VIII Border Legislative Conference Santa Fe, NM July 9, 2004

1. VIII Border Legislative Conference Santa Fe, NM July 9, 2004

2. Welcome to the third coast

4. The U.S. - Mexico Border is Characterized by: • Different cultures and languages (historically agricultural) • Different economic development & severe macro-economic issues • High population growth • Different health systems • Higher unemployment rates in the U.S. border • Migrant and immigrant challenges and opportunities • Beautiful region with a mystique, soul and spirit of its own, share a common destiny • All of the above blend on the borderUSMBHA, 1998

5. More than 13 million inhabitants 400 million border north-bound crossings annually (INS 1999)

6. If the U.S.-Mexico Border were a separate state, it would rank... • Last in access to health care; • Second in death rates due to hepatitis; • Third in deaths related to diabetes; • First in the number of cases of TB; • First in school children living in poverty; and • Last in per capita income. Texas Controller Report 2000

7. United States- Mexico Border Population, 2000 59% of the population lives in the U.S. Border states 79% of the U.S. Border population is of Hispanic origin 40% of the population lives in the Mexico border states 48% of the border population is under 20 years of age PAHO, Mortality Profiles, 1999

8. Populations affected include • Border crossers (documented & undocumented) • Immigrant, migrant and seasonal workers • Refugees and displaced workers • Border impact communities • Tribal nations and reservations NCFH, 1999

9. Poverty Conditions • 38% fall below 200% of U.S. Federal poverty levels • Unemployment rate is 2.5 - 3 times higher than U.S. average • 3 of the 5 poorest cities and 4 of the 10 poorest U.S. counties are in this area • 37 of 44 counties in immediate border area are Health Professional Shortage Areas

10. Commission Mission “To provide international leadership to optimize health and quality of life along the United States-Mexico border.”

11. Commission History • 1988-1994: Intense border, States, and American Medical Association advocacy and legislative efforts; • 1994-Commission has its origins in Public Law 103-400. Authorized the President to enter into an agreement with Mexico; • July 2000-Signing of the International Agreement creates the Commission; and • November 2000-Commission held its 1st Binational Meeting.

12. Purpose • To identify and evaluate current and future health problems affecting the population in the United States-Mexico border area. • To encourage and facilitate actions to address these problems.

13. Goals • To institutionalize a domestic focus on border health which would transcend political changes • To create an effective venue for binational discussion to address public health issues and problems

14. Roles • Promote social and community participation; • Act as a catalyst for needed change; • Act as a policy advocate; • Increase resources for the border; • Encourage self-responsibility for health; and • Facilitate Border Early Warning Infectious Disease Surveillance Project.

15. Composition and Structure • Two sovereign nations and two cultures • Ten border states • 44 counties and 80 municipalities • 14 pairs of sister cities • International organization • 26 Commission Members, two sections and three standing committees • U.S. Inter Agency Border Action Team

16. Basic Elements of Border Cooperation • Identification of common problems and opportunities • Recognition that each country is independent • Trust and respect • Consensus in decision making • Equitable allocation of resources

17. Commission State and Regional Outreach Offices

18. Outreach Office Roles • Assure that the Commission mission and outreach plans are carried out at the local and bilateral level; • Promote Healthy Border 2010 Program; • Complement the local State Border Health Office’s mission by coordinating work plan activities and bilateral efforts with Commission and local organizations.

19. Healthy Border Program • Based on Healthy People and Healthy Gente 2010 • Grounded in science; build through consensus; and designed to measure progress • Focus attention on key health issues • Improve allocation of health resources • Coordinate public and private action • Inspire ownership of objectives through: • coordinated program activities • community projects

20. Access to Care Cancer Diabetes Environmental Health HIV/AIDS Immunization Infectious Diseases Healthy Border 2010 Agenda • Injury Prevention • Maternal, Infant and Child Health • Mental Health (Suicide) • Oral Health • Respiratory Disease (Asthma) • Terrorism Preparedness * * Developmental theme

21. Publication To download a copy, visit www.borderhealth.org

22. Ten Great Public Health AchievementsUnited States, 1900 - 2000 • Vaccination • Motor – vehicle safety • Safer workplaces • Control of infectious diseases • Decline in deaths from coronary heart diseases and stroke • Safer and healthier foods • Healthier mothers and babies • Family planning • Fluoridation of drinking water • Tobacco is a health hazard

23. Existing Challenges • High health and medical cost • Higher uninsured rates • Disproportionate reimbursements • Significant uncompensated care • Significant health disparities • High poverty rates and lower educational attainment

24. Our Vision A border where diseases are prevented when possible, controlled when necessary and treated when appropriate. Reducing burden of disease: Obesity Diabetes Asthma Addressing risk factors: Poor Diet/Nutrition Lack of Physical activity Tobacco use Youth risk tasking

25. Border HealthInformation Network • Web based communication system • Developed jointly with Mexico • Designed to improve communications and collaboration among health professionals • Geographic Information System Tools

27. Mapping Service • Online mapping designed to serve our partners needs; • Tool to map and query HB health indicators; • Assist decision makers in monitoring and assessing health needs; • Completed the 1st phase; and • Gathering health data

28. For more information, please visit www.borderhealth.org

29. United States-Mexico Binational TB Referral and Case Management Project • Binational TB Card- a portable health document • Insures continuity of care and completion of TB treatment • Coordinates the referral of patients between health systems of both countries For information , please visit www.borderhealth.org

