The Conversation: Moving for work — the hidden health impacts of SA’s urban migration

Migration can improve livelihoods without uniformly harming health, researchers find, but urban diets, obesity and blood pressure risks highlight the need for mobile healthcare planning.

Moving between rural homes, towns and cities is a normal part of life for many South Africans. Young adults often leave their home towns or villages in search of work or education; some settle elsewhere for long periods, while others travel repeatedly between rural homes and urban destinations . These patterns of temporary and circular migration have deep roots in South Africa’s labour system and apartheid spatial planning .

Relocating can also alter health determinants such as access to medical care, diet and environmental quality. Despite high levels of internal mobility in South Africa, we still know relatively little about how moving to and spending more time in urban areas affects people’s health – a knowledge gap the Migrant Health Follow-Up Study has attempted to address.

Since 2018, a team of public health and social science researchers from the South African Medical Research Council/Wits Agincourt Unit and Brown University in the US has been following about 3,000 young adults aged 18 to 40 from the Agincourt subdistrict in Bushbuckridge, Mpumalanga, in the rural northeast. The study compares the health of young adults who remain at home with those who move away, including people who later return or move repeatedly between destinations and their rural homes.

Using home visits and telephone interviews over five rounds approximately one year apart, the research team gathered information on migration, education, employment, household characteristics, health and health service use. Health measures included general health, chronic conditions, diet, depression risk and resilience.

During home visits, blood pressure, height and weight were measured, and HIV status was determined through dried blood spots . Following the same people over time helped to distinguish between their pre-migration characteristics and changes that may occur after migration.

The study found that migration was widespread and associated with changes in health, which were shaped by personal characteristics and destination conditions. This shows that migration cannot be treated as a single health exposure with a uniformly positive or negative effect. Who moves, where they move, and how long they remain away all matter.

These insights help clarify the complex relationships between migration, urbanisation and health. This study can help address how migration and livelihood changes may affect chronic health conditions and their treatment, with policy implications for South Africa.

The study’s findings suggest that policies should focus on reducing the health risks that can accompany movement while recognising the opportunities migration can create.