Background of the healthcare system in the United States
Analyse a steady improvement in the complete health care system of the United States population and argues that the situation of the immigrant workers in the health care sector of America is quite disturbing.
The essay analyses a steady improvement in the complete health care system of the United States population and argues that the situation of the immigrant workers in the health care sector of America is quite disturbing (Gallego, Barbieri and González 2017, 43). In the USA, these immigrants have been working as doctors, dentists, nurses and in variety of other health care occupation. As the survey and predictions by the U.S Bureau of Labour Statistics project that the sector is going to create 2.5 million jobs between 2014 and 2024 (Ncbi.nlm.nih.gov, 2017). This share is constantly going upwards and higher in the highly skilled and experienced professionals such as surgeons and specialized physicians (Guiso, Sapienza and Zingales 2015, p 71). These group also include the least skilled direct-care workers like psychiatrists, nurses and carers providing health aids at home but the situation of the immigrant healthcare providers are not as good as their native counterparts
The features of the health workers vary across seven categories like Physicians and surgeons, Therapists, Registered nurses, Health-care technicians, Health practitioners, Health-Care Support Occupations like nursing and assistances to practitioners (Barak, Findler and Wind 2016). The survey has revealed that the foreign health care experts are more likely to join the occupation after obtaining a university level education where as their native counterparts have lower education (Tronto 2013). Immigrant women more than the native work in direct care, low waged occupations and have lower access to the national health insurance. Immigrant men as well as native men on the other hand prefer surgeons and physicians which occupations are very well compensated as well as fall under the universal health insurance access (Betancourt et al. 2016). Therefore, it can be argued that the US born employees have more advantages as they have fluent English and high rates of naturalisation thus get more health insurance coverage.
Troubled past:
Racial along with ethnic diversity is the basic tenet in the evolution of the US society and health care is not an exemption. The progress of socio-economic inequality has always been a dominant dilemma in the USA history. Immigration and conquest have been originating process through which the American ethnic groups were formed and the country itself has become the most ethnically diverse society in the world (Akinboro et al. 2016, 51). In numerous ways the history of the state’s ethnic, class, racial and gender biases as well as conflicts have become evident in the system’s dynamism. This troubled past of America has also affected the health care system which is evident from the poor health condition as well as outcomes of the minorities of the country (Ncbi.nlm.nih.gov, 2017). It is inextricably linked to the racial and cultural discrimination. According to the researchers, in case the current demographic trend continues, dramatic situational transformation will be essential that will certainly include national health care system (Downing 2015, 1572). Racial minority in the USA includes the health care workers who are among the most difficult demographic categories. It is difficult because there are no specific schemes to define these groups as well as classifying them. Despite the fact that the government has tried numerous measures to categorize this complex issue in health care system.
Challenges faced by immigrant healthcare workers in the United States
National health policies:
Data has been collected to assess health status, service utilization and outcomes of the various health issues in the occupations of these immigrant employees. According to the US Federal Program Administrative Reporting and Statistical Activities, there are five definite cultural categories namely Alaskan Native, Asian and Pacific Islander, Hispanic, Africans and Europeans (Kaya 2017, 14). The ethnic data by the United States Census Bureau are symbolic of centrality of national culture. As mentioned before the immigrants in health sector of the country are closely affected by the national health policies as well as service delivery. These immigrant people are being tallied based on their skin colours, religions and origin (Leslie 2017, 450). In spite of the rising influence of the anthropological philosophies of race in the health sector, most of the system is largely depending on these immigrant health care employees due to their resources. Ethnicity was incorporated in the US health system lately as a reaction to the general movements towards the self-definition as well as modern notions of the pluralistic democracy (Tronto 2013).
Distinguishing among the racial, ethnic groups among one another has been useful for medical and health care sector. The researchers have demonstrated that an epidemiological study implicitly describes the nature and source of the human variations based on their behavioural pattern, environmental and cultural impacts that are closely related to the national health care system outcomes (Randel et al 2016, 220). Race-ethnicity affect the factors as diverse as the disease rates, concepts of wellbeing, attitude towards health maintenance long with health treatment. These also include the utilization patterns, interactions among the mainstream and peripheral health care professionals along with their respective organizations, cultural interest groups and medical delivery.
