Surgical workforce in the American South.

There exists a geographic maldistribution of surgeons with significant regional characteristics, which is associated with surgical access differentials that may be contributing to existing health disparities in the United States. We sought to evaluate the trends in the surgical workforce in southern states of the United States from 1981 to 2006 using the American Medical Association Masterfile data. Our study revealed that the general surgery workforce growth peaked in 1986 and has had negative growth per capita as a result of the consistent population growth, unlike other regions in the country. Furthermore, the change in the geographic distribution of general surgeons in the South was slightly greater than for surgical specialists between 1981 and 2006. Twenty-nine per cent of all southern counties with a collective population of 7.4 million people had no general surgeon in 2006. The failure of the general surgery workforce to grow with population expansion has resulted in a significant number of counties that do not meet the recommended standards of geographic access to surgical care. An adequate solution to surgical workforce demand is imperative for viable and successful implementation of healthcare reform, particularly in geographic regions with large healthcare access disparities.

Changes in dentist and dental hygienist numbers in the European Union and economic area.

AIM: To investigate the extent to which changes in the numbers of dental hygienists and dentists have occurred in the Member States of the European Union and Economic Area (EU/EEA) during the last ten years and discuss the changes in relation to the possibilities of sharing tasks between the two groups. METHODS: Numbers for active dentists, registered hygienists and EU/EEA member state populations in 2007 were taken from the website of the Council of European Chief Dental Officers (CECDO) (www.cecdo.org) and from CECDO records for the EU/EEA member states in 1998 and for the new EU member states (who joined in 2004 and 2007) in 2000. From these data, population: active dentists, population: registered dental hygienist and active dentists: registered dental hygienist ratios were calculated together with percentage changes in the number of dentists and dental hygienists by member state, between 1998 and 2007 for the old and between 2000 and 2007 for the new EU member states. RESULTS: In 2007, there were a total of 343,922 active dentists and 30,963 registered dental hygienists in the 30 EU/EEA member states plus Switzerland. The mean population to dentist ratio was about 1500:1 and the mean population to dental hygienist ratio (in the 25 states where dental hygienists were registered) was 13,454:1. During the study period, the population of the EU/EEA plus Switzerland increased by less that 3%, the number of dentists increased by 13% and the number dental hygienists by 42%. The overall ratio of active dentists: dental hygienists changed from 18:1 to 11:1. In six of the 30 member states plus Switzerland the population to dental hygienist ratio was between 2000:1 and 6000:1 and the dentist: dental hygienist ratio less than 1:3. CONCLUSIONS: Although, most member states educate dental hygienists and their numbers in the EU/EEA during the last 10 years have risen more than the dentist numbers, there are still only a handful countries where the hygienist numbers are great enough to make a significant difference to the delivery of oral health care.

Shifting the gaze of the physician from the body to the body in a place: A qualitative analysis of a community-based photovoice approach to teaching place-health concepts to medical students.

Medical practitioners, trained to isolate health within and upon the body of the individual, are now challenged to negotiate research and population health theories that link health status to geographic location as evidence suggests a connection between place and health. This paper builds an integrated place-health model and structural competency analytical framework with nine domains and four levels of proficiency that is utilized to assess a community-based photovoice project's ability to shift the practice of medicine by medical students from the surface of the body to the body within a place. Analysis of the medical student's photovoice data demonstrated that the students achieved structural competency level 1 proficiency and came to understand how health might be connected to place represented by six of the nine domains of the structural competency framework. Results suggest that medical student's engagement with place-health systemic, institutional and structural forces deepens when they co-create narratives of their lived experiences in a place with patients as community members during a community-based photovoice project. Given the importance of place-health theories to explain population health outcomes, a place-health model and structural competency analytical framework utilized during a community-based photovoice project could help medical students merge the image of patients as singular bodies into bodies set within a context.

Dental school applicants by state compared to population and dentist workforce distribution.

