While Canadians complain about a shortage of family doctors and long queues for specialists, people in poor countries are suffering life-threatening gaps in their medical services caused by a brain drain of personnel to Canada and other wealthy countries.
That's the conclusion of the World Health Organization's 2006 report, released yesterday on World Health Day.
The 200-page report, titled "Working Together for Health," cites a crisis in some 57 of the poorest countries, which are lacking 2.4 million doctors, nurses and midwives.
The overall shortfall is about 4.3 million health workers worldwide, leaving at least 1.3 billion people with no access to the most basic health care, and at risk of early death.
Meanwhile, WHO said, Canada, Britain, the United States and New Zealand import a quarter or more of their physicians from other countries, including Africa, which faces serious medical challenges. On average, a quarter of all African-trained doctors have migrated to the world's wealthiest nations.
The organization has called on rich countries to stop "poaching" medical personnel, and urged that poor and wealthy states work on ways of enticing them to stay in their homelands. It called for immediate investment in recruiting and training new workers in needy countries, as well as making it worthwhile for graduates to remain at home.
In an article for the online newsletter cma.ca, Canadian Medical Association president Ruth Collins-Nakai said the report had an "important message" for Canada, because it showed that global competition will only intensify for qualified personnel in the future.
But, she said yesterday at the University of Toronto's Joseph L. Rotman School of Management, Canada itself is the target of a medical recruitment drive.
The U.S. needs large numbers of foreign doctors to fill its workforce gaps, and Canada is a net exporter of health-care professionals, with the "cumulative net loss of MDs to the U.S. more than 4,000 from 1991 to 2004." Only last year was there a "meagre gain" of 55 physicians.
Training doctors is expensive, and importing them saves millions of dollars a year, WHO points out.
But freeloading at the expense of developing countries has deadly consequences, when needy countries are left with no doctors and nurses to carry out vital immunization services, community health care and basic medical services for women and children.
However, points out the CMA's senior communications editor Steve Wharry, the medical personnel who migrate here may not work as doctors — they often end up doing other jobs.
"The issue in Canada is less about poaching and more about getting graduates (from foreign countries) credentialed to work in the Canadian system."
In its report, the WHO acknowledged that doctors in the poorest countries have strong incentives to leave, including the lure of better pay and a higher standard of living.
In their homelands, doctors face "unsafe conditions in the workplace, poor pay and working conditions, low morale and motivation, lack of supportive supervision," and too frequently, "death from the very diseases they work to cure."
The World Medical Association drew up "ethical guidelines" for international recruitment of physicians three years ago, and the Canadian Medical Association has worked with them to endorse principles of social justice and international co-operation, while recognizing the right of medical workers to choose their own destinies.
WHO said it was important to remember that poor countries suffer disproportionately from a lack of qualified personnel. And, it said, in countries where the medical systems have collapsed, there are global implications, such as the spread of SARS and avian flu.
Dangerous psychological conditions that can lead to violence also go untreated.
Africa, which has 11 per cent of the world's population, has 25 per cent of its disease burden and only three per cent of its health workers.
The Americas have over 50 per cent of the world's financial resources, while Africa has less than one per cent, the report adds.
"The global population is growing," said WHO director-general Lee Jong-wook. "But the number of health workers is stagnating or even falling in many of the places where they are needed most."
© Copyright 2006 Toronto Star Newspapers Limited.