Living in the Shadows: Immigrants sometimes healthier than natives

Reporters who have covered immigrant communities may have heard of the “healthy migrant effect.”

It’s a term that started showing up in the scientific literature in the 1990s, and researchers have built a considerable body of evidence under the idea that recent immigrants are often healthier than their native-born neighbors and that their relatively good health runs counter to what are often lower levels of education and lower incomes.

Here are some of the factors at play.

Immigrants arrive with fewer chronic conditions. In 2004, James Ted McDonald at the University of New Brunswick in Canada and colleagues examined surveys from more than 220,000 people from 1996 to 2001. They performed a series of statistical analyses on the data and found, among other things:

[T]he predicted incidence of almost all chronic conditions is lower for recent immigrant men and women than comparable native-born people. The only exceptions are diabetes (where incidence is higher for immigrants arriving between 1970 and 1985), migraines (where incidence is marginally higher for immigrant men), and high blood pressure (where incidence for immigrant women is comparable to native-born levels). … Immigrants also continue to be relatively less likely to have a chronic condition, even after many years in Canada. However, there is also evidence that the gap in health status between recent immigrants and native-born Canadians narrows significantly (albeit slowly) with years in Canada.

Cultural changes can lead to more risk factors. In 2006, Patrick Steffen at Brigham Young University and colleagues reviewed 125 studies that dealt with immigration and blood pressure going back to 1929 but mostly from the 1960s through the early 2000s. They found:

Acculturation to western society is associated with higher BP, and the distress associated with cultural change appears to be more influential than changes in diet or physical activity. Future studies would benefit from investigating how cultural change affects health and examining whether some nonwestern cultural values and practices are health protective.

At higher education levels, the immigrant advantage can disappear. Teresa Janevic at the Jackson Institute for Global Affairs at Yale University studied data from more than 250,000 single births from New York City between 1995 and 2003. They looked at the risk of preterm birth (PTB) or delivering a baby that was small-for-gestational-age (SGA) among immigrants from Russia and Ukraine (RU), Poland, and the former Yugoslavia Republics (FYR) relative to US-born non-Hispanic whites (NHW). They found:

Our hypothesis that the association between Eastern European immigrant status and risk of preterm birth would be moderated by education held among women from RU and FYR – in both of these groups women in the lowest level of education were at decreased risk of PTB relative to US-born NH Whites, but not those in the highest level. For SGA, there was evidence of moderation by education only among women from RU, since among the other groups the risk compared to US-born NH Whites was lower at all levels of education. In all groups there was a protective effect of immigrant status among women in the lowest level of education. … For example, those with little education may have fewer “connections” and resources in their host countries, and more obstacles to emigration. Uneducated women who are able to successfully navigate these barriers may be selectively healthier.

I will explore some of the other research around the healthy migrant in future posts. I welcome your thoughts via askantidote [at] gmail.com or on Twitter @wheisel.

Image by Patrick Briggs via Flickr