Behind the Statistics: Deconstructing the Sociocultural Contexts of The Hispanic Paradox and Undocumented Immigrant Health through Kidney Disease Research Restricted; Files Only

Abstract

This thesis centers the voices of undocumented Hispanic immigrants by examining their health experiences through a mixed-methods approach. It critically contextualizes the narrative of The Hispanic Paradox– an epidemiological theory supporting the notion of the "healthy Hispanic"– by exploring its implications as a hegemonic medical discourse with potentially exclusionary origins, particularly in relation to under-documented and undocumented Hispanic populations. Utilizing chronic kidney disease (CKD) benchmarks, this study statistically evaluates the validity of The Hispanic Paradox by first analyzing pre-pandemic National Health and Nutrition Examination Survey data to identify relevant sociodemographic characteristics among Hispanic individuals with CKD. It then incorporates qualitative interviews to provide narrative-driven insights into the diverse experiences and healthcare-seeking behaviors of under-documented and undocumented Hispanic immigrants. From a sociocultural perspective, this work engages with the historical construction of “illegality” in the United States, its embodied ideological manifestations, and analyzes seven health-focused narratives through anthropological frameworks, including habitus, medical pluralism, the Health Belief Model, and biocommunicability. This approach offers a deeper understanding of the motivations and barriers these communities face when accessing formal healthcare, while also challenging the dominant assumptions embedded within The Hispanic Paradox.

Table of Contents

Chapter I: Introduction ................................................................................................................. 1

Who gets to make choices? Who gets to be human? ........................................................................ 2

The Production of Undocumented Migration and Migrant “Illegality” .............................................. 4

The Hispanic Paradox .................................................................................................................. 5

Kidney Disease Risk Factors and Prevalence among the Hispanic Population ................................... 8

Thesis Overview .......................................................................................................................... 9

Chapter II: Methodology ............................................................................................................ 10

Introduction to Mixed-Methods & Theoretical Frameworks .......................................................... 11

Study Timeline .......................................................................................................................... 11

Research Design ........................................................................................................................ 11

Study Population and Sampling .................................................................................................. 13

Quantitative Analyses ................................................................................................................ 15

Qualitative Data Analyses .......................................................................................................... 16

Ethical Considerations ............................................................................................................... 16

Limitations and Reflexibility ...................................................................................................... 17

Significance and Impact ............................................................................................................. 17

Chapter III: Results ................................................................................................................... 19

NHANES Quantitative Survey Data ............................................................................................. 20

Brief Participant Profiles ........................................................................................................... 22

Interview I ............................................................................................................................... 22

Interview II .............................................................................................................................. 23

Interview III ............................................................................................................................. 24

Interview IV ............................................................................................................................. 25

Interview V .............................................................................................................................. 26

Interview VI ............................................................................................................................. 27

Interview VII ............................................................................................................................ 28

Chapter IV: Documents on the Undocumented ............................................................................ 29

Brief Discussion of Quantitative Findings ................................................................................... 30

Interpretation of Interviews ...................................................................................................... 32

The Historicity of “illegality” and it’s Cultural Manifestations ...................................................... 32

Currency versus The Currency of Health ..................................................................................... 33

Disease, Debilitation & Dependency .......................................................................................... 36

Familiar Remedies & Medical Pluralism ..................................................................................... 38

In the Clinic ............................................................................................................................. 39

Through the Kidneys ................................................................................................................. 41

Chapter V: Conclusion ............................................................................................................... 45

Bibliography ............................................................................................................................. 49

Appendix .................................................................................................................................. 55

A. Verbal Consent Form (English; pg. 56-57) ................................................................................ 55

B. Verbal Consent Form (Spanish; pg. 58-59) ............................................................................... 55

C. Pre-Interview Demographic Questionnaire (Bilingual, pg. 60-61) .............................................. 55

D. Interview Questions (English, pg. 62) ...................................................................................... 55

E. Interview Questions (Spanish, pg. 63) ...................................................................................... 55

F. Interview Transcripts ............................................................................................................. 64

Participante 001 • D .................................................................................................................. 64

Participant 002 • E .................................................................................................................... 85

Participant 003 • L ................................................................................................................... 105

Participante 004 • Y ................................................................................................................. 126

Participante 005 • J .................................................................................................................. 144

Participant 006 • A ................................................................................................................... 157

Participante 007 • C ................................................................................................................. 175

About this Honors Thesis

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School	Emory College
Department	Anthropology
Degree	B.S.
Submission	Honors Thesis
Language	English
Research Field	Anthropology, Medical and Forensic Health Sciences, Epidemiology Anthropology, Cultural
Palabra Clave	sociocultural The Hispanic Paradox mixed-methods undocumented immigrant
Committee Chair / Thesis Advisor	Lindo, John, Emory University
Committee Members	Ristaino, Christine, Emory University Park, Jeanie, Emory University Marsilli-Vargas, Xochitl, Emory University

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