Return of talent programs: rationale and evaluation criteria for programs to ameliorate a 'brain drain'

The term, brain drain, describes the loss of skilled professionals and the nonreturn of students from advanced study abroad. It is now used almost exclusively in reference to mobility from less developed countries to more developed countries. Controversy centers on whether needed skills are being drawn off unfairly at subsidized rates from developing to developed countries or whether excess capability is being utilized in developed countries rather than underemployed or wasted at home. Some causes of high level personnel migration include: 1) wage differentials between sending and receiving countries; 2) absence of opportunities for career development or mobility for reasons other than merit or accomplishment; 3) lack of high quality facilities, equipment, time, and other costly supports in developing countries; 4) employer's lack of knowledge of employee work and the resulting wages; and 5) political disagreement or persecution. Prospects for closing wage gaps and upgrading working conditions on a large scale in developing countries are dim. Growth of the labor force coupled with national needs that are not congruent with professions requiring costly facilities, supplies, and equipment make this a slim possibility. Increasing career mobility possibilities seems to be a more promising route to reducing brain drain. One form of preventive measure is offering study abroad which requires service at the end of the study period; a variation is to guarantee employment for university graduates or for certain sectors, such as scientists. Restructuring decisions on hiring and promotion would have a positive effect, as would developing a better evaluation of expected productivity by type of training. Successful return of talent programs will be relatively modest in terms of the number of people returning and should be thought of as a part of human capital investment. Programs that are concerned with filling positions rather than with luring talent home are more likely to be efficient. The employing agency should be involved and should have some flexibility in negotiation with employment candidates to curb the unnecessary use of resources. In summary, return of talent programs should be used as a tool for development that reduces the incentives for nonreturn from training of for emigration by experienced professionals, not as a brain drain cure.     

A trade unionist looks at population

Rapid and uncontrolled population growth in developing countries is of concern to workers and trade unionists because: 1) it directly affect s a country's prosperity and social infrastructure; and 2) it will swell the ranks of the unemployed unless remarkable efforts are made to increase employment opportunities. A brief review of population figures is given. As a result of these statistics a joint statement was issued by the heads of state of 30 countries calling for population control activities. The chief weapon is education. The problem is that educational needs vary from area to area. The educational system in many countries of Asia is still the same as when it was introduced perhaps a century ago. In these areas there is clear need for more liberal policies of general education with improved methods. The main job of population control and education lies with the government but tra de unions should: 1) integrate family planning education with regular labor educational programs; 2) broaden occupational health services to cover family planning activities; 3) cooperate with voluntary agencies and government clinics in disseminating information, arranging lectures, and providing medical advice; 4) urge employers to provide lecture halls and necessary eqiupment, to integrate family planning with other educational activities, and where possible to provide such instruction; 5) open up trade union newsletters, mass meetings, and such to family planning. More use should be made of such mass media as radio and television. All activities should be voluntary as too much coercion will result in predictably negative attitudes on the part of workers. F amily behavior is quite complex. In some areas improved housing lowers the birthrate, in others the increased privacy increases it. Much research is needed; a concentration of studies in areas of declining fertility might yield results of great value that could serve as guidelines.     

A survey of Colorado's migrant farmworkers: access to health care

This report utilizes data collected in a 1986 sample survey of 329 adult (18 to 50 years old) migrant farmworkers in Colorado to determine their health needs, health services utilization, and overall access to care. Health needs include selected indices of medical, dental, nutrition, and reproductive health. About 1/4 of the population had no usual source of health care. Upstream states such as Colorado are responsible as the primary providers of health services for those who either have no source of health care at their home base or experience a variety of barriers in their attempts to access services. Women are most likely to have had a medical visit over the past 12 months and are more likely to have experienced hospitalization. Unfortunately, although their contact with medical professionals is more frequent, the family planning needs of women are not being met. A large disparity exists between ideal family size and number of pregnancies and live births. The findings of this survey document the inferior health status of the migrant farmworker population in Colorado. Hunger, poverty, and environmental hazards increase the risk of illness, while at the same time, barriers to care often prevent migrants from accessing needed health services. Recommendations include 1) promoting and funding family planning and reproductive health services for migrant farmworker women and their partners, 2) incorporating trained family planning promoters in the migrant health delivery system, 3) maintaining successful models of restorative dental care for adults, 4) increasing access to services in nontraditional settings, 5) increasing use of ancillary personnel to provide services, especially dental services, 6) maintaining outreach programs in the available food programs, and 7) encouraging migrant health programs to provide leadership in the development of alternative food sources.     

