Last month I studied in Łódź, in the centre of Poland. Łódź (pronounce: woodzj) is Poland’s third biggest city, nearly three times the size of Utrecht, and I had never heard of it before.
The city is a remnant of an industrial and communist past moving into a new global era of consumerism and creativity. Grey, run-down buildings dot the urban landscape, interchanged with historical monuments, textile factories turned shopping mall, kebab shops, and an artistic café by the name of Kaliska where the boundaries between art and pornography purposely fade. It is also home to the Medical University of Łódź, where the Asia-Europe Foundation brought together students from 28 countries in Asia and Europe for a summer school on public health.
When discussing public health in an international setting, one inevitably ends up at comparing national health care systems. Hence I found myself trying to woo my Asian audience (except Japan) with the gloomy prospects of ageing populations in Western Europe. I projected a near future in which my retired parents’ generation becomes a greater burden on health care systems than my generation will be able to handle (something I occasionally used to remind my Mom of in my early cash-strapped student years). In reply, some Asian participants pointed out how hospitals in their home countries lacked medical staff: they have been recruited to take care of the elderly in countries like mine. That's why you’ll find skilled Pakistani and Bangladeshi surgeons working as nurses in retirement homes in Holland and Italy. Paradoxically, the Dutch government is supporting such countries’ health care systems with development aid. This is about as fair as a coach claiming his player’s price.
Nobody can deny some of the adverse effects of globalization. Indeed, open markets and faded boundaries have brought great advantages to many people in many societies. However, it also allows those on top to reap what is sown at the bottom. Poland, despite all its progress, seems to be no exception. One student of medicine told me that she was simply waiting to finish her degree so that she could move to Sweden and work there. ‘There is very little reason for me to stay in Poland,’ she said, adding that ‘the facilities are poor, the money is bad and working pressure is high.’ Łódź, where she lived during her time as a student, ‘is lovely but offers little future to me.’ Sure it sounds nice and patriotic to work in one’s mother- or fatherland where the need is highest. But when better pay and working conditions lure and are actively offered across some faded boundary, no kebab shop or deviant café is going to hold you back. And so the vicious cycle continues.
I do not mean to say that we are eating all the icing of other people’s cake. Just that one approach to our ageing populations may have some unintended effects: like causing a brain drain elsewhere. This is a one-sided way forward and we need a broader and more sustainable approach, one that emphasizes national public health education and the training of health workers. By building our own capacity and that of others, the exchange of ideas and resources in the long run will benefit us all. So, will we invest or should we tell our parents to stock up?