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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