Running head: Border health 1

Binational Health Issues: Literature Review

Alexa Ramirez

University of Texas at El Paso

Rhetoric 1302

Dr. Vierra

March 27, 2018

Border health 2

Abstract

The purpose of this study is to explore some of the different variables that influence and

affect cities and regions along the Border. The study seeks to answer all the research questions,

provide methods on how the research questions were answered and include graphical images and

references to support the research. The aim is to analyze the reasons behind why border regions

are affected with border health issues and healthcare policies as well as to determine if it’s

physical, social or economic factors impacting the border cities.

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Binational Health Issues: Literature Review

The United States and Mexico share more than just a 2000-mile border; both countries

are deeply connected economically and culturally. The sheer number of people who live, work

and travel between the United States and Mexico has led to a sharing of capital flow, commerce,

culture and unfortunately the transportation of infectious diseases. Thus, the large movement of

people residing and commuting in the border regions are being affected with the increase of

infectious diseases and low access to healthcare this is known as Border/Binational Health

Issues. The U.S south border population consists majorly of minorities, mixture of cultures and

high percentage of Hispanics. Border population are classified of having low health standards,

low socio-economic conditions and no access to healthcare when compare to the rest of the

nation. (Landeck, 2003) This affects the nation’s border regions because it creates conflict with

healthcare policies, fiscal issues and leaves the region to deal with the local border health issues.

With the increase of globalization, the border regions have been affected negatively when it

comes to health.

However, after years of studies and collaboration of the locals and the city, Public health

commissions and Doctors have been able to identify border health infections, diseases and issues

that affect the public. In the city of El Paso TX and Ciudad Juarez Chih. share a common border,

common airshed, mutual sources of water supply and the ever-present threat of diseases.

Ballesteros reviewed patients that corresponded to living or commuting in the border region and

found findings of diseases like Tuberculosis, Diabetes, waterborne infections, Obesity,

mosquitos’ transmissions etc. are examples of them. (Ballesteros, 2016) With the increase of

deaths, poverty and health issues it raised questions to the Border States to analyze the

surrounding areas of the border. In doing so, several important questions need to be considered:
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1. How do border health issues affect the border region and UTEP students
economically and socially?
2. How does living as a UTEP student in the border region increase the risk of

being affected by infectious diseases?

3. What is the nation, city, community and UTEP doing terms of implementing
ethical health security?
4. Do people that live in the border have the same healthcare access in
comparison to other cities in the nation?
The following review on literature will provide information, quantitative and qualitative research
performed on many border cities and countries like San Diego, Tijuana, Tucson, Guatemala and
Canada and coincidently the city of El Paso and Ciudad Juarez border. The four important
questions above will narrow down the purpose of this literature review by providing the
background of the conflict and the cause and effect of interdependent cities.

The Social and Economical Effects in the Border

The U.S-Mexico 2000-mile border is not just a physical division separating two countries

on the contrary the border is where both cities work together. They trade goods, people work on

either side of border, capital flow and commerce constantly on the go. The communities along

the border are economically and socially interdependent. The population of south border of the

United States majorly consists of Hispanics and Latinos. Not only is the border population

predominantly from spanish origin but also the University of Texas at El Paso. Since the

University sits in the border/sister city of El Paso not only is the city interdependent with Ciudad

Juarez but the country as a whole depends on each other. According to Feldheim, “health care

has been based on the capitalistic and market justice values giving priority to its profit-making

potentials leaving those in poor conditions, poverty or in lower classes with no health coverage”

(Feldheim, 1998). The border population is classified of having low health standards, low socio-
Border health 5

economic conditions and no access to healthcare when compare to the rest of the nation.

(Landeck, 2003) This number has since grown over the years with the rise of immigration and

globalization. Thus, border cities have been economically and socially impacted since

residents/locals fall under the low socio-economic conditions with low health standards. Not

benefiting to access health care coverage increases disease, the environmental factors lead to

disease and people start commuting to Mexico for medical services. Which leads to the next

question.

The Increase of infectious Diseases in the Border

Borders are located in the heart of two different countries with two different cultures. Not

only do people just reside on the border cities but people have families on either side, people

travel, work and commute daily and share similar air and water resources. Leading to the

increase risk of a plethora of diseases. A member of public health Commission, Dr. Cecilia

documents research on the increase of infectious diseases. Diseases and infections that are

present at borders are HIV, Tuberculosis, Obesity, Diabetes, Mosquitos, Hepatitis A, Influenza,

H1n1 and waterborne diseases. (Ballesteros, 2016) Not only through commuting and

interdependency of both countries increase the risk of disease but according to Homedes border

health security is extremely weak with low access to health care and with the rise of disease only

means chaos. If the border population and UTEP are at risk of the transmission of infectious

diseases due to environmental factors like the sharing of same air quality, water quantity and

quality, animal control are issues of great concerns and the American medical association has

characterized U.S-Mexico border as a fertile ground for the development of infectious diseases.

