Why are people so opposed to immigration? #142538

As the evidence piles up that migrants don’t steal jobs (one of the implications of them being human beings is that migrants also buy stuff - so they create exactly as many new jobs as they “take”), some of the more sophisticated immigration opponents turn to the negative impacts of immigration on other things such as housing or public services instead to support their case.

So what does the research evidence say about the impacts of immigration on public services? Really very little actually. The University of Oxford’s Migration Observatory says that there is “no systematic data or analysis.” In health, we know that many healthcare providers are immigrants, but it’s hard to know the impact of migrants as users of health services as (rightly) nobody records people’s migration status when they go to the doctor.

Using household survey data, Jonathan Wadsworth at Royal Holloway found that (shock!) immigrants tend to use GP services and hospitals at roughly the same rate as natives (via Ferdinando Giugliano in the FT).

Taking another approach, a new paper by Osea Giuntella from the Blavatnik School of Government at Oxford, combines household survey data with administrative data on NHS waiting times. Do you need to wait longer for a referral or in A&E in places where there are more immigrants? Come find out at the CGD Europe research seminar on Weds 18 Nov (there will be sandwiches).

Global Organ Trade

Here’s a great idea from Al Roth, the 2012 Economics Nobel Prize winner.

Al got his prize for developing his theoretical matching ideas into a computerized kidney exchange - so if you want to donate a kidney to a family member but you aren’t the right match, you can find another pair of people in the same situation from a different city and criss-cross the pairing, so both kidney transplants can go ahead.

In his new book (reviewed here by Alex Tabarrok), Al proposes extending the kidney exchange internationally.

"Mr. Roth, however, wants to go further. The larger the database, the more lifesaving exchanges can be found. So why not open U.S. transplants to the world? Imagine that A and A´ are Nigerian while B and B´ are American. Nigeria has virtually no transplant surgery or dialysis available, so in Nigeria patient A’ will die for certain. But if we offered a free transplant to him, and received a kidney for an American patient in return, two lives would be saved.

The plan sounds noble but expensive. Yet remember, Mr. Roth says, “removing an American patient from dialysis saves Medicare a quarter of a million dollars. That’s more than enough to finance two kidney transplants.” So offering a free transplant to the Nigerian patient can save money and lives. It’s hard to think of a better example of gains from trade (or a better PR coup for the U.S. on the world stage). Better matching with computerized markets is saving lives, but more than 100,000 people are still waiting for kidneys in the United States alone."

The IMF and Ebola

The debate rumbles on at the Monkey Cage, as Blattman responds to the response by the authors of the Lancet article to his response to their article. I find the debate mostly quite infuriating. To massively oversimplify, what tends to happen when IMF intervention is required is that;

1. Poor country governments spend more than their income for too long

2. They can't find enough people to keep lending them money

3. The IMF comes in as the lender of last resort, quite reasonably tells the government "look, we aren't a commercial lender, we're only lending because we have to, you're going to have to stop spending more than you're bringing in, because that is completely unsustainable"

4. Western academics criticise the IMF for forcing poor countries to cut their spending.

It's a bit like blaming firefighters for causing fires because they are always at the scene of the fire. The IMF isn't some kind of magic money tree. It only gets involved when countries have got themselves into a crisis. 

What complicates this narrative a little is the difference between austerity at home and austerity in poor countries, which are not the same thing. The UK can very happily carry on spending more than its income quite indefinitely, because commercial lenders continue to be very happy to lend enormous amounts at very low interest rates to the UK government, unlike the governments of very small, very poor, fragile states. It is ok and entirely consistent to rail against austerity in the West, and simultaneously support fiscal discipline (not spending more than your income) in poor countries. At least, it is odd to blame the IMF for not letting poor countries spend more than their income indefinitely, when money grows on trees for neither poor country governments nor the IMF.

Hey! Teacher! Leave them kids alone!

Matt has a post up on the clear highlight of the first day of Young Lives 2013 - the final plenary by Lant "Dude is so famous he doesn’t even bother wearing a name tag" Pritchett.

Pritchett’s point was fairly simple: in many settings school can be a pretty awful place to be, especially if the curriculum is moving faster than you can keep up with it. Eventually, all but a select few are left behind, leading to a “flattening out” of the learning curve. At this point, you can’t really learn anything when you are this far behind, so why stick around? At one point - and without warning - Pritchett presented an entire slide in Spanish, to give the audience a sense of how this must feel.

The bottom line is really quite depressing - there are thousands and thousands of kids out there sitting in classrooms learning absolutely nothing.