The government of the USA uses such kind of information and apply them to the distinct groups that could be directly applicable to the distinct groups for appropriate, efficient biometrical along with health service research (de Andrade et al 2015, 1349). These health service researches focus on the promotion of health and disease prevention projects that accurately redirect the health care services as well as restructure the components of health system of the region, guide diversity along with cultural competence programs. The chief aim needs to be a clear identification of the cultural boundaries and the government must devoid of perceiving these impediments as more flexible than rigid so that it can prevent these from becoming agents to fragment and de-focus the national health policy as well as political mechanisms (Hashemi et al 2015, 130). The mixed ethnicity among the immigrant workers have challenged the pluralistic culture oriented data collection, analysis aiming to program creation. Tracking racial and ethnic healthcare outcomes have revealed the existence prominent racial-ethnic bias that refers to an urgency to eliminate these factors from this system. These bias residing within the native cared givers and patients can only be eliminated through re-educating, eliminating stereotypes, conscious and unconscious biases (Downing 2015, 1571).
Basic racial and ethnic problems:
According to Kossek (2015, 176) racial and ethnic groups in America is viewed to be a by-product of the social processes like immigration, group hierarchies, interactions, dominance, assimilation and acculturation. The government has acknowledged the impacts of racial-ethnic problems on both the native and immigrant health professions. The health system of the USA is representative of a continuing contemporary ethnic movement among the liberal and democratic governments across the world (Kok et al 2017, 1407). The social dimensions of the health as well as healthcare delivery serve to be indicators of an increasing awareness, analysis, inspection, and redistribution that finally committed to the notion by approving all of the diversities.
Impact of racial and ethnic diversity on the healthcare system
The USA owes a great debt of gratitude to the heath carers who graduate from the non US medical schools but enlisted in the US health care system. The research has been conducted with psychiatry programs and family practices (Piroozi et al. 2016, 417). The survey has also been conducted by the directors of the surgical residency programs to find out the racial discrimination in the employment and treatment towards the immigrant health workers. 70% of the directors believe that there are problems of discrimination in the selection process of the direct health care workers like physicians and medical practitioners as well as registered nurses (Atun et al. 2015, 1234). The foreign employees face discrimination and less advantages in comparison to their native US colleagues. 20 percent of these research discloses that fact that the directors of the medical college are being pressured to discriminate against immigrant medical students and employees in favour of their native counterparts. The reports also reveal that the reputed physicians are being questioned abusively, insulted even attacked by their patients due to their religion, skin colour and heritage (English, Lambert and Ialongo 2014, 1190). According to some medical journals, the recent situation is so grave have been found to publish guidelines for the doctors elaborating the methods of dealing with racist patients.
Psychological pathways:
On the other hand, the report from the Institute of Medicines has outlined the diverse factors that produce racial and ethnic disparities in health care services in the country problem (Nivet, Castillo-Page and Conrad 2016, 1033). The researchers in this sector have recognized the influence of direct examination of the outcome of psychosocial pathways—particularly examining direct as well as indirect influences of stereotyping, prejudice and discrimination in the clinical encounters, experiences, health behaviour and health services (Lukachko, Hatzenbuehler and Keyes 2014, 47). Negative observations of the health care system in general along with opinions of discrimination particularly, influence the time and manner of people seeking care, whether these people engage in health protective behaviours, the willingness for following medical advices and their level of psychological distress and mental health.
Recent data have revealed that a sizable portion of the US health care workforce. In the healthcare professions, these immigrant employees share most portion. One quarter of the existing surgeons and physicians are foreign born and more than one out of five people working in the healthcare support sector like nursing, home aids and psychiatry (Kaya, 2017, 14). There are some factors that regulate the global mobility and access to the US health care system.
Discrimination:
The paper outlines the influence of workplace injustice, discrimination, abuse, bullying, harassment to the professional health disparities. It illustrates various pathways by which interpersonal as well as institutional injustices leads to different types of risks for the minority workers to the adverse professional health outcomes. This discrimination chiefly effects the employees of demographic minority groups and they become victims of workplace discrimination as well as suffer more hostile outcomes at the time the visit a different country for job. They are more exposed to the hostility when compared to demographic majority group of that country. The researchers have linked the workplace injustice to lowly physical and psychological health. They also linked workplace discrimination to unhealthy behaviours. Immigrant workers facing adverse comments or direct discrimination in various health care organization in the USA, have been reported for a long time which has revealed that injustice due to racial and cultural difference have influenced a great deal in the psychology along with the family life. This ultimately influence the worker’s service related outcomes.
