United States–
Mexico
Border Area
INTRODUCTION
The United States–Mexico border region extends for
3,141 km, stretching from the Gulf of Mexico to the
Pacific Ocean. The 1983 La Paz Agreement, which
was signed between the governments of Mexico and
the United States with the goal of protecting,
improving, and conserving the environment along
the border (1), defines this area as the land within
100 km on either side of the international boundary.
Health in the Americas, 2012 Edition: Country Volume N ’ Pan American Health Organization, 2012
HEALTH IN THE AMERICAS, 2012 N COUNTRY VOLUME
FIGURE 1. United States–Mexico border region.
Mexico Border States
United States Border States
U.S.- Mexico border counties and Municipalities
Country
Mexico
United States
Mexico sister cities
United States sister cities
La Paz Agreement (100km)
Latitude longitude (10 deg)
Major rivers
Source: Elaborated by the PAHO United States-Mexico Border Office.
The border area includes 48 U.S. counties in 4
states1 and 94 Mexican municipalities in 6 states,2
including 15 pairs of sister cities.3
In order to manage its program designed to
improve health along the border, the U.S.-Mexico
Border Health Commission (USMBHC) (2) limited
the border area to the 44 U.S. counties and 80
Mexican municipalities that have most of their
population within the 100-km limit (see Figure 1).
This constitutes a total population of approximately
14.94 million people (7.45 million males and 7.49
million females), about 7.44 million (3.68 million
males and 3.76 million females) in the U.S. (3) and
7.50 million (3.77 million males and 3.73 million
females) in Mexico (4) (see age and sex distribution
1
Arizona, California, New Mexico, and Texas.
Baja California, Coahuila, Chihuahua, Nuevo León,
Sonora, and Tamaulipas.
3
San Diego/Tijuana (California/Baja California),
Calexico/Mexicali (California/Baja California), Yuma/
San Luis Rı́o Colorado (Arizona/Sonora), Nogales/
Nogales (Arizona/Sonora), Naco/Naco (Arizona/Sonora),
Douglas/Agua Prieta (Arizona/Sonora), Columbus/Puerto
Palomas (New Mexico/Chihuahua), El Paso/Ciudad
Juárez (Texas/Chihuahua), Presidio/Ojinaga (Texas/
Chihuahua), Del Rio/Ciudad Acuña (Texas/Coahuila),
Eagle Pass/Piedras Negras (Texas/Coahuila), Laredo/
Nuevo Laredo (Texas/Tamaulipas), McAllen/Reynosa
(Texas/Tamaulipas),
Weslaco/Rı́o
Bravo
(Texas/
Tamaulipas), and Brownsville/Matamoros (Texas/
Tamaulipas).
2
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UNITED STATES–MEXICO BORDER AREA
FIGURE 2. Population structure, by age and sex,a United States border population in 2009 and Mexican border
population in 2010.
6.00
4.00
United States (2009)
Mexico (2010)
85+
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4
85+
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4
2.00
0.00
0.00
2.00
4.00
6.00
6.00
4.00
2.00
Males
0.00
0.00
2.00
4.00
6.00
Percentage
Percentage
Males
Females
Females
Source: United States Census Bureau (2009); Mexico National Institute for Statistics and Geography, Population and Housing Census (2010)
a
Each age group’s percentage represents its proportion of the total for each sex.
of the border population in Figure 2). Between 2000
and 2010 the U.S. border population increased by
about 12% and the Mexican border population
increased by about 18%.
About 84% of the U.S.-Mexico border population is urban. Mexico’s three largest urban municipalities—Ciudad Juárez in Chihuahua, and Tijuana
and Mexicali in Baja California—account for almost
half of the total Mexican border population. Over
80% of the U.S. border population is concentrated in
six counties: San Diego in California; Pima in
Arizona; and Cameron, El Paso, Hidalgo, and Webb
in Texas. San Diego alone, the wealthiest of the U.S.
border counties, represents about 40% of the U.S.
border population. About half of the U.S. border
population is Hispanic, primarily of Mexican
ancestry (5, 6).
The U.S.-Mexico border area represents a
binational geo-political system based on strong
social, economic, cultural, and environmental connections governed by different policies, customs, and
laws. Important dimensions of this binational system
include commerce, tourism, sister-city familial ties,
Mexico’s assembly plants or maquiladoras (plants that
import components for processing or assembly by
Mexican labor and then export the finished products), ecological services, a shared heritage, social
partnerships, and immigration.
The area has experienced continuous growth
since the 1940s associated with the 1942–1947
Bracero Program (laborers contracted in Mexico to
work in the U.S. agricultural sector), the Border
Industrialization Program initiated in 1965, and the
North American Free Trade Agreement (NAFTA)
signed in 1993. Projected population growth rates in
the border region exceed anticipated national average
growth rates for each country. If current trends
continue, the border population is expected to
increase to about 20 million people by 2020 (7).
Trade has also increased significantly, particularly
since the NAFTA agreement came into force. For
example, in 2008, cross-border land trade between the
U.S. and Mexico totaled over US$ 293 billion, about
three times the amount recorded in 1995; 13,300
commercial trucks crossed the border daily, up 70%
from 1995 (8). However, the region is experiencing
several challenges, including the situation of violence
on the Mexican side of the border, the deceleration of
the maquiladora industry, and reduced northbound
illegal immigration stemming from both the slowdown in the U.S. economy and enhanced U.S. border
immigration enforcement efforts. These factors may
slow development and affect cross-border trade and
travel. Personal legal border crossings from Mexico to
the U.S. decreased from 313.8 million in 2006 to
229.7 million in 2010 (9). In addition, the number of
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HEALTH IN THE AMERICAS, 2012 N COUNTRY VOLUME
The African-American population along the
U.S. border area in 2005–2009 comprised approximately 3.2% of the U.S. border population (3),
located primarily in San Diego, California; Tucson,
Arizona; and El Paso, Texas.
This chapter examines health determinants and
health conditions along the border region. In
general, the issues are described at the state level,
with some specific examples given at the county/
municipality level. For several conditions, direct
comparisons between the U.S. and Mexican sides of
the border cannot be made because the available
information is not readily comparable.
apprehensions of unauthorized Mexican migrants in
the U.S. decreased from 1.17 million in 2005 to 0.45
million in 2010 (10).
The population on both sides of the border is
relatively young because of high fertility and a
continuous migratory flow (the population that
migrates north to the U.S. tends to be younger and
healthier). About 30% of the Mexican border
population and 24% of the U.S. border population
is under 15 years of age. In 2007, the total fertility
rates in the Mexican border states ranged from 2.0
children per woman in Nuevo León to 2.2 in the
states of Sonora, Chihuahua, and Coahuila, on a par
with Mexico’s national rate of 2.1. The total fertility
rates in the U.S. border states in 2007 ranged from 2.2
in California to 2.4 in Texas and Arizona, higher than
the U.S. national rate of 2.1. The proportion of
population over 60 years old is about 17% (55%
females) on the U.S. side of the border and 7% (51%
females) on the Mexican side (4, 11).
