Migration is a global phenomenon. In West Africa, about 33% of people have moved from their village of birth. In Ghana, inter-regional movement is a major contributor to where people live, with over 50% of the population living outside the villages they were born in.
Previous research shows that the greater Accra region attracts the largest number of migrants by far. The general trend is that people move from the less economically endowed locations in the northern regions to find work in the relatively richer south.
Many of these migrants end up in poor neighbourhoods in the city’s urban centres because they cannot afford rents in better residential areas. On the margins of society, the poor conditions they live in make them susceptible to environmentally induced diseases such as malaria, cholera and typhoid.
To evaluate the health of migrants, research has traditionally mainly focused on geography, sexual ill health, the double burden of infectious and chronic diseases, the environment, wealth, income and health factors.
The research shows that rural migrants and residents in poor communities have a higher burden of sexual ill health and suffer from both infectious and non-communicable diseases. These are also the major causes of death and disability.
In our study we expanded the lens to understand patterns of disease by looking at lifestyle factors as well as social factors. These included how long migrants stayed in a place, what job they had, how religious they were and how often they ate “street meals”.
What our research points to is that a systematic policy framework to promote the active creation of social networks – at formal and informal work places and at places where people congregate for recreation or for worship – would make a dramatic difference in helping migrants better manage their health.
The factors that affect migrants’ health
Researchers have traditionally used a set of social factors that look at migrants’ disease patterns to determine their health status. These have included living and working conditions, family wealth, health literacy, education, employment and the degree of autonomy in jobs, the quality of housing, ethnicity, and gender.
Environment factors also come into play. These include the quality of food and water, air and soil. For example, diseases thrive in areas where migrants live in degraded, overcrowded environments with poor sanitation. Overcrowding increases the risk and spread of respiratory diseases. This becomes worse when too many people use charcoal and firewood as cooking fuels.
In addition, social relationships have been shown to matter.
Urbanisation dramatically affects social relationships. For example, traditional lifestyles of family cooking and the sharing of home cooked food are replaced by out-of-home “street meals”. This has led to an increase in lifestyle diseases such as cardiovascular diseases and associated risk factors like obesity, high blood pressure, cholera and other diarrhoeal disease epidemics.
Social relationships also affect the social support networks migrants can rely on to access health care services.
Our study looked at the health status of migrants in Jamestown, a poorer neighbourhood in Accra.
We found that socio-demographic factors, individual lifestyles and the type of resources migrants could access through their social networks all played a part in how healthy, or not, they were.
Migrants face multiple health challenges. Hazardous working and poor living conditions as well as the fact that they have moved to new and unfamiliar terrain also play a part. For example, we found that migrants who had lived in the neighbourhood longer were more likely to have a better health status than those who had migrated recently.
The jobs they did also affected their health. Those employed in jobs involving physical activity such as masonry, welding and carpentry were more likely to say they were healthy compared to those who provided services, such as seamstresses, nurses and drivers. Migrants involved in sales such as trading, food vending and fish mongering also did not rate their health highly.
Migrants who bought food from food vendors were more likely to have a lower self-rated health status than those who didn’t.
Social capital
The association between poor migrants’ lifestyles and their health in poor urban neighbourhoods as well as how social capital mediates that association has been a largely neglected area of research.
Previous research in Accra on poverty and health has largely focused on the spatial distribution of inequalities in health. It has shown that there is uneven distribution of diseases with some places having higher prevalence of certain diseases than others.
But we found that those who felt that they had enough information on how to live successfully – including how to access health care from the host population in Jamestown – had a more positive outlook on their health. This confirms earlier research that social capital at the individual and interpersonal level is a major source for passing on information as well as a predictor of health.
This study is important because it provides some of the answers about existing health differentials for people living in disadvantaged neighbourhoods and points out some of the contributions that lifestyles can make. The findings have implications for policy. They can also help design improvements in areas of community health insurance schemes, strengthening community health care systems, and promoting communal and family support systems that are falling apart.
Information and education are key
As things stand, people who don’t get adequate information about health issues often resort to cheaper herbal medicines and unauthorised conventional medicines that are less effective in controlling diseases such as malaria, TB, cholera and even obesity. This not only endangers migrants’ health: it can also contribute to drug resistance.
Of course, health facilities should be improved so that migrants have access to affordable health services. Currently many have little or no access.
But the research highlights the need for intervention at a much more granular level. It shows that there is an urgent need for strong policies to support informal health education, health literacy and counselling to migrants as well as host populations about healthy living.
New policies should be developed to promote proactive social, familial and community support networks that facilitate better information about health. This would include information about healthy living, good hygiene and responsible sexual behaviour.
Strong networks would help facilitate discussions among community members about ways to avoid health risks associated with lifestyles, poor sanitary conditions and unprotected sex. They would provide the channels through which people could be armed with the necessary information to improve their lives, particularly their health. This, then, would encourage them to take the necessary steps to avoid risks.