.ATIONAL 2URAL (EALTH !SSOCIATION 0OLICY "RIEF
!DDRESSING THE (EALTH #ARE .EEDS
IN THE 53-EXICO "ORDER 2EGION
)NTRODUCTION
4HE 53-EXICO BORDER REGION IS DElNED AS THE AREA LAND BEING KILOMETERS MILES NORTH AND SOUTH OF THE
INTERNATIONAL BOUNDARY ,A 0AZ !GREEMENT )T STRETCHES APPROXIMATELY MILES FROM THE 'ULF OF -EXICO 4EXAS
IN THE EAST TO THE 0ACIlC /CEAN #ALIFORNIA IN THE WEST 4HE AREA ENCOMPASSES FOUR 53 STATES 4EXAS .EW -EXICO
!RIZONA AND #ALIFORNIA SIX -EXICAN STATES 4AMAULIPAS .UEVO ,EON #OAHUILA #HIHUAHUA 3ONORA AND "AJA
#ALIFORNIA 53 COUNTIES AND -EXICAN MUNICIPIOS !DDITIONALLY THERE ARE APPROXIMATELY .ATIVE !MERICAN
.ATIONS LOCATED WITHIN THE "ORDER 2EGION CREATING A TRINATIONAL REGION EG !RIZONA -EXICO 4OHONO //DHAM
4RIBAL .ATION -AP SHOWS THE 53 n -EXICO BORDER REGION
-AP 53 -EXICO "ORDER 2EGION
4HIS BORDER POPULATION MILLION IS EXPECTED TO DOUBLE BY 4WO OF THE TEN FASTESTGROWING 5 3 METROPOLITAN
AREAS ,AREDO AND -C!LLEN 48 ARE LOCATED ON THE "ORDER 4HERE ARE PAIRS OF SISTERCITIES ON THE BORDER
4HE 53 n -EXICO "ORDER IS THE BUSIEST AND MOST TRAVELED BORDER IN THE WORLD -ASSIVE MOVEMENT OF PEOPLE MILLION LEGAL CROSSINGS IN AND GOODS BETWEEN -EXICO AND THE 5NITED 3TATES CREATES A PERFECT MECHANISM FOR
TRANSMISSION OF COMMUNICABLE DISEASES 53 BUSINESSES ARE NOW MORE THAN EVER UTILIZING THE LOW WAGES OF THE -EXICAN
LABOR POOL AND ACTIVELY RECRUITING LABORERS TO INDUSTRIES THROUGHOUT THE NATION ESPECIALLY THE SOUTHWESTERN AREA OF THE
5NITED 3TATES
-OST OF THE 53-EXICO BORDER REGION IS RURAL SEE -AP /F THE 53 BORDER COUNTIES ARE -EDICALLY
5NDERSERVED !REAS -5!S AND ARE (EALTH 0ROFESSIONAL 3HORTAGE !REAS (03!S FOR PRIMARY MEDICAL CARE
-AP 53 n -EXICO "ORDER 2EGION 0OPULATION $ENSITY 0ROlLE
$ENSITY 0OPULATION3QUARE MILES
!DDITIONAL &ACTS ABOUT THE 53-EXICO "ORDER 2EGION
&ACTORS THAT ARE HAVING NEGATIVE EFFECTS ON THE HEALTH OF THE BORDER RESIDENTS INCLUDE POOR NUTRITION HIGH LEVELS
OF POLLUTION INADEQUATE HEALTH CARE AND EDUCATION (IGH RATES OF POVERTY AND UNINSURED POSE THE GREATEST CHALLENGE
BARRIER TO HEALTH CARE AND IMPROVING HEALTH STATUS IN THE "ORDER 2EGION
(EALTH CHALLENGES ALONG THE BORDER ARE SIGNIlCANT )F THE BORDER BECAME THE ST 3TATE THE REGION WOULD RANK
s ,AST IN ACCESS TO HEALTH CARE
s ,AST IN PER CAPITA INCOME
s &IRST IN NUMBERS OF SCHOOL CHILDREN LIVING IN POVERTY AND ARE UNINSURED
s 3ECOND IN DEATH RATES DUE TO HEPATITIS
s 4HIRD IN DEATHS RELATED TO DIABETES
s 6ACCINEPREVENTABLE MEASLES AND MUMPS ARE TWICE THE NATIONAL RATE
s 4UBERCULOSIS WHICH IS BECOMING DRUG RESISTANT IS TIMES THE NATIONAL RATE ON THE BORDER
-OST BORDER COUNTIES LACK A PUBLIC HEALTH DEPARTMENT AND ARE COMPLETELY DEPENDENT ON THE RESOURCES OF THEIR STATE
HEALTH DEPARTMENT FOR BASIC PUBLIC HEALTH SERVICES SUCH AS
s )MMUNIZATIONS
s $ISEASE SURVEILLANCE
s ,ABORATORY SERVICES
