Gender and Health Care Worker Migration

Transcription

1 Gender and Health Care Lisa Eckenwiler, Ph.D. Associate Professor Philosophy Director of Health Ethics George Mason University (USA) UNESCO Conference on Gender and Bioethics Kazan, Russian Federation November 21-22, 2011

2 Gender and Health Care Part of the feminization of international migration, women seek work abroad as nurses and other care workers in hospital, and increasingly, LTC settings. A growing number migrate from low-income countries with high disease burdens, more rapidly growing elderly populations and fewer available resources to wealthier, healthier ones (Polsky et al. 2007; WHO 2006). The U.S. is the largest importer, and the only net receiver (Aiken 2007; Dumont and Zurn 2007; OECD 2008).

3 Gender and Health Care Aging populations/underinvestment/poor health policy planning >> care crisis (ICN 2002; WHO 2006; Stone 2004) The increasing reliance on migrant care workers is a symptom of inadequate long-term care policy (IOM 2010, 7).

4 Gender and Health Care Domestic labor policies and workplace practices re: family caregivers The US is distinctive in having some of the weakest family leave policies in the world (Gornick and Meyers, 2003; Heyman, 2007; Pavalko, Henderson, and Cott, 2008).

5 Gender and Health Care Domestic labor policies and workplace practices re: family caregivers As affluent women s opportunities for work in the paid labor force expand and support for family caregivers is scarce, opportunities for other women, increasingly migrants, to provide care for pay emerge (Kofman 2007; Bettio, Simonazi, and Villa, 2006). Cheap and flexible, this model is [embraced] to overcome the structural deficiencies of public family care provision and strikes a good balance between the conflicting needs of publicly supporting care of the elderly and controlling public expenditure in privileged parts of the world (Bettio, et al., 2006: 282).

6 Gender and Health Care Global economic and trade policies SAPs impact on public sector and health care Migrant care workers contribute not just to their own families but also to their home countries economies (World Bank 2005; UNFPA 2006). A growing number of governments view migrants and their economic transfers as strategic resources to be incorporated in national development strategies. For key custodians of the global economy, including the World Trade Organization (WTO), the migration of workers forms an integral and beneficial component of the globalization and the liberalization of the

7 Lobbying in the US for an easing of immigration requirements in order to gain access to nurses and other skilled care workers are industry organizations (for ex: American Hospital Association, American Health Care Association, National Center for Assisted Living), who regard international recruitment as a way to keep hiring costs down and improve retention. (Buchan et al., 2003; Pittman et al., 2007) Gender and Health Care Immigration policies Selective immigration, especially for skilled workers, is a strategy increasingly used as an instrument of industrial policy under globalization. (Ahmad, 2005: 44)

8 Gender and Health Care Recruitment industry for nurses Offers a range of activities related to recruitment, testing, credentialing, and immigration (Connell and Stilwell 2006; Pittman et al. 2007) Hospitals are main drivers, with LTC settings (Brush et al. 2004; Leutz 2007; Browne and Braun 2008) Size of the industry has surged, along with the number of countries in which recruiters operate (Pittman et al. 2007; Van Eyck 2004)

9 Gender and Health Care Gender, racial, and ethnic stereotypes The global division of labor is fueled by the ideological construction of jobs and tasks in terms of notions of appropriate femininity and racial and cultural stereotypes (Mohanty, 2003: 141). Norms are shifting globally, facilitating increased access to global labor force.

10 Why Worry? Distorting subjectivities Seasoning Flexibilization and fragmentation

11 Gender norms at home can also restrict, even preclude, women s participation in decisions concerning how their remitted earnings are spent. Why Worry? Not necessarily enhancing economic agency and security While the feminization of migrant labor might contribute to women s economic, social, and political empowerment, to the extent that they are disproportionately engaged in forms of work designed to maximize profit for the architects of the global economy - low-wage, and also often temporary, part-time, casual, and home-based prospects seem dim.

12 Why Worry? Eroding political and social status Migrant care workers can compromise their political engagement at home, and often lack citizenship in the countries where they are employed and therefore, have a limited set of political and social rights (Parrenas 2001; Bosniak 2009; Ong 2009).

13 Why Worry? Perpetuating global health inequities/eroding health Fifty-seven countries face severe health worker shortages, which serve ultimately to exacerbate global health inequalities (WHO 2006). The adverse effects of losing care workers is not likely compensated by remittances, for they tend neither to contribute to the development of health systems specifically, nor to compensate for the overall economic consequences of losing educated workers, especially when they are educated in source countries (OECD 2008).

14 Why Worry? Eroding social and political capacity To the extent that those with more resources have greater capacities to care now by importing it and so, to produce and sustain more capable citizens, the outflow of caregivers may generate profound global inequalities in social and political capacity.

15 Gender and Health Care According to the recently convened Global Forum on Human Resources: Health worker migration is one of the most pressing issues of our times (Chatterjee 2010).

16 What s the Harm Done? Threatens well-being or welfare Constrains agency and autonomy Denies equal moral worth Distributes resources unfairly Yes, but

17 Structural Injustice Structural injustice exists when social processes put some categories of persons under a systematic threat of domination or deprivation of the means to develop and exercise their capacities, at the same time these processes enable others to dominate or have a wider range of opportunities for developing and exercising their capacities (Young 2006: 114). The ethical concern is not merely that structures constrain. Rather the injustice consists in the way they constrain and enable, and how they expand or contract opportunities.

18 Who Has Responsibilities? Governments International lenders International health organizations Trade unions Industry groups Employers Families with care needs in high-income countries