The nursing shortage: real, getting worse, and global

My thanks to Joe Paduda for alerting me to Health Affair’s articles on the nursing shortage. the shortage is real, will get worse, and is global. So any major new recruitment from abroad takes nurses from other countries. That is the message from a Linda Aiken, a professor of sociology, and director of the Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania in Philadelphia.
Aiken wrote in the Health Affairs blog this month, “Currently, the United States is short an estimated 150,000 nurses. Yet over the next decade, more than 650,000 new jobs in nursing will be created. At the same time, an estimated 450,000 nurses will have retired. By 2020, the nurse shortage is expected to increase to 800,000……The nurse shortage isn’t confined to the U.S. — it’s global. Extracting nurses from other countries would simply bankrupt the international supply of nurses, affecting global health.”
In her 2004 article in Health Affairs, she wrote:
The world’s nurse supply appears insufficient to meet global needs now and in the future. Countries that use the most nurses should make the biggest investments in nursing education in both their own and the developing countries from which they recruit nurses. It is not common for developed countries to invest their international aid in nursing education, and this should change to help build sustainable nursing education infrastructures in developing countries.
Ethical recruitment guidelines provide a strategy for responsibly managing international nurse recruitment, although to date the first test case—the U.K. Department of Health guidelines—has been disappointing. Since 1999, when those guidelines were established, the outflow of nurses from sub-Saharan Africa to the United Kingdom has greatly increased, and emigration from South Africa has quadrupled. The challenge is in enforcement of the guidelines, especially considering the private, entrepreneurial character of international recruitment.
The most promising strategy for achieving international balance in health workforce resources is for each country to have an adequate and sustainable source of health professionals. A two-prong strategy is required for this to happen. First, developed countries must be more diligent in exploring actions to stabilize and increase their domestic supply of nurses and moderate demand through strategic investments. Second, even without the exodus of so many qualified health professionals to work in developed countries, most less developed countries do not have the health care workforce capacity to respond to the health problems of their citizens that also can threaten global health. Making health, especially nursing, a legitimate focus of international aid and democracy building is needed.
She addressed the limited supply of nurses trained overseas:

Continue reading The nursing shortage: real, getting worse, and global

size of Indian work populations in the United States.

Here is some summary data on Indians who work in the United States, which I found at this website. There are roughly 2 million persons of Indian origin in the U. S. today.
About the Asian American Hotel Owners Association
Representing over 8,300 members, AAHOA is one of the leading forces in the hospitality industry and one of the most powerful Asian American advocacy groups. Together, the members own more than 20,000 hotels, which have over one million rooms, representing over 50 percent of the economy lodging properties and nearly 37 percent of all hotel properties in the United States.
Of the hotels owned by AAHOA members, approximately 11,700 are franchised while 6,300 are independent. The market value of the properties owned by AAHOA members is estimated to be $29.9 billion in franchised properties and $8.1 billion in independent properties.
About the American Association of Physicians of Indian Origin
With a constituency of over 41,000 doctors and 10,000 medical students and residents, AAPI is the largest ethnic medical association in the United States and is the largest Indian American professional association in the United States.

The Hispanic vote and the next Congress

It’s worth pausing to think about the November Congressional elections, the Hispanic vote, and the next few years of working immigrant policy. Will the elections results improve chances of a guest worker program being enacted?
There are about 200 million eligible voters in the U.S. About 8.6% of them are Hispanic. The Hispanic population is booming, though more of it is underage compared to white and black populations. Between 2002 and 2005, The Pew Hispanic Center reports that the Hispanic population grew by 21.5% compared to 1.6% among whites, 7.4% among blacks, and 24.6% among Asians.
In 2005, Hispanic comprised at least 5% of eligible votes in 15 states: AZ, CA, CO, FL, HI, IL, MA, NV, NJ, NM, NY, RI, TX, UT and WY.
Democratic takeover of Senate and/or the House will shift power to those who agree with Bush’s guest worker program ideas. Would the prospect of a guest worker program improve if the Hispanic vote on November 7 was more dominant than in the past? I say yes, especially if Hispanic turnout suggests a pattern of increasing participation trending towards white levels of participation.
A recent Pew Hispanic Center study on the 2006 elections reports that Hispanics increased as a share of eligible voters from 7.4% in 2000 to 8.6% in 2006. There are now 17 million Hispanic citizens over the age of 18.
The big question is if the historically low rate of Hispanic registration among eligible voters will improve. According to the Center, in 2004 the registration rates among eligible voters were 58% for “Latinos”, 69% for blacks, and 75% for whites.
This November, if Latinos register according to 2004 patterns, there will be 10 million registered Latino voters. If they register at the 2004 white rate, there will be 12.3 million registered Latino voters.

