The latest available data on the health of the population are
used to compare the health of immigrants and other Australians.
In general, immigrants have better health and lower mortality
rates than the Australian-born population.
INTRODUCTION
How does the health of immigrants compare to that of people born in Australia? In particular, is the health of immigrants of non-English-speaking background, particularly more recent immigrant groups from Asia, worse than that of other groups? A number of analyses have shown that immigrants to Australia generally have lower mortality rates than people born in Australia, but that the differences diminish with increasing length of residence in Australia.1 This paper presents a new analysis of mortality data for recent years together with a health profile derived from recent population health surveys. The principal objective is to document observed and reported differentials in health between birthplace groups in Australia during the early 1990s, and to see whether previously observed differentials are persisting, particularly for specific recent immigrant groups.
Although selection effects are thought to play an important part in explaining the lower mortality rates of many immigrant groups, health differentials involve complex interactions between social, cultural, environmental, biological and genetic factors. The social and cultural context of migrant health in Australia has been explored in a recent book.2 The National Health Strategy has examined the health status and service use of migrants with particular attention to language and cultural barriers to the use of health services.3
In the following analysis, due to the limitations of sample size
in the survey data, and the small numbers of deaths involved for
some individual countries, countries of birth are generally grouped
into five broad groups (see Methods below), although some mortality
ratios are presented here for some individual countries which
have contributed large numbers of migrants to Australia. More
detailed analyses of death rates and population survey data by
individual countries of birth have been published by the National
Health Strategy and the Australian Institute of Health and Welfare.4
DATA SOURCES AND METHODS
Deaths data analysed in this paper were derived from deaths registered
in the three years 1992 to 1994. These data were coded by Australian
Bureau of Statistics (ABS) and provided to the Australian Institute
of Health and Welfare by the State and Territory Registrars of
Births, Deaths and Marriages. Summary health indicators, also
reported here, were drawn from an extensive analysis5
of data from the 1989-90 ABS National Health Survey and the 1988
ABS Survey of Disabled and Aged Persons. The estimated resident
population by country of birth for June 1993 was used for the
calculation of death rates and standardised mortality ratios.6
Country of birth categories
For the analysis of 1992-1994 deaths data, country-of-birth categories were defined in terms of country groups used in the Australian Standard Classification of Countries for Social Statistics.7 These were as follows:
Australia: Australia
UK, Ireland: United Kingdom and Ireland (Eire)
Other Europe: Includes Eastern Europe, the former USSR and Baltic States
Asia: North-East Asia, South-East Asia, and Southern Asia
Other: Middle East, Northern and Southern Africa, the Americas, New Zealand and the Pacific region.
Unit record data released by ABS for the 1989-90 National Health Survey included North-East Asia among an 'Other' category of country of birth. Thus, the country-of-birth categories 'Asia' and 'Other' used for analysis of the National Health Survey differed somewhat:
Asia: Middle East, South-East Asia, Southern Asia
Other: North-East Asia (including China, Hong Kong, Japan, Korea), Northern and Southern Africa, the Americas, New Zealand and the Pacific region.
Definitions of the 'Asia' and 'Other' categories also differed somewhat for the analysis of the 1988 Survey of Disability and Ageing:
Asia: Middle East, Northern Africa and Asia
Other: Southern Africa,
the Americas, New Zealand and the Pacific region.
Standardised mortality ratios
Standardised mortality ratios for country- of-birth groups were calculated using a technique known as indirect age standardisation. This provides an estimate of the number of deaths expected for each group if that population were to experience the same age-specific death rates as the Australian-born population. The ratio of the number of deaths observed to the number expected is known as the standardised mortality ratio (SMR). An SMR greater than 1.0 indicates a level of mortality higher than that of the Australian-born population, while an SMR less than 1.0 indicates a lower level of mortality.
Standardised mortality ratios were calculated for total deaths
(from all causes) and for deaths due to specific groups of causes
using categories based on the Chapters and disease groups specified
in the International Classification of Diseases (9th Revision),8
referred to below as ICD9.
