Theoretical Medicine and Bioethics

, Volume 37, Issue 2, pp 129–148 | Cite as

The challenges of choosing and explaining a phenomenon in epidemiological research on the “Hispanic Paradox”

  • Sean A. VallesEmail author


According to public health data, the US Hispanic population is far healthier than would be expected for a population with low socioeconomic status. Ever since Kyriakos Markides and Jeannine Coreil highlighted this in a seminal 1986 article, public health researchers have sought to explain the so-called “Hispanic paradox.” Several candidate explanations have been offered over the years, but the debate goes on. This article offers a philosophical analysis that clarifies how two sets of obstacles make it particularly difficult to explain the Hispanic paradox. First, different research projects define the Hispanic paradox phenomenon in substantially different ways. Moreover, using Bas van Fraassen’s pragmatic theory of explanation and Sean Valles’s extension of it with the concept of “phenomenon choice,” it also becomes clear that there are also multiple ways of explaining each individual definition of the phenomenon. A second set of philosophical and methodological challenges arises during any attempt to study “Hispanic” phenomena, with one key challenge being that the “Hispanic” panethnic concept was intentionally made vague as it was developed and popularized during the 1960s–1970s. After comparing this case with similar cases in the philosophical literature, the article concludes with observations on what makes this problem unique, particularly its ethical features.


Explanation Health disparities Hispanic paradox Philosophy of epidemiology Philosophy of medicine Public health ethics 



I am grateful to Raj Bhopal and Jamie Nelson for their comments on this article. I am also grateful for input on the project from: Matthew Haber, James Tabery, the audience members of the University of Utah Department of Philosophy colloquium series, the attendees of the 2013 Philosophy of Medicine Roundtable, the 2014 meeting of the American Philosophical Association-Eastern, and the 2014 meeting of the Philosophy of Science Association.