Life expectancy at birth for U.S. border states in
2007 ranged from 77.1 years in New Mexico (74.5 for
males and 79.7 for females) to 81.0 years in California
(78.6 for males and 83.2 for females), compared to
78.8 years for the U.S. (76.0 for males and 81.2 for
females). For the Mexican border states, life expectancy at birth in 2009 ranged from 76.3 years in
Tamaulipas (74.0 for males and 78.7 for females) to
77.1 years (74.9 for males and 79.2 for females) in Baja
California, compared to 75.3 years for Mexico (72.9
for males and 77.6 for females) (12, 13, 14, 15, 16).
The native indigenous population along the
Mexican border area in 2005 totaled approximately
130,000 people, located primarily in Baja California,
Tamaulipas, Chihuahua, and Sonora (17). The
estimated Native American population during 2005–
2009 along the U.S. border area was approximately
80,000 people, located primarily in California and
Arizona (5). Five native indigenous groups have a
permanent land base that extends to both sides of the
border: the Kikapu peoples in Coahuila, known as the
Kickapoo in Texas and Arizona; the Kumiai peoples in
Baja California, known as the Kumeyaay in California;
and the Papago, Cucapá, and Yaqui peoples in Sonora,
known as the Tohono O’odham, Cocopah, and Pascua
Yaqui, respectively, in Arizona.
HEALTH DETERMINANTS AND
INEQUALITIES
In 2009, the per capita gross domestic product
(GDP) for the Mexican border states ranged from
US$ 7,501 in Baja California to US$ 13,481 in
Nuevo León, compared to US$ 8,143 for Mexico as
a whole. The per capita GDP for the U.S. border
states ranged from US$ 39,123 in New Mexico to
US$ 50,871 in California, compared to US$ 45,989
for the nation. The U.S. border region includes both
one of the wealthiest and one of the poorest cities in
the U.S.: in 2009, the per capita GDP of San Diego,
California, was US$ 51,035 whereas the per capita
GDP of McAllen, Texas, was US$ 15,818 (18, 19,
20, 21).
The unemployment rate in the U.S. border
states for 2005–2009, measured as the population 16
years old or older who are in the labor force, was
6.8% in Texas, New Mexico, and Arizona, and 7.9%
in California, compared to 7.2% for the nation. At
the local level, the differences were more significant.
San Diego, California, had an unemployment rate of
6.7% whereas in McAllen, Texas, it was 9.2%. For
the Mexican border states, the unemployment rate in
2010, measured as the labor force for the population
14 years old or older, ranged from 5.9% in Baja
California to 8.7% in Chihuahua, higher than the
5.2% rate for the nation. It should be noted that in
Mexico there is a significant level of underemployment that has not been reported. Unemployment
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UNITED STATES–MEXICO BORDER AREA
rates for the two nations are not readily comparable
(18, 19, 20, 21).
The education level of U.S. border residents is
lower than the national U.S. average, but there are
regional differences. For example, in 2009, in San
Diego, California, 6.8% of the population between
25 and 64 years old had an education level below the
ninth grade and 22.1% had completed a four-year
university degree. In contrast, in Brownsville, Texas,
27.6% had an education level below the ninth grade
and only 10% had a university degree. In the U.S. as
a whole, 6.4% had an education level below the ninth
grade and 17.4% had a university degree. The
education level on the Mexican side of the border
is more homogeneous. In 2010, between 25% and
30% of the border population had completed primary
school (up to sixth grade) and about 10% had a
professional degree, similar to Mexico’s national
average of 32% and 10.7%, respectively (4, 18, 20,
21).
services in the Mexican border cities ranged from
78% of the households in Nogales, Sonora, to over
95% of the households in Tijuana and Mexicali in
Baja California; San Luis Rı́o Colorado, Naco, and
Agua Prieta in Sonora; and Acuña and Piedras
Negras in Coahuila. Access to sewer services ranged
from 84% in Reynosa and Rı́o Bravo in Tamaulipas
to over 95% in Naco, Nogales, and Agua Prieta in
Sonora; Acuña and Piedras Negras in Coahuila; and
Ojinaga in Chihuahua (4). Sewer services may
represent wastewater collected but not treated prior
to discharge.
In U.S. border cities, over 98% of the households have access to piped drinking water and treated
wastewater services (3). However, access to these
services is still a challenge in rural border colonias.
Colonias are mostly unincorporated housing developments located primarily along the New Mexico
and Texas borders; they are characterized by high
poverty rates and may lack basic community infrastructure. In 2010 in the six most populous Texas
border counties with colonias, there were 519 colonias
housing approximately 126,000 residents who lacked
some basic services and an additional 400 colonias
with approximately 50,000 residents who lacked all
basic services (22).
THE ENVIRONMENT AND HUMAN
SECURITY
ACCESS TO CLEAN WATER AND SANITATION
Water is a limited resource in several parts of the
border region. Population growth along with economic development places increasing stress on water
quantity and quality. The International Boundary and
Water Commission (IBWC) is a bi-national governmental organization charged with identifying and
solving boundary and surface water issues arising along
the border between the U.S. and Mexico. In particular,
IBWC is responsible for preserving, protecting, and
delivering the waters of the Colorado and Rio Grande
rivers. The IBWC is not authorized to work on
transnational, groundwater issues.
Access to drinking water and sanitation services
has improved significantly in urban areas on the
Mexican side of the border, but it is still one of the
most significant physical environmental determinants of health in the rural areas of both sides of the
border. In 2010, access to piped drinking water
SOLID WASTE
Millions of scrap tires have accumulated in 46 known
tire piles throughout the border region. As the result
of a strong market for used tires, millions of tires from
the U.S. are imported to Mexico for reuse. Scrap tire
piles create breeding grounds for mosquitoes, rodents,
and other vectors of disease. In addition, tire pile fires
are difficult to extinguish and can emit noxious fumes
for months. From 2004 through 2009, almost 6.9
million scrap tires were removed from 12 areas on the
Mexican side of the border region as part of the U.S.Mexico Border 2012 Environmental Program. The
majority of these tires were used as fuel in cement
kilns. Pilot road paving projects and other innovative,
experimental reuse projects were also implemented
(23, 24).
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AIR POLLUTION
household pesticide. This product is licensed for
industrial agricultural application, but is illegally
packaged and sold to residents for household use. In
2007, a research group of the University of Texas
Health Science Center at Houston (School of Public
Health) reported that in a survey conducted in the
Lower Valley of El Paso County, Texas, about 90%
of participants used pesticides in their homes. Of
these, about 10% admitted using illegal products
(27).
