The Global City: Newcomer Health in Toronto (2011)
Newcomers to Toronto bring many strengths and assets that make our city vibrant and prosperous. These include good health, education, professional experience and skills, cultural diversity and new and innovative perspectives. However, many newcomers face challenges to their health as they establish themselves in Toronto and embark on their journey towards successful integration into Canadian society.
This report describes the “health advantage” that most newcomers bring to Toronto, the decline in their health over time and the need to re-examine and strengthen our efforts to support newcomers, especially those whose health risks are compounded by their income level, gender, immigration status, ethno-racial background, sexual orientation or other factors.
The report tells us that “settlement is a health issue, and health is a settlement issue.” Integrating health and settlement support is key to ensuring a healthy city.
What is this research about?
The report set out to build the first comprehensive picture of newcomer health in Toronto, focusing on:
- The health status of newcomers.
- Determinants of health affecting newcomers.
- Access to health services and barriers.
It answered: What do we know about newcomer health in Toronto? How do newcomers’ health outcomes compare to longer-term immigrants and Canadian-born residents? How does a newcomer’s health change over time? Which social‑determinants shape newcomer health?
Why this research matters
The report responds to a municipal mandate to reduce health inequities for newcomers and to inform planning for a growing, increasingly diverse city. At the time this research was done Toronto was home to half a million newcomers (2000–2009). As of 2006, half the city’s residents were foreign-born, with 81% of newcomers identifying as racialized.
Importantly, the report outlined the newcomer health paradox (the “healthy immigrant effect”). Newcomers often arrive healthier, but over time their health declines, sometimes equaling or exceeding Canadian-born rates of chronic and mental illness. But that decline is not equally felt. The report documents its uneven decline across sub‑populations (e.g., South‑Asian, Caribbean, Sub‑Saharan African groups show higher diabetes risk). It also foregrounds social determinants of health such as employment, housing, discrimination that are rarely quantified in routine health reporting.
The study treats newcomers as a heterogeneous group. Health advantages tend to erode with length of residence, and intersectional factors such as age, gender, ethnicity, income, immigration status, language, sexual orientation produce divergent health trajectories.
The report offers a data‑rich, intersectional portrait of how health evolves for newcomers in a rapidly diversifying city. Its blend of epidemiologic evidence and community voices makes it a valuable blueprint for anyone seeking to design equitable health policies, deliver culturally safe services, or advance scholarly understanding of immigrant health dynamics.
What did the researchers find?
Health advantage & decline:
Newcomers arrive with lower rates of heart disease, cancers, and addictions, but health declines over time. Women, refugees, low-income and racialized newcomers face faster declines. Most newcomers arrive healthier than Canadian‑born peers, but self‑reported health worsens after 5‑10 years.
Longer‑term immigrants report poorer health and higher chronic‑diseases. For example, researchers identified diabetes hot‑spots among specific ethnic groups. Despite overall lower obesity, South‑Asian and Caribbean newcomers show disproportionate diabetes rates, suggesting genetic‑environmental interaction and need for targeted screening.
Barriers to care:
Newcomers have lower primary‑care utilization, fewer regular family doctors, especially among men; significant barriers: language, cost, lack of OHIP (first 3 months), cultural insensitivity, stigma, transportation.
Issues that impact access to care include:
- Language and literacy: “Newcomer challenges are exacerbated when newcomers can’t read, can’t write” (service provider).
- Stigma: Particularly around mental health, HIV/AIDS, and addictions – “due to the stigma… newcomer men with mental health problems will seek help only when faced with legal risks or when the matter is at its worst” (service provider).
- Cultural barriers: Some prefer familiar treatments from home countries or distrust authority figures.
- Mental health: While newcomers self‑report better mental health, qualitative focus‑group participants repeatedly voiced high stress, isolation and trauma, especially among refugee women, highlighting a possible reporting bias or under‑diagnosis. Depression, anxiety, trauma, and stress (linked to unemployment, poverty, racism, intergenerational conflict) were frequently reported.
- Gendered experiences: Women, LGBTQ newcomers, and youth face unique mental health and safety risks (violence, homophobia, isolation).
- Social determinants: Income insecurity, under‑employment, credential non‑recognition, discrimination drive health inequities. 46 % of newcomers (< 5 yr) lived in low‑income households (2006 census).
- Intersection of gender, sexuality and health: 2SLGBTQIA+ newcomers face compounded barriers (language, stigma, limited culturally safe services).
- Barriers for undocumented newcomers: A lack of access to OHIP and fear of deportation create a hidden population that forgoes essential care, a group often omitted from routine surveillance.
How can you use this research?
For policymakers/municipal planners
- Invest in culturally appropriate, linguistically accessible health services.
- Target funding to groups at highest risk (refugees, women, racialized newcomers, LGBTQ newcomers).
- Support research into under-studied groups (e.g., trans newcomers, early childhood development impacts).
- Integrate culturally‑competent navigation services within the first three months of arrival to bridge the OHIP waiting period.
- Invest in multilingual health‑literacy campaigns focusing on preventive care, oral health and mental‑well‑being.
For health planners & public health service providers (Toronto Public Health, PHUs)
- Expand community‑based outreach (e.g., mobile clinics, faith‑based sites) to improve primary‑care linkage for men and recent arrivals.
- Integrate health promotion with settlement services (e.g., language, employment, housing).
- Reduce reliance on printed materials—use audiovisual/interactive formats for low-literacy groups.
- Build stigma-reduction campaigns around mental health and HIV/AIDS.
- Collect longitudinal data on newcomer health trajectories beyond 10 years to monitor the erosion of health advantage.
For Healthcare providers (physicians, nurses, community health workers)
- Screen for diabetes early in high‑risk ethnic groups regardless of BMI.
- Ask about immigration status and language preferences to tailor communication and referrals.
- Offer culturally safe mental‑health referrals (e.g., interpreters, trauma‑informed care).
For community/settlement organizations
- Facilitate “welcome‑to‑care” workshops that explain the health system, OHIP enrolment, and rights to care.
- Foster social supports (conversation circles, community events).
- Highlight positive newcomer stories of healthy adaptation.
For researchers
- Investigate mechanisms behind the rapid loss of health advantage, especially psychosocial stressors.
- Evaluate effectiveness of culturally tailored interventions (e.g., diabetes education, mental‑health peer groups).
- Conduct longitudinal, community-based, participatory studies.
- Prioritize knowledge gaps: LGBTQ+ newcomers, trans newcomers, refugees’ trauma, and early childhood experiences.
What did the researchers do?
- Literature review: 500+ peer-reviewed sources (Toronto/Ontario focused) on health status, determinants, and access.
- Environmental scan: Mapped of neighbourhood‑level indicators (income, housing, services) using Toronto’s 2006 census and municipal data. 90 community/grey literature reports, 48 directly referenced.
- Secondary data analysis: Census (2006), CIC immigration data, Canadian Community Health Survey (2001–2008), Longitudinal Survey of Immigrants in Canada.
- Focus groups (Jan 2011): 75 participants, across 7 groups:
- 2 with newcomer service users (20 total; men and women from Bangladesh, Afghanistan, Philippines, India, Pakistan, USSR, Dubai, Tajikistan).
- 14 settlement workers.
- 10 health providers (CHCs, hospitals, midwives).
- 9 outreach workers.
- 24 Toronto Public Health staff.
- 1 researcher group to identify data gaps.
- Each focus group lasted 120 minutes; all participants gave informed consent.