Hispanic Health 'Paradox': Why Do Latinos Live Longer?

Posted: Dec 01 2014

Shadow Figure-By Stewart Lawrence
It's been called the "Hispanic paradox," and public health researchers have debated its origins and significance for nearly three decades.  Why do Hispanics, whose income profile broadly parallels that of African-Americans and poor whites, have a higher “life expectancy” level, in fact, the highest level of all ethnic groups, regardless of income?  Is it a byproduct of lower Hispanic smoking and drinking levels, healthier eating habits, and a reduced incidence of terminal diseases like cancer?  Or is there something endemic to Hispanic culture - perhaps stronger family and religious ties – that enhances Hispanic longevity?

Some researchers suspect another cause: migration.  It could be that Hispanic immigrants, who comprise about half of all US Hispanics, are healthier than their counterparts back home.  Some researchers hypothesize a self-selection process, in which only the most able-bodied choose to migrate, cognizant of the difficulties of the journey and the rigors that adjustment to a foreign culture will demand.  If so, the presence of this pool of “super-healthy” migrants might skew the health of the Hispanic population upwards, compensating for the weaker health of US-born Hispanics. And the data do seem to support that finding, in fact.

The debate over the “Hispanic paradox,” and its corollary, the “Healthy Migrant effect,” has gained renewed saliency – and urgency – as a result of a series of major studies released in recent years as the nation's Hispanic population as sharply risen.  For example, in 2010, the US Centers for Disease Control that found that Hispanics, on average, lived about 2 years longer than Whites and nearly 8 years longer than Blacks.  The report is considered the most definitive body of research confirming a trend that some researchers have long attributed it to faulty or incomplete statistics, including the absence of comprehensive death certificates for Hispanics.

Average Life Expectancy at Selected Ages (in Years), 2010, by Race and Ethnicity

At Birth

Age 65      
(yrs. left)

Age 75
yrs. left)

Both Sexes

Total Population

78.7

19.1

12.1

Non-Hispanic White

78.8

19.1

12.0

Black

75.1

17.8

11.6

Hispanic

81.2

20.6

13.2

* Black totals include Hispanics.
Source: National Center for Health Statistics, “Deaths: Final Data for 2010,” National Vital Statistics Report 61, no. 4 (2013): Table 7.

Not all researchers have been won over to the CDC’s conclusions. Some skeptics note that large numbers of Hispanics from immigrant backgrounds typically leave the US to die in their native lands which means that some Hispanics – and their age at death – have not been factored into the statistics.  And there is little agreement on whether other immigrant groups, or even different Hispanic sub-groups, exhibit the health paradox in common - or to the same degree.
Some research suggests that immigrant groups’ health is actually worse when they arrive, and that it improves with time, because of better access to quality care, especially among groups with rising incomes. That would seem to confirm, in part, the traditional argument about the relation between income level and health status, including longevity.
Moreover, even if the Hispanic paradox exists, it can’t account for large disparities in life expectancy due to another factor: gender. Hispanic women it turns out, have the highest life expectancy of all gender "sub-groups," followed by White women, then White Men. In fact, White women have slightly longer life expectancy than Hispanic Men. That doesn't disprove the Hispanic paradox, but it does seem to make the case a bit fuzzier.

Hispanic Life Expectancy at Birth 

What makes the paradox especially paradoxical is that Hispanics, especially those with lower incomes, still have some of the highest disease rates for illnesses like diabetes, tuberculosis, and asthma, and because of language and cultural as well as income barriers, appear less willing or able to get treatment for them. But they don't necessarily die any younger, or faster from these diseases.

Which seems to bring many researchers back to the influence of Hispanic culture.  Whatever the additional "risk" factors that Hispanics, especially non-immigrants, seem to face in America, their family ties, reliance on faith and community, and high consumption of fruits and vegetables, among other factors, seem to provide positive "protective" factors that can overshadow these negative influences.

If anything, support for the "Hispanic paradox" thesis appears to have grown in recent years.  In 2013, a study at the University of North Texas directed by John Ruiz, which reviewed a large sample of patients with diabetes, kidney disease, and HIV/AIDS, among other illnesses found that Hispanics were 16-30% more likely to live longer, depending on the illness. Now some researchers want to delve more deeply into these different rates to determine what combination of biological, behavioral, and sociocultural factors might account for them. They also want to explore the role that gender differences might play.

Apparently, many Hispanics are already well aware of their propensity to live longer.  In a survey conducted last year by the Kaiser Foundation, Hispanics and non-Hispanics were asked whether they agreed or disagreed with the following statement:  "I am healthy enough not to need health insurance."  Despite substantially higher median incomes, 64% of non-Hispanic Whites disagreed with that statement, compared to just 48% of Hispanics. In other words, despite their lower incomes, and outstanding health care needs, a decided majority of Hispanics – 52% compared to just 36% of non-Hispanics -- were prepared to “go it alone.”

Such findings -- combined with a growing consensus that a "Hispanic paradox" on mortality indeed exists -- are confounding public health advocates that want to ensure that Hispanics gain equitable access to quality health care. They point to other factors that could explain why Hispanics could report lower levels of interest in health insurance, including concerns over its high cost as well as the documented language and cultural barriers they face when they try to sign up for insurance. Some advocates fear that by highlighting Hispanic longevity, researchers might weaken the case for addressing Hispanic health disparities in early diagnosis and treatment.

Still, the idea that Hispanics might be more resilient in the face of life-threatening diseases also contains a powerful cultural message, some observers say. At a time when minorities continue to be stigmatized as a social or fiscal "burden" on society, highlighting the cultural strength and resilience of Hispanics, especially immigrants, suggests just how much they have to teach others – including their ethnically biased critics -- about the foundations for healthy living.

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