Role of ethnicity in health service research
The United States Equal Employment Opportunity Commission is an organization that takes care of the immigrant employees and protects them from disparities based on age, race/colour, national origin, religion and gender. Beside this organization, other states and federal agencies supported by local laws protect the employees from workplace discrimination originating from race as well as nationality. According to Bruna, and Chanlat (2015), this concept of discrimination, harassment and bullying are status blind usually but chiefly impact on the socially disadvantaged class mainly immigrants. Perpetration of such discrimination in the health care sector has been found taking place in both interpersonal as well as institutional level.
Institutional or structural injustice:
It is the characterisation of organizational racism. It is marked by structurally built differences that prevents access to various social opportunities and services. This kind of injustice in the health care organization is seen to be normative often legalised in some parts. These are seen to be structural and codified in the health care institutions due to maintaining customs, practice and regulations so that there can be an identifiable perpetrator of an organization. According to the research it has been found that structural discrimination can persist even though the individual discrimination is lessened in the American society.
Interpersonal injustice: At individual or interpersonal level, the workplace discrimination may be intentional as well as unintentional. It encompasses actions of commission or omission. Various researches have documented a variety of unfair practices which the immigrant workers face vulnerably. Such discrimination leads to isolation or exclusion of the foreign born workers who are chiefly socially or economically disadvantaged from all the workplace events or activities. The studies have revealed that these workers are subjected to insults related to one’s race or ethnicity as well as subject them to an overtly hostile action as well as behaviour. The reports published in the health care sector of the USA suggest that the employees having African-American origin and other racial minorities mainly immigrant workers are being targets of poor offensive comments in their organizations which have made their duties, services and activities difficult than the native born employees.
Types of workplace discrimination:
The workplace injustice reference to the acts of the organizations and the individuals working in them that set unfair terms or conditions against a particular group or individual which affect their performance. It systematically impairs the capabilities of those individuals having minority background working in a group. In most of the cases, the concept of the discrimination is motivated by the ideology of inferiority of the disadvantaged groups and comparing it with the dominant groups. Immigrants from various African and Asian countries chiefly face the racial discrimination in the US health care sector and people from the middle East face the issues regarding different religion. Discrimination based on race validates the mistreatment or dominance by the members of specific racial groups on the immigrants due to prevalent ideology associated with their cultural or genetic inferiority. This cultural dominance also carries the history of social power relationships among the races.
Eliminating racial and ethnic biases in healthcare
Discrimination in the health care sector in the US even have been seen to occur among the underprivileged groups themselves. The researchers have found that often one particular ethnic group is favoured over another among the immigrant employee groups. This concept of favouritism is initiated as well as propagated by both the co-workers as well as employers of various state owned or private health care organizations in the USA. The report has revealed that the Latino indigenous people working in the American health sector are differently distributed with more hazardous tasks than those of their counterparts. They are also deprived of educational training materials in the languages that they understand whereas they share similar cultural background with Spanish speaking people. The situation of the aging immigrants is also vulnerable. Discrimination is also found the health insurance aspects where they are provided with lesser or no insurance benefits for their age and ethnicity.
Workplace bullying as well as abusive remarks regarding culture or ethnicity involves the actions which offend as well as socially exclude an employee or a group of employees from a particular task due to their national origin. this action has a far reaching negative effect on the reputation of the organization as well as productivity. These actions have been found to be status blind and take place repetitively over a long period of time. These actions directly influence the employees’ sensitivity that hamper the overall care service. These immigrant workers in the health sector have increased the risks of post-traumatic stress disorder related issues when they are exposed to workplace discrimination. This inequality related issues have been effecting blood pressure and psychological health among the immigrant workers irrespective of men and women.
The employees working as physicians, surgeons, registered nurse and technical departments in the health care sector USA possess a strong educational background and have pure intention to serve the various kinds of patients without having any concern for the patient’s background. Racial discrimination in serving the patients and vice versa have been also reported by the medical journals of the country. Here, the health care professionals have been seen to discriminate among their patients in providing care in one hand and the patients dissuading to accept care from an inferior caregiver on the other have been found. Racial discrimination at the US health care sector has resulted poor job quality, consequently reduced the organisational productivity, trust, satisfaction, commitment and morale. The increased cynicism and absenteeism led to increased grievances and ultimately staff turnover.
