Public Health Challenges at the U.S. - Mexican Border:

Lessons for Europe?

Armin Fidler (World Bank)

Alfonso Ruiz (PAHO/WHO)

Nuria Homedes (University of Texas)

U.S. – Mexico Border Population

25 US Counties34 Mexican Municipalities24 Native American Nations12 Million people

Ten States, 70 Million People

Border length 3140 km

U.S. - Mexico Border Population Demographics

55% of the population lives on the U.S. side in 4 states

45% of the population lives on the Mexican side in 6 states

70% of the U.S. border population is of Hispanic origin

47% of the border population is under 20 years of age

2000 Estimated Total U.S.-

Mexico Border population:

12 million

5,054,516

6,268,107

MEXICAN BORDER U.S. BORDER

Population Dynamics

Population growth rate (4.3% for Mexico and 1.8% for U.S) higher than national rates

( 1.9%) Mexico, (0.9%) U.S. Large minority population in

the U.S. border (average Hispanic population 70%)

Three largest Mexican border cities (Juarez, Tijuana, Mexicali) comprise 50% of Mexican Border population

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1990 1994 1997 2000 2005 2010 2015 2020

MexicoU.S.

Estimated Border Population 1990-2020

Population estimate: de Cosio, G. (in Millions)

U.S. - Mexico Border:Socio-Economic Indicators

Mexico exports to U.S. = $90 billion p/a

40% exports from 6 Mexican border states

• Inequities

• 6 Poorest U.S. counties

• Lower poverty rates in Mexican

border states than the nation

2,878 Maquila plants: 1.8 million employees

Maquiladora sites

Maquiladores: A Mixed Blessing?

+ Generate work for 1 M Mexicans + Generate US$ 60 B in exports + US$ 400 M in corporate taxes (2.5% of government

revenues + US$ 1.3 B in social security taxes - highly increased environmental pollution - increased south-north migration - evidence that low skill, low wage business is resettling

elsewhere (India, China) - increased disease incidence due to pollution (smog

related air-borne, water-borne pollutants)

A Normal Day at the Border…..

400 million legal crossing/year South to North

3.8 million commercial truck crossings/year South to North

Health Divide

Hepatitis A: US side 3 times national rate, Mexican side twice national rate (Study El Paso/Cd. Juarez 76% and 96% of pregnant women)

Mexican border: Salmonella incidence 26% higher than in rest of country

High prevalence of TB (9% MTR-TB), dengue, leprosy, rabies

Concerns about increasing injury rates (accidents, violence).

Health Services

US citizens come to Mexico for purchasing drugs and to seek medical and dental care: 18% of patients in Mexican border cities are from US

(mostly uninsured) Mexicans seek treatment in the US for high complexity

treatments BUT: differences in organization, financing and

insurance mechanisms (including malpractice) results in little collaboration or referrals. Some US insurers offer now insurance benefits in

Mexico

History of Border Health

1902 Foundation of PAHO (Pan-American Sanitary Bureau)

1906 Food and Drug Act, regulating pharmaceuticals 1919 Passports required for border crossing 1927 Flood victims support across border 1940 bi-national cooperation to combat infectious and

venereal diseases at border 1942 PAHO establishes Field Office in El Paso, Texas 1943 USMBHA founded 1994 NAFTA signed, Border Health Commission

established

Cross-border Initiatives

US-Mexican Border Health Association (USMBHA) 60 year history:

Annual Meetings – technical cooperation “Enlaces” – capacity building in HIV/AIDS prevention Migrant Partnership Program against substance abuse “Cara a Cara” Project – Latino MSM HIV prevention program Disparities Elimination Project – substance abuse and

mental health program Farm workers Health Program

USMBHA Mission and Objectives

Contribute to Public Health and promote health and living conditions at border

Bring together institutions and professionals with interest in border health

Learn about health needs of populations (Sister Cities, Bi-National Health Councils)

Promote public health and environmental health Serve as mechanisms for communication and

collaboration of local health authorities Carry out and support specific health programs (public

and private sectors)

The North American Free Trade Agreement (NAFTA) 1994

Exponential increase of cross-border transactions of goods and services and capital flows between the US, Mexico and Canada.

But: Globalization may not have promoted increased bi-national health policy cooperation Barriers for health cooperation continue to exist. Informal work has become more difficult, with policy

decisions having been centralized Political, social and cultural interdependence must be

equally understood as international trade is being promoted.

Barriers:

By law, US institutions are not allowed to spend resources in Mexico – channels through PAHO

PAHO: “….there are many meetings but few resources”

US seems only concerned about containing problems spreading north

Border Health Commission approved by Congress in 1994, funded in 1998, first meeting in 2000!

Allegations of red tape, harassment in particular after September 11, 2001 (“federal intrusion”)

Cultural Barriers: distrust, lack of respect, racism, corruption

EU Relevance?

Must understand border as a special area with special needs

Migration may pose health and environmental threats for both sides

Trade agreements may cause deterioration of local working, environmental and public health conditions

Formal and informal mechanisms of exchange and collaboration can make a difference

Targeted funding for cross-border public health interventions is essential