Why Does the Health of Immigrants Deteriorate?

Despite their socio-economic status, Hispanic immigrants in the US initially have better health outcomes than natives. However, while their socio-economic status improves over time and across generations, their health deteriorates (“Hispanic health paradox”). There is an open debate about whether the observed convergence is explained by selection on health or by the the adoption of less healthy lifestyles. This paper uses a unique dataset linking the birth records of two generations of Hispanics born in California and Florida (1975-2009), to analyze the mechanisms behind the generational decline in birth outcomes. Using country-level differences in health outcomes to pin down the degree of selection of the first-generation immigrants and existing estimates to pin down the intergenerational transmission of health status, I develop a simple model to interpret the health trajectories of immigrant descendants. Accounting for socio-economic differences between second-generation Hispanics and natives, the model not only explains the apparent paradox, but it over-predicts convergence with respect to the data. The paradox is reversed; contrary to the non-significant difference observed between third-generation immigrants and natives, the calibration exercise predicts a fairly large health advantage for natives. I show that the lower incidence of risk factors among Hispanics can explain 80% of the “reverse paradox”. There is evidence of a generational worsening of risky behaviors and health conditions (e.g., smoking, alcohol consumption, and, hypertension), but second-generation Hispanics conserve a sizeable advantage compared to white natives. Among Hispanics, worse behaviors and higher assimilation are associated with poorer third-generation birth outcomes. This holds true even when focusing on a subset of second-generation siblings and controlling for grand-mother fixed effects. ∗270 Bay State Road, 02215, Boston (MA); phone: 617-353-5616; fax: 617-353-4449; email: [email protected]. I am grateful to Daniele Paserman, Randall Ellis, Kevin Lang and Claudia Olivetti for their comments and advice. I would like to thank all the participants to the American Society of Health Economists Conference (Minneapolis, 2012), the XII Doctoral Workshop in Economic Theory and Econometrics (EIEF, 2012), the EconCon Conference (Princeton U, 2012), the European Meeting of the Econometric Society (Malaga, 2012), the XV IZA Summer School (Buch-Ammersee, 2012), the European Association of Labor Economists/IZA Conference (Bonn, 2012), as well as all seminar attendees at the BC-BU Green-Line Labor Meeting (2012), the Boston University Empirical Micro-Lunch(2012). Any errors are my own. The project was made possible by generous funding from the Boston University Institute for Economic Development. 1