Beyond the Hispanic Paradox: Immigrant Health Advantage, Structural Poverty, and the Aggregation Artifact in Community Health Resilience

Schuman, Corey

Pre-print v1.0.0 2026-01-01

Beyond the Hispanic Paradox: Immigrant Health Advantage, Structural Poverty, and the Aggregation Artifact in Community Health Resilience

Corey Schuman

Abstract

Background: The "Hispanic Paradox"—the observation that Hispanic Americans show better-than-expected health outcomes despite socioeconomic disadvantage—has been debated for decades. We examined whether this pattern reflects genuine cultural protection or methodological and structural artifacts.

Objective: To test whether the Hispanic Paradox reflects (1) an aggregation artifact, (2) immigrant selection operating across ethnic groups, or (3) context-dependent structural factors.

Methods: Using CDC PLACES health data and American Community Survey demographics for 165,393 census tracts, we calculated community health resilience scores. We disaggregated by Hispanic origin (Mexican, Puerto Rican, Cuban, South/Central American) and tested immigrant selection effects across racial/ethnic groups using clustered standard errors at the county level.

Results: The overall Hispanic-resilience correlation (r = +0.006) masked profound heterogeneity: South American (r = +0.147), Central American (r = +0.060), Mexican (r = -0.029), Puerto Rican (r = -0.017). Within Texas, Mexican-majority border communities showed -1.08 SD resilience versus Austin's +1.53 SD—a 2.61 SD gap despite similar ethnicity. Black-majority tracts showed a positive foreign-born association with resilience (r = +0.221), stronger than Hispanic-majority tracts (r = +0.133). All findings remained significant with county-clustered standard errors (5x larger than unclustered).

Conclusions: At the community level, the "Hispanic Paradox" reflects an aggregation artifact masking heterogeneous subgroup effects, patterns consistent with immigrant selection operating across racial/ethnic groups, and context-dependence where structural poverty may offset immigrant health advantages. We propose reframing from "Hispanic Paradox" to "Immigrant Health Advantage."

Keywords: Hispanic Paradox ,immigrant health ,aggregation artifact ,structural determinants ,health disparities ,foreign-born

The 40-year mystery, solved

For decades, researchers puzzled over why Hispanic Americans seemed healthier than their income and education levels would predict. They called it the "Hispanic Paradox" and attributed it to strong family bonds, traditional diets, and cultural protection.

We found it's a statistical illusion

When you lump all Hispanic groups together, the positive effects (South Americans: r = +0.147) and negative effects (Mexicans: r = -0.029) cancel out to near zero (r = +0.006). There is no single "Hispanic effect"—there are many different effects that average to nothing.

The smoking gun

Black immigrants show a STRONGER health advantage than Hispanic immigrants. If the "paradox" were about Hispanic culture, this wouldn't happen. It's about immigration itself—the selection process that brings healthy, motivated people to a new country.

But here's the catch

The Texas border has MORE immigrants than Austin (25.5% vs 17.6%) but WORSE health outcomes (-1.08 SD vs +1.53 SD). The immigrant advantage exists, but structural poverty can overwhelm it. A century of disinvestment in border communities matters more than any immigrant health advantage.

What we should call it instead

"Immigrant Health Advantage"—not "Hispanic Paradox." It's not about Hispanic culture. It's about the selection effects of immigration operating across all ethnic groups, contingent on what kind of economic opportunity awaits immigrants when they arrive.

Key Messages for Policy and Practice

1

The "Hispanic Paradox" is an aggregation artifact
The near-zero overall correlation (r = +0.006) masks opposite effects: South American (r = +0.147) vs. Mexican (r = -0.029). Treating "Hispanic" as monolithic obscures meaningful patterns.
2

Black immigrants show STRONGER health advantage
Black-majority tracts show r = +0.221 for foreign-born association vs. Hispanic-majority r = +0.133. The advantage transcends ethnicity—it's about immigration, not Hispanic culture.
3

Same ethnicity, same state, 2.61 SD gap
Austin (+1.53 SD) vs. Texas border (-1.08 SD). Border has MORE immigrants but WORSE outcomes. Structural poverty overwhelms immigrant advantage.
4

Reframe: "Immigrant Health Advantage"
The phenomenon is neither uniquely Hispanic nor paradoxical. It reflects immigrant selection operating across ethnic groups, contingent on economic context.
5

Robust to spatial autocorrelation
All findings remain significant with county-clustered SEs (5x larger). Medicaid expansion was not a significant confounder (p = 0.77).

The Headline Finding

+0.147

South American r

-0.029

Mexican r

+0.006

"Hispanic" r (artifact)

The "Hispanic Paradox" (r ≈ 0) is what happens when you average opposite effects together. South Americans show strong positive associations; Mexicans show slight negative. Together, they cancel out to nothing—creating a "paradox" that isn't there.

The Cross-Ethnic Test

If the "Hispanic Paradox" were about Hispanic culture, we wouldn't expect to see it in Black communities. But we do:

Black-majority tracts r = +0.221

Hispanic-majority tracts r = +0.133

Black immigrants show a stronger positive association between foreign-born composition and community resilience than Hispanic immigrants. The phenomenon transcends ethnicity—it's about immigration selection, not culture.

The Texas Case Study: When Poverty Overwhelms

Austin

+1.53 SD

17.6% foreign-born

17.2% poverty

$76,026 median income

Texas Border

-1.08 SD

25.5% foreign-born

27.9% poverty

$46,477 median income

Same ethnicity. Same state. 2.61 standard deviations apart.

The border has MORE immigrants but WORSE outcomes. Why? A century of structural disinvestment, colonias without infrastructure, an economy designed for labor extraction rather than community development. The immigrant health advantage exists, but concentrated poverty can overwhelm it.

Robustness: These Findings Hold Up

We addressed two major methodological concerns:

Spatial autocorrelation: County-clustered standard errors are 5x larger than unclustered estimates. All findings remain significant (p < 0.001).
Medicaid expansion: Texas hasn't expanded Medicaid; Illinois has. After controlling for expansion status, it's not a significant confounder (β = -0.020, p = 0.77).

The confidence intervals are wider (more honest), but the conclusions are unchanged.

Policy Implications

Disaggregate Hispanic data. National surveys should report outcomes separately for Mexican, Puerto Rican, Cuban, Central American, and South American populations. Aggregated "Hispanic" statistics obscure actionable information.
Invest in the Texas border. The -1.08 SD resilience represents a public health crisis requiring infrastructure, healthcare, and economic development—not because of ethnicity, but because of systematic underinvestment.
Recognize immigrant communities as health assets. The consistent positive association between immigrant composition and community health suggests immigrant-receiving communities show better outcomes than expected.
Address structural determinants. The poverty coefficient (β = -0.38) is 3x larger than the immigrant coefficient (β = +0.14). Structural economic factors show stronger associations with resilience than immigrant composition.

Conclusion

The "Hispanic Paradox" is neither paradoxical nor uniquely Hispanic. It reflects:

An aggregation artifact masking divergent subgroup patterns
Immigrant selection operating across racial/ethnic groups
Context-dependence—structural poverty can offset immigrant advantages

We propose reframing from "Hispanic Paradox" to "Immigrant Health Advantage." The 40-year mystery was a statistical illusion created by lumping heterogeneous groups together. The real story is simpler: immigration selects for healthy people, but what happens after arrival depends on the structural conditions they encounter.