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I am very grateful to the five commentators for taking the time to respond to my article ‘The Active Recruitment of Health Workers: A Defense’.1 I have learned a great deal from each of their commentaries, and I am sorry to say that I will be unable to address all their important comments and criticisms in detail. In this response, I will focus on replying to the commentators’ major objections.
In my paper, I suggested that the emigration of health workers from poor countries might not have harmful effects on health outcomes in general, or may only have relatively small negative effects in a wide range of cases. Several commentators challenge my analysis. Carwyn Rhys Hooper suggests that it is prima facie plausible that the emigration of health workers causes harm, and that there is insufficient evidence to reject this claim.2 Gilian Brock3 and Iain Bassington4 argue that my paper failed to consider the full range of possible harms that the active recruitment of health workers brings about. These commentators are correct in that we need more evidence about the effects of migration, and that it may be too soon to arrive at the all-things-considered judgment that the emigration of health workers does not generally enable serious harm.
Nonetheless, I believe that the active recruitment of health workers is still permissible. For one thing, I am less confident than Brock that the empirical research on skilled migration clearly establishes that the migration of skilled professionals causes harm to sending countries. There is a sizable body of empirical research that is inconsistent with many of Brock's claims. It is not obvious that the emigration of skilled workers depletes human capital in the sending country.5 ,6 In fact, there is evidence that the opportunity to emigrate …
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.
↵i Bhargava also criticizes my parenthetical remark that his study with Docquier's finds that the emigration of physicians is sometimes negatively correlated with adult deaths. I am still unclear on why Bhargava believes that this remark is a misrepresentation. In his response, Bhargava writes that the net effect of medical brain drain on adult deaths due to AIDS was negative (−0.005) when computed at the start of the sample in 1991 when the sample mean of HIV prevalence rates was 2.98%. Michael Clemens notes: ‘Bhargava and Docquier find that the fraction of physicians abroad has …a negative and significant effect on AIDS deaths in countries where HIV prevalence is low.’18 I would be curious to know if Bhargava thinks that Clemens’ claim is mistaken.
↵ii An objector might argue that we are also unable to infer that the emigration of health workers does not cause harmful health outcomes from the other studies that I cite. After all, these studies have problems too. It is true that I am unable to rule out the possibility that the other studies that I cite are flawed. Nonetheless, it seems to me that the balance of evidence at least casts doubt on the claim that the emigration of health workers from low-income countries generally enables serious harm, even if these studies fail to conclusively establish this claim.