The International Migration of Health Workers: Ethics, Rights and Justice

239 Pages·2010·1.051 MB·English

by  Rebecca S. Shah (eds.)

The International Migration of Health Workers
The International Migration
of Health Workers
Ethics, Rights and Justice
Edited by
Rebecca S. Shah
Centre for Professional Ethics, Keele University, UK
Palgrave
macmillan
Selection and editorial matter © Rebecca S. Shah 2010
Chapters © their individual authors 2010
Foreword © Thomas Pogge 2010
Softcover reprint of hardcover 1st edition 2010 978-0-230-22441-4
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First published 2010 by
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ISBN 978-1-349-30941-2 ISBN 978-0-230-30729-2 (eBook)
DOI 10.1057/9780230307292
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Library of Congress Cataloging-in-Publication Data
The international migration of health workers : ethics, rights and
justice / edited by Rebecca Shah.
p. cm.
1. Medical personnel, Foreign. 2. Emigration and immigration. 3. Brain drain.
I. Shah, Rebecca.
R697.F6I583 2010
610.69'6—dc22
2010023942
10 9 8 7 6 5 4 3 2 1
19 18 17 16 15 14 13 12 11 10
Transferred to Digital Printing in 2014
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Contents
List of Tables and Figures ix
Foreword x
Thomas Pogge
Acknowledgements xii
List of Abbreviations xiii
Notes on Contributors xiv
Introduction The International Migration of Health Workers:
Ethics, Rights and Justice 1
Rebecca S. Shah
1 International Migration of Health Professionals: Towards
a Multidimensional Framework for Analysis and
Policy Response 9
Giulia Greco
2 Care Worker Migration and Global Health Equity: Thinking
Ecologically 25
Lisa A. Eckenwiler
3 Does the Migration of Health Workers Bring Benefits to the
Countries They Leave Behind? 44
Corinne Packer, Vivien Runnels and Ronald Labonté
4 Conflicting Obligations in the International Migration
of Health Workers 62
Jeremy Snyder
5 The Right to Health, State Responsibility and Global Justice 78
Rebecca S. Shah
6 Brain Drain, Health and Global Justice 103
Alex Sager
7 The Right to Leave versus a Duty to Remain: Health-Care
Workers and the ‘Brain Drain’ 118
Phillip Cole
vii
viii Contents
8 The Right to the Free Movement of Labour 130
Anthony H. Lesser
9 Coercion in the Fight Against Medical Brain Drain 137
Nir Eyal and Samia A. Hurst
10 Maternal Survival and the Crisis in Human Resources for
Health in Africa: Impact of the Brain Drain 159
Staffan Bergström
11 Should I Stay or Should I Go? Brain Drain and Moral Duties 175
Anne Raustøl
12 Nurse Migration from South Africa and the Ethics Discourse 189
Colleen McNeil-Walsh
13 Global Health, Justice and the Brain Drain: A Trade Union
Perspective 203
Nick Sigler
Index 215
List of Tables and Figures
Tables
10.1 Comparison of obstetric endoscopy and ectoscopy 169
11.1 Priority 178
Figures
3.1 Top 20 remittance-receiving countries (as % of GDP), 2006 48
3.2 Top 20 remittance-receiving countries (in US$ billion), 2007 51
ix
Foreword
The poorer half of the world’s population is still very poor: unable
securely to meet their most basic needs. They have not benefited much
from rising global average income; their share of global household
income has reduced to below 3 per cent. On average, these people have
about $200 per person per year, or a little over $500 at purchasing power
parities.
Poverty contributes greatly to ill health. Each year, some 18 million
people, including nine million children under the age of five, are dying
from poverty-related causes, constituting about one-third of all human
deaths. Life expectancy in the poorest sub-Saharan region is 49 years,
more than 30 years lower than life expectancy in the richest North
Atlantic region. Hundreds of millions of poor households are burdened
or threatened by serious health problems that endanger their survival
or livelihood.
Poverty contributes to ill health in three main ways. First, many poor
people lack access to private goods that are essential to maintaining
good health. For the first time in human history, over a billion human
beings are now chronically undernourished, and similar numbers of
people lack access to safe drinking water or minimally adequate shelter.
Second, poor people must work and live under more hazardous condi-
tions. Over 200 million children (aged 5–17) do wage work outside
their household, often under slavery-like and hazardous conditions,
2.5 billion people lack adequate sanitation, and 1.6 billion people lack
electricity which would enable safe and pollution-free cooking. Third,
although poor people are far more likely to be struck by diseases and
accidents, they have far less access to health-care resources such as
doctors, nurses, medicines, and medical equipment. Poor people cannot
afford such facilities. And their governments are not providing it: in
most sub-Saharan countries, for instance, government health spending
is below $15 per person per year. While total health expenditure per
person per year exceeds $7000 in the US, it is below $50 in many poor
countries, including India and most of Africa. As a result, some two
billion people lack access even to essential medicines.
This collection examines closely one important aspect of the health
crisis among the global poor: the migration of many health-care profes-
sionals from poor to more affluent countries. Such migration wastes
x
Foreword xi
some of the scarce resources that poor countries devote to medical
training and it further hurts poor populations by reducing the numbers
of doctors and nurses available to them. While most affluent countries
have over 300 physicians per 100,000 people, for example, most African
countries, with their vastly greater disease burdens, have fewer than 12.
It may seem obvious that a health professional should be legally and
morally free to move across national borders, that the country she wants
to leave should let her go, and that other countries should be free to
admit her and, if they do, should afford her the same opportunities that
are available to other health professionals already there. Conformity to
these reasonable prescriptions would work fine in a just world. But in
our world, marred as it is by vast social and economic inequalities, these
reasonable prescriptions aggravate the unjust exclusion of the poor. We
should make the world just and then stick to the reasonable prescrip-
tions, you may say. I agree. But we are unlikely to achieve a just world
any time soon and hence face the question of what is to be done in the
meantime.
It is this difficult question that the authors of this book are wrestling
with. Taken together, these chapters comprehensively illuminate the
phenomenon: offering rich descriptions of it, careful analysis of the
relevant causal factors, moral assessments of the conduct of migrants
and their employers as well as of the policies of the source and recipi-
ent countries, and original and realistic reform proposals geared to the
world as it is. This volume is an excellent introduction to a very impor-
tant topic. It also affords a new perspective on how the choices and
policies of the world’s more affluent populations are involved in the
catastrophic health situation of the global poor.
Thomas Pogge
New Haven, 20 December 2009