The Healthy Immigrant Effect: Patterns and Evidence from Four Countries

Abstract

The existence of a healthy immigrant effect—where immigrants are on average healthier than the native born—is a widely cited phenomenon across a multitude of literatures including epidemiology and the social sciences. There are many competing explanations. The goals of this paper are twofold: first, to provide further evidence on the presence of the healthy immigrant effect across source and destination country using a set of consistently defined measures of health; and second, to evaluate the role of selectivity as a potential explanation for the existence of the phenomenon. Utilizing data from four major immigrant recipient countries, USA, Canada, UK, and Australia allows us to compare the health of migrants from each with the respective native born who choose not to migrate. This represents a much more appropriate counterfactual than the native born of the immigrant recipient country and yields new insights into the importance of observable selection effects. The analysis finds strong support for the healthy immigrant effect across all four destination countries and that selectivity plays an important role in the observed better health of migrants vis a vis those who stay behind in their country of origin.

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Notes

  1. 1.

    For Canada, see Newbold and Danforth (2003), McDonald and Kennedy (2004), Ng et al. (2005) and Wu and Schimmele (2005). Veenstra (2009) finds that the healthy immigrant effect offsets disparities in health by race. Biddle et al. (2007) document a healthy immigrant effect for immigrants to Australia, while Singh and Siahpush (2002), Jasso et al. (2004) and Antecol and Bedard (2006) do so for immigrants to the USA.

  2. 2.

    Other explanations for the HIE have also been discussed in the literature. Jasso et al. (2004) and McDonald and Kennedy (2004) suggest that reporting—either where recent immigrants understate the incidence of certain chronic conditions because of differences in perception or because such conditions have not yet been diagnosed due to barriers in access to health services—can give rise to the appearance of a healthy immigrant effect. However, Jasso et al. (2004) report that their results are robust to these considerations. As well, McDonald and Kennedy (2004) show that the use of basic health services among recent immigrants to Canada converges to native-born levels much more quickly than is the case for health measures.

  3. 3.

    Nonpecuniary costs capture a myriad of factors including isolation associated with leaving close relatives, cultural adaptation, and assimilation as well as cross-country differences in access and quality of health services.

  4. 4.

    In 2006, the UK announced a restructuring of their immigration program that introduces a point-based system for all prospective immigrants to the UK.

  5. 5.

    http://www.immi.gov.au/allforms/health-requirements/overview-health-req.htm. Accessed 13/8/2013.

  6. 6.

    http://www.cdc.gov/immigrantrefugeehealth/laws-regs/hiv-ban-removal/final-rule.html. Accessed 13/8/2013.

  7. 7.

    For related work on immigrant self-selection in terms of labor market outcomes, see Aydemir 2009; Aydemir and Skuterud 2005, Chiquiar and Hanson 2005, and Borjas 1987.

  8. 8.

    Population weights and robust stand errors are used throughout.

  9. 9.

    Unlike in the UK, Canada and Australia, the USA is characterized by a significant proportion of native-born residents who belong to an ethnic minority. None of the results in this paper are quantitatively affected by the restriction of the native-born sample in each country to white individuals only.

  10. 10.

    Age and gender are both important determinants of health but in the interests of brevity, we do not explore those relationships in detail here. However, as explained in the paper, we control for differences in age and gender composition in obtaining our standardized estimates of immigrant native-born differences.

  11. 11.

    The main exception is Mexican and other Central American immigrants in the USA who have markedly lower education levels.

  12. 12.

    There is an extensive theoretical and empirical literature on the so-called brain drain from developing countries. Estimates of the extent of brain drain from a wide range of developing countries are presented in Docquier and Marfouk (2006) and Adams (2003).

  13. 13.

    Data on smoking rates by country are taken from The World Tobacco Atlas by J. MacKay and M. Eriksen, published in 2002 by The World Health Organization (www.who.int/tobacco)

  14. 14.

    There are wide differences in smoking rates by gender in developing countries that are not apparent from these averages: for example, 4 % of females and 44% of males are daily smokers in China; comparable figures for India are 4 and 28%, for Egypt 18 and 40%, and Vietnam 4 and 51%.

  15. 15.

