No. 2: The Brain Drain of Health Professionals from Sub-Saharan Africa to Canada

Significant numbers of African-trained health workers migrate every year to developed countries including Canada. They leave severely crippled health systems in a region where life expectancy is only 50 years of age, 16 per cent of children die before their fifth birthday and the HIV/AIDS crisis continues to burgeon. The population of Sub-Saharan Africa (SSA) totals over 660 million, with a ratio of fewer than 13 physicians per 100,000. SSA has seen a resurgence of various diseases that were thought to be receding, while public health systems remain inadequately staffed. According to one report, the region needs approximately 700,000 physicians to meet the Millennium Development Goals. Understaffing results in stress and increased workloads. Many of the remaining health professionals are ill-motivated, not only because of their workload, but also because they are poorly paid, poorly equipped and have limited career opportunities. These, in turn, lead to a downward spiral where workers migrate, crippling the system, placing greater strain on the remaining workers who themselves seek to migrate out of the poor working conditions. The ultimate result is an incontestable crisis in health human resources throughout SSA, the region suffering most from the brain drain of health care professionals. The situation in SSA has become severe enough that the final report of the Joint Learning Initiative on Human Resources for Health – a two-year global initiative sponsored by a number of donors studying various aspects of human resources for health performance – has concluded that the future of global health and development in the 21st century lies in the management of the crisis in human resources for health. There is a considerable body of literature attesting to the fact that the migration of skilled professionals from developing to developed countries is large and increasing dramatically. While different experts espouse different reasons for the increase, all agree that it is happening. Developing countries are hit hardest by the brain drain as they lose sometimes staggering portions of their college-educated workers to wealthy countries which can better weather their relatively smaller losses of skilled workers. Highly skilled professionals account for 65 per cent of migrants moving to industrialized countries. The International Organization for Migration (IOM) estimates that about 20,000 Africans leave Africa every year to take up employment in industrialized countries. We do not know how many of these are health care professionals (largely because of inadequate systems for gathering such statistics in African countries).11 The World Health Organization (WHO), however, found that a quarter to two-thirds of health workers interviewed in a recent study expressed an intention to migrate. Historically, and specific to the SSA context, the brain drain has meant not only the exodus of human capital but financial resources as well, as African health care professionals left countries with their savings and reinvested very little of their foreign earnings back into the region. There is only recent evidence suggesting that, while the numbers of professionals leaving continue to increase, émigrés are slowly reinvesting some of their earnings back into their countries. Other research raises doubts about the value of such reinvestments, however, particularly when they are in the form of remittances that are generally private welfare transfers back to family members and are often used for consumption rather than for savings. In recognition of the enormous challenge posed by the international migration of health personnel to health systems in developing countries, the World Health Organization has proclaimed 2005-2015 the decade on human resources for health (HRH)

Family physicians’ and trainees’ experiences regarding cancer screening with patients with intellectual disability: an interpretive description study

People with intellectual disability receive breast, cervical, and colorectal cancer screening at lower rates relative to the general population, although the reasons for this disparity are largely unknown. Research, both with the general population and specific to people with intellectual disability, has revealed that a family physician’s recommendation for cancer screening or continuity of primary care may increase screening rates. We interviewed family physicians and family medicine trainees regarding their experiences recommending cancer screening to patients with intellectual disability. We concluded that the decision to recommend cancer screening is complex, and includes physicians weighing their clinical judgement as to the best provision of care for patients with a patient’s eligibility for screening, while continuing to respect patients’ autonomy. This patient-physician interaction occurs within the larger medical environment. Further research with experienced family physicians is warranted to better understand this complex phenomenon

