It is a great honour for me to visit Japan again and to take part in this annual workshop for the seventh time in so many years. I continue to be impressed by this unique initiative of the Foreign Ministry and inspired by the quality of these annual workshops. This annual gathering presents us all with a unique opportunity, a chance to discuss migration issues openly, an occasion to strengthen cooperation among the Ministry of Foreign Affairs, local governments, universities, international organizations and migrants themselves.

Let me congratulate the workshop co-organizers for choosing such a relevant and significant theme, the potential role of foreign human resources in the field of health care.

Scene-setter:

As a backdrop to my remarks, let me set the scene by giving you some facts on migration realities and stating a migration “thesis.”

We are living in a world on the move.  We are experiencing unprecedented disasters and complex humanitarian crisis – 50 million forced migrants.  At the same time, we face increased anti-migrant sentiment.

Anti-migrant sentiments are borne out of fears.  Because of the global economic slowdown, people fear that migrants will be taking away their jobs.  The “9/11 security syndrome” leads people to fear that tourists are terrorists.  There is also fear that the arrival of migrants will ultimately lead to national identity loss.

The world in which we live today is a world in disarray, an international system unraveling with no one in control, and moral authority eroding.

The drivers of migration – demography, demand for labour, digital revolution, distance-shrinking technology, disasters – natural and man-made, and dreams of a better life – will make migration a mega-trend of our century. More and more people will arrive on our shores and doorsteps who do not look like us or speak as we do, but if properly welcomed and given the opportunity to integrate, can enrich our societies and economies through their contribution.

My thesis therefore is that migration is inevitable, given demography (an ageing North and youthful South) and other trends; necessary, if jobs are to be filled, skills to be available, and economies to flourish; and desirable, if properly managed, that is, responsibly and humanely.

With this backdrop for this year’s workshop, I would like to make three points.

1. Foreign health workers are critical to Japan’s health system;
2. Ethical recruitment of foreign health workers benefits all; and
3. A multicultural health sector is key to managing increasing social diversity

I. Foreign health workers are critical to Japan’s health system

First of all, Japan, like other industrialized countries, including China, is ageing

• Japan is an ageing society with one of the world’s lowest birth rates and with a fourth of the population 65 years or older. Japan has negative replacement rate, that is, there are more Japanese dying than being born at present, and this is a situation that has prevailed for approximately half a century. This creates a demand for foreign healthcare workers especially for health sector looking after the health needs of the elderly.

• Like most other developed countries in the North, the population of Japan is becoming increasingly diverse in terms of culture, language, and ethnicity. It is imperative therefore that Japan’s health system should develop new models of health care models that more closely respond to the inexorably rising linguistic, cultural, social religious and ethnic diversity of an evolving population. This concept is sometimes referred to as migrant-sensitive health systems. An important component of this concept is a culturally competent health workforce, one which includes health workers from different countries of origin. Therefore, recruiting foreign human resources in the health sector can be an important strategy to strengthen migrant-sensitive national health services.

Hence, by recruiting foreign human resources into the health sector Japan achieves two objectives at the same time; it creates a more diverse workforce on the one hand; and, on the other, fills a critical shortage in the health sector – particularly for those who look after the elderly.

In 2008, Japan began to recruit foreign health workers, mainly nurses and care-givers from Indonesia and the Philippines in the context of the “Economic Partnership Agreement (EPA)”. Other migrants, including (a) foreign spouses of Japanese nationals, (b) descendants of Japanese emigrants to Brazil and Peru, and (c) second generation migrants, have also started working in the health care sector.

