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This Article Extract Full Text (PDF) All Versions of this Article: AJPH.2005.070631v1 95/9/1495    most recent Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Wu, Z. Articles by Schimmele, C. M. Search for Related Content PubMed Articles by Wu, Z. Articles by Schimmele, C. M. Related Collections Global Health Other Race/Ethnicity Immigration Surveys

Zheng Wu, PhD and Christoph M. Schimmele, MA

Zheng Wu is with the Department of Sociology and the Centre on Aging, University of Victoria, Victoria, British Columbia. Christoph M. Schimmele is with the Department of Sociology, University of Victoria, Victoria.

Correspondence: Requests for reprints should be sent to Zheng Wu, PhD, Department of Sociology, University of Victoria, PO Box 3050, Victoria, British Columbia, V8W 3P5 Canada (e-mail: zhengwu{at}uvic.ca).

McCarthy and associates observe that analyses of racial/ethnic health disparities in countries with substantial recent immigrant populations must consider the effects of nativity, for this factor influences health differences. We acknowledge this crucial observation, and indeed we are familiar with the literature on healthy migrants. For example, an up-to-date Statistics Canada report indicates that foreign-born individuals report fewer chronic conditions than nonimmigrants.¹ This foreign-born advantage persists after the introduction of controls for age, education, and income. Of interest to McCarthy and others, this report also observes that health risk behaviors (e.g., tobacco consumption) differ between immigrants and nonimmigrants, but that these differences cannot account for the differences in health outcomes.

We have completed research—also using nationally representative data—into the healthy migrant (or immigrant) effect, specifically testing whether this phenomenon applies to depression and whether the effect on depression varies with length of residence.² Our results confirmed that the healthy migrant advantage with regard to depression appears to be concentrated among recent, non-European immigrants, especially Asians, and therefore may not be generalizable. Other research shows a similar pattern for chronic conditions and disabilities.³ In other words, the so-called healthy migrant effect may be spurious and could actually represent a socio-cultural health effect.

McCarthy and colleagues remark that we should be more cautious in our speculative explanation for the superior functional health of Canadian Blacks compared with US Blacks, considering that national differences in immigration histories may confound our findings. We agree that differences in health care policies may not hold the answer, but data and space limitations prevented us from giving a more satisfying explanation. In any case, modeling the healthy migrant effect is virtually impossible without data from source countries, which are necessary to determine whether individual health status is a consistent selection factor in the international migration process.

Our results do, however, confirm that the reported functional health of Canadian Blacks is better after control for immigrant status. We therefore rule out the healthy migrant effect as a valid explanation for why Canadian Blacks are healthier than the Canadian average. Moreover, US research demonstrates that Black–White health differences are attenuated after control for socioeconomic status.⁴ This finding lends indirect support to our argument that Canada’s single-payer health insurance system is a plausible reason for health differences between Canadian and US Blacks. In the United States, in contrast to Canada, there is obviously a robust correlation between health care access and socioeconomic status.

Acknowledgments

The authors gratefully acknowledge financial support from the Social Sciences and Humanities Research Council (grant 410-2002-0152). Additional research support was provided by the Department of Sociology, the University of Victoria.

References

1. Pérez CE. Health status and health behaviour among immigrants. Health Rep. 2002;13:98–109.

2. Wu Z, Schimmele CM. The healthy migrant effect: variation over time? Paper presented at: Annual Meeting of the Population Association of America; March 31, 2005; Philadelphia, Pa.

3. Chen J, Ng E, Wilkins R. The health of Canada’s immigrants in 1994–95. Health Rep. 1996;7:33–45.[Medline]

4. Cooper R. Health and the social status of blacks in the United States. Ann Epidemiol. 1993;3:137–144.[Medline]

This Article Extract Full Text (PDF) All Versions of this Article: AJPH.2005.070631v1 95/9/1495    most recent Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Wu, Z. Articles by Schimmele, C. M. Search for Related Content PubMed Articles by Wu, Z. Articles by Schimmele, C. M. Related Collections Global Health Other Race/Ethnicity Immigration Surveys