, O. (2000), Bounds of Justice, Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  63. O’Neill, O. (2004), ‘Global Justice: Whose Obligation?’ in D. Chatterjee (Ed.), The Ethics of Assistance: Morality and the Distant Needy, New York: Cambridge University Press.Google Scholar
  64. Oulton, J. (2006), ‘The Global Nursing Shortage: Overview of the Issues and Actions’, Policy, Politics, and Nursing Practice, 7, 34–9 (Supplement).CrossRefGoogle Scholar
  65. Packer, C., Labonte, R., and Spitzer, D. (on behalf of the WHO Commission on Social Determinants of Health) (2007), Globalization and Health Worker Crisis, Ottawa: Institute of Population Health.Google Scholar
  66. Page, J. and Plaza, S. (2006), ‘Migration Remittances and Development: A Review of Global Evidence’, Journal of African Economies, 15, 245–336 (Supplement).CrossRefGoogle Scholar
  67. Parreñas, R. S. (2003), ‘The Care Crisis in the Philippines: Children and Transnational Families in the New Global Economy’, in B. Ehrenreich and A. R. Hochschild (Eds), Global Woman: Nannies, Maids, and Sex Workers in the New Economy, New York: Metropolitan Books, pp. 39–54.Google Scholar
  68. Pickett, S. T. A., Kolasa, J., and Jones, C. G. (2007), Ecological Understanding: The Nature of Theory and the Theory of Nature, Amsterdam: Elsevier.Google Scholar
  69. Pittman, P., Folsom, A., Bass, E., and Leonhardy, K. (2007), US-Based International Nurse Recruitment: Structure and Practices of a Burgeoning Industry, Washington: Academy Health.Google Scholar
  70. Pogge, T. W. (2004), ‘Relational Conceptions of Justice: Responsibilities for Health Outcomes’, in S. Anand, F. Peter, and A. Sen (Eds), Public Health, Ethics, and Equity, New York: Oxford University Press, pp. 135–61.Google Scholar
  71. Pogge, T. W. (2005), ‘Real World Justice’, Journal of Ethics, 9, 29–53.CrossRefGoogle Scholar
  72. Polsky, D., Ross, S. J., Brush, B. L., and Sochalski, J. (2007), ‘Trends in Characteristics and Country of Origin among Foreign-Trained Nurses in the United States, 1990 and 2000’, American Journal of Public Health, 97(5), 895–9.CrossRefGoogle Scholar
  73. Priester, R. and Reinardy, J. R. (2003), ‘Recruiting Immigrants for Long-Term Care Nursing Positions’, Journal of Aging and Social Policy, 15(4), 1–19.CrossRefGoogle Scholar
  74. Rawlinson, M. (2010), ‘The Right to Life: Rethinking Universalism in Bioethics’, in J. L. Scully, L. Baldwin-Ragaven, and P. Fitzpatrick (Eds), Feminist Bioethics: At the Center, On the Margins, Baltimore: Johns Hopkins University Press.Google Scholar
  75. Redfoot, D. L. and Houser, A. N. (2005), We Shall Travel On: Quality of Care, Economic Development, and the International Migration of Long-term Care Workers, Washington: AARP Public Policy Institute.Google Scholar
  76. Reichenbach, L. (Ed.) (2007), Exploring the Gender Dimensions of the Global Health Workforce, Cambridge: Global Equity Initiative, Harvard University Press.Google Scholar
  77. Salmon, M. E., Yan J., Hewitt, H., and Guisinger, V. (2007), ‘Managed Migration: The Caribbean Approach to Addressing Nursing Services Capacity’, Health Services Research, 42(3), Part 2, 1354–72.CrossRefGoogle Scholar
  78. Sassen, S. (2002), ‘Women’s Burden: Counter-Geographies of Globalization and the Feminization of Survival’, Nordic Journal of International Law, 71(2), 255–74.Google Scholar
  79. Schulz, R. and Beach, S. R. (1999), ‘Caregiving as a Risk Factor for Mortality: The Caregiver Health Effects Study’, JAMA, 282, 2215–19.CrossRefGoogle Scholar
  80. Seavey, D. (2004), The Cost of Frontline Turnover in Long-Term Care, http://www.bjbc.org/content/docs/TOCostReport.pdf [accessed 17 June 2008].
