Deciphering the healthy immigrant paradox: Social determinants of health in four Chicago communities

In this study I demonstrate the pivotal role that social and relational factors play in the rapid deterioration of the health status immigrant populations. Rather than just assimilation and acculturation, I propose that social stratification formed by cultural practices and sustained by institutions has a direct effect on how immigrants experience health, illness, as well as accessing and utilizing medical services. The study is based on data from the Community Health Assets and Needs Assessment of four Chicago communities, 2006-2008. The study is a multi-methods community-based participatory assessment project. I specifically report on data from 28 focus groups conducted among adolescents, adults and seniors and a probability survey of 1200 community residences. Absolute social conditions such as income play a larger role than levels of acculturation such English proficiency. Relative social conditions such as self perception based on cultural constructs about immigrants play an even larger role in determining how immigrants engage in health practices, experience diseases, and how they seek, access and use medical services. The compounded effects of the different forms of social stratification contribute to the rapid decline of the healthy status that characterizes immigrants. The challenges that remain are two: first, to identify the specific mechanism through which the social forms of stratification penetrate the protective characteristics and affect health outcomes; second, to develop specific programs that, short from addressing the system of inequality, target the factors pathways and mechanisms that make health disparities possible.