Future of Long-Term Care Financing for the Elderly in Korea

ABSTRACT

With rapid aging, change in family structure, and the increase in the labor participation of women, the demand for long-term care has been increasing in Korea. Inappropriate utilization of medical care by the elderly in health care institutions, such as social admissions, also puts a financial burden on the health insurance system. The widening gap between the need for long-term care and the capacity of welfare programs to fulfill that need, along with a rather new national pension scheme and the limited economic capacity of the elderly, calls for a new public financing mechanism to provide protection for a broader range of old people from the costs of long-term care. Many important decisions are yet to be made, although Korea is likely to introduce social insurance for long-term care rather than tax-based financing, following the tradition of social health insurance. Whether it should cover only the elderly long-term care or all types of long-term care including disability of all age groups will have a critical impact on social solidarity and the financial sustainability of the new long-term care insurance. Generosity of benefits or the level of out-of-pocket payment, the role of cash benefits, and the relation with health insurance scheme all should be taken into account in the design of a new financing scheme. Lack of care personnel and facilities is also a barrier to the implementation of public long-term care financing in Korea, and the implementation strategy needs to be carved out carefully.     

Measures which host countries and countries of origin could adopt to promote the return of migrants

The immigration wave in the 1960s and 1970s brought scores of migrants to Europe. Most intended to work a few years in a foreign country and return to their homeland; however, poor economies in their own countries discouraged their return. At the same time, jobs became scarcer in their host countries. Several European countries today are resorting to measures designed to promote the return of migrants to their countries of origin. This paper outlines the two major options open to governments in their reintegration efforts. Option 1 requires instituting a definite reintegration policy. Public aid to promote reintegration may be provided. For example, the French give aid contingent upon the return of foreign workers in the labor force to the country of origin and not just upon their departure from the host country. Classical methods pay conpensation to the foreign worker; the problem then is to determine at what point to limit the funds. It must be decided whether or not unemployment benefits should be capitalized and whether or not to reimburse social security and old age contributions. It is also desirable for foreign workers to have access to a specialized organization which is able to advise them on setting up a project or business on their return; ideally, this organization should finance the project. Perhaps the best solution is to enlist participation of the governments of the countries of origin to make job openings known to their nationals desiring to return. Option 2 requires that reintegration be introduced into other economic and social programs. Returning foreign workers would be included as a factor in overall policy planning. Vocational training for return migrants could be proposed to job seekers as well as to dismissed workers. A portion of money used to finance housing projects could be earmarked for construction or reservation of housing in the country of origin. Bilateral vocational training programs can be addressed to nationals who want to return home. A portion of bilateral public development aid may also be used in support of reintegration projects. Finally, it should be possible to propose small development projects in the country of origin for nationals desiring to return.     

Future of long-term care financing for the elderly in Korea

With rapid aging, change in family structure, and the increase in the labor participation of women, the demand for long-term care has been increasing in Korea. Inappropriate utilization of medical care by the elderly in health care institutions, such as social admissions, also puts a financial burden on the health insurance system. The widening gap between the need for long-term care and the capacity of welfare programs to fulfill that need, along with a rather new national pension scheme and the limited economic capacity of the elderly, calls for a new public financing mechanism to provide protection for a broader range of old people from the costs of long-term care. Many important decisions are yet to be made, although Korea is likely to introduce social insurance for long-term care rather than tax-based financing, following the tradition of social health insurance. Whether it should cover only the elderly longterm care or all types of long-term care including disability of all age groups will have a critical impact on social solidarity and the financial sustainability of the new long-term care insurance. Generosity of benefits or the level of out-of-pocket payment, the role of cash benefits, and the relation with health insurance scheme all should be taken into account in the design of a new financing scheme. Lack of care personnel and facilities is also a barrier to the implementation of public long-term care financing in Korea, and the implementation strategy needs to be carved out carefully.     

