Health professionals for a new century: transforming education to strengthen health systems in an interdependent world

Migration, both within and beyond borders, has become an increasingly prominent theme in domestic and international debates, and is the topic of the 2009 Human Development Report (HDR09). The starting point is that the global distribution of capabilities is extraordinarily unequal, and that this is a major driver for movement of people. Migration can expand their choices — in terms of incomes, accessing services and participation, for example — but the opportunities open to people vary from those who are best endowed to those with limited skills and assets. These underlying inequalities, which can be compounded by policy distortions, is a theme of the report.The report investigates migration in the context of demographic changes and trends in both growth and inequality. It also presents more detailed and nuanced individual, family and village experiences, and explores less visible movements typically pursued by disadvantaged groups such as short term and seasonal migration.There is a range of evidence about the positive impacts of migration on human development, through such avenues as increased household incomes and improved access to education and health services. There is further evidence that migration can empower traditionally disadvantaged groups, in particular women. At the same time, risks to human development are also present where migration is a reaction to threats and denial of choice, and where regular opportunities for movement are constrained.National and local policies play a critical role in enabling better human development outcomes for both those who choose to move in order to improve their circumstances, and those forced to relocate due to conflict, environmental degradation, or other reasons. Host country restrictions can raise both the costs and the risks of migration. Similarly, negative outcomes can arise at the country levels where basic civic rights, like voting, schooling and health care are denied to those who have moved across provincial lines to work and live. HDR09 shows how a human development approach can be a means to redress some of the underlying issues that erode the potential benefits of mobility and/or force migration.

Human Development Report 2009. Overcoming Barriers: Human Mobility and Development

Harvard School of Public Health, Boston, MA, USA (Prof J Frenk MD); China Medical Board, Cambridge, MA, USA (L Chen MD); Aga Khan University, Karachi, Pakistan (Prof Z A Bhutta PhD); George Washington University Medical Center, Washington, DC, USA (Prof J Cohen MD); Independent member of House of Lords, London, UK (N Crisp KCB); James P Grant School of Public Health, Dhaka, Bangladesh (Prof T Evans MD); US Institute of Medicine, Washington, DC, USA (H Fineberg MD, P Kelley MD); School of Public Health Universidad Peruana Cayetano, Heredia, Lima, Peru (Prof P Garcia MD); Peking University Health Science Centre, Beijing, China (Prof Y Ke MD); National Health Laboratory Service, Johannesburg, South Africa (B Kistnasamy MD); School of Nursing, University of Pennsylvania, Philadelphia, PA, USA (Prof A Meleis PhD); University of Toronto, Toronto, ON, Canada (Prof D Naylor MD); The Rockefeller Foundation, New York, NY, USA (A Pablos-Mendez MD); Public Health professionals for a new century: transforming education to strengthen health systems in an interdependent world

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Health Professionals for a New Century: Transforming education to strengthen health systems in an interdependent world

This paper reviews four decades of economics research on the brain drain, with a focus on recent contributions and on development issues. We first assess the magnitude, intensity, and determinants of the brain drain, showing that brain drain (or high-skill) migration is becoming a dominant pattern of international migration and a major aspect of globalization. We then use a stylized growth model to analyze the various channels through which a brain drain affects the sending countries and review the evidence on these channels. The recent empirical literature shows that high-skill emigration need not deplete a country’s human capital stock and can generate positive network externalities. Three case studies are also considered: the African medical brain drain, the exodus of European scientists to the United States, and the role of the Indian diaspora in the development of India’s information technology sector. We conclude with a discussion of the implications of the analysis for education, immigration, and international taxation policies in a global context.

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Globalization, Brain Drain, and Development

(1) Whereas the objectives of the Community, as laid down in the Treaty, as amended by the Treaty on European Union, include creating an ever closer union among the peoples of Europe, fostering closer relations between the States belonging to the Community, ensuring economic and social progress by common action to eliminate the barriers which divide Europe, encouraging the constant improvement of the living conditions of its peoples, preserving and strengthening peace and liberty and promoting democracy on the basis of the fundamental rights recognized in the constitution and laws of the Member States and in the European Convention for the Protection of Human Rights and Fundamental Freedoms;

Some Preliminary Comments on the DIRECTIVE 95/46/EC OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL of 24 October 1995 on the protection of individuals with regard to the processing of personal data and on the free movement of such data.