The other highlight for me was Karthik Muralidharan's plenary - apparently one of the first papers to measure and illustrate the learning progress (or lack of) of individual children as they progress through school years - on a comparable ordinal scale. The approach is smart, borrowing from the "Item Response Theory" used in GRE tests, and allows you to estimate for example whether grade 5 students can answer grade 1 questions without having to ask them. The key policy take-away was that clearly we need more of this kind of testing being done with the same kids on an annual basis. At present, we have a few snapshot surveys of learning outcomes in random years in random countries, and almost nothing in most countries that can reliably tell you something meaningful about the progress that children are making. Part of this will hopefully be solved in a few years as countries sign up to a new post-2015 development goal on learning outcomes and then realise that they have committed to figuring out a way of actually measuring them. This stuff is important. As Karthik noted, all of the RCT randomista experimental literature looks at how much an intervention impoves treatment schools compared with control schools, but misses the larger point that nobody has a clue how much progress the control schools are making over time if any (as you might expect given general economic growth).

Naureen Karachiwalla and Abhijeet Singh both presented really interesting papers, documenting in detail the role of caste in determining learning outcomes in Pakistan, and differences between public and private schools in India, respectively (bottom line: they perform similarly, but private school teachers cost around a fifth of public school teachers so private schools are a lot cheaper to run).

The nonparametric bayesian econometrics (I think that's what it is...) was maybe a bit much for me first thing this morning, but the point to note for survey designers emphasised by Costas Meghir was that the cutting edge Heckman "latent factor" model tools for estimating human capital, cognitive and noncognitive skills, or whatever you want to call it, are data hungry. You need a few (at least 3) different measures of each concept that you are trying to proxy for.

That's all for now, time to sleep. 

Young Lives 2013 (pre-match analysis)

Good morning from Oxford. As you'll already know from reading AidThoughts, the inaugural Young Lives Conference is happening today and tomorrow, and Matt and I will be furiously blogging (like this guy) and tweeting all the good bits at #younglives. You can see the programme and papers here.

First a bit of background: Young Lives is a project at Oxford University which is following thousands of children from Ethiopia, India, Peru, and Vietnam, talking to them and their households every 3 years for 15 years as they grow up, with quantitative and qualitative components. RCTs aside, this kind of longitudinal survey is pretty rare in developing countries to begin with, but in addition to all the standard demographic and socio-economic information, this survey also measures malnutrition, learning outcomes (language and maths), and asks the children directly about their experiences, hopes, and aspirations. (I just tried to see if I could download the actual questionnaire to see what the wording of the questions was, but apparently you need to be part of an academic institution to use the UK data archive where they are kept, which is a bit annoying).

The conference seems to be all economists, which I'm obviously not really going to complain about but it might have been interesting to see some of the fruits of the qualitative work. There are some really big names in the economics of education; Paul Glewwe, Lant Pritchett, Karthik Muralidharan, Jere Behrman, Stefan Dercon, and also some guy called Abhijeet Singh.

Now a bit of a quibble: the conference is organised around the theme of inequalities in children's outcomes. I remain unconvinced about the whole inequality narrative which is being pushed at the moment. You don't have to agree with Mankiw (I don't) to recognise that talking about inequality turns off a lot of people on the right. I still think the last UK Labour government made a great tactical move by tackling inequality and doing redistribution by defining child poverty by a measure of inequality. You can argue with caring about inequality, it's much harder to argue with caring about child poverty. But the focus here is not income inequality but inequality in outcomes. But in a sense isn't it still true that "we are all poor here?" Should we focus on the differences in health outcomes between the children who are only a bit malnourished and the ones who are totally stunted for life, or just despairing about how badly off they all are?

Finally, on my last count there were close to 60 papers being presented here, so we're going to struggle to even scrape the surface here, so do take a look yourself. I think the plan is also to stream the plenaries online. And just as a warning, if Matt is off his best blogging game today, you should cut him some slack, it might have something to do with all the rigorous qualitative research he was doing yesterday into the positive impact of post-war caribbean migration on contemporary British culture (the Cowley Road carnival in the baking heat yesterday might have been the best thing that has happened in Oxford in 1000 years, well worth missing Wimbledon for. So no pressure Young Lives but this conference better be good).

Excellent World Bank blogging

This is very entertaining. Apparently its now ok for World Bank staff to elaborately and brazenly take the piss out of the editor of the Lancet and DFID staff. HT: JustinSandefur

Mental illness in Juba

This is a photo by Hannah McNeish of a mentally ill lady abandoned by her family and locked up in Juba Prison, where

"she receives no psychiatric drugs or any other care. In a city described quite aptly yesterday as "an aid orgy" that the journos claimed surpasses Kabul and Eastern DRC, it's horrible to know that there are around 50 people trapped in dark and dirty cells in the capital going slowly madder as there is no money for medicine."

