Moving from advocacy to activism? The fourth WHO global forum on human resources for health and implications for dentistry.

As we debate shaping the future oral health workforce within the UK, to meet the needs of current and future populations, it is helpful to take an international perspective on this very important issue. Globally, there is a strong recognition that human resources for health (HRH) are fundamentally important to deliver effective care, accessible to all people. This paper reviews the outcome of the fourth global forum held by the World Health Organisation (WHO) in Dublin which highlighted the urgency for action. The main objectives of the forum were to advance the implementation of (i) the WHO Global Strategy on HRH 2030 and (ii) the United Nations High-Level Commission's Health Employment and Economic Growth recommendations. From an oral health perspective, the global burden of oral disease remains huge with untreated dental caries, periodontal disease and tooth loss ranking among the most prevalent conditions worldwide. Major considerations are how dental education, practice delivery and/or oral health systems as a whole could and should innovate to accommodate the growing needs of the population. As dental professionals, it also becomes necessary for us to engage and play a proactive role in this change process. Due to growing differences between population needs and available services, it is necessary for oral health personnel to work more closely with the broader health workforce so as to identify solutions that are in the best interests of the patients and populations at large.

Development of life story experience (LSE) scales for migrant dentists in Australia: a sequential qualitative-quantitative study.

INTRODUCTION: The integration of qualitative and quantitative approaches introduces new avenues to bridge strengths, and address weaknesses of both methods. OBJECTIVE: To develop measure(s) for migrant dentist experiences in Australia through a mixed methods approach. METHODS: The sequential qualitative-quantitative design involved first the harvesting of data items from qualitative study, followed by a national survey of migrant dentists in Australia. Statements representing unique experiences in migrant dentists' life stories were deployed the survey questionnaire, using a five-point Likert scale. Factor analysis was used to examine component factors. RESULTS: Eighty-two statements from 51 participants were harvested from the qualitative analysis. A total of 1,022 of 1,977 migrant dentists (response rate 54.5%) returned completed questionnaires. Factor analysis supported an initial eight-factor solution; further scale development and reliability analysis led to five scales with a final list of 38 life story experience (LSE) items. Three scales were based on home country events: health system and general lifestyle concerns (LSE1; 10 items), society and culture (LSE4; 4 items) and career development (LSE5; 4 items). Two scales included migrant experiences in Australia: appreciation towards Australian way of life (LSE2; 13 items) and settlement concerns (LSE3; 7 items). CONCLUSION: The five life story experience scales provided necessary conceptual clarity and empirical grounding to explore migrant dentist experiences in Australia. Being based on original migrant dentist narrations, these scales have the potential to offer in-depth insights for policy makers and support future research on dentist migration.

Job satisfaction among 'migrant dentists' in Australia: implications for dentist migration and workforce policy.

BACKGROUND: Migrants occupy a significant proportion of the dental workforce in Australia. The objectives of this study were to assess the level of job satisfaction of employed migrant dentists in Australia, and to examine the association between various migrant dentist characteristics and job satisfaction. METHODS: All migrant dentists resident in Australia were surveyed using a five-point Likert scale that measured specific aspects of job, career and satisfaction with area and type of practice. RESULTS: A total of 1022 migrant dentists responded to this study; 974 (95.4%) were employed. Responses for all scales were skewed towards strongly agree (scores ≥4). The overall scale varied by age group, marital status, years since arrival to Australia and specialist qualification (chi-square, p < 0.05). In a multivariate logistic regression model, there was a trend towards greater satisfaction amongst older age groups. Dentists who migrated through the examination pathway (mainly from low- and middle-income countries) had a lower probability of being satisfied with the area and type of practice (OR = 0.71; 0.51-0.98), compared with direct-entry migrant dentists (from high-income countries). CONCLUSIONS: The high level of job satisfaction of migrant dentists reflects well on their work-related experiences in Australia. The study offers policy suggestions towards support for younger dentists and examination pathway migrants, so they have appropriate skills and standards to fit the Australian health care environment.

The importance of workforce surveillance, research evidence and political advocacy in the context of international migration of dentists.

The international migration of dentists is an issue of pressing significance that poses several complex policy challenges. Policy-making is mainly constrained by the lack of workforce surveillance, research evidence and political advocacy - all three are required to work together, yet with different purposes. We first discuss the inconsistencies in migrant dentist surveillance in major country-level governmental systems (immigration departments, dentist registration authorities and workforce agencies). We argue that the limitations in surveillance collections affect independent research and in turn scholarly contributions to dental workforce policy. Differences in country-level surveillance collections also hinder valid cross-country comparisons on migrant dentist data, impeding global policy efforts. Due to these limitations, advocacy, or the political process to influence health policy, suffers, but is integral to future challenges on dentist migration. Country-level advocacy is best targeted at improving migrant dentist surveillance systems. Research interest can be invigorated through targeted funding allocations for migration research and by improving the availability of dentist surveillance data for research purposes. At the global level, the WHOs global code of practice for international recruitment of health personnel (a crucial advocacy tool) needs to be strengthened. Global organisations such as the FDI World Dental Federation have an important role to play in advocating for improved migrant dentist workforce surveillance and research evidence, especially in low- and middle-income countries.

