The Latino Mortality Advantage, or the Hispanic Paradox as it is more commonly referred to, is the scientific finding that Latinos in the United States live longer than non-Latino whites (Borrell). A study conducted by researcher Noreen Goldman found that in 2014, Latinos had a three year advantage in life expectancy at birth over non-Latino whites, (81.8 years compared to 78.8 years). This discovery has been especially prominent among first generation Latinos, especially those from Mexico, and parts of Central and Southern America. The strongest reason for this advantage is the greatly reduced rates of smoking among Latinos compared to non-Latino whites (Goldman). While Latinos, specifically Mexican Americans, continue to live longer than whites, they face many serious health issues, all of which show signs of worsening in the near future if public policies are not implemented to improve their access to health care and insurance coverage.
The Latino Mortality Advantage is often described as a paradox because it is assumed that Latinos are typically less educated, have lower income, have a lower standard of living and have much less frequent access to health insurance than non-Latino whites. Typically, those of a higher socioeconomic status live longer and healthier lives than those of lower status, thus making this finding so intriguing to many scientists. There are various explanations that support this survival advantage such as good health of immigrants at the start of their migration, lower rates of smoking, and strong social networks (Teruya).
The first reason that supports the Hispanic paradox is the good health of immigrants at the start of migration. In a study conducted by researcher, Dr. Martorell, Mexican immigrants' health advantage was a result of selective migration. Selective migration can refer to both in-migration of healthy individuals (healthy migrant effect) or the out-migration of unhealthy individuals (salmon bias). The healthy migrant effect is the concept that healthy people tend to naturally migrate into the country, while unhealthy people leave. Salmon bias refers to the hypothesis that many Latino people return to their country of origin after temporary employment, retirement, or severe illness. This leads to their deaths occurring in their native land and are not taken into U.S. morality reports (Martorell). However, research has reported that Mexican immigrants have significantly better physical function compared to non-Latino whites or U.S.-born Mexican Americans. The Hispanic Paradox advantage is most reflected in the greatly lowered rates of mood swings, anxiety, and substance disorders for Mexican American immigrant men and women compared with the rates of their U.S. born counterparts (Thomson).
The second reason that supports the paradox is the lower rates of smoking among Latinos. Cigarette smoking is the single greatest cause of premature death in the United States, taking 480,000 lives per year. More than 60% of the gap between the mortality rates of Latinos compared to non-Latino whites is attributed to lower rates of smoking among Mexican Americans. Latinos who do smoke are also “less likely to do so every day, smoke fewer cigarettes per day, and have smoked for fewer years on average than non-Latino whites.” (Fenelon) The advantage is largest for causes of death that are strongly associated with smoking including lung cancers, respiratory diseases, and ischemic heart disease (Teruya).
Strong social networks are also a large contributor to the Hispanic paradox. Latinos tend to have stronger family and community ties compared to their counterparts. Certain aspects of the Latino lifestyle also provide a “protective factor” not seen in non-Latino whites (Fenelon). “For example, Latino cultural values such as simpatia (importance of displaying kindness and maintaining interpersonal harmony), familismo (importance of keeping warm family relationships), and personalismo (valuing and building warm relationships) may help to build strong social support itself, [which] is associated with better health and lower mortality risk.” (Borrell) Another hypothesis for the Hispanic paradox advantage suggests that living in the same neighborhood as people with similar ethnic backgrounds offers significant advantages to a person's health. This proves true in a study conducted of elderly Mexican Americans, showing that areas with a dense population of Mexican Americans had a decreased prevalence of stroke, cancer, and hip fractures. The neighborhoods were also reported to have intact family structures, community outreach organizations, and expansive social webs among all the households (Dunlop).
Even though Hispanics have an advantage due to the prior evidence, there are several health trends that suggest a future decrease in the Hispanic advantage. One of these trends includes the growing percentage of obesity among Latinos. Mexicans currently have the highest obesity rate in the world, surpassing the United States, and Mexican Americans are now reported to be statistically more obese than non-Latino whites. The prevalence in obesity is especially seen in women and children. This is due in part to many disadvantaged Latinos being unable to afford healthy food options and then having to resort to unhealthy alternatives, such as fattening fast food (Martorell).
Mexican Americans have much higher rates of Type 2 diabetes than non-Latino whites. The rapidity at which diabetes is increasing among Mexican Americans is astounding. Three out of four Mexican American adults over 20 years were either overweight or obese at the end of the 20th century, and that number continues to increase. For example, a study of Mexican American children along the Mexico–U.S. border showed low intake of fruits and vegetables and excessive consumption of soft drinks and high-fat and high-sodium snacks. This recent spike can also be blamed on in-accessibility to affordable, healthy food options for low income Mexican American households (Martorell).