The most common and harmful air pollutants in the
border region include suspended particulate matter
(PM10, or particulate matter that is 10 m in diameter
or less, and PM2.5, particulate matter 2.5 m in
diameter or less) and ground-level ozone. For
example, San Diego exceeded the U.S. ozone standard
for 24 days in 2008 and Imperial Valley, California,
exceeded the standard for 15 days in 2006. In
addition, Imperial Valley exceeded the U.S. PM10
standard for 20 days in 2007, Nogales (Arizona and
Sonora) exceeded the standard for 45 days in 2006,
and Ciudad Juárez/El Paso exceeded it for 48 days in
2006. A number of measures, such as stricter
standards on motor vehicle emissions, cleaner fuels,
vehicle anti-idling programs, and road paving, have
been implemented in the border region to reduce the
sources of ozone and particulate matter (23).
ROAD SAFETY
Road traffic accidents constitute a major public
health concern in the border region—they are the
leading cause of death for school-aged children in
Mexico (28) and for people between the ages of 5
and 34 years in the United States (29). In 2009,
traffic-related mortality rates in Mexican border
states ranged from 8.1 deaths per 100,000 population
in Baja California to 26.2 in Sonora, compared to
14.0 for the nation. In the U.S. border states, trafficrelated mortality rates ranged from 8.3 in California
to 18.0 in New Mexico compared to 11.0 for the
nation (30). According to the U.S. National
Highway Traffic Safety Administration (31), the
U.S. border states reported a consistent decrease in
traffic-related mortality rates during 2005–2009.
Long-term declining trends in the U.S. have been
associated with behavioral and vehicle safety programs and the issuance of federal motor vehicle
safety standards, such as the Texas Teens in the
Driver’s Seat program. The declining trend since
2007 has coincided with the slowdown of the U.S.
economy (31), and areas that experienced greater
increases in unemployment rates recorded higher
decreases in fatalities.
PESTICIDES
California and Arizona have significant agricultural
industries in their border areas and maintain
reporting systems that track pesticide use.
According to the California Department of
Pesticide Regulation (25), the amount of pesticides
applied in California border counties dropped by
32% from 2006 through 2009, from about 3.1
million kg to 2.1 million kg. Dry winters and springs
and a shift from broad-based pesticides to newer,
more targeted products account for part of the
decline. On the other hand, the amount of pesticides
applied in Arizona border counties increased by 36%
from 2005 through 2009, from about 635,000 kg to
862,000 kg. Between 2006 and 2008, the California
border counties reported 161 definitive or probable
illness/injury incidents related to pesticide exposure,
of which only 54 incidents involved pesticides
intended for use in agricultural production. The
data suggest that most cases of pesticide exposure
occur in the household setting and primarily
involved household pesticides (26).
A major concern on both sides of the border is
the use of polvo de avión or methyl parathion as a
VIOLENCE
The increase of violence in Mexico, mainly in the
northern cities, has been associated with the implementation of national policies to crack down on
organized crime and drug trafficking. In the six largest
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UNITED STATES–MEXICO BORDER AREA
Starr, Cameron, and Hidalgo in Texas and the
Mexican municipalities of Matamoros, Valle
Hermoso, Rio Bravo, Reynosa, Dı́az Ordaz,
Camargo, and Miguel Alemán in Tamaulipas. The
hurricane caused flooding, power outages, evacuation
of about 20,000 people, two deaths on the Mexican
side of the border, and estimated losses of US$ 1.2
billion on the U.S. side (38, 39, 40).
In April 2010, the Mexicali Valley experienced
an earthquake measuring 7.2 on the Richter scale.
Mexicali in Baja California and El Centro in
California were the most affected cities. The earthquake was felt as far away as San Luis Rı́o Colorado
in Sonora. Despite the magnitude of the event, there
were only two deaths and relatively few injuries. The
damage reported included the disruption of the
Mexicali-Tijuana highway, structural collapse of
public buildings and private homes, partial evacuation of 17 hospitals on both sides of the border,
disruption of utilities, and gas leaks (41).
border cities, with an approximate population of 5.3
million inhabitants, the number of homicides related
to organized crime increased from 390 (7.3 deaths per
100,000 population) in 2007 to 3,585 (67.5) in 2010
(32). In the respective U.S. sister cities with a
population of 5.5 million inhabitants, the phenomenon
was the opposite, with a decrease in the number of total
homicides from 192 (3.5 per 100,000 population) in
2007 to 156 (2.8) in 2009. The reasons for this decline
are unclear. The most dramatic difference in the
number of homicides was between Ciudad Juárez,
Chihuahua, with a mortality rate of 167 deaths per
100,000 population, and its sister city of El Paso,
Texas, with a rate of 2 in 2009 (33, 34, 35, 36). In
response to the situation in Ciudad Juárez, the federal
government launched a violence prevention program in
2010 called ‘‘Todos Somos Juárez, Reconstruyamos la
Ciudad’’ (‘‘We Are All Juárez; Let’s Rebuild Our City’’)
with an investment of over US$ 300 million and over
160 social interventions (32).
One of the most significant phenomena of
social violence occurring on the Mexican side of the
border has been the increase in feminicide, defined
as the killing of women and girls. A study conducted
from 2006 to 2008 showed that feminicides in
Ciudad Juárez, Chihuahua, increased from 19 in
2006 to 111 in 2008. To address this phenomenon,
the Government has implemented national legislative measures such as the Law on the Right of
Women to a Life Free of Violence in Chihuahua and
the General Law of Women’s Access to a Life Free
of Violence aimed at reducing systematic female
homicides (37).
CLIMATE CHANGE
The U.S. Global Change Research Program (42)
reported in 2008 that the average temperature in
the southwestern region of the U.S. has increased
about 0.8 uC from a 1960–1979 baseline and
estimated further increases in average temperatures
by 2090 ranging from 3.2 uC to 5.6 uC above the
baseline. Rising temperatures decrease upstream
mountain snowpack and precipitation and increase
the evaporation rate of available water. This affects
the water sources for rivers and reservoirs in the
region and, as a consequence, the availability of
water for human consumption. Increases in
temperatures were also reported in the northern
Mexico border region. Assuming a scenario of
average economic growth for Mexico, average
temperatures would increase between 1.5 uC and
3.0 uC and precipitation would decline between
3.5% and 15% countrywide between 2010 and 2100,
with the greatest impacts being seen in the northern
border region. Water supplies in this region are
already stressed and are projected to become
increasingly scarce in the next 50 years (43).
