Paradox Regained: Immigrant Health in 21st Century United States

Liying Luo, Alain Vandormael, Ross Macmillan, Colleen Unger, Regan Sieck, Naomi Duke, Wen Fan, J Michael Oakes, Hollie Nyseth Brehm

Research output: Contribution to conferencePaper


Health is central to research on both immigration and assimilation, and differences in health among immigrants are a focal part of health disparities research. In both fields, immigrant health has been deemed paradoxical because a) immigrants tend to have better health than is predicted by their socioeconomic position and b) acculturation into American society is associated with declines in immigrant health status despite increasesin socioeconomic position and related utilization of health care. Using data from the 2000-2006 Integrated Health Interview Series, we assess the immigrant health paradox infour ways. First, we conduct a systematic assessment of the health of 10 immigrant groups defined in terms of global region of birth. Second, we examine similarity and difference in health by education gradients and assimilation trajectories across immigrant groups. Third, we assess the ability of widely recognized explanatory factors to account for health differences across immigrant groups, educational gradients, and assimilation effects. Finally, we assess the overall implications of immigrant health dynamics for health disparities in the United States. Across four health outcomes, there is remarkablesimilarity in health advantages, consistency in both educational gradients and detrimental acculturation trajectories, limited ability of the explanatory factors to account for the immigrant health advantage, and enduring differences in health statuses even among those with long tenures in the United States. As these findings highlight the significance of healthy immigrant selection, we discuss implications for existing theory and researchon assimilation processes and health disparities research.Issues of immigrant health have been a central feature of immigration research and a focal concern of health disparities research for more than a century (Jasso, Massey, Rosenzweig, and Smith 2004; Kandula, Kersey, and Lurie 2004; Rumbaut 1997). During this time, an impressive body of work has emerged that highlights the apparent paradox of immigrant health. In one respect, immigrants typically have better health statuses than would be expectedgiven their socioeconomic standing in U.S. society(Padilla, Boardman, Hummer, and Espitia 2002; Palloni and Arias 2004) and the average health status in their sending country (Jasso et al.2004). In another respect, equally compelling evidence suggests that immigrant health declinesover time. Here, acculturation, be it behavioral, linguistic, or simply exposure to U.S. society,seems to foster poorer health (Angel, Buckley, and Sakamoto 2001; Antecol and Bedard 2006; Aravena, and Hummer 2005; Cho, Frisbie, Hummer, and Rogers 2004; Lara et al. 2005; LeClere, Jensen, and Biddlecom 1994; Lopez-Gonzales). This is also paradoxical given that immigrants typically gain ground through acculturation on many of the factorsincome and access to health care, for examplethat improve health in the native population (Rumbaut 1997). Ultimately, the apparent paradox of immigrant health provides a fascinating lens into the dynamics of health over the life course, the nature of immigration and assimilation, and the complexities of health disparities and their life course context. As such, issues of immigrant health are key avenues for theoretical and empirical advancement.This paper makes four unique and necessary contributions to the question of the immigrant health paradox. First, evidence on immigrant health advantages and subsequent declines with increased exposure to U.S. society is primarily based on Hispanic immigrants. While Hispanics are clearly an important facet of the immigrant health issue, the late 20th and early 21st centuries have seen dramatic growth in both the Hispanic and non-Hispanic immigrantpopulation, with the latter including increasing numbers of Asian, Southeast Asian, Indian and Pakistani, and African immigrants (see Figure 1). The increasing prevalence of such groups necessitates further systematic analysis to fully understand both immigrant health as a demographic phenomenon and the scope and extent of the immigrant health paradox. Second, assessment of immigrant health requires simultaneous and comparative assessment of immigrant health dynamics. This includes both socioeconomic gradients in health and assimilation trajectories. Such dynamics have yet to be investigated, particularly in a systematic manner with high quality data that allow for comparisons across multiple immigrant groups. Third, research on health disparities highlights the endogenous factors, such as riskbehaviors and access to health care, that translate socioeconomic, racial, ethnic, and sex differences in differential health outcomes (see Chang and Lauderdale 2009; Link and Phelan 1995, 1996; Ross and Wu 1995). In contrast, immigrant health research has not broadly andsystematically examined such factors and what they mean for health differentials between the various immigrant groups and those born in the United States. Finally, we include multiple comparison populations based on the major racial and ethnic groupings of those born in the United States and thereby avoid the WASP comparator bias in traditional assimilation research(Alba an Nee 2005)
Original languageEnglish (US)
StatePublished - 2011

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