Overwhelming evidence from The United States, Australia, and Canada, and to some extent, other western countries, suggests that voluntary immigrants are selected for good health. And these are overwhelmingly immigrants from non-western origins. They are typically people who immigrate for occupational reasons, who are healthy enough to move, and who want to improve their lives as well as the lives of their family members all of which are consistent with good health. There is also evidence that the health of immigrants to western countries declines with time in the host country, and by the time they reach old age, they experience high rates of morbidity, physical disability, and cognitive impairment. The literature has explained such decline or convergence to native levels in terms of changes in health behaviors, such as diet and physical activity, which are associated with high obesity rates—a key correlate of chronic health problems and generally poor health. It has also been pointed out repeatedly that the process of such acculturation to the host society is often accompanied by discrimination, difficulty adjusting to the new society, more physically demanding occupations, and often substandard medical care.
Part of the story of the immigrant health advantage, at least in the United States, has been the benefits conferred by living in homogeneous ethnic neighborhoods, often referred to as an “ethnic enclave” effect. In particular, Hispanic and Asian-origin immigrants in the United States appear to benefit from living in ethnic enclaves, which might be lacking in socioeconomic resources, but are rich in sociocultural resources. Which raises the issue of how neighborhoods or communities facilitate to integration of immigrants into the larger society. While an ethnic enclave effect has been observed in the United States, limited evidence from Europe has suggested that living in ethnically homogeneous environments might deprive immigrants of the benefits of social integration into the larger society. In fact, unlike the United States, Australia, and Canada, the evidence of an immigrant health advantage is less consistent in European countries, depending on selection factors, immigration policy, and the integration of immigrants into the larger society. Regardless of any benefits conferred by social integration in Europe or elsewhere, immigrants in all settings appear to reach their older years in poorer health than the native-born. And as such, they are more likely to become a burden on their family members than is the case among older people from the native-born population. In recent years, we have seen a lively interest in the study of the burden of caregiving for older family members from different ethnic origins in all western settings and increasingly also in non-western countries such as China, India, and elsewhere.
Much of the evidence on the health and healthcare needs of older immigrants is based on voluntary immigration, characterized by positive health selection of immigrants. Less is known about the health of older refugees, whose numbers have risen dramatically in recent years. What is clear is that older refugees are not health-selected as is the case with voluntary immigrants and are at a higher risk of social isolation and poor health. With rising numbers of refugees and rising anti-immigrant sentiments and policies in many countries, it is paramount that increased attention to this segment of the older immigrant population is much needed.
References
- S.H. Burns, E.H. Baker, C.M. Shehan, K.S. Markides (2025). Disability among middle-aged and older immigrants: Differences by citizenship, English proficiency, and years in the United States. Journal of Aging and Health, pp.1-13.
- L. Chaohui, Ed Ng (2019). Healthy Immigrant effect by immigrant category in Canada. Health Reports, (4): 3-11.
- K.S. Markides, S. Rote (2019). The healthy immigrant effect and aging in the United States and other western countries. The Gerontologist, 59: 205-214
PhD., Annie & John Gnitzinger Professor of Aging at the University of Texas Medical Branch in Galveston Texas, USA. He is the author or coauthor of over 450 publications on aging and health among minorities and immigrants in the United States and elsewhere. His work has been cited over 36,000 times (H-Index 101).