Providing adequate an appropriate health care to meet the needs of a diverse immigrant population in Canada is a major challenge. Immigrants often have past and ongoing experiences that need to be taken into account in understanding and addressing specific health care needs. Complex factors are at play, including socio-economic status, employment, length of residence, social networks, education and other human capital levels, language and cultural practices, the effect of health-based selection at immigration, and access to social services that vary geographically. Health care needs vary individually according to these factors as well as demographic factors such as gender and age. Racism is a major factor both in accessing services on the part of individual newcomers and their communities, and as a system factor in the larger society. More research is needed to understand the systemic effects of racism.