DISASTERS
The most significant natural disasters that affected
the border region during 2006–2010 were a flood, a
major hurricane, and an earthquake. The 2008
flooding in Presidio, Texas/Ojinaga, Chihuahua,
was
unprecedented.
Floodwaters
inundated
Ojinaga’s wastewater treatment plant, sending sewage into the Rio Grande.
In July 2008, Hurricane Dolly hit the coast of
the Gulf of Mexico and affected the U.S. counties of
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HEALTH IN THE AMERICAS, 2012 N COUNTRY VOLUME
New Mexico (65). For the same 2006–2008 period
in Mexico, teen birth rates were 11% higher than the
national average (70 live births per 1,000 females age
15–19 years) in three of the six border states:
Chihuahua (76), Baja California (77), and Coahuila
(77).
HEALTH CONDITIONS AND TRENDS
HEALTH PROBLEMS OF SPECIFIC POPULATION
GROUPS
Maternal and Reproductive Health
Maternal mortality rates for the U.S. border states in
2008 ranged from 8.1 maternal deaths per 100,000 live
births (8 deaths) in Arizona to 22.2 (90 deaths) in
Texas, compared to 12.7 (548 deaths) for the nation in
2007. In Arizona, the rate may not be statistically
reliable because of the low number of deaths. Texas
had the highest rate of maternal deaths consistently
from 2005 to 2008. Among African-American women
living in U.S. border states, maternal mortality was
about twice the national rate. For the Mexican border
states, maternal mortality rates in 2008 ranged from
30.1 (24 deaths) in Nuevo León to 62.9 (40 deaths) in
Chihuahua, compared to 59.7 (1,167 deaths) for the
nation. Chihuahua consistently recorded the highest
rate among the border states from 2005 to 2008 (12,
44, 45, 46).
Early prenatal care (percentage of live births
whose mothers received prenatal care in the first
trimester) for the U.S. border states in 2008 was 52.0%
in New Mexico, 58.4% in Texas, 79.4% in Arizona,
and 80.7% in California, compared to 71% for the
nation. A review of border counties in California
showed that early prenatal care in San Diego (2006–
2010 median household income of US$ 63,069) was
comparable to the level provided throughout the state
(82%), whereas in Imperial County (median household income of US$ 38,685) it was about 53%.
Prenatal care visits (number of visits for pregnant
women) for the Mexican border states in 2004–2009
ranged from 7.3 visits per pregnancy in Sonora to 8.5
in Baja California and Nuevo León. More than 95% of
infants in all six Mexican border states received at least
one prenatal care visit (47, 48, 49, 50, 51).
Teen pregnancy and childbearing is a significant issue in the U.S.-Mexico border region (52, 53).
During 2006–2008, teen birth rates were about 50%
higher than the national average for the U.S. (42 live
births per 1,000 females age 15–19 years) in three of
the four border states: Arizona (60), Texas (63), and
Child Health (0–4-year-olds, except for two U.S.
states that do not report on 1–4-year-olds, only on
1–14-year-olds)
In 2008, infant (children under 1 year of age)
mortality rates for the U.S. border states ranged from
5.1 infant deaths per 1,000 live births in California
and New Mexico to 6.3 in Arizona, lower than the
6.6 infant mortality rate for the country as a whole.
With the exception of 2002 and 2005, infant
mortality rates have remained statistically the same
or decreased significantly each successive year from
1958 through 2008. The leading causes of infant
death in U.S. border states were congenital malformations, deformations, and chromosomal
abnormalities; disorders related to short gestation
and low birthweight; sudden infant death syndrome;
maternal complications of pregnancy; newborns
affected by complications of placenta, cord, and
membrane; and unintentional injuries. In all four
states the infant mortality rates for African
Americans were the highest of all racial/ethnic
groups, ranging from 6.7 in New Mexico to 17.7
in Arizona (14, 45, 54, 55).
Infant mortality rates for the Mexican border
states in 2008 were about double those of the U.S.
border states but lower than the national average for
Mexico. They ranged from 10.6 infant deaths per
1,000 live births in Nuevo León to 13.4 in
Chihuahua, compared to 15.2 for the nation.
These rates were about 20%–25% lower than they
were in 2000. The leading causes of infant death
were certain conditions originating in the perinatal
period; congenital malformations, deformations, and
chromosomal abnormalities; accidents; pneumonia
and influenza; intestinal infectious diseases; acute
respiratory infections; and septicemia (28, 56).
Mortality rates of children 1–4 years of age for
U.S. border states in 2008 were 21.3 deaths per
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UNITED STATES–MEXICO BORDER AREA
MORTALITY
100,000 population (23.4 for males and 19.1 for
females) in California and 36.8 (47.2 for males and
26.2 for females) in New Mexico, compared to 28.6
(31.3 for males and 25.7 for females) for the nation
in 2007. For California, this represents a decrease of
about 20%–25% from the rate in 2000. Texas and
Arizona reported data for children 1–14 years of age,
and mortality rates in 2008 were 19.7 deaths per
100,000 population of this age group (21.9 for
males and 17.5 for females) in Texas and 19.7 (22.3
for males and 17.0 for females) in Arizona. The
leading causes of death for both age groups and sexes
were unintentional injuries, malignant neoplasms,
congenital malformations, and assault (homicide)
(45, 55, 57, 58).
In 2008, deaths among male children 0–4 years
of age in the Mexican border states ranged from
4.0% of the total number of deaths in Coahuila to
6.3% in Tamaulipas, lower than the 6.6% for the
nation. Deaths among female children 0–4 years of
age ranged from 3.9% of the total number of deaths
in Coahuila to 8.4% in Baja California, compared to
6.5% for the nation. The leading causes of death for
both genders were unintentional injuries, congenital
malformations, malignant neoplasms, intestinal
infectious diseases, and septicemia (59, 60).
In 2008, age-adjusted mortality rates in the four U.S.
border states ranged from 650.1 deaths per 100,000
(764.4 for males and 556.4 for females, 2000 U.S.
standard population) in California to 907.9 (982.7
for males and 832.7 for females) in New Mexico,
compared to 758.7 (901.0 for males and 643.7 for
females) for the nation. These rates are about 10%–
15% lower than 2002 rates. Crude mortality rates
ranged from 612.0 deaths per 100,000 population in
California to 740.4 in New Mexico, lower than the
813.3 for the nation. Mortality rates were the highest
for African Americans, ranging from 710.7 in
Arizona to 979.3 in Texas (12, 14, 55, 62).
In 2008, age-adjusted mortality rates in the six
Mexican border states ranged from 620 deaths per
100,000 (760 for males and 500 for females, World
Health Organization world standard population) in
Tamaulipas to 810 (990 for males and 620 for
females) in Chihuahua, compared to 650 (770 for
males and 530 for females) for the nation. For several
states, the rates have increased from previous years.