Other health indicator definitions
Life expectancy at birth: Expected number of years of life for a newborn if the current age-specific pattern of mortality does not change.
Death rate: Number of deaths per 1,000 population for deaths registered in the calendar years 1992, 1993 and 1994.
Severe handicap rate: Prevalence of severe handicap (as a per cent of population). This is calculated using data from the 1988 ABS Survey of Ageing and Disability. A handicap is defined as severe if personal help or supervision is required, or the person is unable to perform tasks relating to self-care, mobility or communication.
Serious chronic illness: The average number of serious chronic (long-term) illness conditions per person in the Australian population, estimated from the numbers of illness conditions which have lasted at least six months, or which the respondent expects to last for six months or more, reported in the ABS National Health Survey 1989-90. Serious illness conditions were defined as conditions that required medical or surgical intervention, that carry a high risk of complications, or that can lead to significant recurring disability.9
Fair/poor health: The estimated percentage of people who reported'Fair' or 'Poor' health using data from the Health Survey, which asked survey respondents aged 18 years or more for self-assessed health status on a four point scale of Excellent, Good, Fair, Poor.
Hospital episodes: Average number of in-patient episodes during the last twelve months estimated from Health Survey self-report data.
Doctor visits: Average number of doctor consultations per
annum, excluding doctor consultations during hospital in-patient
episodes or visits to hospital out-patient/ casualty clinics.
'Doctor' includes general practitioners and specialists. The number
of visits per annum is estimated by multiplying by 26 the average
number of doctor visits reported in the two weeks prior to the
interview in the Health Survey.
Interpretation of data
Despite the fact that these data represent population measures
and therefore do not suffer from sampling variability, apparent
rate differences between country-of-birth groups might arise from
random variations in the numbers of deaths, particularly where
the numbers are small. To assist readers in assessing the significance
of standardised mortality ratios (SMRs) , they are asterisked
where they differ significantly from 1.0 at the 0.01 level of
significance.
RESULTS
Population
Table 1 shows the estimated Australian population aged 15 years
and over for the country-of-birth groups used for the mortality
analyses, and for a number of specific countries which have contributed
substantial numbers of migrants to Australia. Around 27 per cent
of the Australian population aged 15 years and over was foreign-born
in 1993.
| Table 1: Estimated resident population aged 15 years and over, by country of birth and sex, June 1993 | |||
| COUNTRY OF BIRTH | |||
| Australia | 4,919 | 5,131 | 10,051 |
| UK & Ireland | 594 | 587 | 1,180 |
| Other Europe
Italy Former Yugoslavia Greece Germany Netherlands Poland Total Other Europe | 142 88 74 57 51 33 593 | 124 78 70 59 47 32 544 | 266 166 144 117 98 65 1,137 |
| Asia
Vietnam China Philippines India Hong Kong & Macao Total Asia | 64 44 23 34 34 338 | 61 42 48 33 34 365 | 124 87 71 66 66 703 |
| Other
New Zealand Lebanon Total Other | 131 40 388 | 124 35 372 | 255 75 760 |
| Total | 6,832 | 6,999 | 13,830 |
| Source: Australian Bureau of Statistics (cited on note 6) | |||
Tables 2 and 3 show the standardised mortality ratios (SMRs) for males and females aged 15 years and over according to country-of-birth group. These ratios show how the deaths observed in 1992-1994 compare with those which would have been expected if the migrant group had experienced the average mortality rate at each age of the Australian-born population of the relevant sex. Thus, for example, the men born in Asia experienced only 0.65 times as many deaths as they would have done if they had experienced the same risk of death at each age as the Australian-born male population.
