Helping Healthy Immigrants Stay Healthy

By Jelena Martens

When immigrants arrive in a new country they are in better health than the host population. But in about a decade ‘a healthy immigrant effect’ fades away and immigrant health appears to decline and eventually approximates that of the host population.

Canada is one of the developed countries that receives annual quotas of immigrants in the range of 200,000, and immigrants account for close to 60% of population growth.

Immigrants are essential to Canada’s growth and development in numerous ways, healthy immigrants even more. According to Statistics Canada, sometime between 2025 and 2030, the number of births in Canada will equal the number of deaths. If Canada’s population is to continue to grow, immigration will be the source of this growth in the absence of a change in fertility and/or mortality rates. Immigration currently accounts for more than 70 percent of net growth in the labor force, and it is projected to account for 100 percent of that growth within the next decade. While immigration is not the only driver of labour force growth, it is a key source of skilled labour for Canada.

Immigrants arrive healthy to Canada, but over time, the immigrants’ perception of their health converges toward that of the Canadian-born. About 97% of new immigrants rate their health as good, or very good, or excellent six months after their arrival to Canada. However, studies have found that this so-called ‘healthy immigrant effect’ diminishes as the time passes. Health of immigrants may deteriorate during the process of integration into the new country.

According to National Population Health Survey (NPHS) immigrants from non-European countries were twice as likely as the Canadian-born to report worsening of their health between 1994/95 and 2002/03. For European immigrants no statistically significant difference was found. In addition, non-European immigrants visited their doctor over those years more frequently than their European counterparts, which was similar to those of Canadian-born. Moreover, it was also found that immigrants from non-European countries were almost twice as likely as Canadian-born to have a 10% or more increase in their body mass index (BMI)

Does this suggest that recent immigrants from the non-European countries are likely to adopt some unhealthy behaviours from a new country and culture? Typically in this context we think of smoking, inactive leisure time, dietary changes, overweight and obesity. Relatively few non-European immigrants became smokers unlike European immigrants who were as likely to start smoking as Canadian-born. Non-European immigrants were however more likely to become physically inactive at their leisure time.

A versatile group of immigrants undergoes process of acculturation, and adopts new lifestyles and health related behaviours. When these patterns were analyzed, it was revealed that, for example, smoking was consistently less prevalent among immigrants than among Canadian-born counterparts, and this was especially true for woman. In terms of physical activity, Canadian-born population displayed a healthier behaviour, and there was no clear pattern of convergence between the two groups. Overall immigrants seem to eat more fruits and vegetables than Canadian-born.

Even though analyses revealed a remarkable gradient of worsening immigrant health with time increasing since immigration, especially for chronic conditions in general, one must be careful when interpreting the results. Cross-sectional data cannot provide the evidence to prove that the health of immigrants is deteriorating with their increasing length of time in Canada.

Another potential explanation for convergence of health status between immigrants and non-immigrants, in terms of chronic conditions in general, is that, after some time spent living in Canada, the healthiest immigrants emigrate again, at rates higher than the emigration rate for the healthy Canadian-born population. Such emigration would leave a comparatively sicker immigrant population in Canada. Some evidence exists to support this hypothesis. A current study that focuses on immigrants who obtained landed immigrant status in the 1980s has discovered that the most highly skilled immigrants and their dependents are the most likely to emigrate, and it is precisely this group that is healthiest.

There is also research looking into the connection between obesity and ethnicity. In the article titled ‘Obesity, Overweight and Ethnicity’ authors describe the prevalence of self-reported obesity and overweight (based on BMI) by ethnicity, and examine the influence of time since immigration. The authors look at the problem of obesity by examining genetic predispositions and the environment, which is not the same for all ethnic groups. Regional studies in Canada have discovered that there is a higher prevalence of overweight among children and adolescents of First Nations ancestry, compared with those of European.

Authors have analyzed data of two Canadian Community Health Surveys(CCHS 200/01 and 2003) and have discovered that the prevalence of obesity among adults (aged 20-64), based on BMI, differed significantly by ethnic group. Based on the self-reported height and weight, about half of the Caucasians were overweight, East/Southeast Asians had the lowest self-reported prevalence of overweight at 22%, and the Aboriginal people had the highest with 63%.