As well as the students who live in Mexico study here or vice versa. The Raters of Hepatitis A

are 3 times higher than in any part of the country. A recent study documented that the prevalence
Border health 6

of Hepatitis A among women visiting prenatal clinics in EL Paso and Ciudad Juarez the 2 largest

sister municipalities was 96.1% and 75.8%. (Hemedes, 2003) In the United States in

unincorporated poor neighborhoods known as colonias which comprise around 300,000

households; have rates of salmonella and shigella infection, 4 times higher than in the rest of

United States. Tuberculosis (TB) is endemic on both sides of the border and cases of dengue,

leprosy and rabies have been also detected. Thus, with the enormous amount of infections in the

border and with little or no access of health care this only escalates the transmission of infections

and deaths. Figure 2. “Infectious Diseases,” evidently shows a visual image provides support to

how a healthy population with environmental exposure leads to communicable diseases which

ends up in death. Border health is a real issue this leads to the next question.

Nation, City, Community and UTEP Actions

First globalization is understood as economic interdependence among nations. The North

American Free Trade Agreement also known as NAFTA is used as a marker to assess the effects
of economic interdependence on binational health cooperation along the United States-Mexico
Border. NAFTA signed in 1994 signaled the starting point of exponential increase of cross-
border transactions of goods and services of international capital flows between U.S, Mexico and
Canada. With the aim to assess the effects of the growing US-Mexican economic
interdependence created by NAFTA on binational health cooperation along the Border, was to
study the public health of certain cities and borders for example: Tamaulipas, Nuevo León,
Coahuila and Chihuahua. If economic interdependence were to have a positive effect on
international policymaking, we would observe improvements in binational health cooperation
along the United States–Mexico border. (Homedes, 2003) Thus the nation does have treaties
supposedly helping globalization but no focus on binational issues. However, since the national
government focus on globalization is more on an economic standpoint public health problems
are left unresolved.
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Leaving the state trying to develop solutions and plans to redesign binational disasters
organization of emergency services the development of shared information systems and referral
to facilitate continuity of care when a patient initiates case in 1 country and receives additional
care in a neighboring nation. The US priorities in public health do not include Mexican
counterparts, the former director of PAHO field office in El Paso clarified that for the Mexican
government the health problems of the northern border are not priority because the country has
many more problems in the south therefore the border cities in the US—Mexico border are left
with no support from a national level. Texas the binational border cooperation was not a priority
either. Texas government view is the success of Transborder cooperation depends on those who
work at the local level. Therefore the local communities and the University work together to
resolve the trans-border health problems. However the scarcity of local financial and human
resources is not taken into consideration. The city or local communities do not have the sufficient
funds to resolve this issues. El Paso official at the PAHO field station explained the border
activities initiated by the United States such as the TB program Ten against TB transmit a clear
message: “we want Mexico to resolve the problem so that it does not become a problem for us.”
Sister cities collaborated in neighboring municipalities routinely in mosquito control and other
public health activities (i.e., immunizations, emergency response, and control of infectious
diseases). The border has associations like PAHO, private foundations for the sole purpose of
allocating public funds for projects in borders and Mexico. In 1999 the state of Texas requested a
report to clarify federal and state law inhibiting get exchange of epidemiological reporting
between cross-border binational health cooperation. In conclusion border public health experts
indicate that NAFTA brought additional bureaucratic hurdles and did not help improve health
cooperation between 2 federal governments or neighboring states. The city and local
communities were responsible to ensure health security.

Health Care Accessibility

With the U.S side of the population is predominantly of Spanish origin, young and poor.
35% live under the official defined poverty level and it is estimated that the border population
grows faster. As seen in the image below 12 sister cities of the U.S-Mexico Border.
Border health 8

Border cities according to many observations, studies and census the border population

are categorized as low in socio-economics, high on poverty and making it quite difficult to being

able to afford health care in comparison to other parts of the nation. (Macias, 2001) Border cities

have a mixture of two different cultures and living in a neighboring city with cheaper medical

services many border residents have admitted to crossing the border to Mexico to get medical

attention.

