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106 7 The Latino Health Paradox Looking at the Intersection of Sociology and Health Tamara Dubowitz, RAND Corporation Lisa M. Bates, Columbia University Mailman School of Public Health Dolores Acevedo-Garcia, Bouve College of Health Sciences, Northeastern University co-nationals. According to this school of thought, these paradoxes are, after all, not paradoxical. In this chapter, we address conceptual issues related to Latino and immigrant health research and discuss some policy implications. We contend that an integration of the sociology of immigration and social epidemiology of health is critical to understanding health paradoxes. By understanding the social and political context of Hispanic/ Latino immigration in the United States, including processes of immigrant adaptation as well as the Latin American sending countries, Hispanic/ Latino health can become an interdisciplinary dialogue between sociologists of immigrant adaptation and public-health researchers. This may allow for a more effective means of tending to health and health-care concerns of immigrants and specifically of Hispanics/Latinos. Migration Patterns, Demographics, and Socioeconomic Status of the U.S. Latino Population Legal immigration to the United States has increased steadily from 250,000 in the 1930s, 2.5 million in the 1950s, 4.5 million in the 1970s, and 7.3 million in the 1980s to about 10 million The link between socioeconomic disadvantage and poor health has been observed consistently and over time (Berkman and Kawachi 2000). According to U.S. census statistics, in 2007, 21.5 percent of Hispanics/Latinos were living in poverty , compared with 8.2 percent of non-Hispanic whites, 24.5 percent of blacks, and 10.2 percent of Asians.1 In spite of their disproportionate representation among the poor, Hispanics/Latinos have demonstrated lower all-cause mortality and higher life expectancy than we otherwise might expect (Falcon, Molina, and Molina 2001; Hummer et al. 2000; Lin et al. 2003; Singh and Siahpush 2002; Sorlie et al. 1993). The growing domain of health research on Hispanics/Latinos has identified a Latino immigrant health paradox: foreign-born Hispanics/Latinos overall have better health outcomes than we might expect, given their lower socioeconomic standing (Markides and Coreil 1986). For many researchers, the health advantage that Hispanics/Latinos appear to have may be rooted in their “cultural orientation” (presumably related to engagement in healthy behaviors) and strong social networks. Others argue that the so-called paradoxes are the result of immigrant selection processes because U.S. Hispanic/Latino immigrants are healthier than their nonimmigrant The Latino Health Paradox 107 in the 1990s. Following this history, new immigrants (those born outside the United States, or first generation) and their descendants are projected to account for 82 percent of the population increase through the year 2050 (Passel and Cohn 2008). Today, immigrants in the United States are more diverse than ever before in terms of race, ethnicity, language, religion, education, social class, and reasons for and process of immigration . Mexican-born immigrants accounted for 30.8 percent of all foreign born residing in the United States in 2007, by far the largest immigrant group in the United States. Among the remaining countries of origin, the Philippines accounted for 4.5 percent of all foreign born, followed by India and China (excluding Hong Kong and Taiwan) with 3.9 percent and 3.6 percent, respectively. These four countries—together with El Salvador (2.9 percent), Vietnam (2.9 percent), Korea (2.7 percent), Cuba (2.6 percent), Canada (2.2 percent), and the Dominican Republic (2.0 percent)—made up 58.1 percent of all foreign born residing in the United States in 2007 (Terrazas and Batalova 2008). “Generation status” differentiates between individuals who were born outside the United States, those whose parents were born outside the United States, and those who have lived in the United States for two or more generations. In general , studies have demonstrated that as generation status increases, health behaviors and outcomes decline. Traditionally, the term “first-generation immigrants” defines immigrants born outside the United States; “second-generation immigrants” describes individuals born in the United States, one or both of whose parents are first-generation immigrants. Often, each subsequent generation born in the United States is numbered sequentially (second generation are the U.S.-born children of at least one first-generation parent; later generations are the children of U.S.-born parents ). “Generation status” can also include categories such as “mixed parentage” to refer to those who have both foreign-born and U.S.-born parents or “1.5 generation” to refer...

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