University of Helsinki
The speaker of the CEREN Research Seminar held on 9th of November was Professor Ivy Lynn Bourgeault from the Telfer School of Management and Institute of Population Health at the University of Ottawa. Bourgeault introduced her latest study which has been made in cooperation with Sirpa Wrede, Cecilia Benoit and Elena Neiterman. Their aim in the study was to create a logical and pluralistic framework to analyze the complex relation of migration and integration, with especially international professional health workers in their focus. Bourgeault herself has previously studied midwifery and worked with women’s experiences of care in remote communities in Canada.
Bourgeault underlines the twisted situation of Canada, in which most of the immigrant health workers (physicians, nurses and midwives) cannot practice their profession in their new home country. Only in the province of Ontario the number of non-practicing health professionals is more than 5000. In this light, it is possible to draw a conclusion that the integration process of these immigrants has not succeeded in a perfect manner. The fact that only 200 residency spots are available for 5000 residency applicants working in health sector, excludes a great number of highly skilled professionals. The example from Canada shows how migration can lead to brain waste. Besides the country of origin, also the destination country may lose the expertise and skills of the professional migrants. Therefore, the message delivered by Bourgeault is that a coherent theoretical framework formulated from the existing literature should be created in order to investigate these circumstances. The majority of scholars studying health professions approach the topic from the perspective of the nation state, despite the fact that the transnational characteristics of the phenomenon are emphasized in today’s globalized world.
The health workers have migrated in all times, but like Bourgeault states, this phenomenon has currently got some new features. Examples of these new landscapes of recent health professional migration are the growing number of migrants, the accelerating pace and the role of transit countries. Migrants do not necessarily settle in their first destination country, which raises the question of integration and who invests in it. Furthermore, we should remember that the health sector differs from many other branches involved in transnational migration. The health sector is mainly regulated on national level, and it is not run by transnational companies. The health care systems are funded by public sources, instead of private ones. In addition, gender (in connection to other intersections) should be taken into account, when studying the new patterns of health work migration. As migration was previously perceived to be an economic opportunity for men mainly, nowadays women are more and more encouraged to migrate. The decrease of traditional male manufacturing jobs, and on the contrary the growing need for care workers in Western countries has caused women to migrate sometimes even instead of men. When emigrating, women also tend to leave a care deficit in their home countries. Bourgeault reminds, moreover, that settlement does not equal with integration. Considering that in health work the cultural competence plays a crucial role, the integration of immigrant health professionals needs special attention also in academic literature. Not only being left without a license to practice their profession, immigrant health workers also tend to be discriminated and excluded in their work places.
Like already mentioned, the research of Bourgeault and her collaborators intends to formulate a functioning theoretical framework on the relation of migration and integration of the health workers. This was made to follow the micro, macro and meso level divide. In practice, this means distinguishing individual and family experiences and motivations from national and institutional, and global theorizations. It must be noted, nonetheless, that it is impossible to frame an all-fitting theory. According to Bourgeault, the literature on migration and integration is endless in number, but to a great extent disconnected. Macro research approaches health-related issues and also the migration of health workers from the perspective of public health. It also dealt with ethical matters, for instance regarding the legacies of colonialism and the current impacts of, for example, the EU on the migration flows. The most remarkable and clear findings coming from the meso level described the linkage of integration and migration by stressing if the migrants worked in the health sector before and after moving to another country. Through this literature overview, it is feasible to spot usable concepts and to find new ways of using them.
Written by Ulla-Kaisa Pihlaja