  1. 1.
    Markides, Kyriakos S., and Jeannine Coreil. 1986. The health of hispanics in the Southwestern United States: An epidemiologic paradox. Public Health Reports 101(3): 253–265.Google Scholar
  2. 2.
    Waldstein, Anna. 2010. Popular medicine and self-care in a Mexican migrant community: Toward an explanation of an epidemiological paradox. Medical Anthropology 29(1): 71–107.CrossRefGoogle Scholar
  3. 3.
    Ruiz, John M., Patrick Steffen, and Timothy B. Smith. 2013. Hispanic mortality paradox: A systematic review and meta-analysis of the longitudinal literature. American Journal of Public Health 103(3): e52–e60.CrossRefGoogle Scholar
  4. 4.
    Humes, Karen R., Nicholas A. Jones, and Roberto R. Ramirez. 2011. Overview of race and Hispanic origin: 2010. Washington, DC: United States Census Bureau.Google Scholar
  5. 5.
    Karno, Marvin, and Robert B. Edgerton. 1969. Perception of mental illness in a Mexican-American community. Archives of General Psychiatry 20(2): 233–238.CrossRefGoogle Scholar
  6. 6.
    Auger, N., Z.-C. Luo, R.W. Platt, and M. Daniel. 2008. Do mother’s education and foreign born status interact to influence birth outcomes? Clarifying the epidemiological paradox and the healthy migrant effect. Journal of Epidemiology and Community Health 62(5): 402–409.CrossRefGoogle Scholar
  7. 7.
    Hayes-Bautista, David E., Paul Hsu, Maria Hayes-Bautista, Delmy Iñiguez, Cynthia L. Chamberlin, Christian Rico, and Rosa Solorio. 2002. An anomaly within the Latino epidemiological paradox: The Latino adolescent male mortality peak. Archives of Pediatrics and Adolescent Medicine 156(5): 480–484.CrossRefGoogle Scholar
  8. 8.
    Borrell, Luisa N., and Elizabeth A. Lancet. 2012. Race/ethnicity and all-cause mortality in US adults: Revisiting the Hispanic paradox. American Journal of Public Health 102(5): 836–843.CrossRefGoogle Scholar
  9. 9.
    Willey, Joshua Z., Carlos J. Rodriguez, Yeseon Park Moon, et al. 2012. Coronary death and myocardial infarction among Hispanics in the Northern Manhattan Study: Exploring the Hispanic paradox. Annals of Epidemiology 22(5): 303–309.CrossRefGoogle Scholar
  10. 10.
    Espinoza, Sara E., Inkyung Jung, and Helen Hazuda. 2013. The Hispanic paradox and predictors of mortality in an aging biethnic cohort of Mexican Americans and European Americans: The San Antonio Longitudinal Study of Aging. Journal of the American Geriatrics Society 61(9): 1522–1529.CrossRefGoogle Scholar
  11. 11.
    Hayward, Mark D., Robert A. Hummer, Chi-Tsun Chiu, César González-González, and Rebeca Wong. 2014. Does the Hispanic paradox in US adult mortality extend to disability? Population Research and Policy Review 33(1): 81–96.CrossRefGoogle Scholar
  12. 12.
    Cortes-Bergoderi, Mery, Kashish Goel, Mohammad Hassan Murad, et al. 2013. Cardiovascular mortality in Hispanics compared to non-Hispanic whites: A systematic review and meta-analysis of the Hispanic paradox. European Journal of Internal Medicine 24(8): 791–799.CrossRefGoogle Scholar
  13. 13.
    Palloni, Alberto, and Jeffrey D. Morenoff. 2001. Interpreting the paradoxical in the Hispanic paradox. Annals of the New York Academy of Sciences 954(1): 140–174.CrossRefGoogle Scholar
  14. 14.
    Turra, Cassio M., and Noreen Goldman. 2007. Socioeconomic differences in mortality among US adults: Insights into the Hispanic paradox. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 62(3): S184–S192.CrossRefGoogle Scholar
  15. 15.
    Abraído-Lanza, Ana F., Bruce P. Dohrenwend, Daisy S. Ng-Mak, and J. Blake Turner. 1999. The Latino mortality paradox: A test of the “salmon bias” and healthy migrant hypotheses. American Journal of Public Health 89(10): 1543–1548.CrossRefGoogle Scholar
  16. 16.
    Turra, Cassio M., and Irma T. Elo. 2008. The impact of salmon bias on the Hispanic mortality advantage: New evidence from social security data. Population Research and Policy Review 27(5): 515–530.CrossRefGoogle Scholar
  17. 17.
