Yasmin Gure University of Ottawa Health and Economic

Yasmin Gure University of Ottawa Health and Economic Outcomes of Immigrants and Refugees to Canada

Introduction • In the fall of 2013, I participated in a Directed Research program at the University of Ottawa • The program is open to fourth-year students • I decided to register for the course in order to gain research experience, and to determine if I would like to pursue economic research at the graduate level • Under the supervision of Tara Gilkinson, of the Research and Evaluation branch at Citizenship and Immigration Canada (CIC), I prepared a report that focused on the health and economic outcomes of immigrants and refugees to Canada. Health and Economic Outcomes of Immigrants and Refugees to Canada

Introduction • Objective of this project was to provide CIC with a comprehensive literature review, which would highlight key findings, gaps in literature, as well as areas for future research to inform policy. • Brief analysis of current knowledge of health and economic outcomes • Relationship between health and economic outcomes in general, followed by a particular focus on immigrants. • Areas of future research and policy implications Health and Economic Outcomes of Immigrants and Refugees to Canada

Main Findings– Background on Health and Economic Outcomes • Recent Canadian literature on immigrant health supports the existence of the a “healthy immigrant effect”, which affirms that recent immigrants are generally healthier than the host population, although this advantage deteriorates over time (Chen, Ng, Wilkins, 1996; Perez, 2002; Newbold, 2005; Kennedy, Mc. Donald, Biddle, 2006; Zhao, Xue, Gilkinson, 2010) • In terms of economic outcomes, recent immigrants face lower entry wages and minimal returns to foreign credentials. These economic factors have led to increasing low-income rates among recent immigrants (Picot & Hou, 2003; Picot & Sweetman, 2004; Frenette & Morissette, 2005; Green & Worswick 2010) Health and Economic Outcomes of Immigrants and Refugees to Canada

Main Findings– The Link Between Health and Economic Outcomes • Economic factors, such as income level and neighborhood quality (which includes factors such it’s appearance, access to services, social networks, etc. ), are correlated with health status. (Ross and Roberts, 1999; Humphries and Van Doorslaer, 2000; Butler. Jones, 2008) • Low-income individuals were more likely to rate their health as being poor, compared to high-income individuals (Ross & Roberts, 1999) • Significant difference in disease prevalence and in years of life lost between the highest-income quintile and each income level lower (Butler-Jones 2008). Health and Economic Outcomes of Immigrants and Refugees to Canada

Main Findings– The Link Between Health and Economic Outcomes (Continued) • Neighborhood characteristics, such as noise, traffic, and the presence of trash and litter are associated with a decline in physical and mental health (Balfour and Kaplan, 2002; Wilson et al, 2004; Frohlich et al, 2006; Wen et al, 2006) • Neighborhood quality and surrounding socio-economic factors play a significant role in mortality rates (Wilkins et al 1988; Waitzman and Smith 1998; Doubeni et al, 2012) Health and Economic Outcomes of Immigrants and Refugees to Canada

Main Findings– Health and Economic Outcomes for Immigrants in Canada • Immigrants who are over-qualified for their current occupation are more likely to experience a decline in mental health (Reid, 2012; Dean and Wilson, 2009; Chen et al, 2010) • Respondents who were over-qualified for their current occupation were more likely to identify mental health issues as a result of lack of income, loss of employment -related skills, loss of social status and family pressures Health and Economic Outcomes of Immigrants and Refugees to Canada

Main Findings– Health and Economic Outcomes for Immigrants in Canada (Continued) • Duration of unemployment is positively correlated with emotional issues among immigrants, such as depression, stress and negative self-perception (Aycan & Berry, 1996; Beiser and Hou, 2001) • Immigrants with poor self reported health, and reported incidence of emotional problems are more likely to be in the lowest income quartile (Zhao et al 2009; Robert and Gilkinson 2010 ) Health and Economic Outcomes of Immigrants and Refugees to Canada

Main Findings– Health and Economic Outcomes for Immigrants in Canada (Continued) • Recent immigrants are more likely to be employed in physically demanding jobs, compared to their Canadianborn counterparts (Smith et al, 2009) • Immigrant males in their first five years in Canada faced a heightened risk of suffering a workplace injury, compared to Canadian-born male respondents (Smith and Mustard, 2009) • Many immigrant workers who were employed in physically demanding jobs had not received job or occupational health and safety training (Kosny et al, 2012) Health and Economic Outcomes of Immigrants and Refugees to Canada

Areas of Future Research • Build on existing studies to provide further insight into the health status of immigrants, and how health determinants change over time. • The review of literature for economic and health outcomes has also emphasized the lack of data available for the health outcomes of specific immigrant groups (e. g. , refugees, family class immigrants, economic class immigrants). Health and Economic Outcomes of Immigrants and Refugees to Canada

Areas of Future Research (Continued) • Inclusion of longitudinal data, which will provide data on the health status and health determinants of immigrants over time. • More multi-method studies, which combine both quantitative and qualitative approaches. • Subsequent studies in this area could also benefit from the utilization of a new dataset held at the Institute for Clinical Evaluative Sciences (ICES). Health and Economic Outcomes of Immigrants and Refugees to Canada

Policy Implications • Policies and programs aimed towards promoting the economic integration of recent immigrants plays a role in mitigating adverse health outcomes • Information and orientation services that ensure recent immigrants have a good understanding of the healthcare and employment related services. • Nationwide initiatives to improve information on workplace safety for immigrants, such as awareness initiatives targeting recent immigrants and workplace safety information provision in multiple languages) Example: Manitoba Immigrants’ Safety Initiative Health and Economic Outcomes of Immigrants and Refugees to Canada

Thank You! • Participating in the Directed Research project at the University of Ottawa has not only provided me with research experience, but also a sense of direction on what area of economic research I would like to study • As I pursue graduate studies in the fall, I intend to include immigration studies as my main area of research Health and Economic Outcomes of Immigrants and Refugees to Canada