Recent Mexican immigrants, although poorer, tend to be healthier than the average American. They have lower rates of death, heart disease, cancer, and other illnesses, despite being less educated, earning less and having the stress of adapting to a new country and a new language. In research circles, this is the Latino paradox.
But as they are here longer, their health advantage erodes. After five years or more in the U.S., they are 1.5 times more likely to have high blood pressure -- and be obese -- than when they arrived. Within one generation, their health is as poor as other Americans of similar income status.
In Kennett Square, Pennsylvania, about 40 miles south of Philadelphia, Mexican immigrants like Amador Bernal now make up a quarter of the town's population. After almost 25 years in the U.S., Amador has never been to a doctor. And he's not alone.
Some researchers believe that most immigrants come to the U.S. with a health advantage, even if their native country is poor. That's because people who are able to move to another country must be in good physical and mental health to begin with.
Many researchers believe another factor is also at work. "Immigrants bring to this country aspects of culture, of tradition, of tight family social networks and community social networks that essentially form a shield around them and allow them to withstand the deleterious, negative impacts of American culture," says Alameda County (CA) Public Health Director Tony Iton, MD.
But that shield has an expiration date. As Dr. William Vega's research with Mexican immigrants in California shows: "The levels of all major mental disorders increased when we looked at people who had been in the country over 13 years. So you see these protective factors begin to wear down."
One reason is that low wages, working conditions and increased social exclusion tend to break down those protective shields. Isolation is on the rise in the U.S., not just among immigrants. One in four of us say they have no one they can talk to about their problems. And isolation kills.
For Amador Bernal and his family, support from extended family and friends has been central to their ability to stay mentally and physically healthy. But more importantly, their health is protected by the union at the mushroom farm where Amador works; by the social service agency that runs a free clinic on the farm premises for workers; and by the community center that keeps the children safe after school and provides them with friends, after-school tutoring, computer access and a path to a better future. Kennett Square is investing in resources that can help all its citizens feel included and connected.
Unnatural Causes is the acclaimed documentary series broadcast by PBS and now used by thousands of organizations around the country to tackle the root causes of our alarming socio-economic and racial inequities in health.
The four-hour series crisscrosses the nation uncovering startling new findings that suggest there is much more to our health than bad habits, health care, or unlucky genes. The social circumstances in which we are born, live, and work can actually get under our skin and disrupt our physiology as much as germs and viruses.
Extent of continuing physical, emotional, mental, and social ability to cope with one's environment. Good health is harder to define than bad health (which can be equated with presence of disease) because it must convey a more positive concept than mere absence of disease, and there is a variable area between health and disease. A person may be in good physical condition but have a cold or be mentally ill. Someone may appear healthy but have a serious condition (e.g., cancer) that is detectable only by physical examination or diagnostic tests or not even by these.
Science and art of preventing disease, prolonging life, and promoting health through organized community efforts. These include sanitation, control of contagious infections, hygiene education, early diagnosis and preventive treatment, and adequate living standards. It requires understanding not only of epidemiology, nutrition, and antiseptic practices but also of social science. Historical public health measures included quarantine of leprosy victims in the Middle Ages and efforts to improve sanitation following the 14th-century plague epidemics. Population increases in Europe brought with them increased awareness of infant deaths and a proliferation of hospitals. Britain's Public Health Act of 1848 established a special public health ministry. In the U.S., public health is studied and coordinated on a national level by the Centers for Disease Control and Prevention; internationally, the World Health Organization plays an equivalent role.
