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Market-based migrant intermediaries play an important role in skilled migration. Skilled workers, especially in regulated professions such as nursing, face increasingly complex testing and credenti...

Globally there is a care crisis in terms of the quantity of care needed for an aging population and the quality of both the care provided and work conditions of those providing this care. The COVID-19 pandemic has exposed and heighted this crisis of care. In this chapter we review the issue with a particular focus on long-term care (LTC) facilities and the type and skill mix of labour, including the degree to which immigrant workers are over-represented in this sector. We offer some conceptual reflections on elder care as a matter of social justice and ethics in terms of those needing and providing care. These concerns take on a specific global dimension when we understand the transnationalisation of care, or the care provisioning function of what are termed global care chains. We contextualise how this migrant labour is positioned within this sector through international comparisons of funding models for LTC, which also allows us to understand the structural conditions within which this globally-sourced workforce is positioned. We then highlight two significant contributing factors to the current LTC crisis that were intensified and exposed during the COVID-19 pandemic using Ontario, Canada, as an example: the role of the private sector and the unsustainable extraction of profits from this service, and the gendered and racialised devaluing of migrant labour so essential to the sector.

Background The World Health Organization adopted the Global Strategy on Human Resources for Health Workforce 2030 in May 2016. It sets specific milestones for improving health workforce planning in member countries, such as developing a health workforce registry by 2020 and ensuring workforce self-sufficiency by halving dependency on foreign-trained health professionals. Canada falls short in achieving these milestones due to the absence of such a registry and a poor understanding of immigrants in the health workforce, particularly nursing and healthcare support occupations. This paper provides a multiscale (Canada, Ontario, and Ontario’s Local Health Integration Networks) overview of immigrant participation in nursing and health care support occupations, discusses associated enumeration challenges, and the implications for health workforce planning focusing on immigrants. Methods Descriptive data analysis was performed on Canadian Institute for Health Information dataset for 2010 to 2020, and 2016 Canadian Census and other relevant data sources. Results The distribution of nurses in Canada, Ontario, and Ontario’s Local Health Integration Networks reveal a growth in Nurse Practitioners and Registered/Licensed Practical Nurses, and contraction in the share of Registered Nurses. Immigrant entry into the profession was primarily through the practical nurse cadre. Mid-sized communities registered the highest growth in the share of internationally educated nurses. Data also pointed towards the underutilization of immigrants in regulated nursing and health occupations. Conclusion Immigrants comprise an important share of Canada’s nursing and health care support workforce. Immigrant pathways for entering nursing occupations are complex and difficult to accurately enumerate. This paper recommends the creation of an integrated health workforce dataset, including information about immigrant health workers, for both effective national workforce planning and for assessing Canada’s role in global health workforce distribution and utilization.

This collaborative paper written by mid-career and senior faculty employed in public and private institutions explores the challenges of feminist mentoring at mid-career. We engage this pro...

The twenty-first century has witnessed a number of significant demographic and political shifts that have resulted in a care crisis. Addressing the deficit of care provision has led many nations to...

Four years ago, eleven women collaborated on a paper advocating a collective, feminist engagement with the pressures and consequences of the neoliberal academy. Inspired by that work and now as mid-career scholars, the authors of this chapter are increasingly thinking about how to create lasting imprints for a better future inside and outside the academy. They ask what difference a shiFt in thinking towards “imprints” and away from “canons” and “legacies” can make? They imagine future retirements from the academy not in terms of that rarified inclusion in the canon and its individualistic and patrimonial inferences, but in terms of imprint, and the idea of leaving a lasting impression on other scholars and scholarly communities through being-in-relation with others and a diverse set of scholarship.

This chapter focuses on the challenges that the COVID-19 pandemic poses for health professionals and the concurrent challenges for geographical scholarship on them as a group. Without health workers there is no health, and understanding the geographical complexities of occupational hierarchies, distribution, location and circulation of human health resources remains a rich and necessary field of health geography. The pandemic has made it clear that developed world health systems rely on internationally trained immigrant health professionals to fulfil critical roles, but their centrality contrasts with issues of hierarchy and division that beset the health professions. The chapter argues that through research we need to consider the future health human resource challenges of a post-COVID-19 world and also undergo somewhat of a fundamental re-evaluation and transformation in the way we value workers and our commitment to a global health agenda that acknowledges the fundamental reality of one health one planet.

