Immigrant health paradox update

I wrote a few years ago about the surprisingly low infant mortality rates among immigrants, especially Mexican immigrants, given their relative socioeconomic status. As poor as they other, in other words, we would expect higher infant mortality rates than they have. This has been called the epidemiological paradox. Here is an update, which includes some text from the previous post.

In almost every race/ethnic group, immigrants are healthier.* Here’s the pattern for infant mortality, now updated with 2010 infant mortality rates from federal vital statistics records (click to enlarge).

For Latinos in particular, their health is surprisingly good given their economic conditions. Robert Hummer and colleagues, in a 2007 article, offered a succinct description:

…the relatively low levels of education, income, and health insurance coverage among Hispanics compared with non-Hispanic whites is thought to place the former at higher risk for negative health outcomes. However, it is well documented that some Hispanic groups exhibit similar observed death rates compared with the non-Hispanic white population and much lower death rates than the non-Hispanic black population, whom they closely resemble with respect to socioeconomic characteristics. The greatest enigma is exhibited by the Mexican-origin population of the United States. This Hispanic subgroup is characterized by low educational attainment; low health insurance coverage rates; mortality rates similar to non-Hispanic whites; and much more favorable mortality rates than those of non-Hispanic blacks across most of the life course.

In a 2013 revisiting of the paradox, Daniel Powers confirms the basic pattern, but adds an important wrinkle for Mexican mothers: the foreign-born advantage disappears for older mothers. Thus, children born to older Mexican immigrants have similar risks as those who mothers are born in the U.S. He concludes, in part:

Given the association between infant survival and maternal health, differential infant survival within the Mexican-origin population suggests that longer exposure to social conditions in the U.S. undermines the health of mothers who, in general, seem to have more favorable health endowments than their non-Hispanic white counterparts as evidenced by the relatively lower rates of infant mortality at younger ages.

Immigrants are often healthier than the average people in the countries they came from, which explains some of the paradox. However, our ability to accurately assess the relative health of immigrants versus the populations they left behind is limited by available data. Further, in the case of Mexico, the situation is complicated by cyclical movements of immigration and emigration. In a recent paper, Georgiana Bostean reviews this problem, and compares the health of immigrants, non-migrants, and return migrants to Mexico. And — It’s complicated. She concludes:

…there is no simple explanation for Latinos’ perplexing health outcomes, such as simply that healthier people migrate. Rather, migrants are positively selected in some health aspects, negatively selected in others, and in yet other health outcomes, there is no selection effect. In sum, selective migration plays a role in explaining some of U.S. Latinos’ health outcomes, but is not the only explanation and does not account for the Paradox.

These articles are a good place to start on this topic: lots of references to fill in the background and previous research on this paradox, which goes back at least to the 1980s. This is a fascinating and important research area, dealing with such questions as health behavior, intergenerational change, thorny puzzles about different immigrant groups, child development and lots more.

*Because Puerto Rico is part of the U.S. (albeit not a free part), people born in Puerto Rico who move to the states are not immigrants, just migrants. In the figure I used the terms “US Born” and “Foreign born,” but this is just shorthand, and not strictly accurate for Puerto Ricans.

You got your immigrant in my interbreeding!

Immigration is in the news. What will American become this time?

I’m shocked at David Brooks’ gross mischaracterization of history. He writes America is becoming a “nation of mutts”:

…up until now, America was primarily an outpost of European civilization. Between 1830 and 1880, 80 percent of the immigrants came from Northern and Western Europe. Over the following decades, the bulk came from Southern and Central Europe. In 1960, 75 percent of the foreign-born population came from Europe, with European ideas and European heritage.

But were all those European immigrants considered to be part of “European civilization” a century ago? In fact, even excluding American Indians, Blacks, Mexicans, Chinese and others, “we” were already being described as a nation of mutts in the 19th century. To choose one of many examples, here is Timothy Wilfred Coakley speaking at Faneuil Hall in Boston on Independence Day 1906:

We have evolved the race of races, the American race. We are sprung from all the peoples of Europe. … It was not alone that one nation was to be framed from thirteen colonies, it was that Frenchmen and Englishmen, Irishmen, Welshmen, Spaniards, Swedes, Dutchmen, Jew and Gentile, had been welded into one. It was this blend, now of mind, now of body, now of both, which made possible the type of intelligence able to grasp the opportunity and to brave the test of revolution.

