-
Title
-
Immigrant Health Paradox
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Author
-
Markides, Kyriakos S.
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Rote, Sunshine
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Research Area
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The Individual and Society
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Topic
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Health and Illness
-
Abstract
-
With rising rates of immigration around the globe we have seen increased interest in the socioeconomic situation of immigrants as well as their health status and health care needs, and their impact on the host countries' health care system. Much of the research has focused on immigrants of non‐Western origin to the three traditional immigration destinations—the United States, Canada, and Australia. While earlier research was often focused on the negative impact of immigration on immigrants' health and mental health, research in the last couple decades has consistently found evidence of relatively good health among most immigrants especially “voluntary” immigrants from non‐Western origins to western nations, a finding often referred to as an immigrant health paradox. Most interest in immigrant health in the United States has focused primarily on immigrants from Latin America, especially Mexico. Immigrants tend to have better health and mortality profiles than the native born, especially from the same racial/ethnic group. While there are some exceptions to these findings, which we note in the current entry, the preponderance of evidence indicates that selection processes are pivotal for understanding the paradox. Sociocultural resources have also been implicated; however, most of this line of research is still underdeveloped. In the current investigation we outline (a) foundational research, (b) cutting edge research, and (c) key issues for future research. We argue that better health among immigrants is not necessarily paradoxical. Most “voluntary” immigrants arrive in their country of destination with good health and a positive outlook on life. However, the finding that longer stays in the United States deplete health likely reflects acculturation forces. More research is needed to more adequately capture acculturative stress processes, changes in lifestyle factors (smoking, diet, and exercise), and the sociocultural resources that protect immigrants from being vulnerable to premature mortality.
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Identifier
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extracted text
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Immigrant Health Paradox
KYRIAKOS S. MARKIDES and SUNSHINE ROTE
Abstract
With rising rates of immigration around the globe we have seen increased interest in
the socioeconomic situation of immigrants as well as their health status and health
care needs, and their impact on the host countries’ health care system. Much of the
research has focused on immigrants of non-Western origin to the three traditional
immigration destinations—the United States, Canada, and Australia. While earlier
research was often focused on the negative impact of immigration on immigrants’
health and mental health, research in the last couple decades has consistently found
evidence of relatively good health among most immigrants especially “voluntary”
immigrants from non-Western origins to western nations, a finding often referred
to as an immigrant health paradox. Most interest in immigrant health in the United
States has focused primarily on immigrants from Latin America, especially Mexico. Immigrants tend to have better health and mortality profiles than the native
born, especially from the same racial/ethnic group. While there are some exceptions to these findings, which we note in the current entry, the preponderance of
evidence indicates that selection processes are pivotal for understanding the paradox. Sociocultural resources have also been implicated; however, most of this line
of research is still underdeveloped. In the current investigation we outline (a) foundational research, (b) cutting edge research, and (c) key issues for future research.
We argue that better health among immigrants is not necessarily paradoxical. Most
“voluntary” immigrants arrive in their country of destination with good health and
a positive outlook on life. However, the finding that longer stays in the United States
deplete health likely reflects acculturation forces. More research is needed to more
adequately capture acculturative stress processes, changes in lifestyle factors (smoking, diet, and exercise), and the sociocultural resources that protect immigrants from
being vulnerable to premature mortality.
INTRODUCTION
The health of immigrants has often been investigated from a social
stress-illness perspective viewing immigration as a major life stressor (Friis,
Yngve, & Perssan, 1998; Malzberg, 1967). Immigrants are thought to face
many obstacles in adjusting to the host society, including discrimination,
and thus they often experience health and mental health problems. While
no doubt immigrants often are discriminated against and do experience
Emerging Trends in the Social and Behavioral Sciences. Edited by Robert Scott and Stephen Kosslyn.
© 2015 John Wiley & Sons, Inc. ISBN 978-1-118-90077-2.
1
2
EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES
difficulties adjusting to the host society there is little evidence that such
stresses take an immediate toll on their health and mental health at least
in the United States (Cunningham, Ruben, & Narayan, 2008; Markides &
Gerst, 2011; Vega, Rodriguez, & Gruskin, 2009).
