The Healthy Immigrant Effect in Canada: A Systematic Review

Canada’s immigration admissions policy culls 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)