Does immigration affect mortality? A study of the effects of immigration from the former Soviet Union to Israel Dov Raphael MWG meeting St Petersburg, May 2016 May 2016 Immigration and mortality - Dov Raphael 1
Previous studies Health, life expectancy, and mortality patterns among immigrant populations in the United States. Can J Public Health. 2004 May-Jun;95(3):I14-21. The US immigrant population has grown considerably in the last three decades, from 9.6 million in 1970 to 32.5 million in 2002. Male and female immigrants had, respectively, 3.4 and 2.5 years longer life expectancy than the US-born. Compared to their US-born counterparts, black immigrant men and women had, respectively, 9.4 and 7.8 years longer life expectancy, but Chinese, Japanese, and Filipino immigrants had lower life expectancy. Most immigrant groups had lower risks of infant mortality and low birthweight than the US-born. Consistent with the acculturation hypothesis, immigrants' risks of disability and chronic disease morbidity increased with increasing length of residence. INTERPRETATION: Migration selectivity, social support, socio-economic, and behavioural characteristics may account for health differentials between immigrants and the US-born. May 2016 Immigration and mortality - Dov Raphael 2
Previous studies The healthy immigrant effect and mortality rates Edward Ng - Health Analysis Division at Statistics Canada, Ottawa http://www.statcan.gc.ca/pub/82-003-x/2011004/article/11588/abstract-resultat-eng.htm According to the 2006 Census, almost 20% of the Canadian population were foreign-born, a percentage that is projected to reach at least 25% by 2031. Studies based on age-standardized mortality rates (ASMR) have found a healthy immigrant effect, with lower overall rates among immigrants. A duration effect has also been observed immigrants' mortality advantage lessened as their time in Canada increased. However, the relationship between immigration and health is complex, especially because the origins of immigrants to Canada are increasingly diverse. Since the 1960s, the major source countries have shifted from European to non-european nations. Consequently, it is important to analyze the healthy immigrant effect by birthplace and period of immigration. At the national level, the mortality rate among women from the United States and from Sub-Saharan Africa was similar to that of Canadian-born women. For the three largest Census Metropolitan Areas (Toronto, Montreal and Vancouver), a healthy immigrant effect was not observed among women or among most men from the United States or Sub-Saharan Africa. May 2016 Immigration and mortality - Dov Raphael 3
Previous studies DO COHORT MORTALITY TRENDS EMIGRATE? INSIGHTS ON THE U.K. s GOLDEN COHORT FROM A COMPARISON WITH A BRITISH SETTLER COUNTRY By Alison O Connell and Kim Dunstan BAJ 15, Supplement, 91-121 (2009) The assumed rate of future mortality improvement has increased over three recent sets of the UK s national population projections. This optimism has not been so marked in countries which share ancestors with the U.K. population. This paper compares mortality trends in New Zealand with those in England & Wales. Both countries seem to have a golden cohort which enjoys faster improving mortality than people born before or after. The birth of the golden cohort in England& Wales coincided with cohort life expectancy there catching up with New Zealand s. First generation migrants from the U.K. have better mortality than New Zealand born residents likely to have British ancestry. The advantage lasts into older ages, decades after migration. We hypothesise that migrants from the U.K. s golden cohort brought with them an early life mortality improvement advantage, and additionally benefited from the healthier environment of New Zealand at middle to older ages. May 2016 Immigration and mortality - Dov Raphael 4
Israel: population and migration, 1983-2015 (selected years, in '000s) Year Population Births Deaths Expected next year Calculated net migration Official immigration 1983 4,052 99 28 4,123 1 17 1989 4,487 101 29 4,559 14 24 1990 4,573 103 29 4,648 179 200 1991 4,827 106 31 4,901 158 176 1992 5,059 110 33 5,136 58 77 1993 5,194 112 33 5,273 51 77 2001 6,413 137 37 6,512 45 44 2013 7,984 171 42 8,114 20 17 2014 8,134 176 42 8,268 28 Calculated from HMD. Right-hand column from Israel Central Bureau of Statistics May 2016 Immigration and mortality - Dov Raphael 5
Israel s population has more than doubled in the past 32 years In comparison, the population of France increased by 18% in the same period, the UK by 14%, Italy by 9%, and Germany by 5%. The increase is a result of higher fertility rates and high immigration. May 2016 Immigration and mortality - Dov Raphael 6