No. 2: The Brain Drain of Health Professionals from Sub-Saharan Africa to Canada

Significant numbers of African-trained health workers migrate every year to developed countries including Canada. They leave severely crippled health systems in a region where life expectancy is only 50 years of age, 16 per cent of children die before their fifth birthday and the HIV/AIDS crisis continues to burgeon. The population of Sub-Saharan Africa (SSA) totals over 660 million, with a ratio of fewer than 13 physicians per 100,000. SSA has seen a resurgence of various diseases that were thought to be receding, while public health systems remain inadequately staffed. According to one report, the region needs approximately 700,000 physicians to meet the Millennium Development Goals. Understaffing results in stress and increased workloads. Many of the remaining health professionals are ill-motivated, not only because of their workload, but also because they are poorly paid, poorly equipped and have limited career opportunities. These, in turn, lead to a downward spiral where workers migrate, crippling the system, placing greater strain on the remaining workers who themselves seek to migrate out of the poor working conditions. The ultimate result is an incontestable crisis in health human resources throughout SSA, the region suffering most from the brain drain of health care professionals. The situation in SSA has become severe enough that the final report of the Joint Learning Initiative on Human Resources for Health – a two-year global initiative sponsored by a number of donors studying various aspects of human resources for health performance – has concluded that the future of global health and development in the 21st century lies in the management of the crisis in human resources for health. There is a considerable body of literature attesting to the fact that the migration of skilled professionals from developing to developed countries is large and increasing dramatically. While different experts espouse different reasons for the increase, all agree that it is happening. Developing countries are hit hardest by the brain drain as they lose sometimes staggering portions of their college-educated workers to wealthy countries which can better weather their relatively smaller losses of skilled workers. Highly skilled professionals account for 65 per cent of migrants moving to industrialized countries. The International Organization for Migration (IOM) estimates that about 20,000 Africans leave Africa every year to take up employment in industrialized countries. We do not know how many of these are health care professionals (largely because of inadequate systems for gathering such statistics in African countries).11 The World Health Organization (WHO), however, found that a quarter to two-thirds of health workers interviewed in a recent study expressed an intention to migrate. Historically, and specific to the SSA context, the brain drain has meant not only the exodus of human capital but financial resources as well, as African health care professionals left countries with their savings and reinvested very little of their foreign earnings back into the region. There is only recent evidence suggesting that, while the numbers of professionals leaving continue to increase, émigrés are slowly reinvesting some of their earnings back into their countries. Other research raises doubts about the value of such reinvestments, however, particularly when they are in the form of remittances that are generally private welfare transfers back to family members and are often used for consumption rather than for savings. In recognition of the enormous challenge posed by the international migration of health personnel to health systems in developing countries, the World Health Organization has proclaimed 2005-2015 the decade on human resources for health (HRH)

Do Individuals with Depression and Comorbid Medical Conditions Receive Poorer Mental Health Care than those with Depression Alone?

ABSTRACT Introduction The prevalence of depression is 2 to 3 times higher in individuals with comorbid medical condition (CMC) than in the general population. When untreated, depression results in increased mortality, higher health care costs, greater functional disability, decreased quality of life and lower adherence to treatment regimens for the CMC. Currently, studies that examined whether depression care in those with CMC is better or worse compared to those with depression alone show inconsistent results. Furthermore, studies that compare depression care in those with specific CMCs are scarce. Improving knowledge base in this area will enable health care systems to better allocate limited resources to clinical population that need them most. Aims 1) To estimate disparities in depression care in those with one or more CMCs, and 2) to examine if depression care patterns in those with CMCs have been impacted by recent provincial policies. Method We retrospectively examined data from physician claims, hospital separations, vital statistics, and insurance plan registries. Using this linked data, we identified dynamic cohorts of individuals with depression and CMCs in 2005 and 2012, based on the earliest date of depression diagnosis. Each cohort had exactly 12 months of lookback period for case ascertainment and 12 months of follow-up for tracking depression care patterns. The following indicators were tracked: 1) receipt of any psychological therapy, 2) receipt of any antidepressants (AD), 3) receipt of any depression treatment, 4) number of GP visits, 5) GP continuity of care index for all visits, 6) GP continuity of care for mental health visits, 6) counts of psychological therapy sessions, 7) proportion of days covered for AD, and 8) continuous medication gap for AD. Disparities in depression care were examined used generalized linear regression models. Results and Conclusions Use of depression care in individuals with one or more CMC were higher across most indicators we examined except for AD initiation and GP visits for mental health reasons. In specific CMCs like cerebrovascular disease and diabetes, depression care in some areas were lower. Overall, depression care patterns seemed unchanged after the introduction of relevant provincial policies, although improvements over time appeared to have been made in certain areas

BCOHTA 96:6C

ISTAHC '96 Presentation, San Francisco, June 24th, 199Health Care and Epidemiology, Department ofMedicine, Faculty ofPopulation and Public Health (SPPH), School ofUnreviewedFacult

A cross-sectional survey of activities to support mental wellness during the COVID-19 pandemic

Background: During the COVID-19 pandemic, public health restrictions such as social distancing, isolation and self-quarantine have been implemented for several months. Because of these restrictions, in-person contact with friends, family, and mental health supports had been limited, potentially impacting mental wellbeing. Objectives: In this study, we examined the impact of the pandemic on the mental health of adults and investigated the types of activities people engage in to manage and maintain their mental health. Methods: An online survey was circulated in Canada and had a total of 221 participants from September 24 to December 8, 2020. Results: The majority of participants were females (73.2%), between the ages of 18 and 34 (51.1%), and employed full-time (56.1%). Individuals who are unemployed and those with an annual income less than $25,000 had the highest scores in depression, anxiety and psychological distress. Around 19.4% of the sample scored above the cutpoint for depression, which is higher compared to a pre-pandemic population prevalence of 4.7%. Similarly, higher prevalence of anxiety and distress symptoms were observed: 16.3% of the sample had moderate anxiety symptoms compared to a pre-pandemic population prevalence of 11.6%; and 37.7% of the sample had moderate distress symptoms compared to a pre-pandemic population prevalence of 20%. Conclusions: Our findings suggest that the COVID-19 pandemic has negatively impacted the mental health of many adults and that individuals engage in a wide range of activities that may maintain and promote mental wellness during the pandemic, such as exercising, reading, and listening to music