When new immigrants arrive in Canada, they’re healthier on average than the general population. They also have significantly lower age-standardized mortality rates than Canadian-born adults.
But across every immigration category, the longer an immigrant spends in the country the greater their health declines. The situation is even worse for refugees, who are at a higher risk for mental health problems and unidentifiable illnesses.
Immigrants arrive in better health than the average Canadian in large part because the immigration process includes rigorous health screening. Foreign nationals seeking to settle in Canada must complete a thorough medical exam in their native country by a Citizenship and Immigration Canada-approved physician. Also, self-selection is inherent to the immigration process – those too old, too ill or not wealthy enough to travel usually don’t attempt to migrate.
The decline in health after an immigrant arrives is more difficult to explain. According to Edward Ng, a senior analyst in the health analysis division of Statistics Canada, the correlation between language proficiency and declining health status is strong.
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“We saw that people who lacked official language proficiency tended to have the highest risk of moving away from good health,” he said. “Official language proficiency can be an indicator of ability to integrate into society and get support and health care. It’s important.”
According to a 2011 report published by the Canadian Medical Association Journal, the circumstances of an immigrant’s arrival are important because they may indicate the degree to which their health will be affected. Those who come through forced migration and those who have been displaced against their will suffer most.
“Refugees, who are by definition forcefully displaced, are at highest risk of past exposure to harmful living conditions, violence and trauma,” the report reads. “Refugees undergo medical screening before admission to Canada but are protected by law from exclusion on the basis of non-infectious burden of illness (through the Immigration and Refugee Protection Act).”
The report also states refugees are at risk of rapid health decline after arrival, as are low-income immigrants and immigrants with limited English or French language skills.
Ayesha Adhami, administrative coordinator at the Immigrant Women’s Health Centre (IWHC), said a lot of immigrants lack literacy even in their first language.
“A lot of immigrants aren’t even completely literate in their own language,” she said. “Somebody can live in Canada for 20 years and still not have a grasp of English or French. It’s misleading to think that just because someone spends a number of years in Canada, their language skills will improve by osmosis.”
Another possible reason for declining immigrant health is people from sunnier parts of the world are at risk of health problems caused by a lack of vitamin D in Canada. A 2007 study in Norway examined 119 immigrant mothers from Pakistan, Somalia and Turkey and found 57 per cent had a vitamin D deficiency, as did almost half their babies. Vitamin D, naturally derived from sunlight, is essential for bone growth and maintenance because it helps the body absorb calcium and phosphorus.
The degree of health decline also varies significantly depending on where the person emigrated from, according to Ng.
“When I did the national population health survey analysis,” he said, “I saw that non-European immigrants tended to have their health decline over time more than their European counterparts.”
Similarly, a 2010 study in Global Public Health journal found visible minorities and immigrants who experienced discrimination or unfair treatment were likelier to report a decline in their health.
Adhami said social determinants are critical to understanding immigrant health. The Immigrant Women’s Health Centre, which also runs a mobile health clinic for sexual health, often treats women who are unable or unwilling to use other medical facilities due to cultural norms or language barriers.
“I would hear, ‘Oh I can’t go see my family doctor because he’s male and I don’t want to see a man for my breast exam or Pap smear.’”
Adhami suggested immigrants coming to Toronto be given more guidance on how the health care system works and told specifically where to go to get treatment. According to her, this is especially important for older women, who usually have little to no time to look after their own health.
“Older women with immigrant or refugee families have multiple people to take care of,” she said. “Their health care comes last and, in some cases, they don’t have access to education around their bodies. They just don’t understand their sexual health care needs and what resources are available.”
Ng refers to this as “health literacy.” Health literacy measures one’s ability to manage their own health, understand nutritional advice and use medical information. Immigrants tend to have lower health literacy regardless of their education level.
Another large determinant of health is an immigrant’s ability to integrate into society. Those who are unemployed for large stretches of time often experience more stress, which may result in health complications.
“You need to look at the ease of being able to find a job, being able to fund yourself, being able to take care of your family,” Adhami said. “For a lot of newcomers, those barriers are very insurmountable.”
Ng said this particular problem is directly detrimental to immigrant health.
“We have seen that the inability to integrate into labour markets can have a psychosomatic effect,” he said.
The factors shaping health patterns are complex and should be looked at through a socio-economic lens as well as a physical one, Adhami said.
“All these things are connected,” she noted. “If someone can’t get a job and needs to feed their family, they’re not going to spend extra money on themselves.”
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