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5
The Role of Migration
Migration is often the route through which people seek a wider world. There are
economic, demographic, cultural, and social transitions associated with various forms of
migration which have implications for the speed and nature of an epidemiological
transition in the area affected by migration. The act of migration obviously exposes
migrants to a different spatial environment, which in itself may be potentially beneficial
or harmful. For example, migration may involve movement out of a malarial zone (a
positive) to a slum area in a peri-urban settlement where the risk of airborne disease
caused by pathogenic microbial agents is substantially higher (a negative). Migration can
also involve a shift in social environment which may lead to changes in people's
behaviors and norms; this in turn may be associated with changes in diets and lifestyles.
Of particular importance are changes that lead to increases in various risk factors, such as
a more sedentary lifestyle and increased levels of smoking, alcohol use, and consumption
of salt, sugar, and unhealthy oils and fats. In many cases migrants also experience
increased stress from the disruption associated with leaving home.
To explore the connection between migration and epidemiological transitions,
Mark Collinson offered an analysis of data from 19972008 from the Agincourt
(Republic of South Africa) Health and Demographic Surveillance System. Significant
levels of migration were reported, especially temporary labor migration among men and,
increasingly, among women, Collinson said, and the average age of migrants appeared to
be getting younger. Three types of migrants were considered in the analysis: one-way
immigrants, short-duration labor migrants, and long-duration labor migrants. Even
though the data covered only a fairly short time period, it was possible to observe
changes in the causes of death in the Agincourt surveillance system. Communicable
disease mortality and migration were both concentrated in the 2549 age group. The most
important age- and sex-related associations between migration and cause of death were
seen between (1) one-way migrants (both sexes) and communicable disease; (2) short-
duration female labor migrants or long-duration male labor migrants and communicable
diseases; and (3) short-duration female labor migrants or long-duration male labor
migrants and noncommunicable diseases.
The discussion during this session highlighted several general findings from an
analysis of data collected by the International Network for the Demographic Evaluation
of Populations and Their Health (INDEPTH) for Eastern and Southern Africa. The first
was that high levels of circulation have exposed migrants to higher risks of HIV than
would otherwise be the case. Second, return migration was said to be associated with
higher adult mortality compared to that of local residents. Extant data suggest that rural
households and health systems have an elevated burden of disease. Furthermore, given
the intensity of population movements to and from INDEPTH sites, it is important to take
migration into account in the formation of policies and programs. It was noted that
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attrition from INDEPTH study populations is not random, which implies that migration
affects the results obtained from surveillance-site data. Analysts should therefore
consider adjusting for selection bias due to immigration and emigration.
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