Agency to Address Border Health Issues

A new state health agency has begun efforts to confront some of the most stubborn and complex health issues along California’s border with Mexico, ranging from tuberculosis to the smuggling of pharmaceuticals.

The Office of Binational Border Health opened in San Diego in December, the product of legislation signed last year by Gov. Gray Davis. The agency, with a staff of eight plus two specialists assigned by the federal government, represents a much-expanded state role in border health issues. The state previously made do with a public health nurse on loan from San Diego County.

Some see the initiative, which was written by Assemblywoman Denise Ducheny (D-San Diego), as long overdue in a region where poverty and a host of diseases outpace U.S. averages, and the flow of millions of commuters and seasonal migrants back and forth across the border defies simple solutions.

As an additional sign of attention to health issues amid growing binational contact, Los Angeles, San Diego and Imperial counties all have their own border health offices. (Though Los Angeles County does not touch the border, its proximity and sizable Mexican immigrant population mean it is directly affected by many border issues.)

“It’s about time. It’s been an issue in California for many years,” said Robin Raecker, assistant public health director in Imperial County, which opened its one-person border health office two years ago.

The new office in San Diego, with a $750,000 budget, will not treat patients. Rather, officials say, the agency will act as an information clearinghouse and nerve center for a variety of border projects by federal, state and county health agencies. The office is housed at the San Diego County health department, alongside the county’s two-person border team.

Widespread poverty, lack of insurance, free-flowing international traffic, and disparities in health conditions between the two countries give the border an especially tricky set of realities when it comes to prevention and treatment of disease.

Some illnesses, such as hepatitis A and tuberculosis, appear among the 12 million U.S. border residents at rates well above national averages. The TB rate in rural Imperial County, more than triple the national average, tops U.S. border counties; California and Baja California report the greatest number of tuberculosis cases among border states of each nation.

Pollution and poor sanitation along both sides of the border contribute to higher than normal incidences of dysentery and food poisoning, as well as respiratory diseases.

A higher rate of AIDS in the United States seems to have contributed to elevated risk in Mexican border states such as Baja California, where the rate is several times higher than for the rest of Mexico. The incidence of AIDS in the San Diego and Tijuana region is the highest of any stretch of the border.

“The communities are so intertwined. There’s so much travel back and forth, it’s almost one community,” said Alvaro Garza, who heads the state border office. “All of that requires us to work more carefully together to ensure the health of both sides.”

Among the projects is an effort, already underway, to design a uniform system for reporting ordinary diseases on each side of the border. Currently, the way diseases such as hepatitis and measles are diagnosed and labeled varies because U.S. physicians make far greater use of laboratory testing than their Mexican counterparts, said Stephen Waterman, an epidemiologist assigned to the border office by the federal Centers for Disease Control and Prevention.

“Just as NAFTA is trying to merge two economic systems, this is the first step to merging the disease surveillance systems of the two countries,” said Waterman, who will monitor the entire 2,000-mile U.S.-Mexico border.

One of the state staffers will be assigned full-time work with Mexican authorities and U.S. food inspection officials at the border to beef up the oversight of food imported from Mexico. Officials plan to name a specialist to focus on cross-border sexually transmitted diseases, such as syphilis, which is a more severe problem in Mexico but is sometimes carried to California farming regions by migrant workers.

Yet another staffer will be assigned full time to combat the problem of medications imported and dispensed illegally at swap meets north of the border. Los Angeles County’s border office has made illegal pharmaceuticals its chief focus through a public relations campaign.

Health experts concede that rapid breakthroughs are unlikely, but they point to gains in recent years in coping with cross-border TB patients, who, through a binational network, now can be referred by a physician in one country to a doctor in the other so that months-long drug therapy is not interrupted by travel for seasonal work.

At the same time, after several years of delays, the United States has installed members of a new binational health commission to discuss borderwide health issues. Mexico has yet to name its delegation. And the U.S. Health Resources and Services Administration in 1996 launched a border health program, disbursing $200 million for immunization and other health services.

California official Garza said coordination with Mexican officials will be a central concern of the new effort at San Diego’s border, where ambitious binational plans often run up against cultural differences and shortages of government resources in Mexico.

“The challenge is being two different systems, two different countries, two different cultures,” Garza said.