Bernardo Ng
Imperial County, California, United States

The first time I became aware of a scientific group using the term Latinx was in 2018 during a meeting in Austin, Texas. It is a gender-neutral alternative to Latino or Latina that does away with the gender label, making it more inclusive to the growing sexual diversity of this minority. According to the dictionary the first use of the word is traced to 2007.¹

Although the terms “Hispanic” and “Latino” are often used interchangeably in the medical literature, they are not synonyms. The term “Hispanic” refers to people born in a country “conquered” by Spaniards for whom Spanish is their primary language. This applies to most countries in Latin America, except Brazil, the Guianas, Belize, Haiti, and Trinidad and Tobago. The term “Latino” on the other hand is a broader term that refers to people born in a country whose language has evolved from Latin or Romance languages, such as Italy, Spain, France, and all countries in Latin America. Historically, different ethnicities have contributed to the contemporary Hispanic/Latino populations in the US, making this population very heterogeneous. Genome-wide analysis (GWA) within this population found that Dominicans and Puerto Ricans showed the highest levels of African ancestry, whereas, Colombians have a wider distribution of African versus European GWA enrichment. In contrast, Mexico and Peru were two countries with high densities of Native Americans during the pre-Colombian times. As would be expected, individuals from these countries have the highest degree of Native American ancestry.²

The term Latinx was added to the Merriam-Webster dictionary in 2018. According to the dictionary’s “Words we’re watching” section, this word is pronounced something like \luh-TEE-neks\ and it is used as a gender-neutral term that has been especially embraced by members of the LGBTQ communities to identify themselves as being of Latin descent yet possessing a gender identity outside the male/female binary inherent in the Spanish language. The word Latinx purposefully breaks Spanish’s gendered grammatical tradition.^1,3

Sexual minorities in Latin American countries have had a long and difficulty journey. It may appear distant to reflect on the first official Pride Parade in San Francisco in 1972, yet the legal inequalities, disadvantages, and violence protested at that event continue to have a toll on sexual and gender minorities in Latin America. Progress is more noticeable in democratic countries, compared to countries with authoritarian or conservative governments.^4,5

From 1996 to 2006 I worked at a male detention center in California, as a psychiatric consultant, for undocumented detainees awaiting deportation. Most were from Mexico (45%), followed by others from Central America (19%), the Caribbean (8%), and South America (3%). The most common diagnoses were psychotic disorders (25%), bipolar disorders (24%), and depressive disorders (13%); concurrent alcohol use disorder (34%) and illicit drug use (57%) were also present. A few (0.6%) while on the brink of getting deported were fearful because they were either homosexual or transgender. In fact, a transgender individual who was undergoing gender reassignment surgery developed a severe anxiety disorder. She regretted having broken the law and getting deported to Mexico, from where she once had requested asylum. She shared with me that she had been the victim of beatings and harassment since childhood due to her gender identity, but hoped that some progress had occurred in Mexico’s society since she had originally emigrated.⁶

The office of the United States Census published in 2003 that Latinos or Latinx had become the largest minority in the USA. This fact had been projected for decades, a period that was apparently insufficient to prepare for the public and social needs secondary to the expansion of this minority group. Regarding matters of health, and particularly mental health, issues such as stigma, immigration and aging related stress, violence and alcoholism, and concerns about psychotropic medications remain unresolved.⁷ These factors and others including obesity, diabetes, and level of disability are likely to shorten the so-called Hispanic paradox in the next decades. Even though, Latinos do live longer, the excess includes at least six years with disability (i.e., impairment of the senses, physical ability, mental ability, self-care, ability to leave the house), in contrast to four years or less living with disability for non-Hispanic whites.⁸ Furthermore, in clinic environments with timely screenings for cognitive decline, Hispanics/Latinx get diagnosed about four years earlier in age than non-Hispanic whites.⁹

Where do we go from here? It makes sense that the evolution from the term Hispanic to Latin or Latino widened from individuals born or with ancestry in countries that were either conquered by Spain or where Spanish is their first language to include individuals from any country in the American continent south of the United States. The term Latinx intends to break through the binary division of Latino versus Latina, including individuals of any gender identity.

The next question is about the relevance, if any, in the medical field, beyond what appears to be political correctness. The quest of understanding and increasing the visibility of the growing sexual diversity in Latin American countries has been long, difficult, and many times painful. The possibility of having a more inclusive term appears to have a lively reception. It is yet to be seen if Latinx will break through the medical and scientific fields and become the most accepted and definite main-stream term for this community.

References

1. Latinx. Merriam-Webster.com Dictionary, Merriam-Webster, https://www.merriam-webster.com/dictionary/Latinx. Accessed 3 Jul. 2021.
2. Aguayo-Mazzucato C, Diaque P, Hernandez S, Rosas S, Kostic A, Caballero AE. Understanding the growing epidemic of type 2 diabetes in the Hispanic population living in the United States. Diabetes Metab Res Rev. 2019 Feb;35(2):e3097. doi: 10.1002/dmrr.3097.
3. Latinx and gender inclusivity. https://www.merriam-webster.com/words-at-play/word-history-latinx. Accessed 3 Jul, 2021
4. Open SF History. https://opensfhistory.org/news/2020/06/28/the-early-years-of-sf-pride-a-closer-look/. Accessed 3 Jul, 2021
5. Malta M, Cardoso R, Montenegro L, de Jesus JG, Seixas M, Benevides B, das Dores Silva M, LeGrand S, Whetten K. Sexual and gender minorities rights in Latin America and the Caribbean: a multi-country evaluation. BMC Int Health Hum Rights. 2019 Nov 6;19(1):31. doi: 10.1186/s12914-019-0217-3. PMID: 31694637; PMCID: PMC6836409.
6. Ng B, Martinez A (2007). Características psiquiátricas de 904 indocumentados en un Centro de Detención en EUA. Mexican Psychiatric Association 20th National Congress, Mérida Yucatán México. November 16-19. Psiquiatría Suplemento. 2:23;S-4;62
7. Watson MR, Kaltman S, Townsend TG, Goode T, Campoli M. A Collaborative Mental Health Research Agenda in a Community of Poor and Underserved Latinos. J Health Care Poor Underserved. 2013 May;24(2):671-87. doi: 10.1353/hpu.2013.0079.
8. Goldman N. Will the Latino Mortality advantage endure? Res Aging. 2016. Apr; 38(3):263-282. doi: 10.11770164027515620242
9. Fitten LJ, Ortiz F, Fairbanks L, Bartzokis G, Lu P, Klein E, Coppola G, Ringman J. Younger age of dementia diagnosis in a Hispanic population in southern California. Int J Geriatr Psychiatry. 2014 Jun;29(6):586-93. doi: 10.1002/gps.4040. Epub 2014 Jan 29. DOI: 10.1002/gps.4040