Fascinating Findings of Paul Hsu and Colleagues in the September 2018 Issue of Health Affairs

Fascinating Findings of Paul Hsu and Colleagues in the

September 2018 Issue of

Health Affairs


Paul Hsu and colleagues have a fascinating article in the September 2018 issue of Health Affairs. https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2018.0427 It looks at California’s excellent health outcomes such as life expectancy, infant mortality and age adjusted death rates compared to its very high poverty rates, high uninsurance rate and high percentage of adults who did not graduate from college.


Between 1970 to 2016, California experienced massive demographic changes from 22% ethnic minorities in 1970 to 62% (now the new majority) in 2016. Most of those demographic changes were due to immigration to California from Latin America and Asia. Agriculture and the rise of Silicon Valley and its spin offs have fueled this immigration.


California now ranks second to Hawaii in age adjusted health outcomes, followed by New York, Connecticut and Minnesota. The worst health outcomes are: Mississippi, West Virginia, Alabama, Kentucky and Oklahoma. The average age adjusted mortality rates are nearly 50% higher in the bottom five states than the top five. The average African-American death rate in the five top states is 683 per 100,000 lives. The average non-Hispanic White death rate in the five bottom states is 922 per 100,000 in the bottom five states.


Yet, California’s poverty rate adjusted for cost of living is the highest in the nation and its unadjusted poverty rates are above the national average. Until the advent of and its aggressive adoption of the Affordable Care Act, its uninsurance rates were among the highest in the nation. Its percent of adults without a high school graduation is very high – 18.3%, driven largely by the 39.6% of Latinos without a high school diploma.


California’s excellent health outcomes are due in part to the high percentages of Latinos and Asians among its diverse population and their very strong health outcomes, for example with longer life expectancy and lower age adjusted death rates than non-Hispanic whites. The authors speculate that the strength of “community” among immigrant communities accounts for California’s surprisingly strong health outcomes in spite of its high poverty, high uninsurance and high percentages of adults without a high school diploma.


In my opinion it shows the values of immigration as a strong net plus for both California’s fast growing economy and its surprisingly good health outcomes.

Prepared by: Lucien Wulsin

Dated: 9/19/18

Judge Kavanagh on the Issues 

The New CPS (Current Population Survey) Reports on Poverty, Income and the Uninsured