In light of the increasing globalization of the health sector, this article examines ways in which health services can be traded, using the mode-wise characterization of trade defined in the General Agreement on Trade in Services. The trade modes include cross- border delivery of health services via physical and electronic means, and cross-border movement of consumers, professionals, and capital. An examination of the positive and negative implications of trade in health services for equity, efficiency, quality, and access to health care indicates that health services trade has brought mixed benefits and that there is a clear role for policy measures to mitigate the adverse consequences and facilitate the gains. Some policy measures and priority areas for action are outlined, including steps to address the "brain drain"; increasing investment in the health sector and prioritizing this investment better; and promoting linkages between private and public health care services to ensure equity. Data collection, measures, and studies on health services trade all need to be improved, to assess better the magnitude and potential implications of this trade. In this context, the potential costs and benefits of trade in health services are shaped by the underlying structural conditions and existing regulatory, policy, and infrastructure in the health sector. Thus, appropriate policies and safeguard measures are required to take advantage of globalization in health services.

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Trade in health services

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(08)61778-X.pdf

Trade in health-related services.

Medical tourism: A review of the literature and analysis of a role for bi-lateral trade

India and the EU are currently negotiating a Trade and Investment Agreement which also covers services. This paper examines the opportunities for and constraints to India-EU relations in health services in the context of this agreement, focusing on the EU as a market for India's health services exports and collaboration. The paper provides an overview of key features of health services in the EU and India and their bearing on bilateral relations in this sector. Twenty six semi-structured, in-person, and telephonic interviews were conducted in 2007-2008 in four Indian cities. The respondents included management and practitioners in a variety of healthcare establishments, health sector representatives in Indian industry associations, health sector officials in the Indian government, and official representatives of selected EU countries and the European Commission based in New Delhi. Secondary sources were used to supplement and corroborate these findings. The interviews revealed that India-EU relations in health services are currently very limited. However, several opportunity segments exist, namely: (i) Telemedicine; (ii) Clinical trials and research in India for EU-based pharmaceutical companies; (iii) Medical transcriptions and back office support; (iv) Medical value travel; and (v) Collaborative ventures in medical education, research, training, staff deployment, and product development. However, various factors constrain India's exports to the EU. These include data protection regulations; recognition requirements; insurance portability restrictions; discriminatory conditions; and cultural, social, and perception-related barriers. The interviews also revealed several constraints in the Indian health care sector, including disparity in domestic standards and training, absence of clear guidelines and procedures, and inadequate infrastructure. The paper concludes that although there are several promising areas for India-EU relations in health services, it will be difficult to realize these opportunities given the pre-dominance of public healthcare delivery in the EU and sensitivities associated with commercializing healthcare. Hence, a gradual approach based on pilot initiatives and selective collaboration would be advisable initially, which could be expanded once there is demonstrated evidence on outcomes. Overall, the paper makes a contribution to the social science and health literature by adding to the limited primary evidence base on globalization and health, especially from a developing-developed country and regional perspective.

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India-EU relations in health services: prospects and challenges

We provide a first empirical attempt at understanding the scale and type of skilled migration from the Indian software sector and the consequences for firms experiencing loss of skilled workers. The paper draws on some unique survey evidence of software firms in India. The results are not generally consistent with an adverse or brain drain story but provide a more nuanced interpretation. Not only has skilled migration taken a variety of firms - including significant temporary migration - but the evidence suggests that the impact of mobility on performance in the sending firms has not been unambiguously adverse. There is some evidence of associated wage pressure at the height of the software boom in the late 1990s. But there is also evidence of a strong supply side response as workers acquired training and entered the sector.

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Rupa Chanda

Papers

Trade in health services

Trade in health-related services.

Medical tourism: A review of the literature and analysis of a role for bi-lateral trade

India-EU relations in health services: prospects and challenges

Must Skilled Migration Be a Brain Drain? : Evidence from the Indian Software Industry