Numerous factors influence the likelihood of becoming overweight or obese, such as SES, lifestyle, demographic characteristics. Even when adjustments were made for age, education, income and physical activity, ethnic differences in overweight and obesity persisted among men. The length of time in Canada was also taken into consideration, and the prevalence of overweight and obesity was higher among immigrants residing in Canada for 11 or more years than in the more recent immigrants (10 years in Canada or less).

So even though the prevalence of overweight and obesity in some ethnic groups may be very low (East/Southeast Asians), within a decade of life in Canada, the ‘healthy immigrant’ effect seems to fade within all ethnic groups of Canadian immigrants. The authors do point caution when interpreting results for the East/Southeast Asians. Some recent studies have documented an increased prevalence of some metabolic disorders among Asians with a BMI of 23 to 24. It means that the BMI alone offers little potential for exploring ethnic differences, distribution of body fat, or subsequent health problems. Authors point out that the current general body weight guidelines may be inadequate for identifying health risks equally in all ethnic groups.

Apart from genetic predispositions, different ethnic groups also have different social norms of healthy and acceptable body weight. In terms of diet and nutrition, and physical activity, it is the cultural norms that dictate who, when, what, how much, etc. It is important to encourage immigrants through various settlement programs to preserve their healthy traditions in a new environment, and select and adopt a healthy behaviour in a new society while resisting multiple unhealthy temptations (fast-food, sugary beverages, smoking, alcohol, long hours of snacking and sedentary activities such as watching TV, playing video games, and exploring the Internet) of a developed industrialized society such as Canada’s.

It is essential for multicultural Canada to understand the social and environmental context in which different ethnic groups develop overweight and obesity, in order to appropriately target prevention and intervention strategies. Future health policy formulations can explore addressing contributing conditions and factors through:

  • Social support in promoting and sustaining health of immigrants
  • Programs and policies that improve image and value of immigrants in society
  • Programs and services that empower immigrant groups to develop their ethnic specific health-promoting practices

References

  1. Centers for Disease Control and Prevention, Framework for Program Evaluation in Public Health, At: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4811a1.htm, Accessed on July 02, 2010
  2. Edward Ng, Russell Wilkins, François Gendron and Jean-Marie Berthelot (2004) Healthy today, healthy tomorrow? Findings from the National Population Health Survey, Statistics Canada - Catalogue no. 82-618-MWE2005002
  3. Carlos A. Montiero, Erly C. Moura, Wolney L. Conde and Barry M. Popkin (2004) Socioeconomic status and obesity in adult populations of developing countries: a review, Public Health Reviews, Bulletin of the World Health Organization, 82 (12)
  4. Lindsay McLaren (2007) ‘Socioeconomic Status and Obesity ‘Oxford Journals, Epidemiological Reviews, Volume 29, Number 1
  5. Dr Corinna Hawkes (2004) ‘Marketing Food to Children: the Global Regulatory Environment’, World Health Organization
  6. Claudio E. Perez (2002) ‘Health Status and Health Behaviour Among Immigrants’, Statistics Canada, Catalogue 82-003, Health Reports, volume 13, 2002, Page 3 (1)
  7. Mark S. Tremblay, Claudio E. Perez, Chris I. Ardern, Shirley N. Bryan and Peter T. Katzmarzyk (2005) ‘Obesity, overweight and ethnicity’, Statistics Canada, Catalogue 82-003, Health Reports Vol. 16, No 4, 2005
  8. Recommendations for preventing excess weight gain and obesity, World Health Organization, http://www.who.int/nutrition/topics/5_population_nutrient/en/index3.html
  9. Global and regional food consumption patterns and trends, World Health Organization, http://www.who.int/nutrition/topics/3_foodconsumption/en.html
  10. 2007–2008 Report on Plans and Priorities for Citizenship and Immigration Canada (CIC)(www.tbs-sct.gc.ca/rpp/2007-2008/ci-ci/ci-ci01-eng.asp on May 7, 2009)
  11. Health Canada, www.hc-sc.gc.ca
  12. Public Health Agency Canada, At: http://www.phac-aspc.gc.ca/ph-sp/determinants/determinants-eng.php#unhealthy, Accessed on April 27, 2009