Emigration & Social Justice
What should we think about the possible negative effects of high-skilled emigration from developing countries?
By Professor Christine Straehle (University of Ottawa)
January 6, 2016 Picture: IFRC, Stephen Ryan/Flickr.
This article is part of The Critique’s And Who Is My Neighbour Exclusive?
By now, the figures illustrating the challenge of high-skilled worker brain drain are well known: in Kenya, for example, it is estimated that the cost to educate a doctor from primary school to university graduation amounts to US$ 65,997 while educating a nurse costs US$ 43,180. The losses in returns on investment for the state of origin are estimated to be nearly eight times the cost of training the individual health care practitioner. And the pernicious consequences of skilled outmigration go beyond losing valuable professionals: because public finances of sending countries deteriorate due to the loss in investment return, some countries then can’t actually employ the health professionals who remain for lack of funds.
Such figures show that brain drain can challenge the capacity of the state of origin to provide for necessary medical services. They also question the right to exit one’s country of origin. This right has indeed been subject of much debate among political philosophers, in particular among those concerned with justice in migration regimes, both from a global and social justice perspective. Those debating brain drain can be divided roughly into two camps: on the one hand are those who believe that countries facing large-scale emigration, which is threatening the integrity of their institutions, may be justified in imposing temporary exit restrictions, in the form of mandatory service of high-skilled professionals, for instance. The political philosopher Gillian Brock defends this position. On the other side of the spectrum are those who believe that emigration benefits societies of origin, and, most importantly, that it allows individuals to seize opportunities abroad. The economist Michael Clemens is a representative of this line of argument. Along the spectrum are many who struggle with the tangible and often pernicious effects on developing countries of outmigration of high-skilled professionals while also wanting to protect freedom of migration, including emigration, as a liberty right. Michael Blakeand myself are in this camp and I will explain what I believe this struggle should yield as an answer to the question whether or not states should be allowed to restrict emigration.
I agree that providing for individual opportunities should be an important goal when thinking about migration. Yet I also believe that to take the route Clemens advocates is to misunderstand the real challenges that high-skilled emigration poses to developing societies. In a world that is fundamentally unequal and unjust, those individuals who have had access to opportunities to develop their skills that are highly marketable in the rich developed countries will at least be tempted to move where opportunities seem better.
Such a decision need not simply be motivated by better compensation – doctors and nurses are often looking to work in more secure environments than those prevailing in their country of origin. It is simply not enough to argue from the perspective of economic benefit for individuals – that people should be free to migrate where they choose – if what we are concerned with is to provide all individuals everywhere with access to basic needs. Put otherwise, a concern for protecting the liberty rights of (some) individuals is not sufficient to justify their migration, if their migration may negatively affect the liberty and welfare rights of their compatriots. A focus on the welfare of some is not sufficient to justify unjust conditions in an unjust world.
“A concern for protecting the liberty rights of (some) individuals is not sufficient to justify their migration, if their migration may negatively affect the liberty and welfare rights of their compatriots”
To be fair, Clemens has also called for a new research agenda of emigration research in order to assess economic outcomes of emigration more adequately. Yet Clemens argues against a systemic solution to the problem of brain-drain – such as imposing limits and regulations on the recruitment of high-skilled migrants, for instance. Here, our arguments diverge. I believe that the great social benefits for developed societies would justify imposing contributions of these same societies to the training of doctors in developing countries, for example. I also support those who call for strict limits on the kind of active recruitment health care providers from developed countries should be allowed to carry out in developing countries. Any discussion of brain drain needs to include a consideration of the capacity of the state of origin to provide for the basic needs of its people.
This is the perspective Gillian Brock adopts. Brock argues that we should accept that the right to exit can be ‘conditional.’ Brock’s argument for conditions of exit is based on a concern for the social institutions necessary to realize access to basic needs and a modicum of social justice. According to this line of reasoning, individuals are under obligations to contribute to and promote the institutions of justice in their society of training. This obligation can be explained by the foundational role that social institutions play in the realization of social justice. The argument from social justice is not only based on benefits received from the society of orgin – it also appeals to the need to cooperate when realising social justice goals.
In order to protect the institutions of social justice, this argument proposes that the rights of some to exit their states of origin should be tied to duties of justice that need to be satisfied before benefitting from a right to exit. Put differently, societies should be allowed to place certain restrictions on individuals in their exercise of their right to exit if the unfettered exercise of the right to exit risks jeopardising the basis of a good life for others in the society of origin.
And while I am very sympathetic to the concern driving this argument – as I said above, I advocate that we take a social justice perspective when thinking about emigration – I nevertheless believe that there are two problems with the argument Brock proposes. First, it is not clear which institutions we have to support to promote social justice. This is especially the case if we are motivated to achieve a globally just distribution of institutions of justice. Second, institutions are necessarily based on support by those who have to carry burdens when institutional policies are implemented. It is therefore not clear what we should do in the face of emigration: if we impose support on institutions through mandatory service obligations, and if we read emigration as withdrawing support from a set of national institutions, how can institutions of social justice still claim legitimacy?
