A tale of three paradoxes: The weak socioeconomic gradients in health among hispanic immigrants and their relation to the hispanic health paradox and negative acculturation

Although Latino immigrants come from countries with high levels of inequality, their socioeconomic gradients in health are generally weaker than those among their US-born co-ethnics and much weaker than those of US-born non-Hispanic (NH) whites. We review this literature among Latin American immigrants looking at the role of: factors related to conditions in the country of origin, or “gradient importation”; migration-related factors, such as Socioeconomic Status (SES)-graded health selectivity in emigration and return; destination-based factors, including SES-graded protection and selection; and data artifacts, which might be more likely to occur at lower levels of SES. Despite the relative scarcity of studies on the social gradients in health among immigrants, recent research has provided interesting insights on the potential mechanisms driving the Hispanic Health Paradox and on the potential role of socioeconomic status on “acculturation” in health. We discuss which of the reviewed mechanisms may be more relevant in late life, point out potential avenues for future research, and reflect upon the steepness of white gradients in the United States.