Hispanic paradox

Mortality

Though they are often at lower socioeconomic standing, most Hispanic groups, excepting Puerto Ricans, demonstrate lower or equal levels of mortality to their non-Hispanic White counterparts. The Center for Disease Control reported in 2003 that Hispanic’s mortality rate was 25 percent lower than non-Hispanic whites and 43 percent lower than African Americans. This mortality advantage most commonly found among middle-aged and elderly Hispanics. The death rates of Hispanics to non-Hispanic whites was found to exceed 1.00 in the twenties, decreases by age 45, then is severely reduced to 0.75-.90 by at age 65, persisting until death. When controlling for socioeconomic factors, the health advantage gap for Mexican Americans, the largest Hispanic population in the US, increases noticeably.

Hispanics do not have a mortality advantage over non-Hispanic Whites in all mortality rates; they have higher rates for mortality from liver disease, cervical cancer, AIDS, homicide (males), and diabetes.

Infant mortality

Another important indicator of health is the infant mortality rate, which is also either equal or better in Hispanic Americans than in non-Hispanic Americans. A study by Hummer, et al. found that infants born to Mexican Immigrant women in the United States have about a 10% lower mortality in the first hour, first day, and first week than that of infants born to non-Hispanic white, U.S.-born women. In 2003, the national Hispanic infant mortality rate was found to be 5.7, nearly equal to that of non-Hispanic Americans and 58 percent lower than that of African Americans. Hispanic immigrants also have a 20% lower infant mortality rate than that of U.S.-born Hispanics, though the latter population usually has a higher income and education, and are much more likely to have health insurance.

Socio-economic factors

According to Alder and Estrove (2006), the more socioeconomically advantaged individuals are, the better their health. Access to health insurance and preventative medical services are one of the main reasons for socioeconomic health disparities. Economic hardship within the household can cause distress and affect parenting, causing health problems among children leading to depression, substance abuse, and behavior problems. Low socioeconomic status is correlated with increased rates of morbidity and mortality. Mental health disorders are an important health problem for those of low socioeconomic status; they are two to five times more likely to suffer from a diagnosable disorder than those of high socioeconomic status, and are more likely to face barriers to getting treatment. Furthermore, this lack of treatment for mental disorders can affect educational and employment opportunities and achievement.

Residential segregation

Important to the understanding of migrant community health is the increasingly stratified American society, manifested in residential segregation. Beginning in the 1970s, the low to moderate levels of income segregation in the United States began to degrade. As the rich became richer, so did their neighborhoods. This trend was inversely reflected in the poor, as their neighborhoods became poorer. As sociologist Douglas Massey explains, “As a result, poverty and affluence both became more concentrated geographically.” Professor of public administration and economics John Yinger writes that “one way for poor people to win the spatial competition for housing is to rent small or low-quality housing.” However, he continues, low-quality housing often features serious health risks such as lead paint and animal pests. Though lead-based paint was deemed illegal in 1978, it remains on the walls of older apartments and houses, posing a serious neurological risk to children. Asthma, a possible serious health risk, also has a clear link to poverty. Moreover, asthma attacks have been associated with certain aspects of poor housing quality such as the presence of cockroaches, mice, dust, dust mites, mold, and mildew. The 1997 American Housing Survey found that signs of rats or mice are almost twice as likely to be detected in poor households as in non-poor households.

Barrio advantage

One hypothesis for the Hispanic Paradox proposes that living in the same neighborhood as people with similar ethnic backgrounds confers significant advantages to one’s health. In a study of elderly Mexican-Americans, those living in areas with a higher percentage of Mexican-Americans had lower seven-year mortality as well as a decreased prevalence of medical conditions, including stroke, cancer, and hip fracture. Despite these neighborhoods' relatively high rates of poverty due to lack of formal education and low paying, service sector jobs, residents do not suffer from the same mortality and morbidity levels seen in similarly disadvantaged socioeconomic neighborhoods. These neighborhoods do have intact family structures, community institutions, and kinship structures that span households, all of which are thought to provide significant benefits to an individual’s health. These social network support structures are especially important to the health of the elderly population as they deal with declining physical function. Another reason for this phenomenon could be that those Hispanic-Americans that live among those of similar cultural and social backgrounds are shielded from some of the negative effects of assimilation to American culture.

