The Right to Health, State Responsibility and Global Justice

  • Rebecca S. Shah


The greatest moral concerns in the international migration of health workers are its harmful effects on health systems and health outcomes in very poor countries. Poor countries face a vastly greater burden of preventable and treatable morbidity and mortality than rich countries. And yet the world’s poorest countries have grossly inadequate numbers of health workers to serve the health needs of their populations. Relatively speaking, rich countries have health workers in abundance, although many of them also face shortages of domestically trained health workers. The human resources for health crisis is one of the contributing factors to the enormous and abhorrent inequality in health opportunities and outcomes between the global rich and the global poor. This problem is compounded by the fact that many of the world’s poorest countries are failing to see a return on the investment they make in the training of much-needed health workers because many of them migrate to richer countries. The loss of just a few health workers from a critically understaffed health system in a very poor country can have a massive impact on the health services left behind. This is implicitly a question not only of need in poor countries but also of inequality. The substantial financial and health returns are accruing to the health systems, populations and governments of richer countries, which are financially and institutionally equipped to train health workers with far greater ease at the expense of poorer countries.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Action for Global Health (2007), Health Warning: Why Europe Must Act Now to Rescue the Health Millennium Development Goals, Brussels: Action for Global Health.Google Scholar
  2. Ambrose, S. (2006), ‘Preserving Disorder: IMF Policies and Kenya’s Healthcare Crisis’, Pambazuka News, 257: Special Issue on Trade and Justice,[accessed 2 June 2006].
  3. Anderson, B. and Rogaly, B. (2005), Forced Labour and Migration, London: TUC.Google Scholar
  4. Attaran, A. and Walker, R. B. (2008), ‘Shoppers Drug Mart or Poachers Drug Mart?’ CMAJ, 178(3), 265–6.CrossRefGoogle Scholar
  5. Bloom, D. E. (2007), ‘Governing Global Health’, Finance and Development, 44 (4).Google Scholar
  6. Brown, H. (2007), ‘Great Expectations’, British Medical Journal, 334, 874–6.CrossRefGoogle Scholar
  7. Buchan, J., McPake, B., Mensah, K. and Rae, G. (2009), ‘Does a Code Make a Difference — Assessing the English Code of Practice on International Recruitment’, Human Resources for Health, 7, 33–40.CrossRefGoogle Scholar
  8. Bueno de Mesquita, J. and Gordon, M. (2005), The International Migration of Health Workers: A Human Rights Analysis, London: Medact.Google Scholar
  9. Buse, K., Sidibe, M., Whyms, D., Huijts, I. and Jensen, S. (2006), ‘Scaling-Up the HIV/AIDS Response: From Alignment and Harmonisation to Mutual Accountability’, Overseas Development Institute Briefing Paper 9, London: ODI.Google Scholar
  10. Cangiano, A., Shutes, I., Spencer, S. and Leeson, G. (2009), Migrant Care Workers in Ageing Societies: Research Findings in the United Kingdom, Oxford: COMPAS.Google Scholar
  11. Daniels, N. (2006), ‘Equity and Population Health: Towards a Broader Bioethics Agenda’, Hastings Center Report, 36(4), 22–35.CrossRefGoogle Scholar
  12. Deeming, C. (2004), ‘Policy Targets and Ethical Tensions: UK Nurse Recruitment’, Social Policy and Administration, 38(7), 775–92.CrossRefGoogle Scholar
  13. Department of Health (2004), Code of Practice for the International Recruitment of Healthcare Professionals, [accessed 30 December 2009].
  14. Dodd, R., Schieber, G., Cassels, A., Fleisher, L. and Gottret, P. (2007), Aid Effectiveness and Health, Making Health Systems Work: Working Paper No. 9, WHO/HSS/healthsystems/2007.2, Geneva: WHO.Google Scholar
  15. Donnelly, J. (1999), ‘The Social Construction of International Human Rights’, in T. Dunne and N. J. Wheeler, Human Rights in Global Politics, Cambridge: Cambridge University Press, 71–102.CrossRefGoogle Scholar
  16. Dumont, J.-C. (2007), ‘International Migration of Health Professionals: New Evidence and Recent Trends’, presented to the Workshop on Human Resources for Health and Migration: Mobility, Training and the Global Supply of Health Workers, Sussex University, 16–17 May 2007.Google Scholar
  17. England, R. (2007), ‘Are We Spending too much on HIV?’ British Medical Journal, 334, 344.CrossRefGoogle Scholar
  18. Ferrinho, P., van Lerberghe, W., Julien, M. R., Fresta, E., Gomes, A., Dias, F., Gonçalves, A. and Bäckström, B. (1998), ‘How and Why Public Sector Donors Engage in Private Practice in Portuguese-Speaking African Countries’, Health Policy and Planning, 13(3), 332–8.CrossRefGoogle Scholar
  19. Gibney, M., Tomaševski, K. and Vedsted-Hansen, J. (1999), ‘Transnational State Responsibility for Violations of Human Rights’, Harvard Human Rights Journal, 12, 267–95.Google Scholar
  20. Goldsbrough, D., Adovor, E. and Elberger, B. (2007), What Has Happened to Health Spending and Fiscal Flexibility in Low Income Countries with IMF Programs? Center for Global Development Working Group on IMF Programs and Health Expenditures Background Paper, Washington: Center for Global Development.Google Scholar
