The Healthy Migrant Paradox? Internal Migration and Health in China

Background and Purpose. Literature on international migrants from developing countries to the United States, Canada, Australia, and Western Europe note the healthy migrant paradox, that is, immigrants have better health outcomes on a variety of measures than the native-born when they first arrive in the new countries of residence; however, with increasing time in the host society, the immigrant health advantage diminishes significantly. Research on internal migration and health in China presents rather mixed results, suffers from a narrow focus on temporary rural-to-urban migrants, and does not make a distinction based on current hukou (residency registration) status and by place of origin. This study re-examines the healthy migrant phenomenon in China's internal migration process and investigates the different trajectories of place of origin on migrants' self-rated physical health and psychological distress.

Methods. Data come from a pilot survey (N=1,474) conducted in Beijing between May and October in 2009. The target population includes both permanent residents and migrants who are aged 18 to 70 and who are residing in the urban area in Beijing, regardless of the residents' hukou status. The survey employed the Spatial Probability Sampling technology instead of the traditional hukou sampling frame to capture the migrant population. All participants were interviewed face-to-face by trained interviewers. This study focuses on two particular health outcomes: self-rated physical health and K10 psychological distress—both measures have been previously used in the Chinese context. Multivariate regression techniques were used to model the associations between self-rated physical health, psychological distress, and migration experience, controlling for sociodemographic characteristics. Survey design effects (stratum, cluster, and individual weight) were taken into account throughout the analyses to make the weighted sample represent the target population.

Results. Migrants without Beijing hukou reported better physical health status. Migrants of township/small city or countryside origin suffered worse mental health status. The physical health advantage diminished among migrants of township/small city origin but not among migrants from the countryside. Increasing length of residence in the host city reduced the level of psychological distress of urban-to-urban migrants but not of rural-to-urban migrants.

Conclusions and Implications. The healthy migrant phenomenon was observed among migrants on self-rated physical health but not on psychological distress. Different health status trajectories exist between physical health versus mental health and between urban-to-urban migrants versus rural-to-urban migrants. The diminishing physical health advantage indicates that it is necessary to reach out to the migrant population and provide equal access to health services in the urban area. The high level of psychological distress suggests that efforts targeting mental health promotion and mental disorder prevention among the migrant population are in urgent need.