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Paradox Lost

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Sociologists investigate the Hispanic health advantage and why it disappears

When it comes to overall health, the outlook for Hispanics is good. Although the Hispanic population is disproportionately beset by poverty and limited access to quality health coverage and insurance, statistics have long shown that Hispanics live longer, healthier lives than any other group in the United States. Researchers call it the "Hispanic Paradox."

However, those patterns of good health tend to disappear over time and across generations, according to Jacqueline Angel, professor at the Lyndon B. Johnson School of Public Affairs and a sociologist affiliated with the Population Research Center at The University of Texas at Austin.

Jacqueline Angel
Jacqueline Angel, sociologist and professor at the Lyndon B. Johnson School of Public Affairs, studies the health of aging Hispanics and is the author of "Hispanic Families at Risk: The New Economy, Work, and the Welfare State" (Springer, 2009).

"Time and time again, the numbers keep showing Hispanics are living longer," Angel says. "But the longer they live in the United States, the more likely their health will deteriorate."

Angel and other University of Texas at Austin researchers are looking at why that happens—and trying to come up with ways to overcome that problem and help the Hispanic population maintain its overall good health and have access to quality health coverage across generations.

With a focus on improving healthcare and overall wellbeing for elderly Hispanics and their families, Angel co-hosted the 2009 International Conference on Aging in the Americas at The University of Texas at Austin this fall. The challenges are especially important as the nation's Hispanic population, which includes residents descended from Mexico and other Latin American nations, soars.

According to U.S. Census projections, Hispanics are the largest, fastest-growing and youngest minority group in the United States. More than 13 million Hispanic seniors are expected to be living in the United States by the year 2050. Among elderly Hispanics living alone, almost two-thirds are considered poor and one-third live below the poverty level.

Explaining the Hispanic Paradox

The fact that Hispanics are just as healthy—if not healthier—than their white counterparts is perplexing, given the link between economic disadvantage and high mortality rates. According to the 2009-11 Cancer Facts and Figures for Hispanics/Latinos report, Hispanics in the United States are less likely than whites to develop any type of cancer, including breast, prostate, colorectum and lung cancers, the four most common types.

There are no conclusive explanations for this phenomenon, which could partly stem from the sample of people whose data are reviewed by researchers, Angel notes.

Time and time again, the numbers keep showing Hispanics are living longer. But the longer they live in the United States, the more likely their health will deteriorate. Dr. Jacqueline Angel

She questions data that rely heavily on healthy migrant workers who enter the country with youth and ambition. Another possibility is that many immigrants return to their home countries when seriously ill, throwing off mortality statistics in the United States.

Angel suggests the decline in health following immigration, particularly among older Hispanics who migrate to the United States later in life, can be attributed to the emotional and physical difficulties of transitioning to a new land.

Another possible explanation for Hispanics' diminishing health may be linked to stress caused by discrimination and economic hardships. Due to inconsistent data, researchers struggle to estimate with accuracy how acculturation causes poor health. Some evidence suggests obesity rates as high as 55 percent among second-generation Hispanic immigrants. And according to the National Alliance for Hispanic Health, only 15 percent of first-generation Hispanic women smoke, but that number increases to 23 percent among second-generation women.

"Adaptation to a strange culture provides one explanation for increasing chronic morbidity in migrants," Angel says. "The longer they live in the United States, the more likely they'll develop cardiovascular disease, hypertensions and obesity-related illnesses as they adopt unhealthy habits, such as overeating, smoking and increased alcohol consumption."

Problems for the Future

There are several trends affecting Hispanics' health that concern Angel and fellow researchers:

  • Elderly Hispanics often outlive their resources and are unable to provide for themselves or afford health care as they age.
  • "The Mexican-origin population, particularly Hispanic women, have the highest life expectancy at age 65," says Angel, whose research is often done in collaboration with her husband, Ronald Angel, a sociology professor also affiliated with the Population Research Center. "But this creates a conundrum because as their life expectancies continue to expand, they run the risk of outliving their assets and experiencing poverty in old age."
  • Hispanics tend to have limited health insurance, often because they don't have the education needed for jobs that provide benefits.
  • In 2007, 16 percent of whites in Texas had no coverage for all or part of the year, and about 40 percent of Hispanics were uninsured. Inadequate health insurance and the serious lack of retirement coverage among Hispanics are detailed in the Angels' new book, "Hispanic Families at Risk: The New Economy, Work, and the Welfare State."
  • Hispanics' relative lack of education also drives them to jobs that can take a toll on their health.  Barely half of Hispanics 25 and older are high school graduates, a number that creates a vicious cycle of low-wage employment, poor health and limited employment prospects, Angel says.
  • Creative activity helps people stay healthy, according to a 2007 study led by John Mirowsky, a sociology professor affiliated with the Population Research Center. He discovered that non-routine, enjoyable work significantly benefits overall physical and mental health.

There is no single solution to reducing these debilitating health disparities. But we do know that the two biggest contributors to this problem are a lack of access to quality health care and education. Dr. Jacqueline Angel

"Creative work can benefit the health of poor individuals with low education, but their jobs often give little scope for creativity," Mirowsky says. "This is a serious problem—it's a triple hit on their health: chronic economic hardship, few resources for self-direction and tedious, stultifying jobs."

"There is no single solution to reducing these debilitating health disparities," Angel says. "But we do know that the two biggest contributors to this problem are a lack of access to quality health care and education."

It's not just a Hispanic issue. It's a national concern with long-term implications for the U.S. workforce, Angel says. According to Angel's analysis, about half of the population under age five in Texas is of Mexican origin. And as the soaring population of Hispanic youth replaces the current aging workforce, they will be responsible for providing eldercare for non-Hispanic groups and supporting federal and state expenses.

"If this labor force lacks the education necessary to get productive, high-paying jobs, and if they suffer the diminished vitality that inadequate healthcare in childhood and adolescence assures, they will be in no position to bear such an imposing economic burden," Angel says.

By Jessica Sinn
College of Liberal Arts

Photo of Dr. Angel: Christina Murrey

Banner photo: Thomas Barwick