Table 2: Mortality differentials by country of birth and cause of death, males aged 15 years and over, 1992-1994 | ||||||
| Males
Cause of death | ||||||
| Infectious &
parasitic diseases AIDS a | 1,459 1,855 |
| 0.94 0.74 * | 1.10 0.71 * | 1.68 * 0.41 * | 1.34 1.39 * |
| Cancers
Digestive organs Lung Skin Lymph, leukemia etc Prostate | 56,177
15,263 13,935 2,509 5,155 7,471 |
| 0.99
1.01 1.22 * 0.42 * 0.89 * 0.84 * | 0.90 *
0.98 1.04 0.30 * 0.99 0.60 * | 0.67 *
0.94 0.64 * 0.22 * 0.66 * 0.40 * | 0.78 *
0.85 * 0.74 * 0.54 * 0.90 0.66 * |
| Diabetes mellitus | 3,764 | 0.87 * | 1.36 * | 1.11 | 1.32 * | |
| Cardiovascular diseases
Coronary heart disease Stroke | 79,803 49,548 14,799 |
| 0.90 * 0.91 * 0.86 * | 0.88 * 0.88 * 0.87 * | 0.65 * 0.60 * 0.87 | 0.91 * 0.92 * 0.87 * |
| Respiratory system diseases | 16,921 | 0.99 | 0.59 * | 0.57 * | 0.63 * | |
| Digestive system diseases | 5,857 | 0.88 * | 0.94 | 0.55 * | 0.74 * | |
| Injury and Poisoning
Motor vehicle Production injuries b Suicide Homicide | 14,511 3,905 417 5,294 572 |
| 0.91 * 0.93 0.62 * 0.95 0.92 | 1.01 1.02 0.97 1.08 0.98 | 0.61 * 0.72 * 0.46 * 0.39 * 1.06 | 0.85 * 0.92 0.57 0.82 * 1.16 |
| All causes | 192,856 | 0.93 * | 0.88 * | 0.65 * | 0.84* | |
| * p < 0.01
a Rate estimated for all deaths where AIDS is mentioned on the death certificate, irrespective of whether it is identified as the underlying cause of death. Since there were only 81 such deaths for women in 1992-1994, these were not analysed by country of birth. (See Table 3.) b A number of causes of death (being struck by a falling object; accidents involving machinery; falls from ladders, scaffolds; being caught or crushed; and deaths involving an electric current) are known to be mostly work related. This combination of causes has been used as an indicator of production related death. Since there were only 15 production-related deaths for women in 1992-1994, these were not analysed by country of birth. (See Table 3.) | ||||||
It is apparent from Tables 2 and 3 that, overall, the overseas-born population experienced mortality rates significantly lower than those for the Australian-born population. Standardised mortality ratios were lowest for Asian-born men and women at 0.65 and 0.74 respectively.
These lower mortality rates for migrants translate into higher
life expectancies as illustrated in Table 4. Migrants from Europe
have life expectancies at age 15 of around 1.5 to two years higher
than their Australian-born counterparts. Migrants from Asia have
life expectancies around 4.1 years higher for men and 2.1 years
higher for women.
