Tackling migration and the future of work in health

Dr. Christopher Tufton

Gleaner Archive with text from a statement given at 34th Commonwealth Health Ministers Meeting in London – May 22, 2022

Equity in healthcare is a development imperative requiring, among other things, a serious relook at how the future of work is impacted by migration within the Commonwealth.

The movement of labour across the Commonwealth countries has been part of the mechanisms used by many households for advancement. In health, these actions by individuals have resulted in gains for households that have seen economic and social progress. Migration, without a doubt, has very positive impacts on national economies and individual households.

As the world moves through the demographic transition, the pull factors related to migration have become stronger, and as developing states grapple with sustaining healthcare costs and maintaining adequate infrastructure, the push factors have become more significant.

This has resulted in a substantial depletion of the health staff within emigrating states, which inevitably will lead to a fracturing of the health system in developing and low-income countries. As an example, nursing vacancy rates are averaging 40 per cent in these countries, according to recent studies.

The future of work is, therefore, a policy area that requires transformational thinking. While this is not a new concern, recent developments pose new challenges and opportunities.


The Future of Work project was proposed by the International Labour Organization Director-General in 2013. This was followed later by the adoption of the Centenary Declaration on the Future of Work at the 108th International Labour Conference 2019.

The future of work is being defined by:

• Increasing prevalence of digitisation and technology within healthcare;

• Increased use of telehealth and telemedicine;

• Shortage of healthcare workers;

• Increased demand for greater work-life balance; and

•Burnout in the health sector.

Innovative leadership requires us, as a collective, to confront this issue, not with antagonism, but with creative solutions that define the future of work. Leadership requires us to come to the table with a solution-oriented mindset, focused on creating new ways of work that support the needs of all.

We must support programmes and interventions that:

• Strengthen and increase the number of health personnel who are trained in sending countries by providing trainers and opportunities for learning in state-of-the-art health facilities;

• Develop and enhance capacities in technology to improve efficiency of work; and

• Create new labour contracts that allow health workers to operate in flexible arrangements in multiple jurisdictions.


In order to exercise transformational leadership, as a collective and as individual nation states, we must work towards overcoming problems of inequity across the Commonwealth, limited technical and financial capacity, lack of sustainable health financing and brain drain, certainly where the out-migration of nurses is concerned. These are all problems that we can tackle together.

Small Island Developing States are especially vulnerable. This means that our collective efforts at transformational leadership in healthcare must take their special circumstances into consideration.

At the same time, bold leadership is required now to deal with the issues of non-communicable diseases (NCDs) that have claimed far more lives than COVID-19. These lifestyle diseases are responsible for more than 70 per cent of deaths in the Caribbean and kill 41 million people each year, globally.

As the Commonwealth, we will need to confront the contributing factors of abuse of alcohol, the eradication of trans-fats, the reduction of sugars and salts in our diets and champion the cause of personal responsibility within our populations for good health practices.

We are now required to craft the necessary actions to aggressively move this agenda forward, knowing that there are vested interests that may see these policies as acts of aggression. As a collective, we must open wide the doors of consultation and present the undisputed evidence of the impact of NCDs on our global health profile and state unequivocally that “a sick world is a poor world”.

We must also create the space for greater collaboration to tackle the epidemic of NCDs using both clinical and behavioural science approaches and concerted action to regulate and transform our food environment.

The COVID-19 crisis has given us a unique opportunity to engage in transformational leadership in the health sector; leadership that provides and communicates a clear vision for health, encourages creativity, empowers people to deliver results and, most importantly, boldly challenges the status quo. As leaders in the Commonwealth, we must take this opportunity.

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