NARRATOR: Give me your poor, your tired, your huddled masses, the poem goes. Today, many new immigrants to the U.S. arestill poor, and tired. But theyre certainly not sick. In fact, they may be healthier than the rest of us. TONY ITON(Director, Alameda County Public Health Dept.): Theyre doing something right. We have to understand what it is, and tryto spread that benefit to a larger segment of society. Thats the lesson that immigrants teach us in public health.NARRATOR: But the good health many immigrants arrive with comes with an expiration date. Instead of improving theirhealth, life in the U.S. often has the opposite effect. Within a generation, they see their health advantages underminedby the same social forces that erode the health of all of us. ITON: As these new Americans become more like oldAmericans, they get unhealthy. NARRATOR: Amador Bernal arrived in Kennett Square, Pennsylvania from his native Mexico,to work in the mushroom farms. He was 21 years old. 40 miles south of Philadelphia, Kennett Square claims the titlemushroom capital of the world. Mexicans have been migrating here to work since the 1970s. They make up almost one fourthof the towns population. Amador Bernal works at Kaolin Mushroom Farms, one of the biggest. AMADOR BERNAL (speaking inSpanish): I water the mushrooms with a hose and watering can, by myself. If I finish early I water where its needed. Iearn $9.03 an hour. I work 8 hous a day, 7 days a week. In almost 25 years in the U.S., Amador Bernal has never oncebeen to a doctor and hes not the exception. STEVE LARSON (Assoc. Professor of Emergency Medicine, Univ. of PennsylvaniaSchool of Medicine): I sat in on this meeting, and I remember the generalizations. You know, theyre always late fortheir appointments, theyre always dirty, and they all have infectious diseases. And I thought to myself, having workednow for several years with the Mexican population: Boy, where were they getting these generalizations from? NARRATOR: Inthe early 1990s, Steve Larson worked as a doctor with the Kennett Square Mexican community. LARSON: And I had severalthousand patients I would see. So I had the data crunched, and I pulled it out in this meeting and I said, Well, youreactually quite wrong. These are young, healthy people, for the most part. Theyre not here to drain the system. So, thatsa myth. NARRATOR: Health data gathered by researchers going door-to-door in Alameda County, California mirror whatLarson saw in Kennett Square. ITON: One of the things that the data told us, in our health department, was thatimmigrant Latinos had the best health of anybody in the county, by far. They had the lowest rates of death, lowest ratesof heart disease, lowest rates of all the major killers. And that was a startling finding to us. We couldnt understandwhy the poorest, most socially marginalized population actually had the best health. Better health, not just than otherpoor people, but better health than the wealthiest segments of our societies. And thats profound. NARRATOR: On the otherside of the country in Cambridge, Massachusetts, Dr. Margarita Alegra leads a team looking at a similar phenomenonthrough the lens of mental health. In the 1960s, researchers identified what they called the Latino paradox. MARGARITAALEGRA (Psychologist, Harvard Medical School, Cambridge Health Alliance): They were surprised to find that Latinos thatwere immigrant, who had lower education, lower income, were under very stressful conditions of adaptation to the US, hadactually lower rates of psychiatric illness than whites who were higher income, higher education. And this has also beenshown in cardiovascular disease and cancer and other illnesses. So its quite a paradox. NARRATOR: One explanation isthat Latino immigrants who come here have better health on average than those who stay behind. But researchers are alsocircling in on a second hypothesis. ALEGRA: I think the other explanation has been more about the role of very strong,cohesive family ties that hold Latino families together, even under hardship; and these very strong family tiesfacilitate people struggling through, you know, disadvantageous conditions. NARRATOR: For 20 years Amador Bernaltraveled back and forth between Mexico and Kennett Square. AMADOR BERNAL (in Spanish): Id work 4,5,6 months and Id gohome because I missed them so much all of them, but especially Maritza. I used to dream about her. NARRATOR: After hegot his green card, Amador filed papers for his family to join him. It took nine years to get approval. They finallyarrived in the U.S. a year ago. AMADOR BERNAL (in Spanish): Its much better for me because Im not apart from themI