Apparently, it is now publishing articles like this:
Rich countries are poaching so many African health workers that the practice should be viewed as a crime, a team of international disease experts say in the British medical journal The Lancet.
The provision of health services in poor countries is a huge problem that the international community should worry about. But not by declaring medical personnel the property of the state, and their migration therefore a form of thievery. There's been a lot of talk recently about the right of entry for poor people, but even more important is the right of exit. There's a reason that places which require their citizens to get permission to migrate are generally dreadful places to live.
If we’re willing to give our own consumers (and our society in general) the benefits they receive from foreign competition, we shouldn’t deny other countries the benefits they’ll enjoy from having to compete with us for the talents of their best and brightest (chief among these being the necessity for them to get their acts together, lest they lose said best and brightest).
Moreover, there are the rights of the would-be immigrant to consider. China’s loss, in other words, is Mr Chang’s personal gain. Preventing him from immigrating in order to give some sort of benefit to China strikes me as an utterly unjust case of the ends justifying the means
It makes one wonder how poaching is actually happening if there is decent opportunity in these countries. I grew up in a relatively poor community in North America and I would be appalled by the notion that it was theft of human capital from me to move from unemployment to employment.
Add in issues like human rights (e.g. people will move if they fear death from staying) and the general inertia that prevents most people from moving and the real question is "why is it so easy for rich countries to hire health care workers"?
"What the heck is happening to the Lancet?"
It has decided to admit frankly that is under the control of socialist fruitcakes.
Well Jasper and JD, it's so obvious to ever right, err, left thinking anti-westerner who worships the goddess Guilt-Trip that the reason rich countries can steal qualified people is we colonized, enslaved them and now have a leg up and can buy away their talent with money that was stolen from them in the first place.
See, don't you get it, we can only be on "equal" terms when we sell everything we own to the UN, and wait for the UN to distribute us back our allotted portion.
On one hand, it is reasonably for the parties involved on-the-ground to be frustrated when they see their efforts to improve matters locally, be put to nought by superior international offers. This is doubtless a real problem, and one that may not have a ready or obvious solution.
However, it is downright odious to suggest a solution that basically makes people into slaves of their birthplace, and the language employed here suggests a willingness to do exactly that.
It'd be interesting to get the perspective of a physician (or better yet, a medical school professor) to see what exactly is happening to the British medical literature. The Lancet and BMJ seem to publish 'public-health-ish' article; for that matter, JAMA and NEJM do, too.
Thankfully, the closest chemistry gets to this sort of thing is C&E News, which every once in a while, betrays its blue state roots.
I once had a drink with a Solomon Islander trained as a pharmacist by aid funding from New Zealand. It was my round, as his government salary cheque hadn't arrived for a couple of months.
His story could be summarised as "I spent six years learning how to hand out the correct medicine at the correct dosage. Every day I see dozens of really sick people with treatable illnesses. The only drugs I can give them are panadol that is past its expiry date, and some generic Chinese anti-malarial pills of unknown effectiveness."
I asked him what he was going to do. "Migrate to Australia" was his response.
"But not by declaring medical personnel the property of the state, and their migration therefore a form of thievery."
Well, the article in question specifically notes "Health workers should have freedom of movement and choice of where they live and work, just as any workers should" so they're not actually saying what you claim they're saying.
What they are suggesting is that some form of system
whereby poor countries who are losing health professionals get some form of investment into their health sector as recompense.
kennyb,
Why stop at Health workers and why stop at developing countries... how about we setup a system whereby when an immigrant with certain skills (labor, health, tech) migrates the host country has to pay a set amount back to the emmigrating country... We could have the world bank setup immigration accounts and shuffle money around.
We don't because it's crazy! It's clear that such a system would reduce the opportunities for the poorest people, treats people like commodities in need of an export tariff, and simply makes no sense other than global wealth redistribution.
The problem isn't poaching, it's the lack of economic freedom in the developing world. I've had lots of professionals (engineers in my case) in Africa, Mexico and the Middle East approach me about getting work in USA, Canada, EU etc. For a long time I wondered why. They had good jobs and pay, with low costs of living and high prestige in their home countries. This is especially true in Mexico. What I finally concluded was that the insecurity of their situation was the key. Their positions depended only partly on their skills, but much much more on the political state of their country. The change could be as extreme as civil war (Africa) or a peaceful change of clan or group that still cost your your job or promotion. A high degree of personal liberty and rule of law is still vital to a country's progress.
1) The most fundamental test of any state is whether the border guards are trying to keep people in, or trying to keep people out.
2) The problem with the brain drain is that frequently (almost always?), the doctor/nurse/pharmacist got their training free. Charge them tuition, lend them the money if necessary, and require them to pay the student loan back if they emigrate. Then a lot of the problem goes away. In many cases, such as India, the home countries have a comparative advantage in training professionals. They should be doing it and exporting the result. The key contribution the host countries could make would be facilitating the enforcement of the loan contracts.
kennyb,
To give compensation for accepting a country's emigres is the same as treating those emigres as property. To require such compensation is a restriction on the emigres' right to relocate.