Disparities in education, income among second generation immigrants

The Migration Information Service published this week a study of education, language speaking, and income patterns among Latin American and Asian second generation immigrants in southern California (San Diego) and southern Florida (Miami/ fort Lauderdale). I plucked out of the study some interesting figures on relative educational attainment and income of the family in which the second generation immigrant – usually at their mi 20s – is living.
At the low end of educational attainment and family income are Cambodian and Laotians in southern California and Haitians in southern Florida. In contrast, “At the other end, the combination of high parental human capital, a high proportion of intact families, and a neutral context of reception (as defined above), led second-generation Chinese and other Asians to extraordinary levels of educational achievement, only matched in South Florida by the offspring of upper-middle-class Cuban exiles who attended private schools. Vietnamese youths also did quite well despite low average levels of parental education.”
The schedule below lists the region, the nationality, the percentage of high school students who did not go onto higher education, and the average family income. The educational attainment percentage is the share who did NOT go onto higher ed.
These education figures don’t jibe well with national average. Nationally, about 36% do not go onto higher ed. Higher ed utilization rates are notoriously complicated to estimate. The higher education participation figures by nationality seem much too high. However, I think we can use these figures to
*compare* the nationalities below. Chinese second generation people are most active in higher education among all groups. Cambodians and Laotians have the worst rate for post high school education.
How to read the list below…an example: Among Filipinos in southern California, 2nd generation persons were less inclined to pursue post high school education than were Vietnamese, other Asians and Chinese. The median income of the households in which the second generation resides is, for Filipinos, about $55,000 – much higher than any other listed nationality for that region.
Southern California:
Cambodian, Laotian 45.9%, $25,179
Chinese 5.7% $33,611
Filipino 15.5%, $55,323
Mexican 38% $32,585
Vietnamese 12.6% $34,868
Other, Asian 9.1%, $40,278
Other, Latin American 25.5%, $31,500
South Florida
Colombian 17%, $45,948
Cuban (Private School) 7.5%, $70,395
Cuban (Public School) 21.7%, 48,598
Haitian 15.3%, $26,974
Nicaraguan 26.4% $47,054
West Indian 18.1%, $30,326

Homeland Security estimates of unauthorized immigrants January 2005

This study has some useful information about the size of the unauthorized population and the geographic origins. For the first time I see a figure indicating a rapid increase in the number of unauthorized Indians.
The study does not address the number of unauthorized workers. My guess is that a very high percentage of all of these immigrants are working, especially recent arrivals who probably do not come with families. For instance, the 2005 total figures for Mexicao and El Salvador are equal to 5.6% and 7.0% of their respective populations at home. I suspect that the American-based numbers represent more like 7.5% and 10% of the home workforces.
The study estimates the January 2006 figure at “nearly 11 million”, having risen by and “annual average” of 408,000 in the 2000-2004 period. The figure for January 2005 is 10.5 million.
Those within the 10.5 figure came to the U.S. in these time frames:
1980-1984 10%
1985-1989 11%
1990-1994 20%
1995-1999 30%
2000-2002 20%
2003-2004 9%
It estimates that 1/1/05 there were 27,320,000 foreign born ….10,500,000 of these being unauthorized.
Origins (figures in 000s)
Country 2005, 2000
Mexico 5970 4680
El Salvador 470 430
Guatamala 370 290
India 280 120
China 230 190
Korea 210 180
Philippines 210 200
Honduras 180 160
Brazil 170 100
Vietnam 160 160
other 2250 1950

U.S. was 12.4% immigrant in 2005, vs. 11.2% in 2000

The New Times reports on the findings of the 2005 American Community Survey. The Survey results confirm what has been discerned already: more immigrants, chief among them Mexicans, and more spread out across the country.

Two decades ago, demographers said, some 75 percent to 80 percent of new immigrants settled in one of the half-dozen gateway states and tended to stay there. Then, in the last 10 to 15 years, the pattern shifted and increasing numbers began to stay in the gateways briefly and then move. Now, they say, the pattern is that more immigrants are simply bypassing the gateways altogether.

