Diversity through equity and inclusion: The responsibility belongs to all of us.

Despite the recognized benefits of diversity and the decades of programs targeted at increasing diversity in science, technology, engineering, mathematics, and medicine, the underrepresentation of historically excluded groups continues due to persisting systemic inequalities. It is imperative that we reassess our current recruitment strategies and reimagine our campus and workplace environments to provide an inclusive and equitable culture that is free of institutional barriers, affording equal opportunities for each individual to succeed, thrive, and be their whole self. For too long this vision has been the fight of a heroic few, but it must become the fight of all in order to achieve true change. I am working toward, and look forward to, a future where contributing to diversity, equity, and inclusion is fully integrated into the core mission of our institutions and is an expectation for all of us.

Health professional mobility in the WHO European Region and the WHO Global Code of Practice: data from the joint OECD/EUROSTAT/WHO-Europe questionnaire.

WHO Member States adopted the Global Code of Practice on the International Recruitment of Health Personnel 10 years ago. This study assesses adherence with the Code's principles and its continuing relevance in the WHO Europe region with regards to international recruitment of health workers. Data from the joint OECD/EUROSTAT/WHO-Europe questionnaire from 2010 to 2018 are analyzed to determine trends in intra- and inter-regional mobility of foreign-trained doctors and nurses working in case study destination countries in Europe. In 2018, foreign-trained doctors and nurses comprised over a quarter of the physician workforce and 5% of the nursing workforce in five of eight and four of five case study countries, respectively. Since 2010, the proportion of foreign-trained nurses and doctors has risen faster than domestically trained professionals, with increased mobility driven by rising East-West and South-North intra-European migration, especially within the European Union. The number of nurses trained in developing countries but practising in case study countries declined by 26%. Although the number of doctors increased by 27%, this was driven by arrivals from countries experiencing conflict and volatility, suggesting countries generally are increasingly adhering to the Code's principles on ethical recruitment. To support ethical recruitment practices and sustainable workforce development in the region, data collection and monitoring on health worker mobility should be improved.

Plastic Surgery Chairs and Program Directors: Are the Qualifications Different for Men and Women?

BACKGROUND: The gender disparity between the number of female and male chairs and program directors has been previously established. The aim of this study was to determine whether any differences in objective credentials existed between male and female plastic surgery department chairs/division chiefs and program directors. METHODS: Information about each plastic surgery program director and chair/chief was extracted from the websites of all institutions affiliated with a plastic surgery residency program. For each individual, information about the length of their career, number of fellowships completed, and number of publications was recorded. The two-tailed t test was used to compare differences between male and female chairs and program directors. RESULTS: A total of 99 chairs were recorded, of which nine (9.1 percent) were female. Of the 99 program directors, 13 (13.1 percent) were female. There was no difference in the number of years in practice or number of fellowships between men and women for either position. On average, male chairs had significantly fewer publications than female chairs (71.9 versus 128; p < 0.05). There was no significant difference in the number of publications between male and female program directors. Compared to program directors, chairs had significantly more years in practice and numbers of publications, which held true for both men and women. CONCLUSIONS: Women are not only underrepresented in the department chair and program director positions, but also possess higher qualifications that may reflect differences in standards for promotion and appointment. Additional research is needed to elucidate the reasons behind the observed differences in qualifications.

Comparing demographics of signatories to public letters on diversity in the mathematical sciences.

In its December 2019 edition, the Notices of the American Mathematical Society published an essay critical of the use of diversity statements in academic hiring. The publication of this essay prompted many responses, including three public letters circulated within the mathematical sciences community. Each letter was signed by hundreds of people and was published online, also by the American Mathematical Society. We report on a study of the signatories' demographics, which we infer using a crowdsourcing approach. Letter A highlights diversity and social justice. The pool of signatories contains relatively more individuals inferred to be women and/or members of underrepresented ethnic groups. Moreover, this pool is diverse with respect to the levels of professional security and types of academic institutions represented. Letter B does not comment on diversity, but rather, asks for discussion and debate. This letter was signed by a strong majority of individuals inferred to be white men in professionally secure positions at highly research intensive universities. Letter C speaks out specifically against diversity statements, calling them "a mistake," and claiming that their usage during early stages of faculty hiring "diminishes mathematical achievement." Individuals who signed both Letters B and C, that is, signatories who both privilege debate and oppose diversity statements, are overwhelmingly inferred to be tenured white men at highly research intensive universities. Our empirical results are consistent with theories of power drawn from the social sciences.

