印度南部国内移民健康的决定因素及健康移民效应：一项混合方法研究。
Determinants of internal migrant health and the healthy migrant effect in South India: a mixed methods study.
作者信息
Dodd Warren, Humphries Sally, Patel Kirit, Majowicz Shannon, Little Matthew, Dewey Cate
机构信息
Department of Population Medicine, University of Guelph, Guelph, ON, N1G 2W1, Canada.
Department of Sociology and Anthropology, University of Guelph, Guelph, ON, N1G 2W1, Canada.
出版信息
BMC Int Health Hum Rights. 2017 Sep 12;17(1):23. doi: 10.1186/s12914-017-0132-4.
BACKGROUND
Internal labour migration is an important and necessary livelihood strategy for millions of individuals and households in India. However, the precarious position of migrant workers within Indian society may have consequences for the health of these individuals. Previous research on the connections between health and labour mobility within India have primarily focused on the negative health outcomes associated with this practice. Thus, there is a need to better identify the determinants of internal migrant health and how these determinants shape migrant health outcomes.
METHODS
An exploratory mixed methods study was conducted in 26 villages in the Krishnagiri district of Tamil Nadu. Sixty-six semi-structured interviews were completed using snowball sampling, followed by 300 household surveys using multi-stage random sampling. For qualitative data, an analysis of themes and content was completed. For quantitative data, information on current participation in internal labour migration, in addition to self-reported morbidity and determinants of internal migrant health, was collected. Morbidity categories were compared between migrant and non-migrant adults (age 14-65 years) using a Fisher's exact test.
RESULTS
Of the 300 households surveyed, 137 households (45.7%) had at least one current migrant member, with 205 migrant and 1012 non-migrant adults (age 14-65 years) included in this study. The health profile of migrant and non-migrants was similar in this setting, with 53 migrants (25.9%) currently suffering from a health problem compared to 273 non-migrants (27.0%). Migrant households identified both occupational and livelihood factors that contributed to changes in the health of their migrant members. These determinants of internal migrant health were corroborated and further expanded on through the semi-structured interviews.
CONCLUSIONS
Internal labour migration in and of itself is not a determinant of health, as participation in labour mobility can contribute to an improvement in health, a decline in health, or no change in health among migrant workers. Targeted public health interventions should focus on addressing the determinants of internal migrant health to enhance the contributions these individuals can make to their households and villages of origin.
背景
国内劳动力迁移是印度数百万个人和家庭重要且必要的生计策略。然而，农民工在印度社会中的不稳定地位可能会对这些人的健康产生影响。此前关于印度国内健康与劳动力流动之间联系的研究主要集中在与此做法相关的负面健康结果上。因此，有必要更好地确定国内移民健康的决定因素，以及这些决定因素如何塑造移民的健康结果。
方法
在泰米尔纳德邦克里希纳吉里区的26个村庄进行了一项探索性混合方法研究。采用滚雪球抽样完成了66次半结构化访谈，随后采用多阶段随机抽样进行了300户家庭调查。对于定性数据，完成了主题和内容分析。对于定量数据，收集了有关当前参与国内劳动力迁移的信息，以及自我报告的发病率和国内移民健康的决定因素。使用Fisher精确检验比较了移民和非移民成年人（14 - 65岁）之间的发病类别。
结果
在接受调查的300户家庭中，137户家庭（45.7%）至少有一名当前移民成员，本研究纳入了205名移民成年人和1012名非移民成年人（14 - 65岁）。在这种情况下，移民和非移民的健康状况相似，53名移民（25.9%）目前患有健康问题，相比之下，273名非移民（27.0%）患有健康问题。移民家庭确定了导致其移民成员健康变化的职业和生计因素。通过半结构化访谈证实并进一步扩展了这些国内移民健康的决定因素。
结论
国内劳动力迁移本身并不是健康的决定因素，因为参与劳动力流动可能会使农民工的健康状况改善、下降或没有变化。有针对性的公共卫生干预措施应侧重于解决国内移民健康的决定因素，以增强这些人对其家庭和原籍村庄的贡献。
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