Migration of professional health workers

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

Insights to Current Trends of the Immigration in the U.S.

The latest CEREN research seminar was held by Professor Peter Kivisto on 14th of October. The topic concerned the current immigration situation and its historical roots in the U.S. Currently Kivisto is engaged as the Richard A. Swanson Professor of Social Thought at Augustana College in Rock Island, Illinois and as a Research Fellow at the University of Trento.

5361744ea1057 imageThe United States have always been a country of immigrants, and it still is today. It has received 59 million migrants since 1965, when the Hart-Celler Act opened the country’s immigration legislation and policy. However, according to Kivisto, there are new tendencies emerging in American immigration. For example, the education level of immigrants has risen, although the poverty level has not changed. In other words, the immigrants in the U.S. are better educated, but still as poor as before the 1990s. Immigrants have also settled in all states rather than concentrating in certain areas. Furthermore, recent immigration has influenced the overall ethnic composition of the country, as especially the number of Hispanics and Asian-origin immigrants has risen rapidly since 1965. At this point in time, there are also about 11 million undocumented immigrants in the U.S.

During his presentation Kivisto offers the European audience an introduction to the American immigration history in order to understand the current situation. He starts from the Great wave of migration (1880s – 1920s), when urbanization and industrialization in Europe drove millions of migrants to the United States. After this era, migration decreased remarkably due to legislation changes. These policies continued until 1965, when the Hart-Celler Act took place. The legislation from the 1920s was relatively discriminatory as it prioritized white, Anglo-Saxon protestant immigrants and set quotas for other groups. Despite this, the post-World War economy required labour force especially in the agricultural sector in the South, and the Mexicans appeared to fill this labour demand. The U.S. government had a contract with the Mexican government (and some other governments in the Caribbean) regarding these circular migrants, who were allowed to come to work in the U.S. temporarily. When the demand for agrarian labour force decreased, the migrants returned to Mexico. During those years the population pressure in Mexico was extreme, and many families relied on the opportunity of seasonal migration.

Due to the discriminatory nature of the pre-1965 policy, one of the aims of the Hart-Celler Act was to take a more open stance towards immigrants from different backgrounds. The Act also promoted the goals of the Cold War politics of the U.S. government as it strengthened its image as a tolerate country. However, the Hart-Celler reform had some consequences that were not anticipated by the decision makers. As quotas were removed and family reunification was encouraged, this led to the increasing share of non-European immigrants. The slow bureaucracy had a large impact on the government’s flexibility to react the short-term fluctuations of the labour market. The legal status of circular migrants changed from legal to illegal, but this did not remove the phenomenon and the need for agrarian workers in the Southern fields.

According to Kivisto, the present securitization of the U.S.-Mexico border has resulted in the fact that the circular migrants cannot return back to their home country, when the demand for work force on the north side of the border decreases. Simply they cannot be sure that they are able to cross the border again and come back, so they stay in the U.S. However, the Mexican population pressure has relieved since 1965 as the number of children has declined.

When presenting some general information on current American immigration, Kivisto notes that the majority of Americans claim that today’s immigration system does not work, and something needs to be done to improve it. This so-called ‘immigration system’ of today is based on the Hart-Celler Act. One of the key messages of the seminar was that the attitudes towards immigration divide the Americans, and that this division is often reflected in people’s political views. To be more exact, the Democrats generally hold more positive opinions regarding immigration compared to the Republicans. However, within both parties differing views are constantly compromised to form the official opinion of the party. The divided atmosphere shows especially in attitudes concerning undocumented immigrants: states and cities have very different policies when it comes to the illegal immigrant population and for example their opportunities to work. Ultimately, Kivisto states his concern about the fact that the mass media does not inform the broad public about the details and background factors of immigration.

Written by Ulla-Kaisa Pihlaja