, Volume 48, Issue 1, pp 183–209 | Cite as

The Effects of Children’s Migration on Elderly Kin’s Health: A Counterfactual Approach

  • Randall Kuhn
  • Bethany Everett
  • Rachel Silvey


Recent studies of migration and the left-behind have found that elders with migrant children actually experience better health outcomes than those with no migrant children, yet these studies raise many concerns about self-selection. Using three rounds of panel survey data from the Indonesian Family Life Survey, we employ the counterfactual framework developed by Rosenbaum and Rubin to examine the relationship between having a migrant child and the health of elders aged 50 and older, as measured by activities of daily living (ADL), self-rated health (SRH), and mortality. As in earlier studies, we find a positive association between old-age health and children’s migration, an effect that is partly explained by an individual’s propensity to have migrant children. Positive impacts of migration are much greater among elders with a high propensity to have migrant children than among those with low propensity. We note that migration is one of the single greatest sources of health disparity among the elders in our study population, and point to the need for research and policy aimed at broadening the benefits of migration to better improve health systems rather than individual health.


Migration Health Left-behind Mortality Selection Counterfactual framework 



This research was supported by National Science Foundation Grant 0422976. Additional support came from National Institute on Aging Grant R03AG19294-01A1 and NIA Grant 5P30AG017248-02. The authors thank Richard Rogers, Francisca Antman, Ying Lu, and Steve Stillman for their helpful advice; Jarron Saint Onge, Kunga Lama, and Yaffa Truelove for research assistance; Christine Peterson and the IFLS Support Team for data assistance; and Graham Smith and Andrew Linke for editorial assistance. An earlier version of this article was presented at the annual meeting of the Population Association of America in New York in March 2007.


