Beyond healthy immigrant effect: a critical analysis of health trajectory among immigrant populations in Canada

Purpose This paper aims to critically examine the healthy immigrant effect (HIE) in relation to physical and mental health outcomes among immigrant populations in Canada and analyze key social determinants of mental health across premigration, migration and postmigration stages affecting immigrant mental wellness. Design/methodology/approach A comprehensive literature review was conducted examining HIE research in the Canadian context, focusing on longitudinal health trajectories, differential impacts across immigrant subgroups and the intersection of social determinants affecting mental health outcomes. Findings Physical health demonstrates clear HIE patterns, with immigrants showing lower initial prevalence of chronic conditions that begin to erode within a few years of arrival and continue deteriorating over 10–20 years. Mental health advantages are more fragile, eroding markedly among racialized immigrants due to discrimination, economic marginalization and social exclusion. Critical social determinants span premigration trauma, migration journey stressors and postmigration factors including employment barriers, housing insecurity, health-care access limitations, racism and acculturative stress. Research limitations/implications Current HIE research is predominantly cross-sectional; self-reported health measures may be culturally biased; and aggregation of diverse immigrant populations obscures important heterogeneity in health outcomes. Practical implications This review applies an intersectional lens to synthesize HIE evidence across physical and mental health domains, identifying how structural inequities systematically erode immigrant health advantages and highlighting the need for culturally responsive, trauma-informed and antiracism approaches in health-care policy and practice. Social implications The persistence of an HIE that erodes into worse-than-native health outcomes reflects structural, not individual, failure. Health systems, labor markets and social policy in Canada are organized around a “settler-native” baseline that does not account for cumulative exposure to discrimination, precarious employment and fragmented access to culturally safe care. Left unaddressed, this trajectory reinforces health inequities across generations of immigrant families and undermines the economic and social integration goals that immigration policy claims to serve. Recognizing this decline as a policy-attributable outcome – rather than an inevitable acculturation process – creates an obligation for intersectoral action across health, housing, labor and settlement services. Originality/value This review applies an intersectional lens to synthesize HIE evidence across physical and mental health domains, identifying how structural, measurement and life-course factors together shape the erosion of immigrant health advantages and highlighting the need for culturally responsive, trauma-informed and antiracism approaches in health-care policy and practice.