However, the things are being judged for reducing such types of discriminations in a major sector like health care and following initiatives are being taken:
- diversity training
- mentoring programs
- systems to monitor the health care staff and patient outcomes
- resource development
- revision of policies and practices
- recruitment practices
- flexible working provisions
- accepting management styles for managing cultural diversity
These acknowledge the privilege of the dominant group as chief factor of discrimination. These are most common approaches that address all kinds of discrimination in health care organizations. These increase awareness, positive attitude, skill-based learning, action-oriented thinking, role playing, liberal discussion thus create a supportive environment tailoring, knowledge transfer among the groups.
changing situation:
Immigrant health care professionals can admit to the US to a range of temporary as well as permanent visa types. These categories include visa categories H-1B that is for the specialty professions, H-2B for non-agricultural labours, H-3 for trainees, J-1 for the exchange visitors, TN for Mexican and Canadian NAFTA professionals, O-1 for people with surprising ability or achievements (Kossek 2015, 173). Among these, Doctors having foreign degrees apply for J-1 visa for completing medical residency in the USA. It is needed for most of the foreign-educated doctors. The physicians can also apply for temporary visa, like H-1B, for completing a residency training as well as to work in medical field after they complete their U.S. residency programs problem (Nivet, Castillo-Page and Conrad 2016, 1030). This situation is quite similar with other immigrants especially immigrant health care staffs. They can be admitted through the permanent immigration channels based on employment connections or through humanitarian as well as other routes.
The researchers have demonstrated some exceptional trends in the outsourcing in the US health care sector that focus on the women employment in the health care sector. From the data collected in 2010, it could be found that most of the women employees used to be enlisted in the psychiatry and registered nursing and the men enlisted in technical departments in health care sector and the native women preferred working as both registered nurses and technicians whereas the men enlisted in the higher posts like doctors and physicians (Tronto 2013). This situation has been changed from 2014 where both immigrant men and women stated to get opportunity to get employment in the higher designations of the health care hierarchy. They have been seen to overcome the cross-cultural borders though deeper knowledge on the respective subjects therefore placed in the high posts of the US health care system.
According to recent data, the American health care occupation has been served by 75% of foreign-born female workers. Irrespective of origin, the womenfolk accounted for majority in all the 7 health care professional groups excepting only for one that is physicians or surgeons. Now one third of the native-born surgeons or physicians are women in comparison to 35% of the immigrant women working on the health care sector in the USA. On the other hand, women have embodied a considerable share of both the immigrant and native registered nurses (Bruna, and Chanlat 2015). Health care specialists who provide support to the mainstream heath care services including those who are working in nursing, psychiatry and home based health aids along with other supporting roles are also chiefly likely to be females. However, there are categories among the immigrants preferring departments according to their subject areas.
The information regarding the majority of immigrant heath care providers have released the fact that about 46.2% of all the foreign born workers who reside in the USA have Asian background. It is the leading place of birth of 41% of total immigrant employees in health care sector, followed by Latin America 18% (excluding Caribbean) and North America, Europe, Africa 14%. The health care workers originated in Asia and people from Europe, North America and Australia are more likely to be employed in the higher ranks as physicians or surgeons than their counterparts coming from other places along with African (Bruna, and Chanlat 2015). The African women are employed as the listed nurses. The Caribbean origins are more likely to work in the supporting sections than immigrant health care workers. The study has revealed that one third of the immigrant workers in the health care sector are registered nurses and they are from Philippines.
As mentioned before that the health care of America is chiefly dominated by the immigrant workers be tit a higher rank or an assistant level. It is due to their subjective knowledge and achieved degrees in the universities outside America (Banks, Suárez-Orozco and Ben-Peretz 2016). these people are highly educated in comparison to their native counterparts. Therefore, immigrants with more knowledge in health care occupation get higher chance to enter this particular sector. Beside this, age is also a factor where the immigrants have their degrees at the age of 25 hence older in age than the native employees. This gap in age and degree is widest for the health care workers who work in the technological sector, registered nurses and other health care assistance occupations (Vink, Prokic?Breuer and Dronkers 2013, 5-6). However, as the scenario is changing, it can be found that this knowledge and expertise gap is by far decreasing because irrespective of nativity, 80% of all physicians or surgeons in the American health care sector are having university degrees and higher. Near about 93% of both the native-born and immigrant health care employees in the occupational group even including dentists and physician assistants possess a standard university degree and higher (Tronto 2013). Among the civilian employees age 25 and more, 35% of native and 31% of the immigrants have acquired a higher educational credential.
