Healthy Immigrant Paradox

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Studies indicate that new immigrants from around the world, many from poverty-stricken nations, experience better health and live longer than native-born Americans. Flavio Marsiglia, director of the Southwest Interdisciplinary Research Center discusses “People on the Move: Journeys of Resilience towards Health Equity,” an ASU conference focusing on topics that affect the health of immigrants and minority populations.

Jose Cardenas: Thank you for joining us. Studies indicate that new immigrants from around the world, many from poverty-stricken nations, experience better health and live longer than native-born Americans. This week's ASU conference, "People on the Move Journeys of Resilience towards Health Equity," focuses on topics that affect the health of minority populations and immigrants. Here to talk to us about this is Flavio Marsiglia, director of the Southwest Interdisciplinary Research Center. Welcome to "Horizonte."

Jose Cardenas: Part of the reading materials they gave me in advance is this scientific article entitled, "Ethnic Health Advantage", and it talks about about two populations in the United States that tend to outlive their richer, better educated neighbors. One is immigrants, and the other is what they call the Hispanic paradox. Explain that.

Flavio Marisglia: Right. It's an interesting topic and we all are researching it still after like 20 or 25 years. And I think it's good news. Mostly good news.

Jose Cardenas: Most of the time you don't think of poverty as good news.

Flavio Marisglia: Good health is good news. When we look at the conditions in which people live, and sometimes people are resource poor, but because they are resource poor, we merely think their health status would be not as good as the rest of the population. The research data tell us they are doing okay.

Jose Cardenas: Part of that data, you and I talked a little bit before we came on the set about information regarding birth weights.

Flavio Marisglia: Correct.

Jose Cardenas: Where you would have expected immigrant women to give weight to lower weight babies-
Flavio Marisglia: Additional research in this area was conducted with immigrant mothers, mostly coming from the nursing field. They found that these immigrant mothers often did not go for prenatal care, they have very low socioeconomic status, very low income, and they gave birth to healthy babies and they were okay, the mothers, as well. Then they were surprised by this, because the numbers were showing that these were -- this was the norm.

Jose Cardenas: How did they explain it?

Flavio Marisglia: It's not the income, it's not the prenatal care, it has to be something else. We don't know what it is, we usually say it's culture. That's what we do in behavioral health often. And then our colleagues in nursing, like I'm from social work and sociology, other disciplines, may have studied the phenomenon. Yes, we think there is something to do with the culture of origin. To support a family, we know in many cultures the grandmother plays a key role. The friends, the aunts, the women in many cultures kind of come together at the time of pregnancy and birth, and they provide a lot of support. It's more like a traditional way of living that in our more industrialized or post industrialized societies we tend to be more isolated.

Jose Cardenas: What about the fact of the immigrant experience itself, regardless of the cultural background, just the fact that they have made that effort to get to the United States?

Flavio Marisglia: Yeah, that's what the more recent research is kind of emphasizing. We cannot just talk about immigrants and compare them with everybody else. But who is an immigrant? And usually those who leave their country of origin are the ones who are willing to take a risk, who are more entrepreneurial, who are healthier. There's already kind of a biased sample of people when you talk about immigrants. The ones who take the choice, make the choice of leaving their country are probably the stronger ones. Then that's what we are researching more and more now, and then those comparisons become a little more real and clear. But still, when we control for many factors like that, overall immigrants tend to be healthier. We were talking earlier about culture and food, that's very important. I think the way we eat is very much connected to our culture, our norms, and our values. Many immigrant communities have a healthier diet.

Jose Cardenas: A lot of fruit, soups, smaller portions.

Flavio Marisglia: Exactly.

Flavio Marisglia: But over time that may go away because we may become more Americanized and we walk away from the traditional diet. But that's happening in countries outside of the U.S., as well. We see in Mexico there is a big concern about obesity, and maybe there is a difference between the large cities and the small towns and rural areas. It's not just the person from the U.S. or not, but if the person is from another country, is he or she coming from the countryside or a large city?

Jose Cardenas: Where they may have adopted an American lifestyle.

Flavio Marisglia: Exactly.