Again, and to be clear, I accept that high-skilled emigration may jeopardize some of the institutions of a social justice. The example of Kenyan doctors emigrating, it seems to me, illustrates well how basic institutions of social welfare may be jeopardized if too many choose to leave to move to greener shores. Moreover, health care institutions will not be the only institutions likely affected – the effect on society and the state’s finances may be such that other vital institutions like schools, policing, etc., may suffer as well. I believe it safe to say, then, that provision of basic needs and social justice may suffer in the course of emigration in the country of origin. Second, I also accept that members have obligations to support institutions of social justice of the country they live in. This does not, however, tell us that the institutions in question should be those of the country of origin.
To illustrate what I believe is wrong with the institutional argument as it is proposed by Brock, imagine a scenario that may be slightly different from the one most of us have in mind when thinking about migration of high-skilled doctors: instead of, say, a Kenyan doctor migrating to the US – furthering her professional opportunities along the way, while also earning considerably more money than in her country of origin – assume that the same doctor emigrates to Malawi. Her chosen goal in life, we may imagine, is not to maximize her opportunities by moving to a rich country; instead, she is motivated to settle in a country poorer than her own to support the medical services of this country whose people are decimated by HIV/Aids.
It seems to me that we would be hard-pressed to deny that the doctor is concerned with providing access to basic needs and furthering the goals of social justice. What distinguishes her case from that of others is that she aims to help implement principles of social justice in a country other than her country of origin. In light of this scenario, how would we assess the idea that in order to boost medical provisions, Kenya obliges its medical graduates to serve for 5 years in the country, or the new regulation in Ghana that obliges nursing graduates to serve for 5 years in the country before receiving their nursing certificate? In principle, we could say that the mandatory service requirement doesn’t prohibit our doctor from realizing her goal of moving to help Malawians. We could imagine that mandatory service may be a requirement well known ahead of taking up her studies and we may further assume that if she has received her degree, she would have consented to this kind of service. Therefore, it is not the case that she would be surprised by the requirement to serve in her country of origin before moving on to Malawi.
However, two things are important to remember here. First, the idea behind the social justice argument is about supporting institutions of social justice. Yet we may say that the individual who aims to move to Malawi intends to help create institutions of social justice there – so somehow, we need to find an argument why the institutions in a doctor’s country of origin should have moral precedence to those in a chosen country of action. Put differently, it is not clear that the social justice argument can justify the priority of compatriots over other global citizens who may be in more dire need of help.
Moreover, there seems to be a tension between social justice and the fair distribution of institutions of social justice more generally. Surely, migration into health-care deprived countries should count as morally valuable under the social justice account: it may help Malawi’s capacity to establish institutions of social justice. Yet if we restrict high-skilled doctors from Kenya from migrating to Malawi, we would impose a condition on emigration (at least temporarily) that seems to conflict with our intuitions about fair distribution of access to institutions of social justice globally.
This raises the second point about institutions I am concerned about. Let’s remain with the same case of a doctor who aims to migrate from Kenya to Malawi. Oftentimes, medical graduates, rather than joining the public health system of their state of origin after their education, join instead organizational units of the United Nations or one of the foreign–funded humanitarian NGOs. This allows them to effectively employ their skills in a country in need of health-care professionals, since the UN and NGOs are often better equipped than local public health sectors to provide effectively for the medical needs of people in developing countries. To be sure, their motivation may not be entirely altruistic; however, the effect of their choice may be that their skills and expertise are better employed in the parts of the world that need medical help most. They may help realize principles of social justice – just in a society other than that of their country of origin. Of course, the problem for the country of origin remains the same as in the case of a doctor who migrates to greener shores: a society invests in an educational system that allows individuals to gain expertise in a profession of their choice and ability and their emigration affects the society’s capacity to benefit from its investment and to employ the medical graduates in its public health system just as much as if the individual in question had moved to a developed rich country.
Another comment about institutions is warranted here. Institutions rely on the cooperation and compliance of citizens. Citizens are called upon to contribute to public coffers to realize schemes of social justice, like health care, public education, and the like. Note, though, that our duties of justice are duties towards other individuals – they are not duties to realize institutions of justice, even though they require support of just institutions that apply to us. Second, we need to remember that duties of justice are ultimately duties of individuals. We can’t be held hostage, as it were, to the institutions under which we live since duties of justice, in the words of political philosopher John Rawls, apply “between persons, irrespective of their institutional relationships.” A Kenyan doctor may, in other words, choose to help Malawians and she would be justified to say that by moving to Malawi, she wishes to carry out her duties of justice.
