[Workload and health of workers with a migrant background]. / Arbeitsbelastung und Gesundheit von Erwerbstätigen mit Migrationshintergrund.

BACKGROUND AND OBJECTIVES: Diversity is increasing, including among workers. Traditional approaches in occupational safety and health are no longer sufficient to meet the emerging challenges in the workplace. Currently, knowledge about specific needs of workers with a migrant background is insufficient to develop suitable interventions under participatory methods. The aim of this work is to gain knowledge about diversity in the workplace and discuss considerations for suitable prevention and health promotion. MATERIALS AND METHODS: Research in reports, analyses of the German Socio-Economic Panel, as well as a review of the literature in relevant databases served to collate current findings about health indicators, stress and strain, structural conditions, and occupational prevention and health promotion. RESULTS: Differentiated results about health in the workplace and stress and strain could be identified. In particular, workers with a migrant background are more often exposed to physical stress and harsh environmental conditions. Furthermore, structural conditions are worse for these workers, e.g. due to lower employment rates, as well as enhanced atypical employment among the target group. CONCLUSION: Plausible explanations for the reported differences are discussed and useful implications are given. However, the overall lack of data and challenges in data collection must be considered.

Willingness to migrate-a potential effect of burnout? A survey of Hungarian physicians.

BACKGROUND: Burnout worldwide and migration of caregivers are among the most important challenges of the twenty-first century health care. METHODS: Quantitative, online survey of Hungarian physicians (n = 4 784) was performed in 2013. A link to an anonymous, self-administered questionnaire was sent to all potential participants, namely to the registered members of the Hungarian Medical Chamber with a valid e-mail address. Linear regression analysis was used to determine the risk factors of burnout. The association between physicians' burnout and their willingness to migrate was determined by binary logistic regression analysis. RESULTS: Moderate/mild level of personal accomplishment was detected in 65% of respondents, whereas moderate/severe level of emotional exhaustion and depersonalization was detected in 49% and 46%, respectively. Single male physicians younger than 35 composed the cohort with the highest risk for developing burnout. Higher daily working hours and multiple workplaces contribute to the risk of developing burnout. According to logistic regression analysis, the intention to work abroad was affected by the emotional exhaustion dimension of burnout (OR = 1.432) and depersonalization had a tendency to have an impact on the willingness to migrate. CONCLUSIONS: We assume that there is a circular causality between burnout and the willingness to migrate. Burnout increases the willingness to work abroad, whereas contemplating migration might evoke a certain degree of depersonalization in caregivers who are in a dilemma.

Beyond the Bifurcated Myth: The Medical Migration of Female Korean Nurses to West Germany in the 1970s.

This study investigates beyond the bifurcated myth of the medical migration of Korean women to Germany in the 1970s, which is known as the "German dispatchment" myth from the Korean perspective and the "development aid" discourse from that of the Germans, by focusing on the newly-released documents from the German Hospital Federation (Deutsche Krankenhausgesellschaft, DKG). The migration was essentially a transfer of labor from a weak to a strong state, and the disparity of state strength characterized the nature of the recruitment mechanism. Both Korea and Germany have romanticized the labor transfer and appropriated the collective experiences of migrants for their own political purposes. In this transnational business, the Korean Overseas Development Corporation (KODCO) and the DKG maintained exclusivity in the labor migration channel and were faithful to their own interests. The DKG, as a representative of the German healthcare industry, was concerned about being criticized for destroying the healthcare system of developing countries by stealing their skilled workforce. They, therefore, tried to influence publicity in Korea and Germany to persuade the people that the recruitment benefited both countries. However, the DKG was aware of the deceitfulness of its "development aid" discourse. The Korean government, which advanced the labor export for the sake of obtaining foreign currency, romanticized it as patriotism and used the term "German dispatchment." However, the incapacity and corruption of KODCO as an agency from the Korean perspective resulted in criticism regarding its recruitment program. The DKG complained that the selection of incapable personnel coupled with corruption was causing unforeseen financial damage to its member hospitals. Nevertheless, it officially defended its partner for the sake of its own interests, such as avoiding bad publicity and securing the sustainability of the recruitment program. The conflicts regarding nursing tasks and working conditions between Korean nurses and their German colleagues and employers captured in the documents of the DKG trace the origin of the issues in relation to cultural misunderstanding and pervasive racism. The disparity of state strength between the two countries resulted in the subaltern position of Korean female healthcare workers in the global labor market, and they tried to bring forth the best possible outcome while working in a foreign country in unfamiliar circumstances. However, the difficulties with female guest workers from Asia were generally credited to their inability to adhere to the German working style. This study contributes to the existing scholarship on this topic by filling the gaps. Historical research on the medical migration of Korean nurses and nurse-aides to West Germany has relied on limited historical sources. In 2013, the National Archives of Korea transferred official documents regarding these workers that were produced and archived by the DKG, which represented the interests of German healthcare institutions. Its documents on Korean nursing personnel provide supplementary information and display findings in different perspectives. They do not bring forth completely new findings that have never been researched before but are still valuable for delivering concrete evidence on the circumstances of that time, which were previously merely inferred.

