The Hispanic/Latino Population in the United States: Our Black Identity, Our Health and Well-Being

The Hispanic/Latino population represents the only recognized ethnic group by the US Census and the largest minoritized subgroup of the US population. As of 2022, Hispanic/Latino people constitute 19.1% of the US population (63.6 million),¹ a group that is expected to more than double by 2050 (128 million).² While Hispanic/Latino people (hereafter referred to as Hispanic) are aggregated under the ethnicity category in the US Census and, by default, considered a monolithic or homogenous population, they are very heterogeneous. Hispanic people comprise those who self-identify with one or more of at least 19 Latin American and Caribbean countries,³ with almost a third being foreign-born (32%).⁴ Because of their colonialization history, Hispanic people have European, African, and Native Indigenous ancestries.⁵ Consequently, the Hispanic population can be of, and self-identify with, any race in the US decennial Census; and, as shown in the 2020 US Census, a large proportion self-identified with “Some Other Race” alone (42.2%); 20.3% self-identified as White and 1.9% as Black.⁶

Given the salience of race in US society, self-identification with White and Black categories is crucial for our understanding of racial health inequities, especially those experienced by Hispanic Black people. Race is a multidimensional and dynamic social construct rooted in racism, a system of oppression that unequally distributes resources and opportunities across population subgroups—disproportionately impacting Black and other minoritized people.⁷ This systematic oppression creates and perpetuates health inequities in the United States and, particularly among Hispanic people who self-identify as Black, may lead to the same or similar health outcomes to those reported by the non-Hispanic Black population. Thus, this commentary has a three-fold aim. First, it describes the demographic characteristics of Hispanic people who self-identify as Black relative to their peers, who see themselves as White vis-à-vis the Hispanic population as a whole, and those who self-identify as non-Hispanic White and Black. Second, it provides a conceptual framework for how such self-identification affects Hispanic Blacks’ health status and well-being. Finally, it discusses the implications of self-identifying as Black with respect to the health and well-being of the Hispanic/Latino population.

WHO ARE HISPANIC BLACK PEOPLE IN THE UNITED STATES?

The US Census has been collecting information on race and ethnicity beginning in the 1980s.⁸ Race mostly captures the phenotypical traits as seen in the eye of the beholder (i.e., street race) and self-identification based on physical characteristics and skin color. The US Census acknowledges that these categories are socially constructed and, therefore, do not carry any biological or genetic meaning, however, they have been part of the US social fabric since the very first census in 1790, which limited available racial categories to “Black” and “White.” In this way, race reflects the historical and continuing hierarchical relationship dynamics of distinctive populations and, thus, determines the disproportionate allocation of resources and opportunities in US society.⁹

Constructions of race are rooted in structural racism, which is conceptualized here as a fundamental cause of morbidity/mortality that leads to the unequal distribution of either protective or harmful exposures (i.e., promoting or affecting health status), which contributes to creating and maintaining health inequities in the United States. Ultimately, self-identification as either Black or White among Hispanic people could lead to the same or similar health inequities found in comparisons between non-Hispanic White and Black populations in the United States.

Approximately 1.2 million Hispanic people self-identified as Black in the 2020 US Census. It is worth noting that, in recent years, the term Afro-Latino has become a symptom of awareness and acknowledgment of the African ancestry, primarily associated with enslaved groups brought from Africa to the Latin American and the Caribbean regions during the colonial period.⁵ A 2021 survey found that six million people self-identified as Afro-Latino/a or Afro-Caribbean in the United States, constituting about 2% of the US adult population and 12% of the adult Hispanic population.¹⁰ Those from Mexico (29%), Puerto Rico (23%), and the Dominican Republic (18%) were more likely to self-identify as Afro-Latino/a or Afro-Caribbean than their peers from other countries. Notably, 13.3% of those who self-identified as Afro-Latino/a or Afro-Caribbean did not label themselves as Hispanic/Latino. When compared with Hispanic people who do not see themselves as Afro-Latino (12%), those who self-identified as Afro-Latino were at least three times as likely to report having darker skin (37%).¹⁰ These figures related to self-identification as Afro-Latino/a may signal a rising trend among those who may self-identify as Hispanic Black in the future. However, this commentary focuses on Hispanic people who self-identify as Black in the US Census.

It is not customary to present data for the Hispanic population based on racial self-identification, thus, data from the 2015–2019 American Community Survey (ACS) 5-year estimates were used to generate information on Hispanics’ sociodemographic characteristics (Table A, available as a supplement to the online version of this article at https://www.ajph.org).¹¹ The 2015–2019 ACS was used, rather than the census, because information was collected differently during COVID-19 in 2020. Compared with the Hispanic population and people who self-identify as White, Hispanic Blacks are younger and less likely to be foreign-born, but more likely to be single, educated at higher level, speak English, and have health insurance. However, Hispanic Blacks are also more often unemployed and report a lower median household income than the overall Hispanic population and those who self-identify as White. When compared with non-Hispanic Whites and Blacks, not only are Hispanic Blacks younger than non-Hispanic White and Black people, but also share more sociodemographic characteristics with non-Hispanic Blacks than with non-Hispanic Whites.