Acculturation

The extent of a Hispanic American’s acculturation in the United States, or their assimilation to mainstream American culture, is relative to his or her health. One of the main negative effects of acculturation on health has been on substance abuse. More assimilated Latinos have higher rates of illicit drug use, alcohol consumption, and smoking, especially among women. Another negative effect of acculturation is changes in diet and nutrition. More acculturated Latinos eat less fruits, vegetables, vitamins, fiber and protein and consume more fat than their less acculturated counterparts. One of the most significant impacts of acculturation on Latino health is birth outcomes. Studies have found that more acculturated Latinas have higher rates of low birthweight, premature births, teenage pregnancy and undesirable prenatal and postnatal behaviors such as smoking or drinking during pregnancy, and lower rates of breastfeeding. Acculturation and greater time in the United States has also been associated with negative mental health impacts. US-born Latinos or long term residents of the United States had higher rates of mental illness than recent Latino immigrants. In addition, foreign-born Mexican Americans are at significantly lower risk of suicide and depression than those born in the United States. The increased rates of mental illness is thought to be due to increased distress associated with alienation, discrimination and Mexican Americans attempting to advance themselves economically and socially stripping themselves of traditional resources and ethnically-based social support.

Healthy migrant effect

The “healthy migrant effect” hypothesizes that the selection of healthy Hispanic immigrants into the United States is reason for the paradox. International immigration statistics demonstrate that the mortality rate of immigrants is lower than in their country of origin. In the United States, foreign-born individuals have better self-reported health than American-born respondents. Furthermore, Hispanic immigrants have better health than those living in the US for a long amount of time.

Salmon bias

A second popular hypothesis, called the “Salmon Bias”, attempts to factor in the occurrence of returning home to Mexico. This hypothesis purports that many Hispanic people return to Mexico after temporary employment, retirement, or severe illness, meaning that their deaths occur on Mexican soil and are not taken into account by mortality reports in the United States. This hypothesis considers those people as “statistically immortal” because they artificially lower the Hispanic mortality rate. Certain studies hint that it could be reasonable. These studies report that though return migration, both temporary and permanent, depend upon specific economic and social situations in communities, up to 75% of household in Mexican immigrant neighborhoods do some kind of return migration from the U.S. However, Abraido-Lanza, et al. found in 1999 that the “Salmon Hypothesis” cannot account for the lower mortality of Hispanics in the US because, according to their findings, the Hispanic paradox is still present when non-returning migrants are observed (e.g. Cubans).

Slow biological aging

Horvath et al. (2013) have proposed that the lower mortality of Hispanics could reflect a slower biological aging rate of Hispanics. This hypothesis is based on the finding that blood and saliva from Hispanics ages more slowly than that of non-Hispanic whites, African Americans, and other populations according to a biomarker of tissue age known as epigenetic clock.

Comparison with other ethnicities

One of the most important aspects of this phenomenon is the comparison of Hispanics' health to non-Hispanic African Americans' health. Both the current and historical poverty rates for Hispanic and non-Hispanic African American populations in the United States are consistently starkly higher than that of non-Hispanic White and non-Hispanic Asian Americans. Dr. Hector Flores explains that “You can predict in the African–American population, for example, a high infant-mortality rate, so we would think a [similar] poor minority would have the same health outcomes.” However, he said, the health poor outcomes are not present in the Hispanic population. For example, the age-adjusted mortality rate for Hispanics living in Los Angeles County was 52 percent less than the blacks living in the same county.

Criticism

Some public health researchers have argued that the Hispanic paradox is not actually a national phenomenon in the United States. In 2006, Smith and Bradshaw argued that no Hispanic paradox exists. They maintain that life expectancies were nearly equal for non-Hispanic White and Hispanic females, but less close for non-Hispanic White and Hispanic Males. Turra and Goldman argue that the paradox is concentrated among the foreign born from specific national origins, and is only present in those of middle to older ages. At younger ages, they explain, deaths are highly related to environmental factors such as homicides and accidents. Deaths at older ages, they maintain, are more related to detrimental health-related behaviors and health status at younger ages. Therefore, immigration-related processes only offer survival protection to those at middle and older ages; the negative impact of assimilation into poor neighborhoods is higher on the mortality of immigrants at a younger age. In contrast, Palloni and Arias hypothesize that this phenomenon is most likely caused by across-the-board bias in underestimating mortality rates, caused by ethnic misidentification or an overstatement of ages. These errors could also be related to mistakes in matching death records to the National Health Interview Survey, missing security numbers, or complex surnames.