Impact of Children's Migration on Health and Health Care-seeking Behavior of Elderly Left Behind

Ramesh Adhikari; Aree Jampaklay; Aphichat Chamratrithirong


BMC Public Health. 2011;11 

In This Article


In modern times, many factors have intensified migration. Improvement in transportation infrastructure, advances in communications technology (which makes keeping in contact with left-behind over much easier and cheaper), increased trade between countries (including the impact of trade resulting from globalization), political instability, poverty, and unemployment in economically disadvantaged areas/countries are some of the important factors that contribute to this phenomenon.[1]

The interaction between health and migration is complex and dynamic. Migration can have an impact on physical, mental, and emotional health and well-being of migrants themselves, on those left behind in the place of origin, and on those at the destination.[2] The connection between health status and migration is clearly bidirectional. In one direction, the act of migration may influence health outcomes. In the other direction, a person's health may influence one's propensity to migrate or the destination one chooses.[3]

In many places, and especially in most developing countries, the growing proportion of aging individuals challenges public and social institutions responsible for elderly care. These countries face an additional burden of accelerated population aging and a lack of institutional support to meet the needs of older individuals.[4] Changes in demographic events, especially sharp declines in fertility and mortality, have resulted in rising life expectancies and increasing rates of population aging.[5] As is the case in most other countries in Asia, the elderly in Thailand have traditionally relied on their children for personal care and financial support.[6] Trends in declining fertility and increasing internal migration have prevailed in Thailand since 1985, when a period of sustained economic development began.[7,8] These patterns have resulted in decreasing numbers of children available to care for their elderly parents. Increasing out-migration of young adults has created concerns about whether the absence of children in the household or community affects the health of elderly left behind or their health care-seeking behavior. Existing literature on the consequences of migration has focused mainly on the impact of migration on receiving areas and on migrants themselves but has paid little attention to the effects of migration on sending communities and of the family members "left behind" by migrants.[9–11]

Evidence from the literature shows that migration can affect the health of those left behind both positively and negatively. With additional money coming from remittances, people have easier access to health services, can buy expensive medicine, and eat better quality food.[12] Thus, migration can benefit both migrants and left-behind family members as it would enhance their well-being.[13,14] Remittances received from migration could support the family left behind by minimizing economic risk and overcoming capital constraints.[14,15] A study in South Africa found that temporary internal migrants, by increasing their household income, were able to bring positive health outcomes not only for themselves but also for family members[16] including elderly parents left behind.[17] Other research also shows that migration can lead to better health among the population left behind.[18–20] Similarly, a study conducted by Abas et al.[21] found that out-migration of children was independently associated with less depression in parents.

On the other hand, some research notes that out-migration of young adults has severe negative consequences for ageing parents, namely, loneliness, isolation, and the loss of basic instrumental and economic support.[22] A study of Mexico-US migration found evidence of a causal link between poor elderly health outcomes and children's migration to the US.[23] Research in Bangladesh has found that those left behind by adult migrant children face risks stemming from the loss of personal support and care.[18]

Although the separation of families due to migration might have serious implications on the health status of elderly left behind and their health care-seeking behavior, the possible health effects on elderly left behind in Thailand remain unclear. This study aims to explore the impact of migration of adult children on the health of the elderly left behind and on their health care-seeking behavior. In-depth examination of these issues will provide policy makers and program planners with needed information and will raise public attention to this public health issue. The findings of this study will help fill the gap in the literature and provide the understanding necessary for advocacy and for the design of appropriate interventions related to migration in Thailand.


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