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

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Abstract

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.

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Notes

  1. Sometimes the terms “epidemiologic paradox” and “epidemiological paradox” are used in place of “Hispanic paradox,” which is in keeping with the 1986 Markides and Coreil article and an even earlier article on Mexican American mental health [5]. However, these terms are ambiguous since they are sometimes used to refer to a “healthy migrant effect” in any population [6]. Other Hispanic paradox terminological variants include “Latino Paradox” and “Latino Epidemiological Paradox” [7].

  2. As Bennett Holman has helpfully suggested, the Hispanic paradox could perhaps be described without reference to a comparison population if the phenomenon can be reframed as Hispanic populations failing to manifest the typical gradient of health and wealth, in which low socioeconomic status is associated with poor health. There is indeed a body of literature on this subject, particularly noting that education and health are weakly related in US Hispanics (unlike non-Hispanic Whites) [14]. However, this alternative approach to examining Hispanics’ mysteriously good average health still requires comparing Hispanics to other population(s) since there must always be some set of reference data against which the Hispanic health-wealth data is considered aberrant.

  3. See [45] and [46] for additional discussion of the evidential limitations of meta-analyses.

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Acknowledgements

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.

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  1. Lyman Briggs College and Department of Philosophy, Michigan State University, Holmes Hall, 919 E. Shaw Lane, Room E35, East Lansing, MI, 48825, USA

    Sean A. Valles

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Correspondence to Sean A. Valles.

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Valles, S.A. The challenges of choosing and explaining a phenomenon in epidemiological research on the “Hispanic Paradox”. Theor Med Bioeth 37, 129–148 (2016). https://doi.org/10.1007/s11017-015-9349-1

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