Discussion: Worldview of Hispanics
It is believed that the close family structure is a contributing factor to what is called the Hispanic paradox . In 1986, Kyriakos Markides coined the expression “ Hispanic epidemiological paradox” to refer to what appears to be surprisingly good health outcomes for Hispanics for mortality relative to non-Hispanic whites and other minorities (Markides & Coreil, 1986). For example, mortality among Hispanic males has been reported as being 26% lower in 2012 than non-Hispanic white males, and mortality among Hispanic females is 39% lower for non-Hispanic white females (National Center for Health Statistics [NCHS], 2014). In 2013, a review of 58 studies conducted between 1990 and 2010 and involving 4,615,747 participants showed that Hispanic populations had a 17.5% lower risk of mortality compared with other racial groups (Ruis, Steffen, & Smith, 2013). Several efforts to explain this as errors in reporting, self-selection of healthy people entering the United States, or that Hispanics who are ill return to their prior country have not been sustained. It has likewise been suggested and conceded by Kyriako Markides that the support and “ love” associated with strong family ties may contribute to the apparent positive outcomes (Yasmin, 2014).
General Philosophy About Disease Prevention and Health Maintenance
Hispanics generallly view health as being and looking clean, being able to rest and sleep well, feeling good and happy, and having the ability to perform in one’s expected role as mother, father, worker, and so forth. In Puerto Rico, the phrase llenitos y limpios (clean and not too thin) is used (Rhode Island Department of Health, n.d.). A person’s well-being depends upon a balance of emotional, physical, and social factors, and when they are not in balance, illness occurs. Some attribute physical illness to los nervios, believing that illness results from having experienced a strong emotional state. Thus they try to prevent illness by avoiding intense rage, sadness, and other emotions (Rhode Island Department of Health, n.d.). Depression is not talked about openly.
Did You Know?
Even though you might think low income is always associated with health risks, the rate for low-birth-weight infants born to first-generation and less acculturated Mexican immigrant women is the same as that of non-Hispanic whites, and half that of African Americans with similar risks. It appears that sociocultural rather than genetic variables are the primary factors associated with this phenomenon. Higher levels of acculturation to North American values and lifestyle in Mexican American childbearing women have been correlated with poor perinatal outcomes, including low birth weight (Callister & Birkhead, 2002).
Worldview Hispanics tend to value closeness, so touching and embracing are common. Sustained eye contact with an older person is considered rude; direct eye contact with superiors is viewed as being disrespectful. This may not be relevant to second and third generation Hispanics. Using formal names and greeting with a handshake are signs of respect, and health care providers should address and greet Hispanics in this way. Inquiring about family before discussing the health issues is a way of gaining trust. Health care providers should engage in “ small talk” before addressing the patient’s health concerns (Purnell, 2013). Hispanics are reluctant to speak about some topics with health care providers, such as sexuality, but otherwise they are open to discussing their physical problems with providers. This group uses both complementary and alternative medicine (CAM) and allopathic medical care. It is important for health care providers to inquire about the CAM used.
Hispanics tend to be present oriented, so disease prevention may not be a priority. They may arrive late for appointments due to their relaxed sense of time. The social structure is a collectivistic one that values interdependence and cooperation. In the family, traditional gender roles are followed, with women making decisions related to the health of the family. Families are close and decisions are made jointly. This closeness is why Hispanics tend to refrain from putting family members in long-term care, caring instead for them at home.
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