Health, Mortality and Migration in KwaZulu-Natal, South Africa

In this thesis we study two components of population change: mortality and migration, in a demographic surveillance area in South Africa. We do this by analyzing the funeral expenses, the mortality-related predictive power of self-assessments of health, and the internal migration flows of this population.;The first part, which is joint work with Anne Case, Anu Garrib and Alicia Menendez, analyzes funeral arrangements following the deaths of 3,751 people in the Africa Centre Demographic Surveillance Area (DSA). On average, households spend the equivalent of a year's income for an adult's funeral. Approximately one-quarter of all individuals had some form of insurance, which helped surviving household members defray some fraction of funeral expenses. An equal fraction of households borrowed money to pay for the funeral. We develop a model, consistent with ethnographic work in this area, in which households respond to social pressure to bury their dead in a style consistent with the observed social status of the household and that of the deceased. Households that cannot afford a funeral commensurate with social expectations must borrow money to pay for the funeral. The model leads to empirical tests, and we find results consistent with our model of household decision-making.;The second part of this work also deals with mortality in this DSA, but it is concerned with how well subjective measures of health predict future deaths in the region. While self-assessments of health (SAH) are widely employed in epidemiological research, most of the evidence on the predictive power that underlies their popularity originates in the developed world. With the HIV pandemic affecting largely prime age individuals, the conclusions derived from previous work might not be relevant for the younger at-risk groups in our region of interest. We find that the effect of SAH on subsequent mortality is strong for deaths within four and six years of follow-up. Six years from baseline, however, this strong association disappears once HIV status is controlled for.;In the final chapter of this dissertation, we use the previously described self-assessments of health to explore the existence of a health selectivity effect among migrants leaving the DSA. We produce a theoretical framework to understand the sources of this selection. In our model individuals and households are financially constrained and decide whether or not to migrate based on the gains of wage arbitrage. We use this model to derive basic predictions about the effect of individual and household health on the individual probability of migration. Our results confirm the predictions of the model, and offer evidence on the existence of positive health selection of migrants.