Callum Narita, Editorials and Publications Team PMSA
The supply and demand for doctors and healthcare workers varies greatly between geographical regions. The demand typically depends on the number and density of people living in the area, with areas of high population density, such as cities, having a greater usage of healthcare services.
However, the global distribution of healthcare personnel is both unequal and inequitable(1). Several factors contribute to this. Regions such as Europe have a higher proportion of doctors for a relatively low burden of disease, which reflects a large overall healthcare expenditure. Conversely, regions such as Africa and South-East Asia tend to have a high burden of disease, however have a small share of the total number of physicians globally. Equally, the healthcare expenditure in these regions is significantly lower than Europe or North America(1).
The lure of increased income and better working and living conditions results in this inequality, as individuals are drawn towards these large population centres and wealthier locations. Globalisation has furthered the issue, as international and intercontinental movement of healthcare workers becomes more accessible.
This has become problematic in recent times in Pacific Island Countries and Territories (PICTs). Whilst the healthcare worker density has actually increased in recent times across the Pacific region, the distribution amongst PICTs is inequitable(2). The shortage of “human resources for health” in Papua New Guinea (PNG), Samoa and Vanuatu has reached crisis level(2). The number of physicians per 1000 population is as low as 0.055 in PNG(3). Meanwhile, Niue generally have adequate healthcare access and healthcare worker numbers, with a density of 1.84 doctors per 1000 population. For comparison, Australia’s density is currently estimated at 3.496(3).
Despite the high density of healthcare workers, Australia has similar issues with regional and remote areas compared to urban centres and cities. This is particularly true of isolated Indigenous populations(4). This is reflected in medical outcomes, as morbidity and mortality in regional and remote areas is higher(4). The discrepancy can be extrapolated to remote areas of PICTs, as there are the same limitations on healthcare access, particularly specialist care.
This is a pressing subject that, if not addressed now and in the near future, will have lasting effects on a vulnerable population. Whilst some Asia Pacific nations have attempted to rectify this by signing international bilateral labour agreements, these are unfortunately limited in PICTs, the nations who are most in need(5). Developed countries, particularly Australia given the geographic relationship with PICTs, have a responsibility to protect the limited healthcare resources of these countries and ensure vulnerable populations do become victims of these global trends.
1. Scheffler RM, Liu JX, Kinfu Y, Dal Poz MR. Forecasting the global shortage of physicians: an economic-and needs-based approach. Bull World Health Organ. 2008;86(7):516-23B.
2. Yamamoto T, Sunguya B, Shiao L, Amiya R, Saw Y, Jimba M. Migration of health workers in the Pacific Islands: a bottleneck to health development. Asia Pacific Journal of Public Health. 2012;24(4):697-709.
3. World Healh Organization. Global Health Observatory Data Repository, Density per 1000 Geneva: WHO; 2018 [cited 2018 Jun 20]. Available from: http://apps.who.int/gho/data/node.main.A1444.
4. Australian Institute of Health and Welfare. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples: 2015 Canberra: AIHW. 2015 [cited 2018 June 20]. Cat. no. IHW 147.:[Available from: https://www.aihw.gov.au/reports/indigenous-health-welfare/indigenous-health-welfare-2015/.
5. Yeates N, Pillinger J. International healthcare worker migration in Asia Pacific: International policy responses. Asia Pacific Viewpoint. 2018;59(1):92-106.