Selective Migration?

1. Selective Migration? Pierre Buekens, MD, PhD

2. Selective Migration • “Healthy migrant effect”: Migrants could be healthier than compatriots who do not migrate (Marmot et al. 1984).

3. Infant Mortality OR Landale et al., 2000

4. Infant Mortality • “…the results from the pooled analysis are more consistent with an emphasis on selective migration than an emphasis on protective cultural content.” Landale et al., 2000

5. Infant Mortality • “There may be problems of access to or quality of neonatal intensive care in Puerto Rico. Consequently, high-risk newborns in the United States may be more likely than high-risk newborns in Puerto Rico to receive the medical interventions necessary to ensure their survival (Becerra at al., 1989).” Landale et al., 2000

6. Low Birth Weight % Landale et al., 2000

7. Low Birth Weight % Weeks et al., 1999

8. Low Birth Weight OR Weeks et al., 1999

9. Birthweight Distributions in Mexico City and Among US Southwest Mexican Americans: The Effect of Altitude Notzon F, Bobadilla JL, Coria I. Am J Public Health 1992;82:1014-1017.

10. Low Birth Weight % Notzon et al., 1992

11. Low Birth Weight % Notzon et al., 1992

12. Low Birth Weight1981-88 Belgian birth certificates % Buekens et al., 1998

13. Birthweight Distributions1981-88 Belgian birth certificates Buekens et al., 1998

14. Ceuta, North Africa • Spanish territory on the Moroccan Coast • Birthweight of singletons born at term: • Moroccan origin: 3428g (non smokers: 3430g) • Spanish origin: 3280g (non smokers: 3318g) Martinez Cortes et al., 1992

15. Selective Migration? • The effect of selective migration on birth outcomes might be relatively small. • Selection might be complex: • High risk linked to poverty and deprivation • Low risk linked to resilience and healthy migrant effect.