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Care Worker Migration and Global Health Equity: Thinking Ecologically

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The International Migration of Health Workers

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.

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References

  • AARP (2005), International Forum on Long Term Care: Delivering Quality Care with a Global Workforce, Washington, 20 October 2005.

    Google Scholar 

  • Ahmad, O. B. (2005), ‘Managing Medical Migration from Poor Countries’, BMJ, 331, 43–5.

    Article  Google Scholar 

  • Aiken, L. (2007), ‘US Nurse Labor Market Dynamics Are Key to Global Nurse Sufficiency’, Health Services Research, 42(3), Part 2, 1299–320.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Bach, S. (2003), International Migration of Health Workers: Labour and Social Issues, Geneva: International Labour Office.

    Google Scholar 

  • Berliner, H. S. and Ginzberg, E. (2002), ‘Why This Hospital Nursing Shortage is Different’, JAMA, 288(21), 2742–4.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Buchan, J., Parkin, T., and Sochalski, J. (2003), International Nurse Mobility: Trends and Policy Implications, Geneva: WHO.

    Google Scholar 

  • CARICOM/PAHO (2005), Report of the Caribbean Commission on Health and Development, St Lucia: CARICOM/PAHO.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Christakis, N. A. and Allison, P. D. (2006), ‘Mortality after the Hospitalization of a Spouse’, New England Journal of Medicine, 354(7), 719–30.

    Article  Google Scholar 

  • Code, L. (2006), Ecological Knowing: The Politics of Epistemic Location, Oxford: Oxford University Press.

    Book  Google Scholar 

  • 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 

  • 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 

  • 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.

    Article  Google Scholar 

  • 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 

  • 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 

  • Eckenwiler, L. A. (2009), ‘Careworker Migration and Transnational Justice’, Journal of Public Health Ethics, 2, 171–83.

    Article  Google Scholar 

  • Fang, Z. Z. (2007). ‘Potential of China in Global Nurse Migration’, Health Services Research, 42(3), Part 2, 1419–28.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Folbre, N. (1999), ‘The Invisible Heart: Care and the Global Economy’, in Human Development Report, New York: United Nations Development Programme.

    Google Scholar 

  • 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 

  • 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 

  • Gross, J. (2006), ‘As Parents Age, Baby Boomers and Businesses Struggle to Cope’, New York Times (25 March).

    Google Scholar 

  • 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 

  • 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 

  • 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 

  • Institute of Ecosystem Studies (n.d.), ‘Defining Ecology’, http://www.ecostudies.org/definition_ecology.html [accessed 6 June 2009].

  • Institute of Medicine (IOM) (2004), Keeping Patients Safe: Transforming the Work Environment of Nurses, Washington: National Academies Press.

    Google Scholar 

  • INSTRAW (2007), ‘Feminization of Migration’, www.un-instraw.org [accessed 23 May 2009].

  • International Council of Nurses (2006), The Global Nursing Shortage: Priority Areas for Intervention, Geneva: ICN.

    Google Scholar 

  • International Longevity Center and Schmieding Foundation (2006), Caregiving in America, New York: International Longevity Center.

    Google Scholar 

  • International Organization for Migration (2005), World Migration 2005: Costs and Benefits of International Migration, Geneva: International Organization for Migration.

    Google Scholar 

  • Jones, A. (2008), ‘A Silent but Mighty River: The Costs of Women’s Economic Migration’, Signs, 33(4), 761–9.

    Article  Google Scholar 

  • 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 

  • Khadria, B. (2007), ‘International Nurse Recruitment in India’, Health Services Research, 42(3), 1429–36.

    Article  Google Scholar 

  • Kingma, M. (2006), Nurses on the Move: Migration and the Global Health Care Economy, Ithaca: ILR Press.

    Google Scholar 

  • Kingsland, S. (1995), Modeling Nature: Episodes in the History of Population Ecology, Chicago: University of Chicago Press.

    Google Scholar 

  • Kittay, E. F. (2001), ‘A Feminist Public Ethic of Care Meets the New Communitarian Family Policy’, Ethics, 111(3), 523–47.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Krieger, N. (2001), ‘A Glossary of Social Epidemiology’, Journal of Epidemiology and Community Health, 55, 693–700.

    Article  Google Scholar 

  • Krieger, N. (2008), ‘Ladders, Pyramids and Champagne: The Iconography of Health Inequities’, Journal of Epidemiology and Community Health, 62, 1098–104.

    Article  Google Scholar 

  • Kuehn, B. M. (2007), ‘Global Shortage of Health Workers, Brain Drain, Stress Developing Countries’, JAMA, 298(16), 1853–5.

    Article  Google Scholar 

  • 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].

