Transcript Public Health Challenges at the US

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
Ten States, 70 Million People
Border length 3140 km
25 US Counties
34 Mexican Municipalities
24 Native American Nations
12 Million people
U.S. - Mexico
Border Population Demographics
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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
6,268,107
5,054,516
MEXICAN BORDER
U.S. BORDER
Population Dynamics
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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
16
14
12
10
Mexico
U.S.
8
6
4
2
Population estimate: de Cosio, G. (in Millions)
0
1990 1994 1997 2000 2005 2010 2015 2020
Estimated Border Population 1990-2020
U.S. - Mexico Border:
Socio-Economic Indicators
2,878 Maquila plants: 1.8 million employees
Maquiladora sites
• Inequities
 Mexico exports to U.S. = $90 billion p/a
• 6 Poorest U.S. counties
 40% exports from 6 Mexican border states
• Lower poverty rates in Mexican
border states than the nation
Maquiladores: A Mixed Blessing?
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+ Generate work for 1 M Mexicans
+ Generate US$ 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
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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
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US citizens come to Mexico for purchasing
drugs and to seek medical and dental care:
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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.
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Some US insurers offer now insurance benefits in
Mexico
History of Border Health
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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
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US-Mexican Border Health Association
(USMBHA) 60 year history:
Annual Meetings – technical cooperation
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“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
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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
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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
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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:
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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?
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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