Open-System Immigrant Health Conceptual Model

Despite growing evidence of significant changes in physical and mental status of immigrants after settling in the country of immigration, there is a lack of theory –driven frameworks centered on immigrant health. Public health research in the U.S. uses individual-centered acculturation conceptual models created by social scientists. Focusing on the ability of individuals to “acculturate” is supported by the Rational Choice Theory. The implication is increased risk of “victim-blaming explanations” for poor immigrant health outcomes feeding into growing public cynicism. The aim of this study is to offer a non-acculturative redirection in immigrant health research by proposing an Open-System Conceptual Model driven by Critical Realism Theory. This conceptual framework is centered on the proportion of lifetime spent by immigrants (PLI) within the U.S. as a predictor of changes in individual health. Consistent with other health behavioral models, predictors of health status include age, gender, social determinants of health vulnerability (SDHV), health related behaviors risk factors (HBF), and an error term. We propose acculturation to be a component of SDHV. PLI is no longer used as a proxy measure of acculturation. We propose latent unmeasured variables of poor health outcomes including : identity vulnerability at the ontological level; “perpetual mourning ” around the loss of individuals , relationships and spaces in the country of origin; and the self-perception of discrimination and “othering” processes related to social stigmatization. The model focuses on health outcomes at an individual level while incorporating social dynamics and historical context through open-system representation.