**1. Introduction**

In 2015, the number of international migrants reached 244 million [1]. However, a considerably higher number of migrants—740 million—moved within their countries, mainly from rural to urban areas or from one rural area to another [2]. This figure is expected to rise. The Department for International Development of the United Kingdom Government (DFID) estimates that in sub-Saharan Africa (SSA) 50%–80% of rural households include at least one migrant member [3]. The majority of the people who migrate are young individuals [4–13].

These young migrants are between the ages of fifteen and twenty-four and make up one-eighth of the migrant workers who are moving mainly in search of better opportunities [14]. As a number of young men and women lack sufficient access to quality education, job opportunities, and a decent standard of living in their rural areas, the expanding urban informal sector becomes attractive to most of these rural youths [15–17]. This situation is worsened by the fact that farming in some of rural areas is not very attractive, partly because of the lack of capital to acquire advanced farming implements that will help the farmers expand their business. Young people, therefore, see migration to the major cities as the only option to earn decent incomes that will make life comfortable for them [18, 19].

As a result of the lack of the necessary skills, they are unable to compete in the formal labor market at their destination. The same can also be said of the lack of sufficient economic assets, social capital, and cultural capital [20]. They normally end up living in informal settlements [21]. The consequence of this is that most of them are forced to accept low-income employment, precarious work, unemployment, or underemployment [20]. The term precarious work, as used in this study, means work that is uncertain, unstable, and insecure and in which employees are faced with work-related risks and receive limited social benefits and statutory protections [22–28].

What this also means is that the rise of precarious work in urban areas is of great importance not only for the work situations and career opportunities that workers can expect but additionally for large-scale social issues, including the role of the welfare state and the nature of economic policy [29]. Migration can lead to positive development results and eventually to achieving the objectives of the 2030 Agenda for Sustainable Development Goal 8, which talks about decent work for all. At the destination, migrants can provide labor where there are shortages and can also contribute to services, thereby increasing the government budget through the payment of taxes and social security contributions.

However, this does not mean that migration always achieves its full potential. For example, in their study on migration and sustainable cities, Lucci et al., [30] noted that vulnerable urban migrants often work in the informal sector, where the rewards of migration are unrewarding. In most of Ghana's urban areas, for instance, female head porters popularly referred to as "Kayayei", earn a living by carrying loads on their heads in market places and lorry stations. Though this indecent work serves as the main source of income for these female migrants, who are mostly from the northern parts of Ghana, the arduous tasks they perform on a daily basis create a number of health-related problems for them [31–33]. This indicates that migrants are also more likely to encounter work-related accidents and diseases [34, 35]. This situation is especially common among those working in the informal economy, who

#### *In the Process of Being Left Behind: Rural-Urban Migration, Precarious Work Conditions... DOI: http://dx.doi.org/10.5772/intechopen.106907*

are also less likely to be protected through social-insurance schemes. Migrants may, therefore, lose extended periods of time to diseases. They may also end up with disabilities that limit their future earning potential or, in extreme cases, lose their lives. There is also the likelihood that if policies are not put in place to regularize the activities of controllers of the informal sector, most, if not all, of these migrants may return home with different health conditions, and the little money they might have earned will be used to treat these diseases. This can largely affect the migration intentions of many migrants, a situation that will make it difficult to achieve the 2030 Agenda for Sustainable Development Goal 8. It is important to note that the multi-faceted nature of the relationship between migration and development offers concrete and sector-specific policy entry points. For instance, the International Labor Organization (ILO) maintains that one factor that should always be considered in migration issues is the issue of decent work. Any decision to be taken as part of this agenda should consider the specific vulnerabilities of migrants in their various workplaces [30].

There is substantive evidence of precarious work conditions and their associated health outcomes, often connected to international migrant labor workers. For instance, Quandt et al., [36] note that these migrant labor workers are often engaged in what is known as 3-D jobs-dirty, dangerous, and demanding (sometimes degrading or demeaning), and these workers are often hidden from or invisible to the public eye and from public policy. They work for less pay, for long hours, and in worse conditions than non-migrants, and are often subject to human rights violations, abuse, human trafficking, and violence [37]. These conditions put immigrant workers at an increased risk of occupational fatalities and injuries when compared to native-born workers, even those doing the same job in the same industry [38].

However, anecdotal evidence suggests that similar precarious work activities are increasingly becoming common even among natives (internal migrants) of most developing countries who migrate from one part of the country to the cities in search of employment opportunities, and this phenomenon has escaped the research lens, a lacuna this paper attempts to fill. Therefore, this paper attempts to examine the precarious work conditions and health of rural-urban migrants living in the informal settlements of Agbogbloshie in Accra, Ghana. Specifically, the study seeks to ask the following questions: What are the precarious work activities often engaged in by these migrant workers living in the poor urban setting of Accra? How does the precarious work they undertake affect their health outcomes? What has been the government's response to address precarious work conditions among this subpopulation?

#### **1.1 Theoretical underpinning**

For the purpose of this study, we used the Harris–Todaro [19] model of migration and the ecological model of public health [39] to explain the study. The Harris–Todaro model of migration was utilized to explain why individuals engage in rural-urban migration in developing countries despite high joblessness rates in urban areas. Building on studies by early researchers, such as Ravenstein, Harris, and Todaro, view migration as an economic activity, which for the individual migrant could be a balanced choice in spite of the presence of urban

unemployment [19]. They argued that migration is a result of urban-rural differences in expected income rather than actual earnings [19]. Potential migrants consider the various labor market opportunities available in both rural and urban areas and choose the one that augments their expected gains from migration. Although Harris–Todaro's model has been criticized as theoretically simplistic [40, 41], it can be credited with providing some explanations for why people migrate from rural to urban areas despite the lack of jobs. Migrants have no choice but to engage in any type of employment in the city, which is largely unregulated with accompanying health risks.

Our use of the ecological model [39] comes from the fact that it suggests structural changes better and highlights the enormous individual efforts of the migrants, which prevents them from working in activities that are hazardous in nature and ensures behavioral change. The ecological model is a framework widely employed in public health research and practice. It is also a framework of the processes and social conditions that facilitate health-promoting policy and environmental change. Ecological models are visual depictions of dynamic relationships among individuals, groups, and their environments. They derive from a systems orientation to human development in which individuals are understood to influence (and be influenced by) people and organizations with whom they interact, available resources and institutions, and societal norms and rules [39]. In the health promotion field, ecological models have been used to understand and identify targets for both general and specific health behavior interventions [42–48].