In fact, much of the evidence supports immigrant selection for good health
and lower mortality rates than those of the native-born population which
often has been termed an immigrant health paradox. Another perspective has
viewed immigrant health from an acculturation perspective that argues that
immigrant health advantages are reduced with time in the host country and
typically disappear by the next generation. It has been argued that this is
due in part to changes in health behaviors including diet and exercise which
increase obesity rates (Antecol & Bedard, 2006), as well as exposure to chronic
stressors (Viruell-Fuentes, Miranda, & Abdulrahim, 2012).
In this review below we examine the extent to which there is an “immigrant health paradox” or immigrant health advantage characterizing
all immigrants to the United States. We go beyond mortality statistics to
examine data on physical health and disability. We also review evidence
from Canada and Australia, the two other major immigrant destinations.
We conclude with discussion of needed future research and whether it is
appropriate to speak of an “immigrant health paradox.”
FOUNDATIONAL RESEARCH: THE HISPANIC PARADOX
Recent interest in immigrant health in the United States has focused primarily on immigrants from Latin America especially Mexico. For some time
now there has been a suggestion of a “Hispanic Epidemiologic Paradox”
of relatively good health despite relatively poor socioeconomic status. This
“paradox” was pointed out by Markides and Coreil (1986) some 30 years ago
with respect to the health and mortality situation of Southwestern Hispanics, the vast majority of whom were of Mexican origin. They noted that the
health and mortality situation of Mexican Americans was more similar to
that of non-Hispanic Whites than to that of African Americans with whom
they shared relatively similar socioeconomic conditions.
This seemed paradoxical given the long-established association between
socioeconomic status and health. Fueling the notion of a paradox were high
rates of obesity, diabetes, and sedentary life styles of Mexican Americans and
other Hispanics. Data from around 1980 showed that Mexican Americans
had lower mortality rates from cardiovascular diseases and major cancers
especially among men. Explanations emphasized strong family support system, certain health behaviors and cultural practices, as well as health selective
migration (Markides & Coreil, 1986).
Immigrant Health Paradox
3
By the 1990s there was evidence that the life expectancy at birth of Mexican Americans and other Hispanics had surpassed the life expectancy of
non-Hispanic Whites. While there were questions regarding data quality,
there appears to be an emerging consensus that the data are of high quality
and indeed suggest a real advantage. At the same time the suggestion that
the advantage was because of “salmon bias” (Abraido-Lanza, Dohrenwend,
Ng-Mak, & Turner, 1999), or return migration to Mexico or other country of
origin by people in poor health, was challenged by more recent evidence by
Turra and Elo (2008).
MORTALITY AND LIFE EXPECTANCY CUTTING EDGE RESEARCH
The current evidence with respect to the Hispanic Paradox suggests that
there is an advantage in the mortality situation of most Hispanic populations that is driven by an immigrant advantage (Crimmins, Kim, Alley, Karlamangla, & Seeman, 2007; Markides & Eschbach, 2005, 2011). Evidence also
suggests that this long-living population is characterized by higher rates of
comorbidity and disability in their middle and older years (Hayward, Hummer, Shiu, Gonzalez-Gonzalez, & Wong, 2014; Markides & Eschbach, 2011).
Official life tables published in 2010 using data from 2006 show a 2.5-year
advantage of Hispanics over non-Hispanic Whites in life expectancy at birth.
It was 7.7 years higher than that of Blacks/African Americans. The advantage
was present among both genders. Hispanic men had a life expectancy of 77.9
years compared to 75.6 years for non-Hispanic White men and 69.2 years for
African American men. Hispanic women had a life expectancy of 83.1 years
compared to 80.4 years for non-Hispanic White women and 76.2 years for
African American women (Table 1).
