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Title: Unraveling the Hispanic Health Paradox

Citation Type: Journal Article

Publication Year: 2023

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Abstract: Hispanics in the United States tend to have lower household income, education, and health insurance coverage when compared to non-Hispanic Whites. Despite these economic disadvantages, paradoxically, Hispanics have displayed an equality with or even advantages over other minority groups and non-Hispanic Whites across a wide range of health outcomes. For example, in 2019, the Hispanic population had a life expectancy advantage of 3.0 years over the non-Hispanic White population and 7.1 years relative to the non-Hispanic Black population, despite having real household income that was 26 percent lower than non-Hispanic White households (Wilson 2020). Hispanic immigrants have also shown lower infant mortality rates and prevalence of mental illnesses. These stylized facts are collectively known as the “Hispanic health paradox.” This essay will provide an overview of the Hispanic health paradox literature. We will document different instances of the Hispanic health paradox across various measures: life expectancy at birth, infant mortality rate, death rates, causes of death, and morbidity. We will discuss the leading explanations of the Hispanic health paradox and possible ways for economists to contribute to this discussion. The origin of the Hispanic health paradox is often traced to the seminal paper by Markides and Hazuda (1980), in which the outperformance of Hispanics was deemed an “epidemiological paradox.” The authors found that Mexican Americans in southwest Texas had a lower infant mortality rate relative to other groups, including non-Hispanic Whites. Markides and Coreil (1986) reported the same phenomenon for life expectancy, mortality, disease-related health outcomes, and mental and functional health. In fact, the first Hispanic health advantage reported was observed for mental health among Mexican Americans (Karno and Edgerton 1969). Markides and Eschbach (2005) renamed these advantages the Hispanic paradox. In their discussion, they highlight the role of immigration in explaining the paradox, with the initial assumption that immigrants need to be healthy enough to endure the cost associated with immigration: travel, adaptation to new customs, new laws, and potentially with few resources or support available. The Hispanic health paradox is closely tied to the “healthy immigrant effect” (also known as the “healthy immigrant paradox”). The healthy immigrant effect is an observed time path in which the health of immigrants just after the migration is substantially better than that of comparable native-born people, but worsens with additional years in the new country. Stephen et al. (1994) were the first to identify this effect using the 1989 National Health Interview Survey, because this was the first time the survey incorporated the number of years lived in the country. Since then, various authors have identified this effect across numerous health outcomes (Ali 2002; Goel et al. 2004; Kennedy et al. 2015; McDonald and Kennedy 2004; Puyat 2013; Wu and Schimmele 2005; Jasso et al. 2005; Roger et al. 2011; Constant et al. 2018). A vast majority of the Hispanic health paradox literature has treated Hispanics in the United States as a monolithic group.1 Leading explanations of the Hispanic health paradox can be different due to backgrounds and characteristics. To that end, whenever possible, we disaggregate our findings by nativity and ancestry.

Url: https://www.aeaweb.org/full_issue.php?doi=10.1257/jep.37.1#page=147

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Authors: Fernandez, Jose; Garcia-Perez, Monica; Orozco-Aleman, Sandra

Periodical (Full): Journal of Economic Perspectives

Issue: 1

Volume: 37

Pages: 145-168

Data Collections: IPUMS USA, IPUMS CPS, IPUMS Health Surveys - NHIS

Topics: Health, Race and Ethnicity

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