The largest waves of immigration were after the establishment of the State in 1948, and following the collapse of the Soviet Union in 1989 Immigration by year and country of origin (Source: ICBS) Year FSU USA/Can Argentina Ethiopia Other Total 1989 12,932 1,533 1,853 1,448 6,284 24,050 *FSU = Former 1990 185,227 1,546 2,045 4,121 6,577 199,516 Soviet Union 1991 147,839 1,703 666 20,014 5,878 176,100 1992 65,093 2,068 356 3,648 5,892 77,057 1993 66,145 2,280 375 863 7,142 76,805 1994 68,079 2,398 538 1,197 7,632 79,844 1995 64,848 2,503 966 1,312 6,732 76,361 1996 59,048 2,262 1,370 1,411 6,828 70,919 1997 54,621 2,057 1,255 1,661 6,627 66,221 1998 46,032 1,793 738 3,110 5,049 56,722 1999 66,848 1,697 936 2,290 4,995 76,766 May 2016 Immigration and mortality - Dov Raphael 7
Immigration from the Former Soviet Union The total number of immigrants from the FSU is 1.2 million. In 1990 the population of Israel was 4.6 million. In the period 1990-99, 86% of immigrants to Israel were from the FSU, 4% from Ethiopia and 10% from other countries. May 2016 Immigration and mortality - Dov Raphael 8
Immigration in the 1990s relative to the existing population M+F Total 0-29 30-64 65+ Immigration 1990-99 818,632 356,102 358,809 103,721 General pop 1990 4,572,905 2,571,148 1,575,033 426,724 Ratio 18% 14% 23% 24% M Total 0-29 30-64 65+ Immigration 1990-99 366,635 166,781 159,619 40,235 General pop 1990 2,276,235 1,315,322 768,249 192,664 Ratio 16% 13% 21% 21% F Total 0-29 30-64 65+ Immigration 1990-99 451,997 189,321 199,190 63,486 General pop 1990 2,296,670 1,255,826 806,784 234,060 Ratio 20% 15% 25% 27% The resources needed for such a massive exodus were tremendous. Unlike economic immigration (e.g. to Canada), older age-group are over-represented! May 2016 Immigration and mortality - Dov Raphael 9
Russia and Israel: A huge disparity in life expectancy May 2016 Immigration and mortality - Dov Raphael 10
What would we "expect" as a result of this massive immigration? M birth M 65 F birth F 65 Israel life expectancy 1990 75.3 16.6 78.8 18.7 Russian life expectancy 1990 63.8 11.1 74.3 15.1 % of immigrants 16% 21% 20% 27% Expected weighted average 73.7 15.6 78.1 17.9 Expected reduction in LE 1.6 0.9 0.7 0.8 This calculation is illustrative only, since it is clear that the average life expectancy of the immigrants would be higher than the average population of Russia or the Soviet Union. Even so, in influx of close to 20% of the existing population would be expected to have some effect. Many of the immigrants came from the Ukraine and other countries formerly part of the Soviet Union. LE in the Ukraine was 65(M) and 75(F), very similar to Russia. May 2016 Immigration and mortality - Dov Raphael 11
What actually happened? May 2016 Immigration and mortality - Dov Raphael 12
The slowdown in LE improvement occurred shortly after the massive immigration May 2016 Immigration and mortality - Dov Raphael 13
A similar picture emerges for LE at age 65, for males and females Data adjustment from census, not representative May 2016 Immigration and mortality - Dov Raphael 14
An attempt to estimate the LE at 65 of the immigrants Assume LE of veteran population continued to improve according to the trends seen before 1990. Yea r Actual LE Total population Projected LE of veteran population No of immigrants each year Cumulative no of immigrants Derived LE of immigrants LE in Russia in that year 1991 15.89 204,281 16.02 8451 16,991 11.91 1992 15.76 215,384 16.16 3613 20,604 11.75 1993 16.16 221,120 16.30 3536 24,141 10.76 1994 16.22 227,697 16.44 2879 27,019 14.59 10.42 1995 16.16 233,052 16.58 3029 30,048 13.32 10.80 1996 16.57 240,025 16.72 2822 32,870 15.62 11.10 1997 16.43 245,502 16.86 2507 35,377 13.86 11.19 1998 16.52 251,360 17.00 1792 37,168 13.73 11.36 1999 16.68 255,554 17.14 3067 40,235 14.19 11.00 2000 16.88 261,820 17.29 1596 41,832 14.74 10.85 2001 17.12 267,687 17.43 1847 43,678 15.54 10.85 2002 17.25 274,928 17.57 1262 44,941 15.62 10.65 2003 17.32 282,661 17.71 1125 46,065 15.32 10.66 May 2016 Immigration and mortality - Dov Raphael 15
The calculations are illustrative only, but seem to support the idea that LE of the immigrants was better than the general population of Russia but less than the veteran Israeli population. May 2016 Immigration and mortality - Dov Raphael 16
Some comments on the gender gap Russia, followed by other countries in Eastern Europe, has the highest gender gap between LE at birth for females compared to males. Until recently, Israel had the lowest gap among countries in the HMD: currently it is similar to the UK and USA. Has the immigration from the FSU had any effect? May 2016 Immigration and mortality - Dov Raphael 17
Is the gender gap in LE affected by the wave of immigration? It is hard to tell if there was any appreciable effect from the immigration in the 1990s. The gender gap in Israel rose from 3.5 in 1990 to 4.3 in 2000, but has since declined again to 3.7 in 2014. May 2016 Immigration and mortality - Dov Raphael 18
Is the gender gap in LE affected by the wave of immigration? The corresponding comparison for age 65 shows a significant increase in the gender gap, but it seems to have started in the 1980s, before the immigration. Researchers have tried to find explanations for the low gender gap in Israel compared to Western Europe such as lower alcohol consumption, genetic predisposition to female cancers, and under-diagnosis of medical conditions in women. May 2016 Immigration and mortality - Dov Raphael 19
