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George Floyd’s life mattered. Like Ahmaud Arbery, Breonna Taylor, Tony McDade, and too many others whose names we don’t know, Floyd was stolen from friends and family members who loved him and cared about him. His murder cannot be undone, and it is our most recent reminder of the fact that white supremacy, police violence, and racism are dangerously prevalent forces in America today… Read Full Statement

When the Metrics Don’t Add Up: Understanding the Hispanic Paradox

Race is one of the most visible and pressing sources of inequity among Americans, particularly in its effect on health outcomes. Perhaps the most well known instance of racial health disparity lies in life expectancy – a white man in the United States, for example, is expected on average to live four and a half years longer than the average black man. It is a well-established tenet of epidemiology that people of color endure poorer health outcomes than white Americans, with higher rates of infant death and increased risk of developing and dying from diseases like diabetes and AIDS. Epidemiologists attribute this phenomenon to systemic disadvantages faced by minority groups in terms of social determinants of health. Decreased access to care, higher rates of unemployment, and increased likelihood of living below the poverty line all seem to contribute to poor minority health – except in the case of the Hispanic Paradox.

The Hispanic Paradox is the exception to the most basic of public health principles.  Despite facing lower socioeconomic conditions relative to white people, Hispanic Americans overall enjoy comparable and often better health outcomes. This is most visible in life expectancy measurements – those identifying as Hispanic in ethnicity live longer than any other racial group in the United States besides Asian Americans. This is striking because Hispanic Americans, like other minority groups, experience a number of detrimental social conditions widely accepted by the epidemiological world as drivers of reduced health. To illustrate, in 2016 the median household income of Hispanics or Latinos of any race was approximately 14.5k dollars lower than that of white Americans. Furthermore, about 20% of Hispanic or Latino Americans under the age of 65 were living without health insurance coverage in 2017, compared to just 7% of white people. From a public health standpoint, it is unexpected that Hispanic Americans live such statistically healthy lives, outperforming white people in data compilations of COPD and lung cancer mortality, childhood asthma development, and incidence of breast cancer, colorectal cancer, and cancer in general.    

The Hispanic Paradox is generally a poorly understood phenomenon. Public health scholars have proposed a variety of explanations since the trend was identified in the mid 80s, most of which have been refuted. The “salmon bias” and “healthy migrant” hypothesis, for example, focus on the immigrant population within the Hispanic American demographic and its potential to artificially deflate death rates. The “salmon bias” suggests that immigrants may return to their country of origin to die and are not counted in national death statistics. “Healthy migrants” proposes that only the healthiest individuals immigrate to the U.S., and thus the US Hispanic population is skewed and non representative of a true, well-mixed demographic. A 1999 study disproved both of these theories in a data compilation focused on Hispanic demographic groups to which neither hypothesis was applicable. The same nationally established trends persisted among these select groups.

"Decreased access to care, higher rates of unemployment and increased likelihood of living below the poverty line all seem to contribute to poor minority health – except in the case of the Hispanic Paradox."

A natural explanation for the Hispanic Paradox is a manifestation of a genetic component. Epidemiologists have long studied the phenomenon, hoping to uncover a common gene that confers an elusive resilience against death, but to no avail. A great deal of evidence exists in contradiction to the genetic concept, namely the process of acculturation. In the case of Hispanics, health declines with each successive generation as posterity “Americanizes,” shifting the significance of the paradox away from an inherited set of traits. Hispanic children are less likely than their parents to experience the generalized effect of the Hispanic Paradox, and while the lifespan of US-born Hispanics is longer than that of white people, it is shorter than that of their foreign-born predecessors.

Many epidemiologists have theorized a protective element of Hispanic cultural lifestyle that is lost as individuals assimilate, a process which becomes more and more likely with the passing of generations. Some public health officials point a finger at the adoption of high-fat processed foods into the diet of immigrants and their children as catalysts of heart disease and early death, and it is true that some epidemiological studies suggest that acculturation adversely affects dietary quality. However, the conceptualized distinction between the American fast-food based diet and the immigrant plant-based diet is oversimplified and lacking in nuanced analysis.

Eating patterns are a concrete demonstration of shifting cultural behavior, but acculturation is often times a nuanced and intangible progression. It measures the relationship between an individual and the society that surrounds them, a highly complex and individualized event difficult to quantify. Mental health is perhaps the most accurate physiological representation of this phenomenon: Rates of substance abuse, depression and suicide are all higher in US born Hispanics than first generation Hispanic immigrants. These outcomes may stem from theorized byproducts of assimilation, like increased exposure to discrimination, feelings of alienation, isolation, and the breakdown of supportive social ties as the children of immigrants grow up and move away from more ethnically homogeneous neighborhoods.

For all humans regardless of race or ethnicity, health is a largely social experience. Resilience to death and disease is dependent on an array of societal conditions, many of which have little to do with the direct biological basis of wellbeing. The Hispanic Paradox challenges the world of public health to transform culture – a vital and innately human experience – into a clinical and consistent set of data. Perhaps it is an impossible task. The Hispanic Paradox proves that often times, base injustices must be combatted before they are fully understood, because while Hispanic Americans may live to be 82.89, those lives are disproportionately plagued by low quality education, high rates of poverty, food insecurity, and limited access to care.

Photo: “Doctor’s tools