Strikingly, at least half of Hispanic and non-Hispanic Blacks lived below the 200% poverty level, whereas a quarter of non-Hispanic Whites reported a similar level of poverty. This differential remains true for median household income, with $46 411 and $45 733 for Hispanic and non-Hispanic Black people, respectively. The latter are below the median household income for non-Hispanic White people, which stands at $75 537. In terms of country of origin, respondents from Panama (32.5%), the Dominican Republic (13.9%), and Puerto Rico (9%) were more likely to self-identify as Hispanic Black, a label that may reflect their experience of higher levels of racial discrimination and unequal opportunities. Previous studies suggest that Mexican Americans who had either darker skin or American Indian phenotypes, along with darker-skinned Puerto Rican people, were more likely to report discrimination and hold lower-prestige occupations than their lighter-skin counterparts, including those of European appearance and related features.¹² Given the expected growth of the Hispanic population by 2050—to 29% of the US population—and the salience of race as a social stratification factor in the United States, these sociodemographic differences cannot be ignored, as the numbers of Hispanic Blacks are expected to increase along with the overall presence of Latino/Hispanic people in the United States. Thus, these unequal sociodemographic patterns may continue to exist and grow in the future.

RACIAL DISCRIMINATION AND HISPANIC BLACKS

Racial/ethnic discrimination, or the unfair treatment of someone because of their race or skin color, albeit pervasive, is distinctively distributed across racial/ethnic groups in the United States,^7,13 with 88.2% of non-Hispanic Blacks reporting having experienced lifetime discrimination.¹⁴ In 2017, 92% and 78% of non-Hispanic and Hispanic Blacks, respectively, believed that discrimination against Black people existed in America.¹⁵ Among Hispanic people, discrimination has been linked to skin color, with almost two thirds of darker-skin Hispanic people (64%) reporting at least one incident related to discrimination in the previous year.¹⁶ The proportion of lighter skin Hispanic people acknowledging such experiences was 54%. Interestingly, at least two out of five darker-skinned Hispanic people mentioned having been discriminated or treated unfairly by other Hispanic people.¹⁶

Racism and discrimination operate at different levels¹⁷ and have concrete effects on Hispanic Blacks’ lives: from restricting access to high-quality health services to impinging on their mental health and stress-related disorders.^17,18 This is especially relevant considering that Hispanic Black people are more likely to be racialized than other Hispanics,¹⁹ and therefore, they are more exposed to being targets of discrimination, as well as of open and subtle harassment (i.e., microaggressions). Likewise, Hispanic Blacks are not only stigmatized by the White status quo but also by both Black and Hispanic cultures; their in-between positionality is signaled by not being seen as Black by African Americans nor as Hispanic by their Latin American and Caribbean peers—and clearly not as non-Hispanic White. Accordingly, Hispanic Black people may also be more vulnerable to intergroup discrimination than their Hispanic White peers and more prone to experiencing “cultural homelessness,” as they may not feel at home with either non-Hispanic Blacks and White Hispanics or with non-Hispanic Whites.²⁰

Though the mechanisms by which racial discrimination affects health are not well understood, evidence suggests that those experiencing it are more likely to adopt unhealthy health behaviors as a coping or buffering mechanism against stress.⁷ Additionally, individuals suffering from discrimination are less likely to adhere to prescribed medical treatments relative to their peers who do not report it.⁷ These behaviors have direct and indirect consequences on their health status and well-being.

Patterns regarding the impact of racial discrimination on health outcomes among non-Hispanic Black people have been well documented in the literature and largely account for the reported health inequities between non-Hispanic Black and White people. While data on the impact of racial discrimination and racial self-identification on health outcomes among Hispanic people are less often collected, evidence on the association between Black Hispanics’ racial self-identification and health appears to mirror the health inequities observed among non-Hispanic Black and White people in the United States. For example, Hispanic Black people have a lower life expectancy than their Hispanic White counterparts²¹ and report worse outcomes for hypertension, diabetes, mental health, births, obesity, cancer, and mortality risk.^18,22,23 Thus, the evidence points to the same consequences of racial self-identification, and potentially the discrimination that comes with it, for the health status of Hispanic Black people as those observed among the non-Hispanic Black population. Therefore, racial self-identification is not only relevant to individuals’ health outcomes and well-being but also to the Hispanic population’s life chances and opportunities.