American was not a product of a unitary “European civilization,” but of a “racial fraternity” of these “various European races,” which made the “American race.” Here it is in verse:

To the making of heroes like these, perforce,
Humanity’s federate blood-strains have gone;
But, Keltic or Saxon, Teuton or Norse,
Latin or Slav, they are Yankees of course,
For Freedom has fused them in one.

It’s a particular tradition of American racism to believe, as Brooks suggests, that Europeans are all one “race,” that so that only with the latest waves of immigration are “we” becoming a “nation of mutts.”

“Becoming a nation of…”

Brooks’s entry joins the “becoming a nation of…” historical parade I have described before, the roster of which comprises American nations of (in chronological order): free men, drunkards, castes, bull-dogs, music lovers, dreamers, lawyers, neurotics, coffee drinkers, the elderly, readers, illiterates, burger flippers, joiners and orthorexics.

He’s seems a little late to the parade with this term, though. I was sure I’d heard it before, not just from PETA complaining about the Obamas’ dog, but from some guy on the Op-Ed page of the Washington Times in 1997 (“America is rapidly becoming a nation of mutts. Our country’s traditional character is being systematically destroyed by nihilistic “liberals”); Jonathan Turley in 2004 (“If you want a pure breed, buy a dog”); Stanley Crouch; Joe Feuerherd; various college guides, and many more.

How many people should die waiting for citizenship? 319,462?

Just the facts. Or, a very crude estimate of the facts. You tell me if this is too many deaths.

Here I combine sources of information to produce a guess of how many undocumented immigrants will die waiting 13 years to become citizens under the proposed immigration reform bill. The information includes the number and ages of the current undocumented population, and the 2008 Hispanic life table estimates from the National Center for Health Statistics (which tell you the death rate for people in that group for every age by sex).

Here is my guess. If the 11.5 million undocumented immigrants waited 13 years to become citizens, 319,462 — or 2.8% of them — will die in the process. If that were true, do you think it would be too many, or too few?

Some details

The Congressional Research Service in 2012 estimated that there were 11.5 million undocumented immigrants in the country in 2011. This is their age distribution by sex:

My estimate makes the following unreasonable assumptions:

1. The undocumented population is evenly distributed within each of these age groups, with the 55+ group evenly distributed between the ages 55-64 only. This is undoubtedly not true, but probably doesn’t make much difference unless the 55+ group is much older than I’m guessing.
2. The death rates for undocumented immigrants are equal to those of the U.S. Hispanic population. Why? 81% of the undocumented population is from Latin America, so that’s where I start (which seems to be what these serious demographers did, too). This would be off because immigrants have lower mortality rates than US-born Hispanics. On the other hand, undocumented immigrants might have higher mortality than immigrants in general, especially because of health-care access problems, which the proposed bill promises not to address. I don’t know how these or other factors balance out.
3. Nobody leaves the country alive, and no more undocumented immigrants arrive.

If you’d like to see how I did it, here is my spreadsheet. (If you don’t like the way Excel does the maths, by all means, fix it in R.)

Let a hundred churches bloom

For Independence Day, I pause to consider religious freedom and immigration.

I recently made some trips out New Hampshire Ave., in Montgomery County, MD. In a 9-mile stretch of road (including a turn off onto the road where my kids’ summer camp was), here is some of what I saw:

Muslim Community Center

St. Andrew Ukranian Orthodox Cathedral

Iglesia de Dios / Church of God

First Alliance Church

Transfiguration Church Episcopal Anglican

Eun Sam Evangelical Church of Washington

Colesville Baptist Church

Colesville Presbyterian Church

New Hampshire Avenue Gospel Chapel

Our Lady of Vietnam Parish

Kingdom Hall of Jehovah’s Witnesses

Good Shepherd United Methodist Church

Lutheran Church of St. Andrew

Lord’s Prayer Presbyterian Church

St. Thomas Indian Orthodox Church

Unitarian Universalist Church of Silver Spring

New Life Baptist Church

Saints Constantine and Helen Greek Orthodox Church

Heritage Christian Church

Iglesia Adventista

I counted about 30 houses of worship along what some people call the Highway to Heaven. Through some combination of immigration and residential settlement patterns, real estate and zoning conditions, and county tax exemptions, this neighborhood has become an extreme hotbed of religious centers.

I imagine that this kind of eclectic, diverse, religious cacophony is uniquely American, but maybe that’s not true. Anyway, there is something about all this post-modern pre-modernity that I get a kick out of.

