Migrants, Manpower and Math in the Coming Europe.

"A dead child" said stalin "is a tragedy. Two million are a statistic." A single photograph of a beach riveted world attention, converting syrian refugees from statistics to tragedy. But the statistics remain. Three Canadian columnists have offered contrasting interpretations. Eric Reguly argues that a static and aging Europe needs more manpower to sustain its economy. Margaret Wente, however, observes the failure of integration of migrants in Sweden. Migrants are drawn by open borders and a generous welfare state, but do not fit an advanced, high-skill economy. Gwynne Dyer notes that current inflows, IF evenly distributed, are a tiny proportion of the overall European Union. But economic migrants from Africa are a much larger issue. Their numbers are effectively inexhaustible.

Two wings and a prayer: should Canada make it easier for Canadian doctors trained abroad to enter practice here?

About 3,600 Canadians are currently studying medicine abroad (CSMAs). Most hope to return to practise in Canada. But the road back is not easy. These graduates must complete postgraduate residency training in Canada and alas, there are less openings than there are aspirants. One might have thought, amid the endless rhetoric of "physician shortages," that an obvious solution would be to increase the number of residency positions. But provincial governments are well aware, even if the media are not, that Canada is in the early stages of a dramatic expansion in physician supply fuelled by increased domestic training capacity. Last time the physician supply outpaced population growth, as it is doing today, governments choked off the entry of international graduates. It could happen again.

Diagnosing senescence: contributions to physician expenditure increases in british columbia, 1996/97 to 2005/06.

Conventional wisdom holds that Canada suffers from a physician shortage, yet expenditures for physicians' services continue to increase rapidly. We address this apparent paradox, analyzing fee-for-service payments to physicians in British Columbia in 1996/97 and 2005/06. Age-specific per capita expenditures (adjusted for fee changes) rose 1% per year over this period, adding $174 million to 2005/06 expenditures. We partition these increases into changes in the proportion of the population seeing a physician; the number of unique physicians seen; the number of visits per physician; and the average expenditure per visit. Expenditures on laboratory and imaging services, particularly for the elderly and very elderly, have increased dramatically. By contrast, primary care services for the non-elderly appear to have declined. The causes and health consequences of these large changes deserve serious attention.

Thomas McKeown, Meet Fidel Castro: Physicians, Population Health and the Cuban Paradox.

About 40 years ago, Thomas McKeown demonstrated that the historic decline in the great killer diseases owed little or nothing to progress in medicine. A generation of research on population health followed, highlighting the large social gradients in health within populations. These vary greatly across societies, but appear largely unrelated to medical care. Medicine was acknowledged as "powerful, but within limits"; the major determinants of health lie elsewhere. We may have missed something. Cuba has achieved "first world" population health status despite a minimal economic base. Far from marginalizing medicine, Cuba has by far the world's largest physician workforce. But doctors' roles are significantly expanded. The system seems to work.