Mortality rates by cause of death
Table 4: Life expectancy at age 15 by country of birth, 1993 | |||||
| Males
Females |
|
|
|
|
|
Table 3: Mortality differentials by country of birth and cause of death, females aged 15 years and over, 1992-1994 | ||||||
| Females
Cause of death | ||||||
| Infectious & parasitic diseases | 1,254 | 0.88 | 1.18 | 1.53 * | 1.09 | |
| Cancers
Digestive organs Lung Skin Lymph, leukemia etc Cervix Breast | 42,692
12,131 5,420 1,190 4,288 971 7,706 |
| 1.05 *
0.99 1.50 * 0.53 * 0.91 0.85 1.11 * | 0.90 *
0.95 0.68 * 0.40 * 0.97 1.16 0.88 * | 0.72 *
0.83 * 0.71 * 0.11 * 0.70 * 1.18 0.66 * | 0.90 *
0.90 0.81 * 0.46 * 0.90 1.03 0.96 |
| Diabetes mellitus | 3,907 | 0.85 * | 1.86 * | 1.64 * | 1.14 | |
| Cardiovascular
d iseases
Coronary heart Stroke | 82,045 41,684 21,888 |
| 0.90 * 0.92 * 0.85 * | 0.87 * 0.87 * 0.85 * | 0.72 * 0.66 * 0.87 | 0.87 * 0.87 * 0.84 * |
| Respiratory system diseases | 11,876 | 1.03 | 0.56 * | 0.66 * | 0.74 * | |
| Digestive system diseases | 5,567 | 0.99 | 0.80 * | 0.71 * | 0.75 * | |
| Injury and Poisoning
Motor vehicle accidents Suicide Homicide | 5,874 1,648 1,285 310 |
| 1.12 * 1.11 1.34 * 0.72 | 1.04 0.96 1.57 * 1.70 * | 1.02 1.07 0.96 1.31 | 1.04 1.22 1.24 0.97 |
| All causes | 169,262 | 0.96 * | 0.87 * | 0.74 * | 0.87 * | |
| * p < 0.01
See notes to Table 2 (a and b) for differences between Table 2 and Table 3. | ||||||
Tables 2 and 3 also provide SMRs for major causes of death by country-of-birth group in 1992-1994. Overseas-born Australians aged 15 years and over had lower death rates than those born in Australia for most major causes of death. However, people born in the United Kingdom and Ireland had significantly higher death rates from lung cancer than did people born in Australia, with SMRs of 1.2 for men and 1.5 for women. People born in other European countries had significantly higher death rates from diabetes with SMRs of 1.4 for men and 1.9 for women. Women born in 'other' European countries had a higher suicide rate (SMR of 1.6) and a higher homicide rate (SMR of 1.7). Men and women born in Asia had higher death rates from infectious and parasitic diseases (SMRs of 1.7 and 1.5 respectively) and women born in Asia also had a significantly higher death rate due to diabetes (SMR of 1.6). AIDS-related death rates were significantly higher for men born in 'Other' countries (due largely to a high SMR of 2.2 for men born in New Zealand).
Table 5: Mortality differentials for selected countries of birth, by major causes of death, males aged 15 years and over, 1992-1994 | ||||||
| Males | ||||||
|
Country of birth | ||||||
| Europe
Italy Former Yugoslavia Greece Germany Netherlands Poland | 1.06 0.71 1.00 1.40 0.70 1.20 | 0.85 * 0.64 * 0.66 * 0.90 1.08 1.03 | 1.42 * 1.06 1.00 0.98 0.77 1.83 * | 0.71 * 0.71 * 0.69 * 1.02 0.86 * 1.12 * | 0.68 * 0.76 * 0.74 * 1.33 * 0.91 1.60 * | 0.77 * 0.47 * 0.66 * 0.96 0.92 * 1.06 * |
| Asia
Vietnam China Philippines India Hong Kong & Macao | 2.45 * 2.59 * 1.80
1.20 1.01 | 0.72 * 0.76 * 0.64 *
0.62 * 0.75 | 0.46 0.90 0.93
2.10 * 0.41 | 0.36 * 0.60 * 0.58 *
0.90 0.46 * | 0.76 * 0.85 0.33 *
0.59 * 0.37 * | 0.56 * 0.68 * 0.56 *
0.79 * 0.47 * |
| Other
New Zealand Lebanon | 1.43 0.97 | 0.86 * 0.55 * | 0.61 * 1.79 | 0.99 0.83 * | 1.25 * 0.50 * | 0.97 0.67 * |
| * p < 0.01 | ||||||
Tables 5 and 6 give SMRs for some major cause of death groups for individual countries of birth in 1992-1994. Although Australians aged 15 years and over who were born in European countries had lower death rates than those born in Australia for most major causes of death, apart from diabetes, people born in Poland were an exception. Polish-born males and females had SMRs significantly higher than 1.0 for all causes of death and for diabetes and cardiovascular disease. Italian-born men and women also had significantly higher death rates for diabetes. People born in Asian countries had significantly lower death rates for most major causes of death, except for diabetes in Indian-born men and women (SMRs of 2.1 and 1.6 respectively) and Chinese-born women (SMR of 1.9), and infectious and parasitic diseases in men born in Vietnam and China (SMRs of 2.5 and 2.6 respectively). SMRs for women born in these countries were also raised but did not reach statistical significance.
