The Hispanic Paradox

From Friday: In East Texas, lives cut short.

Many of the longest lives in Texas are lived in what would seem to be the least likely place: along the state’s impoverished border with Mexico. Despite conditions that should have the opposite effect — desperately low incomes, a widespread lack of health insurance and poor high school graduation rates — the predominantly Hispanic residents of Hidalgo County live to be 80 years old, two years longer than the United States or Texas average. Residents of other Texas border counties live similarly long lives, according to a preliminary county-by-county analysis by the University of Washington Institute for Health Metrics and Evaluation.

The explanation for this is far from obvious, especially when you consider some of the border region’s other superlatives: sky-high rates of obesity, diabetes and kidney disease. The hypotheses to explain this so-called “Hispanic Paradox” are endless, from theories about cultural differences in the diet, faith and family values of first-generation South Texans to suggestions that natural selection is at play in immigration patterns.

And even if the lifespan numbers are spot-on — which some researchers argue is next to impossible, considering how transient many South Texas immigrants are, and how dire conditions are in the border’s colonias — the region’s health care providers argue that a long life shouldn’t be mistaken for a healthy life. Though these people are living lengthy lives now, they argue, they will not be for long, the result of dramatic changes in the lifestyles of second and third generation Texans. 

“Our youth are increasingly obese, increasingly diabetic, and we’re seeing complications earlier and earlier,” said Dr. Carlos Cardenas, a practicing physician and chairman of the board at Doctors Hospital at Renaissance in Edinburg, in the Rio Grande Valley near the southern tip of the state. “It will ultimately decrease life expectancy, or the quality of that life. It’s devastating to watch and, to a great degree, preventable.” 

A cultural argument 

When Paula S. Gomez reads the obituaries in her local paper, it never fails to amaze her. “People here routinely die at 103, 99, 97, 90,” chuckled Gomez, the executive director of the Brownsville Community Health Center, a safety net organization that provides primary care to those with nowhere else to get it. “I’m talking 90 percent of the people who are dying are in that age group.” And many experts, from sociologists to nutritionists, offer a cultural argument for why.

Some say it is the immigrant diet of low-cost, low-fat Mexican food, as opposed to the greasy Tex-Mex variety. At A&V Lopez Supermarket in Brownsville, multiple generations of Hispanic families shop in aisles stocked with fresh produce and protein: chili-drenched oranges, pineapples and mangoes; whole-roasted chickens; giant tubs of black beans.

“People here are so poor that we grow a lot of our own food, that we buy only what we need,” Gomez said. “In many cases, fast food has really not been introduced.”

Others suggest it is the physically demanding jobs many immigrants have on construction sites and farms that keeps them fit, as opposed to the sedentary office jobs that lend themselves to expanding waistlines.

And though they may not have health insurance, many South Texans cross the border into Mexico to see doctors and get prescriptions filled for a small fraction of the cost in the United States. (In a recent study of border residents, roughly half of the sample population reported crossing the border for care — though this number is dropping due to drug violence in Mexico.)

“The presence of Mexican care is a good thing for those who have no health insurance in this area,” said Dr. Dejun Su, director of the University of Texas-Pan American’s South Texas Border Health Disparities Center.  “It’s an advantage people living in poverty in big metropolitan areas in the U.S. don’t have.” 

South Texas Hispanics also take a different approach to caring for their elders, experts and observers say — one steeped in faith and family tradition. They rarely put their parents or grandparents into nursing homes, instead caring for them in the ever-expanding family home. Being in the presence of a nurturing family prevents loneliness and creates a will to live, health care experts suggest, that is not present in most end-of-life care. Some South Texans wonder if there is also a religious element at play — namely, that highly Catholic Latinos are less likely to suggest hospice, or pull the plug, when there are long-shot, life-extending interventions available.

“The sentiment here is that you’re abandoning them if you put them in a nursing home — you’re saying, ‘I’m done with you,’” said Armando Lopez, director of the Lower Rio Grande Valley Area Health Education Center in Harlingen, whose grandparents are 88 and 84. “It’s a burden that God’s given you, to take care of them — and take care of them well — in their old age.”  

Natural selection? 

Ethnographers take another approach to explaining South Texas’ lengthy lifespan: a Darwinian one. You do not see the sick or the weak crossing rugged, sweltering deserts to get from Mexico into Texas, they say. The first-generation Mexican immigrants that are strong enough to make it into the United States are often of hearty stock and in good health, experts say, making them likely to live long lives and pass along their good genes to their offspring. “The theory is, those who are weak, who are not so healthy, are more likely to stay in their native countries,” Su said.  

This perceived benefit to South Texas’ life expectancy may work in reverse, too. Some suggest that many first-generation immigrants cross back into Mexico toward the end of their lives because they want to die close to their ancestors, leaving no record of their death in Texas. “For many immigrants, their mother country is Mexico,” Lopez said. “They’re very much attached, and have a yearning to go back in their final days.”

But ethnographers who have studied the Hispanic Paradox for years suggest there may be a far more mundane explanation: The numbers are screwed up. It is unclear whether seasonal migrant workers, or the undocumented immigrants living in unincorporated colonias — many of them in substandard housing without water or sewers — are being counted in life expectancy estimates, Su said.

Cardenas is a skeptic, too, especially because he sees firsthand how sickly so many of his patients are becoming at such a young age. Mexican Americans are almost twice as likely as non-Hispanic whites to be diagnosed with diabetes — and are 50 percent more likely to die from it.

But he said there is definitely a factor that helps South Texans lead particularly long lives: "corazón," or heart. It is the will to live and prosper found in anyone “who can cross a Sonoran Desert and survive it,” he said. It is the strength of the Hispanic family unit, evidenced by the generations of extended family that come along for one relative’s doctor’s appointment.

“It’s hard to measure, but it’s palpable in this culture,” Cardenas said, “and it’s something that carries you from cradle to grave.”