Medical screening plays a role in explaining the healthy immigrant effect (HIE) among immigrants newly landed in Canada. The 2002 Immigration and Refugee Protection Act (IRPA) modernized immigration selection by exempting certain immigrant categories (e.g., refugees and certain family-class immigrants) from inadmissibility on health grounds. This study examines the HIE in the IRPA era by sex, with a focus on those categories affected by the IRPA.

Data and methods

The linked Canadian Community Health Survey (CCHS)-Longitudinal Immigration Database (IMDB) was used to compare sex-specific age-standardized proportions of four health measures between Canadian-born and immigrants aged 20 to 65, overall and by duration since landing. Immigrants who landed within three years of the surveys from 2007 to 2014 were examined by sex and immigrant category. Logistic regression was used to further compare the HIE in the same immigrant sub-groups to the Canadian-born, controlling for age and selected confounders.


This study found the HIE in most selected measures for immigrants overall, as well as for those recent immigrants arriving under the IRPA, including the family class. Among refugees, the HIE was observed only in less severe chronic conditions; this was especially the case among females. As expected, a strong HIE was observed among economic-class principal applicants. These health advantages persisted even after adjustment for socioeconomic and health factors. For self-rated health, the advantage existed for some groups only after full adjustment.


This study is a first look at the healthy immigrant effect under the 2002 Immigration and Refugee Protection Act by immigration category. Results corroborate the existing literature on the presence of the HIE among immigrants: the HIE was found to be much weaker among refugees.


immigrant category, refugee, health, Canada, Immigration and Refugee Protection Act, IRPA

DOI: https://www.doi.org/10.25318/82-003-x201900400001-eng


In 2016, immigrants to Canada accounted for 7.5 million people, or almost 22% of the Canadian population. According to Immigration, Refugees and Citizenship Canada (IRCC), almost one million immigrants will be admitted from 2018 to 2020. Given the growth in Canada’s immigrant population, it becomes increasingly important to monitor immigrant health. The well-established literature on the Healthy Immigrant Effect (HIE) finds immigrants to be healthier than the Canadian-born population at their time of arrival, but observes that this health advantage, possibly due to difficulties in adjusting to new environment, stress and/or adoption of risky health behaviors, diminishes over time. Meanwhile, in addition to the Canadian immigration point system, which tends towards the selection of individuals with higher human capital, such as education and language skills for the economic class of immigrants, systematic selection through medical screening tests and positive self-selection were two of the important explanations for the initial health advantage of most immigrants. [Full Text]


Chaohui Lu (Chaohui.lu@canada.ca) is with the Health Statistics Division, and Edward Ng is with the Health Analysis Division at Statistics Canada, Ottawa, Ontario.

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What is already known on this subject?

  • The difference in health outcomes of immigrants to Canada varies by duration since landing.
  • Recent immigrants tended to have the best health. This may be due to medical screening and the admissibility test required by immigration authorities or to other factors.
  • Recent policy changes under the 2002 Immigration and Refugee Protection Act exempt refugees and certain family-class members from medical admissibility requirements.
  • Little research has been done to examine the health of those affected refugees and certain family-class members since the policy changes came into effect. This is due in part to lack of data.

What does this study add?

  • Results show that the health advantage observed among those aged 20 to 65 has persisted among most recent immigrants, by category, who entered Canada under the new Act.
  • This advantage is notable among the family class vs. those born in Canada for most selected health measures.
  • For refugees, the health advantage is observed only among females with less severe chronic conditions while, as expected, a strong healthy immigrant effect was observed among economic-class principal applicants.

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