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“We have to look at other reasons people change their health behaviors as they are in this country longer, including their economic and social environment.”

PUBLIC HEALTH EFFORTS to better understand and promote the health of the Latino population in the United States have focused on the so-called Hispanic paradox and the impact of acculturation. The paradox: On many measures, Latinos are healthier than non-Hispanic whites, despite social and economic disadvantages. Among Latino immigrants and their children, though, this paradox becomes less pronounced over time — an observation that has led many in public health to blame the adoption of unhealthy diet and lifestyle patterns that tends to occur as immigrants become assimilated into American society.

But research over the last decade by Dr. Anne Pebley, professor of community health sciences at the Fielding School, in collaboration with Dr. Noreen Goldman at Princeton University, suggests that the reality is more complex — particularly as it pertains to the health concerns of the nearly 12 million immigrants from Mexico residing in the United States and their children.

Pebley and Goldman were initially motivated to look more closely at these issues by their finding, published in the American Journal of Public Health in 2006, that for Latinos in the U.S., higher levels of education and income were not associated with better health to nearly the same extent as for other racial and ethnic groups. To understand why, they began by looking at the impact of social and economic factors on health in Mexico, the country from which Latino immigrants to the U.S. are most likely to come.

They found that in Mexico, unlike in the U.S., people with more education and higher incomes were more likely than low-income, low-educated people to be obese and to smoke. “In Mexico and other low-income countries, well-to-do people are the most likely to be able to afford high-fat diets and the expense of smoking,” Pebley says. The likelihood that Mexican immigrants to the U.S. bring their health habits with them could explain why better-off Mexican immigrants weren’t necessarily enjoying the health benefits normally associated with income and education, she notes.

But Pebley’s research also documented changing dietary patterns and levels of physical activity that in the ensuing years have led to an epidemic of obesity in Mexico — and consequently among Mexican immigrants to the United States. Today, Pebley says, Mexican immigrant children in the U.S. are at least as likely to be obese as U.S.- born youth of Mexican descent. “Over time, the Latino population in the United States will likely show the expected associations between socioeconomic status and health,” Pebley says. “So our primary focus should be on how to improve the health of people with lower income and less education.”

The idea that acculturation to American society leads immigrants to engage in unhealthy behaviors, such as consuming a poorer diet, has led many public health researchers to conclude that immigrant populations should be urged to hold on to cultural norms, including traditional foods. That thinking has begun to change thanks to the research of Pebley and others. In an analysis of data from the Los Angeles Family and Neighborhood Survey, a RAND-based longitudinal study co-directed by Pebley on Latino health, she found that while duration in the U.S. and generational status are associated with higher obesity rates among Mexican-origin populations, the differences cannot be explained by acculturation.

“We have to look at other reasons people change their health behaviors as they are in this country longer, including their economic and social environment,” Pebley says. “Consumption of unhealthy ‘American’ foods may be driven by their relatively low cost, availability, and other pragmatic concerns. Many immigrants from Mexico are moving into a much lower economic position when they come to the U.S., as well as experiencing discrimination, and it’s difficult to start moving up the ladder. Their health problems over time may be a function of poverty.”

To delve deeper into the impact of migrating to the United States from Mexico, Pebley and her colleagues analyzed data from a study that tracked the health of immigrants — the majority of them undocumented — through multiple interviews before and for several years after their move. They found that although health status improves for some, for the majority both mental and physical health declines significantly during the immediate post-migration period. The study also found that poor health makes it more likely that Mexican immigrants return to Mexico.

Pebley notes that her research is particularly relevant in Southern California, given the large number of individuals of Mexican origin and the unique health issues associated with the population, both positive and negative. “If we want to understand current and future U.S. health patterns, and specifically social determinants of health, we need to look at this population,” she says. “We should be concerned with their health for humanitarian reasons, and also because the health of one segment of our population affects everyone.”

But more broadly, Pebley believes the lessons learned about the Mexican-origin U.S. population can help to inform strategies for improving the health of other immigrant populations — an issue of growing importance given the likelihood that international migration will continue to increase in the future.

“International migration brings its own set of health issues that need to be addressed,” Pebley says. “But we can’t just look at the issues in isolation. This is about the larger set of social and political conditions that affect health. We need to consider the social and economic context when we think about how to promote the health of immigrant populations.”