"Why are immigrants living so long, and what does that teach us about improving health standards for all Americans?."
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Other factors may be equally important. Immigrant selectivity undoubtedly plays some role in lowering mortality risks, not only because the difficult process of moving to a new country demands strength and resilience, but also because skilled workers and professionals are often chosen for admission. Better health might also reflect an optimistic outlook – the opportunities and resources of America are less likely to be taken for granted by newcomers than by those who have never known anything else. Even the poor of America are generally better off than the impoverished elsewhere, and the inspiration of the American dream is still fresh in those newly seeking it. These psychological factors are difficult to quantify and certainly are not universal, but they can be significant.
Still, behavioral characteristics constitute the most persuasive and provable explanation for the native/newcomer mortality divide. Perhaps the most compelling evidence for this theory comes from the countervailing trend of assimilation. Over time, immigrants adopt American values, habits, practices, and behavior, often leading to degrading standards of health. In a preliminary test, Singh and Siahpush show that as immigrants reside longer in the United States, their health risks tend to converge with those of the US-born. Essentially, the more time immigrants have to integrate into American culture, the higher their mortality risk. While time is a primitive measure of acculturation, it suggests that assimilation comes with hazards to health. Immigrant advantages may fade as harmful customs, such as smoking, drug use, and unhealthy diets are adopted.
What do these conclusions suggest about the relationship between health and American culture? The evidence paints a fairly negative picture of America’s own public health problems. Even without health insurance, immigrants take advantage of all that America has to offer and live longer and healthier lives. Chronic disease poses the greatest threat to health, and voluntary behavior is an important, if not the most important, source of chronic illness. Reductions in smoking, obesity, and hypertension can lengthen an already long lifespan. Bad habits hurt American health, but immigrants show us they don’t have to.
The most intractable dilemma of the political debate over healthcare turns on the competing priorities of reducing the cost of care while improving the quality and access of care. A sacrifice in quality seems inevitable if the reduction of cost is the highest priority. Yet there can be another, bottom-up approach to reducing cost. The approach is the long, hard process of societal reform. The value of preventative campaigns has been proved again and again, and this study is yet another concrete example. Tens of thousands of dollars might be spent to prolong life by three years, but preventative tactics might accomplish the same effect much more cheaply. Better health does not need to place excessive burdens on the healthcare system. Prevention campaigns, health education, providing healthier foods, and other broad measures can lead to a healthier society, even if the impact of such initiatives is hard to quantify. As a case study, immigrants certainly point us in that direction by underlining the value of healthy habits. After all, smoking less and eating more healthily doesn’t necessarily cost immigrants anything; it just grants them longer lives.
In a sense, the immigrant study supports emphasis on the very concept of public health. The research shows that reducing smoking and obesity, a mission that depends as much on culture as it does on medicine, can have just as much of an impact as medical innovation. Cultural changes demand time and political momentum, and in practice are difficult to achieve. However, the potential relief to healthcare could be dramatic. Regardless of health habits, it is still essential that the United States promotes greater access to healthcare and that insurance coverage for both immigrants and US-born be expanded. Yet a combined effort, by healthcare providers mindful of quality and cost and by patients taking care of their own health, is the best solution to a healthier nation.
Austin Kilaru is a sophomore in Saybrook College