Arias (2010) suggested that this Hispanic mortality advantage may seem
paradoxical given the population’s lower socioeconomic status as originally
suggested by Markides and Coreil (1986). Yet the estimates were adjusted
for misclassification of race and ethnicity on death certificates as well as age
misstatement. Moreover these estimates were consistent with numerous
Table 1
United States Life Tables by Hispanic Origin
Life Expectancy at Birth
Total
Male
Female
Hispanic:
Non-Hispanic White
Non-Hispanic Black
80.6
78.1
72.9
77.9
75.6
69.2
83.1
80.4
76.2
Adjusted for misclassification of race and Hispanic origin on death certificates. 80+ rates for Hispanics
based on Non-Hispanic White rates. Adapted by Arias (2010).
4
EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES
studies showing a Hispanic mortality advantage. While the estimates were
not available by immigrant status there was confidence that the advantage
was greater among the foreign-born. In addition, while all Hispanics were
lumped together the overall advantage was driven by the Mexican origin
population who constitute almost two thirds of the Hispanic population
(Arias, 2010).
Table 2 (adapted from Hummer, Melvin, Sheehan, & Wang, 2014) shows
death rates per 100,000 as well as mortality ratios by race/ethnicity for adults
aged 45 and over in the United States Patterns observed are similar by gender. Death rates for Blacks are higher than rates for non-Hispanic Whites
through ages 75–84 and lower at ages 85 and over, the latter supporting the
long-noted racial mortality cross-over. While controversial, the most recent
evidence suggests that is the result of higher selective mortality among earlier cohorts of Blacks (Masters, 2012) which is consistent with earlier literature (Manton & Stallard, 1997). The table also shows substantial advantages
for Hispanics which are consistent with the life table data discussed earlier.
Notable advantages are also observed among Asian/Pacific Islanders. The
relatively favorable American Indian rates are the result of substantial misclassification of ethnicity on death rates especially at older ages (Stehr-Green,
Bettles, & Robertson, 2012), with real rates being substantially higher than
those for the non-Hispanic White population.
Hummer et al. (2014) also examined ethnic mortality patterns by cause of
death. They note that Hispanics and Asian Americans exhibit low mortality rates from heart diseases and neoplasms while American Indians exhibit
high mortality rates from accidents and diabetes. Diabetes is also a notable
cause of death among African Americans and Hispanics. Multivariate analysis conducted by Hummer et al. (2014) found that both male and female
foreign-born persons had lower mortality rates than the native-born.
The rates were notably lower among foreign-born women who were in
the United States <10 years. They also note that low mortality among the
foreign-born explained some of the overall mortality advantage of both Hispanics and Asian Americans. Such immigrant advantages are consistent with
health selective immigration (Akresh & Frank, 2008; Markides & Eschbach,
2005). “Salmon bias” or return migration of less healthy persons to their country of origin is not likely to be an important contributing factor (Turra &
Elo, 2008), and there is some evidence that low smoking rates among immigrants may indeed be a major contributing factor (Fenelon, 2013). An overall
Hispanic mortality advantage was also suggested by a recent review and
meta-analysis of longitudinal studies (Ruiz, Steffen, & Smith, 2013). There
is also evidence that Puerto Ricans living in the United States do not share
such an advantage. Puerto Ricans do not experience a migration selection
because, with their US citizenship status, they encounter few or no barriers
5
1.61
1.58
1.34
1.10
0.94
1.45
1.63
1.45
1.19
0.95
496.3
995.0
2,062.9
4,663.9
12,737.3
736.9
1,700.8
3,266.0
6,832.1
14,947.1
Death Rate
Ratios
Source: Adapted from Hummer et al. (2014).