seethem everyday. NARRATOR: Amador and his wife Bernardita have lots of family in Kennett Square. They help ease the stressof settling in a new country. BERNARDITA BERNAL (in Spanish): His father helped us buy the table. My father gave usmoney to buy the TV and microwave. AMADOR BERNAL (in Spanish): Her brothers dont have a car. So they say, Take me toWalmart, and I take them. Like that. We help each other. Thats how we solve our problems. ITON: Immigrants bring to thiscountry aspects of culture, of tradition, of tight family social networks and community social networks that essentiallyform a shield around them and allow them to withstand the deleterious, the negative impacts of American culture.NARRATOR: But maintaining the support networks of close family and community is becoming increasingly difficult--for allAmericans. NARRATOR: We now work longer hours than any other industrialized nation, even Japan. The average American nowspends fifty minutes a day commuting. Ten million of us take two hours or more. One in four Americans say there is noone with whom they discuss important matters. That number nearly tripled in the last twenty years. Social isolation ison the rise in the United States. And isolation can kill. That was the finding of a seminal study conducted inCalifornia in the 1970s. LISA BERKMAN (Epidemiologist, Harvard School of Public Health): It was astounding. Overall,people who are really isolated are at increased risk not only for cardiovascular disease, but for infectious diseases,for diabetes, for strokes, for cancer. They were at increased risk from almost every cause of death. Social isolationkind of metaphorically accelerates the rate of aging. The fact that you got something when you were 50 instead of 80, or30 instead of 60, is because being socially isolated is a chronically stressful situation, which just kind of leans onthe body. NARRATOR: But staying socially connected in a way that protects health takes more than close family ties.ITON: Thats one of the lessons of America, that your family isnt enough ultimately to protect you against some of theinfluences of America. It really is a challenge to try to make sure that before the inevitable breakdown of these closefamily units occurs, that the communities are organized in ways to essentially keep that sort of protective shieldalive. NARRATOR: And the Bernals may have found some of that community support in Kennett Square itself. Its aPennsylvania town with a Quaker sense of mission, and it does more than many communities to invest in its future withgood schools, social services, and many other resources to support all its families. VICTOR GARCIA (CulturalAnthropologist, Indiana Univ. of Pennsylvania): I think what makes Kennett Square so unique in that regard are thedifferent organizations that are trying to not just bridge and create a link with the immigrant population, but is alsoI think helping this population not fall into the category of being underclass. NARRATOR: Everyone benefits if no one isleft behind. That was the idea behind Bridging the Community meetings begun by Joan Holliday in 1997. JOAN HOLLIDAY(Public Health Nurse, Bridging the Community): I, as a public health nurse, felt this community had so many resourcesfor being such a small town, but we werent talking to each other. NARRATOR: The meetings are an opportunity forresidents to find out about resources available in the area and exchange services. LINDA ECKMAN: Linda Eckman and Ivebeen in this community 23 years, and Im starting a twelve-step group for kids with addiction issues. FIDEL VASQUEZ: Minombre es Fidel Vazquez. TRANSLATOR: My name is Fidel Vasquez. FIDEL VASQUEZ: Trabajor de Kaolin, de pick de hongo.TRANSLATOR: I work at Kaolin Mushroom and I pick mushrooms. WOMAN: If you know of anyone who wants part-time orfull-time or anything we just really have a great need for a bilingual receptionist. GARCIA: There are people inpoverty here. There are people here with need. But I dont think its a large population that find themselves in direstraits. Not like you would find in similar communities in other areas of the United States. NARRATOR: Another resourcefor families is The Garage, the towns youth center. After school, students come here to work with volunteers, use thecomputer lab, or just hang out. Alfredo Bernal often comes here to do his homework. His brother Israel practices hisEnglish with a retired executive. ISRAEL BERNAL (in Spanish): New doors have opened for me here. Id like to studyengineering, go to Penn State for example. Here, if they see youre intelligent and really work hard, they support you.ALFREDO BERNAL (in Spanish): My