Immigrant Selection Systems and Immigrant Health

By Chiswick, Barry R.; Lee, Yew Liang et al. | Contemporary Economic Policy, October 2008 | Go to article overview

Immigrant Selection Systems and Immigrant Health


Chiswick, Barry R., Lee, Yew Liang, Miller, Paul W., Contemporary Economic Policy


I. INTRODUCTION

Countries with a history of large immigration movements have typically required some type of formal health screening as part of the immigration process. (1) In the United States, the Immigration Act of 1882 banned entry of persons likely to become a public charge, including those not able to work due to disability, while the Immigration Act of 1891 excluded persons suffering from certain contagious diseases. Similarly, Australia and Canada have general requirements concerning the level of health of their immigrants.

The health screening of immigrants is intended to ensure that risks to public health in the host community are minimized, that public expenditures on health and community services are contained, and that native-born residents are not crowded out from suitable access to health and other community services. As a result, as noted in VandenHeuvel and Wooden (1999, p.94) regarding Australia, immigration is usually viewed as "... a selective process whereby those who do not meet certain health requirements are not granted visas to migrate."

Most studies report that immigrants are generally healthier than their native-born counterparts at the time of immigration, and this has come to be termed the "healthy immigrant effect." Various reasons for this have been advanced, including the health screening that is part of the immigration process, selective immigration, and healthier diets/behaviors in the country of origin (Antecol and Bedard, 2006; Biddle, Kennedy, and McDonald, 2007; McDonald and Kennedy, 2005). It is also reported that immigrants' health advantage declines in the postmigration period. This process has been attributed to changes in lifestyle such as diet, work, recreation and religious practices (termed acculturation), lack of knowledge about the health-care system of the host country, poor knowledge of their rights, difficulties in communicating with health practitioners arising from linguistic and cultural barriers, and discrimination stemming from xenophobia and racism (Antecol and Bedard, 2006; Biddle, Kennedy, and McDonald, 2007; Bourdillon and Bennegadi, 1992; McDonald and Kennedy, 2005; Powles and Gifford, 1990). Thus, immigrants who are selected for entry into a country on the basis of their likely economic success (such as in the skilled worker programs in the United States, Australia, and Canada) might have health patterns at migration and subsequently that differ systematically from those of family reunification or humanitarian (refugee) immigrants. While studies in the United States and Canada (e.g., Hernandez and Charney, 1998; Kasper, 2002; Perez, 2002; Schultz, 1984) have reported many interesting findings concerning immigrant health and how this changes with duration of residence in the destination, there is a lack of evidence on the relationship between visa type and health status. Information on this relationship will assist the development of policy recommendations on the basis of the immigrant health profiles presented in the literature. This paper provides this information.

Specifically, the paper examines the determinants of immigrants' postarrival health in a major immigrant-receiving country, Australia. The analysis focuses on the importance of the degree of selectivity of specific groups of immigrants for entry into Australia, with immigrants selected for entry on the basis of their likely economic success (determined using a skill-based points system) being distinguished from family reunification and humanitarian (refugee) immigrants. The comparison between the points tested and other immigrants has the potential to offer insights into the consequence for immigrant health of adoption of a skill points-based immigrant selection regime, as has been suggested for the United States by Chiswick (1981, 1983), and later by others.

The study also follows immigrants through time to establish if differences across immigrants by visa category are short term or longer lasting. …

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