In some advanced industrial nations, immigrants appear to record superior health status to native-born citizens in, while in others, immigrants appear disadvantaged. The USA is the context par excellence for the observation of superior immigrant health status; Europe is the context of immigrant health disadvantage.   The European evidence conforms to what is virtually a universal sociological law, the regular stratification of health by social class.  Immigrants from less developed nations where population health status is far below the levels achieved in the advanced national and especially if they arrived unlawfully, lack official documentation and are therefore at potentially at risk of economic exploitation, should record mortality rates above average.  This expectation is met  in Europe but not in the USA where immigrants of diverse national origins record significantly below average morality rates and there is even some evidence that the longer the distance between the US and the sending nation, the bigger the beneficial differential. Even immigrants from the poorest African nations record lower mortality risk from all causes   than US citizens born and raised in the world's wealthiest nation.  The phenomenon is a paradox precisely because it defies the expected association between socio-economic status and health. Poor immigrants undocumented and residing in some of the most socio-economically marginal and even dangerous neighborhoods of US cities appear to exhibit exemplary health status by reference to the most powerful indicators based on mortality risk.

How come?  Three alternative explanations can be considered:

1) Selection:   Immigrants are positively selected for their superior health status, by virtue of personal attributes or human capital.  These two characteristics may or may not coincide.  The more individualist rendering of the selection argument focuses on the fact that immigration is an arduous biographical project, which only the most resourceful and genetically well-endowed individuals can contemplate and accomplish. The human capital alternative reflects public policies in developed nations, which deliberately restrict entry to immigrants who are well endowed with educational and occupational credentials, which are already associated with superior health status. Clearly the underlying processes  in these two explanations can work together and indeed may be difficult to distinguish in practice.

2) Statistical Artifact: The immigrant population presents insuperable measurement problems for census enumerators, vital statisticians and socio-medical investigators.  The observation of superior health status is an artifact arising from numerator / denominator incompatibilities. In other words it is not a real phenomenon.

3. Culture:  Superior rates of survival among immigrants reflect positive features of their cultural background and socialization.  This explanation is a based on a pejorative, i.e. health depleting view of the culture of advanced capitalist civilization.  Immigrants are healthy either because they are insulated from either the bad consumption choices of people living in rich industrial nations  (material culture and cigarette smoking in particular), or they are protected from the competitive norms of modern life by immigrants communities which are psycho-social havens of mutual support in otherwise cold and calculating individualist social environment.

This presentation is a preliminary foray into the theoretical and empirical literature of the immigrants health paradox, reviewing the conceptual arguments, the available empirical evidence, and exploring how far the alternative explanations can cope with the double paradox, that the healthy immigrant is a feature of the socio-economic landscape of the USA but not Europe.