The challenges of choosing and explaining a phenomenon in epidemiological research on the “Hispanic Paradox”
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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.
KeywordsExplanation 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.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
- 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
- 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
- 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
- 20.van Fraassen, Bas C. 1990. The scientific image. Clarendon library of logic and philosophy. New York: Oxford University Press.Google Scholar
- 23.Arias, Elizabeth. 2015. United States life tables, 2011. National Vital Statistics Reports 64(11): 1–62.Google Scholar
- 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
- 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.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.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
- 41.The Hispanic paradox. 2015. The Lancet 385(9981): 1918.Google Scholar
- 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
- 52.World Health Organization. 2013. What are social determinants of health? http://www.who.int/social_determinants/sdh_definition/en/. Accessed June 27, 2014.
- 55.Kessler, Glenn. 2015. Is there a link between the measles outbreak and illegal immigration? The Washington Post. http://www.washingtonpost.com/blogs/fact-checker/wp/2015/02/06/is-there-a-link-between-the-measles-outbreak-and-illegal-immigration/. Accessed Oct 11, 2015.