by Jeffrey E. Brandon, Associate Dean, College of Health and Social Services, Head, Department of Health Science, New Mexico State University
Border health has become a topic of significance during the past decade. This increased attention relates to the population increase along the border separating the U.S. and Mexico; to the increase in migration (stimulated by the maquilladoras and NAFTA-related development) in both countries to the border region; and to the resulting worsening of many health conditions, environmental health problems (air and water pollution), and the general lack of infrastructure to support such population growth. Over 56% of the border population in the US and over 45% of the population in Mexico reside in the twelve bordering counties and municipalities (U.S.-Mexico Border Health Association, 1994). It is estimated that these twelve primary binational pairs of sister cities represent 7,803,306 or 86% of the total border population, with 4.4 million of the population from these twelve binational pairs coming from the US. Of these population centers, San Diego county is the most populated, followed by the El Paso County, Texas and Dona Ana county in New Mexico.
The diversity in ethnic groups and illness patterns found along the two thousand mile border creates unique challenges when describing major border health issues. Mortality and morbidity figures, specific communicable and noncommunicable diseases, maternal and child health issues, disability and deaths from trauma--including those associated with chemically impaired driver-related accidents and violence, alcohol, tobacco and other drug abuse (ATODA) problems, mental health issues, and environmental issues are all areas of major concern. An ecological approach to health issues along the US-Mexico border recognizes that to be most effective, disease prevention efforts must be developed and implemented binationally. The fluidity of the US-Mexico border was notably visible to a group of federal congressional and regulatory health staff and foundation program officers on a recent visit to the Texas-New Mexico border region in April of 1994 (National Health Policy Forum, 1994). Just as health professionals in the Juarez, El Paso, and Las Cruces recognize that “we must view the three sister communities as a single epidemiological unit when developing health services strategies” (Crespin & Kallishman, 1991, pg. 5), it is also recognized throughout the length of the border that the border’s population movements have created a distinguishable zone which is displaying unique epidemiological disease patterns, along with specific health characteristics unique to the border region (Brandon, Crespin, Levy, & Reyna, 1997).
Information on the border Mexican-American population suggests that non- communicable diseases, such as diabetes, are genetically-linked, while other problems are due to barriers in obtaining health care and economic differentials (poverty). Problems of access to health care result in significant cross-border utilization of services...[with] these access problems occur[ring] on both sides of the border (Brandon et al., 1997; General Accounting Office, 1988). Problems associated with remoteness, distance, and access, as well as cultural and language barriers, suggest the need for group-specific health promotion/education programs to address such non-communicable diseases as hypertension, obesity, and diabetes (all of which have higher rates among populations living along the border). Also, differences in communicable disease rates along the border have been noted, with gastrointestinal illnesses, tuberculosis, and syphilis have higher rates along the border (Furino & Munoz, 1991; Warner, 1991; USMBHA, 1994; Pan American Health Organization, 1990). Death rates are higher in Mexico for infectious and parasitic diseases. Concerns about the resurgence of vaccine-preventable communicable diseases and other infectious conditions along the border are related to differences in immunization delivery and vaccination schedules between the two countries, differences in surveillance and reporting practices (that make binational comparisons difficult), poor sanitary conditions on both sides of the border--including dumping of raw sewage in communities that lack sewage treatment facilities (Reavis, 1989). Re-emerging infections, such as dengue and cholera, are also of great concern along the border. Substance abuse is another priority for public health professionals along the border (Project Consenso, USMBHA, 1991). Factors possibly related to growing alcohol and drug-related problems include increased poverty on both sides; migration-related issues including loneliness, acculturation, and, for some, fear concerning the immigration status; health care access issues, many related to language and cultural differences. No discussion of border health concerns could be complete without considering environmental pollution. Water and air pollution are major concerns along the border (Council on Scientific Affairs, 1990).
Regional, national, and binational efforts have expanded in attempts to address the growing list of health concerns along the border. The Good Neighbor Environmental Board was created by the Enterprise for the Americas Initiative Act of 1992 to advise the President and Congress on environmental and infrastructure needs within the region. According to Brandon et al. (1997), this board has paid considerable attention to results of the Integrated Border Environmental Plan (EBEP) and to its successor, the “Border 21" plan. Community-based prevention programs, often federally funded, are also becoming more common along the border. For example, the VENCINOS network, which is an expansion of the Community Partnership JUNITOS UNIDOS, has been funded by groups such as the federal Center for Substance Abuse Prevention (CSAP) to address ATODA issues among school-aged children in Santa Cruz county, Arizona and Nogales, Sonora, Mexico.
