Social determinants of health in Canada's immigrant population: results from the National Population Health Survey

As part of the Metropolis project - a large-scale investigation of immigrat ion and integration, including wellbeing of immigrants in a number of areas of social life - in this paper we investigate the social determinants of h ealth in Canada's immigrant population using Canada's National Population H ealth Survey (NPHS). Specifically, we examine differences in health status and health care utilization between immigrants and non-immigrants, immigran ts of European and non-European origin, and immigrants of <10 years and > 1 0 years' residence in Canada. We also examine social determinants of health care utilization and health status in immigrants and nonimmigrants, and ev aluate the utility of large-scale, national databases for these purposes. O ur conceptual approach draws upon a 'population health' perspective, which suggests that the most important antecedents of human health status are not medical care inputs and health behaviours (smoking, diet, exercise, etc.), but rather social and economic characteristics of individuals and populati ons. We iind no obvious, consistent pattern of association between socio-ec onomic characteristics and immigration characteristics on the one hand, and health status on the other, in the NPHS data. This does not mean that soci o-economic factors in Canada are not influential in shaping immigrants' hea lth status. In fact, the results of the logistic regression models calculat ed for immigrants and nonimmigrants on four outcome variables in this study suggest that socio-economic factors are more important for immigrants than non-immigrants, although in ways that defy a simple explanation. The compl exity of immigrants' experiences, combined with the inherent limitations of cross-sectional survey data are discussed as major limitations to this kin d of research. (C) 2000 Elsevier Science Ltd. All rights reserved.