  21. Guissé, E. H. (2004), Effects of Debt on Human Rights, Economic and Social Council of the United Nations, E/CN.4/Sub.2/2004/27, 1 July 2004.Google Scholar
  22. GHWA Task Force on Scaling Up Education and Training for Health Workers (2008), Country Case Study: Malawi’s Emergency Human Resources Programme, Study_FINAL_30May08.pdf [accessed 22 December 2009].
  23. Hunt, P. (2005), Statement by Paul Hunt, Special Rapporteur on the Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health, UN General Assembly, Third Committee, 28 October 2005, [accessed 1 December 2009].Google Scholar
  24. Joint NGO briefing paper (2008), Health Insurance in Low-Income Countries, briefing paper 112, Oxford: Oxfam.Google Scholar
  25. Kirigia, J., Gbary, A., Muthuri, L., Nyoni, J. and Seddoh, A. (2006), ‘The Cost of Health Professionals’ Brain Drain in Kenya’, BMC Health Services Research, 6 (1), [accessed 8 June 2009].
  26. Levine, R., Kinder, M. and the What Works Working Group (2004), Millions Saved: Proven Successes in Global Health, Washington: Peterson Institute for International Economics.Google Scholar
  27. Logie, D. E. and Woodroffe, J. (1993), ‘Structural Adjustment: The Wrong Prescription for Africa?’ British Medical Journal, 301, 41–4.CrossRefGoogle Scholar
  28. Lorenz, N. (2007), ‘Effectiveness of Global Health Partnerships: Will the Past Repeat Itself?’ Bulletin of the World Health Organisation, 85(7), 501–68.Google Scholar
  29. Mensah, K., Mackintosh, M. and Henry, L. (2005), The ‘Skills Drain’ of Health Professionals from the Developing World: A Framework for Policy Formulation, London: Medact.Google Scholar
  30. Mills, E. (2004), ‘Scheffler on Rawls, Justice and Dessert’, Law and Philosophy, 23, 261–72.Google Scholar
  31. Mills, E. J., Schabas, W. A., Volmink, J., Walker, R., Ford, N., Katabira, E., Anema, A., Joffres, M., Cahn, P. and Montaner, J. (2008), ‘Should Active Recruitment of Health Workers from Sub-Saharan Africa be Viewed as a Crime?’ Lancet, 371, 685–8.CrossRefGoogle Scholar
  32. Pogge, T. W. (1992), ‘Cosmopolitanism and Sovereignty’, Ethics, 103(1), 48–75.CrossRefGoogle Scholar
  33. Pogge, T. W. (2001), ‘Priorities of Global Justice’, in T. Pogge (Ed.), Global Justice, Oxford: Blackwell.Google Scholar
  34. Pogge, T. (2005), ‘Real World Justice’, The Journal of Ethics, 9, 29–53.CrossRefGoogle Scholar
  35. Poore, P. (2004), ‘Opinion Piece: The Global Fund to fight Aids, Tuberculosis and Malaria (GFATM)’, Health Policy and Planning, 19(1), 52–3.CrossRefGoogle Scholar
  36. Rawls, J. (1971), A Theory Of Justice, London: The Belknap Press of Harvard University Press.Google Scholar
  37. Shiffman, J. (2006), ‘HIV/AIDS and the Rest of the Global Health Agenda’, Bulletin of the World Health Organisation, 84(12), 923.CrossRefGoogle Scholar
  38. Skrivánková, K. (2006), Trafficking for Forced Labour: UK Country Report, London: Anti-Slavery International.Google Scholar
  39. Smilansky, S. (2006), ‘Control, Dessert and the Difference between Retributive and Distributive Justice’, Philosophical Studies, 131, 511–24.CrossRefGoogle Scholar
  40. Tyson, S. (2007), ‘Human Resources for Health: Ignorance-Based Policy Trends’, presented to the Workshop on Human Resources For Health And Migration: Mobility, Training and the Global Supply of Health Workers, University of Sussex, 16–17 May 2007.Google Scholar
  41. United Nations Committee on Economic, Social and Cultural Rights (UN CESCR) (2000), E/C.12/2000/4. General Comment No. 14, The Right to the Highest Attainable Standard of Health (Article 12 of the International Covenant on Economic, Social and Cultural Rights), 11 August 2000, Geneva: United Nations.Google Scholar
  42. United Nations Development Programme (UNDP) (2009), Human Development Report 2009: Overcoming Barriers: Human Mobility and Development, New York: UNDP.Google Scholar
  43. United Nations General Assembly (UNGA) (1948), Universal Declaration of Human Rights, Resolution 217 A (III), Paris: UNGA.Google Scholar
  44. United Nations General Assembly (2008), Addendum to the Report of the Special Rapporteur on the Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health, Paul Hunt, to the Human Rights Council, Seventh Session, A/HRC/7/11/Add.2.Google Scholar
  45. United Nations Office of the High Commissioner for Human Rights (UN OHCHR) (1966), International Covenant on Economic, Social and Cultural Rights, Geneva: United Nations.Google Scholar
  46. Woodward, D. (2005), ‘The GATS and Trade in Health Services: Implications for Healthcare in Developing Countries’, Review of International Political Economy, 12(3), 511–34.CrossRefGoogle Scholar
  47. World Health Organisation (WHO) (2006), World Health Report 2006: Working Together for Health, Geneva: WHO.Google Scholar
  48. World Health Organization Statistical Information System (WHOSIS) (2009),[accessed 30 December 2009].

Copyright information

© Rebecca S. Shah 2010

Authors and Affiliations

  • Rebecca S. Shah

There are no affiliations available

Personalised recommendations