Montgomery County, which abuts Washington, D.C., is a major urban suburb, with a million people. Not all those churches are filled with immigrants, but many of them are. In the county, 32% of the population is foreign-born, according to the 2010 American Community Survey (table B05006). Talk about diversity, here are the top 50 – out of 122 – countries of origin for residents of the county, color-coded by region (click to enlarge):

Montgomery County, Maryland, immigrants, by country of origin (top 50 countries, 88% of all immigrants shown).

Immigrants tip the county’s numbers toward the “traditional” side of the ledger in terms of marriage and family structure: 60% of immigrants here are married, compared with 49% of the U.S.-born adults (B06008); and 51% of immigrant kids live with both parents, compared with 46% of the natives (B05009). But their religious and cultural diversity push the county toward the less-traditional future, ethnicity-wise.

Good site for some research, I reckon.

Work product: Women’s ethnic immigration education work patterns

Five years ago Jen’nan Read and I published an article about women’s employment for 12 different ethnic groups in the U.S. In my Gender, Work, and Family seminar the other day we read it, and because of the timing in the course we were talking about developing and framing research questions. We looked at a couple of the images Jen’nan and I used to work through the many patterns we were trying to sort out in the data, and I thought the sequence might be interesting for blog readers, too. (These use data from the 2000 Census, with “employed” meaning any employment in the year 1999.)

The overall employment rates ranged widely, from 65% (Mexican, Asian Indian) to 84% (Filipina). First thing, break the groups out by education:

That helps a little. At the low end of education, employment rates are low. But at the high end, the spread is great — the line isn’t helpful — with high- and low-employment groups all found above 14 years of average education.

Next step was nativity (where they were born) and year of immigration for those born elsewhere. Looking at the high and low groups, there were distinct patterns:

Mexican women are on a diagonal line, showing a temporal progression from recent immigrants having low education and employment rates, back in time to those born in the U.S. (mostly children of earlier immigrants) with higher levels of both. The Asian Indian women are on a vertical line, with high education but low employment rates for recent immigrants, who may have come as spouses of men who had (or were getting) jobs here. The Filipinas, who are mostly labor migrants — that is, they came for their own jobs — are bunched up at high levels of both employment and education regardless of immigration timing.

This must have been the time Jen’nan hit on the title of “One Size Fits All?”, since the stories clearly diverged, and we decided to fit models of employment predictors for each group separately (details are in the paper).

One other image, a nice idea but hard to read, is also sitting in the old folder (click to enlarge):

Here there’s a dot for each ethnic group for each year of immigration. That is, the dot down in the bottom left is Mexican women who immigrated in 2000 (“M0″). The line is a weighted regression line, so it’s the overall relationship between education and employment rates. You see the Mexican women crowded around the lower left; the Filipinas in the top right; and recent Arab, Japanese, Korean and Asian Indian immigrants along the bottom. (The other initials you see are for Vietnamese, Puerto Rican, White, Chinese, Cuban, and Iranian).

When possible, I like to do this kind of descriptive exploration — making progressive slices in the data and looking at the patterns — before building complicated statistical models with a lot of factors at once. If the descriptive image survives the statistical analysis, there’s a chance of not only getting the story right, but being able to explain it.

FYI

This is cross-sectional data — that is, what each group is doing in 2000, based on the year they arrived. But it is suggestive of different immigration pathways. I’m not expert on the immigration side, but since I brought it up I should give a few pointers to recent literature on “segmented assimilation,” which focuses on such differences. The idea dates to the early 1990s, maybe this article:

• “The New Second Generation: Segmented Assimilation and Its Variants,” by Alejandro Portes and Min Zhou.

These are more recent, and include reviews of the major research:

• “Generation and Earnings Patterns Among Chinese, Filipino, and Korean Americans in New York,” by Sookhee Oh abd Pyong G. Min
• “The social context of assimilation: Testing implications of segmented assimilation theory,” by Yu Xie and Emily Greenman

Feel free to add suggestions for additional resources in the comments.

News from No Family For You

Inequality comes in many forms in modern societies. On this blog I’ve written about poverty as a lack of income or wealth; people also lack for jobs, health care, or food, among other things. But the more human care and well-being depend on family-based support and labor, the more we need to think about “having” a family — or the family of one’s choice — as a matter of inequality as well.

I’ve gone through some old posts and added a “no family” tag to a series that focus on absence, loss or denial of family relationships as problems of inequality — for example, the deportation of legally married spouses in homogamous couples, state eugenics programs, and the drug war’s father-removal consequences.

