Journal of Perinatology (2006) 26, 246–247 r 2006 Nature Publishing Group All rights reserved. 0743-8346/06 $30 www.nature.com/jp SPECIAL FEATURE Global notes: brain drain or brain power – human resources in a globalized world

D Vidyasagar University of Illinois at Chicago Medical Center, Chicago, IL, USA

Journal of Perinatology (2006) 26, 246–247. doi:10.1038/sj.jp.7211486; future for the children. The statement is true for any profession. published online 16 March 2006 There is also a migration of scientists and professionals from one developed country to another developed country. This phenomenon of ‘Brain Circulation’ is indeed healthy and has higher dividends. In my previous commentary on the 10/90 Gap, I discussed the severe Brain Circulation in itself has several advantages for the three shortage of manpower in the field of health research in developing parties involved: the scientist, the host and the guest countries. 1 countries. I also pointed out that capacity building of health Scientists gain new experience; the host country gains new professionals in conducting research is one of the major goals of expertise; and upon return to their country, the new experience Global Health Research Forum. Interestingly, shortage of highly enhances further research. Not all scientists ‘circulate.’ Many skilled professionals has been a problem for both developing and remain in the host country which gains the most. US is a major developed countries. Indeed, the problem of losing skilled scientists beneficiary of the process. One can only look at the number of from Britain was noted as early as 1950s. It was the British Royal foreign-born US Nobel Prize winners. At least one-third of the Society that coined the expression ‘Brain Drain’ to describe the Nobel Prize winners in Medicine and Physiology during 1901 to 2 outflow of scientists and technologists from UK to US and Canada. 2000 were immigrant scientists.5 It is indeed a myth that the problem of Brain Drain only affects developing and transition economies. Rich countries such as UK, Germany, Australia, and Canada also suffer from this malaise. However, poor countries face greater challenges when they lose Migration of health professionals their skilled professionals. These countries spend enormous Extensive studies indicate that health professionals migrate to amounts of money on education of the professionals only to see developed countries for several reasons. The core issues include: the them go to greener pastures. It is estimated that there are 10 lack of availability of facilities to practice medicine in the country million African-born emigrants living in US, UK, and other of origin, for postgraduate education and for better economic countries outside Africa. One-third of the African budget spent on opportunities. Among the many countries which lose their doctors education of African nationals is working as a supplement to the (India, Philippines, and African countries), sub-Saharan countries American education budget, as most of the African graduates end are the most affected in the world. The emigration of doctors from up in USA. In effect, the African countries are giving developmental sub-Saharan African countries has left many a country with assistance to USA!3 With the loss of professionals, the countries are national crises in providing health care to people. Some countries unable to sustain a stable middle class society, which is essential have experienced a loss of physicians to the extent that more of for the growth of the country. their doctors are outside the country than in the country. Eastwood Same is true of other countries such as India and Philippines, et al.6 discuss loss of health professionals from sub-Saharan which supply large number of health professionals (Doctors and countries. Of the 47 countries, 24 have only one medical school, 11 Nurses) to UK, Canada and USA. The article ‘Brain Drain Costs do not have any at all. Yet, the number of doctors who immigrated India Billions,’ which appeared in Times of India,4 quoted the into UK in 2003 was staggeringly high. UK approved entry of 5880 2001 UNDP report that India loses $2 Billion a year in resources health professionals and doctors from South Africa, 2825 from because of the emigration of computer professionals to USA alone. Zimbabwe, 1510 from Nigeria, and 850 from Ghana. It is noted Why do professionals emigrate? There are many reasons: that only 50 out of 600 doctors trained since independence are still professional satisfaction, ambition, increased earning and better practicing in Zambia.7 These migrations not only reflect manpower losses but Correspondence: Dr D Vidyasagar, Division of Neonatology MC 856, University of Illinois at Chicago Medical Center, 840 S Wood Street, Chicago, IL 60612, USA. enormous economic losses for countries. Each migrating health E-mail: [email protected] professional costs $184 000 to Africa. Global notes D Vidyasagar 247