Assessing exposures in the United Kingdom's Armed Forces--a review of systems that collect data useful for exposure assessment.

The ability to assess the exposure of individuals or groups is a critical element in any effective health surveillance system, as it provides the opportunity to identify the causes of ill health, the levels of exposure resulting in ill health and, through controlling exposures, to protect the health of Service personnel. As part of a wider programme to enhance the health surveillance capabilities of the Defence Medical Services, a project was undertaken to assess the collection and retention of data for exposure assessment in the United Kingdom's Armed Forces. The systems investigated include those for health, safety and environment policy, personnel and pay, medical records, environmental and occupational monitoring and historical records. It was found that the use of many systems for exposure assessment would be hampered by inconsistencies in the data collected, poor accessibility and linkage, and variability in the retention of the data. This paper highlights some of the problems that limit the usefulness of the record systems for exposure assessment and summarizes the principal recommendations made for enhancing the systems to better facilitate health surveillance.

Should public health experts listen to the people or tell them what to think and do? Yes and no, more or less.

This article refers to Margo Kingston's analysis of Pauline Hanson's doomed election campaign in 1998 (Kingston M. Off the Rails: The Pauline Hanson Trip. Sydney: Allen and Unwin; 1999) for insights that may resolve the Chapman/Mooney debate. Should we listen to Pauline Hanson or tell her and her One Nation colleagues what to think and do? Yes, and no, more or less. If more Australian citizens were given access to the material, social, educational and other privileges that Margo Kingston has enjoyed we wouldn't have a debate.

Protecting environmental quality and human health: strategies for harmonisation.

In September 1999 the MRC Institute for Environment and Health hosted a multidisciplinary seminar on the harmonisation of strategies to protect environmental quality and human health. The objectives of the meeting were to share information about ways in which the protection of the environment and human health can be harmonised, and, by bringing together an audience representing a range of disciplines, interests and sectors, to explore how these may be integrated to inform policy, decision-making and the management of risks. Key conclusions from the seminar focused on the importance of sustainable development, harmonising risk assessment and the role of stakeholder involvement. The necessary move from an expert-based to a dialogue-based process will require concerted efforts on the part of scientists, policy-makers, regulators, industry and the public.

George Rupert Palmer--DRG carrier and champion.

Prompted by the retirement of the distinguished health economist, researcher and academic, Professor George Rupert Palmer, the purpose of this paper is to reflect upon and acknowledge one of his many contributions to health services research and development. By employing a conceptual framework devised by Kimberly and de Pouvourville (1993) for analysis of the diffusion of innovations, this paper argues that Palmer played a crucial role in the diffusion into and within Australia of a particular casemix method, diagnosis related groups (DRGs). Textual and interview evidence presented in the paper supports the identification of George Rupert Palmer as the principal carrier of DRGs into Australia, and as one of its key champions within Australia.

From headloading to the iron horse: the unequal health consequences of railway construction and expansion in the Gold Coast, 1898-1929.

This paper examines the health consequences of railway construction and expansion in the Gold Coast (present day Ghana) between 1898 and 1929. More specifically, it examines the differential effects of colonial railway development for the different socio-economic groups of the Gold Coast society. The case study utilizes sociological and historical perspectives to analyse primary historical data on the health of the three groups most affected by the Gold Coast railways: expatriate railway workers, African railway workers and African communities living both within and outside the immediate vicinity of the railways. The study unearths evidence of largely positive health consequences for expatriate workers and African elites, and considerable negative health consequences for the Africans employed as railway labourers, the newly created urban poor as well as those Africans living in the rural areas.

Community participation or community manipulation? A case study of the Illawarra Cancer Appeal-a-thon.

Fashion parades, balls, raffles, and weekly deductions from thousands of workers' pay packets were integral to success of the Cancer Appeal-a-thon in the Illawarra region. In 1986-87 the Illawarra community was induced to contribute $1.5 million in order to purchase a linear accelerator for the Wollongong Hospital. The community agreed that a radiotherapy machine was the number one health service priority for the region. Or did it? Application of Alford's structural interests framework to this case-study reveals how failure to examine power relations between medical monopolizers, health care rationalizers and community participants results in an inability to recognise that alternative community needs--for cancer prevention, domiciliary care, or alternative therapies--might be unarticulated or unobservable, and in an inability to ask whether the community may be mistaken about, or unaware of, its own health needs. Specifically, the paper argues that, 'community needs' are easily manipulated or distorted by powerful interest groups and that the political context within which community needs are recognized, articulated and mobilized is the most important issue for community participation in the health policy-making process.

Physiotherapy - a feminine profession.

The female-dominated professions in health care are not as powerful as the male-dominated medical profession. This paper suggests that the key factor in shaping the discrepancies in pay, status and power between medicine and the female-dominated professions is gender. It is argued that physiotherapy developed as a profession for middle-class women and that family responsibilities continue to take priority over professional responsibilities for the majority of physiotherapists. Physiotherapy enjoys higher occupational prestige than social work, speech therapy, occupational therapy and nursing and it is suggested that physiotherapy has achieved this status through recruitment of women from middle and upper middle class backgrounds. The history of physiotherapy is the history of a middle class feminine profession.