Search

Au Canada, la politique d'immigration favorise les individus ayant un capital humain élevé (Knowles, 2007). Étant donné les liens étroits entre le capital humain et la santé (Jasso et al., 2004) et le fait que les recherches suggèrent la présence d'un avantage de santé universel au sein de la population immigrante au Canada, nous nous attendions à observer l'effet de la sélection de l’immigrant en bonne santé à tous les stades du parcours de vie et sur des problèmes de santé multiples. Notre examen suggère plutôt un modèle plus complexe qu’envisagé initialement. Cette synthèse indique que les immigrants ont clairement un avantage de survie, partiellement attribuable aux processus de sélection positifs aux niveaux individuel et étatique (sauf peut-être pour les réfugiés). Cependant, l’avantage de santé des immigrants varie grandement lorsque mesuré par la morbidité. En outre, en examinant les différentes étapes du parcours de vie des immigrants, on constate une meilleure santé des immigrants à l'âge adulte, mais souvent inférieur pour la période périnatale, l’enfance/adolescence et aux âges avancés. Le processus de sélection des immigrants ne semble pas opérer de la même manière chez les immigrants très jeunes et très âgés que chez les adultes. Si tel est le cas, nous ne devrions pas envisager un avantage de santé des immigrants au sein de ces groupes. Même à l'âge adulte, âge auquel l'effet de la sélection de l’immigrant en bonne santé semble être le plus marqué, certaines divergences subsistent entre les sous-groupes d'immigrants selon le type de mesure de la santé utilisé (par ex., une plus grande variation de la santé auto-déclarée, mais une variation moindre pour la santé mentale, invalidités/incapacités, les comportements à risque et les maladies chroniques).

A number of studies have shown that immigrants tend to be in better health than their fellow citizens in their host countries, at least during the initial period following their arrival. Our work, a systematic review which brings together the results of 77 empirical research studies on this question, demonstrates that while the “healthy immigrant” effect is usually found in adult immigrants, it is another matter for children and older people. The extent of the healthy immigrant selection effect is also much more significant in terms of mortality than of morbidity. Our analysis suggests that immigrant health policies should not be “one size fits all” in type, but need to take into account both the age of immigrants and also those particular health indicators in terms of which the immigrants are most vulnerable.

Plusieurs études montrent que les immigrants sont en meilleure santé que leurs concitoyens du pays d’accueil, du moins dans les premiers temps suivant leur arrivée. Le présent travail de synthèse (prenant en considération 77 travaux empiriques sur la question) démontre que si l’effet de « l’immigrant en bonne santé » est souvent avéré chez les immigrants adultes, il en va tout autrement chez les enfants ou les personnes âgées. L’ampleur de l’effet de sélection est aussi nettement plus significative pour les indicateurs de mortalité que de morbidité. Notre analyse suggère que les politiques en matière de santé des immigrants ne peuvent être de type « taille unique » et qu’ils doivent prendre en compte l’âge des immigrants et les indicateurs de santé pour lesquels les immigrants sont vulnérables.

This study examines the nature and extent of data and research on the role of race or visible minority status on health in Canada. Visible minorities represent a rapidly growing segment of Canada’s population. Approximately one in five Canadians is a member of a visible minority group. Policy makers and researchers are often unable to answer important questions related to visible minority health such as: Are visible minority Canadians healthier or less healthy than their white counterparts? Do risk factors for health conditions differ for visible minority and white Canadians? And how do different visible minority groups compare with one another on health outcomes and measures? Our review of the existing literature on visible minority health indicates that there is a paucity of data and research on the health of visible minorities in Canada, alone, and in comparison to ‘mainstream’ (white) Canadians. We recommend that there is a need for basic health data for visible minorities. Many current health surveys are severely limited by small sample sizes of visible minorities. We recommend oversampling visible minorities in standard health surveys such as the Canadian Community Health Survey, or conducting targeted health surveys of visible minorities. Surveys should collect information on key sociodemographic characteristics such as nativity, visible minority status, socioeconomic status, and age-at-arrival for immigrants. We also recommend that if data were available, researchers consider an intersectionality approach in their analyses. Intersectionality is a flexible holistic approach that takes into account the multiple factors that may affect a visible minority person’s health, including the role of discrimination based on racial status, immigrant characteristics for foreign-born visible minorities, age and the role of ageism for older adults, socioeconomic status, gender (for visible minority women), and geographic place of residence.

Canada’s immigration admissions policy calls for individuals with high human capital (Knowles, 2007). Given the strong links between human capital and health (Jasso et al., 2004) and previous research which suggested the presence of a seemingly universal foreign-born health advantage among Canada’s migrant population, we expected to see the healthy immigrant effect across the life-course and for multiple health outcomes. What we found instead was a pattern much more complex than previously envisioned. Our review uncovered a clear survival advantage for immigrants, owing in part to positive self and state selection processes (at least for non-refugee migrants). However, there is greater variation in the healthy immigrant effect for morbidity. Moreover, viewed through the lens of different life-course stages, we uncovered a strong foreign-born health advantage in adulthood but less so during the perinatal period, childhood/adolescence, and late life. Immigrant selection may be less relevant for the very young and very old, and of course we should thus not expect the presence of a healthy immigrant effect for these groups if that is the case. But even during adulthood when the healthy immigrant effect appears to be most effective, some discrepancies still remain between different immigrant subgroups depending on the type of health measure used (e.g., greater variation for self-rated health but less variation for mental health, disability/functional limitations, risk behaviors, and chronic conditions).

Poster Presentation When comparing the health of immigrants to the native-born, studies have found what is called a “healthy migrant effect” where immigrants are likely to have a health advantage compared to native-born individuals. In Canada, effect could partially be explained by the strict immigration criteria that select immigrants on their health status (Akresh and Frank, 2008). However, immigrants lose this advantage over time so that their level of health often deteriorates below the one of natives. This deterioration is an important issue for the health of populations in Canada and a challenge to adapt the health system to the needs of immigrants. The Longitudinal Survey of Immigration to Canada (LSIC) provides an original way to assess the effects of acculturation, a process of adopting new cultural norms and practices, which has been often cited as one of the leading causes of immigrant’s health deterioration. The LSIC contains a cohort of 7716 landed immigrants in Canada between October 1st 2000 and September 30th 2001. The objective of this paper is to analyze the effects of acculturation on immigrants’ general health and self-perceived mental health. The analysis is based on multivariate logistic regressions that control for pre-migration and post-migration factors which may potentially confound the relationship between acculturation and health. Our results show that acculturation outcomes proposed by Berry (1997) - integration, assimilation, separation, marginalization- influence the health of immigrants through socioeconomic variables such as education and financial status.

This synthesis project is motivated by the apparent neglect of visible minorities in Canadian health data and research. The main question is: Are visible minorities invisible in Canadian health data and research? To address this question, we assess the nature, extent, and range of data and research available on the health and health care access of visible minorities in Canada. Specifically, we summarize: (1) mortality and morbidity patterns for visible minorities; (2) determinants of visible minority health; (3) health status and determinants of visible minority older adult (VMOA) health; and (4) promising data sources that may be used to examine visible minority health in future research. While we reviewed a large number of publications, we note that only 5 examined population-­‐level data to specifically compare visible minorities with white Canadians and just 2 distinguished between Canadian-­‐born visible minorities and foreign-­‐born visible minorities. In addition, because of data and methodological limitations, and differences in topics examined, findings are not easily comparable to provide a clear picture of visible minorities’ health.