Through www.GlobalHealthJobs.com, i help thousands of people find healthcare opportunities across the globe. The clue’s in the platform’s title really. i’m now going to share periodical dispatches from these trenches of recruitment into healthcare around the world. Margaret Fuller said it best — “If you have knowledge, let others light their candles in it.” i hope these thoughts and stories help
The first story i’ll share couldn’t be more insightful and is an increasingly typical experience found within this GlobalJobs platform. Two different candidates; Kingsley from Tanzania and Sean from Ireland. Similar profiles, both have an overlapping interest in reproductive, maternal, new-born and child health. The difference is that Kingsley is a bit of a neo-luddite (anti-technology) and applies for more administrative jobs, Sean isn’t a neo-luddite and even though he has no core technological training, applies for more strategic-focused jobs.
As Mark Britnell highlights in his book, Human, the digital revolution will have a real impact on the delivery of healthcare. Given the founding principle of almost every economic system is that work is the primary route out of poverty, it’s logical to say inequality starts and ends with the ‘work’ of one’s hands. Taking it a step further, the jobs that create the jobs of the future are available now and are affecting inequalities of the future, more than those of today.
You may already be familiar with the way inequalities in businesses and organisations affect products and services. Remember when the Apple Watch tracked every bodily function but forgot women’s menstrual cycle, or that artificial hearts were designed to fit 80% of men but only 20% of women, or those drop-down menus showing “male” over “female”, even when the rest of the menus were alphabetical. Who watches the people recruiting the people designing future healthcare systems and policy?
i think well-shaped market forces will be the best way to fix these inequalities, inequalities that then get expressed in the outputs of these poorly recruited organisations. Market forces, when harnessed well, deliver great things. They were the driving force behind the creation of the NHS; 75 years ago, the Beveridge report, the founding document of Britain’s modern welfare state, was published. Right in the middle of the Second World War, as the country was battered by the Blitz.
What gave the report such impact was its language. Set up to sort out the existing, piecemeal and fragmented benefit system, Beveridge went way beyond his terms of reference, declaring that ‘Want’ (by which he meant poverty) was only one of ‘five giant evils on the road to [post war] reconstruction’. The others were ‘Disease, which often causes that Want […] Ignorance which no democracy can afford among its citizens, Squalor […] and Idleness which destroys wealth and corrupts men. Sounds like a British gentleman’s Porter’s Five Forces to me. And it was out of this came the creation of Britain’s National Health Service.
GAVI and its intervention of the vaccines market to support Low and Middle Income Countries is a great example of a globally coordinated approach to address global health inequalities. Why not a similar shaping approach for the inequitable global health workforce?
Thanks to capitalism, more than a billion people no longer struggle to survive on a few pennies a day. Over the past 30 years, more than a billion people have climbed out of extreme poverty. Whilst the wealth gap between rich and poor has grown, it is a myth that people are locked into their economic class. It is an even bigger myth to ignore the role of capitalist dynamics in the moral maze of healthcare. It is the central tension of hearts and mind at the centre of the Universal Health Coverage debate.
With the invention of ‘money’ and ‘time’, we have created systems where all aspects of human existence and most human problems can benefit from the right incentives being linked to the needed activity. Therefore, a major challenge for those of us who think about healthcare for a living should be to communicate the relevance of market forces to our cause. Instead, the increasing professionalization of the medical profession has been accompanied by a decrease in the pragmatism and the biz-savviness we saw in the early Hippocratic doctors.
As the effects of automation play out, the unequal distribution between support and directive roles is likely to become more concerning, and people lower down the laddder are especially vulnerable. That’s because a much higher percentage of support roles will be automatable as companies adapt and develop new technologies. As the effects of automation concentrate more workers in low-wage jobs, the existing income and wealth gaps between the Seans and Kingsleys are likely to grow.
Retraining in some occupation categories would mitigate some of the risk to the Kingsley workforce. However, since they have access to fewer economic resources to address potential displacement on their own, it will take technology and collaboration across the private, public, and social sectors to promote retraining opportunities for those at risk.
Ideally, Kingsley would have a globally-coordinated response to this problem. With the rise of Nationalism and Populism, today’s designers of tomorrow’s global health workforce, cannot ignore the wider issues.
Over and out