Is Brain Drain Cannibalism?
p. 143-145
Texte intégral
1The notion of a cannibal market seems most clearly relevant when discussing the circulation of human organs and materials of human origin. The commodification of parts and derivatives of the human body is the prerequisite for the existence of such a market, which today is increasingly globalized, and as a result, subject to global inequalities. Yet to apply the metaphor of cannibalism to the worldwide brain drain of skilled health-care personnel would seem rather far-fetched. After all, the “brains” in question are not literally human organs to be transplanted, as in a science-fiction film. These brains sit atop real human beings, who have thoughts, aspirations, public and private commitments, as well as a self-understanding of their professional role and responsibilities. Nevertheless, the language of commodification comes naturally when describing the migration of health-workers from (absolutely or relatively) resource-poor to resource-rich areas. Health-care personnel are “produced,” exported, and imported; in short, traded in an expanding worldwide market that is increasingly a matter of specialist business operations and of explicit commercial and political arrangements. This part presents a wealth of data about health-worker migration in various parts of the world, its significance in terms of economics and health-care provision, and the ethical implications of this largely unequal trade.
2The hemorrhage of doctors and nurses from sub-Saharan Africa described by Delanyo Dovlo and Sheila Mburu provides an impressive example of how low-income countries lose many skilled health-care workers to rich countries. The discrepancy between health-care needs and the availability of health-care personnel is most severe in this region of the world, which nevertheless serves a “perverse subsidy” to wealthier countries through the emigration of doctors and nurses. As worldwide demand increases, “buyers” of this precious commodity will dig deeper into the precarious capabilities of low-income countries to provide educated health-workers. Although voluntary restraints have been in place for some time, they have showed limited effectiveness.
3The picture in Southeast Asia, as presented by Nicola Suyin Pocock, is more complicated, if only because several countries in the region train nurses for the explicit purpose of emigration. In addition, medical tourism, either from nearby countries or from farther afield, provides additional working opportunities for health professionals but may also cause a potential drain away from domestic health needs, especially in underserved rural areas. The pros and cons of health-worker migration hinge upon complex equilibria, where expanding health coverage for the local population, cashing in the economic benefits of health-personnel exports and of medical tourism, preventing the depletion of public health-care systems of needed personnel, and protecting the more vulnerable populations all play an important role. The predicament of the poorest countries in Southeast Asia is still a combination of low health-worker density, low uptake of health services, and low quality of training. As these countries see their economic prospects improve, the question of health-worker migration may arise for them too.
4In the third contribution to this part, Barbara Brush provides an in-depth analysis of the international migration of nurses. The starting point of her analysis is the import of foreign-trained nurses into the United States, a practice that was stable at a relatively low level for a long time, but that has undergone an upswing in recent years. This trend is part of a global increase in nurse migration that evinces more complex patterns (several countries are both at the sending and receiving end of these movements, and new countries such as India are getting into the act), as well as increasingly sophisticated business ventures. The growth of these commercial operations proceeds unfettered, and there are few coordinated efforts to regulate nurse migration across the globe.
5To come to terms with these issues, public oversight is needed. This requires political will and ingenuity, as well as a sound knowledge and appreciation of medical workers’ aspirations. If health-care personnel emigrate, it is for complex reasons that go well beyond better income: they include housing, educational opportunities for their families and themselves, fair career prospects, and sound governance as opposed to favoritism and corruption. Health-care workers are not mere pawns to be shifted about by authoritarian policies, however well-intentioned: that would be the ultimate commodification. Therefore, tackling these issues responsibly is the duty of governments everywhere, no matter where they stand in the international circulation of highly needed skilled professionals.
Auteur
Professor of bioethics at the University of Geneva Faculty of Medicine and director of the Institute for Ethics, History, and the Humanities. He initially trained as a molecular biologist. He moved to the field of bioethics during the late nineteen-eighties and initiated the bioethics program at the University of Geneva. He has worked and taught on a wide range of bioethical issues and has been a member of the Swiss National Advisory Commission on Biomedical Ethics
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