摘要：Although the colonial relationship between the Philippines and the United States precipitated nurse education and migration patterns that exist today, little is known about the factors that sustained them. During the first half of the twentieth century, for example, the Philippines trained its nurse workforce primarily for domestic use. After the country's independence in 1946, however, that practice reversed. Nurse education in the Philippines was driven largely by US market demand in tandem with local messages linking work and nationalism and explicit policies to send nurses abroad. As these ideologies and practices became firmly entrenched, nurse production not only exceeded the country's numerical requirements but focused largely on preparing practitioners for the health care needs of developed nations rather than the public health needs of the indigenous population. This historical trend has important present-day ramifications for the Philippines, whose continued exodus of nurses threatens its public health. IN RECENT YEARS, THE migratory pull of nurses from poorer to richer nations has been a vexing problem, particularly as it relates to variations in state–labor relations and health workforce policies that in some instances threaten the public's health in those nations that send nurses abroad. 1 There have been numerous attempts to address migration of nurses and other health workers and to create guiding principles and voluntary international standards for the ethical recruitment of health workers. 2 Contemporary policies and codes of practice aimed at remedying global disparities in nursing care and the management of nurse migration streams, however, have been largely unsuccessful. Part of their failure is their inattention to the impact of social structures and historical precedents on present-day trends. As it did throughout the twentieth century, the Philippines currently leads the world in exporting nurses to meet demand in the United States and other developed nations. 3 It has been argued, moreover, that the country's persistent production of nurses for the global market is a state strategy to develop an export industry for economic development. 4 Thus, unlike many other countries that lose nurses primarily through aggressive external recruitment, the Philippines has developed explicit internal policies and practices that encourage the production of nurses for export and operate in tandem with state-influenced policies in receiving countries (i.e., immigration services, nursing licensing authorities) to ease the process of emigration. I examine the formation of state policies and practices in the Philippines that guided nurse professionalization, practice, and immigration over the past century. I argue that the Philippines’ state policy priorities were rooted in the imperialist relationship between the United States and the Philippines and that these dominant ideologies were accepted and reinforced over time. Work equated with nationalism, and working abroad and remitting salaries home demonstrated loyalty to the state while enhancing its economic security. These state-influenced messages eventually guided the export-oriented industrialization of nursing in the Philippines that prioritizes economic development over the public's health.