CONCEPTUAL FRAMEWORK: RACIAL IDENTITY, WELL-BEING

Building on Borrell’s conceptual framework on the effect of racial self-identification among Hispanic people on health and well-being,¹⁷ Figure 1 illustrates how Hispanic people’s likelihood to self-identify with the US Census racial categories is influenced by age, sex/gender, country of origin, geographic location, nativity status, length of time in the United States or generation, language spoken, and socioeconomic position (e.g., education). For example, among Hispanic people, those who are younger, more educated, and born in the United States are more likely to self-identify with the US racial categories.¹¹ Similarly, factors associated with acculturation, the process by which individuals assimilate in their host countries, such as the second generation in the United States and English-language proficiency, are associated with racial self-identification.¹⁶ The US Census racial categories are perpetuated by structural racism that affects health directly and indirectly: directly, structural racism affects individuals’ life chances and interactions, their psychosocial status, and the context in which they live, work, and socialize. Indirectly, structural racism perpetuates the racial categories that are intrinsic to US social stratification and hierarchical systems, by unequally distributing risk factors along with access to opportunities and resources that ultimately impact on one’s health status and well-being.

FIGURE 1—

Framework for the Effect of Racial Identity Among the Hispanic Population on Health and Well-Being

Note. The original framework has been modified by adding individual- and contextual-level factors (e.g., age, sex/gender, structural racism, epigenetics) related to racial identity in the Hispanic/Latino population using a life course approach.

Source. Borrell.¹⁷

Once Hispanic individuals self-identify with a racial category, whether Black or White, this identification will channel them into the United States’ system of oppression/privilege, which directly impacts their health and well-being. These systems act independently and jointly at the individual, psychosocial, and contextual levels over the course of the life cycle. These interactions further lead to psychosocial and biological or genetic embodiments of social exposures over the life course. For example, the spatial location of non-Hispanic Black people residing in segregated neighborhoods speaks to the effect of racism at the contextual level, as racial/ethnic segregation could affect the quality of education and health care they will receive. Poor education may lead to low-paying jobs without access to health insurance, resulting in delayed access to health care and poor health outcomes.

Such cumulative social exposures and experiences get embedded in one’s genetic makeup via epigenetics (e.g., DNA methylation) and may lead to changes in an individual’s health status over their life course.^24,25 Thus, Hispanic Blacks’ racial self-identification may reproduce the same health inequity patterns observed for non-Hispanic Black and White people over time. For example, like non-Hispanic Black people, Hispanic Black people tend to reside in minoritized neighborhoods that present a higher proportion of unemployed individuals, along with those whose incomes are below poverty levels, and who report low-quality indicators with respect to education, health care, and other social services.

Additionally, place of residence influences the level of collective efficacy in buffering the effects of the stress associated with racial discrimination and psychosocial stressors, such as exposure to neighborhood poverty and violence. Thus, if a Hispanic individual self-identifies as Black, such a perception could entail the same embodied pathways as reported by non-Hispanic Black people, eventually leading to poor health outcomes. However, given the characteristics associated with racial self-identification among Hispanic populations (e.g., age, sex/gender, education, nativity status), an intersectional approach must be considered to understand how these social identities, either independently or jointly, come together to impact the health and well-being of this population. Embracing such a framework would demand a conceptual departure from individual-based models toward acknowledging multiple intersecting axes of inequality in understanding Hispanic Blacks’ well-being and health outcomes. This approach requires considering the intertwining impact of age, sex/gender, race, education, along with immigration-based factors (i.e., nativity status, legal status, generation, and length of residence in the United States) amid the individual, psychosocial, and contextual levels.¹⁷

METHODOLOGICAL CONSIDERATIONS AND HEALTH EQUITY

While racial self-identification may have crucial implications for the Hispanic population’s health status and social inequities, particularly when compared with other racial/ethnic groups in the United States, it remains pivotal to underscore this population’s rising self-identification with the “Some Other Race” category,⁶ amid the growing popularity of the terms Afro-Latino/a or Afro-Caribbean and Latinx,¹⁰ and Hispanics’ increasing diversity by country of origin.³ These demographic trends could affect the proportion of the Hispanic population that self-identifies as Black in the years to come.

Future studies should incorporate mixed-methods research designs (particularly in their pilot stages) to explore Hispanic Blacks’ racialized experiences, including the impact of racism, in informing their health outcomes. Health surveys could add separate questions for race and ethnicity together with open-ended questions, including participants’ self-identification along with their national and racial/ethnic backgrounds. Broader survey questions aimed at grasping racial/ethnic self-identity would help capture research participants’ racialized experiences.²⁰ Finally, participatory action research designs could be used to grasp Black Hispanics’ “intersectional identities” rooted in community-based definitions of race and ethnicity.

CONCLUSIONS

As the Hispanic population continues to grow and increase in diversity, racial self-identification as Black will play an important role in the years to come. While the implications of such identification may ultimately lead to the same health outcomes as non-Hispanic Blacks, it is likely to become more complex and eventually intertwine with other individual and social characteristics among Hispanic people. Moreover, these intricacies must account for newly emerging identity labels (e.g., Afro-Latino, Afro-Caribbean, Latinx). In sum, racial self-identification as Black among Hispanic people calls attention to the need for an intersectional approach, which involves individual and social characteristics, to fully explain the implications of racial self-identification for Hispanic Blacks’ health status and well-being in the years to come.