BY ISHMAEL TAGOE, PH.D.
The healthy immigrant paradox is a phenomenon experienced in many countries (often wealthier host countries) where recent immigrants, despite facing various economic challenges, tend to have better health outcomes compared to the native-born population and other migrants who have been in the country for a more extended period. This paradox confronts the expectation that lower socioeconomic status should correlate with poorer health.
A profound reflection on this phenomenon will reveal several factors that contribute to the healthy immigrant paradox. One key aspect often discussed in academic research is the “healthy migrant selection.” This concept dwells on the idea that before arriving in the host countries, immigrants often undergo a rigorous selection process, where healthier individuals are more likely to migrate due to the physical demands of the process and the host countries’ requirements. This self-selection bias can skew the health outcomes of the immigrant population.
Several other factors have been associated with the positive initial health outcomes of these immigrants, including:
- Cultural practices that often include traditional diets
- Significant focus on diets rich in fruits and vegetables
- Greater reliance on herbal medicine and physical activity
- Stronger family ties and broader social support
- The quest to survive in the new country
Acculturation and assimilation into the host culture, which may encompass changes in dietary habits, lifestyle choices, and social support structures to align with the host country’s norms gradually, can lead to the erosion of these health advantages, potentially impacting immigrant health. This could explain why recent immigrants often have better health outcomes than those who have been in the host country for a longer time.
Other systemic barriers immigrants face can impede their ability to maintain their initial health advantage, including:
- Limited access to health care
- Language barriers
- Discrimination
- Socioeconomic challenges
The concept holds significant relevance in public health, specifically in promoting health equity and addressing social risk factors that impact the health of immigrants.
Findings from our recent research on the “Associations of depression with hypertension and citizenship among U.S. adults: A cross-sectional study of the interactions of hypertension and citizenship,” which is published in Preventive Medicine Reports, supposes that the healthy immigrant paradox, in the context of hypertension-depression prevention and control, may not apply to noncitizens with hypertension. Our study showed that while hypertension marginally increased the odds of depression among the general U.S. population, individuals who are non-U.S. citizens with hypertension have higher risk of depression regardless of how long they have stayed in the country. Our findings suggest that when applying the concept of the healthy immigrant paradox, significant attention should be given to comorbid conditions and their differential or similar outcomes across noncitizens.
Nevertheless, our study showed that future researchers and clinicians should tailor interventions to preserve positive health behaviors from immigrants’ cultures of origin while addressing the challenges they face in the host country. These interventions may include:
- Promoting cultural norms for health-seeking behavior and use of medication and treatment among immigrants
- Improving access to health care
- Reducing socioeconomic disparities
- Promoting healthy lifestyle choices
- Preserving cultural practices
These strategies can help sustain immigrants’ initial health advantage and enhance their overall well-being in their new communities.