0UBLIC 0OLICY )MPLICATIONS
(IGHER RATES OF COMMUNICABLE DISEASES AND CHRONIC ILLNESSES HAVE A TREMENDOUS IMPACT ON THE BORDERS HEALTH CARE SYSTEM
IN TERMS OF BOTH HUMAN AND lNANCIAL COST 4HE HIGHER DISEASE RATES ARE DRAINING ON AN ALREADY OVERBURDENED HEALTH CARE
SYSTEM 4ODAY THE EXISTING BORDER HEALTH CARE DELIVERY SYSTEM IS UNABLE TO PROVIDE BASIC PRIMARY MEDICAL CARE TO THOSE
IN NEED !S THE NEED FOR MEDICAL CARE CONTINUES TO OUTPACE THE DEVELOPMENT OF THE BORDER INFRASTRUCTURE THE
EXPECTATION IS THAT THE NUMBER OF MEDICALLY UNSERVED AND UNDERSERVED PEOPLE LIVING IN THE BORDER REGION WILL CONTINUE
TO INCREASE SHARPLY
/NE OF THE MOST IMPORTANT OUTCOMES OF THE HEALTH CARE SYSTEM IS THE IMPROVEMENT OF HEALTH STATUS !PPLYING HEALTH
STATUS INDICATORS SUCH AS PREVALENCEINCIDENCE OF INFECTIOUS DISEASES CARDIOVASCULAR DISEASES AND CANCER TO BORDER
COMMUNITIES SHOWS THAT ITS RESIDENTS ARE GENERALLY CHARACTERIZED BY HIGHER RATES OF
!CCIDENTS
$IABETES
)NmUENZA
#ANCER
(EPATITIS !
0NEUMONIA
#HRONIC ,IVER $ISEASE
(OMICIDE
4UBERCULOSIS
&OR EXAMPLE IN THE RATE OF (EPATITIS ! IN 3ANTA #RUZ #OUNTY !RIZONA WAS MORE THAN NINE TIMES THAT OF THE
OVERALL STATE OF !RIZONA PER COMPARED TO FOR THE STATE 4HAT SAME YEAR THE RATE OF 4" IN ,UNA
#OUNTY .EW -EXICO WAS OVER TWICE THAT OF THE OVERALL STATE OF .EW -EXICO PER COMPARED TO FOR
THE STATE
%LIMINATION OF DISPROPORTIONATE SHARE OF DISEASE ILLNESS AND INJURY HEALTH DISPARITIES IS A CRITICAL GOAL #ASES OF
!)$3 HAVE INCREASED MOST DRAMATICALLY AMONG WOMEN PEOPLE OF COLOR AND YOUTH ALONG THE BORDER &OR EXAMPLE IN
!FRICAN !MERICANS IN 3AN $IEGO #OUNTY #ALIFORNIA MADE UP OF THE !)$3 CASES DIAGNOSED THAT YEAR WHILE
COMPRISING ONLY OF THE OVERALL COUNTY POPULATION 4EXAS BORDER RESIDENTS HAVE A DIABETESRELATED DEATH RATE THAT
IS NEARLY GREATER THAN THAT OF THE STATE 3AN $IEGO #OUNTY IS RECOGNIZED BY #$# AS ONE OF THE HIGHEST 4"
INCIDENCE AREAS IN THE NATION
7ITH ALL THE CHALLENGES IDENTIlED PREVIOUSLY THIS MILE AREA HAS OFTEN BEEN REFERRED TO AS THE hFORGOTTEN REGIONv
(OWEVER A VARIETY OF PARTNERS IN THIS BORDER REGION HAVE BEEN WORKING DILIGENTLY OVER MANY YEARS TO IMPROVE
hTHIRDWORLDv LIVING AND WORKING CONDITIONS FOR THE POPULATIONS LIVING IN THE REGION "Y MAKING INVESTMENTS IN THE
INFRASTRUCTURE NEEDS OF THE REGION MUCH IMPROVEMENT COULD BE SEEN IN THE PUBLIC HEALTH INFRASTRUCTURE WHICH IN TURN
WOULD IMPROVE HEALTH OUTCOMES FOR THESE POPULATIONS 4HE 53 -IDTERM !SSESSMENT OF THE (EALTHY "ORDER REmECTS IMPROVEMENT IN SEVERAL AREAS "Y PRIORITIZING BASIC INFRASTRUCTURE WATER WASTE WATER HOUSING ETC PUBLIC
HEALTH A CULTURALLY COMPETENT HEALTH WORKFORCE AND OTHER INFRASTRUCTURE NEEDS FOR THE BORDER REGION BOTH NATIONS WILL
SEE MARKED IMPROVEMENTS IN HEALTH OUTCOMES 4HIS WILL REDUCE FUTURE HEALTH CARE COSTS AND PROVIDE MODELS OF SERVICE
