Broadly, the purpose of this paper is to engage with the ongoing debate surrounding Latinx as a racial category. Since the completion of the 1980 U.S. Census, the Office of Management and Budget (OMB) has flirted with the idea of adding “Hispanic” to the question “What is your race?” on the decennial census, which would formalize Latinx identity as a racial rather than pan-ethnic category (Rodríguez et al. 2013). Even though Latinx has not been formalized as racial category by OMB as of yet, it is already commonly utilized as a de facto racial category in analyses when Latinx is coded to encompass all individuals who identified as Latinx regardless race. Specifically, in this brief paper, I seek to examine the implications that utilizing Latinx as a racial rather than a pan-ethnic category may have for health research, and subsequently interventions and policy. In achieving this aim, I intend to draw from various sociological literatures, including intersectionality, “othering,” and doctor-patient interactions. Evaluating the use of Latinx as a racial category in the context of health research is particularly salient in consideration of the current social and political climate within the United States. For one, the Latinx population is the largest and second-fastest growing minority population in the U.S., encompassing nearly 58 million people in 2016 (Flores 2017). This growing proportion of the U.S. population is likely to face unique health concerns and risk factors, which medical and health professionals may be underprepared to confront. Additionally, “Trump era” politics has again re-energized the “defensive spirit” of modern nationalism, which fears the changes in society that could be brought on by new comers (Sanchez 1998:1019). In so far as social-structural systems are connected, we should consider how political institutions and dialogues influence medical institutions and social constructions of health and illness.
First, I would like to establish a common language and definitional clarity for the terms used throughout this paper. Race is a contextually oriented social construct that encompasses a multitude of dimensions, including racial identity, racial self-classification, appearance-based or interaction-based ascribed race, and phenotype, among others (Roth 2016). This paper is primarily concerned with two dimensions of race – racial identity and racial self-classification. Racial identity references “a person’s subjective self-identification… and does not represent a person’s efforts to fit themselves into any given set of boxes [emphasis added]” (Roth 2016:1313); however, racial self-classification does represent such efforts, in that it “refers to the race that is checked on an official form or survey, such as census or federal financial aid form” (Roth 2016:1314). Ethnicity is similarly a contextually oriented social construct, encompassing numerous dimensions, such as language, religion, collective memory, dress, and cultural norms, behaviors, and values (Meer 2014). Panethnicity, such as “Latinx” or “Asian American,” represents the “development of bridging organizations and solidarities among subgroups of ethnic collectivities that are often seen as homogenous by outsiders” (Lopez and Espiritu 1990:198). The development of panethnicity is influenced by cultural and structural factors, and can be mobilized for both empowerment and disenfranchisement of individuals within a panethnic group (Lopez and Espiritu 1990). To restate – considering these definitions – I am evaluating the implications for the use of Latinx as a racial category for racial self-classification on health research. The extent to which Latinx can or does already serve as a racial identity is beyond the scope of this paper.
Racial self-classification is by far the predominant way that health scholars obtain information on race. However, depending upon the proposed mechanism and health outcome, racial self-classification may not always be the most salient measure of race for health research. Despite a dearth of information in this regard, a few studies have demonstrated that the direction and strength of the association between race and a health outcome may vary when a different dimension of race is examined (Cobb et al. 2016; Garcia et al. 2015). Thus, there is a growing movement to amongst sociologists to include multiple dimensions of race within their research, but this movement has not yet reached public health and medical disciplines, such as epidemiology. This increases the pertinency of examining the use of Latinx as a racial category in analysis, given the reliance of public health and medical disciplines on racial self-classification data.
Intersectionality is easily the most obvious and relevant starting theoretical perspective for this issue. Broadly, intersectionality posits that “multiple social identities… intersect at the micro-level of individual experience to reflect multiple interlocking systems of privilege and oppression… at the macro-social-structural level” (Bowleg 2012: 1267). Furthermore, at its core, intersectional theory holds that these social identities are multidimensional and are so interlocked that they cannot be disentangled (Bowleg 2012). Intersectionality is a strong theoretical framework for elucidating complex relationships that produce health outcomes across multiple levels, and provides a strong rationale for why groups cannot be reduced to unidimensional monoliths in analysis. Additionally, intersectional theory has serious implications for health policy and intervention development, by implying that new health policy or interventions must address the multiple identities and multiple fundamental causes – racism, classism, sexism, heterosexism, etc. – simultaneously in order to affect change.
The current two question data collection standard for race and ethnicity put forth by OMB – “Are you Hispanic, Latino/a, or Spanish origin?” and “What is your race?” – actually lends itself to intersectional analyses, by allowing researchers to examine the effects unique to classifying one’s self as “Latinx, Black,” “Latinx, White,” “Latinx, Some other race,” and so on. Collapsing groups into a single Latinx category regardless of race is a direct denial of intersectionality – in that the interlocking experiences at the micro- and marco-level as both Latinx and Black is not substantively or significantly different than those as both Latinx and White, Latinx and some other race, and so forth. Additionally, utilizing Latinx as racial category in analyses contributes to the erasure of the multitude of unique identities within Latinidades, such as “criollo, mestizo, mulato, LatiNegra, Afro-Latino, and indígena [emphasis in original]” (Amaro and Zambrana 2000: 1725). In capturing some of this information and acknowledging these unique identities within Latinidades, an intersectional approach is able to contend with Latin America’s and the United States’ colonialist histories, in how social stratification and institutional power structures developed along racial lines with systems of discrimination and disenfranchisement to reinforce racial social hierarchies. Although the effects of Latin America’s colonialist history on health is likely best understood through analyses of skin color or skin tone (Montalvo and Codina 2001), these data are not routinely captured in studies by public health and medical professionals. As the available is already limited to self-classified race, to collapse racial groups into a single Latinx category – thereby transmuting Latinx to a de facto racial category – is more ahistorical approach.
Even with the limitations of using racial self-classification, various studies have demonstrated unique relationships between the intersection of Latinx panethnicity and race for a number of health outcomes. These include studies into differences in self-rated health, body mass index, mental health, substance abuse, health services, and health behaviors (Cuevas et al. 2016; LaVeist-Ramos 2012; Hogan et al. 2018). Previous research which functionalized Latinx as a racial category masked these unique, intersectional findings, which ultimately may be helpful developing refined interventions to potentially vulnerable populations.
The importance of examining the intersection of panethnic and racial self-classification can be seen when examining two other aspects of medical sociology. Specifically, this can be seen in investigating the intersection of panethnicity, race, and gender in how the construction and performance of intersectional gender identities within machismo culture influences health, as well as the confluence of panethnicity, race, and gender in shaping doctor-patient interactions.