Once you start reading the news with this problem in mind, the stream seems endless. (For example, what about the future marriage consequences of unbalanced sex ratios resulting from sex selective abortions?) To keep up, I need to do a digest post.

No Family Update

Deportation: The first time I wrote about “Who Gets a Family?” was back in my Huffington Post days, in a story about the parents of U.S.-citizen children being deported. At the time I was shocked that, “Over the 10 years up to 2007, the U.S. deported 108,434 adults whose children were U.S. citizens.” Now we learn from the Applied Research Center’s government document investigation that 46,000 such deportations took place in just the first half of this year.

This is a family loss for both the allegedly illegal immigrant parents and their U.S.-citizen children, many of whom end up in foster care. Some people aren’t sorry for the parents, since coming to the U.S. was their risk. Others aren’t sorry for the children, because it’s their parents’ fault rather than the government’s. (Feeling justified in punishing children for the actions of their parents is one perspective on human rights I can’t get behind.) In any event it clearly shows that the birthright citizenship of these children does not include the right to keep their parents here.

Abduction: Two horrific stories of state-sponsored child abduction made the news for this roundup.

Manoli Pagador's first-born son was taken from her at birth -- the doctor said he died.

In Spain, we are gradually learning that thousands — maybe hundreds of thousands — of children were stolen from their mothers at birth by Catholic nuns and priests in cahoots with the Franco dictatorship, and sold to other families. The BBC has run a series of reports, describing how a program that started out something like American eugenics — except taking away children from socially marginal women rather than sterilizing them — developed into a profit-driven criminal enterprise under the protection of the dictatorship and the cover of Church authority.

This boy spent a year and a half in foster care before being returned to his family.

In South Dakota, hundreds of American Indian children are removed from their family homes every year and placed in White homes or group homes, in violation of the federal law requiring every effort to place them with native families. A heart-rending NPR series revealed that American Indians are 13% of the state’s children but 53% of the children in foster care. Further, the South Dakota system is using their child removals to gain federal funds and funnel money to home operators with deep connections at the highest levels of state government.

James Taylor drowned in a bathtub when he was left unattended at his group home in Schenectady, NY.

Aberration? Finally, the New York Times has a long story on deaths from neglect (my layperson’s term) in privately operated group homes, where adults with disabilities are cared for at state (and federal) expense. The Times looked into the inexcusable or unexplained deaths of hundreds of residents from choking, drowning, fire and other causes. How does this fit? The group homes in New York, as in other states, are the post-deinstitutionalization system of non-family care for people whose developmental or psychiatric disabilities prevent them from living on their own or with their families — given their economic resources. When the family can’t care, who cares? As this story shows, it’s the state that cares — sort of.

(This one struck close to home for me, since I was once a 19-year-old high school graduate working as a counselor in a group home in New York for adults with developmental disabilities. I dispensed medication, supervised household chores and relationships, cooked and cleaned with the residents, and counseled a little. Sometimes I was the only staffer with eight residents or so, even overnight, and now I’m thinking how glad I am nothing awful happened. I had a few days training, and I was very conscientious, and everyone was fine, but it might not have been.)

No family-caregiver-citizenship for you

Add to the No Family For You mantra of the Defense of Marriage Act — which includes denial of immigration (or citizenship) to legal spouses of U.S. citizens — denial of a primary caregiver.

As reported in the San Francisco Chronicle:

Citing the Defense of Marriage Act, the Obama administration denied immigration benefits to a married gay couple from San Francisco and ordered the expulsion of a man who is the primary caregiver to his AIDS-afflicted spouse.

Bradford Wells, a U.S. citizen, and Anthony John Makk, a citizen of Australia, were married seven years ago in Massachusetts. They have lived together 19 years, mostly in an apartment in the Castro district. The U.S. Citizenship and Immigration Services denied Makk’s application to be considered for permanent residency as a spouse of an American citizen, citing the 1996 law that denies all federal benefits to same-sex couples.

Further on:

The agency’s decision cited the Defense of Marriage Act as the reason for the denial of an I-130 visa, or spousal petition that could allow Makk to apply for permanent U.S. residency. “The claimed relationship between the petitioner and the beneficiary is not a petitionable relationship,” the decision said. “For a relationship to qualify as a marriage for purposes of federal law, one partner must be a man and the other a woman.”

Obama and Attorney General Eric Holder decided earlier this year that the law, commonly known as DOMA, is unconstitutional on equal protection grounds and that the administration would no longer defend it in court.

And so it goes.