In rural communities across the Global South, families are relying on temporary and permanent out-migration for work to navigate destabilizing agrarian transformations. While research indicates that success of this household livelihood strategy may depend on the legal status of international migrants, precarious legal status is not solely a problem relegated to people who cross national borders. Indeed, millions worldwide are stateless in the countries of their birth. In this mixed-method study, we assess the importance of legal status for elderly well-being among highlanders in Northern Thailand—rural communities that are experiencing both extensive out-migration and protracted statelessness. We find that elderly wealth and work outcomes are shaped by the legal status of both out-migrants and of the rural elderly themselves. Specifically, we show that when rural elderly or their migrant relatives are stateless, the elderly are more likely to engage in wage work and less likely to gain financial benefits of out-migration to the extent that citizens do. Through ethnographic engagement, we locate the contributions of legal status to rural stratification in its complex entanglements with land access and ethno-nationalism in the region, and in the ways that state and market infrastructures deploy citizenship to surveil highlanders and other minorities in Thailand. Amidst growing calls to resolve statelessness in the Global South, our research suggests that the combination of out-migration and uneven extension of citizenship in rural communities is likely to exacerbate stratification, both for migrants and for those who rarely leave home.

Background Rising nativism and political volatility worldwide threaten to undermine hard-won achievements in human rights and public health. Risks are particularly acute for hundreds of millions of migrants, minorities, and Indigenous peoples, who face disproportionately high health burdens, including HIV/AIDS, and precarious legal status (LS). While LS is receiving increasing attention as a social determinant of health and HIV, understandings are still limited to select immigrant communities. Its effects on health among stateless communities, particularly in the Global South, remain largely unknown. Moreover, widespread limitations in census measures of LS reduce its complexity to a simplistic citizen/non-citizen binary or insufficient proxies. Thailand’s ethnolinguistically diverse highlander population experiences disproportionately high HIV prevalence and comprises one of the world’s largest and most protracted cases of statelessness, an acute condition of precarious LS. As such, analysis of LS and health outcomes among highlanders is both critically warranted, and useful as a case study outside of the migration paradigm. Methods Drawing on the UNESCO Highland Peoples Survey II (2010), an unprecedented and unique cross-sectional census of highlanders in Thailand, we mobilize complex measures of LS in adjusted ordinal logistic regression models to assess how parent citizenship and LS adjudication over the early life course condition adult HIV knowledge—a key protective factor against transmission (n = 8079). Results Adjusted ordinal logistic regression on knowledge scores reveal that parent citizenship predicts odds of greater knowledge by 1.4- to 2.2-fold, depending on ethnic group. This is partially explained by divergent stages of LS adjudication between birth and adulthood, including successful birth registration and adult citizenship acquisition, along with secondary school completion. Precisely how these factors contribute to HIV knowledge varies by ethnic group. Conclusions This study advances knowledge of LS outside of the migration paradigm, reveals heretofore unexamined connections between LS and access to public health information, and elucidates how instabilities in LS adjudication stages underlie health inequalities over the life course. Findings indicate that securing success in public health and human rights agendas requires attention to how states adjudicate and deploy LS in multiple stages across the life course to structure access and exclusion among migrant and non-migrant communities alike.

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