Health, Wealth, and Social Status: An Analysis of the Effects of Migration and Remittances

This dissertation examines the effects of migration and remittances on family members left behind in sending areas. It consists of a systematic review of the literature on the effects of remittances on recipients’ health and empirical analyses that examine the effects of migration and remittances on medical spending and women’s empowerment. In 2019, 270 million international migrants sent over $530 billion dollars in remittances to their home countries. This project advances the literature on the effects of these processes. The empirical analyses use panel and cross-sectional survey data from the 2013 and 2018 waves of the Kerala Migration Survey, a large-scale longitudinal survey conducted in Kerala, India that followed the families of thousands of migrants from 1998 to 2018. The panel analyses used logistic and linear fixed-effects models, and the cross-sectional analyses used factor analysis, linear regression, and two-step Heckman selection models to assess the effects of migration and remittances on medical spending and women’s empowerment. The review found that migration and remittances play an important role in shaping health among individuals in transnational families. Remittances had the most pronounced benefits in areas with limited resources and social protections. They improved health by enabling households to pay for healthy food, medical treatment, and housing, and they improved mental health by easing financial constraints. Remittances were less beneficial in areas with strong safety nets, support systems, and community ties because family members were not dependent on remittances to provide basic needs. Migration and remittances shaped medical spending. Panel and cross-sectional analyses found that migrant households spent more money on medical expenses compared to non-migrant households. The panel analysis found that, compared to non-migrant households, households that received low levels of remittances spent less on medical care and households that received high levels of remittances spent a greater amount of money on medical care. After adjusting for health status and covariates, the cross-sectional analysis found positive and linear relationships between remittances and amount of medical spending. Although out-of-pocket costs of medical care in India can be high and although remittances are often used to maintain and increase social status, remittances were positively associated with increased medical spending in transnational families. Migration and remittances also influenced dimensions of women’s empowerment. They increased women’s management of household responsibilities, including decision-making and income control. However, migration decreased women’s internalized social status and neither migration nor remittances had meaningful effects on spousal attitudes. These findings suggest that women in migrant households may have taken on more household responsibilities, but their social status did not improve. This dissertation’s results suggest that migration and remittances influence health outcomes, certain dimensions of women’s empowerment, and ability to pay for to medical care in Kerala and other settings. However, their effects vary by context and indicators used to measure outcomes. Programs and policies should maximize the benefits of migration and remittances while reducing their associated harms