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The Latino paradox

Imagine if the United States could stretch the life span of its population by a couple of years without spending billions of dollars on extra doctor visits or medical technology. That would be worth looking into, right?

Yet as a nation, we have paid scant attention to the so-called Latino paradox -- the surprising health of Latinos in the United States considering their generally lower incomes and education levels. They are less likely to have health insurance; they go to doctors less often and receive less in the way of hospitalization or high-level care when they are sick. Yet they appear to have lower rates of heart disease, cancer and stroke, the biggest killers of Americans. Pregnant Latino women get less prenatal care, yet infant mortality is lower among this group.

A recent study by the U.S. Centers for Disease Control and Prevention suggests that federal interest has been piqued. The report, released in October, found that Latinos in this country outlive both whites and blacks, with a life expectancy of 80.6 years, compared with 77.7 for the nation as a whole. (People of Asian ancestry have even longer life spans, but because of their relatively high education and affluence levels, those findings are not considered surprising.) Latinos tend to be less educated than African Americans and their poverty rates are similar, yet Latinos outlive black people by nearly eight years.

How can this be? The CDC makes a couple of guesses but offers nothing in the way of research-based explanations. Its study doesn’t distinguish between immigrants and non-immigrants, poor Latinos and affluent, people of Bolivian heritage and those of Mexican or Puerto Rican heritage. Yet teasing out the reasons for Latino health and life expectancy might be one of the most important public-health endeavors the nation could undertake.

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Latinos are the fastest-growing minority in the United States, and longevity is an integral part of the nation’s health profile. In addition, explanations for the paradox might offer answers to improved well-being and longer life for all Americans.

In a few places across the country, researchers have been probing this mystery for years. Their investigations, though, are limited in funding and in scope -- for example, the UCLA Center for the Study of Latino Health and Culture examines data on Latinos only in California. They have not been able to unearth the reasons, but their findings so far have led David Hayes-Bautista, director of the UCLA center, to doubt the main possibilities set forth by the CDC.

The CDC suggests, for instance, that the data might simply be wrong, that perhaps people’s ages at death were misstated. But Hayes-Bautista says that the data are always questioned at first because the results are so surprising, yet studies keep reaching the same conclusion. Another theory put forward by the CDC is that the difficulty of immigrating might lead only the hardiest people to come to the United States. In response, Hayes-Bautista points out that most Latinos are born here, and there are no huge differences in health -- at least so far -- between them and immigrants. The CDC also brings up what’s known as the “salmon bias” -- the possibility that older, ailing Latino immigrants might return home for their last months of life. To this, Hayes-Bautista responds that most elderly Latino immigrants have lived in the U.S. for decades and have deep family and community ties here; there is little to draw them back to their native countries. Simple genetic differences are seen as unlikely because, even within individual Latin American nations, people come from a variety of ethnic backgrounds.

Another explanation -- that aspects of Latino culture such as health-related behaviors, attitudes and social networks are at play -- is mentioned only briefly in the CDC report, which focuses solely on a statistical analysis of death certificates. The next step for the federal government, which is looking to reduce medical costs and increase wellness by boosting preventive care and healthy lifestyles, should be to fund large-scale national research on the topic. Others cannot suddenly adopt Latinos’ DNA, but they can learn to change how they act.

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For example, pregnant Latino women are less likely to smoke, drink alcohol, use drugs or have sexually transmitted diseases than American women as a whole. That probably helps to explain the lower infant mortality rates, and quite probably health later in life.

Here’s another behavioral difference: According to a Stanford study, white adults know more about nutrition than Latino adults -- but Latinos eat somewhat more healthfully, with higher consumption of fruits and vegetables. Another possibility is exercise. In California, a 2005 study found, Latinos walk more than any ethnic group except American Indians, though another study found that Latinos get less exercise. Much of that walking is for transportation rather than leisure, because they are less likely to own a car.

Many studies have found that social networks have a profound effect on health. Latino culture is particularly family-oriented; there also are strong community and neighborhood networks, often tied to the church.

If any or all of these are factors in the Latino paradox, there’s reason for concern that they will diminish over time. Second- and third-generation Latinos in the United States tend to smoke and drink more than their immigrant forebears. Fast food, an expensive luxury in such countries as Mexico, is often the cheapest available food here and dominates the restaurant scene in poor black and Latino neighborhoods. Billboards for fast food also are more common in these neighborhoods, according to a report this month from Yale University’s Rudd Center for Food Policy and Obesity. And a report last week from the National Council of La Raza concludes that although Latino children who immigrate to the U.S. with their parents have lower rates of obesity than their U.S.-born peers, their risk of obesity increases the longer they live here. Nearly 40% of Latino children in this country are overweight or obese. Mexican American women are 30% more likely to be overweight than white American women.

Of the top 10 causes of death in the United States, one -- diabetes, an obesity-related disease -- is far more common among Latinos than the population as a whole. In other words, acculturation to the American way of life may worsen the health of Latinos, especially when combined with lack of access to medical care.

The piecemeal research so far offers tantalizing hints to preserving life and health with a minimum of spending, but it will take a large-scale epidemiological study to unravel the lessons in the Latino paradox for all of us.


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