Finally, and most importantly for my purposes here, duties of justice have to be justified to those who have to carry their burden. Call this the justifiability clause attached to duty generating institutions of social justice. If we demand a set of duties from individuals, we have to make sure that we can justify the grounds of the duties. What should we think, then, of those to whom it doesn’t seem plausible to first satisfy duties towards compatriots, even though there may be needier people in the world? In particular, how should we think of their responsibility towards their society of origin?
David Miller has argued that the justifiability clause explains why demands of global justice may sometimes have to yield to demands of social justice: the state can’t justify to the members of the democratic community the delivery of global justice goods elsewhere, particularly not if this implies having to scale back the state’s provision of social justice goods. We can’t simply say that the demands of global justice represent a “more urgent set of ethical demands” than those of social justice: even if we can agree that saving a life may be morally more important than providing access to primary schooling, we have to take into consideration the deliberative democratic process in society that will determine our justice commitments – social and global.
If this is the case, then how should we think of those who argue that social justice demands in Malawi are a “more urgent set of ethical demands” than those in Kenya? If, in other words, individuals believe it to be more important to satisfy duties of social justice elsewhere, then it seems that the justification requirement may call us to accept that social justice provisions at home lose justificatory ground over acts of social justice abroad. The point of joining a humanitarian NGO or the UN is not simply to enrich myself, as in cases of medical brain drain to rich and developed countries. Instead, joining an organization that promotes and advocates social justice elsewhere may mean that the state is no longer able to rally the support of its members sufficiently, exclusively or primarily to prioritize the cause of social justice in their countries of origin. The fact that there are individuals who are sufficiently motivated to join international organizations or humanitarian NGOs seems to indicate that the problem for countries experiencing brain drain is not to motivate individuals to accept social justice duties – their problem is that some of their (highly-skilled) members don’t prioritize social justice concerns in their country of origin over those elsewhere. This, it seems to me, poses a problem to the liberal institutional argument for exit restrictions: as I said earlier, the institutional argument can’t tell us which institutions of social justice to support.
Instead of putting the burden of addressing the problems of the unjust world we live in onto the shoulder of individuals, by prohibiting them from leaving their societies of origin and making exit conditional, I believe that we need to actively promote systems of ‘pay for work’ for recruiting rich countries instead. These countries need to be called upon to pay back the educational cost to the country of origin, or to pay the taxes collected from high-skilled immigrants. The problem of brain drain is a systemic problem in the unjust world we live in, where health care systems are national and reliant on national resources, whereas competition for medical professionals is global.
Footnotes & References
 See Kirigia, J. M., Gbary, A. R., Muthuri, L. K., Nyoni, J. and Seddoh, A. (2006). ‘The Cost of Health Professionals’ Brain Drain in Kenya’. Biomed Central Health Services Research, 6(89). Compare these figures to those published in the British Medical Journal in November 2011, which put the training costs for British doctors between US$ 436,000 to US$620,500, depending on the level of doctor. See Mills et al (2011) ‘The financial cost of doctors emigrating from sub-Saharan Africa: human capital analysis’ British Medical Journal 343: d7031. It is fair to say, then, that the current situation is a de facto subsidy that developing countries provide to their developed counterparts, by training what are to the latter inexpensive health care workers at a high cost to the former.
 Gillian Brock in Brock and Blake, Debating Brain Drain – May Governments restrict Emigration ? New York : Oxford University Press, 2015.
 Michael Clemens (2014) A case against taxes and quotas on skilled emigration. Journal of Globalization and Development, 5 (1): 1–39.
 Blake in Brock and Blake, Debating Brain Drain – May Governments restrict Emigration ? New York : Oxford University Press, 2015.
 In previous work, I have argued that exit restrictions, such as mandatory service for graduates, say, would not yield the desired benefit of maintaining institutions of social justice in the country of origin. They could therefore not be justified. See Christine Straehle, Healthcare Migration, Vulnerability and Individual Autonomy : The Case of Malawi in Lenard and Straehle, Health Inequality and Global Justice, Edinburgh : Edinburgh University Press, 2013.
 Michael Clemens (2011) Economics and Emigration: Trillion-Dollar Bills on the Sidewalk? Journal of Economic Perspectives, 25 (3): 83–106
 See also Anna Stilz, (forthcoming). Is There an Unqualified Right to Leave?Migration in Political Theory: The Ethics of Movement and Membership. Sarah Fine and Lea Ypi (eds.), Oxford, Oxford University Press; Anna Stilz (2009)Political Loyalty. Princeton, Princeton University Press.
 Lea Ypi, (2008). “Justice in Migration: A Closed Borders Utopia?” Journal of Political Philosophy 16(4): 391-418.
 See Straehle 2013.
 See John Rawls (1999). A Theory of Justice 2nd rev. edition. Cambridge (Mass.): Harvard University Press, p 97ff.
 Ibid, 99.
 David Miller (2013). Justice for earthlings : essays in political philosophy. Cambridge, Cambridge : Cambridge University Press, p. 177.