Background: Gender roles affect health worker migration and their migration experiences, but policy responses have rarely considered the gender dimensions of health worker migration. This invisibility and lack of attention can lead to social, health and labour market inequities. Methods: A Canadian-led research team with co-investigators in the Philippines, South Africa, and India studied the international migration of health workers from these ‘source’ countries through documentary, interview and survey data with workers and country-based stakeholder interviews. Our particular focus was to examine the causes, consequences and policy responses to health worker migration. Here we undertake an explicit gender-based analysis highlighting the gender-related influences and implications that emerged from the literature, policy documents and empirical data. Results: Our data from nurses, physicians, and other health workers reveal that gender mediates health workers’ access and participation in health worker training, employment, and migration, and the impact of health worker migration is gendered, depending on country context. Female migrant health workers were “preferred” for “innate” personal characteristics and cultural reasons. Female nurse migration in particular is greatly influenced and linked to personal relationships and social networks including friends in the diaspora. Remittances by female nurses to family back home may play a large role in the decision to migrate. Migration may improve social status of women nurses, but it also exposes them to deskilling, sexism and racialization. Regardless of these apparent differences in migration decision-making and experiences for women and men health workers, gender is rarely considered either as an important contextual influence or analytic category in the policy responses.Conclusion: An explicit gender-based analysis on health worker migration offers useful insights for health workers considering migration and those that ultimately migrate, the workplaces and families they leave behind, and social and health policy of their countries.

Background Gender roles and relations affect both the drivers and experiences of health worker migration, yet policy responses rarely consider these gender dimensions. This lack of explicit attention from source country perspectives can lead to inadequate policy responses. Methods A Canadian-led research team partnered with co-investigators in the Philippines, South Africa, and India to examine the causes, consequences and policy responses to the international migration of health workers from these ‘source’ countries. Multiple-methods combined an initial documentary analysis, interviews and surveys with health workers and country-based stakeholders. We undertook an explicit gender-based analysis highlighting the gender-related influences and implications that emerged from the published literature and policy documents from the decade 2005 to 2015; in-depth interviews with 117 stakeholders; and surveys conducted with 3580 health workers. Results The documentary analysis of health worker emigration from South Africa, India and the Philippines reveal that gender can mediate access to and participation in health worker training, employment, and ultimately migration. Our analysis of survey data from nurses, physicians and other health workers in South Africa, India and the Philippines and interviews with policy stakeholders, however, reveals a curious absence of how gender might mediate health worker migration. Stereotypical views were evident amongst stakeholders; for example, in South Africa female health workers were described as “preferred” for “innate” personal characteristics and cultural reasons, and in India men are directed away from nursing roles particularly because they are considered only for women. The finding that inadequate remuneration was as a key migration driver amongst survey respondents in India and the Philippines, where nurses predominated in our sample, was not necessarily linked to underlying gender-based pay inequity. The documentary data suggest that migration may improve social status of female nurses, but it may also expose them to deskilling, as a result of the intersecting racism and sexism experienced in destination countries. Regardless of these underlying influences in migration decision-making, gender is rarely considered either as an important contextual influence or analytic category in the policy responses. Conclusion An explicit gender-based analysis of health worker emigration, which may help to emphasize important equity considerations, could offer useful insights for the health and social policy responses adopted by source countries.

This paper examines masculinity, migration and the changing occupational status of nursing through the lens of therapeutic mobilities; health related mobilities of people (nurses) and products (cre...

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This paper investigates international labour migration financing processes and related resource backwash – the flow of resources away from the migrant household which continue sometime after the in...

