Chapter 10: The Enigma of Globalisation
In a long-term reversal of fortune, for half a century there has been substantial international migration of skilled health workers to more developed countries, initially particularly from Asian countries, and subsequently from sub-Saharan Africa and small island states. Migration has been constantly in flux, depending on market demands, domestic pressures, recruitment, economic and political crises, and perceptions of amenable destinations. While still centred on global and local uneven development, it has become more complex, more global yet also more intra-regional, absorbing most countries, many as both sources and recipients, and increasingly dominated by women. Only South America stands partly aloof as neither source nor recipient. Intensified competition has exacerbated the concerns of those countries that lose workers from fragile health systems, yet economic challenges have resulted in more strategic external orientation. Globalisation is inherently uneven, differing in economic, social and political terms and between places. Countries most affected by emigration are not the least developed countries, but relatively poorly performing economies, with inadequate resources to counteract the costs. Migrant numbers, however, have been greatest from larger Asian countries. International flows are also intra-regional, as something of a twotier system has emerged: from poorer states to other nearby states, and onwards to the metropoles. Developing and developed countries, the South and the North, are increasingly linked through migration in what has gradually become a global health care chain, moving along ‘steps’ and ‘escalators’ through the Gulf and (mainly) European (OECD) states, often culminating in the USA, as it does for many...
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