For example, between 2005 and 2008 age-adjusted
mortality rates in Chihuahua increased from 750 to
810. Crude mortality rates ranged from 460 deaths
per 100,000 population in Baja California to 630 in
Chihuahua, compared to 510 for the nation (63).
Table 1 describes the 10 leading causes of death for
the Mexican border states in 2008 and U.S. border
states in 2007.
Indigenous Peoples
Available health data specific for indigenous groups
are limited. In 2009, a study of Native American
residents of Arizona showed that this population
ranked poorly on maternal and reproductive health
measures. On average, indigenous populations are
19.5 years younger than white non-Hispanics. They
also had high mortality from alcohol-induced causes
(62.1/100,000 population age-adjusted to 2000
standard), diabetes (54.2), influenza and pneumonia
(42.7), motor vehicle accidents (36.9), and from
other unintentional injuries (92.6). However, they
ranked better than average on mortality rates for
several chronic diseases (Alzheimer’s disease, lung
cancer, breast cancer, prostate cancer, colorectal
cancer, chronic lower respiratory diseases, and
coronary heart disease), tobacco use, and incidence
of genital herpes among women giving birth (61).
MORBIDITY
Communicable Diseases
Vector-borne Diseases
In 2010, 1,021 cases of West Nile virus infection
were reported in the U.S.; 38% of these cases were in
the four U.S. border states: Arizona (167 cases and
15 deaths), California (111 cases and 6 deaths), New
Mexico (25 cases and 1 death), and Texas (89 cases
and 6 deaths). El Paso reported 30% (27 cases) of the
cases in Texas. The 28 deaths in border states
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TABLE 1. Ten leading causes of death, United States and Mexican border states, 2007 and 2008.
U.S. border states (2007)
Cause of death
Mexican border states (2008)
Mortality per
100,000 population
Cause of death
Mortality per
100,000 population
1. Diseases of the heart
162.5–168.8
1. Diseases of the heart
78.0–112.2
2. Malignant neoplasms
150.5–164.4
2. Malignant neoplasm
52.9–76.5
3. Unintentional injuries
31.8–67.5
3. Diabetes mellitus
45.0–87.4
4. Cerebrovascular diseases
34.8–41.0
4. Homicides
5. Chronic lower respiratory diseases
33.9–44.9
5. Unintentional injuries
25.9–55.0
6. Diabetes mellitus
18.3–34.2
6. Cerebrovascular diseases
20.4–29.7
7. Alzheimer’s disease
16.3–32.4
7. Chronic liver disease and cirrhosis
17.6–29.8
8. Influenza and pneumonia
13.5–17.9
8. Influenza and pneumonia
8.2–15.8
9. Chronic liver disease and cirrhosis
10.6–18.9
9. Conditions originating in the perinatal period
7.4–16.3
10. Chronic obstructive pulmonary diseases
9.1–16.5
10. Suicide
9.9–20.4
7.6–75.2
Sources: United States, Centers for Disease Control and Prevention. Deaths, percent of total deaths, and death rates for the 15 leading causes of death:
United States and each state [Internet]; 2007. Available at: http://www.cdc.gov/nchs/data/dvs/LCWK9_2007.pdf. Accessed on 29 December 2011.
México, Sistema Nacional de Información en Salud. Principales causas de mortalidad general por entidad federativa [Internet]; 2008. Available at: http://sinais.
salud.gob.mx/mortalidad. Accessed on 29 December 2011.
have sizable dengue control programs, but the U.S.
has more limited and inconsistent programs to that
end.
Rocky Mountain spotted fever (RMSF), caused
by Rickettsia rickettsii, is a tick-borne disease with
epidemic potential that has been reported in U.S.Mexico border areas. During 2010, 1,682 cases of
RMSF were reported in the United States. Arizona
reported 41 cases during this time period (69), all
associated with tribal lands and transmission from
Rhipicephalussanguineus, the brown dog tick (70).
The disease has also been reported along the
Mexican side of the border. During 2009–2010,
over 1,000 cases of RMSF were reported in Mexicali,
Mexico. The Mexicali outbreak was also linked to
transmission by Rhipicephalussanguineus, and spread
through infected ticks by stray and free-roaming
dogs (71) Subsequent surveillance efforts have
suggested that sporadic RMSF cases, likely associated with the brown dog tick, are widespread
throughout many Mexican border states.
represent nearly half (49%) of the total deaths from
West Nile virus infections reported in the U.S. in
2010. From 2006 to 2010, the number of reported
West Nile Virus cases and deaths in the U.S. border
states decreased by about half (64, 65). In the
Mexican border states only one West Nile virus case,
in Nuevo León in 2010, was reported. However, the
number of cases reported on the U.S. side of the
border, with markedly similar ecology, suggests that
West Nile virus may be a health concern along both
sides of the border (66).
Nuevo León, Sonora, and Tamaulipas are the
Mexican border states with the highest risk for
dengue fever. In 2010, Nuevo León reported 12,464
cases of dengue fever and 141 of dengue hemorrhagic fever, Sonora reported 3,588 and 191 cases,
respectively, and Tamaulipas reported 1,361 and 186
cases, respectively (66). The last reported continental
dengue activity on the U.S. side of the border was in
south Texas in 2005, when a local case of dengue
hemorrhagic fever was reported in Brownsville,
Texas. The number of cases in the U.S. may be
underreported, however (67, 68). Beginning in 2009,
all dengue infections diagnosed in the U.S. have
been reportable to the U.S. Centers for Disease
Control and Prevention. Most Mexican border states
Vaccine-preventable Diseases
Childhood immunization programs have been a
success in both countries and in the border area
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females (5.0) and African Americans had the highest
rate (36.8) (78). In 2008, New Mexico reported
1,458 new cases of HIV and 4,356 new cases of
AIDS (88% males) (79). California reported 29,939
new cases of HIV and 138,013 of AIDS (89% males)
(80).
In 2007, reported new cases of HIV in the
Mexican border states ranged from 12 in Coahuila to
91 in Tamaulipas; reported new cases of that same
year ranged from 5 in Coahuila to 85 in Baja
California, with a mortality rate between 3.1 deaths
per 100,000 population in Coahuila to 9.5 in Baja
California (81).