  1. Abraido-Lanza, A. F., Dohrenwend, B. P., Ng-Mak, D. S., & Turner, J. B. (1999). The Latino mortality paradox: A test of the ‘salmon bias’ and healthy migrant hypotheses. American Journal of Public Health, 89, 1543–1548.CrossRefGoogle Scholar
  2. Acosta, P. (2006). Labor supply, school attendance, and remittances from international migration: The case of El Salvador (Policy Research Working Paper No. 3903). World Bank, Washington, DC.Google Scholar
  3. Aiken, L. H., Smith, H. L., & Lake, E. T. (1994). Lower medicare mortality among a set of hospitals known for good nursing care. Medical Care, 32, 771–787.CrossRefGoogle Scholar
  4. Antman, F. M. (2008). Who cares for the elderly? Intrafamily resource allocation and migration in Mexico (Working Paper No. 08-01). Boulder, CO: Department of Economics, University of Colorado at Boulder.Google Scholar
  5. Asis, M. M. B. (2006). Living with migration: Experiences of left-behind children in the Philippines. Asian Population Studies, 2, 45–67.CrossRefGoogle Scholar
  6. Asis, M. M. B., & Baggio, F. (2003, September). The other face of migration: Children and families left behind. Paper presented at the 8th International Metropolis Conference, Vienna, Austria.Google Scholar
  7. Battistella, G., & Gastardo-Conaco, M. C. G. (1998). The impact of labor migration on the children left behind: A study of elementary school children in the Philippines. Sojourn, 13, 220–241.Google Scholar
  8. Beard, V. A., & Kunharibowo, Y. (2001). Living arrangements and support relationships among elderly Indonesians: Case studies from Java and Sumatra. International Journal of Population Geography, 7, 17–33.CrossRefGoogle Scholar
  9. Becker, S., & Ichino, A. (2002). Estimation of average treatment effects based on propensity scores. The Stata Journal, 2, 358–377.Google Scholar
  10. Bhrolcháin, M. N. (2001). ‘Divorce effects’ and causality in the social sciences. European Sociological Review, 17, 33–57.CrossRefGoogle Scholar
  11. Borjas, G. J. (1987). Self-selection and the earnings of immigrants. The American Economic Review, 77, 531–553.Google Scholar
  12. Brown, C. (2003). A short history of Indonesia: The unlikely nation? Crows Nest: Allen and Unwin.Google Scholar
  13. Chang, T. P. (1992). Implications of changing family structures on old-age support in the ESCAP Region. Asia-Pacific Population Journal, 7(2), 49–66.Google Scholar
  14. Cochran, W. G. (1968). The effectiveness of adjustment by subclassification in removing bias in observational studies. Biometrics, 24, 295–313.CrossRefGoogle Scholar
  15. Curran, S. R. (2002). Migration, social capital, and the environment: Considering migrant selectivity and networks in relation to coastal ecosystems. Population and Environment: Methods of Analysis, Population and Development Review, 28(Suppl.), 89–125.Google Scholar
  16. Curran, S. R., & Rivero-Fuentes, E. (2003). Engendering migrant networks: The case of Mexican migration. Demography, 40, 289–307.CrossRefGoogle Scholar
  17. Curran, S. R., & Saguy, A. C. (2001). Migration and cultural change: A role for gender and social networks? Journal for International Women’s Studies, 2(3), 54–77.Google Scholar
  18. Cutler, D., Deaton, A., & Lleras-Muney, A. (2006). The determinants of mortality. The Journal of Economic Perspectives, 20(3), 97–120.CrossRefGoogle Scholar
  19. DaVanzo, J., & Chan, A. (1994). Living arrangements of older Malaysians: Who coresides with their adult children. Demography, 31, 95–113.CrossRefGoogle Scholar
  20. Diaz, J. J., & Handa, S. (2006). An assessment of propensity score matching as a nonexperimental impact estimator: Evidence from Mexico’s PROGRESA program. The Journal of Human Resources, XLI, 319–345.Google Scholar
  21. Duncan, G., Huston, A., & Weisner, T. (2007). Higher ground: New hope for the working poor and their children. New York: Russell Sage Foundation.Google Scholar
  22. Frank, R., & Hummer, R. A. (2002). The other side of the paradox: The risk of low birth weight among infants of migrant and nonmigrant households within Mexico. International Migration Review, 36, 746–765.CrossRefGoogle Scholar
