Are immigrants healthier than native-born Canadians? A systematic review of the healthy immigrant effect in Canada

ABSTRACT

Objectives: Immigrants are typically healthier than the native-born population in the receiving country and also tend to be healthier than non-migrants in the countries of origin. This foreign-born health advantage has been referred to as the healthy immigrant effect (HIE). We examined evidence for the HIE in Canada.

Design: We employed a systematic search of the literature on immigration and health and identified 78 eligible studies. We used a narrative method to synthesize the HIE across different stages of the life-course and different health outcomes within each stage. We also examined the empirical evidence for positive selection and duration effects – two common explanations of migrants’ health advantage and deterioration, respectively.

Results: We find that the HIE appears to be strongest during adulthood but less so during childhood/adolescence and late life. A foreign-born health advantage is also more robust for mortality but less so for morbidity. The HIE is also stronger for more recent immigrants but further research is needed to determine the critical threshold for when migrants’ advantage disappears. Positive selection as an explanation for the HIE remains underdeveloped.

Conclusions: There is an absence of a uniform foreign-born health advantage across different life-course stages and health outcomes in Canada. Nonetheless, it remains the case that the HIE characterizes the majority of contemporary migrants since Canada’s foreign-born population consists mostly of core working age adults.

KEYWORDS:

• Healthy immigrant effect
• Canada
• international migration
• selection
• morbidity
• mortality

Acknowledgements

We thank Susan McDaniel and the anonymous reviewers for helpful feedback on earlier drafts. Any remaining errors are our own.

Disclosure statement

No potential conflict of interest was reported by the authors.

Key messages

1. Immigrants’ health advantage varies across the life-course, and within each stage of the life-course, by different health outcomes.

2. The healthy immigrant effect appears to be strongest during adulthood but less so during childhood/adolescence and late life.

3. A foreign-born health advantage is robust for mortality but less so for morbidity.

4. Immigrant women have worse maternal health than Canadian-born women. Mental health among immigrant mothers is especially poor.

Additional information

Funding

We are grateful to Rod Beaujot, Zenaida Ravenera, and the Population Change and Lifecourse Strategic Knowledge Cluster for providing financial support via a Big Synthesis grant.