Assessing the influence of health on rural outmigration in Alaska

Objectives. This formative study is intended to generate questions and hypotheses regarding the relationship between health and outmigration from Alaska's rural communities. This study is the first to provide perspectives of rural Alaskans in the context of health concerns and health care delivery as determinants of outmigration. Study design. The study collected secondary data through a comprehensive review of the literature and primary data through semi-structured interviews. Methods. The research design consisted of two iterative phases: a comprehensive review of published and gray literature relevant to rural health and migration in Alaska, and in-depth interviews with rural Alaskans who had recently moved from rural to urban settings. A total of 31 Alaskans aged 18+ from communities throughout the state were interviewed about the factors influencing their decision to move to an urban centre. Results. Three health-related determinants of outmigration from rural to urban Alaska emerged: (1) limited access to primary and specialized health care; (2) perceptions of health risks in rural communities; and (3) ripple effect migration of friends and family providing social support for rural Alaskans requiring health care. These determinants had disproportionate effects on young and female study participants. Conclusions. We present data describing the growing influence of health concerns and health care delivery on outmigration in this underserved population, and conclude with recommendations for future avenues of research. Expanding the body of knowledge of the link between health and outmigration will provide rural Alaskans the opportunity to live and grow old in their own communities. (Int J Circumpolar Health 2010; 69(5):528-544)