The Times reports that the survey is intended as an annual bolster to the bureau’s constitutionally mandated census of the country’s population every 10 years. It began as a test program in 1996 and has gradually expanded to where it can now provide detailed data for nearly 7,000 geographic areas, including all Congressional districts and counties or cities of 65,000 or more.
It goes on:
“What’s happening now is that immigrants are showing up in many more communities all across the country than they have ever been in,” said Audrey Singer, an immigration fellow at the Brookings Institution. “So it’s easy for people to look around and not just see them, but feel the impact they’re having in their communities. And a lot of these are communities that are not accustomed to seeing immigrants in their schools, at the workplace, in their hospitals.”
By far the largest numbers of immigrants continue to live in the six states that have traditionally attracted them: California, New York, Texas, Florida, New Jersey and Illinois. Immigrants also continue to flow into a handful of states in the Southeast, like Georgia and North Carolina, a trend that was discerned in the 2000 census. But it is in the less-expected immigrant destinations that demographers find the most of interest in the new data. Indiana saw a 34 percent increase in the number of immigrants; South Dakota saw a 44 percent rise; Delaware 32 percent; Missouri 31 percent; Colorado 28 percent; and New Hampshire 26 percent.
“Essentially, it’s a continuation of the Mexicanization of U.S. immigration,” said Steven Camarota, director of research at the Center for Immigration Studies. “You would expect Mexicans to be increasing their share in places like Georgia and North Carolina, which already saw some increases, but they’ve also increased their share of the population, and quite dramatically, in states like Michigan, Delaware and Montana.”
More of America’s immigrants, legal or not, come from Mexico than any other country, an estimated 11 million in 2005, compared with nearly 1.8 million Chinese and 1.4 million Indians.

“Building boom in Mexican town was born in Minnesota”

This Bremerton, WA Kitsap Sun article is about as insightful an analysis of inter-country financial flows from low wage immigrant workers as I have seen. A southern Mexico town of 30,000 is receiving about $2,000 per resident per year in remittances!
By Kevin Diaz, July 12, 2006

A pickup truck with Minnesota plates bounced down the dirt road on the edge of town, raising clouds of reddish dust. It caught the eye of a grazing Brahman bull and disappeared behind a clutch of mango trees bordering a new subdivision, where tangles of steel reinforcing bars sprouted from the roofs of unfinished concrete block houses.

Many of the new houses were paid for with money sent by a secret workforce in Minnesota. By Mayor Leopoldo Rodriguez’s estimate, almost a third of the town’s workers have crossed the border – many of them illegally – and headed north to work in the Minneapolis-St. Paul metro area over the past 10 years.

The money they wire back arrives daily by police escort in armored trucks. Altogether, it comes to between $4 million and $7 million a month, according to money-transfer agencies in the Twin Cities region. The cash has forged an economic link between Axochiapan and Minneapolis-St. Paul that is part of a global trend. It is changing Axochiapan, one household at a time.

Padre Miguel Franco Galicia, parish priest at the Church of San Pablo in Axochiapan…has visited Minneapolis several times to minister to his expatriate parishioners. He estimates that at least 60 percent of Axochiapan’s population receives money from family members working in the United States, most of them in Minnesota. ‘To be honest, I think there are more pluses than minuses, from an economic point of view,’ he said. ‘But the social devastation is enormous.’

Axochiapan (pronounced Ah-sho-chee-AH-pahn), a town of about 30,000 in southern Mexico, has known little but poverty for centuries. People made a living by farming, or by working in the gypsum mines outside of town. The recent flow of Minnesota money has improved life. Pizza deliveries, aerobics studios and Internet cafes, alongside tortilla shops and taquerias, now serve an increasingly cosmopolitan population.

More below….

Continue reading “Building boom in Mexican town was born in Minnesota”

Where are Hispanic voters concentrated?

A Pew Hispanic Center study of the Hispanic vote in the 2004 elections analyzes the where eligible voters reside. (The study discusses in depth the low actual voting rate of Hispanics, as well.)
The Hispanic population remains concentrated in a few states. Several of those states were decided by wide margins in the last presidential election and do not appear to be battlegrounds in the current campaign. Texas, California and New York are all generally considered uncontested states in the presidential race, and 58% of all Latino eligible voters live in those three states alone.
Among the 18 states generally considered battlegrounds in the presidential election because they were decided by a margin of less than 7% of the popular vote in 2000, Latinos comprise at least 10% of the eligible voters in Florida, New Mexico, Nevada and Arizona. The Hispanic electorate has distinctly different characteristics in each of those states and different patterns of growth since 2000.
Florida: Hispanics make up 14% of the eligible voters, and they are unusual
because so many are naturalized citizens (44% of Latino eligible voters in Florida
compared to 24% nationally). Nonetheless, the fastest growth has been among
native born Latinos who account for 83% of the new eligible Latino voters in
Florida.
New Mexico: Latinos are 40% of the eligible voters, a greater share by far than in
any other state. These voters are overwhelmingly native-born citizens, 93%.
Nevada: Latinos account for 13% of the eligible voters but their numbers are
growing very fast. Since the last presidential election, the number of eligible
Latinos in Nevada has increased by about 50%, and Latinos account for about half
of all the increase in the Nevada electorate. About two-thirds of the Latino
eligible voters in Nevada are native born.
Arizona: Some 16% of eligible voters in Arizona are Hispanics, and 80% are
native-born citizens.

