The Other White America and the Hispanic Paradox

I have a piece on a particular aspect of the new Case-Deaton study showing a a sharp decline in life expectancy among middle-aged less educated whites: the study’s illustration of the so-called Hispanic paradox in public health:

One aspect of the Case-Deaton study that has gone largely unnoticed is the extent to which it reveals an ongoing intensification of the so-called “Hispanic paradox.” The paradox is this: Normally, socio-economic status, as reflected in education levels and income, correlates well with health outcomes, as indeed it does among the whites in their study. American Hispanics have far less formal education, and make considerably less money, on average, than white Americans. Middle-aged white Americans are three times more likely to have college degrees than middle-aged Hispanics, and are 55 percent more likely to have graduated from high school. Median household income for whites is 46 percent higher than it is for Hispanics.

Despite these differences, which would ordinarily produce far better health outcomes for the more educated and wealthier group, American Hispanics now have longer life expectancies than whites. Indeed, the Case-Deaton study found that, among middle-aged Americans, this gap is growing at a fast pace, as mortality rates among Hispanics continue to drop rapidly, while they are actually rising among whites. The result is that mortality rates for middle-aged whites are now 54 percent higher than for Hispanics.

An even more startling contrast can be found between the mortality rates of Hispanics, and of whites with no more than a high school education. Since approximately 80 percent of middle-aged Hispanics never went to college, the educational credentials of this group largely overlap with those of white Americans with high school degrees or less. Yet the middle-aged members of the Other White America now have a mortality rate that is an astonishing 173 percent higher than that of their Hispanic peers.

. . .

The Hispanic paradox is essentially a paradox about social class. Why are Hispanics now enjoying better health outcomes than whites, and in particular drastically better health outcomes than whites of the same education and income levels? The answer, I suggest, has much to do with the very different social trajectories of the white and Hispanic working classes.

While it is always dangerous to generalize about as diverse a group as American Hispanics, it is safe to say that much of the Hispanic working class in America is made up of families that immigrated relatively recently from Mexico and Central America. For these people, the United States is still a land of remarkable opportunity: a place where it is likely that they, and their children, will end up much better off than their families were in their countries of origin.

For working class whites, by contrast, the situation is almost precisely the opposite. The members of the Other White America live in a world that, by most standard economic and cultural measures, has gotten worse for them than it was for their parents and grandparents. Working class whites and Hispanics may have similar income and education levels, but they are communities moving in starkly different directions. The starkly different direction the literal health of these two groups is taking is, it seems, a reflection of these larger patterns.

Also:

Mortality rate for 45-54 white non-Hispanics in 2013: 415 per 100,000

Obesity rate for white non-Hispanics 40-59 in 2012: 38.6%

Mortality rate for 45-54 Hispanics in 2013: 269 per 100,000

Obesity rate for 40-59 Hispanics in 2012: 46%