Hispanic Health Paradox

Good grief.  Over the years, as I scan various data sources, it has seemed to me, across many of those sources, that Hispanics have better health outcomes than any other segment in the US despite markedly lower household incomes and a variety of other circumstances that might be health impeding.  

I have not been confident that my casual observations were in fact real.  But if real, what might be the origin of the health benefit?  I have assumed, if the benefit was real, that it was perhaps related to a much lower demographic age.  Younger is usually healthier.  Additionally, I have assumed that, given how much of the population has grown owing to illegal immigration over the past three decades, that there might have been a filtering process.  If you are going to undertake the hazards of a perilous journey, it seems likely that you are also likely distinctly more healthy than the average population.  

But that has all been sort of hazy background speculation and conjecture based only on a sense of data exposure, not any sort of actual investigation of the issue.

Then, out of the blue, I discover that this has been a long known phenomenon which is real and even has a name - the Hispanic Health Paradox.  Not only a name but apparently a reasonable amount of research.

I know philosophically that almost tautologically our knowledge is finite and our ignorance infinite but it is always somewhat jarring when I discover once again that it is true.  

From Unraveling the Hispanic Health Paradox by José Fernandez, Mónica García-Pérez, and Sandra Orozco-Aleman.

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.

 

Regrettably, they do not arrive at any sort of an outline of an answer.  They make the useful observation that the category of Hispanic is not especially meaningful, covering, as it does, so many highly variant population groups.  But they do confirm that the phenomenon is real.

They also confirm that my assumption of lower average age and healthy immigrant status are contributors.  However, they are not confident that that is the primary explanation. 

They also point out the salmon bias hypothesis.

Second, the salmon bias hypothesis is a negative selection effect that refers to a sample selection bias resulting from return migration. Pablos-Méndez (1994, p. 1237) pointed out that “many Hispanics return to their country of birth when they retire, become severely ill, or simply after a temporary job.” He referred to this pattern as “salmon bias,” “highlighting the compulsion to die in one’s birthplace.” The deaths of those who return to their country of origin will not be recorded in US mortality statistics: as Pablos-Méndez wrote, “[S]ome individuals are rendered statistically immortal.” As a result, the immigrants that remain in the US will tend to be younger and healthier than those who return. Among the other reasons to return to the country of origin, researchers find a lower cost of living, the presence of family members, and lower return migration costs (Arenas et al. 2015). In early studies, Jasso and Rosenzweig (1982) found that all immigrant Hispanics, except for Cubans, have large emigration rates. Conversely, Abraído-Lanza et al. (1999) find evidence rejecting that the salmon bias hypothesis explains the Hispanic health paradox without ruling out some role for selective migration.

There is interesting discussion and observation throughout.