Background
The more than 35 million Hispanics in of the United States are the largest minority group in the United States, comprising 12.5% of the population. The Hispanic population encompasses wide diversity in country of origin, race, migration experience, spatial distribution, and socio economic status. With the exception of Cuban-Americans, U.S. Hispanic populations have high rates of poverty, and low educational and job classification levels. Census data show that 21.2% of Hispanics live in poverty, compared to 22.1% of African-Americans and 7.5% of non-Hispanic whites. In 1998 35% of Hispanics were uninsured for at least part of the year compared to 12% of non-Hispanic whites and 22% of African-Americans.
Despite the generally low socio-economic standing of the Hispanic population, the all-cause mortality rate for persons of Hispanic origin in the United States is lower than that for non-Hispanic Whites. Hispanics have lower death rates from leading causes of death, including cardiovascular diseases and cancer, when compared to non-Hispanics Whites in the United States. The absence of a major mortality disadvantage for Hispanics has been viewed as a paradox, because lower education and economic standing are strongly correlated with higher all-cause mortality.
There are three important reasons to focus attention on the determinants of Hispanic health status. First, the Hispanic advantage is transitory. The advantage is rooted in part in social and cultural practices that decline as a function of assimilation. Identification of the precise resources and practices within Hispanic communities that maintain advantageous outcomes may facilitate interventions that diffuse them throughout Hispanic communities. Second, despite an overall mortality advantage, Hispanic populations experience off-setting health disadvantages that are associated with their minority and disadvantaged economic status. Third, national incidence and mortality rates average conditions that vary across local settings. To understand and redress health inequalities affecting Hispanic populations, we have to understand the diversity of mechanisms affecting health outcomes in different environments.
