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Many immigrants and refugees leave their home countries in search of a new life in Canada. In 2014, Canada welcomed 28,662 refugees and 231,750 immigrants, and these numbers increased in 2016 (Government of Canada, 2015, 2016). After their arrival in Canada, immigrants and refugees may experience a range of challenges related to adjustment and settlement, including poverty, unemployment, low wages, difficulties finding housing and work permit delays (Francis and Hiebert, 2014; Hiebert et al., 2009; Murdie, 2008; Preston et al., 2009; Sherrell et al., 2007; Teixeira, 2009, 2014). Furthermore, foreign-born individuals may also be vulnerable to a range of health outcomes following their migration to Canada. The length of time that immigrants and refugees have spent in the new country has an influence on these health outcomes (McDonald and Kennedy, 2004; Newbold, 2005).
The “healthy immigrant effect” refers to the observation that newcomers report fewer problems than do Canadian-born individuals when they first arrive in Canada, but that their reported health declines as their time spent in the country increases (De Maio, 2010; Vang et al., 2015). Early in their settlement, compared to Canadian-born individuals, immigrants report better mental health, better physical health and fewer chronic medical conditions (De Maio, 2010; Islam, 2013; Newbold, 2010). This pattern may be partially explained by Canada’s health screening criteria that restrict admission to immigrants who are in good health when they enter the country (Vang et al., 2015), but it may also reflect willingness to disclose problems. After about five to ten years in Canada, immigrants’ reported health has been shown to decline: a finding that some have attributed to the development of unhealthy behaviors like smoking, drinking alcohol, and reduced physical activity (Newbold, 2010; Vang et al., 2015). Further, emerging health problems experienced by foreign-born individuals can be exacerbated by barriers accessing needed services and supports. These can include language barriers and communication difficulties, cultural differences and difficulty building doctor–patient relationships (Campbell et al., 2014; Kirmayer et al., 2011). As a result, compared to Canadian-born individuals, immigrants and refugees tend to have low rates of health service use and more unmet healthcare needs (Beiser, 2005; DesMeules et al., 2004; Newbold, 2005, 2010; Newbold and Danforth, 2003), which may,...