Females
45–54
55–64
65–74
75–84
85+
Males
45–54
55–64
65–74
75–84
85+
Death
Rates
Sex and Age Non-Hispanic Black
Group
351.5
814.6
1,773.7
4,461 3
11,775.6
193.7
449.8
1,084.6
3,066.4
10,235.6
Death
Rates
0.69
0.78
0.79
0.77
0.75
0.63
0.71
0.71
0.73
0.76
213.9
519.4
1225.0
3,436.6
10,822.7
127.9
298.8
788.5
2,445.2
8,586.9
0.42
0.50
0.54
0.60
0.69
0.42
0.47
0.51
0.58
0.63
Death Rate
Ratios
Asian/Pacific Islander
Death Rate Death
Ratios
Rates
Hispanic Origin
495.3
948.2
1,969.7
4,441.5
10,240.5
325.5
622.7
1,478.20
3,362.5
9,249.3
Death
Rates
0.98
0.91
0.87
0.77
0.65
1.06
0.99
0.96
0.80
0.68
Death Rate
Ratios
American
Indian/Alaskan Native
507.5
1,045.1
2,254.5
5,763.8
15,796.1
307.4
630.9
1,534.3
4,228.4
13,525.7
Death
Rates
1.00
1.00
1.00
1.00
1.00
1.00
1.00
1.00
1.00
1.00
Death Rate
Ratios
Non-Hispanic White
Table 2
Death Rates per 100,000 by Race/Ethnicity and Mortality Rate Ratios for Racial/Ethnic Minority Groups Compared with
Non-Hispanic Whites, US Adults Aged 45 and above, Official (Preliminary) Vital Statistics Mortality Data, 2010
6
EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES
to their migration from the island to the mainland and thus are not as selected
(Markides & Gerst, 2011).
As suggested earlier, the immigrant mortality advantage in the United
States is not confined to Hispanics. There appears to be an overall immigrant
advantage that may have increased in recent years possibly because of growing heterogeneity of the immigrant population, continuing advantages in
health behaviors, and health selective migration (Singh & Hiatt, 2006). While
the Hispanic foreign-born advantage is widely known and established, the
foreign-born black advantage is not well-known. It is now believed that there
is a substantial foreign-born black advantage over US-born Blacks and it is
greatest among the African-born followed by the Caribbean-born. Signh and
Miller (2004) estimated that foreign-born black men and women lived 9.4
and 7.8 years longer than their native-born counterparts during 1986–2000.
In a more recent analysis of various data sources Singh, Rodriguez-Lainz,
and Kogan (2013) found that in all racial and ethnic groups the foreign-born
had a higher life expectancy than their US-born counter-parts around
1999–2001. The greatest advantage was among black immigrants who had a
life expectancy 7.4 years higher than US-born blacks. Another recent analysis
of foreign-born mortality advantage at ages 65 and above using Medicare
data and (Dupre, Gu, & Vaupel, 2012) found that indeed the advantage was
greatest among foreign-born blacks. They conclude that the foreign-born
population increased the overall life expectancy of the United States and
that the US foreign-borns are among the longest-lived people in the world.
While immigrants to the United States may be healthier than immigrants to
other developed countries there is evidence of significant mortality advantages among immigrants in Canada and Australia (Biddle, Kennedy, &
McDonald, 2007; Chen, Ng, & Wilkins, 1996). Moreover, as in the United
States (see Antecol & Bedard, 2006) there appears to be a convergence
to native health levels in both Canada and Australia within 10–20 years
(Biddle et al., 2007; McDonald & Kennedy, 2004). Moreover the immigrant
advantage in both countries appears to be greatest among immigrants from
non-Western origins (see also, Kennedy, McDonald, & Biddle, 2006).
DISABILITY AND PHYSICAL HEALTH
While there is a clear advantage in mortality and life expectancy among
Mexican Americans and other Hispanics, the evidence is quite mixed with
respect to other health indicators such as measures of morbidity, disability,
and other outcomes. It appears that Mexican Americans are a long-living
population primarily because of immigrant selection (Arias, 2010; Markides
& Eschbach, 2005). Mexican immigrants arrive in the United States in
relatively good health but lose their advantage with time in the United
Immigrant Health Paradox
7
States so that they become more disabled in late middle and old age than the
non-Hispanic White population partly because of a lifetime of physical labor
and substandard medical care (Markides & Gerst, 2011) as well as changes
in health behavior with acculturation (Antecol & Bedard, 2006). In fact, data
from the Hispanic Established population for the Epidemiological Study of
the Elderly (Hispanic EPESE) have suggested high disability rates of older
Mexican Americans have increased in recent years (Markides & Gerst, 2011).
