Access to Primary and Preventive Care among Foreign-Born Adults in Canada and the United States

Understanding the health care needs of immigrant populations is important because of their large and growing numbers. Migration patterns have a significant impact on the demographic composition of postindustrial countries, such as Canada and the United States. These countries display stagnant population growth due to lower fertility rates and higher life expectancy, and they attract immigration from countries that are still maturing (LaVeist 2005). The proportion of foreign born in both countries has been growing steadily in the past few decades and, if current trends persist, is expected to surpass historical peaks. Currently, about 20 percent (6.2 million) of the Canadian population and 12 percent (34 million) of the American population is foreign born (Larsen 2004; Statistics Canada 2007;). The United States currently gains about 1.2 million new immigrants each year, with top source countries including Mexico, Philippines, China, India, Vietnam, El Salvador, and South Korea (Passel and Suro 2005; Terrazas, Batalova, and Fan 2007;). Canada receives about 220,000 new immigrants each year, a much smaller absolute number than the United States but twice the rate per capita; top source countries include China, India, Philippines, Pakistan, the United States, and South Korea (Citizenship and Immigration Canada 2007). As immigrant populations continue to grow, the health of this group will increasingly be reflected in the overall health status of Canada and the United States, making it ever more critical to monitor immigrant health and health care. The “healthy immigrant effect” is well documented in the scientific literature (Frisbie, Cho, and Hummer 2001; Singh and Siahpush 2001; McDonald and Kennedy 2004; Newbold 2005; Cunningham, Ruben, and Narayan 2008;), and it is a term used to describe the phenomenon whereby immigrants of all racial/ethnic groups are healthier upon arrival to their country of resettlement, compared with their native-born counterparts; however, this health advantage decreases over time (Stephen et al. 1994; Lara et al. 2005; Antecol and Bedard 2006;). Various hypotheses have been proposed to explain this phenomenon, but one of particular relevance to this study is the notion that poor access to health care, especially primary and preventive care which can prevent or detect health problems early, contributes to immigrants' health deterioration (LeClerce, Jensen, and Biddlecom 1994; Shi et al. 2002; Newbold 2005; Starfield, Shi, and Macinko 2005;). That is, although immigrants may be relatively healthy upon arrival, barriers to health care may lead to increased health risks over time. Thus, understanding the extent to which barriers to care exist has important implications for maintaining the health of individuals who migrate to these countries.