Unequal Returns? Wealth and Debt Gradients in Health Among Immigrants and Natives in Norway

Background: Socioeconomic status (SES) is positively associated with health, but these benefits are not equally shared across groups. The Minorities’ Diminished Returns (MDRs) framework posits that marginalized groups derive weaker health returns from economic resources than majority populations. Extending this framework to a migration context, this study examines wealth- and debt–health gradients in Norway, comparing first-generation immigrants with native-born Norwegians, disaggregated by region of origin and reason for migration.Methods: Using full-population administrative data from Norway (2017) and Poisson regression models, we analyze 590,274 first-generation immigrants and 2,867,668 native-born individuals aged 27 and older. Gross wealth (real and financial assets) and debt are the main predictors, with physician-diagnosed morbidity as the outcome.Findings: Wealth is more strongly associated with better health among natives than immigrants, consistent with MDRs. Gradients are steepest at lower wealth levels, plateau at higher levels, and vary by subgroup. Higher debt often predicts lower morbidity, particularly among individuals with substantial debt, suggesting debt can function as a resource as well as a burden.Conclusion: Migration background moderates the health returns to wealth and debt, underscoring the need for policies addressing economic inequality and institutional barriers limiting immigrants’ ability to convert resources into health benefits.