yesenia sandoval She is a graduate in Biochemistry and minor in Biotechnology and she is from 2024-25 Health Care Ethics Trainee But Markkula Center for Applied Ethics At Santa Clara University. The views are his own.
Let’s start with a story about Daniel, a Hispanic man who immigrated from Mexico and struggles to find a good-paying job and lives in a low-income neighborhood. Despite financial challenges and being uninsured, Daniel tries his best to eat healthy and attend church regularly. He finds a home within the church community. Despite growing old with difficulties, Daniel lived to be 85. How is this possible? There are several hypotheses to explain the contradiction between the disadvantaged status of most Hispanics and their longer life span. Research shows that spirituality and religion have a strong association with life expectancy, which may be the explanation and should be integrated into overall patient care.
Currently, in the United States non-Hispanic whites live age 77.5Compared to Hispanics who live to be 80 on average. This country is full of people from diverse population Hispanics represent 19.1% of the populationDue to which it became the second largest ethnic group. However, this community faces many challenges. Currently, they are the largest insured group in the United States. 16.8% compared to 5.3% of non-Hispanic whites. they have higher unemployment rates 4.5%, with a low average income of $65,882. They are less educated, with 73.1% Have a high school diploma and 20.4% Having a bachelor’s degree. Despite this, they often live longer than the average American. This phenomenon is known as the Hispanic death paradox.
What is the Hispanic mortality paradox?
The Hispanic mortality paradox helps explain how Hispanics often Better health outcomes and live longer, Despite fewer doctor visits, discussion of health concerns, and poor diet. Two theories currently offer explanations for this paradox. the first principle is “The Salmon Bias” Where immigrants return to their country of origin when they become ill, retire, or need a job. The second principle is “healthy migration hypothesis“Where only the healthiest people from a country migrate to the new country. There is no strong evidence that indicates either explanation proves the paradox, as both seem to contribute without providing a complete answer.”
One explanation that is worth mentioning is that “Barrio Neighborhood Advantage”. This is where immigrants live in similar areas, providing a space of similar cultures and experiences, which can reduce stress and anxiety. It emphasizes the importance of social relationships, which Reduces diabetes, cognitive decline and other chronic conditions. In this article, an additional explanation is offered through exploring the role of spirituality and religion in the Hispanic mortality paradox, which requires rethinking how spirituality and health care co-exist.
Spiritual culture in holistic care among Hispanics.
Holistic medicine emphasizes treatment The whole person through an understanding of social, psychological, family, social and ethical factors. One of these holistic approaches is the spirituality of the individual. spirituality is It is defined as the search for a meaning or purpose that lies beyond a deep understanding of life. In Hispanic culture, spirituality may be practiced alongside religion, although it is important to recognize that the two can exist independently. According to Pew Research, 72% of Hispanics report religious affiliation.
While religion and spirituality share similar practices such as prayer and meditation, they can impact health independently. Among Hispanics, research shows that they are more likely to value religion and engage in frequent religious prayer. This will lead to better competition and less stress Because they provide coping mechanisms and comfort. There has been a distinct increase in spirituality It is associated with fewer deaths, improved cognition, better self-reported health, and fewer mental health effects. Spirituality and religion both are related to emotions Less loneliness and increased feelings of faith and hope. Religious and spiritual health can provide support that can improve a person’s overall mental health. Mental health also affects physical health This may increase the risk of long-term conditions (such as diabetes, heart disease, etc.). This is important because spiritual and religious health can be positive indicators of a person’s mental and physical health.
Ethical Considerations for the American Health Care System
The Hispanic mortality paradox suggests that incorporating discussions about religion and spirituality may lead to better patient outcomes and a more comprehensive understanding of the patient’s overall well-being. Health care providers must evolve cultural humilityWho recognize that they may not fully understand the patient’s culture, but can still respect its values, including religion and spirituality. The fact that this approach was only formal Accepted by the American Medical Association (AMA) through an opinion in 2015 It is surprising. This delay reflects not only differences in professional standards, but also a cultural hesitation within American society to openly engage with religion and spirituality in professional settings.
currently, 41% of Americans decide to avoid discussing religion to avoid disagreementSuggests reluctance to have these conversations. It is important to remember that promoting discussion about spiritual health is not about imposing one’s own views, but about recognizing that spirituality can play an integral role in people’s lives. The four main ethical principles held by physicians – beneficence, nonmaleficence, autonomy, and justice – are often understood only through a Secular approach excluding spiritual well-being.
In 2018, AMA released a guide How to include discussions about spirituality and religion during care for physicians. This emphasizes that physicians have There is a duty to provide holistic care that respects the whole person Which includes their spiritual self. According to the ethical principles of beneficence and autonomy, providers are obliged to respect patients’ right to self-determination and promote their well-being. When the criteria for physician-patient interactions do not include discussion about religion, patients with religious beliefs are limited in expressing themselves fully. In other words, their autonomy is disrupted. Failure to fully consider this aspect of care can prevent a physician from fully caring for their patient and break trust. Research shows that these subjects Still being neglected in care. in Neglect is detrimental to the quality of care patients receive And so, they have confidence in the health care system. If physicians fail to establish trust, those patients May be less likely to follow medical advice or adhere to treatment plans. This directly violates the principle of non-maleficence, which means doing no harm.
Although this aspect of care has been overlooked, Hispanics continue to experience longer life spans. The Hispanic mortality paradox particularly highlights the gap in medical education and training in addressing overall needs, Despite increased efforts since 2018. When applying the ethical principle of justice, it becomes clear that the integration of spirituality in health care can be used to fight ongoing health disparities, including among other minority communities. Justice demands that all patients receive equitable, patient-centered care. This begins with physicians establishing trust, openness, and a focus on the whole person.
The purpose of health care is to promote positive health outcomes and life longevity. Despite challenges in health care, the Hispanic community still lives longer lives. Spirituality and religion likely play a role. Ultimately, physicians have an ethical responsibility to discuss spirituality and religion if it is deemed beneficial. Health care institutions have a responsibility to create a culture of respect and openness to spirituality and religion in health care to promote inclusive and compassionate patient care.