Health of overseas-born Australians
Mortality data provide an objective picture of the health status of Australia's migrant population, but mortality is an extreme health endpoint which may not necessarily reflect differentials in other important dimensions of health status, such as disability, handicap, illness prevalence and perceived health. The author has analysed health interview survey data from the National Health Survey of 1989-90 and the ABS Survey of Disability and Ageing 1988 to provide a detailed picture of reported health differentials between overseas-born Australians and other Australians. This has been reported elsewhere10 but it is summarised here to complement the picture provided by the mortality analysis.
Table 6: Mortality differentials for selected countries of birth, by major causes of death, females aged 15 years and over, 1992-1994 | ||||||
Females | ||||||
Country of birth |
||||||
|
Europe Italy Former Yugoslavia Greece Germany Netherlands Poland |
| 0.75 * 0.61 * 0.68 * 1.06 0.93 1.10 | 2.36 * 1.40 1.37 1.27 1.48 2.18 * | 0.73 * 0.68 * 0.66 0.95 0.80 * 1.19 * | 0.66 * 0.84 * 0.78 1.27 0.88 1.48 | 0.74 * 0.65 * 0.67 * 0.97 0.84 * 1.14 * |
Asia Vietnam China Philippines India Hong Kong & Macao |
| 0.60 * 0.75 * 0.84 0.96 0.65 * | 1.08 1.88 * 0.96 1.61 * 0.53 | 0.59 * 0.69 * 0.54 * 0.97 0.36 * | 0.91 1.13 0.70 1.16 0.78 | 0.60 * 0.75 * 0.65 * 0.95 0.49 * |
Other New Zealand Lebanon |
| 1.00 0.83 * | 0.45 * 2.23 | 0.89 0.90 | 1.11 1.02 | 0.93 0.84 * |
* p < 0.01 | ||||||
Tables 7 and 8 show the ratios of a number of key health indicators to their levels in the Australian-born population for three lifecycle stages: young adults (15-24 years), working-age adults (25-64 years) and older people (65 years and over). In general, people born overseas reported significantly less serious chronic illness than did those born in Australia. But this favourable picture is modified by the fact that men and women born in continental Europe and Asia were generally more likely to report fair or poor health (rather than excellent or good health) than Australian-born men and women.
As with mortality, it has been shown that there is a gradient of reported morbidity with duration of residence in Australia.11 Men and women aged 25 to 64 years who had been in Australia for less than five years reported around 40 per cent fewer chronic and recent illnesses than did Australian-born men and women. They also reported fewer days of reduced activity than did Australian-born people (50 per cent fewer for men and 25 per cent for women). As the period of residence in Australia increased, these indicators approached the levels of the Australian-born. A different pattern was seen for reported days of reduced activity. On average, migrants who had been in Australia 10 years or more reported 10 per cent higher levels of reduced activity than did Australian-born men and women.
Previous analyses have found that overseas-born Australians had
fewer hospital admissions but were slightly more likely to have
visited a doctor in the last two weeks.12 Results from
the Health Survey reported in Tables 7 and 8 confirm these findings.
Men and women born overseas generally reported fewer hospital
episodes, though this did not reach statistical significance,
and more doctor visits. In particular, average numbers of doctor
visits were significantly higher for working-age men born in the
United Kingdom and Ireland, in other European countries, and in
Asia, and for young men and women born in 'other' countries. Working-age
women born in other European countries and Asia were also significantly
less likely to have had a mammogram or Pap smear in the last three
years or to be immunized for rubella.