  • 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 

  • Lipson, D. and Regan, C. (2004), Health Insurance Coverage for Direct Care Workers: Riding Out the Storm, Washington: Better Jobs Better Care.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • 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 

  • 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 

  • May, J. H., Bazzoli, G. J., and Gerland, A. M. (2006), ‘Hospitals’ Responses to Nurse Staffing Shortages’, Health Affairs, 25(4), 316–23.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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].

  • 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.

    Article  Google Scholar 

  • 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].

  • Ncayiyana, D. (1999), ‘Doctor Migration Is a Universal Phenomenon’, South African Medical Journal, 89, 1107.

    Google Scholar 

  • 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 

  • Nussbaum, M. C. (1995), Poetic Justice: The Literary Imagination and Public Life, Boston: Beacon Press.

    Google Scholar 

  • Nussbaum, M. C. (2006), Frontiers of Justice: Disability, Nationality, Species Membership, Cambridge: Harvard University Press.

    Google Scholar 

  • 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.

    Chapter  Google Scholar 

  • O’Neill, O. (2000), Bounds of Justice, Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • 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 

  • Oulton, J. (2006), ‘The Global Nursing Shortage: Overview of the Issues and Actions’, Policy, Politics, and Nursing Practice, 7, 34–9 (Supplement).

    Article  Google Scholar 

  • 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 

  • Page, J. and Plaza, S. (2006), ‘Migration Remittances and Development: A Review of Global Evidence’, Journal of African Economies, 15, 245–336 (Supplement).

    Article  Google Scholar 

  • 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 

  • 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 

  • 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 

  • 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 

  • Pogge, T. W. (2005), ‘Real World Justice’, Journal of Ethics, 9, 29–53.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • 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 

  • Reichenbach, L. (Ed.) (2007), Exploring the Gender Dimensions of the Global Health Workforce, Cambridge: Global Equity Initiative, Harvard University Press.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • Schulz, R. and Beach, S. R. (1999), ‘Caregiving as a Risk Factor for Mortality: The Caregiver Health Effects Study’, JAMA, 282, 2215–19.

    Article  Google Scholar 

  • Seavey, D. (2004), The Cost of Frontline Turnover in Long-Term Care, http://www.bjbc.org/content/docs/TOCostReport.pdf [accessed 17 June 2008].

  • Seavey, D. (2007), Testimony before House Committee on Education, Labor, Subcommittee on Workforce Protections, Washington, 25 October.

    Google Scholar 

  • Singer, P. (1993), Practical Ethics, Cambridge: Cambridge University Press.

    Google Scholar 

  • Steinbrook, R. (2002), ‘Nursing in the Crossfire’, New England Journal of Medicine, 346(22), 1757–66.

    Article  Google Scholar 

  • 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 

  • Stone, R. (2001), Long-Term Care Workforce Shortages: Impact on Families, San Francisco: Family Caregiver Alliance.

    Google Scholar 

  • United Nations Population Fund (UNFPA) (2006), State of World Population 2006: A Passage to Hope; Women and International Migration, New York: UNFPA.

    Google Scholar 

  • United States Bureau of Labor Statistics (BLS) (2007), Nonfatal Occupational Injuries and Illnesses Requiring Days Away from Work, Washington: USBLS.

    Google Scholar 

  • United States Census Bureau (2008), Statistical Abstract of the United States: 2008, Washington: USCB.

    Google Scholar 

  • 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 

  • 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 

  • 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.

    Article  Google Scholar 

  • 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 

  • Wolff, J. L. and Kasper, J. D. (2006), ‘Caregivers of Frail Elders: Updating a National Profile’, Gerontologist, 46(3), 344–56.

    Article  Google Scholar 

  • World Bank (2001), Global Economic Prospects and the Developing Countries 2002, Washington: World Bank.

    Google Scholar 

  • World Bank (2005), Global Economic Prospects 2006: Economic Implications of Remittances and Migration, Washington: World Bank.

    Book  Google Scholar 

  • World Health Organization (2003), Key Policy Issues in Long-Term Care, Geneva: WHO.

    Google Scholar 

  • World Health Organization (2006), World Health Report: Working Together for Health, Geneva: WHO.

    Google Scholar 

  • Yeates, N. (2009), Globalizing Care Economies and Migrant Workers: Explorations in Global Care Chains, New York: Palgrave Macmillan.

    Google Scholar 

  • Young, I. M. (2004), ‘Responsibility and Global Labor Justice’, Journal of Political Philosophy, 12(4), 365–88.

    Article  Google Scholar 

  • Young, I. M. (2006), ‘Responsibility and Global Justice: A Social Connection Model’, Social Philosophy and Policy, 23, 102–30.

    Article  Google Scholar 

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© 2010 Lisa A. Eckenwiler

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Eckenwiler, L.A. (2010). Care Worker Migration and Global Health Equity: Thinking Ecologically. In: Shah, R.S. (eds) The International Migration of Health Workers. Palgrave Macmillan, London. https://doi.org/10.1057/9780230307292_3

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