Michelle Bromberg ANTH 274-AD 18 April 2012

Economic Inequalities Shaping the Work of Health Care

The health care sector in America is currently undergoing many changes. An influx of foreign-born health care workers is shaping the work of the American health care system. The reasons for this influx are rooted in the many inequalities that plague the world. One of the inequalities that proves to be most influential on health care is that of wealth. The consequences of economic inequality have ties to many of the health care work issues in the U.S. and beyond, either as a cause or catalyst for the alteration of the contours of the health care work landscape. Based on two articles, Globalization, Womens Migration, and the Long-Term-Care Workforce by Colette Browne and Kathryn Braun, and Recruiting Primary Care Physicians From Abroad by Amy Hagopian, I argue that economic inequalities affect the work of health care in American society and the world by causing immigration to the U.S., which leads to the shifting of the shortage of health care workers worldwide and the shaping the demographics of the American work force. These issues can lead to secondary problems that also affect the work of health care, such as the quality of care provided by workers and the relation between worker and patient. The economic disparities between the global south and developed nations such as the U.S. cause the migration of health care workers to the U.S. This movement, in turn, affects health work by filling in labor gaps in the U.S. while widening these shortages in the countries that supply the workers. Given that the number of health care workers that exist in the world is smaller than what is needed in many nations, there is a dearth of health care workers in many nations. Instead of all of these countries sharing this burden, nations with certain privileges that are afforded by wealth, such as those that are enjoyed by the U.S., utilize this advantage to import health care workers to fulfill demand. This leaves even larger holes in the health care service sector of the countries that supply the health care workers to the U.S. (Browne and Braun, 21).

This supply of workers does not arrive simply because the U.S. wants them. These workers are more or less coming of their own volition (as opposed to being trafficked), but their motivations for seeking work abroad stem from a desire to fight against the economic inequalities in the world. Migrationis a poverty reduction strategy that allows DLTC [direct long-term care] immigrant workers to send money home in the form ofremittances (Browne and Braun, 21). Immigrant health care workers are not moving to the U.S. to help relieve worker shortages, and they do not intend to widen the care gap in their home country by leaving; they merely seek better economic opportunities for themselves and their families. While this theme of economic pursuit is present in both of the articles, it is interesting to note that in some cases, an individuals choice to immigrate is supported by both the supplying and the receiving nations. Conversely, other instances show that immigration is driven by individual economic pursuit at the encouragement of the receiving nation, despite the wishes of the supplying nation. To demonstrate the former, Browne and Braun give the example of the Filipino government, which encourages its citizens to work abroad because they provide a much needed economic boost to their home country in the form of remittances (Browne and Braun, 19). The U.S. also depends upon these economically disadvantaged foreigners to fill certain health care jobs (Browne and Braun, 16), leading to the migration of foreign-born health care workers to the U.S. On the other hand, many international medical graduates (IMGs) that train in developing nations move to the U.S. without the blessing of their home country. The U.S. recruits these IMGs all the same, but the resource-poor supply countries mourn the loss of their best and brightest. These countries invest in the education of IMGs in the hopes that these students will improve the country by providing medical services within the country (Hagopian, 484). Ultimately, however, many IMGs choose to immigrate to the US in pursuit of better economic opportunity. As Fitzhugh Mullan so aptly noted, absent a public policy motivating other choices, physicians follow the money (Hagopian, 485). The

resulting migration of the pursuit of wealth creates a noticeable mark on health care work in the U.S. Due to the global economic situations described above, the immigration of citizens of developing nations and their subsequent employment as primary care physicians or DLTC workers is shaping health care work in America by changing the demographic of its work force. Over 28% of primary care doctors in the U.S. received their medical training abroad, in countries with poor health indicators and shortages of physicians (Hagopian, 483-4), which one can interpret to mean that these physicians are coming from the global south. This is a change from years past, when immigrants working in health care typically came from Europe (Hagopian, 484). Three-fourths of the eldercare home care staff in LA in 2000 were Filipina immigrants (Browne and Braun, 19). While I cannot find a figure that accurately quantifies the demographic in generations prior to that time, my guess is that such a large Filipina presence has not always been the case. Because of economic-induced immigration to the U.S., the country is seeing a change in the nationalities of its health care workers. While the reasons for migration for both DLTC workers and primary care physicians stem of economic gain, the implications of their immigration on the regulation and quality of American health care work vary. As was mentioned above, a study conducted in 2000 found that 75% of home care providers for the elderly in LA were Filipina immigrants, and they were either not licensed or not registered (Browne and Braun, 19). With a lack of regulation and training, it can be difficult to regulate the quality of the work that DLTC workers provide. The different cultural backgrounds of these workers can also play a role in care quality. A 2006 study found that there were many issues that were tied to DLTC workers and those for whom they provide care, such as difficulties with communication [and] discriminatory attitudes and behaviors (Browne and Braun, 22). For IMGs, the requirement of completing at US residency training program in order become a licensed practitioner should preclude issues with regulation of practices (Hagopian, 484). However,

similar cross-cultural issues presumably exist between IMGs and their patients, given their foreign upbringing. In sum, we see in these two articles that economic hardship, a major force of global migration, is bringing about change in American health care work by filling labor gaps and diversifying the background of the work force, for better or for worse.

Works Cited Browne, Colette V., and Kathryn L. Braun. "Globalization, Womens Migration, and the LongTerm-Care Workforce." The Gerontologist 16-24 48.1 (2008): 16-24. Print. Hagopian, Amy. "Recruiting Primary Care Physicians From Abroad." Annals of Family Medicine 5.6 (2007): 483-85. Print.