Table 7: Health differentials between immigrants and Australian-born males aged 15 years and over, by life-cycle stage | ||||||
|
Health indicator Life cycle stage |
|
| ||||
| Deaths (per 100,000) in 1991-1993
Young men (15-24 yrs) Working-age men (25-64 yrs) Older men (65 yrs or more) | 1.0 4.1 58.3 | 1.00 1.00 1.00 | 1.03 0.81 * 0.95 * | 0.85 0.80 0.90 | 0.64 * 0.58 * 0.72 * | 0.89 0.80 * 0.85 * |
| Severe handicap (per cent)
Young men (15-24 yrs) Working-age men (25-64 yrs) Older men (65 yrs or more) | 1.1 2.6 14.4 | 1.00 1.00 1.00 | 0.66 0.81 0.85 | - 1.29 1.15 | - 0.70 0.60 | 0.92 0.87 0.44 |
| Serious chronic illnesses (av. no. per person)
Young men (15-24 yrs) Working-age men (25-64 yrs) Older men (65 yrs or more) | 0.16 0.26 0.70 | 1.00 1.00 1.00 | 1.32 0.90 1.06 | 0.65 0.72 * 0.85 | 0.30 * 0.71 * 1.12 | 0.89 0.57 * 0.70 * |
| Fair/poor health (per cent)
Young men (15-24 yrs) Working-age men (25-64 yrs) Older men (65 yrs or more) | 10.9 17.2 43.4 | 1.00 1.00 1.00 | 0.90 0.84 0.87 | 0.65 1.30 1.17 | 0.57 1.25 1.25 | 0.83 0.67 0.98 |
| Doctor visits (per year)
Young men (15-24 yrs) Working-age men (25-64 yrs) Older men (65 yrs or more) | 3.96 4.95 11.40 | 1.00 1.00 1.00 | 0.83 1.11 0.88 | 1.44 1.20 * 0.91 | 1.09 1.40 * 0.93 | 1.58 * 1.01 0.65 * |
Hospital episodes (per year) Young men (15-24 yrs) Working-age men (25-64 yrs) Older men (65 yrs or more) | 0.11 0.15 0.42 | 1.00 1.00 1.00 | 1.35 0.74 1.08 | 0.87 0.75 0.68 | 0.45 0.80 0.92 | 0.83 0.87 0.97 |
* p < 0.01 Source: Mathers as cited in notes 5, 10, 18 | ||||||
DISCUSSION AND CONCLUSIONS
It is clear that immigrants to Australia generally have better overall health as measured by mortality rates, life expectancy and various self-reported measures of health status. However, there are some specific diseases and disease groups where immigrants from some countries have worse health, particular in relation to some cancers, diabetes and infectious diseases. These differentials reduce with increasing length of residence in Australia.
Immigrants are highly selected by health status, both explicitly
by the health criteria applied by the Australian Government to
people seeking to migrate to Australia and also because people
who are in poor health are less likely to have the ability and
economic resources to migrate. Although it is likely that these
selection effects explain a considerable part of the observed
health differentials, a number of other factors are also likely
to contribute, including differences in genetic inheritance, diet
and lifestyle, socioeconomic status and working conditions, and
possibly in access to health facilities. For example, it is possible
that some of the apparent differences between country-of-birth
groups in health indicators based on self-report may be due to
differences in reporting due to language limitations or cultural
differences.