  23. Frankenberg, E., & Thomas, D. (2000). The Indonesia Family Life Survey (IFLS): Study design and results from Waves 1 and 2. Santa Monica: RAND.Google Scholar
  24. Frankenberg, E., & Jones, N. R. (2004). Self-rated health and mortality: Does the relationship extend to a low income setting? Journal of Health and Social Behavior, 45, 441–452.CrossRefGoogle Scholar
  25. Frankenberg, E., & Kuhn, R. S. (2004). The role of social context in shaping intergenerational relations in Indonesia and Bangladesh. Annual Review of Gerontology & Geriatrics, 24, 177–198.Google Scholar
  26. Frankenberg, E., Karoly, L. A., Gertler, P., Achmad, S., Agung, I. G., Hatmadji, S. H., & Sudharto, P. (1995). The 1993 Indonesian Family Life Survey: Overview and field report. Santa Monica: RAND.Google Scholar
  27. Frankenberg, E., Beegle, K., Sikoki, B., & Thomas, D. (1999). Health, family planning and wellbeing in Indonesia during an economic crisis: Early results from the Indonesian Family Life Survey (Labor and Population Program Working Paper Series 99-06). Santa Monica, CA: RAND.Google Scholar
  28. Frankenberg, E., Lillard, L., & Willis, R. J. (2002). Patterns of intergenerational transfers in Southeast Asia. Journal of Marriage and Family, 64, 624–641.CrossRefGoogle Scholar
  29. Gum, P. A., Thamilarasan, M., Watanabe, J., Blackstone, E. H., & Lauer, M. S. (2001). Aspirin use and all-cause mortality among patients being evaluated for known or suspected coronary artery disease: A propensity analysis. Journal of the American Medical Association, 286, 1187–1194.CrossRefGoogle Scholar
  30. Guo, M., Chi, I., & Silverstein, M. (2009). Intergenerational support of Chinese rural elders with migrant children: Do sons’ or daughters’ migrations make a difference? Journal of Gerontological Social Work, 52, 534–554.CrossRefGoogle Scholar
  31. Hadi, A. (1999). Overseas migration and the well-being of those left behind in rural communities of Bangladesh. Asia-Pacific Population Journal, 14(1), 43–58.Google Scholar
  32. Ham, J. C., Li, X., & Reagan, P. B. (2004). Propensity score matching, a distance-based measure of migration, and the wage growth of young men (IEPR Working Paper No. 05.13). Los Angeles, CA: Institute of Economic Policy Research, University of Southern California.Google Scholar
  33. Hermalin, A. I. (2002). The well-being of the elderly in Asia: A four-country comparative study. Ann Arbor: University of Michigan Press.Google Scholar
  34. Hill, H. (1995). Indonesia’s great leap forward? Technology development and policy issues. Bulletin of Indonesian Economic Studies, 31(2), 83–123.CrossRefGoogle Scholar
  35. Hill, H. (1996). The Indonesian economy since 1966: Southeast Asia’s emerging giant. Cambridge: Cambridge University Press.Google Scholar
  36. Hugo, G. J. (1982). Circular migration in Indonesia. Population and Development Review, 8, 59–84.CrossRefGoogle Scholar
  37. Hummer, R. A., Rogers, R. G., Nam, C. B., & LeClere, F. B. (1999). Race/ethnicity, nativity, and U.S. adult mortality. Social Science Quarterly, 80, 136–153.Google Scholar
  38. Huston, A. C., Duncan, G. J., McLoyd, V. C., Crosby, D. A., Ripke, M. N., Weisner, T. S., & Eldred, C. A. (2005). Impacts on children of a policy to promote employment and reduce poverty for low-income parents: New hope after 5 years. Developmental Psychology, 41, 902–918.CrossRefGoogle Scholar
  39. Jasso, G., Massey, D. S., Rosenzweig, M. R., & Smith, J. P. (2004). Immigrant health: Selectivity and acculturation. In N. B. Anderson, R. A. Bulatao, & B. Cohen (Eds.), Critical perspectives on racial and ethnic differences in health in late life (pp. 227–266). Washington, DC: National Academies Press.Google Scholar
  40. Joffe, M. M., & Rosenbaum, P. R. (1999). Invited commentary: Propensity scores. American Journal of Epidemiology, 150, 327–333.Google Scholar
  41. Kabir, Z. N., Szebehely, M., Tishelman, C., Chowdhury, A. M. R., Hojer, B., & Winbland, B. (1998). Aging trends––Making an invisible population visible: The elderly in Bangladesh. Journal of Cross-Cultural Gerontology, 13, 361–378.CrossRefGoogle Scholar