Millions of Americans face significant barriers that limit their access to oral health care, including the lack of dental health care professionals willing to provide dental services in underserved areas. The purpose of this study was to evaluate the relationship between the geographic distribution of dental school applicants and the population and number of dentists by state. Data from the Associated American Dental Schools Application Service (AADSAS), the American Dental Association (ADA), the U.S. Census Bureau, and the U.S. Department of Commerce were used to determine the total number of dental school applicants, dentists, and populations by individual state. Results suggest that, based on national averages, the majority of states may have too few dentists to meet current and future state population needs. Also, many of these same states may have too few dental school applicants when compared to state population and dental workforce figures. It was concluded that states may wish to consider targeted initiatives aimed at increasing the sizes of their dental school applicant pools in order to help address current and future local or regional dental workforce needs.

The economics of dental practice--present and future.

The combination of increased practitioner income, increases in the proportion of the population reporting visits for dental services, decreases in the number of dental school graduates, decreases in the dentist-to-population ratio, and increases in the number of female students and practitioners (many of whom report significantly fewer work hours than their male counterparts), portends favorable economics for dental practices. However, the cost of dental care is "felt" to a greater extent than for other health services. Current and future funding arrangements for dental services could be vulnerable to economic downturns, efforts to control business overhead costs and continued minimal government support. There may need to be concern regarding the infrastructure of economics of dental practice. A series of favorable developments, including increasing dental practitioner income, an increasing use of dental services, decreasing numbers of graduates and decreasing practitioner-to-population ratios would seem to favor continued encouraging prospects for the future of dental practices. However, compared to other health services, the reliance on (1) out-of-pocket funding for a major share of dental expenditures, and (2) limited government support for dental services raise questions regarding the infrastructure of dental economics. These subjects are reviewed in the following presentation.

A realistic approach to locating dental practices: further considerations.

There are considerable demographic data that can be used in an organized manner to give dentists and graduating dental students greater insight relative to locating dental practices. This article further explores the concept and emphasizes the methods that can be used to measure and compare qualitatively the suitability of communities (service areas) and specific sites as practice locations. In addition, a method is reported that enables the user to ascertain the representativeness of a service area in terms of the demographic factors that affect the demand for dental services.

A survey of dental hygienist numbers in Canada, the European Economic area, Japan and the United States of America in 1998.

OBJECTIVE: The aims of this study were to establish how many dental hygienists were licensed to practice in Canada, Japan, USA and the 18 member states of the European Economic Area (EEA) and to compare these with the populations and numbers of dentists practising in the countries concerned. METHOD: Data for the overall populations, numbers of 'active' dentists, of dental hygienists and of employed dental hygienists in the member states of the EEA in 1998 were taken from the responses to a Council of European Chief Dental Officers survey carried out in 2000/2001. Data for these variables for Canada, Japan and the USA in 1998 were accessed from published reports. The ratios of population: active dentist; population: dental hygienist; and active dentist: dental hygienist were calculated and compared. RESULTS: The overall populations and total number of active dentists in the 18 EEA member states and Canada plus Japan plus the USA were broadly similar in 1998 (EEA overall population 381 million with 245169 active dentists: Canada/Japan/USA overall population 421 million with 253825 active dentists). However, there were only 13295 dental hygienists in the EEA as opposed to a total of 215435 in Canada, Japan and the USA. In terms of population:dental hygienist and active dentist: dental hygienist ratios the UK was found to have proportionally far fewer dental hygienists than Canada, Japan, USA or the four Nordic members of the EEA. CONCLUSION: The survey revealed that relative to overall populations and numbers of dentists, there are far fewer dental hygienists in the EEA than in Canada, Japan and the USA and that scope for the UK to import dental hygienists from other EEA member states is probably very limited.

Self-selection and intermunicipal migration in Canada.

