Global justice and the brain drain

INTRODUCTION ESSAY

Global justice and the brain drain

Gillian Brock1* and Michael Blake2

1University of Auckland, Auckland, New Zealand; 2Department of Philosophy, School of Public Policy and Governance, University of Washington, Seattle, USA

Citation: Ethics & Global Politics, Vol. 9, 2016, http://dx.doi.org/10.3402/egp.v9.33498

Copyright: ©2016 G. Brock & M. Blake. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license.

Published: 17 October 2016

*Correspondence to: Gillian Brock, University of Auckland, Philosophy, Arts 1, Room 458, 18 Symonds St, Auckland, 1142, New Zealand, Email: g.brock@auckland.ac.nz

This paper is part of the Special Issue: Book symposium on Debating Brain Drain: May Government Restrict Emigration? More papers from this issue can be found at http://www.ethicsandglobalpolitics.net

 

Our world is a terribly unequal place. It is unequal in terms of simple dollars and cents: the average citizen of Malawi has an annual income of US$320, while the average citizen of Japan has an annual income of almost US$48,000.1 This sort of inequality has been much discussed in recent political philosophy and theory; theorists have spent a great deal of time trying to understand precisely what sorts of inequality might be regarded as unjust, and why.2

The world is, however, terribly unequal in other ways, and these ways have not received similar levels of analysis. Consider again Malawi and Japan: Japan has around 21 physicians per 10,000 people, while Malawi has only one physician for every 50,000 people.3 This radical inequality in medical skills and talents has, obviously, bad consequences for health; people born in Malawi will live, on average, 32 years fewer than their counterparts born in Japan.4 These facts are troubling in themselves. They become more troubling, though, when we start asking why nations like Malawi have so few physicians. It is not that the citizens of developing countries have no interest in becoming physicians, or entirely lack the opportunity for training. Indeed, developing societies spend a great deal of money training new physicians and spots in medical schools are avidly sought. Rather, the low number of physicians has much to do with what medical training provides—namely, the opportunity to leave that developing society, in search of perceived better prospects. Developed societies such as the United States and the United Kingdom have made immigration comparatively easy for those with scarce medical skills, and such citizens often choose to pursue these immigration options. Consider, for instance, that in 2000, Ghana trained 250 new nurses—and lost 500 nurses to emigration.5 In 2001, Zimbabwe graduated 40 pharmacists—and lost 60.6 In 2002 alone, Malawi lost 75 nurses to the United Kingdom—a cohort that represented 12% of all the nurses resident in Malawi.7 The result has been a continued shortage of medical personnel in developing countries, especially in sub-Saharan Africa, despite considerable African investment in education.

This phenomenon of high levels of migration of skilled people from developing nations to developed ones is often referred to as the brain drain. Brain drain should be troubling to those who care about global justice. The phenomenon seems poised to perpetuate the inequality in life-chances between developing and developed societies. The absent talent of the emigrant undermines both the life-chances of present citizens of the developing society—a society with fewer doctors, after all, is a society in which more people will die avoidable deaths—and the chances for that society to develop flourishing institutions for future citizens. The phenomenon is troubling in other ways: the wealthy citizens of the developed world, already well-equipped with skilled citizens, are further increasing their stock by drawing on some of the world's worst-off societies, thus rendering those societies even more badly positioned to address citizens’ needs in the future.8

Debating Brain Drain: May Governments Restrict Emigration?9, by Gillian Brock and Michael Blake, seeks to offer some clarity about the morally rightful responses to these problems. While Brock and Blake share some premises—they are both liberal political philosophers, who care about the application of liberal justice to international problems—they disagree in particular about how it is that developing countries might respond to the brain drain. This article will give a brief overview of how this disagreement is developed in our book. The hope of this volume, more than anything else, is to bring to light the fact that political scientists and philosophers have an obligation to take brain drain seriously as a phenomenon. As globalization develops, we will have more need than ever to develop compelling moral responses to the new promises and new pitfalls that global change entails.

This moral disagreement, though, must begin with some analysis of the empirical facts of skilled emigration.10 There is an enormous amount of research on this topic, and there are multiple important effects that need to be weighed prior to any particular evaluation of overall consequences. Population size, geography, educational systems, language, or levels of disease burden can all make important differences—both in how it is that emigration affects individuals, and in how it affects societies. Sometimes high levels of skilled migration can be beneficial—as, for instance, when that migration results in increased economic opportunities, a healthy flow of revenue back to the country of origin, or increased uptake of new technologies. Sometimes the picture is more mixed, with some positive and some negative effects. And, sometimes, there are indeed important net losses for sender countries.11

What, if anything, ought to be done to address losses resulting from brain drain, when those losses exist? Like any complex phenomenon, various people have different responsibilities. Agents from affluent developed countries—such as recruiting agents for healthcare organizations in the United States—have one set of important responsibilities and those in poor developing countries might have another. When agents from affluent developed countries fail to play their part in discharging duties, what may poor developing countries do to solve their problems themselves? Might governments of poor developing countries defensibly introduce compulsory service programs of (say) 1 year's duration? Would they be justified in requiring high-skilled migrants who have left the country to pay taxes for a short period (such as 3 years) after leaving their countries of origin?

