Rebalancing brain drain: Exploring resource reallocation to address health worker migration and promote global health

Global public health is threatened by an imbalance in health worker migration from resource-poor countries to developed countries. This "brain drain" results in health workforce shortages, health system weakening, and economic loss and waste, threatening the well-being of vulnerable populations and effectiveness of global health interventions. Current structural imbalances in resource allocation and global incentive structures have resulted in 57 countries identified by WHO as having a "critical shortage" of health workers. Yet current efforts to strengthen domestic health systems have fallen short in addressing this issue. Instead, global solutions should focus on sustainable forms of equitable resource sharing. This can be accomplished by adoption of mandatory global resource and staff-sharing programs in conjunction with implementation of state-based health services corps.     

Australia and New Zealand's contribution to Pacific Island health worker brain drain

Objective: The paper aims to quantify Australia and New Zealand's contribution to the brain drain of Pacific Island health workers and to contribute firm evidence to the ongoing, highly‐contested health professional migration issue. Methods: The study uses the Australian and New Zealand 2006 census data to examine the number of Pacific Island born health professionals living in Australia and New Zealand and uses World Health Organization data to compare it against the numbers of health workers in Pacific Island countries. Results: Six hundred and fifty‐two Pacific Island born doctors and 3,467 Pacific Island born nurses and midwives are working in Australia and New Zealand, more than half of whom are from Fiji with significant numbers from Papua New Guinea, Samoa and Tonga as well. There are almost as many Fiji‐born doctors in Australia and New Zealand as there are in Fiji. There are more Samoa, Tonga and Fiji‐born nurses and midwives in Australia and New Zealand than in the domestic workforce. Conclusions: Migration of Pacific Island health professionals to Australia and New Zealand is very high and contributes to the shortage of health workers in Pacific Island countries. Implications: Australia and New Zealand are encouraged to actively address the issue in collaboration with Pacific Island partners with a number of solutions proposed.     

Public health policy research: making the case for a political science approach

The past few years have seen the emergence of claims that the political determinants of health do not get due consideration and a growing demand for better insights into public policy analysis in the health research field. Several public health and health promotion researchers are calling for better training and a stronger research culture in health policy. The development of these studies tends to be more advanced in health promotion than in other areas of public health research, but researchers are still commonly caught in a na?ve, idealistic and narrow view of public policy. This article argues that the political science discipline has developed a specific approach to public policy analysis that can help to open up unexplored levers of influence for public health research and practice and that can contribute to a better understanding of public policy as a determinant of health. It describes and critiques the public health model of policy analysis, analyzes political science's specific approach to public policy analysis, and discusses how the politics of research provides opportunities and barriers to the integration of political science's distinctive contributions to policy analysis in health promotion.     

Evaluation of a village health worker programme: the use of village health worker retained records

A village health worker (VHW) programme in a rural area in South Africa is evaluated, a year after the introduction of VHW-retained child record cards. The programme's success in promoting immunization and breastfeeding and the coverage of and contact with the community by the VHWs was investigated. A population survey on children under one year was matched to VHW records, showing that VHWs were reaching 70.8% of the target population. VHWs were more likely to visit a child with a Road to Health Card (RTHC) and who was born in the village. VHWs generally visit mothers once a month and make contact with most children in their first month of life. Children born before the start of the new VHW programme were compared with those born after, using survival analysis techniques and data from the RTHC on the first year of life of all children under two. An increase in polio immunization coverage was detected but there was a drop in measles immunization coverage. We conclude that a VHW-retained child record for the first year of life plays a valuable role in ongoing health care evaluation.     

The impact of health worker migration on development dynamics: evidence of wealth effects from Africa

This article examines three relevant hypotheses on the effect of health worker migration on human development and economic prosperity (at the macro- and micro-levels) in Africa. Owing to the lack of relevant data on health human resource (HHR) migration for the continent, the subject matter has remained empirically void over the last decades despite the acute concern about health professional emigration. Using quantile regression, the following findings have been established. (1) The effect of HHR emigration is positive (negative) at low (high) levels of economic growth. (2) HHR emigration improves (mitigates) human development (GDP per capita growth) in low (high) quantiles of the distribution. (3) Specific differences in effects are found in top quantiles of human development and low quantiles of GDP per capita growth where the physician (nurse) emigration elasticities of development are positive (negative) and negative (positive), respectively. As a policy implication, blanket health-worker emigration control policies are unlikely to succeed across countries with different levels of human development and economic prosperity. Hence, the policies should be contingent on the prevailing levels of development and tailored differently across the most and least developed African countries.     

我国卫生决策和政策实施的政治环境分析

本文通过对卫生的性质和特点与内在政治激励关系以及我国行政管理体制对卫生决策和政策实施的影响的研究，描述了我国卫生决策和政策实施政治环境特点以及影响卫生决策和政策实施的相关政治因素，目的是为寻求有利于卫生决策和卫生政策推行的有效途径提供理论解释。     

Protect the health of your health care worker

This article reviews the many health and safety risks that confront health care workers every day and lists the various regulations that administrators need to understand and implement to provide for the well-being of hospital employees. In an age of growing public awareness of health and safety issues and an increase in litigation covering such issues, this article demonstrates how crucial it is for administrators to take the offensive to ensure that their hospitals are in full compliance with all health and safety regulations. This article describes possible health hazards in various hospital departments, cites appropriate restrictions and guidelines, both governmental and JCAHO, and offers suggestions for remediation.     

Valuable human capital: the aging health care worker

With the workforce growing older and the supply of younger workers diminishing, it is critical for health care managers to understand the factors necessary to capitalize on their vintage employees. Retaining this segment of the workforce has a multitude of benefits including the preservation of valuable intellectual capital, which is necessary to ensure that health care organizations maintain their competitive advantage in the consumer-driven market. Retaining the aging employee is possible if health care managers learn the motivators and training differences associated with this category of the workforce. These employees should be considered a valuable resource of human capital because without their extensive expertise, intense loyalty and work ethic, and superior customer service skills, health care organizations could suffer severe economic repercussions in the near future.     

The health behaviors of the older US worker

BACKGROUND: As the US workforce ages, lifestyle factors will increasingly affect their health, yet little information is available on their prevalence in older working populations. METHODS: Using the nationally representative 1997-2003 National Health Interview Survey (NHIS), reported current smoking, risky drinking and leisure-time physical activity behaviors of older workers (> or =65 years) were compared with older non-workers. These behaviors were evaluated by age, gender, race, ethnicity, and occupation, as well as prototype "healthy" and "risky" persons. RESULTS: The study population of 4,946 older US workers and 38,313 older non-workers represented an estimated 3.9 million older workers and 28.9 million older non-workers annually. Relative to older non-workers, older workers reported more current smoking and risky drinking, but higher levels of leisure-time physical activity with variations by subpopulations. CONCLUSIONS: Less than 4% of the older US worker population reported overall healthy behaviors. Certain occupations and other subpopulations can be targeted for age-appropriate behavioral interventions.