Promoting anti-corruption, transparency and accountability in the recruitment and promotion of health workers to safeguard health outcomes.

Background: Human Resources for Health are a core building block of a health system, playing a crucial role in improving health outcomes. While the existing literature has examined various forms of corruption that affect the health sector, few articles have examined the role and impact of corruption in the recruitment and promotion of health-workers.Objectives: This study reviews the role of corrupt practices such as nepotism, bribery and sextortion in health-worker recruitment and promotion and their implications for health systems.Methods: The study is based on an interdisciplinary non-systematic review of peer-reviewed journal articles in the public health/medicine and political science literature, complemented with the 'grey' literature such as technical reports and working papers.Results: Political and personal ties, rather than merit are often factors in the recruitment and promotion of health-workers in many countries. This results in the employment or promotion of poorly qualified or unsuitable workers, with negative implications for health outcomes.Conclusion: Corrupt practices in health-worker recruitment and promotion 'set the tone' for other forms of corruption such as absenteeism, embezzlement, theft and bid-rigging to flourish, as those recruited corruptly can collude for nefarious purposes. On the other hand, merit-based recruitment is important for curbing corruption. Corrupt recruitment practices have deleterious effects on health-worker motivation and retention, quality and competency, citizens' trust in health services and health outcomes. Whereas international law and policy such as the United Nations Convention Against Corruption and the WHO Handbook on Monitoring and Evaluation of Human Resources for Health state that recruitment of public officers and health workers respectively should be done in a transparent and accountable manner, more research is needed to inform policies on merit-based recruitment.

Rosalinda Dimapilis-Baldoz: balancing domestic and international needs for health workers.

Rosalinda Dimapilis-Baldoz talks to Fiona Fleck about the health worker migration policy of the Philippines and discusses the challenges faced by the WHO Global code of practice on the international recruitment of health personnel.

Managing intra-EU mobility-do WHO principles of ethical recruitment have relevance?

BACKGROUND: The WHO Global Code of Practice on the International Recruitment of Health Personnel provides for guidance in health workforce management and cooperation in the international context. This article aims to examine whether the principles of the voluntary WHO Global Code of Practice can be applied to trigger health policy decisions within the EU zone of free movement of persons. METHODS: In the framework of the Joint Action on European Health Workforce Planning and Forecasting project (Grant Agreement: JA EUHWF 20122201 (see healthworkforce.eu)), focus group discussions were organised with over 30 experts representing ministries, universities and professional and international organisations. Ideas were collected about the applicability of the principles and with the aim to find EU law compatible, relevant solutions using a qualitative approach based on a standardised, semi-structured interview guide and pre-defined statements. RESULTS: Based on implementation practices summarised, focus group experts concluded that positive effects of adhering to the Code can be identified and useful ideas-compatible with EU law-exist to manage intra-EU mobility. The most relevant areas for intervention include bilateral cooperations, better use of EU financial resources, improved retention and integration policies and better data flow and monitoring. Improving retention is of key importance; however, ethical considerations should also apply within the EU. Compensation of source countries can be a solution to further elaborate on when developing EU financial mechanisms. Intra-EU circular mobility might be feasible and made more transparent if directed by tailor-made, institutional-level bilateral cooperations adjusted to different groups and profiles of health professionals. Integration policies should be improved as discrimination still exists when offering jobs despite the legal environment facilitating the recognition of professional qualifications. A system of feedback on registration/licencing data should be promoted providing for more evidence on intra-EU mobility and support its management. CONCLUSIONS: Workforce planning in EU Member States can be supported, and more equitable distribution of the workforce can be provided by building policy decisions on the principles of the WHO Code. Political commitment has to be strengthened in EU countries to adopt implementation solutions for intra-EU problems. Long-term benefits of respecting global principles of the Code should be better demonstrated in order to incentivise all parties to follow such long-term objectives.

Values-based recruitment ignores real issues, say university leaders.

New rules on recruiting nursing students with the right caring values will not help prevent a repeat of appalling care like that uncovered at Mid Staffordshire NHS Foundation Trust, according to university leaders.

Health care institutions should not exclude smokers from employment.