I saw something similar in a slum in Nairobi. Winding through a dark dirty crowded maze of alleys and dwellings I caught a glimpse of what seemed to be a person locked in a small dark room. I was in a hurry and it wasn't the safest part of town so I didn't stop to ask questions but it creeped the hell out of me. Here is more from Hannah on prisoners in Juba.

Does deworming really work?

The latest Cochrane Collaboration review of the evidence on the impact of deworming on various outcomes has come out decidedly less than optimistic.

Here's a summary by the very smart Alexander Berger from Givewell, some discussion on the Public Library of Science blog including comment from one of the Cochrane authors and Alan Fenwick from SCI, and finally a rebuttal to the review's findings on schooling from IPA, JPAL, CEGA, Deworm the World, and the authors of the original Busia experiment on deworming.

I haven't spent enough time looking at the details to come to a strong opinion here, but one point made on the IPA blog seems evidently correct - random assignment should be enough to ensure pre-treatment balance between treatment and control. That is the whole point of random assignment. And  following the recent debacle of the medical journal the Lancet being forced to retract the key finding of a social-science-y study after some actual social scientists pointed out a mathematical error, combined with my disciplinary and professional loyalties, I'm inclined to go with the social scientists rather than the doctors on this one.


Update: Thoughts from David McKenzie

The Lancet's editors don't get evaluation (sadface)

So Matt beat me to the punch on Friday on the Lancet Millennium Village retraction. Since then I've being trying to think of a polite way of expressing my total dismay and despair at the tripe written by the Lancet editors in response to the retraction (for which, by the way, a little bit of Kudos to Pronyk et al).

The Lancet editors write:

The Millennium Villages project team has quickly and commendably corrected the record after understanding the validity of the challenge it received. But the withdrawal of this element of the paper does not detract from the larger result—namely, that after 3 years Millennium Villages saw falls in poverty, food insecurity, stunting, and malaria parasitaemia, together with increases in access to safe water and sanitation.

Which is just total nonsense. For all we know, poverty fell in the Villages at the exact same rate as everywhere else. That is not an important result to be celebrated. I challenged Lancet editor Richard Horton on twitter as to why he would continue to emphasise this non-result, and he responded with yet more nonsense;

1. richardhorton1 @rovingbandit To be fair, there were falls in each of the 5 MDG-1 poverty/nutrition measures, but these were not statistically significant. 18 May 2025 from web

That isn't even true. The first of the measures - wealth - is the opposite of poverty. It is *wealth* that fell (statistically insignificantly) in the Villages relative to comparisons. I despair. And kind of question my own sanity. Despite what Tim Worstall says, I'm really not a scientist, but its pretty galling that people say economics is not a science like the physical sciences when this is the kind of guff published by the world's top medical journal.

Bill Easterly has a whole long list here of more terrible social science published in medical journals. At the bottom of the post, Ben Goldacre comments

i think journals publishing things outside of their field of expertise is risky, but i wld caution against developing a world view that economics journals are in a better shape overall than medical ones. as someone who flits into both, there are lots of things that are routine in medical journals, to a greater or lesser extent, but notably almost unheard of in economics. stuff like declarations of conflict of interest, structured write-ups, registering a protocol in advance of doing a study, etc. all of which wld be great to see more of outside medicine.

All of which is true. In particular I am struck by how easily readable a short, structured, 4 page Lancet write-up is. There are definitely lessons to be learnt across disciplines both ways. It's just an incredibly sad state of affairs that one of the lessons that journals of medicine, the discipline that gave us randomized controlled trials, needs to learn from economics, is a more careful attention to statistics and causality. 

"What's killing us"

Alanna Shaikh's new book is a nice quick fun read, packed full of things I didn't know on almost every page.

Some (on reflection, almost a little too extensive?) highlights:

Fifty-two percent of the women in Gabon are overweight, and so are 50 percent of the women in Zimbabwe and 53 percent of the women in Botswana. And obesity isn’t limited to Africa. Forty percent of the women in Thailand are overweight, as are 49 percent of the women in Bhutan (location 120).  