FOR BORDER POPULATIONS THAT INEVITABLY WILL BE MIGRATING TO OTHER REGIONS OF THE 53 AS WE ARE SEEING PRESENTLY
! "LUEPRINT FOR !DDRESSING THE 53-EXICO "ORDER 2EGION (EALTH #ARE .EEDS
4HE 53 -EXICO BORDER REGION NO LONGER EXISTS IN ISOLATION FROM THE REST OF BOTH THE 5NITED 3TATES AND -EXICO 4HE
YOUNG AND HIGHLY MOBILE POPULATIONS FOUND IN THIS REGION WILL REQUIRE INVESTMENTS TO ENSURE THAT HEALTH PROBLEMS DO
NOT MIGRATE TO OTHER REGIONS OF BOTH COUNTRIES 4HIS WILL IN TURN CREATE CHALLENGES AND STRAINS TO EXISTING STRUCTURES IN
PROVIDING SERVICES FOR THESE NEWLYARRIVED POPULATIONS 4HE BORDER REGION COULD SERVE AS A MODEL FOR THE PROVISION OF
CULTURALLY APPROPRIATE SERVICES TO THESE POPULATIONS WHICH CAN BE REPLICATED IN OTHER REGIONS EG !PPALACHIA AND $ELTA
2EGIONS 4HERE ARE MANY PARTNERS IN THE BORDER REGION WHO HAVE WORKED AND WILL CONTINUE TO ADDRESS THESE CHALLENGES
WITH ADDITIONAL SUPPORT AND RESOURCES THEY CAN SUCCEED IN IMPROVING HEALTH OUTCOMES IN THIS h"ORDER )MPACT 2EGIONv
4HE BLUEPRINT FOR ADDRESSING THE REGIONAL HEALTH CARE NEEDS INCLUDES DEVELOPMENT OF INNOVATIVE HEALTH PROGRAM MODELS
FOR THE REGION ADMINISTERED THROUGH THE 53-EXICO "ORDER (EALTH #OMMISSION AND FUNDING THE /FlCE OF 2URAL
(EALTH 0OLICYS BORDER HEALTH PROGRAMS AND RESEARCH
2ECOMMENDATIONS
4HREE RECOMMENDATIONS THAT WILL BRING ADDITIONAL SUPPORT AND RESOURCES TO THE 53-EXICO BORDER REGION INCLUDE
4HE 53 -EXICO "ORDER (EALTH #OMMISSION FUNDING LEVEL NEEDS TO BE INCREASED IN ORDER TO DEVELOP AND
IMPLEMENT NEW BORDER HEALTH PROGRAMMING THAT WILL ADDRESS THE GROWING HEALTH NEEDS OF THE REGION AND THE
(EALTHY "ORDER /BJECTIVES 4HE #OMMISSION WILL WORK WITH DIRECTLY WITH PUBLIC PRIVATE AND UNIVERSITY
BORDER PARTNERS TO DEVELOP INNOVATIVE PROGRAM MODELS THAT COULD BE REPLICATED THROUGHOUT THE REGION TO
IMPROVE THE HEALTH OF BORDER AND RURAL POPULATIONS
4HE /FlCE OF 2URAL (EALTH 0OLICY /2(0 HAS BEEN GIVEN THE PRIMARY BORDER HEALTH RESPONSIBILITY WITHIN
(23! BUT HAS RECEIVED LITTLE FUNDING FOR THIS ROLE 4HE /2(0 FUNDING LEVEL FOR BORDER HEALTH NEEDS TO BE
INCREASED TO SUPPORT ITS ACTIVITIES AND TO ESTABLISH A BORDER HEALTH RESEARCH PROGRAM SIMILAR TO ONE FOR RURAL
HEALTH THAT WOULD ASSIST IN THE DEVELOPMENT OF HEALTH POLICIES FOR THE 53-EXICO BORDER REGION
h(EALTHY "ORDERS v 0RE0UBLICATION %DITION FROM THE 53-EXICO "ORDER (EALTH #OMMISSION -EETING
/CTOBER (EALTH 2ESOURCES AND 3ERVICES !DMINISTRATION "UREAU OF 0RIMARY (EALTH #ARE
!RIZONA $EPARTMENT OF (EALTH 3ERVICES "UREAU OF %PIDEMIOLOGY AND $ISEASE #ONTROL 3ERVICES
.EW -EXICO $EPARTMENT OF (EALTH /FlCE OF .EW -EXICO 6ITAL 2ECORDS AND (EALTH 3TATISTICS
"ORDERING THE &UTURE 4EXAS #OMPTROLLER OF 0UBLIC !CCOUNTS
0OLICY ADOPTED *ANUARY 'OVERNMENT !FFAIRS /FlCE
+ 3TREET .7 ND &LOOR
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