International Health Section (APHA) proposes
Resolution proposed for adoption in 2006 (Revised from 2005 item D-3)
Authors: Amy Hagopian (University of Washington) and Eric Friedman (Physicians for Human Rights). Assistance from Harry Perlstad.
Corresponding author: Amy Hagopian, Box 354982 Seattle WA 98195; 206-706-0989; hagopian@u.washington.edu
Ethical Restrictions on International Recruitment of Health Professionals to the U.S.
The American Public Health Association
Acknowledges that the World Federation of Public Health Associations adopted a resolution at its General Assembly in Geneva, Switzerland on May 16, 2005, supporting ethical restrictions on international recruitment of health professionals from developing countries, and further
Acknowledges that migration of health professionals from less prosperous countries to privileged countries is increasing, widening the gaps between rich and poor nations, and
Notes that
- While the developed countries have only one-third of the world’s population, they contain three fourths of the world’s physicians and 89% of the world’s migrating physicians, and
- in sub-Saharan Africa, 1.3% of the world’s health workers must provide health services to 13.8% of the world’s population in a region that suffers from 25% of the world’s burden of disease, and
- 180,000 (nearly 25%) of American’s physicians are trained abroad, with 64.4% of them in low and lower-middle income nations, and,
- 90,000 nurses (4% of the U.S. overall nurse workforce, but 14% of recently licensed nurses) are trained abroad, and the number is increasing at a rate faster than that of U.S.-educated new nurses, and
Is concerned about the growing demand for health professionals in the United States in the face of stagnant supply; the Department of Health and Human Services estimates that the United States could be short 808,000 nurses by 2020, and academic studies estimate that the United States needs an additional 85,000 to 200,000 physicians by 2020, and
Recognizes the longstanding and serious shortage of health professionals in rural and inner city locations, and the fact that international medical graduates provide a great deal of health care in those areas, and
Encourages developed countries to become self-sufficient in meeting their health workforce needs, by producing additional graduates as well as by engaging both domestic- and foreign-trained health professionals who are not presently employed in the health workforce, and
Recognizes the regrettable absence in the U.S. of a rational, unified national health system that can adopt ethical recruitment policy in the face of a health care marketplace that is growing increasingly dependent on foreign-trained health workers, and
Expects that unless measures are taken to increase U.S. health workforce self-sufficiency and to adopt ethical recruitment practices, aggressive recruitment from countries and companies perceiving shortages of health professionals will increase, and
Respects that individual countries, such as the U.K., and international organizations, such as the Commonwealth Health Ministers, the World Conference of Family Doctors and the International Council of Nurses, that have adopted codes of practice for the international recruitment of health care professionals and while these Codes of practice have not solved the recruitment problem, they signify concern and have probably slowed the pace of recruitment, and
Notes that in May of 2004 the World Health Assembly (WHA) adopted a resolution (57.19) on the international migration of health personnel, urging member states to “develop strategies to mitigate the adverse effects of migration of health personnel and minimize its negative impact on health systems,” and
Recognizes that health worker migration to the U.S. and other rich countries has varying effects on source countries, in some cases benefiting them through remittances and beneficial training and experiences, but in other cases undermining the economic, social and health status of exporting poor countries, and
Recognizes the plight of health care workers in poor countries who often work under dangerous conditions that do not meet their needs or those of their patients, and understands their frequent desire to leave their countries, and
Affirms the right of health workers to migrate as guaranteed them by the 1948 Universal Declaration of Human Rights, while also seeking to balance the responsibilities of heath workers to the countries in which they were initially trained, and
Affirms the right to the highest standard of health as guaranteed by the International Covenant on Economic, Social and Cultural Rights; and
Notes that the Joint Learning Initiative, a collection of more than 100 global health experts, has estimated that Africa needs about 1 million more health care workers to achieve the health-related Millennium Development Goals; and that these goals were established by all 191 United Nations member states, who pledged to meet the goals by 2015. The goals set internationally agreed upon targets for reducing poverty, hunger, disease, illiteracy, environmental degradation and discrimination against women, and
Acknowledges the U.S. Physicians for Human Rights (PHR) and the New York Times editorial recommendations that low-income countries be compensated for the loss of health professionals to rich countries, and
Acknowledges the need for the U.S. to adopt a national ethical recruitment codes, and
Recognizes that ethical recruitment is only one element of the actions needed to redress the health worker crisis that is most severe in Africa.
THEREFORE, the APHA
Urges U.S. health worker employers, including public and private hospitals, long-term care facilities, and outpatient facilities, to voluntarily adopt a code of ethics that guides their judicious management of the recruitment and employment of health professionals (including unlicensed caregivers) from developing countries; and
Recommends that these codes of ethics be developed in accordance with standards developed by the World Federation of Public Health Associations, the World Health Organization, and other international bodies concerned with this issue; and
Urges that these codes of ethics aim to mutually benefit health needs in both the United States and the developing countries that are the source of these health professionals, at the least causing no harm to health services in those countries; and
Strongly encourages U.S. health care employers to develop their codes in consultation with ministries of health and other stakeholders in developing countries; and
Encourages U.S. health professional training programs to expand their class sizes to develop a sufficient internally-trained workforce; and
Encourages the U.S. government to both subsidize health professional class size expansions and provide incentives to better distribute the health professionals in the U.S.; and
Recommends that the U.S. government encourage compliance with ethical codes by contracting only with health care delivery organizations that have developed and are abiding by a code; and further
Recommends that the U.S. government ask health care employers to report regularly on their recruitment practices, results of which would be gathered into an annual U.S. government report on recruitment and retention practices of U.S. health care employers.