"This paper investigates individual intermunicipal migration behaviour in Canada within the context of a human capital model that adjusts for the migrant's selectivity in computing expected income gains. In addition to the typical regional determinants of migration, housing and labour market characteristics are found to influence intermunicipal migration significantly, the effects differing with age. Structural coefficients remained more or less stable during the decade 1971-1981. It is shown that the failure to adjust income gains for selectivity bias results in an underestimation of the migration-impacts of income gains and municipal-specific factors."

The underemployment of American rural women: prevalence, trends and spatial inequality.

PIP: The growing numerical significance of women in the US nonmetropolitan labor force has not been matched by parallel efforts to document the changing quality of their employment. In this paper. Lichter uses the labor utilization framework of Clogg and Sullivan to examine the prevalence and spatial convergence of various forms of female underemployment during 1970-1985. Data from the March annual demographic files of the Current Population Survey reveal that underemployment has been a significant aspect of the employment experiences of nonmetropolitan women during this period. There has been little evidence of spatial or sex convergence in labor market outcomes. Roughly 1 of every 3 rural female workers today is a discouraged worker, jobless, employed part-time involuntarily, or working for poverty-level wages. Moreover, rural women continue to suffer substantially higher levels of economic underemployment than urban women and rural men. This study reinforces the view that rural women remain a seriously underutilized labor resource in the US.^ieng

Afro-Caribbean migrants in France: employment, state policy and the migration process.

"Afro-Caribbean labour in France plays a distinctive role relative to the French population as a whole and the foreign immigrant population. Using a variety of qualitative and quantitative sources, this paper demonstrates that the role of the state in the process of migration from the French Caribbean islands of Martinique and Guadeloupe from the early 1960s onwards was crucial.... Aggregate sources are used to describe detailed occupational distributions while records of individual migrants illustrate the process of migration and the influences on employment. At a time usually characterized by lack of direct involvement in migration by the French state, for Afro-Caribbeans state intervention in recruitment, training and settlement is shown to be very substantial."

International migration and real wages: a resolution note.

PIP: The authors examine the impact of international labor migration on wages in country of origin. Two types of emigration are distinguished: bundled emigration, which can result in a reduction of real wages; and pure labor emigration, which results in an increase in real wages.^ieng

Urbanization in a developing country: city size and population composition.

Reasons for the high correlation between city size and educational attainment in developing countries are explored. "Two explanations are examined. First, the types of goods produced in larger cities require relatively high skill labor inputs. Second, public and perhaps private services demanded by higher skill people are only offered in larger cities. The paper econometrically tests these hypotheses for Brazil, estimating the elasticities of substitution (or typically complementarity) between high and low skill labor and the 'bright lights' effect for high versus low skill labor."

Population pressure, intensification of agriculture, and rural-urban migration.

"In this paper I provide an analytical basis for why labor absorption [in agriculture] may improve with higher population density. My argument is in two parts. First, analysing agriculture in isolation, I use the Boserup insight to show that higher population density is associated with more intensive techniques of land use. Second, using a two-sector model, I show that the rate of labor absorption (defined as the rate of natural population growth minus the rate of rural-urban migration) increases with the intensity of land use." Cross-sectional data for Iran are used to illustrate the model.

PIP: This paper considers the Malthusian implication that population density leads to the inability of agriculture to absorb labor. The argument is presented that higher population density is associated with more intensive techniques of land use, based on the Boserup model, and that the rate of labor absorption (natural population growth minus the rate of rural-to-urban migration) increases with the intensity of land use. The model reveals that the availability of jobs in urban areas slows agricultural intensification and increases migration. The Asian model is different in that urbanization and intensification occur simultaneously. The model is empirically tested with Iranian data. Results indicate negative signs for the intensity coefficients (irrigation ratio and cropping intensity), which means a negative influence on rural out-migration. Population density has a positive coefficient. The effect of the percentage of land tilled by tractors is positive, while the number of diesel pumps in operation reduces out-migration. The contrasting results of Annable, Bilsborrow, and Winegarden are considered plausible, since an intensification factor is not included and population density is picking up the negative effect of the intensity of cultivation. High rates of out-migration from low population density areas usually are explained by the poor natural resources available. It is argued that poor soil quality is related to cultivation intensity, and thus, soil fertility is exogenous. The results are intended not as a definitive proof of the direct effect of population density on agricultural employment, but as an alternative explanation for out-migration from low density areas. Population increases clearly cause declines in wages in the proposed model and may not lead to intensification but to out-migration. Increases in agricultural prices or lowering the cost of inputs can promote intensification. Population density will always reduce the potential of a region to absorb population. Government has the ability to influence public investment in agriculture and trading through its regulations, which can speed up intensification and the capacity to provide agricultural employment. Government can also indirectly encourage out-migration through the promotion of attractive urban labor markets.

