In Debating Brain Drain. May Governments Restrict Emigration? Gillian Brock and Michael Blake engage in a discussion over what they identify as one of the core issues of global injustice, namely the movement of highly skilled professionals from poorer to richer countries. They take particular issue with the international movement of health-care professionals such as medical doctors, nurses and caregivers. Both authors are political philosophers, and apart from occasionally interspersed figures, readers will not find any empirical data in this book. What the book does, however, introduce to its readers is a thoughtful debate on “whether or not a state may […] condition or prevent exit from its borders” (p. 4). Gillian Brock argues that states may very well do so, on the precondition of their compliance with liberal morality in their policies. Michael Blake's stance is that states may not interfere with citizens’ choices of movement, neither within nor beyond state borders. Resembling the character of an actual debate, the book consists of three main parts, with Part 1 being written by Brock and Part 2 by Blake. In Part 3, both authors respond to each other's arguments.

Brock organizes Part 1 of the book along a set of seven research questions, which correspond to three main areas of the debate. While she uses the first two questions to establish the starting point of her argumentation, namely that states indeed face damages due to the emigration of highly skilled professionals, questions three to five address policies that might be put in place in order to avoid or compensate for these damages. The remaining questions, six and seven, ask whether these kinds of policy measures are in fact “fair” (p. 14). Blake, on the other hand, composed Part 2 of this book in three subsections, each one entitled “The Right to Leave: […]” with additional and varying subtitles, namely “Looking Back”, “Looking Forward”, and “What Remains” (p. vi). While Brock's line of argumentation is clearly structured and conceptual, Blake's writing is free-style and colorful, and a little more daring – despite him starting off with a disclaimer saying that “[I]t is rarely enjoyable to argue in favor of the status quo” (p. 111). In fact, he states, “The institutions we have – here and now – are more or less the institutions we ought to have” (p. 111, italics in original).

Let me address the three areas of debate as Brock defines them, and Blake counters them. Firstly, on the point of establishing damages, Brock points to two particular realms. She argues that states, which have invested some of their scarce financial and logistical resources to train personnel, suffer economic loss when these workers emigrate. She points out that the bare economic loss in some sectors, such as health care, is accompanied by more severe effects such as a low quality of life and even a low level of life expectancy of citizens in the state undergoing emigration, whereas the already well-off, receiving states of migrants will profit from a higher density of health-care personnel. This is the classical brain drain argument, which for some decades now has been vividly debated in migration studies, in particular against the backdrop of brain circulation. Brock discusses some of these points, most prominently the possibly stimulating role of remittances, on pp. 41–45. Blake, too, discusses the role of remittances among other factors such as trade and knowledge, all of which he calls “diaspora effects” (p. 162). Naturally, given his position in the debate, he subscribes more credit to these effects when it comes to their contribution to the development of the poorer countries.

Neither of the authors, however, addresses market actors. I find this hugely surprising! Brock and Blake agree “that developed world agents have many global justice responsibilities” (p. 30, italics in original), and yet the only agents they talk about are states. I think it is next to impossible to understand, let alone attempt to regulate, global migration flows, while at the same time neglecting the profound economic interests of business actors (and states for that matter). This holds true especially for the health care profession, which has long been advertised as a “portable profession”,Footnote ¹ especially in countries such as the Philippines, where workers have become “an ideal commodity for export” with “2,300 persons [being] deployed overseas every day”.Footnote ² In other words, maybe the less well-off countries consciously and willingly use labor export as a means of economic development.

Neither Brock nor Blake comprehensively addresses the predominant position in the scholarly discourse of migration and development, i.e. the idea that the countries of emigration will in the mid- to long-run also profit from an enhanced skill level of returning workers who might then push the overall skill level of the profession to higher ground. Neither of the authors provides empirics here, but research by Mireille KingmaFootnote ³ of the International Council of Nurses has previously shown that such a spill-over of skills does not always work out well, in particular when the medical equipment the nurses have been working with in more developed countries’ hospitals is lacking in their countries of origin. This is a point, which actually supports Brock's argument of the sending countries facing mostly “losses” due to emigration (p. 36).

The other aspect Brock draws her readers’ attention to in the realm of establishing damages is an argument that is much harder to grasp, namely the idea that highly skilled professionals – apparently no matter of which profession – can be expected to “be energetic and skillful builders of social institutions” (p. 14). I have to admit that I do not see how medical doctors necessarily become community leaders or political representatives. They may very well do so, but the number of single cases that comes to mind here does not seem to fully justify the dimension of the discussion put forward here. Blake argues that “[i]f all humans matter, and matter equally, then all humans are obligated to build a world within which the moral status of humanity is given adequate respect” (p. 158) – then why would Brock distinguish within this discussion between highly skilled professionals and those who are not? The obligation falls to all of us.

Secondly, regarding the policy proposals Brock sketches out in her part of the book, the policies she most prominently has in mind are compulsory service and taxation. In other words, Brock argues for compensation by emigrants for the investment that their countries of origin put into training them as human resources – be it in the form of physical presence, e.g. at a workplace (compulsory service) or in the form of financial payments, e.g. via taxes (pp. 48–53). Blake counters these approaches by pointing to any individual's right to exit (from their place of residence) and right to renunciation (of their citizenship) (pp. 191–92). To Blake coercion, such as through compulsory service, is not something that a state can impose on its citizens, and neither is taxation after emigration, or as he calls it “permanent allegiance” (p. 213).

In other words, why is it the highly skilled professionals of a comparatively poor country who should bear the burden of global economic injustice? We have been propelled now into the midst of point three, namely the question of what kind of policies can be deemed “fair” (p. 14) when addressing the issue of brain drain as a symptom of (or cause of?) global injustices. This is where Brock and Blake differ profoundly. While Brock looks to the individual to bear the burden, Blake looks beyond the nation-state's borders, and asks “What Can We Do Together?” (p. 224). Right away, “ethical recruitment” (p. 220) comes to mind, which – again – would require taking into consideration the role of business actors, or, alternatively, treating the active recruitment of health-care professionals “as a crime under international law” (p. 221). Blake correctly points out that measures like these would put “restrictions on recruitment, rather than on mobility” (p. 221, italics in original), and thus ethically would be much easier to argue for.

The debate between Brock and Blake over how to address brain drain in the context of global injustice may continue beyond this book, and hopefully even more scholars will join in, and add their perspectives to it. Doubtless this book contributes to one of the central questions of our time, and deserves to be read by a wide audience.