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New evidence on the healthy immigrant effect

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Abstract

This paper presents new evidence that immigrants have better health than natives upon arrival to their destination. It analyzes a very interesting episode in international migration, namely the exodus of Ecuadorians in the aftermath of the economic collapse in the late 1990s. More than 600,000 Ecuadorians from 1999 to 2005 left their homeland, most relocating in Spain. Using information from the birth certificate data, the paper compares the birth outcomes of immigrant women in Spain not only to that of natives at destination, but to that of natives in Ecuador and immigrants from other nationalities in Spain. These comparisons suggest that the better health at birth of children born to immigrants from Ecuador partly responds to the selection of healthier women into migration.

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Notes

  1. For the US see Jasso et al. (2004), Abraido-Lanza et al. (1999), Antecol and Bedard (2006), and Giuntella (2012). Chen et al. (1996), Deri (2003), McDonald (2003) and Laroche (2000) have documented a health advantage among immigrants to Canada, while Donovan et al. (1992), Chiswick et al. (2008), and Powles and Gifford (1990) do so for immigrants to Australia.

  2. It has also been suggested that the immigrant health advantage could derive from the mandatory health screening that is part of the migration process in some countries. However, some evidence indicates that admission policies are not the principal determinant of the health gap (Laroche 2000; Uitenbroek and Verhoeff 2002).

  3. See Aizer and Currie (2014) for a detailed survey of the literature.

  4. As a result of the exodus, the Ecuadorian population in Spain increased from 76,000 individuals before 2000 to 457,000 in 2005 (Bertoli et al. 2011).

  5. An important debate in this literature is the existence of nonlinearities in the effect of birth weight. For example, Almond et al. (2005) and Royer (2009) find that the relationship between birth weight and infant mortality is strongest for the lower birth weight births. Behrman and Rosenzweig (2004) also find that augmenting birth weight among lower birth weight babies, but not among higher birth weight ones, has significant labor market payoffs. In contrast, they also find that increasing birth weight increases adult schooling attainment and adult height for babies at most levels of birth weight. Similarly, Black et al. (2007) find little evidence of significant nonlinearities in earnings, education, height, or IQ tests. Finally, Royer (2009) shows that the effect of birth weight on education is strongest in the 2500+ g range, while Oreopoulos et al. (2008) find strong effects of birth weight on outcomes such as death between ages 1 and 17 years, grade completion, and months on social assistance after age 18 years, even for ranges not considered overtly concerning (for example, birth weights between 2500 and 3500 g).

  6. Evidence of positive selection on health has been documented in Jasso et al. (2004) and Antecol and Bedard (2006).

  7. See Table 11 in the Appendix.

  8. In the first half of the 2000s in Spain, there were three amnesties to illegal immigrants (2001, 2002, and 2005).

  9. The same authors estimate that the Ecuadorian population in the USA increased from 272,000 before 2000 to 394,000 in 2005 and represented 1.3 % of immigration flows in the USA during this period.

  10. Deindustrialization led to a decrease of almost 3 million jobs in industrial employment that particularly impacted younger and older workers, who were less likely to find new employment opportunities (Voicu 2005).

  11. See Macias (2008).

  12. According to Fernández-Huertas Moraga (2013), between 2000 and 2007 a 5.1 % of the population in Romania had a college degree, while this number was 9.5 % among immigrants in Spain.

  13. In order to register a birth, the parents or the legal representative of the child have to present a document with statistical information on the birth outcome (Informe Estadístico del Nacido Vivo in Ecuador, or Boletí n Estadístico del Parto in Spain).

  14. The Spanish data protection policy prevents the police from accessing the local population registry to identify illegal aliens.

  15. Unfortunately, the birth certificates do not contain information on prenatal care.

  16. See Table 11 in the Appendix.

  17. The birth certificate data for Spain are made publicly available by the National Statistical Institute (INE).

  18. The descriptive statistics in Table 2 consider only the nationality of the mother. In estimation, I will take into account the nationality of the father.

  19. These data are available from the Instituto Nacional de Estadística y Censos (INEC) in Ecuador.

  20. Note that the information for Ecuadorian immigrants in Spain is taken from the Spanish birth certificate data.

  21. Only 40 % of the observations with valid information on birth weight report gestational length.

  22. Note that healthy habits may vary across individuals from the same sending country (e.g., different rates of prenatal care or nutrition). Differences among immigrants and non-immigrants in this dimension will be captured by the selection ( β selection) rather than the habits component ( β habits).

  23. See Fernández-Huertas Moraga (2013) and Bertoli et al. (2013).

  24. While the lexical similarity between Romanian and Spanish has been estimated at 71 %, some immigrants upon arrival my not properly understand the native language.

  25. Differences in fertility patterns across groups and their implications for the results are investigated in the next section.

  26. The estimate is obtained by including as additional controls in Eq. 1 the gender of the child, an indicator for the month and year of birth, a set of dummies for the mother’s age at the date of birth, as well as indicators for the province of residence in Spain.

  27. I replicate the results in Table 5 but excluding from estimation mixed couples (i.e., babies born to mothers from Ecuador and fathers from Spain and that born to mothers from Spain and fathers from other nationalities). The main conclusions in Table 5 remain unaffected. The largest difference appears in terms of birth weight: when mixed couples are excluded the estimated healthy immigrant effect is reduced by 10 g. The results when mixed couples are excluded are available upon request from the author.