hopes are to study social work, so that I can help people who come from Mexico orreally, anyone who needs help. NARRATOR: Community support in Kennett Square gives Alfredo and Israel reason to behopeful as they look ahead. And if they can climb the economic ladder they stand a better chance of a healthy future.ANTHONY ITON: In America, wealth pretty much equals health. And thats true for me as it is true for, you know, thepoorest person in, in the quote, unquote inner city. Theres a gradient. And all the way along the way, you can findyourself somewhere along that gradient. Its not like youre poor and you have bad health, and then youre not poor and youhave good health. For each step along that wealth gradient, you have a corresponding step of health. When youre a newimmigrant, the relationship between wealth and health is relatively loose. As you become more American, thatrelationship becomes tighter and tighter and tighter. NARRATOR: After only 5 years in the U.S., Latino immigrants areone and a half times more likely to have high blood pressure than when they first arrived and to be obese. Rates ofheart disease and diabetes also increase. More than 20% of Latino households are poor. The longer theyre here, the moreimmigrant families struggle with discrimination, low-paying jobs, bad schools, and bad housing. ITON: And if thatenvironment is giving you cues that youre not valuable, that you have very little prospect for a good future, thatstarts to build up and you internalize that devaluation. NARRATOR: One in four Latino children drop out of high school.Shockingly, one in seven teenaged Latina girls attempt suicide. ITON: Immigrant Latinos, as they acculturate, as thestress levels accumulate, their children start to lose that sense of why it is that they were here, they lose thatconnection to their parents hopefulness. They become more American, they acquire American habits, American diets,American sensibilities. Theyre gaining traction in the American way of life, but theyre losing that hopefulness thattheir immigrant parents brought with them that might actually be health-protective. NARRATOR: Today the Bernals arestill healthy. But theyre facing the same kinds of pressures and stresses many of us live with day in and day out.NARRATOR: Bernardita Bernal packs mushrooms. BERNARDITA BERNAL (in Spanish): We put on the lids, the labels We weigh theboxes They come out fast, 12 or 15 boxes a minute. I work 9 or 10 hours a day. If there are a lot of mushrooms we worksix days a week. NARRATOR: Bernardita earns $6.50 an hour. Like many American families, the Bernals need as many incomesas they can generate. ALFREDO BERNAL (in Spanish): My brother and I work in a restaurant, Longwood Garden, asdishwashers. Before working here, I worked afternoons from 4 oclock and sometimes I didnt leave until late and Id be sotired when I got home Id just fall asleep, so I wouldnt do my homework and then my grades went down. Thats why I preferto only work weekends. ALFREDO BERNAL (in Spanish, to parents): Did anyone call? BERNARDITA BERNAL (in Spanish): Yes,someone called. ALFREDO BERNAL (in Spanish): Who was it? BERNARDITA BERNAL (in Spanish): Some girl. ALFREDO BERNAL (inSpanish): I wonder which of the two. (Laughs) No, no, just kidding. NARRATOR: Like half of American households, theBernals live on about $46,000 a year. And theyre trying to make ends meet in one of the most upscale counties inPennsylvania. Even renting a small house by the train tracks is expensive. Three fourths of their income goes to basicexpenses, like rent, food, utilities and transportationfor a family of six. AMADOR BERNAL (in Spanish): Turkey. Turkeyson special. NARRATOR: Three out of four of Americans who started out at the bottom of the income ladder in the late1980s were still there a decade later. ITON: Theres this mythology of the American dream that (you know) anybody canmove up that ladder with the right amount of gumption. And therere certainly anecdotal stories of that, and people havegood luck, and good fortune. But for the most part, the overwhelming majority of people dont move up that ladder.NARRATOR: These economic insecurities erode the social and family ties that support our health. OLGA BERNAL (inSpanish): We cant have our parents all the time like in Mexico, my mom would be there when I got home from school. Here,when I get home Im alone until my sister comes home, and my Dad. Then he goes to pick up my Mom. ITON: One of the thingsthat we know that immigrant parents do is that they work, and they work a lot. And so as a consequence, their childrenhave less time with them, they have less exposure to them, to those