Stewart Publishes Article on World Health Care

An article co-authored by Dr. James Stewart, a member of Penn State Greater Allegheny's faculty, has generated world-wide interest.

The article, "The globalization of the labor market for health-care professionals," focuses on the growing shortage of doctors and nurses throughout the world and the migration of health care professionals from underdeveloped to developed countries. 

Funded through a grant from the Africana Research Center, Dr. Stewart, Professor of Labor Studies and Employment Relations and African and African American Studies;   Dr. Paul Clark, head of Penn State's Department of Labor Studies and Employment Relations, and Darlene Clark, Instructor in Nursing for the University, joined in writing the article.  Since its initial publication, the article has been published in three languages, been the focus of a story in the Pittsburgh Post-Gazette, and has been featured on the website of the AFL-CIO.

Dr. Stewart's research has included the globalization of workers and how migration to developed countries has particularly impacted African workers and their families.  His interest includes the African worker's adaptation to his/her new work environment in a post-industrial country context.

As the population of a country ages, there is a growing need for health care workers to care for that aging population.  Currently there is a shortage of health care workers globally and competition for their services is high.   Developed countries are able to pay more, provide better and safer working conditions, and offer expanded career opportunities.  Coupled with political stability and a better quality of life for their citizenry, developed countries have the attributes necessary to attract and hire health care professionals.  This practice creates a "brain drain" of trained workers from impoverished countries.  Especially successful in recruiting health care workers are those countries that have a nationalized health care program; i.e., the United Kingdom.  These countries better understand the needs of their health care system and can pinpoint target areas of concern.   Countries with decentralized systems; i.e., the United States, are not as well equipped to gather information and develop an overall recruitment plan. 

The migration of workers from underdeveloped countries can also cause a downward spiral of pay and working conditions for health care professionals overall as workers migrating to developed countries are more willing to accept contractual or part time employment.  This makes it increasingly difficult for health care workers to lobby for better benefits and higher pay, depressing wages and worsening employment conditions for all.   

Some countries, like the Philippines, are training and deliberately outsourcing their health care workers.  Providing trained employees to developed countries has become a business which contributes significantly to the Phillipine economy.  Most underdeveloped countries, however, are forced to develop policies to stop the drain of those health care professionals they have trained and educated with increasingly scarce resources.   Policies to stop the attrition have included imposing taxes on those countries which recruit health care professionals from the underdeveloped country, "bonding" policies which requires repayment by the worker for a period of time to compensate for the training received, as well as inter-country agreements which limit the number of recruits which can leave for employment elsewhere..

It is interesting to note that local hospitals currently have similar "bonding" programs in place for their nurse trainees.  Both Shadyside Hospital and Mercy have nurse training programs which require the nurse to become an employee of the hospital for a three-year period after training is completed.

Global and regional health organizations like the World Health Organization (WHO) have documented the minimum need of trained professionals for even the most basic of care (20 doctors for every 100,000 people).  Using this benchmark most underdeveloped countries are critically understaffed.  As an example, Liberia has only 2.3 doctors for every 100.000 people. 

When questioned on the role that global organizations could play in solving the migration of workers from underdeveloped nations, , Dr. Stewart stated that organizations like the WHO "could get a handle on the problem at large, could  inform and impart the best practices of all nations,  and could develop multi-level agreements between nations which might minimize the harm while maximizing the benefits of training and supplying health care professionals as needed."  As stated in the article, however, regulations could also impede the rights and needs of the individual worker.  The problem is complex, but must be examined and remedied in order to ensure the safety of the world's population and the containment of serious disease.  

The authors (Clark, Stewart, and Clark)  received funding for the article as part of a competitive process through the Africana Research Center.  The Center was part of the outgrowth of concerns that African-American students voiced to Penn State in the early 1990's.  The Center encourages and supports programs and interdisciplinary work to researchers who focus on issues of critical concern to those of African descent.  Dr. Stewart has served on the Advisory Board of the institution since its inception.    It is his hope to create active satellite operations of the center throughout the state of Pennsylvania in areas where larger populations of African Americans exist.