Balaji, Padmini

Arts & Sciences



Population health research on migrant and vulnerable communities living in the Greater Bay Area region of China

The Greater Bay Area Region is experiencing a growing influx of migrants. These communities are at risk for multiple psychosocial, infectious disease, and physical health concerns due to highly stressful working conditions and lack of health protections. Among the most vulnerable labor migrants are domestic workers from Philippines, Indonesia, and Vietnam.

The health and mental health of migrant communities is a significant public health concern because subsets of migrants are at an increased risk of mental health and physical health problems. There are a number of important risks to health that have been documented in migrant communities. These include vulnerabilities to mental health problems based on country of origin concerns (e.g., past history of violence), and current stressors and challenges in adaptation to the post-migration context (e.g., discrimination, remittance strain, social isolation, abuse by employers, poor living conditions).

This research program has the following aims: 1) to establish a longitudinal cohort of labor migrants for the purpose of establishing the population prevalence and incidence of critical physical (obesity), sexual (HIV/Syphilis), and mental health (PTSD, depression, addictions), issues among migrant worker communities in South China using respondent driven sampling (RDS) methods, 2) to identify key drivers of poor population health utilizing a socioecological framework, including personal health behaviors and social determinants of health, and, 3) to focus particular attention on social networks and social capital as a critical levels of analysis to understand population health. In conjunction with this RDS study, the study team is undergoing intervention development and adaptation for migrant health. The aim of this work is to disseminate evidence based low intensity interventions to reduce the burden of poor mental and physical health, in collaboration with the World Health Organization.

Pilot projects are also underway in various provinces in China to address the burden of mental ill health across the life-course (including youth and elders). 

PI Mentor: Carl Latkin

“City of Dreams” is one of 38 casinos in Macao, which made my first steps out of the airport seem more like “Las Vegas vacation” than “global health field placement.” Dazzling lights, imitation fresco ceilings, giant mechanical dragons that materialize from underground – in addition to traditional Portuguese architecture, quaint Buddhist temples, and boutiques overflowing with Chinese antiques or herbal medicines – Macao (SAR), China fuses scenes from all over the world into just 30 square kilometers. Aside from its unique culture and cityscape, it will have the highest per capita income in 2020, thanks to it emerging casino industry and reputation as a tourist hub. However, despite its rapid globalization, Macau faces its own set of health challenges which became clear during my 10 weeks studying global mental health there.

Prior to my arrival, I heard from my supervisor and read bits and pieces about common psychological stressors in Macao, including gambling addiction, long hours and difficult working conditions faced by migrant workers, and a culture shying away from conversation about mental health. On my first day in the city, a research assistant in the group showed me around. She mentioned how Macao, despite boasting one of the world’s highest population densities, has just a handful of established clinical psychologists and virtually no program for local people to pursue that career path – yet still an 8% prevalence of major depression. 

Through locals’ stories and work in my research group, I came to understand that in Macao, psychological distress often goes unrecognized until it encroaches the boundaries of physical pain or an incapacity to get out of bed, obstacles that prevent one from working and making a living, especially because language and idioms surrounding mental health in the region emphasize the physical aspects of psychological illness. While mental health is already stigmatized in the U.S., learning about the increased layers of stigma complicating treatment-seeking in Macao, as well as cultural differences in labeling mental illness that Western teachings struggle to make sense of, was humbling and motivated me to better understand this nuanced way of thinking and also institute positive change surrounding stigma globally.

As my stay in Macao continued, I was repeatedly inspired by how Macao citizens were motivated to institute such change as well. I strived to match their levels of commitment to their goals. For one project, I helped organize a crowdsourcing competition for Macao college students to design marketing packages promoting a digital mental health intervention. One individual, in front of the other 48 contest participants, emphasized that she wanted to join the course because she was experiencing mental illness and wanted to learn more about it. Inspired by her strength to share this with such confidence, I was encouraged to have the same confidence as I stepped out of my comfort zone to present about crowdsourcing to these students, whom I knew were still learning English and would struggle to understand me if I did not present clearly.

On a broader perspective, I was inspired by a coworker of mine, who received a degree in clinical psychology in Beijing before returning to her birthplace of Macao to study in hopes of giving back to her people and transforming the landscape of mental healthcare in the region. I likewise became motivated to give back to areas lacking in resources. In Macao, I noticed that, contrasting the city’s booming growth, there lacked a systematic approach to educating adolescents on sex education and mental health. Additionally, certain populations (migrants, in particular) experienced a heavy mental illness and communicable disease burden. After witnessing such health disparities, I am committed to a career in global health through which I can help dismantle these inequities and improve mental healthcare for all. “City of Dreams,” beyond just a glitzy logo on Macao’s skyline, summarizes the city’s imprint and influence on me – misconceptions, revelations, and aspirations galore.

Me with my coworker at Broadway Macau after dinner

Research group members volunteering at Rehabilitation International Asia and Pacific Regional Conference (RIAPRC) 2019 in the Venetian Hotel

A piece within an exhibition at RIAPRC 2019: Arts and Handicrafts of People with Disabilities

Selfie of research group members at a crowdsourcing contest we organized to promote digital mental health

Me with my in-country mentor, Dr. Brian Hall, on my last day in Macau


September 2022




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