Diversity, Ethnicity, Migration and Work: International Perspectives PDF
Preview Diversity, Ethnicity, Migration and Work: International Perspectives
Diversity, Ethnicity, Migration and Work This page intentionally left blank Diversity, Ethnicity, Migration and Work International Perspectives Geraldine Healy and Franklin Oikelome ©GeraldineHealyandFranklinOikelome2011 Allrightsreserved.Noreproduction,copyortransmissionofthis publicationmaybemadewithoutwrittenpermission. Noportionofthispublicationmaybereproduced,copiedortransmitted savewithwrittenpermissionorinaccordancewiththeprovisionsofthe Copyright,DesignsandPatentsAct1988,orunderthetermsofanylicence permittinglimitedcopyingissuedbytheCopyrightLicensingAgency, SaffronHouse,6-10KirbyStreet,LondonEC1N8TS. Anypersonwhodoesanyunauthorizedactinrelationtothispublication maybeliabletocriminalprosecutionandcivilclaimsfordamages. Theauthorshaveassertedtheirrightstobeidentified astheauthorsofthisworkinaccordancewiththeCopyright, DesignsandPatentsAct1988. Firstpublished2011by PALGRAVEMACMILLAN PalgraveMacmillanintheUKisanimprintofMacmillanPublishersLimited, registeredinEngland,companynumber785998,ofHoundmills,Basingstoke, HampshireRG216XS. PalgraveMacmillanintheUSisadivisionofStMartin’sPressLLC, 175FifthAvenue,NewYork,NY10010. PalgraveMacmillanistheglobalacademicimprintoftheabovecompanies andhascompaniesandrepresentativesthroughouttheworld. Palgrave®andMacmillan®areregisteredtrademarksintheUnitedStates, theUnitedKingdom,Europeandothercountries. ISBN978–0–230–25218–9 Thisbookisprintedonpapersuitableforrecyclingandmadefromfully managedandsustainedforestsources.Logging,pulpingandmanufacturing processesareexpectedtoconformtotheenvironmentalregulationsofthe countryoforigin. AcataloguerecordforthisbookisavailablefromtheBritishLibrary. LibraryofCongressCataloging-in-PublicationData Healy,Geraldine(GeraldineMary) Diversity,ethnicity,migration,andwork:international perspectives/GeraldineHealy,FranklinOikelome. p. cm. Includesindex. Summary:“Providingacomprehensivepictureofdiversity,ethnicity, andmigrationinthehealthsectorthisbookanalysesthekey themesofcareerandcareerstructures,socialprocesses, segregation,racismandsexismatinternational,nationalandlocal levels”—Providedbypublisher. ISBN978–0–230–25218–9(hardback) 1. Healthservicesadministration. 2. Diversityintheworkplace. I. Oikelome,Franklin,1969– II. Title. RA971.H4632011 331.7(cid:2)613621—dc23 2011016925 10 9 8 7 6 5 4 3 2 1 20 19 18 17 16 15 14 13 12 11 PrintedandboundinGreatBritainby CPIAntonyRowe,ChippenhamandEastbourne Contents ListofTables viii Acknowledgements xi GlossaryofAbbreviations xii 1 WorkingintheHealthServices–Troubles,Issues, MigrationandEthnicity 1 2 DifferentHealthCareSystems–DifferentConditions? AComparativePerspective 16 Introduction 16 SettingthesceneintheUnitedKingdomandUnited States–thedebateonObama’shealthcarereform 16 Nigerian,UKandUShealthcarethroughacomparative lens 19 Theinternationalhealthcareworkforce 25 Conclusion 34 3 Diversity,Ethnicity,MigrationandWork:UKandUS Perspectives 36 Introduction 36 Diversitymanagement–background 37 UKinequalities:historicalandinstitutionalresponses 40 MigrationandtheBritishlegislativeresponse 42 Inequalitiesinhealthcarework 47 USinequalities:historicalandinstitutionalresponses 54 WorkinginhealthcareintheUnitedStates 62 Conclusions 65 4 Diversity,Ethnicity,MigrationandHealthina DevelopingCountry–TheCaseofNigeria 67 Introduction 67 EthnicdiversityinNigeria:issues,pastandpresent 68 ManagingdiversityinNigeria:policiesandinitiatives 73 Anassessmentofthepolicies 76 v vi Contents ThecaseofthehealthsectorinNigeria 79 Administration 80 Financing 81 Workforceandrecruitment 81 Migrationofhealthworkers 83 Inequalityanddiversityissues 86 Conclusions 89 5 InternationalMedicalGraduates–Workingina Two-TierSystem? 