It’s been a rough year for workers in the US, with about 10 percent of the population unable to find a job, and many more not able to find enough consistent work. One sector that is consistently adding jobs is the healthcare industry. Since about 90 percent of healthcare support workers are women, and over half of new medical students are female, this should be great news for women, right?

Well…maybe. But maybe not.

In reality, the healthcare field is a complex and varied industry that often perpetuates inequality on a global scale. In her new book  — Insourced: How Importing Jobs Impacts the Healthcare Crisis Here and Abroad — Kate Tulenko exposes how global inequalities are reproduced by US immigration policy and lack of strong healthcare worker recruitment policy.

For example, almost 6,000 regions in the US don’t have enough healthcare workers, but recruitment of potential healthcare workers from these communities is rare. At the same time, a study in Malawi showed that there are more Malawian physicians in Manchester, England than in Malawi. Ironically, poor countries such as India and Malawi, invest a significant part of the income into training physicians and nurses who often go abroad because the pay and working conditions are better, meaning that the countries don’t even get a return on their investment.


The US facilitates this process by providing special healthcare worker visas to those seeking to immigrate.

Tulenko, the senior director of health system innovation at IntraHealth International, has worked both domestically and abroad and experienced many of these inequalities firsthand. She points out that when the US facilitates immigration of healthcare workers from these countries, it negatively affect health indices.

It is irrational and immoral to recruit health workers from countries where one in five children die before their fifth birthday when we could be recruiting and training workers domestically. Doing so would help our economy, global public health and the 314 million Americans who rely on our medical system to provide high-quality, affordable care.

This immorality crosses over into domestic policies as well, since many African American and Lation communities are served by transient physicians and nurses, who come to these communities to gan experience but rarely stay on longterm. Tulenko argues that recruiting healthcare workers (of all levels) from the communities that need them most could better serve disenfranchised neighborhoods in the US.

She  writes:

There are other casualties, closer to home. Every study that has examined how to incentivize health workers to move to underserved areas has shown that training people from these communities is the most cost-effective approach. But because we’ve essentially given up on recruiting from underserved places in the United States, we’ve made their chronic lack of health workers much worse. Some 54 million people live in the 5,700 parts of the country defined as “health professional shortage areas,” the communities with the worst health statistics and the worst unemployment.

Even with the high unemployment rate, there is often a healthcare worker shortage in this country. This shortage is attributable to a variety of factors: medical school (and post-secondary education in general) has become extremely expensive.

It’s similar to the so-called “skills gap” in manufacturing, described in this article. When manufacturing workers are paid only $10 an hour to do a complex job that requires they pay for training at a community college, they often find that financially they would be better off working at McDonalds.

At the same time that there is a growing demand for healthcare workers, the educational requirements have increased.  According to a report from Georgetown University:

The demand for postsecondary education and training in healthcare, already high, will continue to edge upward. In 2010, it was 81%; by 2020, it will rise slightly to 82%. For professional and technical occupations, however, that number rises to 94%. A bachelor’s degree will be required for 24% of all healthcare jobs, up from 21%  in 2010. This high demand for postsecondary talent in healthcare is second only to STEM and education occupations

Almost 90 percent of health support workers are women.

While nurses and other healthcare professionals are paid well, according to the report, 70 % of healthcare support workers earn less than $30 000. Soon, most of these jobs will require at least some post-secondary education, but there’s no guarantee that wages will go up.

Healthcare systems – like the economic system – are intertwined, we don’t live in a vacuum. This is an interesting example of the ways that the broken US healthcare system has spread its tentacles all over the world.


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