Introduction How do capital and labour mobilities interact in the context of Indian nurse training and migration, and what kind of institutional actors facilitate the multiscalar mobility of this labour? This chapter will address this question using the example of the global mobility of nurses. Nurses represent the largest, most internationalized and feminized section of the health profession, and developed regions of world have demanded well-trained nurses because of demographic and health care delivery changes. These changes are connecting regions of the world through increasingly globally oriented models of nursing training, skills development, and labour and related capital mobility. The nature of historic and new migration corridors marks the evolving spatiality of this labour mobility and associated capital flows. Novel state–market interactions structure these processes of labour mobility and mark new institutional forms of governance related to nurse training and deployment of migrant labour. Nursing is a specifically gendered occupation, and the cultural context allows us to understand the particular embodied nature of nursing—how this contributes to the disciplining and controlling of workers, and how their skills and capabilities are constructed and utilized. This chapter makes explicit connection between labour and capital mobility by drawing upon research conducted in India and Canada to highlight how labour and capital mobilities interact in global nursing labour circulation. The health care services industry is one of the most significant and growing parts of the global economy. The United Nations’ International Standard Industrial Classification (ISIC) categorizes the health care industry as hospital activities, medical and dental practice activities, and other human health activities that occur under the supervision of health professionals in various areas. In terms of value, a 2017 health care outlook report by Deloitte (2017) indicated that health care spending represents 10.4 per cent of global GDP in 2015 (US$7 trillion in 2015) and is expected to rise over the next 5 years, especially in low-income nations. Health care is witnessing neoliberal industrialization in terms of the division, standardization, deskilling of health care labour, and rise of managerial superstructures (Rastegar, 2004), including widespread but differentiated engagement with New Public Management approaches to increase efficiency and enhance innovation (Pollitt and Bouckaert, 2017).

This paper examines nurse migration from India and the Philippines through the lens of the sustainable development goals (SDGs) 4.3 (access to training), 10.7 (orderly and responsible migration) and 3.c (retention of health workers). The international migration of health workers has increasingly featured on the agenda of global health agencies. Ameliorating the negative impact of international nurse emigration from low-income nations has been addressed by several western governments with the adoption of ethical recruitment guidelines, one element of an orderly migration framework. One of the challenges in creating such guidelines is to understand how the emigration of trained nurses influences health education and clinical training systems within nurse exporting nations such as India and the Philippines, and how these relate to various SDGs. This paper maps the connections between India’s and the Philippines’ increasing role in the provision of nurses for international markets and the SDGs related to training and migration governance and the retention of health workers. The paper calls for greater attention to the global structuring of migrant mobility in order to assess national abilities to meet SDG goals in these areas.

Background: Older adults are the fastest growing age group worldwide and in Canada. Immigrants represent a significant proportion of older Canadians. Social isolation is common among older adults and has many negative consequences, including limited community and civic participation, increased income insecurity, and increased risk of elder abuse. Additional factors such as the social, cultural, and economic changes that accompany migration, language differences, racism, and ageism heighten older immigrants’ vulnerability to social isolation. Objective: This mixed-methods sequential (qualitative-quantitative) study seeks to clarify older immigrants’ social needs, networks, and support and how these shape their capacity, resilience, and independence in aging well in Ontario. Methods: Theoretically, our research is informed by an intersectionality perspective and an ecological model, allowing us to critically examine the complexity surrounding multiple dimensions of social identity (eg, gender and immigration) and how these interrelate at the micro (individual and family), meso (community), and macro (societal) levels in diverse geographical settings. Methodologically, the project is guided by a collaborative, community-based, mixed-methods approach to engaging a range of stakeholders in Toronto, Ottawa, Waterloo, and London in generating knowledge. The 4 settings were strategically chosen for their diversity in the level of urbanization, size of community, and the number of immigrants and immigrant-serving organizations. Interviews will be conducted in Arabic, Mandarin, and Spanish with older women, older men, family members, community leaders, and service providers. The study protocol has received ethics approval from the 4 participating universities. Results: Quantitative and qualitative data collection is ongoing. The project is funded by the Social Sciences and Humanities Council of Canada. Conclusions: Comparative analyses of qualitative and quantitative data within and across sites will provide insights about common and unique factors that contribute to the well-being of older immigrants in different regions of Ontario. Given the comprehensive approach to incorporating local knowledge and expert contributions from multilevel stakeholders, the empirical and theoretical findings will be highly relevant to our community partners, help facilitate practice change, and improve the well-being of older men and women in immigrant communities. International Registered Report Identifier (IRRID): DERR1-10.2196/12616

Globalisation, supply–demand dynamics, uneven development, enhanced connectivity including the better flow of information, communication and the reduced cost of travel have encouraged the global integration of nursing labour markets. Developed regions of the world have attracted internationally educated nurses (IENs) because of growing healthcare needs. India, along with the Philippines, has become a key supplier of nurses in the global economy. Traditionally the supply of nurses was heavily regionalised in south India, especially Kerala, but of late Punjab, in north India, has played an increasing role in nurse training and migration as the profession has become more respected and more international. This paper uses survey and interview data to detail the recent interest in nursing as a channel for independent female international migration from Punjab, and to examine how migratory ambitions have developed over the last decade in parallel with the changing status of nursing as an internationally ...