These latter questions are important, and they are the ones over which people of good will are likely to find themselves in disagreement. On the one hand, proposals for compulsory service or taxation might be construed as both unfair and illiberal. They might be thought unfair because they place a disproportionate share of the burden of global justice on talented and educated residents of developing societies. And they might be thought of as illiberal because they rest upon an illegitimate vision of what the state is entitled to claim as its own. Michael Blake, in his chapters in the book, develops a vision of this response to these potential responses to the brain drain. On his analysis, a liberal state cannot rightly insist upon the continued allegiance or labor of a citizen, after that citizen is willing and (apart from the state's coercion) able to leave that state. If this leaves the liberal state somewhat hamstrung in its efforts to respond to skilled emigration, this simply reflects the truth that liberalism does not exist to maximize the options open to political communities. The rights of persons, after all, frequently act as constraints against state action, and the lack of a perfectly effective response to skilled emigration might simply reflect the inconvenient fact that states cannot always do whatever would maximize their own abilities and powers.

On the other hand, some might be more persuaded that it can be reasonable for migrants to be assigned such responsibilities. Factors that may seem relevant include the dire needs of compatriots, the investment of public resources in training highly skilled citizens who leave, governments’ responsibilities to provide services that would meet needs, the benefits the migrant has received while living in his or her country of origin, duties to reciprocate, and the like. Gillian Brock, in her chapters in the book, develops and defends these arguments and shows that these thoughts can justify certain moderate and reasonable restrictions on the right of skilled emigrants to leave. These restrictions are temporary, and must be justified with reference to the rights and values of the citizens affected by the emigrant's decision. The justification, however, can be accomplished, for some particular set of policy responses to skilled emigration. Brock thus argues that states have a wider array of legitimate potential responses to skilled emigration than arguments like Blake's permits.

Debating Brain Drain is thus a sustained debate over the morality of political responses to the brain drain phenomenon. During this debate, Brock and Blake consider a number of important questions. These include: Do compulsory service programs not inappropriately limit emigrants’ freedoms and opportunities? Why think it is justifiable to coerce some people to labor for the benefit of others? Why distribute so much of the responsibility for assisting the needy on relatively poor compatriots rather than affluent developed world citizens? And why think the emigrant can assist best by staying in the country of origin rather than from outside of it? These are the sorts of questions that this book seeks to analyze. Although Brock and Blake disagree about the answers to many of these questions, they share the commitment that these questions must be asked by anyone concerned to address the unequal and unjust structure of global society. A rightful response to global underdevelopment cannot look solely at financial forms of inequality; it must also address the many ways in which economic inequality exacerbates, and is exacerbated by, more complex forms of inequality. Such a response will likely never be finished, of course—the world will likely continue to develop new pathologies, even as we seek to understand those that already exist—but it is a worthwhile task to try. We may, at least, hope that exchanges like the present one might demonstrate the importance of this endeavor; we are grateful to our critics, both for their insightful comments, and for their participation in this shared task.

NOTES

1. Data from 2012 World Bank survey. http://data.worldbank.org/country (accessed March 16, 2016).

2. See, for a survey of some recent work on this, Michael Blake, ‘Global Distributive Justice: Why Political Philosophy Needs Political Science’, Annual Review of Political Science 15 (2012): 121–36.

3. The data are from studies between 2005 and 2012. http://kff.org/global-indicator/physicians/ (accessed March 16, 2016).

4. Figures are from 2012 life expectancy data. http://cia.gov/library/publications/the-world-factbook(accessed March 16, 2016).

5. Magda Awases, et al. Migration of Health Professionals in Africa: A Synthesis Report (Brazzaville: World Health Organization, 2004).

6. David R. Katere and Lloyd Matowe, ‘Effect of Pharmacist Emigration on Pharmaceutical Services in Southern Africa’, American Journal of Health-System Pharmacy 60 (2003): 1169–70.

7. Sue J. Ross, Daniel Polsky and Julie Sochalski, ‘Nursing Shortages and International Nurse Migration’, International Nursing Review 52 (2005): 253–62.

8. Matt McAllester, ‘America Is Stealing the World's Doctors’, The New York Times March 7, 2012.

9. Gillian Brock and Michael Blake, Debating Brain Drain: May Governments Restrict Emigration? (New York: Oxford University Press, 2015).

10. We review this literature in several places in Gillian Brock and Michael Blake, Debating Brain Drain: May Governments Restrict Emigration? (New York: Oxford University Press, 2015). See, especially 258–67.

11. Gillian Brock and Michael Blake, Debating Brain Drain: May Governments Restrict Emigration? (New York: Oxford University Press, 2015). See, especially 258–67.

About The Authors

Gillian Brock

New Zealand

Michael Blake

United States

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