Table 8: Health differentials between immigrants and Australian-born females aged 15 years and over, by life-cycle stage | ||||||
|
Health indicator
Life cycle stage |
|
| ||||
|
Deaths (per 100,000) in 1991-1993 Young women (15-24 yrs) Working-age women (25-64 yrs) Older women (65 yrs or more) | 0.4 2.2 36.5 |
| 0.68* 0.87* 0.96* | 0.65 * 0.75 * 0.92 * | 0.71 * 0.67 * 0.76 * | 1.09 0.82 * 0.91 * |
Severe handicap (per cent) Young wowomen (15-24 yrs) Working-age women (25-64 yrs) Older women (65 yrs or more) | 1.28 3.13 20.38 |
| 0.60 1.01 1.03 | - 0.51 * 1.15 | 0.28 0.85 0.92 | 0.38 1.17 1.44 |
Serious chronic illnesses (av. no. per person) Young women (15-24 yrs) Working-age women (25-64 yrs) Older women (65 yrs or more) | 0.20 0.26 0.54 |
| 0.66 0.99 1.11 | 0.27 * 0.71 * 0.93 | 0.38 * 0.51 * 0.75 | 0.87 0.69 * 0.87 |
Fair/poor health (per cent) Young women (15-24 yrs) Working-age women (25-64 yrs) Older women (65 yrs or more) | 11.9 16.5 41.5 |
| 1.03 0.87 0.86 | 0.32 1.71 * 1.49 * | 1.61 * 1.40 * 1.37 | 1.31 1.08 0.96 |
Doctor visits (per year) Young women (15-24 yrs) Working-age women (25-64 yrs) Older women (65 yrs or more) | 6.92 7.87 11.64 |
| 1.09 1.03 1.06 | 0.61 * 1.06 1.07 | 0.71 * 1.05 1.28 | 1.32 * 0.97 0.94 |
Hospital episodes (per year) Young women (15-24 yrs) Working-age women (25-64 yrs) Older women (65 yrs or more) | 0.21 0.24 0.31 |
| 1.09 0.97 1.06 | 0.30 0.97 0.89 | 0.54 1.04 1.24 | 0.78 0.85 0.70 |
* p < 0.01 Source: Mathers as cited in notes 5, 10, 18 | ||||||
The author has carried out multivariate analyses of self-reported health status and number of illness conditions by country-of-birth group which took into account or 'adjusted for' differences in factors such as length of residence, language spoken at home, a number of lifestyle risk factors, age and socioeconomic status.13 It was concluded that lifestyle risk factors (smoking, risk drinking, overweight and inactivity) and socioeconomic factors (family income, family composition, employment status, education level and region of residence) were not important explanatory factors for the differentials observed between immigrants and other Australians.
People who did not speak English at home, when compared to those who did, reported fewer chronic illnesses, but were much more likely to report their health to be worse. When these people were excluded from the analysis, differentials in self-reported health by birth region largely disappeared and differentials in numbers of illness reported were reduced. It is possible that non-English-speaking people had more difficulties in reporting specific illnesses than English-speaking people, or that there are cultural differences in perceptions of health, so the results of the multivariate analyses discussed above should be treated with caution. It is also possible that language spoken at home is acting as a surrogate indicator of more recent migration or of lower levels of adoption of health-related aspects of Australian lifestyle.
Adjustment for health factors, length of residence, language spoken at home and other factors in a multivariate analysis, generally had little effect on the health service utilisation differentials of overseas-born Australian men.14 However, for women, adjustment for these factors removed the apparent higher doctor-visit rate of European-born women (because they reported worse perceived health status) but suggested that Asian-born women were hospitalised more often than their reported health status and language distribution would warrant. Men born in the United Kingdom and Ireland visited the doctor significantly more often than Australian-born men reporting the same health status.
These broad analyses suggested that health service utilisation rates are broadly consistent with reported health status for most adult immigrant groups, but that there may be some immigrant groups whose utilisation is higher than would be expected on the basis of their reported health status. More detailed analyses would be required to explore this issue further.
Although immigrants generally have better health status than other Australians, there has been concern that language and cultural differences may create barriers to accessing health services and health information. People of non-English-speaking background (NESB) have been identified as a priority population for monitoring equity objectives of social and health programs.15 In addition, there are specific health problems and aspects of lifestyle where there is a need to have information on Australians from particular ethnic backgrounds. It has even been suggested that the decline of immigrant health with increasing length of residence is an equity issue in itself, and that the health system should attempt to preserve the better health of immigrants.16 The highest priority data item relating to ethnic origin is country of birth and the Australian Institute of Health and Welfare has recommended that this information should be collected in all health and welfare-related data collections in a manner consistent with the Australian standard classification of countries for social statistics.17
In conclusion, immigrants to Australia generally have lower mortality
rates for most major causes of death and they report better health
status. Their lower levels of hospitalisation are generally consistent
with their better health status, unlike their comparable or somewhat
higher levels of doctor consultation. It is very likely that the
lower mortality of many overseas-born people is due to health
selection effects upon migration, combined with cultural factors
such as a healthier diet for some groups. These factors may conceal
adverse health effects associated with work, or with poorer socio-economic
status, for some immigrant groups in Australia.