Modernization and the demographic transition: cross-sectional and longitudinal analyses of a revised model

Problems associated with past research on the fertility-development issue are identified in this article, and a model of the macro-level determinants of fertility -- a model informed by the revised theory of fertility transition -- is specified. This model is estimated both cross-sectionally and longitudinally. In addition, a model is specified that assesses the importance of a family planning program effort on fertility change in less developed countries. The effects on fertility change of other variables is controlled. Using crude birth rates for 117 countries, the model is operationalized and the revised model is applied to 1974 rates. A longitudinal model of 1955-1959 to 1974 change in rates is then tested. The final model for 81 less developed countries from the original set of 117 countries includes a measure of family planning effort. Results support the view that high levels of modernization increase motivation to control fertility, but they also show that excessive reliance on developmental change in less developed countries to bring about fetility declines would prolong unnecessarily the current period of rapid population growth. The dominant role of modernization in the models that lack data on family planning programs only facilitates understanding of the past. Modernization is not the only road to future lower fertility. Modernization, abortion, and family planning programs are explicit policy relevant variables. It was found that legalized abortion has a large and independent impact on lowering birth rates and that family planning programs also reduce unwanted births in less developed countries. These programs were the most important factor related to change in 1955-1959 to 1974 crude birth rate.     

International migrations to and from Zimbabwe and the influence of political changes on population movements, 1965-1987

"This article suggests that the special case of [international migration in] southern African countries (Namibia, South Africa and Zimbabwe), in which the majority of permanent movers have historically been whites of European origin, requires that greater attention should be given to the politico-structural context of voluntary international migrations [as compared to economic motivation]. Statistical data on international migrations to and from Zimbabwe during the past quarter of a century are used to demonstrate that the temporal magnitude and spatial patterns of population movements are best explained by reference to the changing political, rather than economic, conditions within the country."     

Costs of promoting cancer screening: Evidence from CDC’s Colorectal Cancer Control Program (CRCCP)

The Colorectal Cancer Control Program (CRCCP) provided funding to 29 grantees to increase colorectal cancer screening. We describe the screening promotion costs of CRCCP grantees to evaluate the extent to which the program model resulted in the use of funding to support interventions recommended by the Guide to Community Preventive Services (Community Guide). We analyzed expenditures for screening promotion for the first three years of the CRCCP to assess cost per promotion strategy, and estimated the cost per person screened at the state level based on various projected increases in screening rates. All grantees engaged in small media activities and more than 90% used either client reminders, provider assessment and feedback, or patient navigation. Based on all expenditures, projected cost per eligible person screened for a 1%, 5%, and 10% increase in state-level screening proportions are $172, $34, and $17, respectively. CRCCP grantees expended the majority of their funding on Community Guide recommended screening promotion strategies but about a third was spent on other interventions. Based on this finding, future CRC programs should be provided with targeted education and information on evidence-based strategies, rather than broad based recommendations, to ensure that program funds are expended mainly on evidence-based interventions.     

Measures to facilitate the return and reintegration of highly skilled migrants into African countries

