Assessing the influence of health on rural outmigration in Alaska

After several years of marked increases in outmigration from rural Alaska many researchers identified economic reasons that may have caused rural residents to move to larger populations centers within the state. The Institute for Circumpolar Health Studies (ICHS) at the University of Alaska Anchorage (UAA) collaborated with the Institute of Social and Economic Research (ISER) to re-examine the standard economic model of Arctic outmigration. The aim of the two-year study, funded by the Robert Wood Johnson Foundation, was to examine the health-related factors, including access to health care, involved in Alaskan outmigration, and to develop recommendations to respond to these factors that would allow rural residents of the state to remain in their communities if they wish to do so. The study consisted of two iterative phases. In the first phase of the study researchers conducted an extensive literature review on outmigration and health in Alaska. In the second phase of the study researchers conducted in-depth, individual interviews (31) to verify and augment the literature review findings.

Phase one of the study resulted in a detailed annotated bibliography of publications regarding health care needs or outmigration among residents of the circumpolar north. Two key themes emerged: (1) accessing primary and secondary health care is problematic for rural residents due to the limited capabilities of village clinic personnel, geographic barriers to transportation to clinics, and costs of care, and (2) health-related outmigration usually includes "ripple effect" migrants, often family members who leave their community along with the patient seeking care.

During interviews many study participants reportedly left their rural communities seeking both primary and secondary health care. Primary health care needs were often due to pediatric infections or injuries. Secondary health care needs included treatment for cancer, heart disease, diabetes, COPD and substance abuse. Women were more likely than men to report that they had moved from their home communities to access health care for chronic illnesses. Men were more likely than women to leave their home villages for substance abuse treatment.

The health concerns identified by participants in this study represent a relatively unknown challenge that adversely affects the health of rural Alaskans. Although previous research has identified economic factors associated with rural outmigration (5), this study is among the first to describe how health care and health concerns influence rural Alaskans' decisions to outmigrate. Many of the participants in this study cited challenges to primary and specialized health care access as an important factor in their decision to outmigrate. Specifically, participants described the need for increased access to quality health care for chronic illnesses, primary care and substance abuse treatment as factors in their outmigration decisions.

To improve understanding of the health issues surrounding outmigration, the ICHS plans to conduct a larger, representative study.

David Driscoll, Bruce Dotterrer, Jenny Miller and Hannah Voorhees conducted this study.

Results of the study will be published in a special edition of the International Journal of Circumpolar Health due out this month.