There were also significant increases in the prevalence of diabetes, hypertension, obesity, and cognitive impairment (Markides & Gerst, 2011). The
increase in the prevalence of diabetes suggests better management of the disease by the medical establishment as well as by older Mexican Americans and
their families (Beard, Al Ghatrif, Samper-Ternent, Gerst, & Markides, 2009).
At the same time the increase in diabetes prevalence has been accompanied
by increases in cognitive impairment (Markides & Gerst, 2011).
An analysis of the 2,000 United States Census disability rates showed that
older African Americans and Native Americans were the most disabled
among major ethnic groups followed by Hispanics, Asian Americans and
non-Hispanic Whites (Markides, Eschbach, Ray, & Peek, 2007). Analysis
by place of birth showed a foreign-born male advantage among Hispanics
including Mexican Americans but not among females supporting the
notion that most immigrant men were selected because they migrated for
occupational reasons while many of the women migrated to be with their
families (Markides et al., 2007).
As mentioned in the previous section we have recently seen an increase
in interest in the health of immigrant Blacks whose numbers have been rising in recent years (Elo, Mehta, & Huang, 2011; Hamilton & Hummer, 2011;
Mehta, Sudharsanan, & Elo, 2014). Elo et al. (2011) used the 2,000 US census 5% Public Use Micro Data Sample (PUMS), also used by Markides et al.
(2007) discussed above, and found that among persons aged 25 and above
age-standardized disability rates were lower among all foreign-born subgroups than rates for native-born Blacks. Among foreign-born Blacks, the
lowest rates were those for immigrants from Africa, followed by Caribbean
origin non-Hispanic Blacks. They also found that the immigrant advantage
was greater at lower levels of schooling among non-Hispanic African and
Caribbean origin immigrants a pattern they also observed among Hispanics
(Markides & Eschbach, 2005; Turra & Goldman, 2007). Elo et al. (2011) also
found evidence of convergence of disability rates of immigrants with native
rates with time in the United States supporting of the notion that immigrants
adopt habits of the host environment with respect to diets and other health
behaviors (Antecol & Bedard, 2006). A critical mechanism is increases in obesity according to Antecol and Bedard (2006).
8
EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES
Hamilton and Hummer (2011) used data on working-age immigrant
and US-born Blacks for 1996–2010 from the Current Population Surveys
to investigate the importance of region or country of origin. They found
that Caribbean-born Blacks lose much of their health advantage relative
to US-born Blacks after about 20 years in the United States as suggested
by the convergence model discussed above by Antecol and Bedard (2006).
However, African-born immigrants appear to maintain a health advantage
over US-born Blacks beyond 20 years in the United States. Nevertheless all
Black immigrants appear to be selected for good health as also found by
others (see Elo et al., 2011; Hummer et al., 2014).
Mehta et al. (2014) more recently examined patterns and trends in disability and its determinants, among older people in major US racial and ethnic
groups using National Health Interview Survey (NHIS) data for 2000–2010.
As expected they found a foreign-born disability advantage among Hispanics and African Americans. However, the opposite was true for Asian Americans. As also suggested, in previous literature this finding is likely to result
of compositional differences between native-born and foreign-born Asian
Americans: Most native-born older Asian Americans are of Japanese and
Chinese origins, whereas around half of foreign-born older Asian Americans
are of Vietnamese, Filipino, or other less advantaged origins (Markides et al.,
2007). The authors found little evidence that African American to White disparities in disability changed from 2000 to 2010. At the same time they found
some evidence that older Hispanic women appeared to be getting worse
off relative to non-Hispanic White women possibly because of rising obesity rates among Hispanics both native-born as well as immigrants (Singh,
Siahpush, Hiatt, & Timsina, 2011).
