Slide 1 PERSPECTIVES ON GLOBALIZATION AND HEALTH POLICY Presented by Barbara L. Nichols, DHL, MS, RN, FAAN Slide 2 Slide 3
Slide 4 Overview of Globalization Slide 5 A Global Perspective Four Policy Issues Globalization Migration Demographics Policy Changes Slide 6 A Global Perspective Globalization Migration
Slide 7 A Global Perspective GLOBALIZATION A borderless world Globalization: the international movement of technology, ideas, labor, products, and professional education and standards Slide 8 A Global Perspective GLOBALIZATION MEANS MOBILITY OF: Capital Organizations Ideas Technology Immigrants Slide 9 A Global Perspective GLOBALIZATION Transcends all boundaries Involves Migration Erases perceived differences Ignores local definitions Seeps through porous borders Is IRREVERSIBLE
Slide 10 A Global Perspective MIGRATION MIGRATION is the movement of people across borders, usually for the purpose of employment or acquiring a new residence. It occurs within countries (Internal rural to urban) or External through daily commuting, seasonal relocation or internationally. Slide 11 BY THE NUMBERS Nearly ONE BILLION annually Predicted to increase to 1.5 Billion in ten years Slide 12 INCLUDE: Immigrants Refugees Migrant Workers International Adoptees
Slide 13 INCLUDE (Cont d.): Trafficking Victims Displaced Persons Tourists Business Travelers Slide 14 MIGRATION TRENDS: 212 million worldwide immigrants One million come to the U.S. annually Slide 15 MIGRATION TRENDS: Worldwide one of every 35 is a migrant In urban areas one of every 6 is a migrant
Slide 16 2010 MIGRATION TRENDS: 42.8 Million USA 12.3 Million Russian Federation 10.8 Million Germany 7.3 Million Saudi Arabia 7.2 Million Canada Slide 17 MIGRATION TRENDS-USA Tripled in the last 30 years Largest continuous wave in US history No longer from Scandinavia, Western and Eastern Europe, but Asia, Africa, and Arab Countries Slide 18 MIGRATION TRENDS-USA Today, the United States is the largest recipient of international migrants.
Slide 19 MIGRATION TRENDS Not a New Phenomenon Slide 20 MIGRATION TRENDS Different in Character Cyclical but continual Global rather than western Overwhelmingly female Slide 21 MIGRATION TRENDS Different in Character Nationality Religion Socioeconomic status
Slide 22 USA EXPERIENCE 1912 2011 Nationalities Nationalities Irish, Italians, Germans Asians, Africans, Arabs Religions Catholic, different protestant faiths Socioeconomic status Craftsmen Laborers Religions Hindu, Muslim, Buddhist Socioeconomic status Professionals Skilled Technocrats Slide 23 MIGRATION TRENDS Not new but recurring Change in characteristics and context From melting pot to the mosaic From blue collar to white collar workers Slide 24 MIGRATION Migration is one of the defining issues of the twenty-first century. It is now an essential, inevitable and potentially beneficial component of the economic and social life of every country and region.
