Re-envisioning Human Capital: Priorities in the Developed and Developing World

As much as private capital—in the form of finance and investment—matters for the initiation and growth of global health programs, human capital underlies the sustainability and success of such programs. Physicians, nurses, and medical personnel all play a central role in supporting primary health care services and thus strengthening national health systems. This is precisely why the “brain drain” phenomenon in developing nations receives so much attention: according to a 2002 British Medical Journal article, roughly 23,000 medical professionals emigrate from Africa each year, costing the originating developing nation over $180,000 per individual trained.¹ What is less understood, however, are the health disparities present between urban and rural dwellers in the developed world. As Kaiser Health News recently reported, mortality rates among rural American populations have decreased at half the pace of urban mortality rates, largely due to rural inhabitants’ limited access to medical care.² Given the importance of human capital to health problems in both developed and developing nations, then, the United States has a unique opportunity to improve global health outcomes by placing human capital at the forefront of its global health efforts

In the developing world, emigration of health professionals strips nations of their medical talent, thus sapping health systems of their scope, depth, and quality. Numerous factors explain such emigration, including dwindling employment opportunities for medical graduates, downward pressure on professionals’ wages, and inadequate facilities for treating patients. Amid these disheartening figures, however, is cause for hope. In Malawi, a nation ravaged by the AIDS pandemic and burdened by a shortage of nurses, the Ministry of Health created an emergency plan—using funding from the United Kingdom’s Department for International Development—to increase nurses’ salaries. Though simple, that plan produced promising results: the number of nurses leaving each year fell dramatically, while the number of Malawians attending nursing school increased by 50 percent.³ In such cases where the state dominates health care spending and where nurses, in particular, supply the majority of labor, the United States should provide funding for salary hikes to health professionals. In doing so, the United States must avoid placing arbitrary restrictions on its aid, as its previous conditional loans to Malawi were in fact responsible for health budget cuts that ultimately drained the nation of its health professionals. Continued migration of health professionals to the developed world is inevitable unless nations like the United States take an active step toward strengthening their own health systems. Current policies do little to incentivize students to pursue medical careers, or encourage medical graduates to practice in rural areas. In fact, rural residents account for 40 percent of the U.S. population but have access to only 10 percent of U.S. physicians.⁴ To improve health outcomes in rural America, the federal government must partner with university programs to encourage students to pursue medical training more generally and rural training more specifically. The former may be accomplished through government-sponsored loan forgiveness programs—given the high costs of medical training—while the latter requires greater investment in innovative programs, such as Tulane University’s Rural Medical Education Program, which provides extensive training and financial aid opportunities to accepted students.

By undertaking these two particular policies, the United States will place human capital at the center of the global health debate. Yet, this is only the first step. The dearth of health professionals in the world reflects the international community’s mismanaged health priorities. When international and state organizations address brain drain cases on a state-by-state basis, they lose sight of internal and regional migration trends; when they focus on regional migration, they ignore international migration patterns. The pulls and pushes of globalization thus create a precarious situation where a balance of health professionals among nations appears impossible. Here, the United States is uniquely positioned to coordinate efforts among nations to better resolve their migration problems. First, through programs like the Global Fund and PEPFAR, the United States has already established its commitment to improved health outcomes, thus giving it ample influence to harmonize state policies around human capital initiatives. Second, its connection to numerous nonprofits, such as the Gates and Clinton Foundations, permits it to broadcast its message to areas beyond the reach of most state-level policies. With these two observations in mind, the United States should establish a new framework—possibly through an international summit outside the WHO or World Bank framework—that places the diffusion of health professionals on the international agenda. In doing so, the United States will be investing its leadership and resources in a cause with implications for the whole of global health and society.

Sources

1. Tikki Pang, Mary Ann Lansang, and Andy Haines, “Brain Drain and Health Professionals,” BMJ 324 (2002): 499- 500.
2. Kaiser Health News, “Report Highlights Rural Health Care Challenges,” 2 October 2009, http://www.kaiserhealthnews.org/Daily-Reports/2009/October/02/Rural-perspectives.aspx#
3. Christine Gorman, “Malawi halts nursing brain drain,” CNN, 30 July 2009, http://edition.cnn.com/2009/HEALTH/07/29/malawi.nurses.shortage/
4. National Rural Health Association, “What’s Different about Rural Health Care?” http://www.ruralhealthweb.org/go/left/about-rural-health (date accessed: 28 October 2009)