The observations made by the US-Mexico Border Health Task Group reinforced that the strategies needed to combat the public health problems of the border must be based on binational cooperation. In recognition of the fact that solutions to many of the health issues unique to the border region must incorporate this binational perspective, one of the six policy recommendations made by the XII Border Governors’ Conference (Committee on Health and Social Implications of Increased Trade Along the Border Region, 1994) called for the establishment of a US-Mexico Border Health Commission. The Committee suggested that the overall purpose of the Commission would be to:
...reinforce organizational structures needed to improve medical and public health practices in a unique environment that requires a cooperative multi-state and binational approach. This Commission is particularly necessary in a region that has two distinct operational and legal systems, yet share geographic and epidemiologic environments. The establishment of a Border Health commission follows the recognition that border population centers should be considered as a single epidemiological area. The...Commission will be established on the border to: 1) facilitate the implementation of public health and prevention programs within existing structures; 2) facilitate and coordinate the development of public and private partnerships to deal with general health problems at the border (e.g., disease prevention, emergency care, perinatal care, selected health services, and developing an appropriate system of medical care insurance); 3) establish criteria for community health guidelines as they relate to urban planning standards; and 4) to design/develop a continuing public health assessment system and hearing process for implementation in the border region (p. 10-11).
While the Border Health Commission Act was authorized by the US Congress in 1993, no funds have been appropriated for implementation, and the endorsement of such a binational comission has yet to be even considered by the Secretariat of Health in Mexico. In the meantime, most binational activities will continue to occur at the local level, such as the sister communities projects supported by the USMBHA. Universities along the border which offer the Master of Public Health degree seem particularly interested in collaborating with communities and regional health authorities on needs assessments, health program planning and implementation, and comprehensive evaluations. The MPH faculty at New Mexico State University have coordinated two meetings which were attended by MPH faculty from San Diego State University, University of Arizona, University of New Mexico, the University of Texas Health Sciences Center MPH satellite programs at San Antonio and El Paso, and from the Autonomous University of Juarez to develop ideas for collaboration. They have formed the Border MPH Work Group out of this process, which all hope will grow into a viable collaborative partner for communities to include in their health planning and intervention efforts. Those interested in the MPH at NMSU, in the work group, or in the upcoming early 1997 release of Border Health: Challenges Along the U.S.- Mexico Border, should contact the author of this paper at the Department of Health Science, Box 3 HLS, New Mexico State University, Las Cruces, NM 88003, USA (or e-mail jbrandon@nmsu.edu).
References
Brandon, J.E., Crespin, F.H., Levy, C., & Reyna, D.M. (1997). Border health issues. IN: J.Bruhn and JE Brandon’s (Eds) Border health: Challenges along the U.S.-Mexico Border. NY: Garland Press.
Committee on Health and Social Implications of Increased Trade along the Border Region. (1994). Preliminary recommendations for the 1994 border governors’ conference. Tijuana, Baja California.
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Crespin, F.H., & Kalishman, N. (1991). New Mexico’s health status: A natural experiment in border industrialization. Border Health Conference. McAllen, TX.
Furino, A., & Munoz, E. 91991). Health status among Hispanics: Major themes and new priorities. Journal of the American Medical Association, 265(2), 255-257.
Pan American Health Organization (1990). US-Mexico border health statistics. El Paso, TX: El Paso Field Office, PAHO.
Reavis, R. (1989). Border health conference proceedings. Pan American Health Organization, El Paso Field Office, El Paso, TX, 23-24.
United States General Accounting Office (1988). Health care: Availability in the Texas- Mexico border area. (GAO Document # HRD-89-12). Washington, DC: Governmental Accounting Office.
United States-Mexico Border Health Association (1991). Project Consenso Final Report. El Paso, TX: Pan American Health Organization, El Paso Field Office. United States-Mexico Border Health Association (1994). Sister communities health profiles: United States-Mexico border, 1989-1991. El Paso, TX: Pan American Health Organization, El Paso Field Office.
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