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Marielle Schweickart SOCI 280// Dr. Emerson October 20, 2011 Wikipedia Entry Draft 1

Hispanic Paradox
The Hispanic Paradox, or Latino Paradox, also known as the "Epidemiologic Paradox," refers to the epidemiological finding that Hispanic and Latino Americans tend to have health outcomes that paradoxically are comparable to, or in some cases better than, those of their U.S. white counterparts, even though Hispanics have lower average income. (Low socioeconomic status is almost universally associated with worse population health and higher death rates everywhere in the world.) In comparison with non-Hispanic whites, Hispanics usually have less education, less health insurance, and higher poverty rates but a lower all-cause mortality rate. The paradox usually refers in particular to low mortality among Latinos in the United States relative to non-Hispanic whites. Some believe that there is no Hispanic Paradox, however, and that inaccurate counting of Hispanic deaths in the United States leads to an underestimate of Hispanic or Latino mortality. Furthermore, 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. .

Also known as Hispanic Epidemiological Paradox and Latino Epidemiological 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. 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 for Mexican Americans, the largest Hispanic population in the US, the health advantage gap increases noticeably.

Infant Morality
Another important indicator of health is infant mortality, which is also either equal or better in Hispanic Americans than in non-Hispanic Americans. 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 on of the main reasons for socioeconomic heath 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 they are more likely to face barriers to getting the disorders treated. 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, 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 feature 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 AHS found that signs of rats and/or mice are almost twice as likely to be detected in poor households as in non-poor households.

The “Barrio Advantage”
The “barrio advantage” is the phenomenon that the sociocultural benefits conferred on Hispanic Americans living in high-density Hispanic-American neighborhoods outweigh the disadvantages caused by the high poverty rates of those neighborhoods. The results of a study done by Eschbach, et. al indicate that in older Hispanic Americans, the negative health effects of neighborhood poverty are less influential on health than the positive health effects due to the community of highly ethnically concentrated enclaves.

Cultural Factors
Cultural considerations are important to fully understand the Hispanic paradox. For any population, culture influences mortality outcomes because it affects lifestyle and health behaviors, social networks, and family structures. One’s diet, use of cigarettes, alcohol consumption, exercise habits, and use of medical care are all heavily influenced by their cultural practices.

Acculturation
The extent of a Hispanic American’s acculturation in the United States is relative to his or her health. In general, Hispanics have a health advantage for lung, colon, breast, and prostate cancer and cardiovascular disease because they are less likely to drink alcohol and Hispanic women are less likely to smoke to non-Hispanic Whites. They are also less likely to do drugs and contract sexually transmitted diseases. However, unhealthy behaviors, such as smoking, have been found to increase with greater acculturation.

The “Healthy Migrant Effect”
The “Health 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. However, Abraido-Lanza, et. al

The “Salmon Bias” Hypothesis”
A second popular hypothesis, called the “Salmon Bias”, and 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, Abrafdo-Lanza, et. al found in 1999 that the “Salmon Hypothesis” cannot account for the lower mortality of Hispanics in the US.

Comparison to other ethnicities
One of the most important aspects of this phenomenon is the comparison of Hispanic’s health to African American’s health. Both the current and historical poverty rates for Hispanic and African American populations in the United States are consistently starkly lower than that of non-Hispanic White and 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.