Caught between a rock and a hard place: mental health of migrant live-in caregivers in Canada.

BACKGROUND: Canada depends on Temporary Foreign Workers (TFWs), also known as migrant workers, to fill labour shortage in agriculture, hospitality, construction, child/senior care, and other low-skilled occupations. Evidence shows that TFWs, especially women live-in caregivers (LC), constitute a vulnerable population. Their health is compromised by the precarious and harsh working and living conditions they encounter. There is a paucity of research on the mental health of LCs, their support systems and access to mental health services. METHOD: In this community-based exploratory study, we used mixed methods of survey and focus groups to explore the work related experiences and mental health of migrant live-in caregivers in the Greater Toronto Area in Ontario, Canada. Convenience and snowball sampling were used to recruit participants. The inclusion criteria were: being 18 years or older, initially migrated to Canada as TFWs under LC program, resided in the Greater Toronto Area, and able to understand and converse in English based on self-report. This paper reports on the focus group results derived from inductive thematic analysis. RESULTS: A total of 30 women LCs participated in the study. Most of them were from the Philippines. A number of key themes emerged from the participants' narratives: (1) precarious migration-employment status (re)produces exploitation; (2) deskilling and downward social mobility reinforce alienation; (3) endurance of hardship for family back home; (4) double lives of public cheerfulness and private anguish; and (4) unrecognized mental health needs. The study results reflected gross injustices experienced by these women. CONCLUSION: A multi-faceted approach is required to improve the working and living conditions of this vulnerable group and ultimately their health outcomes. We recommend the following: government inspection to ensure employer compliance with the labour standards and provision of safe working and living conditions; change immigration policy to allow migrant caregivers to apply for permanent residence upon arrival; the TFWs Program to establish fair wages and subsidized housing so that caregivers can truly access the live-out option; and local ethno-specific, settlement and faith organizations be leveraged to provide TFWs with social support as well as information about their rights and how to access health and social care.

Migration of nurses in Australia: where and why?

The Australian health care workforce has benefited from an increasing migration of nurses over the past decades. The nursing profession is the largest single health profession, making up over half of the Australian health care workforce. Migration ofnurses into the Australian nursing workforce impacts significantly on the size ofthe workforce and the capacity to provide health care to the Australian multicultural community. Migration of nurses plays an important role in providing a solution to the ongoing challenges of workforce attraction and retention, hence an understanding of the factors contributing to nurse migration is important. This paper will critically analyse factors reported to impact on migration of nurses to Australia, in particular in relation to: (1) globalisation; (2) Australian society and nursing workforce; and (3) personal reasons. The current and potential implications of nurse migration are not limited to the Australian health care workforce, but also extend to political, socioeconomic and other aspects in Australia.

Responding to the health needs of migrant farm workers in South Africa: Opportunities and challenges for sustainable community-based responses.