92 Introduction 92 InternationalandUKMedicalGraduates 94 Medicalcareergrades 96 Reward,workload,autonomyandmorale 99 Discussionincomparativecontext 106 Conclusions 107 6 GenderandInternationalMedicalGraduates: Historical,ContemporaryandIntersectional Perspectives 111 Introduction 111 Women’shistoricalstruggleintomedicine 113 Womendoctors:growth,segregationandinternational medicalgraduates 117 Gender,inequality,moraleandcareeraspiration 122 Discussionandinternationalperspectives 126 Conclusions 128 7 Front-lineHospitalWorkersandInequalities:Social Processes,RacismandCareerDevelopment 130 Introduction 130 ResearchingGreenfieldandBrownfield 132 Attitudesandexperiencesofworkingonthefront-linein healthcare 136 Manifestationsofracism 142 Challengingunfairtreatment 153 Conclusions 159 8 ChallengingInequalityIssues:TheUnionRole 162 Introduction 162 Labourunions 163 Unionidentitynetworks 164 Contents vii ReturningtoGreenfieldandBrownfield–perceptionsand experiencesofunions 169 UnionmembershipinGreenfieldandBrownfield 171 Experiencingtradeunionsintheworkplace 176 HowdoestheAmericanexperiencecompare? 180 Atthefrontline 184 AjourneytounioninvolvementintheAmericanhealth caresector 187 Conclusions 190 9 IdentitySocialNetworks–Formal,Informal, ProfessionalandCommunity 192 Introduction 192 Management-sponsorednetworks–backtoGreenfield andBrownfield 193 Informalandexternalnetworksandsocialcapital 200 Communityorganizations 204 Professionalidentitynetworks 207 Discussion 212 10 ManagingDiversityinUKandUSHealthCare Sector 214 Introduction 214 Revisitingthemanagementofdiversity contexts 215 Diversitymanagementinitiatives 217 EqualityanddiversityprojectsinUKandUShealth careorganizations 225 Discussionandconclusions 232 11 ReflectionsonDiversity,EthnicityandMigrationat WorkataTimeofChange 236 Appendices 249 Notes 301 Bibliography 317 Index 343 List of Tables 2.1 TheNigerian,UKandUShealthsystemscompared 24 2.2 Top20countriesofmedicaleducationforUSIMG physicians 27 2.3 USandIMGphysicianpopulationoverview 27 2.4 First-time,foreign-trainedRegisteredNurse(RN) candidatesforUSLicensureExamination,bytopsix exportingcountries,1997–2001 28 2.5 Top20countriesofqualificationforUKIMGs 30 2.6 TotalnumberofnursesandmidwivesonUKregister from2004to2008 32 2.7 InitialadmissionstotheUKregister:European economicareaandoverseascountries 32 2.8 InitialUKnursingadmissionsfiguresfor32source overseascountries 33 3.1 UKnon-medicalstaffbyethnicgroup 50 3.2 UKHospitalandCommunityHealthService(HCHS) medicalanddentalstaffbygradeandethnicity 52 3.3 Race-basedcharges:1997–2007 59 3.4 KeychangesforAfricanAmericanssinceCivilRights Act(1964) 61 4.1 Nigerianhealthworkerpopulationatnationallevel 82 4.2 NursesseekingemploymentoutsideNigeriafrom2004 to2006 84 4.3 Nigeriandoctorswhorequestedforcertificateofgood standingandtheirdestinationcountriesfortheyears 2005–2007 85 4.4 GenderdistributionbyhealthoccupationinNigeria 2007 87 4.5 Numberofhealthtrainingschoolsbygeographical distributioninNigeria 88 4.6 Regionaldistributionofhealthworkers:northand southofNigeria 89 5.1 UKmedicalanddentalstaff 97 viii ListofTables ix 5.2 UKmedicalstaffbygradeandcountryofqualification 98 5.3 ComparativeexperienceofUKMGsandIMGsof reward,workload,autonomyandmorale 102 6.1 UKdoctorsandIMGsbygenderandgrade 120 6.2 Medicalanddentalstaffbyspecialityandgender(SAS only) 121 7.1 CharacteristicsofintervieweesinGreenfieldand Brownfield 135 8.1 RepresentationofwomenandBMEmembersin UNISONstructures 169 8.2 UnionmembershipofBrownfieldandGreenfield intervieweesbysex 172 10.1 CoxandBlake(1991)andDreachslin’s(1999)diversity initiativesapproaches 219 Appendices A2.1 Top20USstatesIMGspractice(%ofstatephysician workforce) 249 A2.2 NHSHCHSandgeneralpracticeworkforce,1998–2008 250 A2.3 GuidefordoctorsnewtotheUK(2008) 252 A2.3.1 Howtogetstarted:Immigrationregulationsfor internationaldoctorscomingtotheUK 252 A5.1 Definitionsofvariablesusedinregressionmodels 256 A5.2 Regressioncoefficientsofsuccess,autonomyand workloadonindependentvariables 257 A5.3 Proportioncurrentlyreceivingdiscretionarypointsby qualificationandgender 258 A5.4 Autonomyindicatorsbyqualificationandagegroups 258 A5.5 Characteristicsofsurveyrespondentsinfull-time employment 259 A6.1 PhysiciansintheUSbygender:1970–2008 261 A6.2 MedicalanddentalstaffNHShospitalandcommunity healthservices 261 A6.3 TopPrimaryspecialties:AllIMG,maleandfemale physicians 262 A6.4 Medicalanddentalstaffbygrade,genderandnature ofcontract 263 A6.5 Characteristicsofsurveyrespondents 263
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