According to the data published in 2015, more than 66.4% of the immigrant people employed in the health care works applied and gained US nationality through naturalization. The high rate of naturalisation for all the civilian born people ages 16 or over has been employed in the USA. In case of other profession, the rate is around 45 percent. A considerable number of the immigrant employees in all of the 7 health care expert groups reported to have gained the U.S. citizenship. The rates of naturalization are ranging from 57 percent in the assistance sector America (Banks, Suárez-Orozco and Ben-Peretz 2016). People working as nurses, psychiatric as well as home based health aides to 68 percent for the other health care consultants along with technical jobs. On the other hand, the high designated experts such as surgeons, physicians, registered nurses and technicians, technologists have naturalization rates more than 70 percent and higher.
Another important factor that create hurdles in global mobility for professional reason is the language. However, as the USA English very much recognisable as well as accessible to the people deciding to migrate to the country for entering the health care profession in the USA (Whitehouse and Nesic 2014). More than 73% of the immigrant workers occupied the higher ranks like registered nurses and doctors in the health care sector is reported to speak English fluently which means they speak English fluently or very well. The proficiency rate for the civilian employed immigrant employees regardless of designation is more than 55 percent (Chae et al. 2014, 101). A considerable number of immigrants reported to speak English proficiently in care sector though the percentage vary from country to country.
It is important to discuss the benefits that the foreign born employees working in the US health sector enjoy currently. Regardless of the care occupational groups as well as nativity, the bulk of people employed in US health care section had been facilitated with health insurances in 2012 (Whitehouse and Nesic 2014). Now the insurance coverage rate is 88% and higher for the natives as well as foreign workers who are hired in maximum the health care occupational groups. The insurance exposure is close to the universal standard for the surgeons regardless of their nativity (Vink, Prokic?Breuer and Dronkers 2013, 7). Nursing, psychiatry and home based health aids along with other healthcare assistance specialists however are the exclusion. More than one-fourth of the immigrants which is 23 percent as well as native-born persons that is 24 percent employed in lower level occupations lack the national health insurance. In cases of other health care assistance professionals 14.66% of the native-born and 26 percent of immigrant employees lack health insurance.
The articles published in the medical journals in the United States have addressed numerous problems regarding the immigration and outsourcing in the health care sector. The problems associated with racism in medicine is one in many of the same things. To matter of racism and discrimination needs to be solved which is the urge of the time (Chae et al. 2014, 102). The federal government as well as the health care organizations and insurance sector need to recognize the requirement and understand the reason of discriminative attitudes and actions prevailed in the society (Tronto 2013). These institutions also required to be open for identifying as well as controlling their own implicit biases. All the associated sectors depending or relating to the health care sector must be able to manage overt bigotry safely by learning from them and educating others. It is really very important to connect all these objectives and actions together because these are layers of a singular huge problem (Nivet, Castillo-Page and Conrad 2016, 1031). The subconscious yet implicit bias, deceptive structural racism and external discrimination originate from a same place. To that end, the call to action for addressing racism, discrimination in the health care sector is for providers as well as patients.
Conclusion:
Therefore, it can be concluded that the health cate sector in the USA has a considerable amount of immigrant workers who have come to the country from all the continents. There are differences among the preference along with academic proficiency which vary from immigrants to immigrants. There is a hard competition between the native born employees and foreign born employees which is ignited by the racial issues. This need to be solved in no time for providing aid and care to the citizens as well as for inclusive growth of the country. Recognition of the existence as well as the dynamics of racial, ethnic bias in American health care arena, programs teaching the dynamics of the bias-producing processes and the stereotyping can be a positive initiation towards eradicating discrimination. These problem has closely affected the American health care sector. it has become important to develop the measures for teaching patients as well as providers the particular cultural competence, cross-cultural skills and diversity in order to maximize the assistances of the doctor-patient relationships. These themes must be a part of the USA medical education, as well as institutional policies. There is a need to model tolerance and practice them, respect other cultures, open-mindedness for achieving peaceful coexistence for inclusive growth and proper care.
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