  28. Birth weight can be an inaccurate measure of maternal health as in some cases health problems of the mother, like diabetes, lead to an elevated weight of the baby. Therefore, I extend the analysis to these other pregnancy outcomes that are also related to maternal health (see Aizer and Currie 2014).

  29. Differences in birth weight and the probability of low birth weight between natives and immigrants could result from the observed differences in gestational length. To examine this possibility I have re-estimated the birth weight and the low birth weight regressions in column (1) and (2) in Table 5 including as an additional control gestational length. This slightly reduces the size of the healthy immigrant effect (from 117.7 to 110.1 g in the birth weight regression and from −0.022 to −0.019 in the probability of low birth weight). These differences are still significant at any conventional level.

  30. The model also includes a set of dummies for the age of the mother, as well as province and year indicators.

  31. Note that the estimated models in Table 5 include these controls.

  32. Note that the estimates in Table 5 are obtained from the births occurred between 2001 and 2005. Given the characteristics of the Ecuadorian exodus, most of these births are likely to be to recent immigrants or immigrants that have been in the country for less than 5 years. However, this assumption cannot be tested as information on year since arrival is not available in the data. There is evidence, mostly among Mexican immigrants in the USA (see Antecol and Bedard 2006) showing that the initial health advantage erodes over time as immigrants assimilates. If this pattern also existed among Ecuadorian immigrants in Spain (data limitation issues prevent me from testing it), the estimates in Table 5 would represent a lower bound of the healthy immigrant effect.

  33. As discussed in Section IV, the analysis is restricted to the years 2001–2005 (i.e., pre-crisis period). Fernández-Huertas Moraga (2014) shows that migration flows to Spain were positively selected in terms of productive skills during the booming years, and that, on average, they improved after the crisis. However, for the Ecuadorian case, there is evidence of negative selection in terms of some education measures after the crisis. This suggests that my estimates of the healthy immigrant effect for the period 2001-2005 may be positively biased as a result of the different selection patterns over the business cycle.

  34. Gestational age is only reported for 40 % of the births with valid information on weight, and there is no information to construct the death within 24 h after birth.

  35. The lexical similarity of Romanian with Spanish has been estimated at 71 %.

  36. Table 11 in the Appendix indicates that among the Ecuadorian and Romanian immigrants living in Spain in 2007, 72 % of them arrived between 2000 and 2004.

  37. These results are obtained after controlling for differences in socioeconomic characteristics. A similar message is obtained when the models are estimated without including the additional controls.

  38. Note that the health advantage in terms of birth weight is present even if the average birth weight in Romania is higher than in Ecuador (i.e., 3196 versus 3098).

  39. See Camacho 2008; Almond and Mazumder 2013; and Bozzoli and Quintana 2014 for evidence of the negative effect of stress and malnutrition on birth outcomes.

  40. Table 15 in the Appendix reports the estimates of the fertility model for these groups. Note that immigrants from Colombia and Bulgaria have lower fertility rates than immigrants from Ecuador. Thus, the health advantage of Ecuadorian immigrants does not respond to lower fertility.

  41. Note that Chinese immigrants have a long tradition in Spain. There is evidence that the initial health advantage of immigrants erodes over time as their practices and behaviors converge to that of natives (Antecol and Bedard 2006). Thus, the healthy immigrant effect for the Chinese reported in Table 10 could be underestimated due to the presence of non-recent immigrants in the data.

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Acknowledgments

I am thankful to the editor, Klaus Zimmermann, and three anonymous referees for their comments, help and guidance. I also acknowledge the comments and suggestions by Jesús Fernández-Huertas Moraga, Hillel Rapoport, Deborah Cobb-Clark, Matilde Machado, Libertad González, Alessia Matano and participants at the 10th IZA Annual Migration Meeting and 4th Migration Topic Week, the 15th IZA/CEPR European Summer Symposium in Labor Economics and the 14th IZA/SOLE Transatlantic Meetings of Labor Economists for comments and suggestions. I acknowledge the financial support of the Government of Catalonia (grant SGR2014-325), the Ministry of Economy and Competitiveness (grant ECO2014-59959-P-P) and the RecerCaixa 2012 grant.

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Authors and Affiliations

  1. Department of Economic Policy (GiM-IREA), Universitat de Barcelona, Carrer Keynes 1-11, 08034, Barcelona, Spain

    Lídia Farré

  2. Institut d’Anàlisi Econòmica (IAE-CSIC), Campus UAB, 08193, Bellaterra, Spain

    Lídia Farré

  3. IZA, Bonn, Germany

    Lídia Farré

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Correspondence to Lídia Farré.

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Responsible editor: Klaus F. Zimmermann

Appendix

Appendix

Table 11 Year of arrival by country of origin
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Table 12 Aggregate health statistics
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Table 13 Missing birth weight information in the birth certificate data in Ecuador
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Table 14 Socioeconomic characteristics of female natives and immigrants in Spain
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Table 15 Differences in fertility across immigrant groups
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Farré, L. New evidence on the healthy immigrant effect. J Popul Econ 29, 365–394 (2016). https://doi.org/10.1007/s00148-015-0578-4

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