Health status of Canada's immigrants

Two studies released today shed light on the so-called "healthy immigrant effect," which suggests that immigrants are healthier than the Canadian-born population, even when accounting for age differences between the two groups.

The health status of immigrants may be influenced by their personal characteristics as well as by the health requirements for entry into Canada. However, it has been observed that the longer immigrants live in Canada, the more their health resembles that of the Canadian-born population.

It has been speculated that among the reasons for this is that, over time, immigrants tend to emulate other Canadians' health-related behaviours, such as smoking and dietary patterns. The two new studies are aimed at updating our knowledge of this healthy immigrant effect, one focussing on physical health and the other on mental health.

Previous research has looked at the physical health of immigrants, such as the presence of chronic conditions. The new physical health study revisits the issue by examining current available data on chronic conditions in general, but also focusses on four specific conditions: heart disease, diabetes, high blood pressure and cancer. It also explores the role of health behaviours in explaining health patterns.

The study that looks at the mental health of immigrants uses measures of depression and alcohol dependence to examine the healthy immigrant effect.

Immigrants and Canadian-born similar in terms of diabetes, high blood pressure and cancer

According to the study Health status and health behaviour among immigrants, based on the 2000/01 Canadian Community Health Survey (CCHS), 59.6% of immigrants reported that they had a chronic condition.

Consistent with previous research, this rate was significantly lower than the 65.2% for the Canadian-born population. Even after adjusting for age, education and income, the differences between immigrants and non-immigrants persisted. The study also revealed that the incidence of chronic conditions in general rose with time since immigration to Canada.

Moreover, immigrants who had been in Canada the longest had health outcomes similar to those of their Canadian-born counterparts, again accounting for age and other factors. Thus, in terms of chronic conditions in general, immigrants and non-immigrants appear to converge in health status over time. However, cross-sectional data cannot confirm this.

Since the data show that more recent immigrants are also healthier than those immigrants who have been here longer, another possible explanation for these patterns may be that newer immigrants constitute a healthier cohort than their counterparts who immigrated earlier; that is, they were healthier at the time of their arrival in Canada than were those who immigrated earlier.

Another possibility is that the healthiest immigrants eventually leave Canada, and the comparatively less healthy immigrants remain in this country.

The results were not consistent, however, for the specific chronic conditions under study. Newly-arrived men had lower odds than Canadian-born men of reporting heart disease; but for diabetes, high blood pressure and cancer, there appeared to be no advantage for either male or female immigrants over their Canadian-born counterparts.

Data adjusted for age, education and income showed that the odds of reporting these conditions were similar for immigrants and the Canadian-born population. This shows that the healthy immigrant effect does not necessarily apply to all measures of physical health.

In addition, the study found that poor health behaviours, such as smoking, heavy drinking and obesity, differed between immigrants and the Canadian-born population and varied with the length of an immigrant's residence in Canada.

However, first-generation immigrants do not necessarily adopt health-related lifestyle changes to the point of eventually resembling other Canadians. Furthermore, differences in behaviours accounted for little of the differences in chronic diseases between immigrants and non-immigrants.

Mental health of immigrants: Lower rates of depression and alcohol dependence

According to the CCHS, in 2000/01, 7.9% of Canadians aged 15 to 75 reported having experienced at least one major episode of depression in the 12 months before the survey. The rate among people born in Canada was 8.3%, whereas the rate among immigrants was significantly lower, at 6.2%.

Similarly, 2.1% of Canadians reported having experienced problems with alcohol dependence. Such symptoms were reported by 2.5% of the Canadian-born population, but only 0.5% of immigrants. The patterns for depression and alcohol dependence held when the rates were adjusted for age and sex.

This healthy immigrant effect was strongest among recent immigrants, according to the study Mental health of Canada's immigrants. Those from Asia in particular had the lowest rates of depression, and those from Africa had the lowest rates of alcohol dependence.

These two trends are related, since recent immigrants have tended to come from Africa and Asia, whereas the majority of those who immigrated more than a decade ago came from Europe. Earlier immigrants have similar rates of depression as the Canadian-born population.

The study examined whether the lower rates of depression and alcohol dependence among immigrants were the result of demographic or socio-economic differences between immigrants and the Canadian-born population.

After accounting for such factors as age, sex, marital status, income and education, all immigrants except those who arrived at least 30 years ago had lower rates of alcohol dependence than the Canadian-born population. Similarly, adjustment for these demographic and socio-economic factors did not affect the patterns for depression. In other words, they do not account for the healthy immigrant effect.

Furthermore, the study found that language barriers, immigrants' higher unemployment rates, and their lower sense of belonging to the local community did not diminish this gap with respect to either depression or alcohol dependence.

These results on measures of mental health are consistent with previous findings on physical health, which showed that immigrants in Canada are in better health than the Canadian-born population. On the whole, immigrants reported fewer mental health problems than the Canadian-born population.

Information on methods and data quality available in the Integrated Meta Data Base: survey number 3226.

The studies Health status and health behaviour among immigrants (82-003-SIE, free) and Mental health of Canada's immigrants (82-003-SIE, free) are now available on Statistics Canada's Web site (). From the Our products and services page, choose Free publications, then Health.

For more information, or to enquire about the concepts, methods or data quality of the article on health status and health behaviour, contact Claudio E. Perez (613-951-1733; perecla@statcan.gc.ca), Health Statistics Division.

For more information, or to enquire about the concepts, methods or data quality of the article on the mental health of immigrants, contact Jennifer Ali (613-951-4798; jennifer.ali@statcan.gc.ca), Health Statistics Division.