Elsevier

Social Science & Medicine

Volume 59, Issue 8, October 2004, Pages 1613-1627
Social Science & Medicine

Insights into the ‘healthy immigrant effect’: health status and health service use of immigrants to Canada

https://doi.org/10.1016/j.socscimed.2004.02.004Get rights and content

Abstract

This paper combines multiple cross-sections of data drawn from the National Population Health Survey and Canadian Community Health Survey to confirm the existence of the ‘healthy immigrant effect’, specifically that immigrants are in relatively better health on arrival in Canada compared to native-born Canadians, and that immigrant health converges with years in Canada to native-born levels. The paper finds robust evidence that the healthy immigrant effect is present for the incidence of chronic conditions for both men and women, and results in relatively slow convergence to native-born levels. There is only weak evidence in terms of self-assessed health status. The inclusion of controls for region of origin and year of arrival does not account for the observed effects, although region of origin is an important determinants of immigrant health. The paper then considers some alternative explanations for the observed differences, and support is found for the idea that the healthy immigrant effect reflects convergence in physical health rather than convergence in screening and detection of existing health problems.

Introduction

The health of Canada's immigrant population is of prime concern to scholars and policymakers for two main reasons. First, the large number of immigrants resident in Canada means that the health of Canada's immigrants is also an important determinant of general measures of population health, and so is directly related to issues of the cost and adequacy of the Canadian healthcare system. According to data from the 2001 Census, 18% of Canada's population was born in another country, and over 250 000 people gained permanent residency in 2001 alone. Second, the health of Canada's immigrants is one important determinant of the costs and benefits of immigration policy, and so relates to questions such as whether immigrants constitute an undue burden on Canada's taxpayer-funded healthcare system. More broadly, immigrant health is an important component of the general issue about whether Canada is maximizing the returns to its large-scale immigration program.

A key question relates to the time path of immigrant health, i.e., what happens to an immigrant's health as he or she spends more time in the new country. Much of the recent literature on immigrant health has focused on identifying the presence and magnitude of what is known as the ‘healthy immigrant effect’—an observed time path in which the health of immigrants just after migration is substantially better than that of comparable native-born people, but worsens with additional years in the new country (denoted YSM—years since immigration).

The current paper contributes to this literature in two main ways. First, we present new evidence on the healthy immigrant effect for Canada, using multiple cross-sections from large micro-level datasets that allow for control of unobserved (cohort) effects, place of birth, and country of origin that could otherwise obscure the true YSM effect on immigrant health. Second, we provide some preliminary evidence on what might be underlying the estimated YSM effects on health, by analyzing immigrants’ use of some basic health services. Similar patterns in the use of these health services might indicate that barriers in the access of health services by recent immigrants are contributing to relatively lower reported incidence of health conditions, giving the impression of relatively healthier immigrants.

The outline for the paper is as follows. Following a review of recent literature in the literature section, the subsequent section sets out an empirical framework for analyzing health status and specifies the estimating equations. This is followed by a section on description of the data and the construction of the sample used in estimation. The next section presents and discusses the main results. The paper then attempts to identify some possible underlying reasons for the observed differences in health patterns in the penultimate section by considering immigrant use of health services and by examining the incidence of specific health conditions. The final section concludes by summarizing the main results and outlining avenues for future research.

Section snippets

Review of the literature

Health researchers use a range of measures as indicators of health status, including the existence of diagnosed chronic health conditions, limitations in mobility, and indicators of general health as measured by subjective self-assessment. (See Kinnon, 1999; Hyman, 2001, for recent reviews.) Evidence of a healthy immigrant effect is reported in Chen et al., (1996), who use the 1994–95 wave of the National Population Health Survey (NPHS), Newbold and Danforth (2003) who use the 1998–99 wave of

Determinants of health

Following Frank (1995) and Dunn and Dyck (2000), our theoretical starting point is the ‘population health’ perspective that defines the major determinants of health status to be cultural, social and economic factors rather than medical care inputs and utilization per se. Although age and gender are key determinants of individual health, the importance of measures of socioeconomic status such as income and education is also well-established in the Canadian and international literature. We

Data sources and descriptive statistics

We make use of pooled cross-sectional data drawn from two large unit record datasets on health outcomes and health services use published by Statistics Canada. These are the 1996 wave of the National Population Health Survey (NPHS) and the 2000–01 wave of the Canadian Community Health Survey (CCHS). The NPHS and CCHS are comparable in terms of survey design and collection, and both surveys are representative of the Canadian population (although the NPHS collects information on people of all

Cohort and YSM effects

The first issue of interest is whether there are significant differences in the health of immigrants compared to the native-born after controlling for differences in age and other characteristics that are important determinants of health. Coefficient estimates for the immigrant variables obtained from estimating specification (1) are reported in Table 2a for men and Table 2b for women. (Other coefficient estimates are reported in appendix Table 4.) For each measure of health, we report the

Access to basic health services

One possible reason for the apparent decline in immigrant health in terms of chronic conditions is that for recent immigrants, chronic conditions may be more likely to go undiagnosed. This may be due to social, cultural or language differences that mean recent immigrants—particularly those from NESB regions—are less likely to interact with Canada's health system the same way that native-born Canadians do. However, with increasing years in Canada, these differences narrow as health services are

Discussion

This analysis finds a number of robust results that give some insight into the determinants of immigrant health. First, there is compelling evidence of a healthy immigrant effect for recent immigrant arrivals, with both immigrant men and women significantly less likely to have been diagnosed with a chronic condition than otherwise comparable native-born Canadians. Immigrants also continue to be relatively less likely to have a chronic condition, even after many years in Canada. However, there

Acknowledgements

We would like to thank Nick Biddle, Lori Curtis, Brian Ferguson, Bruce Newbold, Doug Willms, conference participants at the 2003 Canadian Economics Association meetings and two anonymous referees for helpful comments. Financial assistance from SSHRC (grant # 410-2002-1357) is gratefully acknowledged. The econometric analysis in this paper was conducted at the Statistics Canada-CRISP Research Data Centre at the University of New Brunswick.

References (24)

  • Globerman, S. (1998). Immigration and health care utilization patterns in Canada. Vancouver: Research on Immigration...
  • Hyman, I. (2001). Immigration and health. Health Policy Working Paper 01-05. Ottawa: Health...
  • Cited by (0)

    View full text