The Ethnic Health Advantage

Image: Illustration by Edel Rodriguez

For decades scholars and public health officials have known that people with greater income or formal education tend to live longer and enjoy better health than their counterparts who have less money or schooling. The trend holds true wherever researchers look?in poor countries or rich ones, in Europe, Asia or the Americas?but two notable exceptions stand out.

One is known as the healthy immigrant effect. Looked at as a group, immigrants to countries as diverse as the U.S., Australia, Germany and Canada live longer than their new native-born neighbors. Yet immigrants also tend to be less well educated and are often more likely to live in poverty in those countries.

The other exception is called the Hispanic paradox and is particular to the U.S. In study after study, people of Hispanic descent (typically of Spanish, Mexican, Cuban, Puerto Rican, or Central or South American origin) seem to live longer than non-Hispanic whites, who on average happen to be richer and better educated. In 2006, for example, life expectancy at birth in the U.S. was 2.5 years higher for Hispanics than for non-Hispanic whites. The paradox is real; data errors, such as small sample size or the underreporting of Hispanic ethnicity on death certificates, cannot explain it. Yet the cause of the paradox has long been a mystery.

Recently I took a closer look at both the healthy immigrant effect and the Hispanic paradox with Andrew Fenelon, a graduate student at the University of Pennsylvania. Fenelon studies sociology and, like me, demography?a relatively small field that I often describe as the ecology of human populations. Just like ecologists, demographers are interested in the fertility, mortality and migration patterns of certain species; in our case, that species is humans. Samuel Preston, one of the world?s leading demographers (and Fenelon?s Ph.D. adviser), had a hunch about what might cause the U.S. Hispanics? longevity advantage in particular, and Fenelon and I had some ideas about how to test that hunch and to see if it applied as well to the immigrant advantage.

Today Fenelon and I believe we can largely explain both anomalies. If our research is correct, then it largely stems from just one factor?a factor that was hiding in plain sight all along.

Unraveling a Mystery
Scholars have come up with many hypotheses to explain the general immigrant advantage, and most of these ideas simultaneously attempt to account for the more specific Hispanic paradox as well. They link the two phenomena because many Hispanics in the U.S. are immigrants: according to the latest census data, two out of five Hispanics living in the U.S. were not born there.

Among the most popular explanations for the immigrant advantage is that such individuals might be unusually resilient, both mentally and physically. They must, after all, need energy and motivation to leave their homes and build a new life on foreign soil, the thinking goes. At the very least they are not likely to be on their deathbeds when they move. Perhaps, therefore, immigrants are simply healthier than the average person when they arrive in the U.S. Alternatively, maybe immigrants who get sick leave the U.S. and return home for care, which would then leave the population of remaining immigrants unusually healthy.

In addition to a putative immigrant advantage, proposed explanations for the Hispanic paradox generally emphasize culture and lifestyle. Hispanics in the U.S. could have stronger family ties that may help steer them through periods of ill health and stress. Another possibility: Hispanics might eat more nutritious foods. Or their work and leisure activities might be more physically demanding, which promotes physical fitness. All these notions are plausible. Yet to date, no studies have been convincingly able to link such behaviors to the Hispanic lifespan advantage.

One lifestyle factor, however, correlates with elevated death rates in almost every mortality study of any population in the world: smoking.

Source: http://rss.sciam.com/click.phdo?i=8770a8fb8c7bdb05b3126bdd34e839ed

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