Intended for healthcare professionals

Feature Essay

The neocoloniality of who cares: US underinvestment in medical education exacerbates global inequities

BMJ 2020; 371 doi: (Published 17 November 2020) Cite this as: BMJ 2020;371:m4293
  1. Eric Reinhart, doctoral candidate, and candidate in adult psychoanalysis123,
  2. Eram Alam, assistant professor of the history of medicine4
  1. 1Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
  2. 2Department of Anthropology, Harvard University, Cambridge, MA, USA
  3. 3The Chicago Center for Psychoanalysis, Evanston, IL, USA
  4. 4Department of the History of Science, Harvard University, Cambridge, MA, USA
  1. reinhar{at}

The US has chronically underinvested in medical education and relies on the annual recruitment of thousands of foreign trained healthcare professionals from nations with far greater unmet healthcare needs. This bears partial responsibility for the dire situation India finds itself in during the pandemic, write Eric Reinhart and Eram Alam

As covid-19 cases and deaths continue to accelerate beneath a mushrooming pandemic cloud, the United States and India have emerged as two nations experiencing the most acute crises. Although these countries have dramatically different health systems, both have proven inadequate to tackle the scale of the growing crisis. Since the early months of the pandemic, shortages—of hospital beds, equipment, and healthcare providers—have hampered both treatment and prevention, compounding the fallout of the virus.

In the face of limited resources, pandemic responses have channelled growing nationalist impulses, manifesting in the hoarding of protective equipment and concealment of scientific research, among other things. One of the starkest examples of this has been the retrenchment of geographic borders alongside a rise in xenophobic rhetoric and policy. Nonetheless, even under a US administration of wall building and anti-immigrant executive orders, the recruitment of foreign healthcare workers to cover deficiencies in healthcare investment has remained unchanged. In his proclamation on 22 June suspending entry to the US of immigrants who represent risk to the labor market, President Trump made a notable exception—healthcare professionals able to provide “medical care to individuals who have contracted covid-19 and are currently hospitalized” are welcome to enter the country. This authorized the state department to issue “mission critical” visas to foreign medical professionals.

This points to the longstanding structural connection between US and Indian healthcare systems that closely links the unfolding situations in both countries. The covid-19 crisis—itself an exacerbation of a much longer crisis of inequality and inadequate healthcare …

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