  81. Seavey, D. (2007), Testimony before House Committee on Education, Labor, Subcommittee on Workforce Protections, Washington, 25 October.Google Scholar
  82. Singer, P. (1993), Practical Ethics, Cambridge: Cambridge University Press.Google Scholar
  83. Steinbrook, R. (2002), ‘Nursing in the Crossfire’, New England Journal of Medicine, 346(22), 1757–66.CrossRefGoogle Scholar
  84. Stilwell, B., Diallo, K., Zurn, P., Vujicic, M., Adams, O., and Dal Poz, M. (2004), ‘Migration of Health Care Workers from Developing Contries: Strategic Approaches to Its Management’, Bulletin of the World Health Organization, 82, 595–600.Google Scholar
  85. Stone, R. (2001), Long-Term Care Workforce Shortages: Impact on Families, San Francisco: Family Caregiver Alliance.Google Scholar
  86. United Nations Population Fund (UNFPA) (2006), State of World Population 2006: A Passage to Hope; Women and International Migration, New York: UNFPA.Google Scholar
  87. United States Bureau of Labor Statistics (BLS) (2007), Nonfatal Occupational Injuries and Illnesses Requiring Days Away from Work, Washington: USBLS.Google Scholar
  88. United States Census Bureau (2008), Statistical Abstract of the United States: 2008, Washington: USCB.Google Scholar
  89. United States Department of Health and Human Services and Health Resources and Services Administration (US DHHS HRSA) (2004a), Nursing Aides, Home Health Aides, and Related Health Care Occupations: National and Local Workforce Shortages and Associated Data Needs, Washington: HRSA.Google Scholar
  90. United States Department of Health and Human Services and Health Resources Services Administration (US DHHS HRSA) (2004b), Projected Supply, Demand, and Shortages of Registered Nurses: 2000–2020, Washington: HRSA.Google Scholar
  91. Wenger, N. S., Solomon, D. H., Roth, C. P., MacLean, C. H., Saliba, D., Kamberg, C. J., Rubenstein, L., Young, R., Sloss, E., Louie, R., Adams, J., Chang, J., Venus, P., Schnelle, J., and Shekelle, P. (2003), ‘The Quality of Medical Care Provided to Vulnerable Community-Dwelling Older Patients’, Annals of Internal Medicine, 139(9), 740–7.CrossRefGoogle Scholar
  92. Williams, J. (2006), One Sick Child Away from Being Fired: When ‘Opting Out’ Is Not an Option, Hastings: UC Hastings College of Law.Google Scholar
  93. Wolff, J. L. and Kasper, J. D. (2006), ‘Caregivers of Frail Elders: Updating a National Profile’, Gerontologist, 46(3), 344–56.CrossRefGoogle Scholar
  94. World Bank (2001), Global Economic Prospects and the Developing Countries 2002, Washington: World Bank.Google Scholar
  95. World Bank (2005), Global Economic Prospects 2006: Economic Implications of Remittances and Migration, Washington: World Bank.CrossRefGoogle Scholar
  96. World Health Organization (2003), Key Policy Issues in Long-Term Care, Geneva: WHO.Google Scholar
  97. World Health Organization (2006), World Health Report: Working Together for Health, Geneva: WHO.Google Scholar
  98. Yeates, N. (2009), Globalizing Care Economies and Migrant Workers: Explorations in Global Care Chains, New York: Palgrave Macmillan.Google Scholar
  99. Young, I. M. (2004), ‘Responsibility and Global Labor Justice’, Journal of Political Philosophy, 12(4), 365–88.CrossRefGoogle Scholar
  100. Young, I. M. (2006), ‘Responsibility and Global Justice: A Social Connection Model’, Social Philosophy and Policy, 23, 102–30.CrossRefGoogle Scholar

Copyright information

© Lisa A. Eckenwiler 2010

Authors and Affiliations

  • Lisa A. Eckenwiler

There are no affiliations available

Personalised recommendations