cultural aspects of family, of community that thatparents inculcate in their children. NARRATOR: Olga and Martiza were 11 and 8 when they came to the U.S. When social andfamily ties begin to fray, its the mental health of the youngest arrivals thats the most vulnerable. The risk ofpsychiatric disorders for Latino immigrant children depends on their age when they arrive here. MARGARITA ALEGRA: Thelonger you stay in your country of origin, for especially the times where you have a higher risk of developing illnesseslike psychiatric disorders, like anxiety, or like depression the longer you stay in your country of origin, the lowerthe risk youre going to have of developing those disorders. What is it in this country that suddenly increases your riskfor psychiatric illness? What are we doing here? NARRATOR: William Vega has studied the psychological health of Mexicanimmigrants in California. WILLIAM VEGA (Psychiatric Epidemiologist, David Geffen School of Medicine UCLA): If nothingelse, the paradox is putting the spotlight on the fact that the United States has very high levels of depression. And wefound when we looked at the population that came as immigrants and had about 13 years or less in the country, they hadvery, very low levels of major depression. Only about 8%. The general population in the United States, that would beabout 18-20% in a lifetime. But those levels increased when we looked at people who had been in the country over 13years. See these protective factors begin to wear down. And then subsequently over multiple generations we cananticipate that theyll look increasingly just like the American people as a population, because they live here. Theyvebecome Americans. NARRATOR: For immigrant mushroom workers, becoming an American is a journey filled with opportunity,challenges and risks. A number of workers are beginning to feel the affects of newly diagnosed chronic diseases.MARGUERITE HARRIS (in Spanish): Does anyone in your family have diabetes? PATIENT (in Spanish): I have it. MARGUERITEHARRIS: You have it? When was it diagnosed? PATIENT: Oh, about nine months ago. NARRATOR: Like almost half of Americasworkforce, mushroom workers get no paid sick days. Recently, three mushroom farms allowed La Comunidad Hispana, a socialservice agency in Kennett Square, to open clinics on-site. MARGUERITE HARRIS (Clinical Health Director, Project Salud):Workers dont like to take time off from work. Its money not being earned and they really do need to earn money. So thatthey would not necessarily go to see anybody until symptoms are pretty bad. Obesity probably is the leading issue hereand along with that comes all the other problems of diabetes and hypertension, hypercholesterolemia. And of course withall of that you have strokes coming down the pike, congestive heart failure. So we do a screening of all of those forwhatever reason a patient comes in. Thats the protocol. NARRATOR: By the year 2050, one in four Americans will beLatino. STEVE LARSON: If we acknowledge that this is the population thats growing, then you know, we have to plan for 20years from now, 30 years from now. If wellbeing isnt prioritized now, then whats the landscape of our country going tolook like twenty, thirty years from now? AMADOR BERNAL (in Spanish): If I had credit, I would like to buy a house. Butright now we have nothing saved. When you have a little money then you can get more credit for a house, and pay for itlittle by little. NARRATOR: The Bernals are hopeful about the future. But can they maintain their hopeand their healthasthey become more American, and as America becomes more a part of them? WILLIAM VEGA: When we talk about acculturationand the process of becoming more Americanized, its not a process of changing cultures A to Z. Its a process ofselectively taking on elements of American culture. And I think if we can bring that selection process into clearerfocus, of which processes are selected and which are not selected, and which are retained from the old culture, you havea better mix. NARRATOR: And this may have lessons for all of us. ANTHONY ITON: As a society, we can build hope. And wedo that by giving people access to those things that give them the potential for success: thats good education, thatsaccess to good jobs, decent housing, and then a sense of belonging to a community, belonging to something larger thanyourself, larger than your family. The potential right now is to try to take what we can see obviously in new immigrantcommunitiesthe health protective benefits of being a new immigrantand understand and translate that into public healthinterventions now that affect the broader community.