Overcoming the Challenges of Reporting on the Healthy Immigrant Effect
My three-part series for Voice of OC on the decline in the health of immigrants in Orange County began two years ago with a study that got my attention. It showed that life expectancy rates in the OC were higher for Latinos than whites (83 compared to 80).
I was surprised for a couple reasons: I’d come to understand that wealth was a decisive factor in good health. The income difference between immigrant Latinos and whites in Orange County is significant and would suggest white advantages in life expectancy.
Further, I had read numerous studies and articles about low-income ethnic communities being subject to higher rates of obesity, diabetes, asthma and other ills. I had made the mistake of assuming that Latino communities had consistently poor health outcomes. But it’s not that simple.
My research confirmed that immigrants in general, and Latinos in particular, embody a theory known as the Latino Health Paradox or Healthy Immigrant Effect. Despite arriving with lower levels of education and wealth, Mexican immigrants traditionally have arrived in better health than the U.S. population on a number of measures, including life expectancy, healthy birth, heart disease, drug use, STDs and more.
But the paradox is only half the story. Immigrants living in the U.S. lose their health advantages, and the health of their American children continues along this decline, resulting in well-known disparities compared to the general U.S. population.
I became curious: What did this pattern of eroding health protections reveal about the lives of immigrants – but also about the environments in which they’d made their new home? I wanted to tell the story of the paradox and its reversal, and I wanted to see how it unfolded in Orange County.
My biggest challenge on the public health beat is finding people in underserved communities who are willing to trust me in talking about personal matters and their children’s lives. Basic communication in demographically varied Orange County is possible though not easy. For example, I speak a fair amount of Spanish, but I don’t know Vietnamese or Korean. Further, many people in the OC’s ethnic communities are undocumented, and they don’t seek public attention.
It would seem obvious that ethnic and community health advocates could be a key link, but I have haven’t had a lot of luck with that route. Most activists seem to feel that it’s hard enough for them to earn the trust of people in underserved communities, and they generally have not been willing to put me in touch with the people they serve. Twice during the project, for example, activists told me they would connect me to some of their clients, only to have their superiors veto the idea.
As for medical professionals, doctors have not always been helpful; they’re concerned about patient privacy even though I am willing to work by their rules.
There’s another complication, this one involving parents. No one wants a son or daughter to be the poster child for youth obesity. And since overweight kids already face a lot of teasing in school, the last thing they want is to talk about what they view as an embarrassing problem.
Finally, I was inexperienced in using video, which I wanted to incorporate into my storytelling. While I knew how to write a video script, and was sure that I wanted to embed video and photo into text in an integrated way, how to make that happen was a mystery.
Finding data about the paradox is no problem: this is an established, scientifically validated theory. And I had access to some great experts in medicine, public health and medical anthropology from the universities and medicals school in my area. Public health agencies, too, publish statistics on county trends, and state advocacy groups rate cities and school districts according to health, obesity and other factors.
I found people to interview through a local research project involving ethnic communities and diabetes care. Participants I interviewed not only have type 2 diabetes but also coach fellow patients in their Latino immigrant community, so they provided a lot of insight. Additionally, I gained permission to wander the grounds during an exercise and nutrition program focused on low-income kids; a lot of moms were there, and I was able to approach parents.
When I talked to parents, I was careful not to start asking about their child’s weight. Instead, I asked about the food they ate growing up in Mexico – favorite dishes are a welcome topic among many of the Latina moms I interview – and then we contrasted these with meals eaten here. Information about changes in diet emerged in these conversations.
Whenever possible, I generally try to interview in Spanish rather than force people to speak in English or rely on translators, and my interview subjects don’t seem to mind my mistakes. Perhaps it is a welcome change for people struggling with a new language and culture to be the experts.
I like walking around a community. It’s one thing to read that a city has 4.7 times the number of fast food restaurants and convenience stores as grocery stores. It’s another to walk into a bakery with huge .35 cent sweet rolls, next to a taqueria with meaty $1 tacos, and then a fast food franchise with chicken nuggets for $1.29. The message is clear: some of the most filling, tasty and in some cases unnourishing foods are the cheapest.
It’s important to acknowledge trends that might call the premise of your story into question. Shortly before publishing, a report on a study showing Mexico to be the most obese nation in the world made news. I had to ask experts if heavier weights in Mexico meant that immigrants no longer bring health protections to the U.S. It turns out that researchers don’t yet know the answer, especially since Mexican immigration has slowed tremendously in recent years.
As for multimedia, I was extremely lucky that my colleague Nick Gerda filmed the expert interviews. I wrote and narrated the video scripts, oversaw the photography and selected the video excerpts, but Nick put the pieces together and did the back-end work to embed the segments in the story. He later used these elements to produce a package for our website’s public television media partner.
The decline in immigrants’ robust health upon coming to the U.S. and poor health of their American-born children is a subject that many reporters could explore in their communities. I would love to see innovations in storytelling on such a project: for example, using interactive graphics to create a neighborhood map of food options, for example, or giving a video tour of an unhealthy neighborhood. There is more to say and show on this topic, and I look forward to seeing it.