Growing Up and Moving Out: The Critical Link Between Health and Migration

International migration has increased in absolute and relative terms since 1990, with more migrants coming from low- and middle-income countries (see figure below). Explanations for these trends tend to focus on migration as the product of desperate circumstances. People are pushed from their homes by factors such as conflict and climate change and are pulled to the relative safety and prosperity offered elsewhere. In many cases, however, international migration has been the byproduct of success—improved child survival rates that, fifteen to twenty years later, led to a booming young-adult population (ages fifteen to twenty-four).

Between 1990 and 2016, there has been a remarkable 63 percent decline in child (under age five) mortality in low- and lower-middle-income countries—the result of generous aid initiatives, improved access to effective drugs and vaccines, and the hard work of local officials and health workers. Yet, the declines in mortality in these countries have not been accompanied by the same societal changes that coincided with reductions in mortality in other nations. With more children surviving, women in many developing nations are having fewer of them, but those declines in fertility rates have been slow and uneven. As a result, the young-adult populations in these nations are expanding fast. By 2040, the working-age population is projected to increase by 330 million people in low-income countries and by 625 million people in middle-income countries. Importantly, this population growth in low- and lower-middle-income nations has also not been accompanied by the same increases in wealth that occurred during earlier declines in child mortality in higher-income countries (see figure below).

The growth in the young-adult population in low- and lower-middle-income nations is having a profound effect on international migration. Young adults are the population segment most likely to emigrate; more young adults means more people with a propensity to aspire to a better life and a greater willingness to move abroad to improve their circumstances. A study of eighty low- and middle-income nations in Population Studies shows that significant increases in the population of young adults had a greater effect on emigration than political instability, conflict, natural disasters, the promise of higher incomes in the destination country, and other factors that push or pull migrants abroad.

As national income rises, the link between a growing young-adult population and emigration becomes weaker, most likely because wealthier nations are more able to employ many of those young adults. The figure below shows how national income—as measured with gross domestic product (GDP) per capita—changes the relationship between emigration and a growing population of young adults at home. Accordingly, changing demographics have caused the most dramatic increases in emigration in poorer countries and countries in sub-Saharan Africa in particular, where the population grew 2.7 percent per year between 1970 and 2010. In contrast, in the wealthiest countries, the effects of population growth on emigration disappear and are no longer statistically significant.

Between 1990 and 2015, there would have been an estimated 20.4 million fewer migrants globally if the young-adult population had remained steady. While that number represents a small portion of the more than 200 million migrants globally over that time, it has had significant consequences in some nations. In absolute terms, growth in young-adult populations spurred the most migrants in populous countries: Bangladesh (2.9 million) and Pakistan (1.9 million) (see figure below). In percentage terms, population growth led to the most emigrants from African and Middle Eastern nations, driving more than 30 percent hikes in emigration rates from Gambia, Ethiopia, Niger, Somalia, and Uganda over that twenty-year period.

It is too soon to know for certain how the COVID-19 pandemic will affect these population pressures and home countries’ abilities to employ young adults. Circumstances may change, but COVID-19 is currently disproportionately taking the lives of older people, with most children and young adults surviving infection. Childhood immunizations have fallen globally, but more modestly than many had feared at the start of pandemic. Lockdowns and school closures designed to control the spread of the virus have caused children of poorer households to disproportionally miss out on significant portions of their expected lifetime education. The pandemic is devastating the economies of already poor nations, with the worst consequences falling on low-skilled workers and young adults. In other words, COVID-19 has potentially intensified many of the forces that have spurred international migration in the past. The mounting consequences of climate change in many low- and lower-middle-income nations will further limit employment opportunities in those nations.

Increased migration from poorer nations, especially from sub-Saharan Africa, has occurred alongside increased hostility to immigration and social unrest in the United States and the European Union. During the coronavirus pandemic, nearly every nation has imposed travel and entry restrictions, and the crisis spurred a rise in anti-immigrant sentiment in some countries. These entry restrictions may not be sufficient to reduce the demographically driven migration expected to occur and may instead perpetuate irregular migration, which occurs outside the laws of the destination state. Desperate, irregular migration can lead to negative consequences for migrants, migrants’ home nations, and the citizens of host countries. Since the beginning of 2014, more than twenty-three thousand migrants, most from the Middle East and Africa, drowned while attempting to cross the dangerous Mediterranean Sea in ramshackle boats. In migrants’ home nations, the failure to employ a rising generation of young adults is a missed opportunity, particularly for sub-Saharan African countries, to build the same prosperity that other once-poor nations, such as China, enjoyed from similar demographic circumstances [PDF].

Whether the demographics of poor nations result in prolonged and irregular migration crises depends on the choices of policymakers. Donor investments in voluntary family-planning programs have helped increase access to contraceptive use in Kenya and Senegal. More support for such programs in other nations can help reduce fertility rates to sustainable levels, freeing more women to join and remain in the workforce and leaving more resources to educate children. International development and aid programs should also focus resources on targeted, context-specific investments to support youth employment, such as wage subsidies and apprenticeships, and quality education and health programs that increase the productivity of rising workers. Such efforts will be especially important in light of the disproportionate economic toll of COVID-19 in under-vaccinated low- and lower-middle-income countries, where economic growth is expected to slow and income inequality is considerably higher than in advanced economies. Freer trade between wealthy and low-income nations and greater aid investments in quality education will not stop all young adults from wanting a better life and emigrating, but it can provide some of them with a reason to stay and the means to achieve a better future.

With emigration flows likely to increase substantially, especially from sub-Saharan Africa, origin and destination nations need policies that will facilitate, rather than impede, positive outcomes from that migration. A viable pathway to legal migration, lower barriers to business ownership, and employment policies that channel migrants toward unfilled labor needs can provide migrants from sub-Saharan Africa and other lower-income regions with the same chance as past migrants to contribute to the future prosperity of their host nations.

This interactive is one in a series of data interactives that CFR is producing on the changes occurring in global health and their broader implications for societies and economies. The first one, The Changing Demographics of Global Health, reveals that population growth and aging are fueling a dramatic rise in noncommunicable diseases in poor countries that lack the health-care systems and funds to handle them. The second, The Future of Global Health Is Urban Health, argues that rapidly urbanizing low-income countries will need to address the health and environmental challenges of urban lives. The third, Democracy Matters in Global Health, shows that a country’s democratic experience is increasingly important in reducing noncommunicable diseases and injuries among adults. This interactive was made possible by a generous grant from Bloomberg Philanthropies. The statements made and views expressed are solely the responsibility of the author. The Council on Foreign Relations takes no institutional positions on policy issues and has no affiliation with the U.S. government.