Largest groups by source country amongst Canadian permanent residents: Philippine, Chinese, Indian.

Of permanent residents from Africa and the Middle East, had 10 years of schooling or more, had a university degree. Similarly for immigrants from Asia and the Pacific and from South and Central America.

20-25% of physicians in the U.S. and Canada are immigrants. 40% of nurses in the U.S. are foreign-trained. Doctors per 1000 population (2011): Canada: 2.0 EU: 3.41 Cuba: 6.7 Switzerland: 4

Whom or what do immigrants in the healthcare sector leave behind in their home countries?

Physicians per 1000 of population (2004): Malawi: 0.02 South Africa: 0.77 Niger: 0.02 Philippines: 1.15 India: 0.6 Pakistan: 0.8

37% of health workers work in the American continent (mainly US and Canada). 1.3% of health workers work in sub-Saharan Africa where 14% of the world’s population lives and the health burden is extreme.

Flows of healthcare workers Training costs

Welfare of the health workers (why do they leave their home countries?): - poor salaries - few promotion prospects - poor working conditions - Instability/insecurity in home country.

- About 3% of the world’s population live outside their country of origin. - Remittances to less developed countries ≈ $400 billion. - Highest recipient countries: India, China, Philippines, Mexico, Nigeria. - Tajikistan receives remittances equal to nearly 50% of its GDP. (World Bank statistics, 2012)

What about those trained in healthcare who are not permitted to practice their profession in rich countries? 34% of skilled immigrants to Canada were unemployed in the mid-2000s.

Do utilitarian considerations dictate that health workers should not be allowed to emigrate? Do health workers have a right to emigrate?

Positive and negative duties (again) Are we, as individuals, morally responsible for the poverty, disease and deaths of others?

What should we and/or governments of rich countries do to help? Example of UK. What can the governments of donor countries do to help? Examples of Hungary and Lithuania.