In 2010, the incidence rates of congenital
syphilis reported in the Mexican border northern
states were among the highest in the nation. Rates
were the highest in Baja California (0.3 per 1,000
population under 1 year) and Sonora (0.21), compared
to 0.03 for the nation (82) In the U.S. border states in
2010, congenital syphilis ranged from 0.0 cases per
100,000 live births in New Mexico to 25.3 in Texas,
compared to 8.7 for the nation (83).
itself. Immunization coverage in 2009 with a
complete vaccine series in the U.S. border states
(four doses of diphtheria, tetanus, and pertussis
[DtaP] vaccine; three of polio; one of measles,
mumps, and rubella [MMR]; three doses of
Haemophilus influenzae type b vaccine; three of
hepatitis B; and one dose of varicella vaccine by a
child’s second birthday) ranged from 84.2% in New
Mexico to 87.9% in California. It should be noted
that some border counties had significantly lower
coverage. For example, the coverage in Imperial
County, California, and Doña Ana County, New
Mexico, was 65% and 57%, respectively. The coverage improves to over 95% by the fifth birthday
because of compulsory vaccination laws for school
entry. Coverage of fully immunized children 1–4
years old in the six Mexican border states by the end
of the second quarter of 2009 ranged from 93.9% in
Chihuahua to 99.4% in Tamaulipas (72, 73, 74).
In 2007, the incidence of acute hepatitis A and
hepatitis B in the U.S. border states was 1.6 and 1.1
cases per 100,000 population, respectively, in
California; 2.4 and 1.3 in Arizona; 0.6 and 0.7 in
New Mexico; and 1.1 and 3.1 in Texas. For 2006–
2010, the six Mexican border states reported 13,553
cases of hepatitis A and 557 cases of hepatitis B, with
Sonora having the highest number of hepatitis A
cases (4,329 cases, 162 cases per 100,000 population)
and Tamaulipas having the highest number of
hepatitis B cases (132 cases, 4 cases per 100,000
population) (4, 75, 76).
Tuberculosis
Tuberculosis (TB) continues to be a concern along
the border. For the U.S. border states, in 2009,
California reported the highest incidence rate in the
region (6.7 cases per 100,000 population), followed
by Texas (6.1), Arizona (3.5), and New Mexico
(2.4). California had the highest incidence rate in the
continental U.S. and the highest number of cases
(2,470) in the nation. However, the rate was about
13% lower than the 2005 state rate. The decrease has
been less among foreign-born persons, who comprise
about 60% of all reported cases (84, 85).
The six Mexican border states reported TB
incidence rates higher than the national average of
13.5 cases per 100,000 population in 2007. Baja
California reported the highest incidence rate (38.3)
and the highest number of cases (1,147) in the
border area and the nation, followed by Tamaulipas
(32.4 and 1,011), Sonora (26.1 and 644), Chihuahua
(18.4 and 612), Nuevo León (18.1 and 783), and
Coahuila (16.7 and 430). With the exception of
Sonora, these rates were significantly lower than the
HIV/AIDS and Other Sexually-transmitted Infections
In 2009, along the U.S. side of the border, Arizona
reported a total of 676 (587 males and 89 females)
newly reported cases of HIV/AIDS, with an
incidence rate of 10.2 cases per 100,000 population
and a death rate of 1.6 deaths per 100,000
population (77). Texas reported a total of 4,230
(3,289 males and 941 females) newly reported cases
of HIV infection, with an incidence rate of 17.1
(26.5 for males and 7.6 for females). African
Americans had the highest incidence rates of HIV
infection (62.7) in Texas. In addition, males had a
higher incidence rate of AIDS (15.6/100,000) than
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population), none of the border states surpassed
national incidence rates. The age-adjusted mortality
rates for the top five cancer sites were: lung and
bronchus (37.8–47.6 deaths per 100,000 U.S.
standard population), female breast (20.1–22.6),
prostate (19.1–24.5), colon and rectum (14.5–16.4),
and pancreas (9.4–10.4) (90, 91). For the Mexican
border states of Chihuahua and Sonora, in 2008 the
mortality rates for the top three cancer sites were:
lung and bronchus (11.1 and 13.0 deaths per 100,000
population), female breast (6.8 and 6.9), and colon
and rectum (4.9 and 5.7) (28).
2002 rates. In Sonora, the incidence rate increased
about 18% between 2002 and 2007 (86).
Emerging Diseases
The first two H1N1 influenza sentinel cases in the
border area were detected and confirmed in San
Diego and Imperial Valley, California (87).
California reported 596 fatal H1N1 influenza cases
between April 2009 and August 2010. In 2009,
Mexico reported 2,074 confirmed cases in Baja
California (54.77/100,000 population), 1,142 in
Chihuahua (34.23), 398 in Coahuila (15.63), 3,902
in Nuevo León (90.76), 2,377 in Sonora (105.55),
and 2,281 in Tamaulipas (71.28) (66, 88).
Diabetes
For the Mexican border states in 2009, the rate of
new cases of type 2 diabetes mellitus ranged from
346 cases per 100,000 population in Sonora to 621 in
Coahuila, compared to 397 for the nation. Only
Sonora had an incidence rate below the national
average (76). For the U.S. border states in 2009, the
age-adjusted rate of new cases of diabetes ranged
from 860 in California and New Mexico to 1,010 in
Arizona, compared to 840 for the nation. Between
2000 and 2009, the number of adults diagnosed with
diabetes since 1994 increased 49.5% in Arizona, 43%
in Texas, 37% in New Mexico, and 32% in
California. Native Americans, African Americans,
and Hispanics have higher rates after adjusting for
population age differences. For example, the 2009
death rate from diabetes for Native Americans in
Arizona was about 245% higher than the state rate
for total population (61, 92, 93).
Chronic, Noncommunicable Diseases
Cardiovascular Diseases
In 2008, the crude mortality rates due to heart
disease in the Mexican border states ranged from
78.0 deaths per 100,000 population in Baja
California to 112.2 in Sonora and Chihuahua,
compared to 86.9 for the nation. The main
contributor to heart disease mortality was mortality
from ischemic heart disease (28). For the U.S. border
states in 2007, the crude mortality rates due to heart
disease ranged from 162.5 deaths per 100,000
population in Arizona to 168.8 in California, lower
than the 204.3 for the nation. These rates were about
15% to 18% lower than the 2003 rates (89).
Malignant Neoplasms
Nutritional Diseases
Malignant neoplasms continue to be either the
second or third leading cause of death in all four U.S.
and all six Mexican border states. For the U.S.
border states in 2007, the age-adjusted incidence
rates for the top five cancer sites were: prostate
(120.0–151.7 cases per 100,000 population), female
breast (99.9–122.2), lung and bronchus (44.5–61.9),
colon and rectum (34.3–43.9), and corpus and uterus
(not otherwise specified) (18.7–22.4). With the
exception of the incidence rate for female breast
cancer in California (122.2 cases per 100,000
Obesity
In 2010, the age-adjusted percentage of adults who
were obese (body mass index > 30) in the U.S.
border states ranged from 24% in California to 31%
in Texas, compared to 33.8% for the nation. In 2009,
the prevalence of obesity among low-income children aged 2 to 4 years was 10%–15% in Arizona and
New Mexico and 15%–20% in California and Texas,
compared to about 15% for the nation (94, 95).
