Older Immigrants Face Multiple Hurdles to Health Equity

By Wallace, Steven P. | Aging Today, November/December 2012 | Go to article overview

Older Immigrants Face Multiple Hurdles to Health Equity


Wallace, Steven P., Aging Today


Immigrants helped to build the United States, and they continue to contribute to its economic and cultural vitality. Our nation's immigrant population deserves better than the health disparities they now face as they age in their adopted country.

In the overall population of the United States, older adults in general are less diverse, but immigrants age 65 and older are more diverse: 60 percent of older immigrants are from racial and ethnic minority groups, compared to only 20 percent of the total older population being persons of color. In contrast, the non-elderly population is 38 percent persons of color, according to the 2010 American Community Survey (ACS) of the U.S. Census (http://usa.ipums.org/usa/).

Patterns of immigration to the United States have changed dramatically over the past century, and we are now seeing the effect of those changes. In 1970, 79 percent of the 3 million immigrants, ages 65 and older, in the United States were from Europe-a legacy of pre-World War I immigration patterns and restrictive immigration policy. The most common country of birth was Italy. By 2010, the ACS shows that fewer than 30 percent of older immigrants were born in Europe, and 32 percent were born in Latin America and the Caribbean. Older adults born in Asia also constitute a large share (about a quarter) of older immigrants.

As a result of these shifts, health equity concerns are of particular relevance to older immigrants.

Health Inequity and the 'Immigrant Paradox'

Health inequity is the result of avoidable differences between populations; these stem from a pattern of health determinants, outcomes and resources associated with broader social inequities. As described in my chapter in Prohaska and colleague's Public Health for an Aging Society (Baltimore, Md.: John Hopkins University Press, 2012), when patterns of social exclusion, blocked opportunities or unequal returns on effort are common to a population, the resulting differences in health status and healthcare are inequitable.

Health equity may not at first be an obvious concern for older immigrants because of what health researchers call the "immigrant paradox." Despite having levels of income, education, occupation and living circumstances normally associated with below average health, immigrants experience better mortality outcomes than their U.S.-born peers. This is true for immigrants from every part of the world. Most research shows, however, that the health advantage of immigrants declines over time, suggesting that the living situations immigrants face erode the "health capital" that they bring.

The exact mechanisms are not fully understood, but the decline is likely a result partly of structural conditions: stress from uncertainty about immigration status (regardless of actual status); discrimination exacerbated by the highly publicized politicization of immigration policy; living and working conditions that promote poor diets, unhealthy behaviors such as binge drinking and limited physical activity; and poor access to healthcare. Then there are cultural issues, such as conflict with children and grandchildren and increased social isolation, also called acculturative stress.

When older immigrants are people of color, they face intersecting lines of oppression, and socially and politically created differences in power and privilege that lead to differences in access to healthcare and the conditions necessary for healthy aging. While we are a nation of immigrants, the United States has a long history of discrimination and exploitation of its immigrant populations. …

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