In this paper we reflect on the Komagata Maru as a fundamental foreshadowing of a century of Sikh negotiation with the Canadian state to achieve inclusion and belonging. The commitment of Gurdit Singh, who charted the vessel, is emblematic of miri piri, the idea that the spiritual and political cannot be separated in the fight for justice. We use miri piri as a lens through which to examine a century of Sikh struggle in Canada since the Komagata Maru. We examine four cases of Sikh-led social activism that illustrate the spirit of miri piri – the integration of the spiritual and the political in the act of resistance against injustice. Our cases include the demand for refugee rights, recognition and inclusion of minority veterans, the protection of minority groups in the wake of 9/11, and the fight to protect religious expression in Quebec. We then address what we believe is missing in Sikh social activism in terms of fighting for gender and caste equality within Sikh communities themselves. We con...

It is with pleasure that we open this issue of Gender, Place and Culture with a short commentary as it enters its 25th year of publication! For a quarter of a century, feminist geographers have bee...

International audience; This Special Issue expands mobilities research through the idea of therapeutic mobilities, which consist of multiple movements of health-related things and beings, including, though not limited to, nurses, doctors, patients, narratives, information, gifts and pharmaceuticals. The therapeutic emerges from the encounters of mobile human and non-human, animate and inanimate subjects with places and environments and the individual components they are made of. We argue that an interaction of mobilities and health research offers essential benefits: First, it contributes to knowledge production in a field of tremendous social relevance, i.e. transnational health care. Second, it encourages researchers to think about and through functionally limited, ill, injured, mentally disturbed, unwell and hurting bodies. Third, it engages with the transformative character of mobilities at various scales. And fourth, it brings together different kinds of mobilities. The papers in this Special Issue contribute to three themes key for the therapeutic in mobilities: a) transformations (and stabilizations) of selves, bodies and positionalities, b) uneven im/mobilities and therapeutic inequalities and c) multiple and contingent im/mobilities. Therapeutic mobilities comprise practices and processes that are multi-layered and mutable; sometimes bizarre, sometimes ironic, often drastically uneven; sometimes brutal, sometimes beautiful – and sometimes all of this at the same time.

BACKGROUND Older adults are the fastest growing age group worldwide and in Canada. Immigrants represent a significant proportion of older Canadians. Social isolation is common among older adults and has many negative consequences, including limited community and civic participation, increased income insecurity, and increased risk of elder abuse. Additional factors such as the social, cultural, and economic changes that accompany migration, language differences, racism, and ageism heighten older immigrants’ vulnerability to social isolation. OBJECTIVE This mixed-methods sequential (qualitative-quantitative) study seeks to clarify older immigrants’ social needs, networks, and support and how these shape their capacity, resilience, and independence in aging well in Ontario. METHODS Theoretically, our research is informed by an intersectionality perspective and an ecological model, allowing us to critically examine the complexity surrounding multiple dimensions of social identity (eg, gender and immigration) and how these interrelate at the micro (individual and family), meso (community), and macro (societal) levels in diverse geographical settings. Methodologically, the project is guided by a collaborative, community-based, mixed-methods approach to engaging a range of stakeholders in Toronto, Ottawa, Waterloo, and London in generating knowledge. The 4 settings were strategically chosen for their diversity in the level of urbanization, size of community, and the number of immigrants and immigrant-serving organizations. Interviews will be conducted in Arabic, Mandarin, and Spanish with older women, older men, family members, community leaders, and service providers. The study protocol has received ethics approval from the 4 participating universities. RESULTS Quantitative and qualitative data collection is ongoing. The project is funded by the Social Sciences and Humanities Council of Canada. CONCLUSIONS Comparative analyses of qualitative and quantitative data within and across sites will provide insights about common and unique factors that contribute to the well-being of older immigrants in different regions of Ontario. Given the comprehensive approach to incorporating local knowledge and expert contributions from multilevel stakeholders, the empirical and theoretical findings will be highly relevant to our community partners, help facilitate practice change, and improve the well-being of older men and women in immigrant communities. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/12616

In this chapter, Margaret Walton-Roberts provides an analysis of Donald Trump through an intersectional gendered lens. In this analysis, Walton-Roberts reveals the complex role of gender in generating support for, or resistance to, “Trumpism” in America. Walton-Roberts illustrates her argument through analyzing female voting patterns, the Global Gag Rule and anti-Abortion laws, the Women’s March in the US, and other resistance coalitions structured around multiple axis of identity.

