Under pressure? Forced migration and public health

• In Event: The Health Consequences of Forced Migration and Democratic Erosion

Abstract

We examine the impact of a large and sudden inflow of refugees on public health and local fiscal capacity in a developing country. Specifically, we provide evidence on the geographically concentrated arrival of Venezuelans in Brazil. For identification, we use distance to the country’s only official border crossing with Venezuela as an instrument for exposure to this shock. We find that a one–percentage–point increase in the refugee share raises overall mortality by 4.2% and infant mortality by up to 9%. We also find evidence of intensified hospital congestion, increased bed occupancy, and preventable admissions. Heterogeneity analysis shows that Venezuelans account for a disproportionately large share of hospitalizations and deaths. Furthermore, we show that healthcare spending lags behind demand, with municipalities bearing most of the costs and diverting funds from education. These patterns reflect two reinforcing mechanisms: the poorer  health status of arriving refugees and the financial constraints of the affected municipalities. Our findings show that, without national support, decentralized universal health systems cannot withstand the pressure of large and highly concentrated migration shocks.

Author

• Renan Chicarelli Marques, Duke University
  Presenting Author