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risk factors and resources in immigrant populations

One of the factors contributing to the good health profile of immigrants is their selection on the basis of health. Recent sociological research has shown that differences in the SES of immigrant streams is the key determinant of variations in health selection among immigrants with immigrants to the U.S. from all regions of the world having higher levels of positive health selection than immigrants from Mexico (Akresh and Frank 2008). That is, the surprisingly good health of immigrants from Mexico is not primarily due to the better health of Mexican immigrants relative to Mexicans who did not migrate. Future research is needed to clearly identify the relative contribution of various factors to the health status of immigrants and how these may vary across various immigrant populations.

Third, sociological research has began to characterize how risk factors and resources in immigrant populations such as the stressors and strains associated with migration and adaptation, inadequate health care in the country of origin and factors linked to larger social structures and context, such as institutional racism and interpersonal discrimination can affect the health of immigrants (Angel and Angel 2006). For example, a study of adult migrant Mexican workers in California found that stressors linked to discrimination, legal status and problems speaking English were inversely related to self-reported measures of physical and mental health and partially accounted for the declines in these health indicators with increasing years in the U.S. (Finch, Frank, and Vega 2004).

Finally, sociologists have also shown that a full understanding of the health effects of migration requires an assessment of the ways in which migration impacts the health of sending communities. For example, a study of infant health in two high migration sending states in Mexico found that infants born to fathers who had migrated to the U.S. had a lower risk of low birth weight and prematurity compared to infants born to fathers who had never migrated (Frank 2005). This study also found that women with partners in the U.S. had lower levels of social support and higher levels of stress during pregnancy than women with nonimmigrant partners, but the benefits of the receipt of remittances and the practice of better health behaviors led to improved infant health outcomes. These findings highlight the importance of attending to the bi-directional effects of migration processes.

At the same time, the good health profile of immigrants highlights how much we still need to learn regarding the determinants of health and the needed policies to improve the health of all Americans and reduce inequities in health across population groups. Especially striking and intriguing are the data for Mexican immigrants. Despite having levels of poverty comparable to those of African Americans and among the lowest levels of access to health care of any racial/ethnic group in the U.S., Mexican immigrants nonetheless have levels of health that are often equivalent and sometimes superior to those of whites (Williams et al 2010). These data emphasize that health is not primarily driven by medical care but by other social contextual factors. However, precisely what these social determinants of health are, and how they may operate in the absence of high levels of SES, and why they change over time is less clear. Accordingly, for both research and policy reasons, there is an urgent need to identify the relevant factors that shape the association between migration status and health for Mexicans and other immigrants. Moreover, we need to identify and implement the interventions, if any, that can avert or reverse the downward health trajectory of immigrants with increasing length of stay in the U.S.