Reflecting global trends, migrant farm workers in South Africa experience challenges in accessing healthcare. On the commercial farms in Musina, a sub-district bordering Zimbabwe, Medécins sans Frontières and the International Organization for Migration both implemented migration-aware community-based programmes that included the training of community-based healthcare workers, to address these challenges. Using qualitative data, this paper explores the experiences that migrant farm workers, specifically those involved in the programmes, had of these interventions. A total of 79 semi-structured interviews were completed with migrant farm workers, farm managers, NGO employees and civil servants between January 2017 and July 2018. These data were supplemented by a review of grey and published literature, as well as observation and field notes. Findings indicate that participants were primarily positive about the interventions. However, since the departure of both Medécins sans Frontières and the International Organization for Migration, community members have struggled to sustain the projects and the structural differences between the two programmes have created tensions. This paper highlights the ways in which local interventions that mobilise community members can improve the access that rural, migrant farming communities have to healthcare. However, it simultaneously points to the ways in which these interventions are unsustainable given the realities of non-state interventions and the fragmented state approach to community-based healthcare workers. The findings presented in this paper support global calls for the inclusion of migration and health in government policy making at all levels. However, findings also capture the limitations of community-based interventions that do not recognise community-based healthcare workers as social actors and fail to take into account their motivations, desires and need for continued supervision. As such, ensuring that the ways in which migration and health are included in policy making are sustainable emerges as a necessary element to be included in global calls.

International Nurse Migration.

Nurses' dual role as migrants caring for other migrants.

Migration among temporary foreign workers: Examining health and access to health care among Filipina live-in caregivers.

In 2015, approximately 14,000 migrants were accepted into Canada as live-in caregivers. While extensive research has documented the working conditions of migrant live-in caregivers, few studies examine the health experiences of this population related to their employment as caregivers. This research examines the relationship between employment under the Federal Government's (Live-in) Caregiver Program and health and access to healthcare services among 21 Filipina caregivers working in the Greater Toronto Area, Ontario. Results of in-depth interviews reveal that long work hours are perceived to negatively affect physical health while separation from family negatively impacts mental health. Among the women interviewed, work responsibilities and living-in the place of employment are perceived to negatively impact both physical and mental health. The research also demonstrates that working as a live-in caregiver both facilitates and creates barriers to accessing health services. Future research is needed to better understand the health of more socially isolated caregivers and caregivers living-out(side) their place of employment.

The Portuguese contribution to the brain drain from Portuguese speaking African countries.

In the first part of this paper, a secondary analysis of multiple data sources was done to identify how many nurses, physicians, dentists, pharmacists and other health workers have migrated from the Portuguese speaking African countries (PSAC) to Portugal between 1998 and 2002. In the second part, the results of a 2003 questionnaire based survey of 45 nurses, from Guinea-Bissau, residing in Portugal are reported. Health professionals are increasing as a proportion of total immigrants into Portugal. Relatively to the countries' of origin population, the PSAC contribute the most with foreign health professionals to the Portuguese healthcare system. Our study of Guinea-Bissau nurses in Portugal replicates the results of other studies and suggests that the decision to emigrate is multiply determined. The implication for policy makers is that the causal complexity among factors spurring emigration makes that the marginal effect of policy reforms addressing one or more of the multiple determinants of emigration may be sufficient to retain some proportion of health professionals, even when other determinants of emigration are present. The situation observed is also indicative of the need of programs for social integration of these professionals.

Structural Characteristics of Migrant Farmworkers Reporting a Relationship with a Primary Care Physician.

Migrant farmworkers are disproportionately affected by many adverse health conditions, but access healthcare sparingly. This study of migrant farmworkers examined the distribution and general characteristics associated with having access to healthcare. Access to healthcare was measured by asking whether the participants (N = 413) had a primary care physician. Majority of participants did not have a primary care physician. Female migrant workers (AOR = 2.823 CI: 1.575-4.103) with insurance (AOR = 6.183 CI: 4.956-11.937) who lived at study site for more than 5 years (AOR = 2.728 CI: 1.936-7.837) and born in the United States (AOR = 2.648 CI: 1.373-3.338) had greater odds to have a primary care physician than recent male migrants without insurance who were born outside United States. There is a need to focus on Community Health Centers and Migrant Health Centers in tailoring their services and to widen the implementation and improve funding of Accountable Care Organizations to improve access to care of migrant farmworkers.

Migrants, Manpower and Math in the Coming Europe.

"A dead child" said stalin "is a tragedy. Two million are a statistic." A single photograph of a beach riveted world attention, converting syrian refugees from statistics to tragedy. But the statistics remain. Three Canadian columnists have offered contrasting interpretations. Eric Reguly argues that a static and aging Europe needs more manpower to sustain its economy. Margaret Wente, however, observes the failure of integration of migrants in Sweden. Migrants are drawn by open borders and a generous welfare state, but do not fit an advanced, high-skill economy. Gwynne Dyer notes that current inflows, IF evenly distributed, are a tiny proportion of the overall European Union. But economic migrants from Africa are a much larger issue. Their numbers are effectively inexhaustible.