  42. Kalache, A., & Sen, K. (1998). Ageing in developing countries, principles and practice of geriatric medicine. Chichester: Wiley.Google Scholar
  43. Kanaiaupuni, S. M., & Donato, K. M. (1999). Migradollars and mortality: The effects of migration on infant survival in Mexico. Demography, 36, 339–353.CrossRefGoogle Scholar
  44. Kanaiaupuni, S. M., Donato, K. M., Thompson-Colón, T., & Stainback, M. (2005). Counting on Kin: Social networks, social support and child health. Social Forces, 83, 1137–1164.CrossRefGoogle Scholar
  45. Keasberry, I. N. (2001). Elder care and intergenerational relationships in rural Yogyakarta, Indonesia. Aging and Society, 21, 641–665.CrossRefGoogle Scholar
  46. Knodel, J., & Debavalya, N. (1997). Living arrangements and support among the elderly in South-East Asia: An introduction. Asia-Pacific Population Journal, 12(4), 5–16.Google Scholar
  47. Knodel, J. E., & Saengtienchai, C. (2007). Rural parents with urban children: Social and economic implications of migration for the rural elderly in Thailand. Population Space and Place, 13, 193–210.CrossRefGoogle Scholar
  48. Kreager, P. (2006). Migration, social structure and old-age support networks: A comparison of three Indonesian communities. Ageing & Society, 26, 37–60.CrossRefGoogle Scholar
  49. Kuhn, R. (2003). Identities in motion: Social exchange networks and rural-urban migration in Bangladesh. Contributions to Indian Sociology, 37(1–2), 311–337.CrossRefGoogle Scholar
  50. Kuhn, R. (2005). A longitudinal analysis of health and mortality in a migrant-sending region of Bangladesh. In S. Jatrana, M. Toyota, & B. S. A. Yeoh (Eds.), Migration and health in Asia (pp. 318–357). London: Routledge.Google Scholar
  51. Kuhn, R. (2006). The effects of fathers’ and siblings’ migration on children’s pace of schooling in a migrant-sending region of Bangladesh. Asian Population Studies, 2, 69–92.CrossRefGoogle Scholar
  52. Liang, J., Liu, X., & Gu, S. (2001). Transitions in functional status among older people in Wuhan, China: Socioeconomic differentials. Journal of Clinical Epidemiology, 54, 1126–1138.CrossRefGoogle Scholar
  53. Lieberson, S. (1987). Making it count: The improvement of social research and theory. Berkeley: University of California Press.Google Scholar
  54. Lieberson, S. (1991). Small N’s and big conclusions: An examination of the reasoning in comparative studies based on a small number of cases. Social Forces, 70, 307–320.CrossRefGoogle Scholar
  55. Link, B. G., & Phelan, J. (1995). Social conditions as fundamental causes of disease. Journal of Health and Social Behavior, 35, 80–94.CrossRefGoogle Scholar
  56. Little, R. J., & Rubin, D. B. (2000). Causal effects in clinical and epidemiological studies via potential outcomes: Concepts and analytical approaches. Annual Review of Public Helath, 21, 121–145.CrossRefGoogle Scholar
  57. Marini, M. M., & Singer, B. (1988). Causality in the social sciences. Sociological Methodology, 18, 347–409.CrossRefGoogle Scholar
  58. Marmot, M. G., Adelstein, A. M., & Bulusu, L. (1984). Lessons from the study of immigrant mortality. Lancet, 1, 1455–1457.CrossRefGoogle Scholar
  59. Massey, D. S. (1988). Economic development and international migration in comparative perspective. Population and Development Review, 14, 383–413.CrossRefGoogle Scholar
  60. Massey, D. S. (1990). Social structure, household strategies, and the cumulative causation of migration. Population Index, 56, 3–26.CrossRefGoogle Scholar
  61. Massey, D. S. (1999). International migration at the dawn of the twenty-first century: The role of the state. Population and Development Review, 25, 303–322.CrossRefGoogle Scholar
  62. Massey, D. S., Arango, J., Hugo, G., Kouaouci, A., Pellegrino, A., & Taylor, J. E. (1999). Worlds in motion: Understanding international migration at the end of the millennium. New York: Oxford University Press.Google Scholar
  63. McKenzie, D., & Hildebrandt, N. (2005). The effects of migration on child health in Mexico. Economia, 6, 257–289.Google Scholar