Jose Cardenas: Let's talk about the Hispanic paradox. The article identified Hispanics as yet another exception to the norm where, if you have money or education, you tend to live a healthier, longer life.

Flavio Marisglia: Right. With the Hispanic paradox, the samples used mostly for those studies were mostly about Mexican immigrants. I think they tend to do better than other communities when they are compared with other immigrant communities, especially other Latino communities.

Jose Cardenas: Why would that be?

Flavio Marisglia: I think because most of the immigrants, especially to areas like Arizona and California, the people come from the countryside. Then I think that's my hypothesis, there's some connection to place of origin, where these immigrant families come from. They come already with a lifestyle; we work mostly in our center with young people. What we found in a big study here in Phoenix, mostly South and Central Phoenix, now a good seven years ago, we have seen other studies since then that found the same thing. 7,000 middle school students, a majority Mexican, Mexican-American, first generation, second generation, they have a much lower alcohol, tobacco and other drug use rates than other children. But when we move to third generation, those children start to look more like their classmates.

Jose Cardenas: So again, perhaps acculturation is occurring.

Flavio Marisglia: It's a big factor that we continue to study. There is something that we are trying develop now is interventions that identify what is protecting these families or these children from bad health or bad behaviors that may lead to bad health, and try to identify what is protective and work with that to make it strong, not to let it go, not to disappear. Because if we don't work on it, acculturation may in a way take that protective factor away.

Jose Cardenas: It'll erase the advantage.

Flavio Marisglia: Right.

Jose Cardenas: Let's talk about the conference coming up. Your industries the host and we see funding from the NIH?

Flavio Marisglia: Correct. We are a research center that studies health disparities and minority health. It's funded by NIH. We like to use the word minority health, and that's what this conference is about, it's about health. Trying to understand the healthy family, the healthy child, and then work with them to maintain that good health status. Our keynote speaker is Bill Vega from the University of Southern California, and he specializes in this area of research, the immigrant advantage of the Latino paradox, the different names we have given to this phenomenon, that he will provide us the most recent research that he's conducting in this area. But also we will work with the refugee community and mental health. Arizona is a receiving place for refugees from all over the world, mostly Africa. And our center also works with that community.

Jose Cardenas: Do you find some of the same things there, in terms of their physical well-being? Are they better off when they arrive here?

Flavio Marisglia: In the case of the refugees, many of them have left areas in Africa with natural disasters, and then the level of trauma is sometimes so high that in a way it takes away some of those protective factors. Then it's a little more complex, in terms of speaking about the immigrant advantage as refugee people. Many of them lived in camps for many years before they became eligible to come to the U.S. It's a very unique community, but very rich in culture and resources and assets, as well. But also with trauma.

Jose Cardenas: Doctor, let me ask you this. The conference is subtitled "Journeys of Resilience towards Health Equity." Given the advantages you say immigrants and Hispanics have in some respects, if you're journeying toward health equity, would it suggest that you're going lower, to poorer health?

Flavio Marisglia: Everything refers to access to services. Not only equity and good health. Then for us to do what we're trying do, to maintain people healthy, then we need to be sure that people have access to quality care. And that's a concern in our community. For many reasons people may not have access to care, or quality care or competent care.

Jose Cardenas: What sort of act do you think we would have?

Flavio Marisglia: We have a great impact; we hope our community will benefit from it.

Jose Cardenas: Do you think that would be true, despite suggestions that immigrants, Hispanics, minority groups may not be as likely to sign up?

Flavio Marisglia: There are many grass roots efforts, navigators helping community members to really benefit from this amazing opportunity to get health care. Many of our community members don't go to the doctor until they are very sick. And often it's too late. And also injury is very high because of the kind of jobs many members have. We need to do much more with safety education, awareness. I know that would be helped by the Affordable Care Act.

Jose Cardenas: And all of this will be discussed at the upcoming conference?

Flavio Marisglia: It will be.

Jose Cardenas: Thanks for joining us to talk about it.

Flavio Marisglia: Our pleasure.

Flavio Marsiglia:Director, Southwest Interdisciplinary Research Center;

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