Geographies of health have neglected relevant consideration of health human resources. Five developments in the sub-discipline are examined to demonstrate how health labour has been neglected. Three research themes, circulation, regulation and distribution, are then presented to indicate the value of a greater focus on health workers for the geography of health, and we suggest that deeper analytical engagement with labour and feminist geographies can support this. Each theme points to the increasingly global organization of health care and the need for health geographers to seriously examine the role of health workers during a period of health transformation, globalization, and privatization.

In this paper, I explore the migration of Indian-trained nurses enrolled in a post-graduate critical/geriatric care programme at a Canadian public college. Calling upon recent literature on gender, modernity and mobility in India, I examine the extent to which skilled transnational migration is shaped by gender relations established in India. While feminized international migration suggests increased autonomy of female migrants, this research highlights two important dimensions of such migration. The first is that family migration strategies are major determinants of the occupational choice and migration processes that daughters engage in, and the second is that the moral subjectivity of daughters is maintained through transnational methods of care and control.

This article examines global social policy formation in the area of skilled migration, with a focus on the Gulf Arab region. Across the globe, migration governance presents challenges to multiple levels of authority; its complexity crosses many scales and involves a multitude of actors with diverse interests. Despite this jurisdictional complexity, migration remains one of the most staunchly defended realms of sovereign policy control. Building on global social policy literature, this article examines how ‘domestic’ labour migration policies reflect the entanglement of multiple states’ and agencies’ interests. Such entanglements result in what we characterize as a ‘multiplex system’, where skilled-migration policies are formed within, and shaped by, globalized policy spaces. To illustrate, we examine policies that shape the nursing labour market in Oman during a period when the state aims to transition from dependence on an expatriate to an increasingly nationalized labour force. Engaging a case-study methodology including a survey of migrant healthcare workers, semi-structured interviews and data analysis, we find that nursing labour markets in Oman represent an example of global policy formation due to the interaction of domestic and expatriate labour policies and provisioning systems. The transnational structuring of policy making that emerges reflects a contingent process marked by conflicting outcomes. We contend that Oman’s nursing labour market is an example of new spaces where global social policies emerge from the tension of competing national state and market interests.

Simon ChilversIndian Formation Research SocietyMargaret Walton-RobertsWilfrid Laurier UniversityIn May 2011 the International Migration Research Centre at WilfridLaurier University (Canada) hosted a conference on South Asian migra-tion. It was organized as an interdisciplinary gathering with supportfrom the Social Sciences and Humanities Research Council. MargaretWalton-Roberts and Simon Chilvers were the principal organizers.While most research papers (a total of 60) were contributed by scholarsbased in North America and Western Europe, 14 came from the SouthAsian region itself.The event’s premise was that research on South Asian migrationincreasingly required interdisciplinary and transnational collaboration(and still does). Major aims were to “take stock” of topics being ex-plored and identify significant new areas of research. Prominent discus-sions included (1) how to adequately conceptualize factors determiningacts of migration; (2) different types of migration (e.g., internal, interna-tional, temporary, permanent, etc.) and their connections; (3) changingspaces and scales of citizenship claims; (4) developmental roles per-formed by overseas South Asians in the subcontinent; and (5) how dis-tinctive intra- and intergenerational identities were reproduced, yetevidently with considerable flux in different conjunctures.This special issue of Diaspora presents a selection of articles con-cerned with the last theme, with an emphasis on how contemporarySouth Asian communities in Canada are actively reconstituting theircollective identities. The purpose of this introduction is to supply abrief background context and highlight significant commonalities anddivergences between authors.The history of South Asian migration to Canada can be traced (atleast) to 1867, when different British North American colonies were fed-erated. The origins and formation of diasporic communities can beDiaspora 17:2 2008 / published Spring 2014Simon Chilvers and Margaret Walton-Roberts, “Introduction: Decon-structing the (Re)construction of South Asian Identities in Canada,”Diaspora 17, 2 (2008): 121–129. © 2014 Diaspora: a journal of transna-tional studies.121