Assuring the Health of Immigrants: What the Leading Health Indicators Tell Us

Abstract

Over the past 20 years, the United States has experienced one of the largest waves of immigration in its history. Understanding the health status and needs of immigrants is important because of their growing numbers and their contribution to the health of the nation, but it is challenging because of gaps in national databases, the heterogeneity of immigrant populations, and uncertainty about how migration affects health. Healthy People 2010 outlines the nation's public health objectives for the current decade. It includes ten leading health indicators (LHIs) chosen because of their importance as public health issues, their ability to motivate action, and the availability of data to measure their progress. In this paper, we discuss the health of immigrants from the perspective of these LHIs, as they provide a framework for anticipating some of the future health needs of immigrants and help define priority areas for research and action. INTRODUCTIONOver the past 20 years, the United States has experienced one of the largest waves of immigration in its history. Understanding the health status and needs of immigrants is important because of their growing numbers and their contribution to the health of the nation, but it is challenging because of gaps in national databases, the heterogeneity of immigrant populations, and uncertainty about how migration affects health. The health status and health needs of immigrants are poorly understood. Until recently, most health research did not collect data on nativity and immigration status. When immigration status was collected, many studies grouped all Asians or Latinos together, despite marked differences within subgroups with respect to culture, socioeconomic status, health status, and patterns of immigration.The effect of immigration on health is controversial. Some studies have shown that immigrants enjoy superior health compared to the U.S. born, despite higher 358KANDULA KERSEY LURIE rates of poverty and poorer access to health care (1,23,100,102). Others find that some groups experience much higher rates of disease and poor health than previously suspected (36,101,112). As immigrants adopt traditional American health behaviors over time, their health status begins to converge with that of the general U.S. population (20,63,66,90,96,101,112). Yet the literature on how acculturation affects health is often difficult to interpret because there are few validated and consistent measures of acculturation (57). Data on immigrant health status are also often difficult to interpret because of uncertain impact of selection biases [e.g., immigrants to the United States may represent the most healthy and motivated individuals, thus able to make the long journey to the United States (1, 34); they live healthier lifestyles, with fewer risk-taking behaviors and better diets (57); and they return to their native country prior to dying and therefore are not counted in U.S. death records or vital statistics (57)]. Healthy People 2010 outlines the nation's public health objecti...

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