The health of immigrants and refugees in Canada

Canada admits between more than 200,000 immigrants every year. National policy emphasizes rigorous selection to ensure that Canada admits healthy immigrants. However, remarkably little policy is directed to ensuring that they stay healthy. This neglect is wrong-headed: keeping new settlers healthy is just, humane, and consistent with national self-interest. By identifying personal vulnerabilities, salient resettlement stressors that act alone or interact with predisposition in order to create health risk, and the personal and social resources that reduce risk and promote well-being, health research can enlighten policy and practice. However, the paradigms that have dominated immigrant health research over the past 100 years - the sick and healthy immigrant, respectively - have been inadequate. Part of the problem is that socio-political controversy has influenced the questions asked about immigrant health, and the manner of their investigation. Beginning with a review of studies that point out the shortcomings of the sick immigrant and healthy immigrant paradigms, this article argues that an interaction model that takes into account both predisposition and socio-environmental factors, provides the best explanatory framework for extant findings, and the best guide for future research. Finally, the article argues that forging stronger links between research, policy and the delivery of services will not only help make resettlement a more humane process, it will help ensure that Canada benefits from the human capital that its newest settlers bring with them.