NATURAL EXPERIMENTS BUT DO

NOT CONTROL VARIABLES

Natural Experiment Evidence on the Effect of

Migration on
Blood Pressure and Hypertension
John Gibson, University of Waikato and Motu Economic and Public Policy Research
*
Steven Stillman, Motu, University of Waikato, IZA and CReAM
David McKenzie, Development Research Group, World Bank, IZA and CReAM
Halahingano Rohorua, University of Waikato
 PROBLEM STATEMENT
FINDING THE EFFECT OF MIGRATION ON
HEALTH
• comparing successful and unsuccessful applicants to a
migration lottery to experimentally estimate the impact of
migration on measured blood pressure and hypertension.
• Keywords: Blood pressure, Hypertension, Lottery, Migration, Natural
experiment.
 REASONS FOR THE EXPERIMENT

• Hypertension is a predominant and costly public health

problem
• Hypertension is more rampant as one migrates
• It is a good inverse indicator of the overall well being of
particular population groups across
countries(Blanchflower and Oswald(2008)
 TECHNICAL APPROACH
• The approach is biological based on the comparison the effect of
migration on blood pressure and hypertension.
• The rejected group was a control and comparisons were made
with the migrants.
• They started by examining two sample sub-groups for systolic and
diastolic blood pressure and the incidence of measured and self-
reported hypertension.
 TECHNICAL APPROACH

• The unweight count of observations and the results of

tests of hypotheses for equal means for each sub-group
was stated.
• They randomly selected 120 non-applicant households
 RESULTS

• Average blood pressure of migrants was higher than the

control group of ballot losers in Tonga, by between 2.4 mm.Hg
(diastolic) and 3.6 mm.Hg (systolic).
• The incidence of hypertension is also higher, by 9.1% points
when using measured blood pressure and by 3.2% using the
self-report on diagnosed hypertension.
 RESULTS

• The hypothesized pathways for migration to

cause blood pressure increase are stress and
anxiety (Jonas and Lando, 2000), or from the
increased sodium content of a more urbanized
diet.
 CONCLUSIONS
• The selection problems affecting these previous studies
were overcome by analysing a migration program which
uses a random ballot to select amongst an excess number
of applicants.
• Migrating from Tonga to New Zealand leads to increases
in blood pressure.
 CONCLUSIONS

• Hypertension rises by about ten percentage points,

equivalent to over one-third of the standard rate in the
non-migrant population.