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UNITED STATES–MEXICO BORDER AREA
A survey conducted in 2006 (95) indicated that
the prevalence of abdominal obesity in adults in the
Mexican border states ranged from 76.9% in Baja
California to 82.9% in Tamaulipas (the highest of
the nation). Excessive weight gain, obesity, and
abdominal obesity have increased among adults
compared to a 2000 national study. Among the
many possible explanations cited for the increases
were factors related to urbanization, increased access
to unhealthy foods, and lack of opportunities for
physical activity.
in Chihuahua, compared to 15.1% for the nation (98).
For the U.S. border states, the prevalence of heavy
drinking in men (defined as consuming an average of
more than two drinks per day) ranged from 5.2% in
New Mexico to 6.9% in California, compared to 5.7%
for the nation. The prevalence of heavy drinking
consumption in women (consuming an average of
more than one drink per day) ranged from 3.5% in
New Mexico to 4.9% in California, compared to 4.2%
for the nation (99, 100, 101).
Mental Disorders
HEALTH POLICIES, THE HEALTH SYSTEM,
AND SOCIAL PROTECTION
The rate of suicide deaths has declined in the United
States–Mexico border region over the past decade,
but remains relatively high in certain states and
communities. In 2007, New Mexico had the highest
rate of suicides among U.S. border states (20.4
deaths per 100,000 population), followed by Arizona
(16.0), Texas (10.2), and California (9.9), compared
to 11.3 for the nation, rendering suicide the 10th
leading cause of death in this geographical region.
Almost four times as many males as females died by
suicide in the U.S. and it was the third leading cause
of death for young people ages 15 to 24 (89, 96). For
the Mexican border states, in 2008 Sonora had the
highest rate of suicides (7.6 deaths per 100,000
population), followed by Chihuahua (6.9), Coahuila
(5.8), Nuevo León (5.6), Tamaulipas (4.5), and Baja
California (4.1), compared to 4.4 for the nation,
corresponding to about 23% of the suicides for the
nation. About 80%–90% of suicides were males in
Mexican border states (63, 97).
HEALTH SYSTEMS AND SERVICES
In the United States, the health care system is
characterized by a demand model and health care is
delivered through a fee-for-service system. Health
services are provided primarily by nonprofit institutions and private entities. Native Americans also
receive services through the public Indian Health
Service. In 2008–2009, private health insurance
coverage ranged from 44% in New Mexico to 53%
in California. Public health insurance such as
Medicare (for an individual over 65 years of age who
has been a U.S. citizen or permanent legal resident for
five years) covered 9%–12% of the population and
Medicaid (for low-income and disabled U.S. citizens
or permanent legal residents) covered 15%–19% of the
population. The uninsured population in the border
states was higher than for the nation as a whole, from
19% in California to 26% in Texas, compared to 17%
for the nation. The uninsured population in the three
most populous border counties of Texas was 33% (102,
103); with this high percentage of population lacking
health insurance, Texas faces a significant challenge of
uncompensated health care. In 2008, Texas hospitals
reported US$ 13.6 billion in uncompensated care
charges (104). The federal Patient Protection and
Affordable Care Act of March 2010 put in place a
comprehensive health insurance reform to expand
health insurance coverage (105).
In Mexico, health is considered a constitutional
right, but there is no universal health care coverage.
Risk and Protection Factors
Alcoholism
In 2008, the prevalence of heavy drinking in men
(defined as having more than five drinks per occasion)
in the Mexican border states ranged from 23.6% in
Baja California to 47.5% in Nuevo León, compared to
39.1% for the nation. The prevalence of heavy
drinking in women (having more than four drinks
per occasion) ranged from 9.6% in Coahuila to 14.1%
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HEALTH IN THE AMERICAS, 2012 N COUNTRY VOLUME
Maintaining the health workforce in the border
region faces a number of challenges, including a lack of
medical and public health higher education institutions. There are 19 schools offering medical education
and 12 schools offering graduate degrees in public
health in the U.S. border states and 19 medical schools
and 15 public health programs in the Mexican border
states. New investments in health education have been
made in the U.S. border counties since 2006. For
example, a new master in public health program was
started at the University of Texas in El Paso in 2008
and a medical school was created in El Paso, Texas in
2009 (109). It has been equally challenging to attract a
health workforce within the border region.
For the U.S. border states in 2009, the number
of hospital beds ranged from 1.9 per 1,000 population
in California (0.4 in state/local government facilities,
1.2 in nonprofit facilities, and 0.3 in for-profit
facilities) to 2.5 in Texas (0.4 in state/local government facilities, 1.1 in nonprofit facilities, and 1.0 in
for-profit facilities), compared to 2.6 for the nation
(0.4 in state/local government facilities, 1.8 in nonprofit facilities, and 0.4 in for-profit facilities).
Hospital admissions ranged from 91 per 1,000
population in New Mexico to 107 in Arizona,
compared to 116 for the nation, and hospital
emergency room visits ranged from 286 per 1,000
population in California to 413 in New Mexico,
compared to 415 for the nation (102). In the Mexican
border states in 2009, the number of beds in facilities
of the National Health System (excluding facilities of
the Secretary of National Defense) ranged from 0.6
per 1,000 population in Baja California to 1.0 in
Sonora, compared to 0.7 for the nation (107).
Public and private institutions provide health care
services. In 2009, the uninsured population in the
Mexican border states ranged from 20% in Nuevo
León to 28% in Baja California, lower than the 34%
for the nation. An insurance system known as
‘‘Seguro Popular’’ became available in 2002 to provide
health service coverage, through voluntary enrollment,
for persons who are not affiliated to the country’s social
security scheme (106). Between 2002 and 2009, more
than 500,000 families from border municipalities and
over 2 million families from the border states enrolled
in this system (107).
The U.S. and Mexican health care systems have
various programs and projects in place to promote
health services along the border. For example, the
Binational Health Week and Border Binational
Health Week promote public health care, outreach,
and immunization services every October, reaching
vulnerable groups along the border. The Ventanillas de
Salud (health stations) program provides on-site health
advice and outreach at Mexican Consulates in the U.S.
to low-income and Hispanic migrant families unfamiliar with the U.S. health system. It was launched in
San Diego and Los Angeles in 2002 and has expanded
to include all 50 consular offices in the U.S. (108).
HUMAN RESOURCES
The number of professionally active physicians per
10,000 civilian population for the U.S. border states
in 2008 ranged from 21.5 in Texas to 26.2 in
California, lower than the 27.7 for the nation. In
Texas, most border counties are federally designated
as medically underserved areas (having too few
primary health care providers). In 2007, the number
of professionally active dentists per 10,000 civilian
population ranged from 4.6 in Texas and New
Mexico to 7.6 in California, compared to 6.0 for the
nation. In 2010, the number of registered nurses per
10,000 population ranged from 64.4 in California to
70.1 in Texas, compared to 86.0 for the nation (102).
