Academic journal article World Review of Political Economy

SOUTH-NORTH NURSE MIGRATION AND ACCUMULATION BY DISPOSSESSION IN THE LATE 20th AND EARLY 21st CENTURIES

Academic journal article World Review of Political Economy

SOUTH-NORTH NURSE MIGRATION AND ACCUMULATION BY DISPOSSESSION IN THE LATE 20th AND EARLY 21st CENTURIES

Article excerpt

Abstract: Using David Harvey's notion of "accumulation by dispossession," this article brings systematic understanding to the connections between two widely observed contemporary phenomena: growing inequality on a world scale, and the rapidly increasing shortages of nursing and other health labor in the global South. Through an exploration of the dynamics of late 20thand early 21st-century nurse migration, it is demonstrated that the increasing flow of temporary migrant skilled labor from African and other countries of the global South, to the global North, is a new form of accumulation by dispossession. Socialist feminist notions of caring labor and the Marxian concept of unequal exchange are used to articulate how the disproportionate accumulation of global nursing labor in the global North represents a dispossession of yet greater proportions in the global South.

Key words: accumulation by dispossession; unequal exchange; international nurse migration

This article aims to use the notion of accumulation by dispossession to bring systematic understanding to the connections between two widely observed contemporary phenomena: growing inequality on a world scale (ILO 2008; DESA 2005) and the rapidly increasing shortages of nursing and other health labor in the global South (Buchan and Calman 2004; Van Eyck 2004). In 2005, the United Nations Department of Social Affairs (DESA) reported that the world had become more polarized than ten years earlier, with persistent and deepening inequality between the world's formal and informal economies, skilled and unskilled workers, men and women, and growing disparities in health and education (DESA 2005). By 2008, despite high economic growth rates and the creation of millions of new jobs in the early 1990s, income inequality had grown dramatically in most regions of the world (ILO 2008). Examining nurse to population ratios, while the average ratio in Western Europe and North America is 1,000 nurses to 100,000 people, in Africa, Southeast Asia and Latin America the ratio is 100 nurses to 100,000 people (Buchan and Calman 2004). Perhaps the most salient illustration of the overlap of world inequality and international health migration is the following statistic. From the continent of Africa alone, 20,000 health workers migrate to North America and Europe annually, though African health workers represent only 3 percent of the world's health care labor force (Blanchet and Keith 2006: 13). Meanwhile, one-quarter of the world's deaths due to illness occur in Africa.

Through an exploration of the dynamics of late 20th- and early 21st-century nurse migration, it is demonstrated in this article that the increasing flow of temporary migrant skilled labor from African and other countries of the global South, to the global North, is a new form of accumulation by dispossession. The Marxian interpretation of the concept of unequal exchange is used to articulate how the disproportionate accumulation of global nursing labor in the global North represents a dispossession of yet greater proportions in the global South. The gathering of foreign exchange by Southern states via migrant worker remittances-a state activity increasingly encouraged by the World Bank and other institutions as a means to economic development-is put in question here through the interpretation of late 20th-, early 21st-century nurse migration as a form of accumulation by dispossession.

The first section of this article entails an overview of the causes and consequences of nurse emigration from the Philippines, the world's major supplier of migrant nurses. In terms of discussion of accumulation by dispossession in Africa, the instance of the Philippines is of salience given two important parallels between the Philippines and countries in Africa. Like the Philippines, several African countries are suppliers of migrant nurses to relatively wealthier countries in the world system, and like the Philippines, several countries of Africa face chronic shortages of foreign exchange for which migrant worker remittances are increasingly being promoted as a solution. …

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