The earnings of Mexican immigrants in the United States.

"This paper documents the trends in the earnings of Mexican immigrants during the 1970-1990 period. The empirical evidence indicates that there has been a decline in the relative wage of successive Mexican immigrant waves in the past three decades and that little wage convergence occurs between the typical Mexican immigrant and the typical native worker. The data also suggest that the increasing importance of Mexican immigration is partly responsible for the deterioration in relative skills observed in the aggregate immigrant population, but that there has also been a decline in relative skills even among non-Mexican immigrants."

Migration, remittances, and inequality: estimating the net effects of migration on income distribution.

"This paper examines the net effects of migration and remittances on income distribution. Potential home earnings of migrants are imputed, as are the earnings of non-migrants in migrant households, in order to construct no-migration counterfactuals to compare with the observed income distribution including remittances. The earnings functions used to impute migrant home earnings are estimated from observations on non-migrants in a selection-corrected estimation framework which incorporates migration choice and labor-force participation decisions. For a sample of households in Bluefields, Nicaragua, migration and remittances increase income inequality when compared with the no-migration counterfactual."

Migration to the United States and Mexican rural development: a case study.

An analysis of the impact of migration to the United States on the sending community and on the labor market in the receiving country is presented based on a case study of Las Animas, Mexico. "As the community becomes increasingly involved in migration, tendencies can be identified regarding changing migration patterns, class differentiation among villagers, impact of migration on village economy, and the changing role of Mexican workers in California labor markets. Results indicate the importance of social networks in determining the outcome of migration; while migration is individually rational, it is a factor of stagnation for village economy, and it helps reproduce segmented California labor markets."

The determinants of East-West German migration: some first results.

Determinants of the propensity to migrate are explored using data collected in a survey of East German residents following German reunification in 1991. The author notes that in the period 1989-1992, some 870,000 individuals migrated to West Germany, representing about 5% of the total East German population and 10% of the work force. He suggests that "recent developments in the literature on the option value of waiting may yield important insights into these determinants."

Immigration from poor to wealthy countries: experience of the United States.

PIP: The U.S. experience with immigration from poor countries is examined using the results of two projects carried out by the National Bureau of Economic Research. Questions considered include what determines the supply of immigrants, how such immigrants fare in the U.S. job market, and how this immigration affects the prospects of native-born workers.^ieng

Why do rich countries prefer free trade over free migration? The role of the modern welfare state.

"According to traditional trade theory (Heckscher-Ohlin), free trade and free migration are equivalent measures of economic integration leading both to an equalization of factor prices. This prediction is in sharp opposition to the observed preference of rich countries for free trade over free migration. We provide an explanation for this inconsistency: the redistribution policies in the countries. Social welfare in countries with a relatively small number of low-skilled native workers is higher with free trade than with free migration due to redistribution of income towards immigrating workers."

Gendered histories: garment production and migration in Mexico.

Data gathered in Aguascalientes during the 1990s are used to analyze how the garment industry in Mexico has responded to economic recession and trade liberalization. In particular, the relationship between industrial change and gendered patterns of migration are explored. The author concludes that "migration over recent years has increasingly allowed working women the possibility of entering a transnational labour force and given them important labouring and living experiences on both sides of the border."