    Comparing obesity incidence with published country-specific obesity rates does not yield consistent patterns. (Note that obesity data are only available for selected countries so that it is not possible to calculate exact weighted average obesity rates for our classification of regions of origin. Thus, this discussion should be seen as indicative rather than conclusive). Obesity rates in China and Vietnam are in the order of 1 %, close to what is found for immigrants from East Asia. Obesity rates for India are also around 1 % and are substantially lower than what is seen for Indian immigrants. For the Middle East, immigrant obesity rates are probably lower than for nonimmigrants since comparable rates for Iran and Turkey are 18 and 22 %, respectively. Finally, obesity rates for European immigrants are probably lower than for nonimmigrant Europeans, which vary from 7 % in France and 8 % in Italy to 17 % in Russia, 18 % in Bosnia and 19 % in Germany. Source: WHO Global Infobase (http://infobase.who.int).

  16. 16.

    The “public use” NHIS data only began reporting region of origin for immigrants in the 2000 NHIS, although data on year of arrival and race of immigrants is available from earlier NHIS surveys. As well, although there is detailed information on race/ethnicity, data on region of origin are reported for groups of countries rather than individual countries. However, this does not prove to be a serious obstacle, as either the regions of origin represent relatively homogeneous sets of countries, or a single country dominates the supply of immigrants (for example immigrants from “East Asia” are mainly Chinese).

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Acknowledgments

The authors would like to acknowledge the financial assistance provided by SSHRC and SEDAP at McMaster University. Analysis of confidential Canadian data was conducted at the NB Research Data Centre in Fredericton while analysis of confidential Australian data was conducted at the Australian Bureau of Statistics in Canberra. Views expressed here are not necessarily those of Statistics Canada, Australian Treasury, or the Australian Bureau of Statistics.

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Correspondence to Michael P. Kidd.

Appendix: Data Sources and Characteristics

Appendix: Data Sources and Characteristics

The US data are drawn from the public-use National Health Interview Surveys (NHIS) for the years 2000 to 2005. While earlier years of data are available for the NHIS, they do not contain immigrant region of origin information. US-born Hispanics are included in the native-born US, but their exclusion has little impact on the results. When measuring region of origin in the US data, immigrants from Europe include those from the UK as well as from Continental Europe. Moreover, there are no data on mother tongue or language first spoken. Australian and Canadian immigrants are not explicitly identified in the USA data but are assumed to be immigrants from other areas who are white (“other” areas include Canada, Australia, New Zealand, and the pacific islands—thus, this approximation seems reasonable). Immigrants from India are not explicitly identified, but we impute this category based on immigrants from South Asia who are of “Indian” descent.Footnote 16

The Canadian micro-data are based on confidential versions of recent large-scale datasets collected by Statistics Canada: the National Population Health Survey (1996) and the Canadian Community Health Survey (2001 and 2003). Specific country of origin is available in the Canadian data so it is possible to combine groups of countries in order to be consistent with the more limited data on region of origin available in the US and UK data.

Two sets of comparable micro-data for the UK are drawn from two separate sources: the General Population Surveys 2000 to 2004 and the UK Health Surveys for 1999 and 2004 (note that people born in Ireland who are in the UK are not considered immigrants for the purposes of this study). While the general population survey has more disaggregated information on region of origin, it also appears seriously to under-report the incidence of particular chronic conditions, as the reported incidence is very low for all conditions. There are also no data on body mass index and obesity in this survey. For these reasons, we utilize the UK Health Surveys for 1999 and 2004. Unfortunately, while health surveys are available for other years, it is only for these 2 years that information on year of arrival and region of origin are both available. Also, only a limited number of regions of origin are identified for immigrants. Asians outside of South Asia are grouped into a single category—thus, to approximate the region East Asia, we include only those immigrants who report being of Chinese descent. Therefore, the percentage of this group among all foreign-born is much lower than for the UK general survey. Further, Europe, USA, Canada, and Australia are not separately identified, so to approximate developed country foreign-born, we select foreign-born white immigrants and report them as one pooled category. The incidence of chronic conditions as measured by the UK health surveys is still lower than for other countries but higher than for the UK general surveys.

Australian micro-data are sourced from confidentialized versions of the Australian Bureau of Statistics National Health Surveys from 1995 and 2001. New Zealanders are excluded from the subsample of immigrants owing to the reciprocal rights of residency, employment, and income support between Australia and New Zealand. Country of origin information is available on these data sets and so immigrants can be categorized for consistency with the regions of origin available in the UK and US data.

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Kennedy, S., Kidd, M.P., McDonald, J.T. et al. The Healthy Immigrant Effect: Patterns and Evidence from Four Countries. Int. Migration & Integration 16, 317–332 (2015). https://doi.org/10.1007/s12134-014-0340-x

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Keywords

  • Immigrant health
  • Selection effects
  • Smoking
  • Obesity

JEL

  • I12
  • I00
  • J61