ETHNIC NEIGHBORHOODS AND IMMIGRANT ENCLAVES
In the search for mechanisms explaining immigrant health advantages there
has been considerable interest in the role of immigrant or ethnic neighborhoods. Again the primary focus has been on Hispanics and Hispanic immigrants. With respect to overall mortality ethnic concentration has been found
to be associated with lower mortality net of individual factors by LeClere,
Rogers, and Peters (1997). Using data from the Hispanic EPESE, Eschbach,
Ostir, Patel, Markides, and Goodwin (2004) found a significant association
between Hispanic concentration in census tracts and total mortality of older
Mexican Americans in the Southwestern United States. Moreover they found
that ethnic concentration was also associated with lower prevalence of cancer, stroke, and hip fracture. Other analyses using the same data yielded similar results with respect to self-rated health (Patel, Eschbach, Rudkin, Peek,
& Markides, 2003) and depressive symptoms (Ostir, Eschbach, Markides, &
Immigrant Health Paradox
9
Goodwin, 2004). All three analyses suggested the importance of cultural factors that may contribute to a health advantage of older Mexican Americans.
Are the above results on older Mexican Americans unique to them?
Eschbach, Mahnken, and Goodwin (2005) analyzed data from the SEER
program and the US Bureau of the Census and found that Hispanic concentration was associated at all ages with lower incidence of lung, breast, and
colorectal cancer at the census tract level. However, there is some evidence
that Hispanics living in neighborhoods with high Hispanic concentration
are more likely to be diagnosed with late-stage colorectal, cervical, and
breast cancer possibly because of poorer access to care in such communities
(Reyes-Ortiz, Eschbach, Zhang, & Goodwing, 2008). More specifically
with respect to immigrant concentration or immigrant “enclaves” Osypuk,
Diez roux, Hadley, and Kandula (2009) used data from the multi-Ethnic
Study of Atherosclerosis (MESA) and found evidence that census tract
immigrant concentration was associated with less consumption of high-fat
foods among both Hispanic and Chinese Americans. In contrast immigrant
concentration among Hispanics was associated with lower levels of physical
activity possibly because of lower walkability and availability of recreational
resources.
At best the evidence on immigrant enclave or ethnic neighborhood concentration is mixed and a search of mechanisms continues. There is also speculation that ethnic density might be more beneficial to older people who are
more limited to the immediate neighborhood than to younger people who
typically have a larger life space (Markides & Gerst, 2011).
CONVERGENCE TO NATIVE LEVELS IN THE UNITED STATES,
AUSTRALIA, AND CANADA
A relatively consistent finding in the immigrant health literature in the
United States is that immigrant health advantages appear to converge
to native levels with time. Antecol and Bedard (2006), using data on all
immigrants from the 1989 to 1996 National Health Interview Survey (NHIS),
showed that immigrants arrive in the United States with lower average
body Mass Index (BMI) levels than those of native-born Americans. They
found that immigrant men appear to close one-third of the gap within 15
years and that women converge to native BMI levels within 10 years. Vega
et al. (2009) found evidence of reductions in immigrant mortality advantages
in subsequent generations most likely because of changes in health behavior
and suboptimal medical care (see also, Achintya, Dey, & Wilson Lucas, 2006).
There has also been substantial attention to the importance of age at migration on health advantages and subsequent convergence levels to native
levels. Angel, Angel, Dias Venegas, and Bonazzo (2010) used Hispanic
10
EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES
EPESE data and found that those immigrating in mature adulthood have a
lower mortality than those immigrating as children. It has been suggested
that those immigrating as children do not fare as well health-wise later
in life because they are less likely to be selected by physical health status
than those immigrating as adults. And, since they grow up in the United
States they are more likely to adopt its health behaviors that are associated
with poor health later in life (see Gubernskaya, Bean, & Van Hook, 2013).
In addition, there is some literature suggesting that, at least among today’s
older immigrants, men were more selected than women because they were
more likely to immigrate for occupational reasons while women were more
likely to immigrate to follow their spouses (Markides et al., 2007).