Poll: hispanic voters turning away from Bush, Repubican party

Hispanic voters – 9% of the total electorate – may be “the fastest growing and perhaps the most volatile swing electorate in American politics.” What has the past year or two done to their political loyalties, after over a decade of movement towards the Republican party? The answer, from this NDN poll discussed further below:
In 2004 Kerry beat Bush 59%-40% with all Hispanics. When asked how they would vote if the Presidential election were held today, this group gives Democrats a remarkable 36-point advantage: 59%-23%. Thus the Republicans lost serious ground but Democrats did not gain any.
Bush’s standing with this group has plummeted. In the 2004 cycle, Bush regularly received a 60% favorable rating from Hispanics. In our survey this was reversed, as 38% see him favorably, 58% unfavorably, with 40% very unfavorable towards the President.
NDN, a Democratic Party-affiliated public interest group, released the results of this survey of Hispanic voters this week, in collaboration with its Hispanic Strategy Center. Another article on a recent Pew Hispanic Center political poll is found
here in the Washington Post.
The NDN survey found that support for Bush and Republicans has “dramatically declined” but that support for Democats has not proportionately increased. “Additionally, the poll offers clear evidence that the immigration debate has increased this community’s participation in the civic life of their nation. More than half of those questioned say the issue will make it more likely that they will vote this year. A remarkable 25% of those surveyed state that they have taken part in recent public demonstrations for better immigration policies. It appears that millions of Hispanics are rising to the “today we march, tomorrow we vote” challenge offered by the leaders of community this year.
The poll, conducted by the New York-based market research firm LatinInsights, surveyed a 600-person national sample of Spanish-dominant Hispanic registered voters. It is the largest poll of Spanish-language dominant Hispanic voters we’ve come across. The poll was paid for by the NDN Political Fund.

Continue reading Poll: hispanic voters turning away from Bush, Repubican party

High impact of immigrant workers on civilian labor force, 1990 – 2001 and beyond

Northeastern University’s Center for Labor Market Studies prepared in 2002 a study of the impact on new immigration to the civilian labor force, by region, between 1990 and 2001. These figures instantly convey the dependence of the economy on immigrant labor. It is reasonable to infer that over a third of the new immigrants were working illegally. Since 2001, the share of immigrant worker growth has probably shifted more to the illegal category, to 1 out of 2 instead of 1 out of 3.
Below are listed regions and the percentage of civilian labor force growth attributed to immigration. A figure of over 100% indicates that without immigrants, the labor force would have declined.
New England 567%
Mid-Atlantic 369%
Eastern North Central 35%
Western North Central 20%
South Atlantic 45%
Eastern South Central 14%
Western South Central 37%
Rocky Mountains 37%
Pacific 21%
These figures appear to understate the impact of immigrant labor on the labor force, because the impact rose after the early 1990s. According to one analysis, the President’s 2005 Economic Report estimated that “The President’s report points out that “between 1996 and 2003, when total employment grew by 11 million, 58 percent of the net increase was among foreign-born workers,” almost all of whom had arrived since 1995. The immigrant share of employment growth was even higher in particular occupations, amounting in the 1996-2002 period to 86 percent of the 1 million new positions in “precision production, craft, and repair” (which includes mechanics and construction workers) and 62 percent of the 2 million new positions in service occupations (such as janitors, kitchen workers, and grounds workers).
“Moreover, this pattern holds true beyond the traditional immigrant-receiving states of California, New York, Texas, and Florida. The President’s report notes that between 1996 and 2003 immigrants accounted for 84 percent of labor-force growth in eastern North Central states (Indiana, Illinois, Michigan, Ohio, and Wisconsin) and 47 percent in eastern South Central states (Alabama, Kentucky, Mississippi, and Tennessee).”
The press release from Northeastern is as follows:

Continue reading High impact of immigrant workers on civilian labor force, 1990 – 2001 and beyond