II. Ethical recruitment of foreign health workers benefits all

It is crucial that Japan, along with other countries, incorporate ethical recruitment principles and good recruitment practices.

a. IOM’s International Recruitment Integrity System or IRIS, fills gaps in government regulation as well as in private sector social auditing.  Among others, it checks in deceptions of job offers, and possible deskilling of workers due to skills mismatches. By enhancing the integrity and transparency of the global recruitment industry, IRIS strengthens the implementation of existing government regulations, reduce potential losses to employers for hiring unqualified workers, and will improve migrant workers’ safety and protection.

b. Recruiting foreign health workers should not create health worker shortages in countries of origin. A severe shortage of health personnel in many developing countries, including highly educated and trained health personnel, constitutes a major threat to the performance of health systems and undermines the ability of these countries to achieve the Millennium Development Goals. In this regard, countries should adhere to the WHO Global Code of Practice on the International Recruitment of Health Personnel that was adopted in 2010 by all WHO member states, including Japan. The Code stipulates that international migration of health personnel can make a sound contribution to the development and strengthening of health systems, if recruitment is properly managed. This requires adherence to ethical recruitment principles and close coordination between receiving and sending countries to mitigate possible negative effects of health personnel migration on the health systems of developing countries and to safeguard the rights of health personnel.

There are no quick or easy solutions to ensuring foreign human resources in the field of health care.  Let me give you two examples of good practices:

1. The State of Colorado in the United States offers newcomers, both immigrants and refugees with a healthcare background, targeted training and career guidance in order to match their professional background, skills, and cultural competencies with the demands of the health sector. The Colorado strategy assists these potential health care workers to gain better language skills, and to get entry-level positions within the health care sector, in order to hone their skills and gain practical first-hand experience.
    
2. The second example is the German Federal Employment Agency’s International Placement Services, which implements the “Triple Win Project”. The project recruits nurses for the German labour market from countries outside the European Union, such as Serbia, Bosnia and Herzegovina, and the Philippines, where unemployment rate among nurses is so high that they cannot be absorbed by the local labour markets. This project’s “triple wins” are:

• The labour markets in the countries of origin are relieved of pressure;
• Migrants’ remittances provide a developmental stimulus in their countries of origin; and
• The shortage of nurses in Germany is alleviated.

For the selection of partner countries, the project has followed the World Health Organization’s (WHO) Global Code of Practice for International Recruitment of Health Personnel. The procedures are coordinated with the agencies in the nurses’ countries of origin.

After the nurses have completed their assignment in Germany, they may return to their countries of origin, or if they continue working as nurses, they may extend their stay in Germany. They are ideally prepared for both options. Some nurses plan to return at some point in order to help improve the nursing situation in the hospitals of their countries of origin. In today’s world – so influenced by the virtual world – we need to think in terms of “brain circulation.”

III. A multicultural health sector is key to managing increasing social diversity

Finally, we must recognize the value of growing multicultural competencies in the health sector. This includes health workers’ ability to speak a variety of languages and to relate to patients with varied ethnic and cultural backgrounds, whether they are citizens, permanent residents, visiting tourists or business people. As globalization continues, we increasingly find transnational communities with ties to two or three cultural and linguistic groups.

In 2020, the Olympic and Paralympic games will be held in Tokyo. It is anticipated that in every year leading up to these games, some 20 million foreign visitors will enter Japan. This past year alone, there have been 14 million foreign visitors to Japan and the goal is 20 million per annum by the year 2020. This fact, in itself, calls for a robust health care sector with foreign language skills, dedicated to serving a non-Japanese as well as Japanese clientele. It is never too early to begin planning for these new trends. By tapping into the potential role of foreign human resources and local migrants in the field of health care, Japan can demonstrate how it is a nation on the forefront of change, poised to take the initiative and responsibly adopt ways to address these challenges.

Capacitating and developing foreign nationals in the health care sector may be one of many key strategic solutions to the challenges facing Japan and many other highly industrialized nations that face the current trends of ageing populations and globalization.

Conclusion

To succeed in attracting foreign health workers, “high road” policies will be needed. These might include:

1. Multiple-entry visa
2. Laws permitting dual-nationality
3. Portable social security and welfare benefits
4. Diaspora policies that facilitate ties with home and host countries
5. A clear path to integration including permanent residency and citizenship as options
6. Postal and other means to reduce remittance transfer costs

Despite these policies and all other efforts and good intentions however, we risk ultimately failing in a foreign worker-assisted health sector unless we can successfully address the two greatest migration challenges facing us, namely: changing the migration narrative, and managing diversity.