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Latinos as healthcare saviors?

David E. Hayes-Bautista is professor of medicine at UCLA and author of "La Nueva California: Latinos in the Golden State." He is also a member of the board of directors of Health Net of California.

Atidal wave of aging baby boomers is crashing down on our already troubled healthcare system, threatening to overwhelm our operating rooms (heart disease is our No. 1 cause of death) and bankrupt insurers that will have to pay for lengthy recoveries from cancer and strokes (our No. 2 and No. 3 causes). Is there anything that can help protect California from this healthcare train-wreck scenario?

Yes, here’s one thing that could, if properly understood and applied, help mitigate the approaching crisis: the surprisingly strong health profile of the state’s nearly 14 million Latinos.

That’s right: Confounding all expectations for a low-income, low-education population, Latinos have far lower death rates than non-Latino whites in each of those top categories. Latinos are about 25% lower for heart diseases, 35% lower for cancer and 15% lower for stroke. When you study all causes of death in 2004, the Latino age-adjusted rate of 557.1 deaths per 100,000 people was 25% lower than the non-Latino white rate of 743.1. (The only major exception to this pattern is diabetes, a far rarer event than heart, cancer or stroke deaths). In all, Latinos have nearly a five-year-longer life expectancy compared with non-Latino whites.

Latinos manage to do this, year after year, while seeing doctors far less than whites do, and utilizing hospitals far less as well. This is seen clearly in the case of infant mortality. In spite of receiving less prenatal care and receiving it later in the pregnancy, Latinos have an infant mortality rate that is equal to non-Latino whites.

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This surprisingly strong health profile is known as the “Latino epidemiological paradox.” By the standard epidemiological risk factor models currently in use, this low-income, low-education population that utilizes few services should have high mortality rates. Instead, defying expectations, it has some of the lowest.

Now, let’s apply this profile to today’s debates about health insurance. Health insurance works best when the risks of the few are spread over the gains of the many. The riskiest population -- the aging baby boomers -- are nearly all covered by insurance and are heavy users of medical services. Latinos -- who are younger, healthier and have longer life expectancies and fewer chronic illnesses -- are the group most likely to be shut out of the insurance pool. This is largely because they tend to work for small businesses that do not offer health insurance, yet because they work, they earn too much to be eligible for Medi-Cal and other public programs. Latinos do make substantial healthcare expenditures, but these dollars are out of pocket, outside the insurance pool.

So they’re not doing any good for those who are in the pool. If properly incorporated, the inclusion of a few million more healthy, employed, low-service-use Latinos into the health insurance pool would provide a timely “shock absorber” for the costs of the inevitable baby boomer crunch over the next two to three decades. Because of their youth, these newly incorporated Latinos would make few demands for heart transplants and hip replacements, so costs would remain low.

In other words, contrary to the conventional wisdom, increasing the number of insured Latinos would be good for baby boomer healthcare costs.

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By the way, what is it that Latinos are doing that reduces their risk for heart disease, cancer and stroke? We don’t fully know. But data from the birth certificates offer a clue. Latinas giving birth in California are far less likely, compared to non-Latino white mothers, to drink, smoke, use drugs or have a sexually transmitted disease. Any doctor will tell you that if you are pregnant, you shouldn’t smoke, drink or do drugs.

But Latinas don’t learn these behaviors from the doctor -- they learn them from their participation in the state’s ongoing Latino culture, which has been influencing Latino lives for nearly 240 years, ever since Latinos first arrived in California in 1769. Interestingly, as Latinas loosen their participation in Latino social life and become more assimilated into the American mainstream, their rates of smoking, drinking, drug use and sexually transmitted disease also increase, approximating non-Latino white levels.

Culture shapes behavior, which in turn influences health. This is very evident in the epidemiological data. Although some people believe that efforts to study cultural diversity are merely exercises in feel-good political correctness, this is clearly not the case in the field of health. Diversity-oriented biomedical research into the connection between Latino culture and Latino health profiles is not a matter of political correctness. It holds the key to saving thousands of lives.


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