Editor—Socioeconomic imbalances have a habit of exacerbating themselves: we call them virtuous and vicious cycles. It is near impossible to change the one into the other.
The world is increasingly one integrated system, and costs and benefits are not directly linked. Those who benefit are not those who pay. Conscience may persuade some, some of the time, to pay for the value they receive. These discussions serve as part payment, a salve to conscience, but no pragmatist expects or believes that the brain drain will be reversed.1
The convenient solution is to introduce friction to the free movement of health professionals: the health professionals pay; the benefiting countries say, “See, we have made it difficult for them”; and the losing countries are left with nothing.
The entire argument seems misplaced. Seen as a unit, the whole world suffers from a dearth of health professionals.
Poor countries—developing countries—need more health, not more healthcare or more health professionals. Below a recognised threshold, health equates with income, both direct and indirect (the entire focus of public health initiatives: potable water, sewerage systems, electrification, telephones, roads, mass immunisation, etc.) and yet still the health of nations focuses on the movement of health professionals.
The health of a nation has little to do with the movement or the numbers or the training or the remuneration of health professionals: America and Cuba are proof of that.
I am in favour of dialogue, and I will award myself Brownie points for this piece; I know that it will make no difference to the health of any nation, but I will feel better, and that will certainly be good for me.
Competing interests: EH is a health professional.
References
- 1.Coombes R. Developed world is robbing African countries of health staff. BMJ >2005;330: 923. (23 April.) [DOI] [PMC free article] [PubMed] [Google Scholar]