Culture and the Hispanic paradox

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Short description: Possible cultural explanations for the disproportionately good health experienced by Latino Americans
Map of Latin America
Death rates for cancer and heart disease among men aged 45–64, by race and ethnicity: United States, 1999–2017[1]
Death rates for cancer and heart disease among women aged 45–64, by race and ethnicity: United States, 1999–2017[1]

The Hispanic paradox refers to an epidemiological paradox in which Hispanic and Latino Americans have a lower all-cause mortality and experience better health than non-Hispanic Whites in the United States despite a generally lower socioeconomic status, including lower income and level of education attained.[2][3][4][5][6][7] According to the Center for Disease Control's 2015 Vital Signs report, Hispanics in the United States had a 24% lower risk of mortality, as well as lower risk for nine of the fifteen leading causes of death as compared to Whites.[8]

There are multiple hypotheses which aim to determine the reason for the existence of this paradox. Some attribute the Hispanic paradox to biases created by patterns or selection in migration.[2][5] One such hypothesis is the Salmon Bias, which suggests that Hispanics tend to return home towards the end of their life, ultimately rendering an individual "statistically immortal" and thus artificially lowering mortality for Hispanics in the United States.[2][5] Another hypothesis in this group is that of the Healthy Migrant, which attributes the better health of Hispanics to the assumption that the healthiest and strongest members of a population are most likely to migrate.[2][5]

Other hypotheses around the Hispanic paradox maintain that the phenomenon is real, and is caused by sociocultural factors which characterize the Latino population. Many of these factors can be described under the more broad categories of cultural values, interpersonal context, and community context.[9]

Sociocultural factors

Cultural values

Speculation of a sociocultural advantage stems from the idea that many traditional Latino cultural values are protective in health.[7] One such value is that of simpatia, a drive toward social harmony, which may serve to ameliorate social conflict and the negative stress-related health implications that come with it.[3] Familismo (family-centeredness) and allocentrismo (valuing the group) are both values which emphasize the needs of the group in accordance to those of the individual.[3] Respeto is another familial value in which family members are largely invested in care of their elders.[7] Emphasis on family attachment in the Latino culture is believed to foster social cohesion and a sturdy social support network, which is protective of health during adverse circumstances.[3][7] Furthermore, familial support has been associated with higher likelihood of taking preventative health measures and of seeking medical attention when ill.[3] Overall psychological and physical well-being has been found to be better in individuals who come from a supportive family than those who experience family conflict, which is why the family-centered culture of Hispanics may be advantageous in health.[3]

Interpersonal context

Social comparison theory

Social comparison theory proposes that individuals make comparisons with others, most often those of a similar group, in order to evaluate their own well-being and worth.[10] The psychological implications that these comparisons present depend on the nature of the comparisons. Upward comparisons often result in negative psychological effects due to feelings of disadvantage when being compared to those higher in the hierarchy. Conversely, lateral and downward comparisons often result in satisfaction when one sees himself as better off than those lower in the hierarchy.[10] Latino Americans and noncitizen Latinos are expected to make lateral or downward comparisons, either to other low-economic status Latinos and/or to relatives and friends in their home country. Such downward comparisons would result in boosted self-esteem and less psychological stress, resulting in better health.[10]

Social networks and support

Social capital is thought to be a significant moderator in the advantageous health outcomes of Latinos.[3][7] It has been found that the magnitude of the effect of social integration on mortality is greater than smoking fifteen cigarettes a day.[7] Characteristic values of Latino culture such as familismo and allocentrismo contribute to greater social cohesion and social support networks.[3] This tight social fabric is a mechanism which fosters resilience through social support.[7] Resilience is the ability to adapt to a disadvantageous experience and high resilience is protective in health.[11]

Community context

Characteristics of the community in which one lives can also affect health.[6][9] Research shows that Latino immigrants living in communities with a large proportion of Latinos experience better health than immigrants who live in communities with a smaller proportion of Latinos.[6][9] This is thought to be at least in part due to greater levels of social ties within majority-Latino communities which have been associated with greater social integration and social support.[9] While strong family ties definitively promote psychological and physical well-being, weaker ties such as those formed with other members of the community are thought to have similar health-promoting effects.[9] High collective efficacy, trust within the community which engenders mutually beneficial action, within Latino communities has also been shown to be protective of health, particularly in ameliorating asthma and breathing problems.[6] Better health outcomes for those living in communities with a high proportion of Latinos have been hypothesized to result from increased information exchange facilitated through a common language and ethnicity, as well as from benefits conferred through greater social support within the community.[6]

