A Multilevel Approach in Identifying Determinants of Internal Migration and Variability in Migrant Health

Open Access
Abiero, Beatrice Atieno
Graduate Program:
Health Policy and Administration
Doctor of Philosophy
Document Type:
Date of Defense:
February 26, 2016
Committee Members:
  • Rhonda Belue, Dissertation Advisor
  • Rhonda Belue, Committee Chair
  • Marianne Messersmith Hillemeier, Committee Member
  • Kevin J Thomas, Committee Member
  • D Wayne Osgood, Committee Member
  • multilevel context internal migration health Indonesia
Migration is nested within a hierarchy of factors that stem from individual and household decisions, social networks, regional ties, and socioeconomic conditions. Health is also critically linked to migration because overall health influences the propensity to move. As a result, a multilevel framework aids in disentangling whether individual-level effects or other household- or community-level characteristics impact migration and variability in migrant health outcomes. The dataset used for this research was the Indonesia Family Life Survey. Indonesia serves as an appropriate case study to investigate the relationship among these factors because the country faces pressing socioeconomic and demographic trends that are found globally. Several multilevel analyses were conducted to predict migration incidence as well as variability in six health outcomes (i.e., health status, acute illness, mental health, problems with ADLs, hypertension, and anemia) among migrants. Migration resulted from differences in household and community composition. Select demographic and socioeconomic characteristics significantly predicted migration decision and these determinants were consistent with previous literature. Findings suggest that inadequate distribution of health resources may serve as a push factor in motivating individuals living in communities without medical access to migrate. Multilevel effects were detected across all the health outcomes indicating significant clustering of health characteristics across households and communities. Two themes emerged from the findings: 1) stark gender differences in health, and 2) positive health selection among younger migrants compared to older migrants who were negatively selected on health. Although health did not play a major role as a determinant of migration, this research found significant multilevel effects for predicting migration and variability in health among migrants. This dissertation offers a perspective on the determinants of internal migration that are critical in a developing context and also provides insight into selection effects on health among migrants.