    Eschbach, Karl, Glenn V. Ostir, Kushang V. Patel, Kyriakos S. Markides, and James S. Goodwin. 2004. Neighborhood context and mortality among older Mexican Americans: Is there a barrio advantage? American Journal of Public Health 94(10): 1807–1812.CrossRefGoogle Scholar
  18. 18.
    Arias, Elizabeth, Karl Eschbach, William S. Schauman, Eric L. Backlund, and Paul D. Sorlie. 2010. The Hispanic mortality advantage and ethnic misclassification on US death certificates. American Journal of Public Health 100(S1): S171–S177.CrossRefGoogle Scholar
  19. 19.
    Valles, Sean A. 2010. The mystery of the mystery of common genetic diseases. Biology and Philosophy 25(2): 183–201.CrossRefGoogle Scholar
  20. 20.
    van Fraassen, Bas C. 1990. The scientific image. Clarendon library of logic and philosophy. New York: Oxford University Press.Google Scholar
  21. 21.
    Fenelon, Andrew. 2013. Revisiting the Hispanic mortality advantage in the United States: The role of smoking. Social Science and Medicine 82: 1–9.CrossRefGoogle Scholar
  22. 22.
    Smith, David P., and Benjamin S. Bradshaw. 2006. Rethinking the Hispanic paradox: Death rates and life expectancy for US non-Hispanic White and Hispanic populations. American Journal of Public Health 96(9): 1686–1692.CrossRefGoogle Scholar
  23. 23.
    Arias, Elizabeth. 2015. United States life tables, 2011. National Vital Statistics Reports 64(11): 1–62.Google Scholar
  24. 24.
    Hummer, Robert A., Daniel A. Powers, Starling G. Pullum, Ginger L. Gossman, and W. Parker Frisbie. 2007. Paradox found (again): Infant mortality among the Mexican-origin population in the United States. Demography 44(3): 441–457.CrossRefGoogle Scholar
  25. 25.
    Beckles, Gloria L., and Benedict I. Truman. 2013. Education and income—United States, 2009 and 2011. Morbidity and Mortality Weekly Report 62(3, suppl.): 9–19.Google Scholar
  26. 26.
    Mora, G.Cristina. 2014. Making Hispanics: How activists, bureaucrats, and media constructed a new American. Chicago: University of Chicago Press.CrossRefGoogle Scholar
  27. 27.
    Pletcher, Mark J., Stefan G. Kertesz, Michael A. Kohn, and Ralph Gonzales. 2008. Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments. Journal of the American Medical Association 299(1): 70–78.Google Scholar
  28. 28.
    Ulmer, Cheryl, Bernadette McFadden, and David R. Nerenz. 2009. Race, ethnicity, and language data: Standardization for health care quality improvement. Washington, DC: The National Academies Press.Google Scholar
  29. 29.
    Office of Management and Budget. 1997. Revisions to the standards for the classification of federal data on race and ethnicity. Federal Register 62(210): 58782–58790.Google Scholar
  30. 30.
    Callister, Paul, Robert Didham, Deborah Potter, and Tony Blakely. 2007. Measuring ethnicity in New Zealand: Developing tools for health outcomes analysis. Ethnicity and Health 12(4): 299–320.CrossRefGoogle Scholar
  31. 31.
    Aspinall, P.J. 2011. The utility and validity for public health of ethnicity categorization in the 1991, 2001 and 2011 British Censuses. Public Health 125(10): 680–687.CrossRefGoogle Scholar
  32. 32.
    Smith, Kenneth. 2002. Some critical observations on the use of the concept of ‘ethnicity’ in Modood et al., ethnic minorities in Britain. Sociology 36(2): 399–417.CrossRefGoogle Scholar
  33. 33.
    Modood, Tariq, Richard Berthoud, and James Nazroo. 2002. ‘Race’, racism and ethnicity: A response to Ken Smith. Sociology 36(2): 419–427.CrossRefGoogle Scholar
  34. 34.
    Visser, M.Anne. 2012. Two plus two equals three: Classification error and the Hispanic undercount in United States census surveys. American Review of Public Administration 44(2): 233–251.CrossRefGoogle Scholar
  35. 35.
    Alba, Richard, and Tariqul Islam. 2009. The case of the disappearing Mexican Americans: An ethnic-identity mystery. Population Research and Policy Review 28(2): 109–121.CrossRefGoogle Scholar
  36. 36.
    Lariscy, Joseph T. 2011. Differential record linkage by Hispanic ethnicity and age in linked mortality studies: Implications for the epidemiologic paradox. Journal of Aging and Health 23(8): 1263–1284.CrossRefGoogle Scholar