The number of physicians per 10,000 population for
the Mexican border states in 2009 ranged from 14.6
in Baja California to 20.2 in Sonora, compared to
16.9 for the nation (107).
KNOWLEDGE, TECHNOLOGY,
INFORMATION, AND HUMAN RESOURCE
MANAGEMENT
EVIDENCE-BASED PRACTICE AND INFORMATION
ACCESS
Since 2008, the U.S. Health Resources and Services
Administration has been working closely with
academic institutions, health sciences libraries, and
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UNITED STATES–MEXICO BORDER AREA
Commission (BECC) and its sister institution, the
North American Development Bank (NADB) (113);
the Border 2012 Environmental Program (114); the
Border Governor’s Conference (115); the Border
Legislative Conference (116); the Coalition of
Border Mayors; and PAHO/WHO’s U.S.-Mexico
Border Office.
The U.S.-Mexico Border Health Commission
was created as a binational health commission in July
2000 and was charged with providing leadership to
optimize health and quality of life along the border.
Commission membership includes the Minister of
Health of Mexico and the U.S. Secretary of Health,
the chief health officers of the 10 border states, and
prominent health professionals from both nations.
During 2006–2010 the Commission held several
research forums (117), established expert panels,
sponsored activities each year for the National Infant
Immunization Week and Vaccination Week in the
Americas, supported a tuberculosis working group,
and established a tuberculosis consortium. Each year
the Commission has sponsored activities for the
Binational Border Health Week, including workshops and seminars on topics such as health
diplomacy, tobacco policy, and diabetes prevention
(86).
The Binational Health Councils (BHC) were
originally established as local chapters of the U.S.Mexico Border Health Association, which stopped
operations in 2010. There are 16 Councils, consisting of volunteer members from local health services
and community organizations from both sides of the
border. In June 2008, the Councils defined borderwide health priority areas for 2009–2011. Most
Councils identified TB and issues associated with
diabetes, obesity, and nutrition among their priorities. At least half of the Councils identified dengue
fever; the Early Warning Infectious Disease
Surveillance program; issues relating to mental
health, substance abuse, and domestic violence; and
HIV/AIDS and other sexually-transmitted infections as issues of leading concern (118).
The Border Environment Cooperation Commission and the North American Development
Bank were created as interdependent institutions
in 1993 under a side agreement to NAFTA. Both
the U.S. National Library of Medicine to assess the
need and implementation of evidence-based practice
approaches that contribute to strengthening health
systems and improving health care in the border
region (110). As a result, Frontera Collaboration
(‘‘Border Collaboration’’) was created to bring
together members of the Border Virtual Health
Library and the National Network of Libraries of
Medicine in the U.S. border states to improve the
evidence-based practice skills and information access
of health professionals working in rural clinics and
community health centers (111).
HEALTH INFORMATION TECHNOLOGY
In the U.S., substantial progress has been made
toward the establishment of the National Health
Information Infrastructure, particularly in setting
standards to harmonize information systems and
enhance interoperability. Since 2003, the U.S.
Department of Health and Human Services has
allocated over US$ 40.6 million to northern and
southern border states for this purpose. Combined
allocations for Arizona, California, New Mexico,
and Texas exceed US$ 30.5 million for the U.S.
Border State Early Warning Infectious Disease
Surveillance Project (EWIDS) (112). In the U.S.Mexico border area, EWIDS and the Border
Infectious Disease Surveillance Program collaboration demonstrated its relevancy during the 2009
H1N1 influenza pandemic through exchange of
surveillance findings, distribution of laboratory
supplies, availability of highly trained technical staff,
and training of public health personnel.
HEALTH AND INTERNATIONAL
COOPERATION
There are several transnational agreements, alliances,
and partnerships along the U.S.-Mexico border. The
most notable are the U.S.-Mexico Border Health
Commission (86); the Binational Health Councils;
the International Boundary and Water Commission
(IBWC); the Border Environment Cooperation
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HEALTH IN THE AMERICAS, 2012 N COUNTRY VOLUME
entities were intended to improve environmental
conditions along the U.S.-Mexico. They work
with communities and project sponsors to develop,
finance, and build sustainable projects that address
human health and environmental needs. Between
1995 and 2010 the Border Environment
Cooperation Commission certified 175 projects—93
in Mexico and 82 in the U.S.—with an estimated
total cost of US$ 3.924 billion. These projects
provided access to safe and sanitary water infrastructure, increased wastewater management efficiency, enhanced proper waste disposal, and
improved air quality related to paving to approximately 7.2 million border residents (113).
Strategies such as Healthy Border 2012, an initiative
of the U.S.-Mexico Border Health Commission
(119) and the Border 2020 Environmental Program
(120), administered by Mexico’s Secretariat for
the
Environment and
Natural Resources
(SEMARNAT) and the U.S. Environmental
Protection Agency (EPA), will set important
benchmarks to improve health and quality of life
along the border. Finally, increasing investments in
health education, including the establishment of new
medical and public health schools in the area, will
provide much needed opportunities for young
professionals to stay and work in the border
region.
SYNTHESIS AND PROSPECTS
REFERENCES
1. United States of America and United Mexican
States. La Paz Agreement: agreement between
the United States of America and the United
Mexican States on cooperation for the protection and improvement of the environment in
the border area. La Paz, Baja California,
México; 1983.
2. United States-Mexico Border Health Commission. Healthy Border 2010. An agenda for
improving health on the United StatesMexico border. El Paso, TX, and Mexico.
U.S.-Mexico Border Health Commission;
2003.
3. United States, Census Bureau. 2009 American
Community Survey 1-year estimates [Internet];
2009. Available at: http://factfinder.census.gov/
servlet/CTGeoSearchByListServlet?ds_
name5ACS_2009_1YR_G00_&_lang5en&_
ts5327254662201 Accessed on 29 December
2011.
4. Instituto Nacional de Estadı́stica y Geografı́a.
Censo de Población y Vivienda 2010.
Cuestionario básico [Internet]; 2010. Available
at: http: //www3.inegi.org.mx/sistemas/
TabuladosBasicos/Default.aspx?c527302&
s5est Accessed on 29 December 2011.
5. United States, Census Bureau. 2005–2009
American Community Survey 5-year estimates
This chapter shows that differences in economic
development persist between both sides of the U.S.
Mexico border region and that significant differences
persist along the U.S. side of the border. Water
supplies in the area are already stressed and are
projected to become increasingly scarce in the next
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