30. 2004 Work Plan • Commission infrastructure: • Operation of U.S. and Mexico Sections • Information technology • Assessment, surveillance & evaluation • Behavioral Risk Factor Surveillance Survey (BRFSS) • Healthy Border outreach plans: performance focus • Health innovation and best practices • Border Binational Health Week • Immunization Week in the Americas • Binational public emergency preparedness

31. Planning and Response to Public Health Emergencies Forums • Sonora-Arizona • Chihuahua-New Mexico-Texas • Mexico-Texas Border States • Baja California-California

32. Early Warning Infectious Disease Surveillance (EWIDS) • Enhance the infectious disease surveillance capabilities along the United States-Mexico Border by creating public health preparedness systems in the six Mexican Border States that are interoperable with one another and with those of the four United States Border States. • A collaboration between the Commission, Mexico Secretariat of Health, U.S. Department of Health and Human Services, and CDC.

33. Core Recommendations to Governments • Access to Health Care • Disease Prevention and Health Education • Health Workforce Needs • Public Health Infrastructure Improvements

34. USDHHS Inter Agency Border Action Team Dissemination of 2004 - 2005 Healthy Border Calendar December 12, 2003 Mexico Sectretariat of Health State Health Offices U.S.-Mexico Border Binational Health Week “Families in Action for Health” Healthy Border Health Cards “Tarjetas de Salud” Summer of 2004 USMBHC Healthy Border 2010 Program October 11 - 17, 2004 U.S.-Mexico Border Immunization Week in the Americas World Tuberculosis (TB) Day March 24, 2004 Border Celebration in Tijuana, Baja California April 1st Love them. Protect them. Immunize them. World Health Day “Road Safety” April 7, 2004 Binational Conference on Transportation and Road Safety April 14 –16, 2004 South Padre Island, TX 1st Wk is April 24-30 (1st Dose) 2nd Wk is July 31-August 6 (2nd Dose) 3rd Wk is October 11-17 (3rd Dose) Border Health Offices Outreach Offices U.S.-Mexico Core Partners

35. Border Binational Health Week October 11- 17 Inauguration hosted by Arizona – Sonora, October 12 Closing events hosted by Texas – New Mexico, October 15

36. Goal Advance the implementation of the Healthy Border 2010 Program, by: Encouraging and creating sustainable efforts, organizational relationships, and community networks to improve health status; and Address health disparities in a border wide manner.

37. Partnerships in place U.S. Department of Health and Human Services; Mexico Secretariat of Health; Health Resources and Services Administration; Office of Minority Health; The ten U.S.-Mexico Border States; USMBHC Outreach Offices/States Offices of Border Health; Centers for Disease Control and Prevention; California-Mexico Health Initiative; and Pan American Health Organization.

38. Theme: Families in Action to Improve Health Primary Topics: Access Immunization Healthy Life Styles Actions: Simple Practical Tangible Border Focused Binational Activities Services: Immunizations (Across Life Span) Screenings/Referrals Trainings Health Fairs/Fiestas Other

39. Expected Outcomes Share easy to understand health information, prevention and best practices; Strengthen community based organizational networks and structures and foster partnership opportunities in support of HB 2010 program; Exercise binational collaboration; Leverage financial, technical, organizational support and partnerships; and Establish benchmark indicators to document outcomes and progress.

40. Time Line October 11 • León, Guanajuato • Inauguration by President Fox and both Secretaries of Health and Policy Forum on Migrant Health • San Diego/Tijuana • Launch event with Promotoras Conference October 12 • Arizona-Sonora • Inauguration of Binational Health Week by Sec. Tommy Thompson and Sec. Julio Frenk Mora October 13 • Douglas/Agua Prieta • Children and Families, Immunizations, Heart Healthy

41. Time Line October 14 • Tohono O’odham Nation/Puerto Peñasco • Health fair, Physical Activity, Immunizations October 15 • Yuma and San Luis Counties • Health fair, Immunizations, Teens, Substance Abuse • San Diego/Tijuana • HIV/AIDS conference • Closing ceremony by Surgeon General Richard Carmona, Dr. Elizabeth Duke and Mexico Health officials in Paso del Norte region

42. Time Line October 16 • San Diego/Tijuana • Mobile units in northern San Diego County October 17 • San Diego/Tijuana • Mobile units in northern San Diego County

43. BORDER IMMUNIZATION WEEKS IN THE AMERICAS JULY 31 – AUGUST 6 & OCTOBER 11 - 17

45. Substance Abuse Illicit drug situation in the border is characterized by: • Heroin has surpassed crack with the most serious consequences; • Number of female heroin users has increased, seeing gender equity among a number of chronic drug users; • Marijuana remains the most widely abused illicit drug; Pulse Check 2002

46. Substance Abuse • Metamphetamine continues to be an emerging problem contributing to domestic violence; • Tobacco continues to be the number one preventable killer in America; and • Heightened security at U.S.-Mexico points of entry may have changed trafficking modes or routes. Pulse Check 2002

47. Challenges and Opportunities • Promote, fund and disseminate substance abuse education • Have accessible and affordable treatment services • Reduce demand and availability • Fund behavioral and mental health services • Fund comprehensive and effective prevention, education, and treatment programs

48. “Our challenge is to have a border, a world of order, characterized by peace and prosperity in the midst of diversity.”

49. Thank you for all that you do – Graciaspor todo lo que hacenFor more information:www.borderhealth.orgwww.saludfronteriza.org