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Reuters reports today (Kavita Chandran and Tan Ee Lyn) that the

. . .health crisis in developing countries is . . . being exacerbated by the West as countries relax stringent immigration regulations to attract doctors and nurses from less developed countries to boost their own flagging health systems while saving money on expensive training.

The consequences of this “brain drain” are grave as it leaves gaping holes in the healthcare systems of developing countries where diseases such as AIDS, tuberculosis and malaria run rampant and children die daily from diarrhea.

I’ve written a number of times that we seriously underestimated the depth and impact of the globalization of health care and how entangled and interdependent we are with the health problems plaguing the rest of the planet. So at the risk of being a PITA I want to repeat my message.

1. Our public discourse in health care is often too insular, too self-serving and thus irrelevant when it comes to the rest of the world;
2. The world, and health care with it, is changing in dramatic ways;
3. We are not paying enough attention to the above two points.

Step back for a moment and consider the overwhelming preponderance of words, time and money we spend in taking apart the U.S. health care system. Now think about how much of that talk goes toward building an understanding of our dependencies on the rest of the world for that care. Or for that matter, how much of the world’s health care, in turn, depends on us.

Not much. In fact we tend to polarize our thoughts into strict them-and-us compartments that essentially diminish any appreciation of the depth of those inter-relationships.

It also shows in our ignorance of health care systems in other countries (especially so when we boast of the superiority of either theirs or ours); in our odd blindness to the fact that, demographically speaking, the world is already living in our own house; and in our easy dismissal of international health comparisons not favorable to us. We are, to be blunt, isolationist, and to many on the planet, arrogant,when it comes to health care.

Keeping the world at an arm’s length is no longer possible or desirable. Much like an “American” car or anything you can buy at Wal-Mart, health care is fast becoming the product of a complex world-wide process. While the health care services Americans receive may appear to be local, each drug, patient record, and operating room is the culmination of a complicated international exchange we need to better understand.

Every health care issue confronting today has underlying global aspects. The U.S. health care is discovering itself inextricably caught up in international diplomacy, the throes of globalization, and even the murky dealings of illegal transnational organizations.

We’re witnessing the emergence of a new order, with its corresponding growth opportunities, intractable problems, and chaotic flash points. For example, the drug industry: new drug biologics, research, testing, manufacturing, pricing, distribution, profits, and counterfeiting — all are derivatives of active public and private global networks. International coordination and information exchange is clearly critical in controlling infectious diseases such as SARS, avian flu, or HIV.

“Medical tourism” (international hospital competition) increases every year. More of our physicians are either foreign-born or being trained in other countries– indeed our entire health care infrastructure is increasingly dependent on foreign labor. Research into other countries’ health care practices will usher a new wave of alternative and complementary care into mainstream medicine. And, of course, health care IT. Electronic claims transaction, systems installations and software testing, call centers with advanced technology –- you name it — and its major components are more and more often located offshore.

Borders are increasingly, or already, irrelevant to health care. We are either getting flattened, or doing it to others. Adapting to that emerging reality is critical. But we seem to be missing the signals. Even in the grand ideas fermenting in the speeches of our presidential candidates we see little recognition of what is going on around us. So we need to start interrogating the global connection of every health care problem we face.

The message has to get out: the globalization of health care is not an optional sub-specialty anymore. It is front and center required reading.