Partial social inclusion may harm immigrants' long-term health

There is a well-documented puzzle in social epidemiology: immigrants have better health than the native-born when they first arrive, but they lose this advantage at older ages. Is acculturation to blame – the process by which immigrants adopt the culture and behavior of their new country?

Although this is a popular hypothesis, a new study published in the Journal of Health and Social Behavior tells a different story. If anything, acculturation appears to protect health: older U.S. immigrants who speak English well have 40 to 50 per cent lower odds of having a disability than those who don't. Having a U.S.-born spouse, a marker of social adaptation, is linked with 10 to 20 per cent lower odds of disability than having a foreign-born spouse.

However, when immigrants are acculturated on some dimensions but not on others – an experience called "acculturative discordance" – they have worse health. For example, being married to a U.S.-born spouse but not speaking English well predicts higher risks of ambulatory disability than having a foreign-born spouse and limited English proficiency. Ambulatory disability, including difficulties with walking or climbing, is the most prevalent disability in the U.S. and affects one in four adults aged 65 and older.

Some immigrants behave and feel very much like Americans, yet they get perceived as foreigners because they don't sound like the average American or they live in an immigrant enclave. The results indicate that this discordance can be physically stressful – and show up as disability in later life."

Leafia Ye, assistant professor of sociology, University of Toronto and author of the study

The study was based on the American Community Survey, a large population survey collected by the U.S. Census Bureau. It contained 958,211 immigrants aged 65 to 80.

Another key finding is that acculturation protects health more for white immigrants than for Black, Hispanic and Asian immigrants. As a result, highly acculturated white immigrants can retain their health advantage over the U.S.-born at older ages, but minoritized immigrants lose their advantage.

"Racially minoritized immigrants experience another layer of discordance – as they adapt more to U.S. society, they might also confront more racial discrimination and exclusion. This discordance helps explain the racial disparities in health as immigrants get older," says Ye, who is also an affiliate faculty member with the Institute for Life Course & Aging and the Global Migration Lab at the Munk School of Global Affairs & Public Policy.

"This study highlights that being 'half-included' is a tough experience – you are blending in more, but you might also be hitting a wall. It is not the immigrant experience that people typically imagine, so it too often gets ignored – but shouldn't."