These countries could try contracts- in return for receiving medical training, you have to stay a certain number of years before leaving. I have no objection to freely entered contracts.
The Lancet is no longer credible as a scientific journal. It has become a vehicle for socialist propaganda.
If there is a crime occurring, something a medical journal is not competent to determine, then it is the failure of the government funding the education to get a contract with the eprson taking the education to stay in country for whatever period of time both parties agree to. The US military calls this kind of thing a "utilization tour." The difference between that and what the Lancet is hinting at, despite its ass-covering disclaimer, is that the student knows the terms and agrees to them going in.
Acad Ronin,
Singapore actually has a system like this in place. A friend of mine and his fiance are currently tearing their hair out because the Singaporean government is demanding that she either A) spend the next 5 years in Singapore as an elemnetary school teacher or B) come up with the entirety of her tuition as a lump sum.
They're both furious about this, and she knew what the deal was when she went off to college. I can't imagine what their response would be if someone sprung this sort of trap on them with no warning.
"Why stop at Health workers and why stop at developing countries... how about we setup a system whereby when an immigrant with certain skills (labor, health, tech) migrates the host country has to pay a set amount back to the emmigrating country... We could have the world bank setup immigration accounts and shuffle money around. "
Hell, no!
You don't want the world bank doing this. The NBA has more experience. A doctor should be worth a first and second round draft choice over the next 2 years, unless it's a lottery pick...
Njorl,
The NBA!! They don't invest in the basketball programs they steal underclassmen from!
Tough on that vein, I wonder how much the Lancet authors think the US should invest in Africa for Hakeem Olajuwon, especially since we educated him.
I've heard that some countries had exit exams in the past, where only the cream of the crop of engineering students would be allowed to leave and study abroad. This was in the ROC; has anyone else heard this?
2) The problem with the brain drain is that frequently (almost always?), the doctor/nurse/pharmacist got their training free. Charge them tuition, lend them the money if necessary, and require them to pay the student loan back if they emigrate. Then a lot of the problem goes away.
Yes, the problem goes away because the health care system in the poor country goes away. Certainly there would be no problem of a brain drain of health professionals from poor countries if there were no health professionals in poor countries.
My daughter had malaria at 6 months in a town in Mali. She was saved by a couple of government-paid Cuban doctors. The Cuban doctors there were infinitely better than the American doctors there. Because there were no American doctors there. Here in the US we already have a desperate shortage of health care pros in poor rural areas; our government has to pay immigrant doctors to live in eastern Kentucky. Do we somehow imagine this problem doesn't exist in the third world?
I have a more complete solution to the problem here. First, let all the health professionals from the third world immigrate to the first world if they want to. Then, let everyone else from the third world come to the first world too, so they won't have to go without health care. Problem solved.
As a rule, when a newspaper article starts with the expression "According to the Lancet" I stop reading.
Even when I agree with it (I'm strongly pro-choice), I find its scientific standards low. It's a scientific journal, but much in the same sense that News Of the World is a weekly newspaper.
I have a more complete solution to the problem here. First, let all the health professionals from the third world immigrate to the first world if they want to. Then, let everyone else from the third world come to the first world too, so they won't have to go without health care. Problem solved.
Why not simply turn the third world into the first world? That way all those people don't even have to move and we won't have all that wasted space.
SG,
Did you miss colonialism in history? We tried exporting our values and social structures abroad, and I think most people were rather unhappy with the results of that.
Short of setting up puppet governments and supplying law enforcement, external parties can't make a society modernize or westernize. We can support those that do, help those that want to, but no amount of aid will help Zimbabwe or other third world countries during the lifespan of its current citizens.
Skullberg:
Sometimes sarcasm doesn't come across in the printed word. I thought the original proposal (let every 3rd world resident emigrate to the 1st world) was, to be polite, fantasy, so in that same vein I put forth my own modest proposal.
Although, I now realize that I might have misinterpreted sarcasm for sincerity too. Was the original proposal serious?
SG,
Increased flow of labor and capital is generally (around these parts) as providing positive benefits to both the countries and workers involved.
Obviously moving them all to first world countries would be impossible, but I'm not convinced stepped up immigration flows (especially for skilled workers), would be a) more expensive than dumping aid, b) less efficient or c) more harmful to the emigrant country.
It seems that the bloggers on here actually failed to read the Lancet article. First of all, it top public health people from around the world, including Africa, that wrote it. Do you really think they went lightly into this difficult issue?
the greater concern I see from people's messages here is their own concern if they weren't allowed to better themselves. There is a reason we don't recruit painters, waiters, etc from Africa. We have a tonne of untrained folks ourselves. Its true that they have a right to leave, but they don't actually have a right to be accepted into their destination country. Remember, thats what immigration is all about.