Migration and the Globalisation of Health Care
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Migration and the Globalisation of Health Care

The Health Worker Exodus?

John Connell

The international migration of health workers has been described by Nelson Mandela as the ‘poaching’ of desperately needed skills from under-privileged regions. This book examines the controversial recent history of skilled migration, and explores the economic and cultural rationale behind this rise of a complex global market in qualified migrants and its multifaceted outcomes.
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Chapter 3: Phases of Globalisation

John Connell


The migration of health workers is scarcely new, even if the current phase is more comprehensively global and of greater social and economic significance than those that have preceded it. Migration has changed direction, acquired greater complexity and taken on different gender dimensions over the past century, with flows from developing countries becoming more important, quantitatively and qualitatively, than either migration to them or more established migration flows between developed countries. The rise of international migration has been neither steady nor inexorable, as a short-lived hiatus in the 1980s demonstrated, when many countries appeared to have an oversupply and human resource policies briefly went into reverse. In the present century, few countries are isolated from significant migration flows, and oversupply is highly unusual. This chapter distinguishes at least three broad phases of migration and examines their implications and consequences. FIRST PHASE: EARLY DAYS, COLONIAL YEARS The international migration of SHWs was largely ignored until the 1960s. But the colonial era constituted a first phase: the movement of health workers from Western nations, often in association with missionary activities as part of the colonial endeavour. In most parts of the world the provision of health by government authorities was at least as late as the mid-nineteenth century. Until well into the twentieth century, in the developing world, colonial authorities introduced ‘modern’ medicine, in the administrative centres (often serving little more than the needs of Europeans and their employees), emphasising clinical and curative medicine, until large-scale preventive campaigns got under way. With...

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