نبذة مختصرة : Background Temporary labor migration is an increasingly important mode of migration that generates substantial remittance flows, but raises important concerns for migrant well-being. The migration and health literature has seen a growing call for longitudinal, binational surveys that compare migrants to relevant non-migrant counterfactual groups in the sending country, in order to answer the basic question “Is migration good for health?” This study compares the health of male international migrants, internal migrants, and non-migrants using a unique representative panel survey of the Matlab subdistrict of Bangladesh. Methods and findings A cohort of 5,072 respondents born 1958–1992 were interviewed in 1996–1997, and reinterviewed in 2012–2014. Extensive migrant follow-up yielded a 92% reinterview rate. We explored health and income outcomes for respondents who at the time of the follow-up interview were current international migrants (n = 790), returned international migrants (n = 209), internal migrants (n = 1,260), and non-migrants (n = 2,037). Compared to non-migrants, current international migrants were younger (mean 32.9 years versus 35.8 years), had more schooling (7.6 years versus 5.8 years), and were more likely to have an international migrant father (9.7% versus 4.0%) or brother (49.1% versus 30.3%). We estimated multivariate ordinary least squares and logistic regression models controlling for a wide range of control variables measured as far back as 1982. Results show that current international migrants had substantially better health status on factors that likely relate to self-selection such as grip strength and self-rated health. Current international migrants had no excess risk of injury in the past 12 months compared to non-migrants (adjusted mean risk = 6.0% versus 9.3%, p = 0.084). Compared to non-migrants, current international migrants had roughly twice the risk of overweight/obesity (adjusted mean risk = 51.7% versus 23.3%, p < 0.001), obesity (6.9% versus 3.4%, p = 0.012), and stage 1 or higher hypertension (13.0% versus 7.0%, p = 0.014). Compared to internal migrants, current international migrants had significantly higher levels of overweight/obesity (adjusted mean risk = 51.7% versus 37.7%, p < 0.001). Current international migrants showed above average levels of depressive symptoms on a 12-item standardized short-form Center for Epidemiologic Studies Depression Scale (+0.220 SD, 95% CI 0.098–0.342), significantly higher than internal migrants (−0.028 SD, 95% CI −0.111, 0.055; p < 0.001). Depressive symptoms differed significantly from those reported by non-migrants when restricting to items on negative emotions (international migrant score = 0.254 SD, non-migrant score = 0.056 SD, p = 0.004). Key limitations include the descriptive nature of the analysis, the use of both in-person and phone survey data for international migrants, the long recall period for occupational and mental health risk measures, and the coverage of a single out-migration area of origin. Conclusions In this study, we observed that international migrants had comparable or lower injury and mortality risks compared to respondents remaining in Bangladesh, due in part to the high risks present in Bangladesh. International migrants also showed higher levels of self-rated health and physical strength, reflective of positive self-selection into migration. They had substantially higher risks of overweight/obesity, hypertension, and depression. Negative health impacts may reflect the effects of both harsh migration conditions and assimilation into host population conditions. Our results suggest the need for bilateral cooperation to improve the health of guest workers.
Randall Kuhn and colleagues study the health of male migrants and non-migrants from Matlab, Bangladesh.
Author summary Why was this study done? Temporary international guest workers comprise perhaps one-third of the world’s migrant workers, or about 50–60 million in 2018. Concerns have been raised about the health and safety of these workers, particularly those working in the nations of the Gulf Cooperation Council (GCC). Yet little rigorous evidence has quantified these risks, and guest workers typically migrate from highly disadvantaged sending areas where health risks might be equally high or higher. In recent years, studies of migrant well-being have recognized the need to compare migrants to relevant non-migrant counterfactual groups, in order to answer the basic question “Is migration good for your health?” What did the researchers do and find? In 1996–1997, we interviewed 5,072 male respondents born 1958–1992. In 2012–2014, we successfully located 92% of surviving respondents (n = 4,296), and classified respondents as current international migrants (n = 790), returned international migrants (n = 209), internal migrants (1,260), and non-migrants (2,037). More than 70% of international migrants worked in GCC countries. We estimated the metabolic health, mental health, injury risk, and income of the 4 migration status groups, controlling for a wide range of factors relating to current sociodemographic characteristics, family background, and familial migration history. We report results in terms of “adjusted” means to allow easy comparison of the risks facing international migrants to those of other groups. International migrants showed comparable or lower levels of injury and mortality risk than other groups. Migrants also fared better on physical strength and general self-rated health. International migrants had much higher risk of being overweight/obese (52%) than non-migrants (23%) and internal migrants (38%), they had higher risk of obesity (6.9%) than non-migrants (3.4%), and they had higher risk of stage 1 or higher hypertension (13.0%) than non-migrants (7.0%). International migrants also reported a significantly higher level of depressive symptoms than non-migrants and internal migrants. What do the findings mean? Many concerns have been raised about the health and safety of guest workers, particularly those living in the Gulf Cooperation Council countries. Guest workers do face excess health risks compared to those who do not migrate, but these may not be the risks that draw widespread media attention. While injury and mortality risks were lower and migrants were far stronger physically, they faced higher burdens of obesity, hypertension and mental illness that may reflect both the harsh conditions of migration and some adoption of local behaviors of the host country.
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