The idea is so entrenched that it has become something of a trope: immigrants come to Canada for a better life, including better healthcare. But as it turns out, many immigrants are healthier than the citizens of the high-income Western countries that they move to. There’s a term for this: the Healthy Immigrant Effect (HIE), which describes a pattern wherein immigrants, generally, tend to be in better health when they arrive in countries such as Canada, the  U.S., Australia, the U.K. compared to natives of those countries, though the advantage only tends to last up to 10 years. 

There are a few explanations for this trend. A 2015 systematic review by McGill researcher Zoua Vang and others argues that the HIE is due to a mix of both individual and state-level factors: Canada’s immigration point system tends to favour those with strong skills that make them better workers. Having an education, job experience, an occupation that is in high demand and language proficiency all fall under those strong skills and promising attributes, and are all associated with better health. There’s also the excessive demand threshold, a protocol in which, while reviewing an immigration application, an immigration officer assesses whether they think a potential immigrant will exceed a specified monetary threshold for using healthcare services. If the officer thinks they’re likely to exceed that, then they’re likely to be rejected. 

There are other factors, too. The self-selection hypothesis argues that migrating to a new country takes a large amount of money, energy and resources, so people who choose to move may already be wealthier and healthier than those who stay behind and the median population of where they’re migrating to. And, of course, Ilene Hyman, a social epidemiologist and adjunct professor at the University of Toronto’s Dalla Lana School of Public Health, says income is “one of the most potent, strongest determinants of health.” 

There is one hypothesis that is more contentious—the idea that chronically ill people aren’t allowed into Canada, at least according to Ted McDonald, a professor of political science at the University of New Brunswick. Some countries, including Canada and the U.S., require a medical exam for immigration admission. But while Canada does require a medical exam to apply for permanent residency, McDonald says it’s unlikely to affect one’s ability to enter. 

“In practice, the research has indicated that this is not really much of a barrier at all,” McDonald says. “As long as chronic conditions are managed, [the health exam] would not risk [and] would not restrict you from moving.”

In 2015, when the most recent and relevant statistics were available, about 0.3% of potential immigrants were deemed inadmissible to Canada for health reasons. And after all, the report notes, “the effect of positive self-selection is hard to quantify.”

Still, countless disability activists maintain that Canada’s immigration policies are ableist. The country does have a long history of racist and discriminatory immigration bans, and when it comes to that “excessive demand,” those living with mental and physical impairments are the ones who pay the price.

Either way, as time goes on, newcomers’ health outcomes regulate to the receiving country and become poorer than when they arrived, having adopted the health habits of their new communities. This can also be due to the sheer stress of moving and losing one’s social support, culture clash, barriers to healthcare, losing work thanks to unrecognized international credentials, the list goes on.

But that adoption of health habits works in reverse, too. Recent data from The Local, in collaboration with the MAP Centre for Urban Health Solutions at Toronto’s St. Michael’s Hospital, found that Yonge-Doris, an average-income neighbourhood in North York, has the city’s highest life expectancy. This neighbourhood is primarily composed of immigrants from the economic class or those with higher human capital (i.e. education, language proficiency, etc.). 

McDonald notes that this could be due to the ethnic network effect, which is the collective benefit of immigrant communities. Consider if a certain ethnic group’s diet consists of healthier foods. Then, it’s much easier to access those foods in that group’s communities, and living near them provides that advantage to the entire neighbourhood. Similarly, some communities may not consume alcohol for religious or cultural reasons, which may influence their neighbours not to imbibe when attending local alcohol-free events. 

“When you look at outcomes for newcomers who moved to areas where there aren’t people of the same [ethnicity], culture, country of origin or background compared to people who do, you see different effects,” McDonald says. “You see differences in terms of labour market outcomes, employment and earnings, measures of happiness […] The community itself makes it easier for you to maintain those characteristics that might be associated with healthier behaviour and, so, a longer life.”

Meanwhile, Hyman adds that, in Canada, ethnic enclaves—residential areas where people of the same or similar ethnic background are surrounded by the dominant group—are common. They can be “health-enhancing” and helpful when it comes to integrating economically and socially. Examples include Ontario’s Brampton or British Columbia’s Surrey, both of which have significant South Asian populations.

However, HIE isn’t the only important indicator of immigrant health. Susitha Wanigaratne, a senior research associate at the Edwin S.H. Leong Centre for Healthy Children and a social epidemiologist, argues that HIE and the upward social mobility of subsequent generations have led to an oversimplification of the complex health needs of immigrant communities by policymakers and more research is needed. For example, refugees and asylum seekers have different health outcomes than economic immigrants, but that gets blurred when it comes to concepts like HIE.  

And both Wanigaratne and Hyman say that health equity for marginalized communities needs to be a stronger focus for policymakers and researchers, as different communities have different behaviours, advantages and concerns.

“It’s not just a matter of luck whether someone is healthy or not,” says Hyman. “Social determinants, like where people live and work on a daily basis, are the strongest determinants of whether someone will be healthy or not. In addition, there are structural determinants, which have to do with the policies, practices and features of our institutions that can advantage or disadvantage people’s life opportunities. So, structural determinants contribute to social determinants, which contribute to health outcomes; this is true in every population, not just immigrant and refugee populations.” She notes, too, the importance of considering pre-migration advantages and post-migration stresses. 

“We have immigrants that come to Canada, they’re highly educated, but they’re underemployed, their incomes are lower than what you’d expect, and they live generally— especially in the initial period and probably for longer—in neighbourhoods that are more disadvantaged,” Wanigaratne adds. “When you think about those social environments and how that tracks over time…that would influence a decline in health over time.” 

In response to waning public support for immigration and the impact of it on housing and social services, in October 2024, the Canadian government announced a new, controversial immigration plan. It will see a reduction in permanent resident targets from 500,000 in 2024 to 395,000 in 2025 to 380,000 in 2026 and 365,000 in 2027. This means, in the next year, the migrant population will decrease by 445,901 in 2025, and 445,662 in 2026. Still, there is a significant number of migrants making up the backbone of Canada’s economy.  

“There’s probably more temporary residents in Canada than permanent residents, so the population still exists,” says Wanigaratne. “We still need to understand their needs. They’re still here.”

And that means we’re all in this together. 

As McDonald explains, “The health of immigrants is increasingly defining the health of our broader population. It’s important to focus on the role of community, networks and neighbourhoods, on health in addition to broader policy and environmental characteristics. It all goes into what determines how healthy we [all] are and how long we [might] live for.”