Reducing Outmigration by Addressing the Health Needs and Concerns of Rural Alaskans

Rural Alaska is experiencing an increasing rate of rural to urban migration, or “outmigration” compared to historical trends. Outmigration threatens the long-term sustainability of Alaska's isolated communities and creates unexpected demands on social services in metropolitan areas. Previous attempts to address the determinants of outmigration have emphasized the role of economic push factors such as under-employment and high fuel costs. This study is the first to assess the role of health concerns and health care needs as determinants of outmigration in Alaska. The research design consisted of two iterative phases; first, a comprehensive review of published and gray literature relevant to rural health and migration in Alaska, and second, in-depth interviews with a purposive sample of rural Alaskans who had recently moved from rural to urban settings. Our findings revealed three determinants of increased outmigration from rural to urban Alaska: (1) an aging segment of rural Alaskans require long-term care and support that cannot currently be met in village settings; (2) obstacles to timely pediatric, mental health, and substance abuse treatment in rural settings; and (3) the need for social support networks for rural Alaskans moving to urban settings lead to ripple outmigration of friends and family. We present statistical, historical, and narrative data describing the growing influence of health concerns and health care needs on outmigration in this under-served population, and conclude with recommendations to improve rural community health care and allow rural Alaskans to live and grow old in their own communities.