The convergence in the health of immigrants to native levels has also been
observed in Canada and Australia. McDonald and Kennedy (2004) found
that recent immigrants to Canada had better health and health behaviors
that native-born Canadians especially those of non-European origin. They
also suggested that the health status of immigrants tended to converge to
native Canadian levels within approximately 10 years. They argued that such
convergence to native levels was real and not the result of a convergence in
screening and diagnosis of existing health problems. Australian data tend to
be consistent with Canadian and American data. Biddle et al. (2007) at ages
20–64 found that immigrants had better health than native-born Australians.
As in Canada immigrants from non-Western origins and non-English speaking Europe arrived in better health than immigrants from the United Kingdom and Canada who had fewer barriers to immigration. As in Canada and
the United States they found that the health of immigrants appears to converge to native levels within approximately 10–20 years.
KEY ISSUES FOR FUTURE RESEARCH
There seems to be an emerging consensus that the physical health of
immigrants (or most immigrants) to the United States and other developed
nations is superior to the health of the native-born at entry. Major factors
accounting for such an advantage include migration selection and better
health behaviors. There is also an emerging consensus that the health of
immigrants converges to native levels over time and with any mortality
advantages disappearing by the next generation.
One fruitful area of inquiry is the influence of ethnic or immigrant neighborhoods often referred to as an enclave effect. A search for mechanisms
associated with health advantages continues with supportive cultural factors
thought to be important and possibly more important for older people. At
the same time some ethnic communities appear to be characterized by factors
that are not conducive to good health, including walkability and availability
Immigrant Health Paradox
11
of recreational resources. Clearly more research on such mechanisms must
continue. Very important is to examine how changes in ethnic communities
over time may impact health. Changes may be compositional with respect
to population mix as well as socioeconomic with respect to availability of
economic resources, as well as political and broader social factors.
Another area of inquiry is the meaning of social class among immigrant and
ethnic populations in comparison to native-born populations. Many immigrants are of low socioeconomic status with respect to education, occupation,
and income. Yet they appear to be socially engaged sometimes working two
or three jobs, and often sending money to family members in their countries
of origin. Is it possibly that low social class is less detrimental to the health
of immigrants as it is to native-born populations?
We also must continue to examine trends in the evidence that the health of
immigrants converges to native levels with time in the United States. Related
is the need to monitor trends in immigration and the health of immigrants
including factors in sending countries. For example, how is the obesity epidemic in Mexico influencing the health of current and future immigrants to
the United States?
Critical is attention to why certain immigrant populations arrive at a
healthy state but lose their advantages because of poor access to medical
care. There are huge policy issues here, including immigration reform as
well as health care reform currently under way.
Finally there is a need to reconsider the notion of an “immigrant health
paradox.” Immigrants are healthier because of selection forces related to
physical, psychological, and behavioral advantages, such as low smoking
rates. Given increasing globalization and rising immigration from developing to developed countries it is critical to better monitor how these
trends influence public health outcomes as well as health and social policy
outcomes in both sending and receiving societies.
REFERENCES
Akresh, I. R., & Frank, R. (2008). Health selection among immigrants. American Journal of Public Health, 98, 2058–2064.
Abraido-Lanza, A. F., Dohrenwend, B. P., Ng-Mak, D. S., & Turner, J. B. (1999). The
Latino mortality paradox: A test of the salmon bias and health migrant hypotheses. American Journal of Public Health, 89, 1534–1548.
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KYRIAKOS S. MARKIDES SHORT BIOGRAPHY
Kyriakos S. Markides is Annie and John Gnitzinger Distinguished Professor
at the University of Texas Medical Branch. His research has focused on health
and aging in the Mexican American population, as well as minority aging in
general.
SUNSHINE ROTE SHORT BIOGRAPHY
Sunshine Rote is an Assistant Professor in the Kent School of Social Work at
University of Louisville. She received her PhD in sociology from Florida State
University in 2012 and completed a postdoctoral fellowship in the Sealy Center on Aging at the University of Texas Medical Branch in 2014. Her research
has focused on the health and mental health of minority populations including older Mexican Americans.
Immigrant Health Paradox
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