Migration, Urbanization and Health in a Transition Setting

 描述(由申请人提供)：我们提出了一项研究，利用现有数据和对大约4,000人的新的纵向调查来研究移民、城市化和健康之间的关系。我们的项目旨在帮助解决移民-城市化-健康关系中的困惑，对南非有直接的政策影响，并为低收入和中等收入国家(LMIC)的一系列科学问题提供实质性和方法性的经验教训。更好地了解这些再分配力量对健康的作用方式(及其与经济发展的复杂相互作用)，有助于通过以下方式为全球卫生政策提供信息：(1)提高我们对移民和城市化如何影响人口健康的理解，从而更好地理解与城市化(居住在城镇的人口比例不断增加，与城市增长率不同)相关的社会经济环境的有益增加与伴随这种转变而来的健康风险之间的权衡；(2)提高我们对人口再分配的理解，以便更好地准备将空间人口学纳入伴随的健康调查；(3)确定人口流动本身可能损害治疗级联的情况--损害为慢性病提供适当保健所需的连续性；和(4)在该区域建设科学能力。我们计划进行一项新的为期五年的观察性研究，旨在揭示流动人口如何获得和管理慢性病以及获得长期护理的问题，结合了对4000名移民和居留者进行的一项新的纵向队列研究的见解，以及20多年来人口监测中目前超过10万人的现有数据。我们的研究地点是南非东北部的一个农村地区，以及来自该来源的移民迁徙的地点。我们进行这项研究是为了在个人层面上更好地了解当代复杂的移民和城市化模式如何帮助推动低收入和中等收入国家的健康转型。我们的创新方法收集了一系列社会经济变量和生活史项目、健康状况、行为和选定的生物标志物的新数据。我们研究了几个相互交织的人口和健康动态。我们研究了关键健康结果的风险因素的决定因素。我们衡量卫生保健的可获得性和治疗，并测试移民是否构成了护理障碍。我们还直接调查移民动态，以便更好地了解人口再分布的决定因素和目的地移民适应的路径。

 DESCRIPTION (provided by applicant): We propose a study using both existing data and a new longitudinal survey of approximately 4,000 individuals to study the relationships among migration, urbanization, and health. Our project is designed to help resolve confusion in the migration-urbanization-health nexus, with direct policy implications for South Africa and both substantive and methodological lessons for a broad array of scientific concerns in Low and Middle Income Countries (LMICs). A better understanding of the way in which these redistributive forces operate on health (and its complex interplay with economic development) can help inform global health policy by (1) improving our understanding of how migration and urbanization impact population health, so as to better understand the trade-off between the salutary increases in socioeconomic circumstances associated with urbanization (the increasing share of a population residing in towns and cities, as distinct from the urban growth rate) and the health risks that accompany that shift; (2) improving our understanding of population redistribution, so as to be better equipped to incorporate spatial demography into companion health investigations; (3) identifying circumstances where population mobility itself may compromise the treatment cascade - compromising the continuity necessary to deliver suitable health care for chronic conditions; and (4) building scientific capacity in the region. We plan to conduct a new five-year observational study aimed at shedding light on issues of how mobile individuals acquire and manage chronic diseases and access long-term care, combining insights from a new longitudinal cohort study of 4,000 migrants and stayers and more than twenty years of extant data for a population of now more than 100,000 in demographic surveillance. Our study site is a district in rural northeast South Africa and the locations to whih migrants from that origin move. We carry out this study to better understand, at the individual level, how a contemporary, complex pattern of migration and urbanization helps drive the health transition in low and middle income countries. Our innovative approach gathers new data on an array of socioeconomic variables and life history items, health conditions, behaviors, and selected biomarkers. We study several intertwined demographic and health dynamics. We examine the determinants of risk factors for key health outcomes. We measure health care access and treatment, and test whether barriers to care are posed by migration. We also investigate migration dynamics directly so as to better to understand the determinants of population redistribution and the paths of migrant adjustment in destinations.