Health worker migrations: Re-thinking the meaning of community and the grounding of responsibility

Given the unprecedented migration rates of health personnel to affluent, English- speaking countries in the global North (chiefly the US), the loss, in turn, in low-income countries of public investment in education and training, and of urgently needed health personnel, we are compelled to ask how we, the beneficiaries of this migration, should reason about responsibilities. In particular, I consider how we ought to conceptualize “community” and understand its scope in the context of global health personnel shortages. Do we have responsibilities to distant communities that serve as sources for our own public health system? If so, what are they, what is their basis, and how shall we assign them? How, in addition, should we regard and treat migrant health professionals and paraprofessionals in our own communities? How might we revise conceptualizations of citizenship in order to recognize the contributions to our communities of migrant health personnel? While prevailing accounts of global justice ground it in our shared humanity or participation in injustice, I will suggest that additional insights on global responsibilities (their basis and content) can be gleaned from scrutinizing our status as “ecological subjects”, that is, beings whose identities, communities, and habitats are relational, indeed, mutually constitutive.