Primary Research/ Methods

In this review of literature contended a conversation between sources. The main form of

primary research was a survey done to 20 University of El Paso students and 10 adults. The

survey research questions were simple and required for the subjects to answer with the best of

their knowledge without googling or searching any answers. The survey consisted of 5 close-

ended survey questions and 3 open-ended. In Figure 4. Titled Survey Research Questions,

provides a visual display of the survey questions asked as a primary research. Followed by

Figure 3. Which consists of 1 out of the 30 subjects who attempted the survey. Figure 3. Shows

the results of a 4.0 GPA student majoring in Psychology at the University of Texas at El Paso.

The primary research and methods done for the literature review and and topic was an arbitrary

survey on different majors of UTEP as well as 5 students with the same major and 10 adults. The

results were fascinating and will be further discussed in detail. As for now the main focus is how

I went about collecting my data.

Conclusion/Synthesis

In conclusion, this literary review has analyzed extensive amount of data and answered

the four major questions concerning the situation surrounding border health issues. Binational

Health issues situation is ever changing and finally being treated as a problem. There are many
Border health 9

health commissions on all southern Border States working on solutions and health policies.

Further public health organizations would need to be ongoing got to keep up with this

complicated border issues. This literature review presented quantity, quality data to cover all

different perspectives. Border health issues is now a more well-known problem around the globe.

Figure1. Sister Cities

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Figure 2. Infectious Diseases

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Figure 3. Example of a Subjects Answer

Figure 4. Survey Research Questions

References:
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Ballesteros, R., Scott, e., & Jill Eileen Guernsey De, Z. (2016). Editorial: Emergent public health
issues in the US-Mexico border region. Frontiers In Public Health, Vol 4 (2016),
doi:10.3389/fpubh.2016.00093/full

Brown, S.A, Garcia A. A., Kouzekanani. & Hanis, C. L (2002, February 01). Culturally
Competent Diabetes Self-Management Education for Mexican Americans.

Fatima Syed, T. S. (2017). Pitching our health care across the border. Toronto Star (Canada).

Feldheim, M. (1998). HEALTH CARE POLICY EVALUATION: A CONCEPTUAL MODEL

USING MEDICAL ETHICS. Journal of Health and Human Services
Administration, 21(2), 181-198. Retrieved from http://www.jstor.org/stable/41426765

Goldenberg, S. M., Jimenez, T. R., Brouwer, K. C., Silverman, J. G., & Miranda, S. M.
(2018). Influence of indoor work environments on health, safety, and human rights among
migrant sex workers at the Guatemala Mexico border: A call for occupational health and
safety interventions

Homedes, N., & Ugalde, A. (2003). Globalization and health at the United States–Mexico
border. Am J Public Health, 93(12), 2016-2022. 10.2105/AJPH.93.12.2016

Kozo, J., Rogelio Zapata-Garibay, Mara, G. R., Fernandez, A., Ricardo Hirata-Okamoto,
Wooten, W., . . . Charles, E. M. (2018). The border health consortium of the California’s-
Forming a binational (California, Baja California) entity to address the health of a border
region: A case study. Frontiers in Public Health, Vol 5
(2018), 10.3389/fpubh.2017.00368/full; 10.3389/fpubh.2017.00368

Landeck, M., & Garza, C. (2003). Utilization of physician health care services in Mexico by U.S.
Hispanic border residents. Health Marketing Quarterly, 20(1), 3-16.
10.1300/J026v20n01_02 \

Lara, M., Gamboa, C., Kahramanian, M. I., Morales, L. S., & Bautista, D. E. (2005).
ACCULTURATION AND LATINO HEALTH IN THE UNITED STATES: A Review of
the Literature and its Sociopolitical Context. Annual Review of Public Health, 26(1), 367-
397.
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Macias, E. P. & Morales, L. S. (2001). Crossing the Border for Health Care. Journal of Health
Care for the Poor and Underserved 12(1), 77-87. Johns Hopkins University Press.
Retrieved March 20, 2018, from Project MUSE database.
Richard Bath, C. (1982). Health and environmental problems: The role of the border in El Paso-
Ciudad Juárez coordination. Journal of Interamerican Studies and World Affairs, 24(3),
375-392. 10.2307/165503

Sapkota, S., Kohl, H. W., Gilchrist, J., McAuliffe, J., Parks, B., England, B., Nolte, K. B. (2006).
Unauthorized border crossings and migrant deaths: Arizona, New Mexico, and El Paso,
Texas, 2002–2003. Am J Public Health, 96(7), 1282-1287.10.2105/AJPH.2005.075168
Retrieved from https://doi.org/10.2105/AJPH.2005.075168

Su, D., Richardson, C., Wen, M., & Pagán, J. A. (2011). Cross-Border Utilization of Health
Care: Evidence from a Population-Based Study in South Texas. Health Services
Research, 46(3), 859–876.