Marginalization-related diminished returns of education level on self-rated physical and mental health among immigrants: an analysis of six high-income countries

Objective: To assess whether the association between level of education and self-rated physical and mental health is weaker for immigrants than non-immigrants, and to explore gender-based intersections. Methods: We conducted a cross-sectional study using data from the Wave 1 of the Global Flourishing Study—a multi-country survey with national representativeness. Data were drawn from Australia, Germany, Spain, Sweden, the United Kingdom and the United States. Self-rated physical and mental health were measured on a 11-point scale. Level of education was categorized into four levels based on country-specific classifications. Immigrant status was defined as being born outside the country of residence. We estimated linear regression models separately for each country, including interaction terms between educational level, immigration status, and gender. Country-specific estimates were then pooled using random-effects meta-analysis. Results: A total of 75,464 participants were included. Self-rated health scores increased with higher education levels, but immigrants had higher scores. However, the associations between level of education and health outcomes were significantly weaker for immigrants—they have reduced health benefits. Further, diminished health returns were more pronounced among female immigrants than their male counterparts, but these estimates had poor precision. Conclusions: Due to marginalization-related diminished returns, immigrants get less health benefits from the same level of education attained than their non-immigrant counterparts. This health gap is wider among female immigrants. Structural and contextual barriers obstruct the protective effects of education among marginalized populations.