  64. McKenzie, D., Gibson, J., & Stillman, S. (2010). How important is selection? Experimental vs. non-experimental measures of the income gains from migration. Journal of the European Economic Association, 8, 913–945.CrossRefGoogle Scholar
  65. McMichael, A. J. (1999). Prisoners of the proximate: Loosening the constraints on epidemiology in an age of change. American Journal of Epidemiology, 149, 887–897.Google Scholar
  66. Miech, R. A., Caspi, A., Moffitt, T. E., Entner, B. R., Wright, P., & Silva, A. (1999). Low socioeconomic status and mental disorders: A longitudinal study of selection and causation during young adulthood. The American Journal of Sociology, 104, 1096–1131.CrossRefGoogle Scholar
  67. Mincer, J. (1978). Family migration decisions. Journal of Political Economy, 8, 749–773.CrossRefGoogle Scholar
  68. Nguyen, L., Yeoh, B. S. A., & Toyota, M. (2006). Migration and the well-being of the ‘left behind’ in Asia. Asian Population Studies, 2, 37–44.CrossRefGoogle Scholar
  69. Nyberg-Sørensen, N., Van Hear, N., & Engberg-Pedersen, P. (2002). The migration-development nexus evidence and policy options state-of-the-art overview. International Migration, 40(5), 3–47.CrossRefGoogle Scholar
  70. Ozden, C., & Schiff, M. (2007). International migration, economic development and policy. New York and Washington, DC: Palgrave Macmillan and World Bank.Google Scholar
  71. Palloni, A., & Arias, E. (2004). Paradox lost: Explaining the Hispanic adult mortality advantage. Demography, 41, 385–415.CrossRefGoogle Scholar
  72. Palloni, A., & Morenoff, J. D. (2001). Interpreting the paradoxical in the Hispanic paradox: Demographic and epidemiologic approaches. Annals of the New York Academy of Sciences, 954, 140–174.CrossRefGoogle Scholar
  73. Portes, A., & Sensenbrenner, J. (1993). Embeddedness and immigration: Notes on the social determinants of economic action. The American Journal of Sociology, 98, 1320–1350.CrossRefGoogle Scholar
  74. Quinn, M. A., & Rubb, S. (2005). The importance of education-occupation matching in migration decisions. Demography, 42, 153–167.CrossRefGoogle Scholar
  75. Raftery, A. E. (2001). Statistics in sociology, 1950–2000: A selective review. Sociological Methodology, 31, 1–45.CrossRefGoogle Scholar
  76. Rahman, M. O. (1999). Age and gender variation in the impact of household structure on elderly mortality. International Journal of Epidemiology, 28, 485–491.CrossRefGoogle Scholar
  77. Rahman, M. O. (2000). The impact of co-resident spouses and sons on elderly mortality in rural Bangladesh. Journal of Biosocial Science, 32, 89–98.CrossRefGoogle Scholar
  78. Rahman, M. O. (2001). Living arrangements and the health of older persons in developing countries: Evidence from rural Bangladesh. Population Bulletin of the United Nations: Ageing and Living Arrangements of Older Persons. Critical Issues and Policy Responses. Special Issue Nos. 42/43:330–47. New York: United Nations.Google Scholar
  79. Rahman, M. O., Menken, J., & Kuhn, R. (2004). The impact of family members on the self-reported health of older men and women in a rural area of Bangladesh. Ageing and Society, 24, 903–920.CrossRefGoogle Scholar
  80. Rogers, R. G., Hummer, R. A., & Nam, C. B. (2000). Living and dying in the USA: Behavioral, health, and social differences in adult mortality. New York: Academic Press.Google Scholar
  81. Rosenbaum, P. R., & Rubin, D. B. (1983a). Assessing sensitivity to an unobserved covariate in an observational study with binary outcome. Journal of the Royal Statistical Society, 45, 212–218.Google Scholar
  82. Rosenbaum, P. R., & Rubin, D. B. (1983b). The central role of the propensity score in observational studies for causal effects. Biometrika, 70, 41–55.CrossRefGoogle Scholar
  83. Rosenbaum, P. R., & Rubin, D. B. (1984). Reducing bias in observational studies using subclassification on the propensity score. Journal of the American Statistical Association, 79, 516–524.CrossRefGoogle Scholar
  84. Roy, A. K., & Nangia, P. (2003). Reproductive health status of left behind women of male outmigrants: A study of rural Bihar, India. In S. Jatrana, M. Toyota, & B. S. A. Yeoh (Eds.), Migration and health in Asia (pp. 209–241). London: Routledge.Google Scholar
