The UK Office of National Statistics recently looked at mortality rates by ethnicity. This was not an easy task. UK death certificates do not include ehnicity. Instead they tied the recent census to the death certificates. The result was surprising. The “White British” group had the worse mortality rate. This was after allowing for different age profiles. They were followed by Bangladeshi, “Mixed”, “White Other”... The lowest were the Chinese. Their mortality rate was fifty percent lower than the “white British”. They same results appear in life expectancy data.

The Bangladeshi and Pakistani groups topped the mortality list for many individual conditions. These including diabetes, kidney disease, and many diseases of the heart. They also topped the list for respiratory diseases such as pneumonia and asthma. They suffered the worst with COVID. The Black Caribbean group had the highest rates for prostate cancer and cancer of the blood. Despite this the "White British" had higher death rates.

There are many factors affecting mortality rates. Deprivation is one of the key ones. People living in the worst levels of deprivation have worse mortality rates. Nearly twice as high as those in the least. Some argue that ethnic minorities tend to live in higher levels of deprivation. It is surprising that the “white British” still top the mortality table. One big explanation is the “Healthy Migrant Effect”.

The “Healthy Migrant Effect”.

This is an effect that has been studied for many years. New immigrants are healthier than comparable native-born groups. This is surprising because of the very nature of migration. People move countries in search of a better economic future. The flow tends therefore to be from developing countries to more developed ones. From countries with higher incidence of disease and mortality. What is even more surprising is that many of the host countries have only limited heath screens.

The answer lies with two very different selection processes. Migrants chose to leave their own country and countries chose to let them enter. In many cases the emigrants are the ones who are better educated. A recent academic study looked at four possible destinations. They were the UK, the USA, Australia and Canada. They looked at a large range of exit countries. They compared the education levels. The migrants had higher levels of education than similar groups in their new homes. The gap was often as high as 20%.

It is clear that emigration is an expensive and dislocating process. The individuals who chose to leave see a brighter future. They expect more opportunity to use their education. Many destination countries are looking for skilled immigrants. The countries with points systems will favour those with skills and education. They may even campaign to get them. This is self-reinforcing as it can attract this group. They believe that they have a high chance of being accepted. Migrants tend to be younger. Both age and education are strongly associated with health. The effects still exist for people moving between developed countries. Migration involves a "brain drain".

There is also a direct health effect. Immigrants tend to have healthier lifestyles even before they move. Average smoking levels are lower than comparable groups in their home country. For example obesity and US. Emmigrants tend to be less obese that comparable groups they leave behind. The same is true for Australia, Canada and the UK. There are exceptions. Those who migrate not out of choice are one. Refugees entering Australia tend to have poorer health than the comparable local group.

The healthy migrant effect is due to the youth and higher education of the immigrants. All over the world education is associated with health. There is clearly a self-selection going on.

The Assimilation Effect

Assimilation is part of any Governments’ immigration plan. Politically they need immigrants to accept the cultural norms of their new home. Unfortunately, this can undermine the Healthy Migrant Effect. The Office of National Statistics looked at this. They compared the health of recent immigrants with those who had been in the UK for ten years. The mortality levels of the “older immigrants” converged with the UK natives. They were learning unhealthy behaviours.

Exactly the same effect has been seen with fertility. It seems to take only one generation. Immigrants arrive young and in the first generation will have as many children as was common “at home”. For many this is higher than the norm of the Society in which they find themselves. A proportion of migration comes from the reunification of families. The incidence of children peaks within one to two years of arriving.

By the second generation they are starting to conform to a new local stereotype. This generation is more likely to be entitled to childbearing benefits. Certainly more than their mothers. Even so fertility falls. The drop in fertility is often used as an indicator of assimilation.

Economic Levers are not Enough

It is important to remember that fertility rates are falling all over the world. The norms in the country the migrants once called home are changing. For example, in that same generation fertility in India fell from 4.8 in 1980 to 2.2. It is a reminder how much social context influences fertility. Governments should look to their own immigrant populations. The impact of Society is very visible. Economic levers may not be enough. (see last weeks Newsletter #147: “Demographic Rearmament”).