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For Immediate Release

US Should Not Deprive Poor Countries of Doctors and Nurses, Say Global Health Advocates

Pending legislation to expand US health workforce could worsen brain drain from Africa and elsewhere

Cambridge, Mass - 09/14/2009

Cambridge, Mass. — Congress is considering legislation that could worsen the current brain drain of doctors and nurses from poor countries, such as Ghana, Ethiopia and Uganda, say global health advocates.

A coalition of organizations and individuals committed to improving health in low-income countries has written to President Obama and Congressional leaders opposing bills introduced in Congress that could negatively impact global health. The bills, which are separate from the broad health insurance reform plans currently being debate in Congress, would increase the number of doctors and nurses from abroad relocating to the United States to provide health care.

The coalition supports efforts to enable everyone in the US to receive the health care they need, but objects to meeting America's health care needs at the expense of developing countries, many of which have no doctors or nurses to spare. Instead, the letter advocates for legislation and funding to increase training opportunities for US residents seeking to enter the health profession.

The letter, signed by public health and human rights organizations such as Physicians for Human Rights and Partners In Health, states, "How we go about meeting the growing demand for care in the United States, especially the need for more nurses and primary care physicians, risks exacerbating already severe international health workforce shortages." The specific bills addressed in the letter would create immigrant visas for 60,000 nurses (H.R. 2536), and open spaces in medical residency programs for an additional 15,000 doctors, most of which would be filled by physicians from other countries (S. 973).

Lincoln Chen, based at Harvard University, who chairs the China Medical Board and serves on the National Academy of Sciences' Institute of Medicine, said, "We sincerely appreciate the considerable contributions that foreign-trained health professionals make to health care in the United States, and recognize the many reasons they choose to migrate. But we reject, and we urge Congress to reject, current and future bills that augment the US health workforce without consideration for the losses and the deleterious health consequences to developing countries of the health workers they have trained — often subsidized with their own scarce funding."

A number of bills introduced in Congress contain similar legislative language to increase Medicare-funded graduate medical education (GME) positions by 15%, the equivalent of roughly 15,000 new residents, at a cost of well over a billion dollars a year. Another signatory to the letter, Dr. Fitzhugh Mullan, Murdock Head Professor of Medicine and Health Policy at The George Washington University, said, "The US does not produce enough medical school graduates to fill these proposed new slots. US medical school enrollment is growing but only very slowly so that the new positions would have to be filled with doctors educated in other countries."

Mullan further pointed out the unintended negative effects of the proposed legislation. "Should Congress pass this legislation, the medical brain drain from the developing world would get worse. Some have called this 'reverse foreign aid.' Strengthening health systems in developing nations is, in fact, a major policy objective of the US government and many private organizations. Taking more doctors from these countries is short-sighted policy and will be seen as bad global citizenship in many parts of the world."

Amy Hagopian, a faculty member at the University of Washington School of Public Health, added, "One in four doctors in America is already trained in another country, and sixty percent of those people were trained in a lower-income country."

While acknowledging the right to migration for health care workers, Donna Barry from Partners In Health noted that there are severe nursing shortages in all of the countries where PIH works and expressed concern about how the additional visas for nurses would further decrease the nurses available to serve the poorest populations around the world. In addition, she noted that recent data from the United States shows that the nursing shortage in the US has been somewhat alleviated during the economic downturn and that further analysis is required to determine the current state of the nursing shortage in the US.

Eric Friedman, Senior Global Health Policy Advisor at Physicians for Human Rights, said, "The US must respect the internationally recognized human right to health. Therefore, Congress must not enact policies that would harm health care abroad, which is just what these bills risk doing. There are better ways to address our own health worker requirements. These include expanding the medical residency slots for primary care physicians and increasing funding to boost the number of nursing instructors in the United States."

Friedman concluded, "Legislation that stands to increase the brain drain of doctors and nurses undermines the United States' own investments in developing countries."

The letter, signed by more than ninety individuals and organizations, can be read here.

Physicians for Human Rights (PHR) is an independent organization that uses medicine and science to stop mass atrocities and severe human rights violations. We are supported by the expertise and passion of health professionals and concerned citizens alike.

Since 1986, PHR has conducted investigations in more than 40 countries around the world, including Afghanistan, the Democratic Republic of the Congo, Rwanda, Sudan, the United States, the former Yugoslavia, and Zimbabwe.

  • 1986 — Led investigations of torture in Chile gaining freedom for heroic doctors there
  • 1988 — First to document the Iraqi use of chemical weapons on Kurds providing               evidence for prosecution of war criminals
  • 1996 — Exhumed mass graves in the Balkans and Rwanda to provide evidence for               International Criminal Tribunals
  • 1997 — Shared the Nobel Peace Prize for the International Campaign to Ban Landmines
  • 2003 — Warned US Policymakers on health and human rights conditions prior to and               during the invasion of Iraq
  • 2004 — Documented genocide and sexual violence in Darfur in support of international               prosecutions
  • 2010 — Investigated the epidemic of violence spread by Burma’s military junta
  • 2011 — Championed the principle of noninterference with medical services in times of               armed conflict and civil unrest during the Arab Spring
  • 2012 — Trained doctors, lawyers, police, and judges in the Democratic Republic of the               Congo, Kenya, and Syria on the proper collection of evidence in sexual               violence cases
  • 2013 — Won first prize in the Tech Challenge for Atrocity Prevention with MediCapt, our               mobile app that documents evidence of torture and sexual violence

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