African Female Physicians and Nurses in the Global Care Chain: Qualitative Explorations from Five Destination Countries.

Migration of health professionals is an important policy issue for both source and destination countries around the world. The majority of migrant care workers in industrialized countries today are women. However, the dimension of mobility of highly skilled females from countries of the global south has been almost entirely neglected for many years. This paper explores the experiences of high-skilled female African migrant health-workers (MHW) utilising the framework of Global Care Chain (GCC) research. In the frame of the EU-project HURAPRIM (Human Resources for Primary Health Care in Africa), the research team conducted 88 semi-structured interviews with female and male African MHWs in five countries (Botswana, South Africa, Belgium, Austria, UK) from July 2011 until April 2012. For this paper we analysed the 34 interviews with female physicians and nurses using the qualitative framework analysis approach and the software atlas.ti. In terms of the effect of the migration on their career, almost all of the respondents experienced short-term, long-term or permanent inability to work as health-care professionals; few however also reported a positive career development post-migration. Discrimination based on a foreign nationality, race or gender was reported by many of our respondents, physicians and nurses alike, whether they worked in an African or a European country. Our study shows that in addition to the phenomenon of deskilling often reported in GCC research, many female MHW are unable to work according to their qualifications due to the fact that their diplomas are not recognized in the country of destination. Policy strategies are needed regarding integration of migrants in the labour market and working against discrimination based on race and gender.

Health professionals moving to... and from Portugal.

The mobility of health professionals in the European Union is a phenomenon which policy-makers must take into account to provide the conditions to adjust for demand and supply of health services. This paper presents the case of Portugal, a country which at the same time imports and exports health workers. Since the early 1990s Portugal became a destination country receiving foreign health care professionals. This situation is now changing with the current economic situation as fewer immigrants come and more Portuguese emigrate. Foreigners coming to Portugal do so in part for similar reasons that bring Portuguese to want to emigrate, mainly the search for better work conditions and professional development opportunities. The emigration of Portuguese health professionals is also stimulated by the difficulty for recently graduated nurses, dentists and diagnostic and therapeutic technicians to find employment, low salaries in the public and private sectors, heavy workloads, remuneration not related to performance and poor career prospects. The paradoxes described in this study illustrate the consequences of the absence of a policy for the health professions. Strategies based on evidence, and on an integrated information system that captures the dynamic evolution of the workforce in health are not only necessary but also a good investment.

Perú: Estadística de la migración internacional de peruanos, 1990-2008 / Peru: Statistics on the International Migration of Peruvians, 1990-2008

El mundo entero está en un período de observación, elaboración de estrategias y formulación de políticas para hacerle frente a la crisis económica-financiera y la amenaza de recesión mundial. Para los países de origen de la migración, existe una preocupación adicional a la crisis que guarda relación con las políticas de regulación de la migración que se han dictado en países de mayor desarrollo y la pérdida de oportunidades laborales en sectores económicos de mayor empleo de migrantes. Esta situación podría significar el retorno masivo de migrantes a sus países de origen con economías ya maltrechas por la crisis. El regreso de contingentes de migrantes sin una clara oportunidad de poder reinsertarse en un mercado económico ya disminuido en su capacidad de creación de empleo significaría mayor desempleo y un aumento de los niveles de pobreza. Alrededor de dos millones de peruanos han migrado al exterior en los últimos diecinueve años, según las cifras que se presentan en este documento. Cualquier suceso que afecte a esta concentración de nacionales en el exterior resulta sumamente importante, pues de su situación están pendientes 704,000 hogares peruanos que indicaron tener al menos un exmiembro del hogar viviendo en el exterior, según los datos recogidos en el Censo del 2007. Es importante para el Estado ahondar en el conocimiento de las condiciones sociales y económicas de su diáspora y establecer una más estrecha vinculación con sus nacionales en el exterior para crear estrategias y planificar el reforzamiento de políticas económicas, sociales y culturales a favor de ellos, lo que a su vez protegería a la población beneficiaria de las remesas sociales y económicas que los migrantes producen. (AU)