A very large number of skilled Africans are found to be operating in the developed industrialized countries of the West at a time when their national economies are crying out for their services. Ways must be found to return as many of these skilled Africans as possible to the African economy. This out-migration or brain drain has a number of causes, including: 1) real incomes in Africa have been on the decline in the past several years while prices were constantly rising. Professional and salaried workers seek employment in other countries that pay much higher salaries. 2) Promotion on criteria other than merit is common in Africa and diligence and high productivity are not often rewarded. 3) Political interference frustrates public services professionals; they are rendered unable to use their professional judgement in making decisions that affect the economic and social fabric. 4) The inadequacy of higher education facilities and opportunities in African countries encourages the brightest and best qualified Africans to go to Western Europe and North America for school; they tend not to return after graduation. 5) Political upheavals and general instability contribute to feelings of individual insecurity, sending Africans to seek sanctuary in more politically stable and less repressive environments. Actions needed to control this out-migration include: 1) incentive systems should be reviewed with a view to providing realistic levels of renumeration and working conditions should be made to promote job satisfaction and self-actualization. 2) Capacities and capabilities should be strengthened so as to ensure that production of goods and services becomes indigenized and that the development and operation of institutions emanates from within the continent. 3) Educational services should be expanded and improved to obviate the need for large numbers of Africans to seek educational opportunities abroad.     

Barriers to the implementation of medication-assisted treatment for substance use disorders: the importance of funding policies and medical infrastructure

Despite growing interest in the use of evidence-based treatment practices, adoption of pharmacotherapies for treating substance use disorders (SUDs) remains modest. Using data from telephone interviews with 250 administrators of publicly funded SUD treatment programs, this study estimated a model of adoption of medication assisted treatment (MAT) for SUDs and examined the relative importance of regulatory, cultural, medical resource, patient-level, and funding barriers to MAT implementation. MAT-adopting programs had significantly greater medical resources, as measured by the employment of physicians and nurses, than non-adopting programs. Administrators of non-adopting programs were asked to rate the importance of 18 barriers to MAT implementation. The most strongly endorsed barriers were regulatory prohibitions due to the program's lack of medical staff, funding barriers to implementing MAT, and lack of access to medical personnel with expertise in delivering MAT. Barriers related to insufficient information about MAT and unsupportive staff attitudes were not widely endorsed. These findings suggest that efforts to promote the implementation of MAT that are inattentive to funding barriers and weaknesses in medical infrastructure may achieve sub-optimal results.     

Promoting a Development Focus in the Community Organization Curriculum

As the problem of poverty has become more acute, community organization teaching needs to focus more directly on programs that will raise standards of living at the local level. This article suggests that African community development is highly relevant to the promotion of community-based economic and social development projects. Although the idea that approaches from Third World countries can be adapted to enhance educational programs in the United States is a novel one, the African approach to community development has much to offer American schools of social work that are seeking to prepare students to work with poor communities in both inner-city and rural areas.     

An Exploration of African American Forest Landowners in Mississippi

In Mississippi counties with large African American populations, forest resources constitute one of the most important agricultural outputs. Despite the efforts of natural resources extension personnel to provide educational programming to this group, little is known about their needs, concerns, and meanings of the landscape for them. Research has taken place in the Carolinas, Alabama, and Georgia; however, forests and African American forest landowners in Mississippi face unique social, historical, and ecological contexts that need to be examined. If forests and forestry programs are to provide an equitable distribution of benefits to diverse populations in Mississippi, a culturally based understanding of landowners is needed with special attention to those populations who have been traditionally underserved because of race and income. We address this need by presenting data from focus groups with African American forest landowners in several rural Mississippi counties. Findings indicate that a complex relationship with the landscape has inculcated much traditional knowledge about forest resources, opportunities and challenges to participation in programs and landowner associations, and concerns over heir property, among other factors. We discuss implications for how forestry can meet the sustainable natural resource goals and rural development needs of African American landowners and communities.     

Young African American Males: Barriers to Access to Health Care

African American males continue to experience an unacceptable and disproportionate number of health disparities when compared with other racial and ethnic groups. Young African American males can expect to live the least amount of time when compared to any other ethnic minority or racial sub-group. Understanding the obstacles and barriers that impede access to health care and wellness services among young African American males is essential to begin the process of decreasing health disparities. The goal of this qualitative study was to explore and identify the barriers experienced by young African American males in accessing health care services while also creating a rare opportunity to give voice to young African American males. The study results indicate that young African American males have multiple perceptions of barriers to health care services. Their perceptions fell into three categories: the negative impact of environment or community, lack of finances or no insurance, and distrust of medical practices associated with race history resulting in accessing healthcare as a last resort. Additional research is needed to craft community-based programs to: a) educate young African American males on the importance of preventative strategies to maintain wellness; and b) ensure that the appropriate medical and wellness services are available and reaching young African American males in need.     

