The Immigrant Advantage: What We Can Learn from Newcomers to America about Health, Happiness and Hope

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Kwak K. An evaluation of the healthy immigrant effect with adolescents in Canada: examinations of gender and length of residence. Soc Sci Med. 2016;157:87–95.

No consistent evidence was revealed for more optimal overall MH among immigrants, compared to domestic-born individuals (Table 2). Immigrants in North America and Europe showed significantly better overall MH compared to domestic-borns in studies by Kearns et al. [ 65], Kwak [ 66], and Huang et al. [ 67] whereas other North American and European studies either revealed significantly worse overall MH [ 68, 69] or non-significant differences [ 20, 60, 70]. Well-being was investigated in only two European studies and was significantly higher among 1st generation immigrants relative to domestic-born individuals [ 65, 71]. Calvo et al. [ 72] reported significantly higher life satisfaction levels among immigrants compared to US-born individuals. Change in Immigrants’ MH with Increased Length of Residency Schutt RK, Nayak MM, Creighton M. The healthy immigrant effect: a test of competing explanations in a low income population. Heal Sociol Rev. 2019;28:1–19.

Introduction

In 2012, Gallup took a survey regarding immigration and found that 640 million people would move to a different country if given the opportunity. The United States was the top destination in the survey, with 23% of people choosing it as their top destination choice. Riosmena, F., & Dennis, J. A. (2012). A tale of three paradoxes: The Weak Socioeconomic Gradients in Health Among Hispanic Immigrants and their Relation to the Hispanic Health Paradox and Negative Acculturation, Chap 8. In J. L. Angel, F. M. Torres-Gil, & K. Markides (Eds.), Aging, Health, and Longevity in the Mexican-Origin Population (pp. 95–110). Springer: New York, NY. Oh H, Abe J, Negi N, DeVylder J. Immigration and psychotic experiences in the United States: another example of the epidemiological paradox? Psychiatry Res. 2015;229:784–90.

Kwak K, Rudmin F. Adolescent health and adaptation in Canada: examination of gender and age aspects of the healthy immigrant effect. Int J Equity Health. 2014;13:103. Gissler M, Alexander S, Macfarlane A, Small R, Stray-Pedersen B, Zeitlin J, et al. Stillbirths and infant deaths among migrants in industrialized countries. Acta Obstet Gynecol Scand. 2009;88:134–48.Statistics Canada. Focus on geography series, 2016 census. 2019. https://www12.statcan.gc.ca/census-recensement/2016/as-sa/fogs-spg/Facts-can-eng.cfm?Lang=Eng&GK=CAN&GC=01&TOPIC=7. Accessed 12 June 2020. Bousmah M-Q, Combes J-BS, Abu-Zaineh M. Health differentials between citizens and immigrants in Europe: a heterogeneous convergence. Health Policy. 2019;123:235–43. The healthy immigrant paradox refers to the unexpected health advantages of immigrant groups settled in host countries. In this population-based study we analyze immigrant advantages in birthweight decomposing differences between infants born to immigrant mothers from specific origins. Method

The issues around the usage of the HIE theory were categorized into three categories: (1) conceptual and usage issues, (2) study design issues, and (3) measurement and analysis issues. Conceptual and Usage Issues Mendenhall E, Kim AW. Rethinking idioms of distress and resilience in anthropology and global mental health. In: Dyer AR, Kohrt BA, Candilis PJ, editors. Global mental health ethics. Cham: Springer; 2021. p. 157–70. People often come from overpopulated countries to find new opportunities for themselves. The idea of the “American Dream” is not present in every country in the world. There are only 33 out of 200+ nations that are considered to be developed. Immigration allows people from under-developed countries to create opportunities for themselves that would normally not be available to them. A complementary phenomenon to the HIE theory is the “years since immigration effect” (YSIE), which proposes that the initially healthy immigrants experience a decline in their health outcomes with increased length of residency in the destination country [ 30]. There is limited attention given to the YSIE in HIE research, with most studies that assessed the phenomenon adopting a cross-sectional or secondary analysis design [ 12, 31]. A longitudinal design is the most efficient methodology to examine the YSIE phenomenon, allowing for a reliable assessment of the long-term change in immigrants’ health through excluding unobserved individual differences and time-invariants [ 32, 33, 34]. The observed decline in immigrants’ health over time has been linked to unhealthful acculturation into a Western lifestyle (i.e., giving up one’s ethnic identity and associated healthy practices and adopting risky/unhealthy behaviors, including over-reliance on low-nutrient, convenience food and sedentary lifestyle, etc.). Another common explanation for the noted decline in immigrants’ health is related to the cumulative exposure to various stressors at different levels: individual (e.g. financial constraints, language issues), societal (e.g. discrimination, racism, unequal job opportunities) and organizational (e.g. difficulties navigating food, housing, health and social care systems) [ 35]. These stressors are suggested to build up gradually over years, eventually giving rise to the noted decline in their health with increased length of residency [ 36]. This aligns with the cumulative stress theory and suggests that human exposure to different stressors cumulatively adds up to cause a dysregulation of physiological mediators, resulting in various physical and MH impairments [ 37].Within immigrant health research, there has been a focus on the “healthy immigrant effect” (HIE) theory, also called the “Immigrant Paradox”, which suggests that immigrants exhibit better health outcomes than domestic-born populations in the destination country [ 10]. Most of the research that supports the presence of health advantage among immigrants focuses on mortality, overall health and physical health outcomes/indicators (e.g., body mass index, total cholesterol, diabetes), demonstrating lower prevalence of these diseases/indicators for immigrants compared to host populations when potential confounders are controlled for in the models [ 11, 12, 13]. Little specific attention, on the other hand, has been given to MH outcomes in HIE studies [ 14]. Across studies that employed the HIE theory for investigating immigrants’ health, there is inconsistency in the definition of both immigrant and domestic-born/reference groups [ 15]. While some studies define immigrants as solely those who are foreign-born (1st generation immigrants) [ 16, 17], others have a much broader definition, including foreign-born immigrants and their domestic-born descendants (2nd and/or 3rd + generation immigrants) [ 18, 19]. Regarding comparison groups, studies show substantial variations, where definitions varied between 2nd + /3rd + generation immigrants, domestic-born non-immigrants, or a combination of both [ 17, 20, 21]. These inconsistencies in definitions highlight the need for caution when interpreting HIE studies’ findings with regards to the presence of health advantage among immigrants. Mood, C. (2010). Logistic regression: Why we cannot do what we think we can do, and what we can do about it. European Sociological Review, 26(1), 67–82. https://doi.org/10.1093/esr/jcp006. Moreno O, Cardemil E. The role of religious attendance on mental health among Mexican populations: a contribution toward the discussion of the immigrant health paradox. Am J Orthopsychiatry. 2016;88:10.