Inequity, acculturation and the 'Mediterranean paradox'

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Abstract
Sirs—Khlat and Darmon1 extend the ‘Hispanic Paradox’, the low all-cause mortality that Hispanics experience in the US in spite of a low socioeconomic status, to Mediterranean migrant populations in Europe. They analyse the role that a ‘salmon bias’ (the re-migration of ill migrants to their country of origin) and a ‘healthy migrant effect’ (a selection of healthy individuals at the time of immigration) might play. One of the key questions they raise is why a mortality advantage of migrants would persist over decades. In view of low socioeconomic status and poor working conditions, as well as presumably deteriorating health behaviours with acculturation, any mortality advantage that migrants experience would be expected to disappear quickly with time spent in the host country.

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