Acculturation

Acculturation, a phenomenon whereby individuals internalize habits and beliefs of a new culture upon being immersed in its social institutions, is also believed to influence the health of Latinos in the United States.[2][9][4][3] In this case, acculturation of Latino immigrants would mean the relinquishment of the characteristic sociocultural aspects of Latino culture listed above in favor of characteristics which are more representative of the American lifestyle. Research has given mixed results regarding the idea that the health of Latino immigrants worsen as length of stay in the United States increases.[2] As Latinos adopt American tendencies, for example, it is thought that the strong social support networks of tight-knit Latino communities are eroded, and the resulting stress begets worse health outcomes.[3] On the other hand, greater acculturation to the United States has been associated with worsening in some health behaviors, including higher rates of smoking and alcohol use, but improvement in others, such as physical activity.[4] It is important to note, however, that measurements of acculturation such as length of time in the United States, proportion of Latino friends, and language use are proxy measures and as such are not completely precise.[4][2] Furthermore, it is possible that confounding factors such as socioeconomic status influence the mixed effects of acculturation seen in health outcomes and behaviors.[2]

References

  1. ↑ 1.0 1.1 Anderson, Robert N. (2005), "National Vital Statistics Reports", SAGE Publications, Inc., doi:10.4135/9781412952484.n432, ISBN 9781412904759 
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Franzini, Luisa; Ribble, John; Keddie, Arlene (2001-02-01). "Understanding the Hispanic Health Paradox". Ethnicity & Disease 11: 496–518. https://www.researchgate.net/publication/11776689. 
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 Gallo, Linda C.; Penedo, Frank J.; Espinosa de los Monteros, Karla; Arguelles, William (December 2009). "Resiliency in the Face of Disadvantage: Do Hispanic Cultural Characteristics Protect Health Outcomes?". Journal of Personality 77 (6): 1707–1746. doi:10.1111/j.1467-6494.2009.00598.x. ISSN 0022-3506. PMID 19796063. 
  4. ↑ 4.0 4.1 4.2 4.3 Abraído-Lanza, Ana F.; Chao, Maria T.; Flórez, Karen R. (September 2005). "Do healthy behaviors decline with greater acculturation?: Implications for the Latino mortality paradox". Social Science & Medicine 61 (6): 1243–1255. doi:10.1016/j.socscimed.2005.01.016. ISSN 0277-9536. PMID 15970234. 
  5. ↑ 5.0 5.1 5.2 5.3 Abraído-Lanza, A F; Dohrenwend, B P; Ng-Mak, D S; Turner, J B (October 1999). "The Latino mortality paradox: a test of the "salmon bias" and healthy migrant hypotheses.". American Journal of Public Health 89 (10): 1543–1548. doi:10.2105/ajph.89.10.1543. ISSN 0090-0036. PMID 10511837. 
  6. ↑ 6.0 6.1 6.2 6.3 6.4 Cagney, Kathleen A.; Browning, Christopher R.; Wallace, Danielle M. (May 2007). "The Latino Paradox in Neighborhood Context: The Case of Asthma and Other Respiratory Conditions". American Journal of Public Health 97 (5): 919–925. doi:10.2105/ajph.2005.071472. ISSN 0090-0036. PMID 17395846. 
  7. ↑ 7.0 7.1 7.2 7.3 7.4 7.5 7.6 Ruiz, John M.; Campos, Belinda; Garcia, James J. (May 2016). "Special issue on Latino physical health: Disparities, paradoxes, and future directions.". Journal of Latina/o Psychology 4 (2): 61–66. doi:10.1037/lat0000065. ISSN 2163-0070. 
  8. ↑ The Lancet (May 2015). "The Hispanic paradox". The Lancet 385 (9981): 1918. doi:10.1016/s0140-6736(15)60945-x. ISSN 0140-6736. PMID 26090624. 
  9. ↑ 9.0 9.1 9.2 9.3 9.4 9.5 Abraído-Lanza, Ana F.; Echeverría, Sandra E.; Flórez, Karen R. (2016-03-18). "Latino Immigrants, Acculturation, and Health: Promising New Directions in Research". Annual Review of Public Health 37 (1): 219–236. doi:10.1146/annurev-publhealth-032315-021545. ISSN 0163-7525. PMID 26735431. 
  10. ↑ 10.0 10.1 10.2 Campbell, Kelly; Garcia, Donna M.; Granillo, Christina V.; Chavez, David V. (2012-04-30). "Exploring the Latino Paradox". Hispanic Journal of Behavioral Sciences 34 (2): 187–207. doi:10.1177/0739986312437552. ISSN 0739-9863. 
  11. ↑ Smith, Matthew Lee; Bergeron, Caroline D.; McCord, Carly E.; Hochhalter, Angela K.; Ory, Marcia G. (2018), "Successful Aging and Resilience: Applications for Public Health, Health Care, and Policy", Resilience in Aging (Springer International Publishing): pp. 17–33, doi:10.1007/978-3-030-04555-5_2, ISBN 9783030045548 




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