Stilwell8 analyzed the loss of health professionals from Nigeria. The challenge is to keep their skilled professionals ‘at home’ About 20 000 health professionals migrate from Africa annually. through various incentives. Return of the Brain Power, however, The annual legal Migration of Nigerian nurses to UK increased occurs in small doses and in few countries. from 347 in 2000 to 2001, to 432 in 2001 to 2002: causing a great In a recent book, ‘Flight Capital: The Alarming Exodus of threat to the sustainability of health care in Nigeria. America’s Best and Brightest,’11 the author says that as many as 1000 former US immigrants leave US every day. Heenan, the author, expresses severe concerns that such reverse Brain Drain Where do professionals migrate to? may create a generation gap in human capital for America. The US is the center of attraction for skilled workers from around the same fears expressed by the poor countries so far. world. Since early 1990s, close to a million highly skilled I would argue that Brain Mobility or circulation is good for the professionals from India, China, Russia, and some from UK, global economic health. The fears are based on the old paradigm Germany, and Canada have entered the workforce in US. US is also that existed before globalization of trade and communication: once the center for 32% of all foreign students studying in the OECD you are out of the country, your bearings are out. It can be countries. In total, 40% of its foreign-born adult population has speculated that current well-developed communications will only tertiary level education, the main driving force that fuels the become more sophisticated in future. Whether you are in New York scientific and economic engine of America. As of 1995, 79% of the City Wall Street or in a remote corner of the world, you are students with doctoral degrees is from India and 88% from China instantaneously connected to the world by the tail of the mouse. in 1990 to 1991 remained in USA . Same is true of migrant Managing business through Internet makes the physical presence/ population from the Caribbean region.9 Majority of them continue residence of a skilled person in the country less important. This is to stay in US and add to the Brain Power and the associated substantiated by the shifting of call centers to India and elsewhere. economic growth of the country. In essence, we foresee the world to become a TRUE GLOBAL VILLAGE, where each one of us, although thousands of miles apart, will be connected to each other in every aspect of life. The term Brain drain or brain bank? Brain Drain, then, will become irrelevant. Mrs Gandhi, the visionary Prime Minister of India during 1970s to 1980s, is quoted to have said that losing scientists to developed countries ‘is not brain drain but it is a brain bank’ that the country References can draw upon. Indeed, schemes were developed to invite expatriate scientists to India to interact with scientists and industries. 1 Vidyasagar D. Global Notes: the 10/90 Gap – disparities in global health On the economic front, the expatriates’ remittances to their research. J Perinat 2006; 26: 55–56. country of origin have exceeded the foreign aid. The amount of 2 Cervantes M, Guellec D. The Brain Drain: Old Myths, New Realities. OECD- remittance to home countries in 1995 was only US $70 billion; in Observer; May 2002. http://www.oecdobserver.org/news. 2003 it was estimated to be more than 100 billion USD. Close to 3 Kaba AJ. Africa’s migration brain drain: the costs and benefits to the continent. Chimera; The Creation of Imagination, vol. 2: 3, Fall-Winter home, the immigrants from Latin America have contributed over 2004. $32 billion dollars to their county of origin, an amount that 4 Brain Drain Costs India Billions. The Times of India Online mhtml:file:// 9 exceeds US aid. C:\Documents and Settings\ekoh\Local Settings\Temp\11 July 2001. 5 Raju TNK. The Nobel Chronicles. A Handbook of Nobel Prizes in Physiology or Medicine, 1901–2000. 1st Books Library Inc, 2002 pp 478. Reverse brain drain: the future 6 Eastwood JB, Conroy RE, Naicker S, West PA, Tutt RC, Plange-Rhule J. Loss Although the poor countries are experiencing Brain Drain of health of health professionals from sub-Saharan Africa: the pivotal role of the UK. professionals, in other fields, especially in the field of computers Lancet 2005; 365: 1893–1900. and information technology. The phenomenon of reverse Brain 7 Report of Global Commission on International Migration. 2005, Drain and Brain Power is being discussed in the business world of www.gcim.org. the rich countries with great interest. 8 Stilwell B. Migration of health-care workers from developing countries: When countries like Taiwan, Korea, Japan in the past, and India strategic approaches to its management. Bull World Health Organ 2004; 82: 595–600. and China most recently, create the right environment of openness, 9 Lowell L. Skilled Migration Abroad or Human Capital Flight? Migration of freedom from governmental restraints and of promotion of Information Source. June 1, 2003. http://www.migrationinformation.org. science and free market economy, there is hope for the return of 10 Kanth DR. India Set to Witness Reverse Brain Drain. Deccan Herald; June 23, 10 expatriates. The UNDP report identified the return of IT 2005, http://www.deccanherald.com. companies backed by Indian expatriates to the city of Bangalore as 11 Heenan D. Flight Capital; The Alarming Exodus of America’s Best and one of India’s success stories. Other countries are following suit. Brightest. Davies-Black Publishing: Mountain View, CA, 2005.

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