  85. Rubin, D. B. (1974). Estimating the causal effects of treatment in randomized and nonrandomized studies. Journal of Educational Psychology, 66, 688–701.CrossRefGoogle Scholar
  86. Rubin, D. B. (1977). Assignment to treatment group on the basis of a covariate. Journal of Educational Statistics, 2, 1–26.CrossRefGoogle Scholar
  87. Seeman, T. E., Charpentier, P. A., Berkman, L. F., Tinetti, M. E., Guralnik, J. M., Albert, M., & Rowe, J. W. (1994). Predicting changes in physical performance in a high-functioning elderly Cohort: MacArthur studies of successful aging. Journal of Gerontology, 49, M97–M108.Google Scholar
  88. Sjaastad, L. A. (1962). The costs and returns of human migration. Journal of Political Economy, 70, 80–93.CrossRefGoogle Scholar
  89. Sobel, M. E. (2000). Causal inference in the social sciences. Journal of the American Statistical Association, 95, 647–651.CrossRefGoogle Scholar
  90. Sorlie, P. D., Backlund, E., Johnson, N. J., & Rogot, E. (1993). Mortality by hispanic status in the United States. Jounral of the American Medical Association, 270, 246–248.CrossRefGoogle Scholar
  91. Speare, A., Jr., & Harris, J. (1986). Education, earnings, and migration in Indonesia. Economic Development and Cultural Change, 34, 223–244.CrossRefGoogle Scholar
  92. Stark, O., & Bloom, D. E. (1985). The new economics of labor migration. The American Economic Review, 75, 173–178.Google Scholar
  93. Stone, R. A., Obrosky, D. S., Singer, D. E., Kapoor, W. N., Fine, M. J., & the Pneumonia Patient Outcomes Research Team (PORT) Investigators. (1995). Propensity score adjustment for pretreatment differences between hospitalized and ambulatory patients with community-acquired pneumonia. Medical Care, 33, AS56–AS66.Google Scholar
  94. Sturmer, T., Joshi, M., Glynn, R. J., Avorn, J., Rothman, K. J., & Schneeweiss, S. (2006). A review of the application of propensity score methods yielded increasing use, advantages in specific settings, but not substantially different estimates compared with conventional multivariate methods. Journal of Clinical Epidemiology, 59, 437–447.CrossRefGoogle Scholar
  95. Taylor, E. G. (1999). The new economics of labour migration and the role of remittances in the migration process. International Migration, 37(1), 63–88.CrossRefGoogle Scholar
  96. Toyota, M., Yeoh, B. S., & Nguyen, L. (2007). Bringing the ‘left behind’ back into view in Asia: A framework for understanding the ‘migration-left behind nexus.’ Population, Space, and Place, 13, 157–161.CrossRefGoogle Scholar
  97. VanWey, L. K. (2004). Altruistic and contractual remittances between male and female migrants and household in rural Thailand. Demography, 41, 739–756.CrossRefGoogle Scholar
  98. Wingate, M. S., & Alexander, G. R. (2006). The healthy migrant theory: Variations in pregnancy outcomes among US-born migrants. Social Science & Medicine, 62, 491–498.CrossRefGoogle Scholar
  99. Winship, C., & Morgan, S. L. (1999). The estimation of causal effects from observational data. Annual Review of Sociology, 25, 659–706.CrossRefGoogle Scholar
  100. Wong, R., Palloni, A., & Soldo, B. J. (2007). Wealth in middle and old age in Mexico: The role of international migration. International Migration Review, 41, 127–151.CrossRefGoogle Scholar
  101. Zimmer, Z., & Martin, L. G. (2007). Key topics in the study of older adult health in developing countries that are experiencing population aging. Journal of Cross-Cultural Gerontology, 22, 235–241.CrossRefGoogle Scholar
  102. Zimmer, Z., Chayovan, N., Lin, H.-S., & Natividad, J. (2004). How indicators of socioeconomic status relate to physical functioning of older adults in three Asian societies. Research on Aging, 26, 224–258.CrossRefGoogle Scholar

Copyright information

© Population Association of America 2011

Authors and Affiliations

  1. 1.Josef Korbel School of International StudiesUniversity of DenverDenverUSA
  2. 2.Department of SociologyUniversity of Colorado–BoulderBoulderUSA
  3. 3.Department of GeographyUniversity of TorontoTorontoCanada

Personalised recommendations