Slide 25 MIGRATION TRENDS Migrants bring NEW culture Religion Language Cultural practices and norms Slide 26 Globally Mobile Health Professionals HEALTH WORKFORCE Mirror three major trends Cultural value differences Linguistic and language differences Racial and ethnic differences Slide 27 Globally Mobile Health Professionals HEALTH WORKFORCE 59 Million Health Care Workforce 2/3 Health Service Providers 1/3 Health Management Support Workers
Slide 28 Globally Mobile Health Professionals HEALTH WORKFORCE Shortages Maldistribution Skill Mix Gender Public/Private Slide 29 Globally Mobile Health Professionals HEALTH WORKFORCE Tug of war Lack of standardized data elements Lack of comparable data base Slide 30 Globally Mobile Health Professionals HEALTH WORKFORCE How to mitigate grave imbalances Balance the right move without damaging the right to basic standards of care
Slide 31 Globally Mobile Health Professionals HEALTH WORKFORCE NURSES ARE: Largest global health workforce Largest global health workforce in any country Slide 32 Globally Mobile Health Professionals GLOBAL PERSPECTIVE Freedom Security Opportunity Slide 33 Globally Mobile Health Professionals GLOBAL PERSPECTIVE World poverty Readily affordable transportation Communications revolution Increased demand for workers Changes in immigration policy Growing worker networks
Slide 34 Changing Demographics - Global Slide 35 Changing Demographics - Global Slide 36 Changing Demographics - Global
Slide 37 Changing Demographics - Global WOMENS MIGRATION Feminization and coloration of labor Empowerment and women's rights Slide 38 Changing Demographics - USA RACE TRENDS 2050 90% of US population will come from Asians People of color are a majority in 48 of the nations largest 100 cities Hispanics largest ethnic minority Slide 39 Changing Demographics - USA RACE TRENDS Five states have minority majorities California Hawaii New Mexico Texas Florida
Slide 40 Changing Demographics - USA RACE TRENDS Five states have non-white populations around 40% Georgia Maryland Mississippi New York Arizona Slide 41 Changing Demographics - USA RELIGIOUS TRENDS Islam fastest growing religion Slide 42 Changing Demographics - USA TREND The United States is becoming more
Slide 43 Changing Demographics - USA TREND Becoming more Slide 44 Changing Demographics - USA Health Workforce Trends 1.1 million immigrants account for 17% of U.S. healthcare providers 13% are nurses Slide 45 Changing Demographics - USA Health Workforce Trends MIRROR: Racial and ethnic disparities in patient outcomes Cross-cultural value differences Linguistic and language differences
Slide 46 Changing Demographics - USA Health Workforce Trends Representation in health professions low Under-representation in management and administrative positions Racial disparities have worsened Slide 47 Changing Demographics - Global MEANS Diversity in age, race and religion challenge responses to health care delivery, practices and outcomes. Slide 48 This Means That COLOR Matters
Slide 49 Prejudice Matters PREJ-U-DICE Judgment or preconceived idea before the facts are known; usually unfavorable; marked by fear, intolerance, or hatred Webster, New World Dictionary Slide 50 Prejudice Matters Stereotype + Categorization = Prejudice Prejudice + Social Context = Discrimination Gordon Allport, The Nature of Prejudice Slide 51 Changing Demographics - Global MEANS Can no longer conceptualize disease over there or disease seen here
Slide 52 Changing Demographics - Global MEANS Expanding our view about health and care Understanding that migrants bring new cultural dynamics and influence Slide 53 Changing Demographics - Global HEALTH CARE PROFESSIONALS R E S P E C T just a little bit Slide 54 Changing Demographics - Global MEANS Humane Treatment Ethical Practices Lens of Opportunity
Slide 55 Changing Demographics - Global MEANS Universal Human Right EVERYONE has the right to leave any country, including his own, and to return to his country. Slide 56 Defining Issues SUMMARY I was taught the way to progress is neither swift nor easy. Marie Curie Slide 57 Defining Issues SUMMARY World Poverty Economic Inequalities Feminization of Labor Globalization
Slide 58 Defining Issues SUMMARY Migration Diversity Cultural Competence Embedded Social Justice Issues Slide 59 Defining Issues SUMMARY Martin Luther King, Jr. We are tied together in a single garment of destiny, in the web of mutuality. 1968 Slide 60 Defining Issues SUMMARY. Collaboration is Key
Slide 61 Health is a valuable resource a basic human right and a global public good that needs to be practiced and promoted by the global community. Ilona Kickbusch Yale University, 2002 Slide 62 Barbara L. Nichols, DHL, MS, RN, FAAN President and Chief Executive Officer Barbara Nichols Consulting Barbara.nichols@att.blackberry.net