How Applicable are Western Models of Patient‐Physician Relationship in Asia?: Changing Patient‐Physician Relationship in Contemporary Japan

Abstract:  The social and political environments surrounding patient-physician relationship have been changing in Japan for the last few decades. This paper aims to illustrate social and cultural factors that underlie current situations and problems of patient-physician relationship in Japan through a comparison with those in western countries, and to consider how mutual participation model of patient-physician relationship could be applied and fostered in Japan as well as other Asian cultures. Four major sociocultural factors are discussed in relation to the patient-physician relationship in Japan: (1) individualism versus collectivism; (2) low context versus high context; (3) femininity versus masculinity; and (4) Christianity versus Confucianism. Two key issues in discussing the mutual participation model of patient-physician relationship in Japan have emerged; the family and the communication style. The patient autonomy in Japan should be considered within the context of the triadic relationship of patient, family, and physician. Also, since the communication style might differ between Japan and western countries, communication training programs and interventions for medical professionals as well as for patients should be tailored in a culturally appropriate way in order to improve the communication in medical encounters and to achieve the mutual participation. Beyond mere advocacy of the patient autonomy, the mutual participation model of patient-physician relationship should be pursued within our social and cultural context to be truly fruitful for patients and physicians in Japan.     

Orphans at risk in sub-Saharan Africa: evidence on educational and health outcomes

Based on comparable data for eleven sub-Saharan African countries with especially high rates of orphanhood, we examine how orphanhood affects children’s educational and health outcomes. Using household fixed-effects to control for influences at the household level, we show that orphans do not only fare worse than non-orphans because they tend to live in poorer households, but that they are also at a disadvantage compared to non-orphans within the same household. They lag behind in education and are more often malnourished and stunted. (The coefficients on the health outcomes are only statistically significant for some of the countries and some of the health measures, however.) Moreover, we show that non-orphaned children not living with a biological parent are also worse off compared to biological children of the same caregivers. Educational gaps are particularly evident for children whose mother is deceased or absent. The additional effect of paternal death or absence is rather modest or insignificant in most countries.     

Managed Care for High-Risk Populations

A review of studies of managed medical care demonstration programs for high-risk populations shows that, though there have been many such programs, they appear to have limited effects. Programs have often been characterized by conceptual inconsistency, about the nature of managed care, and limited goals, related mostly to cost savings. Program evaluations have often been methodologically weak. Insofar as the managed care programs have affected costs, medical care utilization patterns, or quality, the effects have been limited to subsets of the high-risk populations studied. Though managed care programs may have the same kinds of benefits for high-risk populations as they do for general working populations, they also entail substantial risk. Inferences from general to high-risk populations should be made cautiously and demonstration programs should be implemented only with careful attention to ethical, legal, and medical concerns.     

The role of social support in the psychological well-being of African American girls who experience dating violence victimization

The goals of this study were to test the relationship between dating violence victimization (i.e., verbal, emotional, and physical abuse) and psychological well-being (i.e., depressive symptomatology, self-esteem, and body image) among 522 African American girls, and to determine whether social support acted as a buffer of negative effects (moderator) or as an intervening factor (mediator) in the relationship between dating violence victimization and psychological well-being. Results from structural equation modeling indicated that dating violence victimization was associated with negative psychological outcomes. Although social support did not moderate this relationship, it served as a mediator of the relationship between dating violence victimization and psychological well-being. Dating violence programs for African American girls should consider how to incorporate family, church, and other networks in the community to foster support, and allow adolescent girls to discuss their abusive experiences in a nonblaming environment. If programs are able to buoy girls who experience dating violence, then they may be able to ameliorate the associated negative psychological sequelae.