Latinos also have higher rates of disability than non-Latino whites. Researcher Noreen Goldman states that “This is due to Latinos having physically demanding and dangerous occupations and poor living conditions.” (Goldman). Latinos are more likely to be working “under the table”, which means that their employers are not required to provide any of the basic benefits that many other workers are entitled to. When/If they get injured while on the job, their employers are not required to provide any sort of medical care for them, or even compensation for work missed due to injury or illness. This greatly impacts the increases in mortality rates (Dunlop).
Additionally, the process of migration greatly affects the health of many Latino immigrants, as there are many stressors that correlate with the arduous migration process. The stressors these people can experience include: the dangerous border crossing for undocumented immigrants, anxieties about being detained and deported, difficulties in finding work, housing and healthcare, discrimination, and an ever more hostile political climate (Molina). There are also many stressors for immigrants associated with trying to acculturate into their new society. One of the biggest negative effects of acculturation on their health is the growing rates of substance abuse. Studies have found that more acculturated Latinos have higher rates for illegal drug usage, excessive alcohol consumption, and smoking. Another effect of acculturation, which is also linked to the increase in the rates of diabetes, is unhealthy changes in diet and nutrition among Latinos. More acculturated Latinos typically eat less fruits, vegetables, vitamins, fiber, protein, and consume more fat than Latinos who were less assimilated (Rodriguez). Furthermore, unfavorable birth outcomes, such as low birthweight, premature births, teenage pregnancy, and lower rates of breastfeeding have increased among more assimilated Latinas (Thomson).
Moreover, acculturation has lead to the prevalence of mental health issues among Latinos. U.S. born Latinos and long term residents have also had higher rates of mental illness than recent arrivals. As seen through the research of psychiatrist Dr. Margarita Alegria:
U.S.-born Latinos are at significantly higher risk than immigrant Latinos for major depressive episode (18.6% vs. 13.4%, p=0.001), any depressive disorder (19.8% vs. 14.8%, p=0.003), social phobia (8.5% vs. 6.0%, p=0.037), post- traumatic stress disorder (5.9% vs. 4.0%, p=0.048), any anxiety disorder (18.9% vs. 15.2%, p=0.033), alcohol dependence (6.9% vs. 2.8%, p<.001), alcohol abuse (9.3% vs. 3.5%, p<.001), drug dependence (5.1% vs. 1.7%, p<.001), drug abuse (6.1% vs. 2.2%, p<.001), and any disorder (37.1% vs. 24.9%.p<.001).
These results are striking when compared to foreign born Latinos but they are very similar to those found when researching non-Latino whites (Alegria). This finding further proves that acculturation into American society is detrimental to Latinos and further proves the Hispanic paradox.
Without proper access to healthcare, obesity and diabetes will continue to increase at an accelerated rate among Latinos. The Institute for Alternative Futures, projects that by 2025 the number of Hispanic Americans suffering from diabetes will increase to 11,452,100. By implementing and promoting targeted screening for Hispanic adults to identify those with pre-diabetes and undiagnosed diabetes, there will be a much more controlled growth in the number of people suffering with the disease. Additionally increasing patient compliance with therapy will also prove effective in battling the rapid prevalence of the diabetes. Tackling the problem of obesity starts with increasing access to proper physical education in schools and communities. Making healthy food options, such as organic produce, more affordable to Latino families will steer them away from fattening and unhealthy fast food that is sometimes unfairly targeted towards them (United States' Diabetes Crisis among Hispanic Americans: Today and Future Trends).
Medicaid expansion through the Affordable Care Act can assist in helping needy Latino families have easy access to healthcare. Under the current presidential administration, Latino healthcare was been further threatened. During the Obama administration, Latinos were targeted during health insurance enrollment season because of their high uninsured rate. The Trump administration has developed a “laissez-faire” approach toward the upcoming enrollment period, with a shorted enrollment season, and major cutbacks in marketing which is detrimental to Latinos (Molina). According to the Latino outreach specialist Alexander N. Ortega:
Nearly a million people who identify themselves as Latino or Hispanic enrolled in marketplace plans this year, making up a 10th of customers. The uninsured rate among Latinos dropped from 43% in 2010 to under 25% in 2016. Still, millions are eligible and remain uninsured.
In addition to these challenges, the government is making it even harder for Latinos to enroll in healthcare by shutting down the Spanish language enrollment website on Sundays, the day when many churches and community centers offer enrollment health. Implementing a single-payer system, which provides healthcare to state residents irrespective of immigration status would greatly benefit Latinos (Ortega).
The Hispanic paradox has proven to be true for Latinos for a very long time, but in the current climate their health advantage has been threatened. This threat is large and expansive and poses to eliminate the Latino health advantage if action is not taken quickly. For those without access to health care, increases in obesity and diabetes will lead to unnecessary suffering and threaten the ability of Latino families to support themselves financially. The implementation of universal health coverage in the U.S. would directly address and ameliorate this concern. In addition to this idea, higher rates of insurance coverage, would have a positive impact on Latinos' future health.
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