Some health care institutions, including academic health centers, have adopted policies excluding smokers from employment. Claims advanced on behalf of these policies include financial savings from reduced health costs and absenteeism as well as advantages consonant with their message of healthy living. The authors suggest that the institutional savings from these policies are speculative and unproven. Also, in settings where large medical schools operate, it is likely to be the poor, including members of minority groups, who, under an employee smoker ban, will lose the opportunity to work for an employer that offers health insurance and other benefits. In response to the incentives created by such bans, some will quit smoking, but most will not. Thus, at the community level, employee smoker bans are more likely to be harmful than beneficial.Although private businesses may rightly choose not to hire smokers in the 19 states where such policies are legal, health care institutions, including academic health centers, should consider hiring choices in light of the values they profess. The traditional values of medicine include service to all persons in need, even when illness results from addiction or unsafe behavior. Secular academic communities require a shared dedication to discovery without requiring strict conformity of private behavior or belief. The authors conclude that for health care institutions, policies of hiring smokers and helping them to quit are both prudent and expressive of the norms of medical care, such as inclusion, compassion, and fellowship, that academic health professionals seek to honor.

Age-based hiring discrimination as a function of equity norms and self-perceived objectivity.

Participants completed a questionnaire priming them to perceive themselves as either objective or biased, either before or after evaluating a young or old job applicant for a position linked to youthful stereotypes. Participants agreed that they were objective and tended to disagree that they were biased. Extending past research, both the objective and bias priming conditions led to an increase in age discrimination compared to the control condition. We also investigated whether equity norms reduced age discrimination, by manipulating the presence or absence of an equity statement reminding decision-makers of the legal prohibitions against discrimination "on the basis of age, disability, national or ethnic origin, race, religion, or sex." The presence of equity norms increased enthusiasm for both young and old applicants when participants were not already primed to think of themselves as objective, but did not reduce age-based hiring discrimination. Equity norms had no effect when individuals thought of themselves as objective - they preferred the younger more than the older job applicant. However, the presence of equity norms did affect individuals' perceptions of which factors were important to their hiring decisions, increasing the perceived importance of applicants' expertise and decreasing the perceived importance of the applicants' age. The results suggest that interventions that rely exclusively on decision-makers' intentions to behave equitably may be ineffective.

Foreign nurse recruitment: global risk.

Recruitment of nurses by industrialized nations from developing countries has been common practice for decades. Globalization, a crucial trend of the 21st century, raises the world's awareness of the economic and social disparities between nations. The direct impact on nurse emigration emphasizes the ethical, economic, and social inequalities between source and destination countries. It is often more cost-effective for industrialized countries to recruit from developing countries; however, the depletion of source country resources has created a global healthcare crisis. Destination countries are being challenged on the ethical implications of aggressive recruitment and their lack of developing a sustainable self-sufficient domestic workforce. Similarly, source countries are confronting the same challenges as they struggle to fund and educate adequate numbers of nurses for domestic needs and emigrant replacement. This article will review the ethical, economic, and social impacts of continued unrestricted international recruitment of nurses and present a proposal for development of an international treaty addressing global sustainability.

Monitoring the implementation of the WHO Global Code of Practice on the International Recruitment of Health Personnel.

OBJECTIVE: To present the findings of the first round of monitoring of the global implementation of the WHO Global Code of Practice on the International Recruitment of Health Personnel ("the Code"), a voluntary code adopted in 2010 by all 193 Member States of the World Health Organization (WHO). METHODS: WHO requested that its Member States designate a national authority for facilitating information exchange on health personnel migration and the implementation of the Code. Each designated authority was then sent a cross-sectional survey with 15 questions on a range of topics pertaining to the 10 articles included in the Code. FINDINGS: A national authority was designated by 85 countries. Only 56 countries reported on the status of Code implementation. Of these, 37 had taken steps towards implementing the Code, primarily by engaging relevant stakeholders. In 90% of countries, migrant health professionals reportedly enjoy the same legal rights and responsibilities as domestically trained health personnel. In the context of the Code, cooperation in the area of health workforce development goes beyond migration-related issues. An international comparative information base on health workforce mobility is needed but can only be developed through a collaborative, multi-partnered approach. CONCLUSION: Reporting on the implementation of the Code has been suboptimal in all but one WHO region. Greater collaboration among state and non-state actors is needed to raise awareness of the Code and reinforce its relevance as a potent framework for policy dialogue on ways to address the health workforce crisis.