References
1 Some recent analyses include: C. Young Selection and survival: immigrant mortality in Australia, Department of Immigration and Ethnic Affairs, Australian Government Publishing Service (AGPS), Canberra, 1986; J. Reid and P. Trompf (eds) The Health of Immigrant Australia: A Social Perspective, Harcourt Brace Jovanovich, Marrickville, 1990; C. Young 'Mortality: the ultimate indicator of survival: the differential experience between birthplace groups', in: J. Donovan et al. (eds), Immigrants in Australia: A Health Profile, Australian Institute of Health and Welfare (AIHW), Ethnic Series No. 1, AGPS, Canberra, 1992, pp.34-70.
2 Reid and Trompf, op. cit.
3 National Health Strategy, 'Removing cultural and language barriers to health', Issues Paper No 6, National Health Strategy, Melbourne, 1993
4 J. Donovan et al., 'Immigrants in Australia: a health profile', AIHW, Ethnic Series No. 1, AGPS, Canberra 1992; G. Giles, P. Jelfs and E. Kliewer, 'Cancer in migrants to Australia 1979-1988', AIHW, Canberra, 1995; National Health Strategy, op. cit.
5 C. Mathers, Health differentials among Australian adults aged 25-64 years, AIHW, Canberra, 1994a
6 Estimated resident population by country of birth, age and sex, Australia. Preliminary June 1992 and June 1993, Catalogue No. 3221.0, Australian Bureau of Statistics (ABS), Canberra
7 Australian Standard Classification of Countries for Social Statistics, Catalogue No. 1269.0, ABS, Canberra, 1990
8 World Health Organisation, Manual of the international statistical classification of diseases, injuries and causes of death, Ninth revision, volumes 1 and 2, WHO, Geneva, 1977
9 See C. Mathers, 1994a, op. cit. Appendix A.
10 See ibid.; C. Mathers Health differentials among older Australians, AIHW, Canberra 1994b; C. Mathers Health differentials among Australian children, AIHW, Canberra, 1995.
11 Australia's Health 1992: the third biennial report of the Australian Institute of Health and Welfare. AGPS, Canberra, 1994, Table 4.13.
12 E. T. d'Espaignet and C. Stevenson, 'Differences in causes of hospitalisation in New South Wales' and C. Young & A. Coles 'Women's health, use of medical services, medication, lifestyle and chronic illness: some findings from the 1989-90 National Health Survey', in J. Donovan et al., op. cit., pp. 71-121, 122-191
13 Mathers, 1994a, op. cit., Chapters 13 and 14.
14 ibid.
15 See Office of Multicultural Affairs, Access and Equity - Annual Report 1995, Department of the Prime Minister and Cabinet, AGPS, Canberra, 1995; Commonwealth Department of Human Services and Health, Better health outcomes for Australians, AGPS, Canberra, 1994; 'Report of the 1994 National Health Information Forum', AIHW, Canberra, 1994.
16 T. Schofield 'The health of Australians of non-English-speaking background: key concerns', Australian Journal of Public Health , vol. 19, no. 2, pp. 117-118, 1995
17 C. Mathers, B. Armstrong, A. M. Waters & J. Clark, Identification of Ethnicity and Indigenous Status in National Health and Welfare Data Collections, Information Paper, AIHW, Canberra, 1996
18 C. Mathers, Health differentials among young Australian adults, AIHW, Canberra 1996 (in press)
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