  37. 37.
    Lee, Min-Ah, and Kenneth F. Ferraro. 2007. Neighborhood residential segregation and physical health among Hispanic Americans: Good, bad, or benign? Journal of Health and Social Behavior 48(2): 131–148.CrossRefGoogle Scholar
  38. 38.
    Palloni, Alberto, and Elizabeth Arias. 2004. Paradox lost: Explaining the Hispanic adult mortality advantage. Demography 41(3): 385–415.CrossRefGoogle Scholar
  39. 39.
    Bhopal, R.S. 2006. Race and ethnicity: Responsible use from epidemiological and public health perspectives. Journal of Law, Medicine and Ethics 34(3): 500–507.CrossRefGoogle Scholar
  40. 40.
    Valles, Sean A. 2012. Heterogeneity of risk within racial groups, a challenge for public health programs. Preventive Medicine 55(5): 405–408.CrossRefGoogle Scholar
  41. 41.
    The Hispanic paradox. 2015. The Lancet 385(9981): 1918.Google Scholar
  42. 42.
    Sullivan, Jacqueline A. 2010. Reconsidering ‘spatial memory’ and the Morris water maze. Synthese 177(2): 261–283.CrossRefGoogle Scholar
  43. 43.
    Tabery, James. 2014. Beyond versus: The struggle to understand the interaction of nature and nurture. Cambridge, MA: MIT Press.CrossRefGoogle Scholar
  44. 44.
    Swenson, Carolyn J., Mary Jo Trepka, Marian J. Rewers, Sharon Scarbro, William R. Hiatt, and Richard F. Hamman. 2002. Cardiovascular disease mortality in Hispanics and non-Hispanic whites. American Journal of Epidemiology 156(10): 919–928.CrossRefGoogle Scholar
  45. 45.
    Borgerson, Kirstin. 2009. Why reading the title isn’t good enough: An evaluation of the 4S approach to evidence-based medicine. International Journal of Feminist Approaches to Bioethics 2(2): 152–175.CrossRefGoogle Scholar
  46. 46.
    Stegenga, Jacob. 2011. Is meta-analysis the platinum standard of evidence? Studies in History and Philosophy of Biological and Biomedical Sciences 42(4): 497–507.CrossRefGoogle Scholar
  47. 47.
    Mir, Ghazala, Sarah Salway, Joe Kai, Saffron Karlsen, Raj Bhopal, George T.H. Ellison, and Aziz Sheikh. 2013. Principles for research on ethnicity and health: The Leeds Consensus Statement. The European Journal of Public Health 23(3): 504–510.CrossRefGoogle Scholar
  48. 48.
    Markides, Kyriakos S., and Karl Eschbach. 2005. Aging, migration, and mortality: Current status of research on the Hispanic paradox. Journals of Gerontology: Series B, Psychological sciences and social sciences 60(spec. 2): 68–75.CrossRefGoogle Scholar
  49. 49.
    Berkman, Lisa F., and Ichiro Kawachi. 2000. A historical framework for social epidemiology. In Social epidemiology, ed. Lisa F. Berkman, and Ichiro Kawachi. New York: Oxford University Press.Google Scholar
  50. 50.
    Krieger, Nancy, and Anne-Emanuelle Birn. 1998. A vision of social justice as the foundation of public health: Commemorating 150 years of the spirit of 1848. American Journal of Public Health 88(11): 1603–1606.CrossRefGoogle Scholar
  51. 51.
    Irwin, Alec, and Emile Scali. 2007. Action on the social determinants of health: A historical perspective. Global Public Health 2(3): 235–256.CrossRefGoogle Scholar
  52. 52.
    World Health Organization. 2013. What are social determinants of health? Accessed June 27, 2014.
  53. 53.
    Katikireddi, S. Vittal., and Sean A. Valles. 2015. Coupled ethical–epistemic analysis of public health research and practice: Categorizing variables to improve population health and equity. American Journal of Public Health 105(1): e36–e42.CrossRefGoogle Scholar
  54. 54.
    Root, Michael. 2003. The use of race in medicine as a proxy for genetic differences. Philosophy of Science 70(5): 1173–1183.CrossRefGoogle Scholar
  55. 55.
    Kessler, Glenn. 2015. Is there a link between the measles outbreak and illegal immigration? The Washington Post. Accessed Oct 11, 2015.

Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  1. 1.Lyman Briggs College and Department of PhilosophyMichigan State UniversityEast LansingUSA

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