TB is our biggest global pandemic, though it doesn’t always make headlines. One out of every three people on this planet is infected with TB bacteria. (location 258) 

Each year, nearly 8 million children under the age of 5 die from disease. Six conditions cause 90 percent of those deaths: neonatal (early infant) illnesses, pneumonia, diarrhea, malaria, measles, and HIV/AIDS. Most of the deaths could be prevented, and it wouldn’t be all that expensive to do so (location 376) 

And, surprisingly, better access to drugs isn’t the most important issue. What’s really needed are more health care providers with better skills. About 75 percent of child deaths are in Africa and Southeast Asia (location 379) 

We’ve already seen dramatic decreases in child mortality. From 1960 to 1990, child mortality in developing regions was reduced by half. Continuing to bring down the number of child deaths is largely a case of continuing to do the stuff that works and targeting the areas of child mortality we haven’t made progress in yet (location 380) 

70 percent of the deaths in children under 5 years old could be prevented or treated with simple, low-cost interventions (location 395) 

The real cause of maternal mortality is gender discrimination. In the U.S., for example, maternal mortality didn’t improve as the country grew richer. It improved in the 1920s, when women finally gained the right to vote. You can see the same pattern in other countries; as women gain political rights and greater decision-making power, maternal mortality decreases (location 454) 

Maternal mortality doesn’t improve along with other health issues; it improves only when women begin to be treated equally (location 458) 

Based on current projections, antibiotics will stop working in 10 years. Completely. (location 495)

 Recommended. 

How Sierra Leone provided Free Health Care

On April 27, 2010, Sierra Leone started free health care for pregnant women, new mothers, and young children. John Donnelly takes an in-depth look at how the war-torn nation managed it.

There is even a brief cameo by Juba's finest payroll consultants;

A consultant from Booz & Company did an extensive analysis of the ministry's payroll of more than 7000 workers, which included all employees, even those who worked in remote health posts throughout the country. The analysis found more than 850 phantom workers, who were mostly retirees still receiving their salaries, however paltry. Those people were removed from the payroll, allowing the ministry to add 1000 new workers.

Stirring stuff - well worth reading the rest in full at the Lancet (although that Booz consultant does describe this as the "Hollyoaks version" of the story).

Very Serious UK Health Policy Analysis

via The Guardian

Migration: Good for your wallet, not so good for your blood pressure

Over 200 million people live outside their country of birth and experience large gains in material well-being by moving to where wages are higher. But the effect of this migration on health is less clear and existing evidence is ambiguous because of the potential for self-selection bias. In this paper, we use a natural experiment, comparing successful and unsuccessful applicants to a migration lottery to experimentally estimate the impact of migration on measured blood pressure and hypertension…
the results suggest significant and persistent increases in blood pressure and hypertension, which have implications for future health budgets given the recent worldwide increases in immigration.

From a new Working Paper by John Gibson, Steven Stillman, David McKenzie, and Halahingano Rohorua. David McKenzie is an IPA research affiliate and has lots of interesting research on migration.
Don’t say my migration coverage is one-sided.
In other migration news,

Immigrants should pay a bond of £5,000 to cover the costs of using public services, a key ally of David Cameron suggests.
Tory MP Nick Boles - a friend and former aide of the Prime Minister - has urged the Government to impose a ‘surety’ on migrants before granting them visas.

Which almost sounds like Gary Becker’s proposal to charge immigrants for entry. Sounds like a good idea to me. If there are health costs to the public purse from migration and migrants are willing to pay those costs out of their massively increased earnings, then why the hell not?

On healthcare and luck

New post on the IPA blog. (Photo credit: Emily Oriel Lowe)

From the annals of weird aid

There are two ambulances parked outside of the Ministry of Health in Accra.

Donated by the Government of…..wait for it…..

the Islamic Republic of Iran.

Malaria almost eradicated from Zanzibar?

Apparently rates have fallen from 38% in 2008 to less than 1% in 2010. Too good to be true?

IRIN via African Politics Portal

Is migration at fault for poor healthcare in Africa?

You can probably guess what I think. Here is the OECD and WHO:

What is the impact of migration on less developed countries?

“In 2000, all African-born doctors and nurses working in the OECD represented no more than 12% of the total shortage for the region, as estimated by WHO. The corresponding percentage was even lower in Southeast Asia (9%). International migration is neither the main cause of healthcare shortages in developing countries, nor would its reduction be enough to address to the worldwide health human resources crisis. It is true, however, that in less developed countries that have particularly high emigration rates, emigration contributes to exacerbate the acuteness of health workforce problems and further weaken already fragile health systems.”

How can countries respond?

Source countries need to strengthen health workforce retention. Such policies should focus on rural areas, as there seems to be a link between internal and international migration. (Most international migrants come from urban areas although the most acute shortages tend to be in rural areas.)