Moving for work — the hidden health impacts of SA’s urban migration

Moving between rural homes, towns and cities is a normal part of life for many South Africans. Young adults often leave their home towns or villages in search of work or education; some settle elsewhere for long periods, while others travel repeatedly between rural homes and urban destinations. These patterns of temporary and circular migration have deep roots in South Africa’s labour system and apartheid spatial planning.

Relocating can also alter health determinants such as access to medical care, diet and environmental quality. Despite high levels of internal mobility in South Africa, we still know relatively little about how moving to and spending more time in urban areas affects people’s health – a knowledge gap the Migrant Health Follow-Up Study has attempted to address.

Since 2018, a team of public health and social science researchers from the South African Medical Research Council/Wits Agincourt Unit and Brown University in the US has been following about 3,000 young adults aged 18 to 40 from the Agincourt subdistrict in Bushbuckridge, Mpumalanga, in the rural northeast. The study compares the health of young adults who remain at home with those who move away, including people who later return or move repeatedly between destinations and their rural homes.

Using home visits and telephone interviews over five rounds approximately one year apart, the research team gathered information on migration, education, employment, household characteristics, health and health service use. Health measures included general health, chronic conditions, diet, depression risk and resilience.

During home visits, blood pressure, height and weight were measured, and HIV status was determined through dried blood spots. Following the same people over time helped to distinguish between their pre-migration characteristics and changes that may occur after migration.

The study found that migration was widespread and associated with changes in health, which were shaped by personal characteristics and destination conditions. This shows that migration cannot be treated as a single health exposure with a uniformly positive or negative effect. Who moves, where they move, and how long they remain away all matter.

These insights help clarify the complex relationships between migration, urbanisation and health. This study can help address how migration and livelihood changes may affect chronic health conditions and their treatment, with policy implications for South Africa.

The study’s findings suggest that policies should focus on reducing the health risks that can accompany movement while recognising the opportunities migration can create. In turn, the results encourage policy and planning that improves migrants’ integration in destinations by improving access to services and economic inclusion.

Those who go and those who stay

Over the observation period, about a third of the sample lived continuously in destinations outside the Agincourt study area, while about a third remained within the Agincourt subdistrict. The remaining participants had more dynamic movement patterns. Some moved away for the first time, some returned after living elsewhere, and others moved repeatedly between destinations and rural homes in a pattern of circular migration.

Gauteng, South Africa’s economic engine, about 500km from Agincourt, was the most common destination. A substantial share of moves also took place within Mpumalanga, some to the city of Mbombela and the industrial towns of Witbank, Middelburg and Secunda. Internal migration included a range of destinations and repeated movement over time.

Migrants differed from those who stayed behind in several important ways – they tended to be younger, and the majority were men. Retrospective information collected in the survey also indicated that migration was increasingly likely among younger cohorts of women. Migrants had higher levels of education and fewer chronic conditions, and appeared to be more resilient, as indicated by a psychological index of “grit”.

These findings are consistent with the well-known “healthy migrant hypothesis”: people who migrate are often healthier than their non-migrant counterparts at the point when they move.

Migration and employment are closely linked

For many young adults in rural South Africa, moving is a livelihood strategy. Migrants in our study were far more likely than those who remained at home to report being employed. On average, about two-thirds of migrants were working in destinations, while more than half of those who remained at home were unemployed and looking for work.

The relationship became particularly visible during the Covid-19 pandemic. Job losses resulted in some people returning to the Agincourt subdistrict. Employment levels recovered in the post-Covid period.

For those who found work, migration could also benefit households in rural areas because migrants were able to send money or goods home and contribute to household living conditions.

The health effects are mixed

Our findings so far do not support a simple story in which migration makes people less healthy. The prevalence of chronic conditions increased over the duration of the study among both migrants and non-migrants, but the increases were lower among migrants, suggesting that some of the health advantage seen at the time of migration persisted.

At the same time, living in urban areas can introduce particular health risks. There, migrants consumed processed food more frequently and had a higher chance of abdominal obesity. Other risks were unevenly distributed. Our more recent work, for example, suggests that migration to urban areas may increase blood pressure, particularly among women. But the reasons for higher blood pressure among migrant women are not obvious. Migration may be especially stressful for women, which could be contributing to higher blood pressure.

The net effects of migration on health over time are therefore still being established.

Plan for mobility

The findings point to the need for attention to continuity of healthcare as people move between places, as well as to the urban conditions that shape diet, blood pressure and longer-term chronic disease risk.

This also means planning around the reality that many people’s lives span more than one place. Internal migrants contribute to destination economies while remaining connected to their places of origin. Health services, urban planning, employment, housing and social protection need to account for these patterns of residence. DM

Carren Ginsburg, senior researcher in public health, University of the Witwatersrand; Chantel Pheiffer, assistant professor in urban public health, UMass Boston; Mark A Collinson, reader in population and public health, MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, and Michael White, professor emeritus of Sociology, Brown University

This article is republished from The Conversation under a Creative Commons license. Read the original article.