How Africa Subsidizes U.S. Health Care

[rodeodance]

http://www.washingtonpost.com/wp-dyn/articles/A18883-2004Nov28.html?referrer=email

How Africa Subsidizes U.S. Health Care

By Sebastian Mallaby

Monday, November 29, 2004; Page A19


This Wednesday is World AIDS Day: It will be marked by concerts and candlelit vigils from Armenia to Zambia. The speeches and statistics will have a horrific familiarity: Two decades after the first diagnoses, AIDS shows no signs of letting up. And yet the debate about AIDS is changing subtly. In Africa, the epicenter of the crisis, the shortage of cash and affordable medicines is no longer the prime issue. Attention is turning to the shortage of health workers, and hence to a dark aspect of globalization.

It isn't a surprise that Africa is short of doctors and nurses: The continent has 1.4 health workers per 1,000 people, compared with 9.9 per 1,000 in North America. What's shocking is that this shortage is partly created by rich countries. Poor nations such as Malawi and Zambia are paying to train medics who emigrate to staff the hospitals of the United States and Europe. We should be helping Africa. Instead, Africa is subsidizing us......

.....It's a particularly vivid one, however. After a century of the most spectacular health advances in human history, life expectancy in many poor countries is actually falling. Donors have battled this reversal by making money and medicines available: In Botswana, for example, the pharmaceutical giant Merck has teamed up with the Bill and Melinda Gates Foundation to bring overwhelming resources to bear in the battle against AIDS. But Botswana has made only gradual progress, and a main obstacle has been the shortage of competent administrators and health workers.

It's hard to weigh the issues here: the right of individuals to seek a better life by emigrating and the poverty trap that they entrench by doing so. But it's clear that, in the absence of some kind of intervention, this poverty trap may deepen. The citizens of the rich world are aging; their willingness to care for infirm relatives is waning; medical breakthroughs constantly expand the demand for medical personnel. All these factors reinforce the rich world's temptation to poach the poor world's health workers......