A comprehensive study using data not publicly available analyses this topic in more detail Noncommunicabledisease mortality and life expectancy in immigrants to Israel from the former Soviet Union: country of origin compared with host country Jördis Jennifer Ott, Ari M Paltiel & Heiko Becher Bull World Health Organ 2009;87:20 29 doi:10.2471/blt.07.045138 Several countries, including Finland, Germany, Greece, Hungary and Israel, have immigration policies that encourage migration on the basis of common ancestry. Such diaspora migrations were especially numerous following the fall of the Iron Curtain, a notable example being the arrival in Israel of about 1 million immigrants from the former Soviet Union (FSU) between 1989 and 2003. Most were Jews, and about one quarter were non-jewish family members. The proportion of highly educated professionals among them was much higher than among the Israeli population, but so was the proportion of single-parent families and elderly people. Although these migrants have enjoyed generous conditions of reception, the new country s health system, standards of medical care, lifestyles and environment have differed greatly from those in their country of origin. Such changes, in addition to a decline in social standing and the difficulties of integration, are factors that should have an effect on mortality rates. May 2016 Immigration and mortality - Dov Raphael 20
A comprehensive study using data not publicly available analyses this topic in more detail(continued) The arrival in Israel of migrants from the FSU was expected to cause a significant rise in Israel s mortality rates. However, a study of mortality among Jews in Moscow showed that these men and women had lower mortality rates than did other ethnic groups within Russia, even when controlling for their relatively high educational level. Mortality among immigrant groups is known to be affected by stress from having to cope with a new social and cultural environment or a downward shift in employment status. Conclusion: Noncommunicable disease mortality among FSU immigrants to Israel is lower than in the population of the Russian Federation. Mortality rates in FSU immigrants, particularly from circulatory diseases, have rapidly adjusted and have become similar to those of the destination country. However, immigrants from the FSU have considerably higher mortality than other Israelis from external causes and some noncommunicable diseases such as cancer. Mortality rates in these diaspora migrants show a mixed picture of rapid assimilation together with persistent country of origin effects, as well as the effects of adjustment hardships. May 2016 Immigration and mortality - Dov Raphael 21
A comprehensive study using data not publicly available analyses this topic in more detail(continued) May 2016 Immigration and mortality - Dov Raphael 22
Comments and conclusions Population mortality shows heterogeneity for many reasons (ethnic, geographic, socio-economic ). Migrant populations can be expected to have lower mortality than the norm. TheimmigrationfromtheFSUtoIsraelisunusualbecauseofthe enormous gaps between the two populations, and the significant increase in the absorbing country. The immigrants undoubtedly had lower mortality than the general Russian population, probably since many (but not all) belonged to higher socio-economic groups, and perhaps due to cultural factors(less alcohol?). Theirlifeexpectancymay haveimprovedas a result of the move to Israel (e.g. better health care), although stresses resulting fromthemovemayhavehadanegativeeffect. May 2016 Immigration and mortality - Dov Raphael 23
Comments and conclusions Estimating longevity improvements for pension liabilities is problematic in a changing population. In general, the Israeli population shows a golden cohort effect similar to Western Europe. A slowing down of longevity improvements was noted at the time of the mass immigration (early 1990s) As a result, there may have been an underestimate of mortality improvements in the existing population. The gender gap is low is Israel relative to other developed countries; there has been some increase, but this does not seem to be the result of immigration. May 2016 Immigration and mortality - Dov Raphael 24
Acknowledgements Bridget Browne, former member of the MWG Avi Bar-Or, ILAA Ari Paltiel, Israel Central Bureau of Statistics Disclaimer The views expressed in this presentation are those of the author only and do not reflect opinions of the International Actuarial Association or of the Israel Association of Actuaries. May 2016 Immigration and mortality - Dov Raphael 25
Thank you for your attention! Dov Raphael Consultant Actuary Tel +972 26541430 dov@4actuaries.co.il May 2016 Immigration and mortality - Dov Raphael 26