U.S., Mexico Team Up on Health Care

The United States and Mexico took some imaginative steps this week to combat health problems that plague border communities and migrant workers, including tuberculosis, diabetes and AIDS.

Meeting in El Paso and neighboring Ciudad Juarez, Mexico, health experts from the two nations agreed on a 10-year agenda for improving care for the 11.5 million people living along the nearly 2,000-mile border.

Mexico also launched a program that promises a new approach to treating migrants’ health problems. Formally unveiled in Ciudad Juarez on Sunday, the “Go Healthy, Return Healthy” initiative seeks to help Mexican migrants in their hometowns, along the routes they travel and during their stays in the United States.

Elsewhere, California and Mexico kicked off the program by staging their first joint “health week.” California is conducting a flurry of activities through Friday for migrants in the state, including vaccinations, checkups and information campaigns. The California Endowment is devoting part of a $50-million agricultural health grant to the initiative.

The mere fact that U.S. Health and Human Services Secretary Tommy G. Thompson showed up for the U.S.-Mexico Border Health Commission meeting here Monday--despite an international anthrax scare--delighted the Mexicans, who have worried that U.S. relations with their nation would become a low priority for the Bush administration following the Sept. 11 terrorist attacks.

Officials from both nations emphasized that the border health problems are real and immediate threats, killing many thousands of people each year.

“We should not let the anthrax scare kidnap our entire health agenda,” said Mexican Health Secretary Julio Frenk. “There are a lot of other very important issues of much higher risk to our populations.”

Thompson, meanwhile, offered a challenge to the U.S. delegation to the year-old Border Health Commission: He’ll try to come up with an additional $25 million for health projects along the frontier if they can come up with specific, effective ways to spend the money.

A commission study issued Monday detailed the serious health challenges on the border, compounded by population growth of 28% on the U.S. side and 39% on the Mexican side during the 1990s, about twice the national growth rate in each country.

The study found that rates of communicable diseases such as tuberculosis, HIV/AIDS and hepatitis A are higher in the border region than nationally for both countries. Cancer, asthma and diabetes rates also are higher along the border.

“The high level of border crossings between the U.S. and Mexico complicates the development of strategies to address the spread of infectious diseases,” the report says, heightening the need for coordinated policies.

While the commission debated overall strategies, a workshop of about 100 experts on tuberculosis met to map out innovative cross-border approaches to tracking and caring for patients. The interruption of tuberculosis treatment is highly dangerous for patients because it can lead to resistance to medication. Yet such breaks in treatment occur frequently when ailing migrants cross illegally into the United States.

The workshop focused on development of a binational tuberculosis card that would allow patients to continue treatment on either side of the border with confidentiality. The card would not only ensure continuity in treatment but allow both countries to improve their database of tuberculosis cases.

Dr. Lincoln Chen, a public health expert from the Rockefeller Foundation, said such initiatives make the border region “the cutting edge of health in the 21st century. . . . This is the front line of global health.”

Thompson and Frenk visited sites that symbolize the emerging cooperation, from the La Fe health clinic in south El Paso, which treats many Latino AIDS patients, to a U.S. Food and Drug Administration inspection operation. In September, the two governments agreed to expand efforts to ensure the safety of meat, poultry and egg products that are shipped across the border in immense volumes.

In California, meanwhile, seven counties that are home to large numbers of migrant workers took part in the health week with Mexico. Jose Ignacio Santos, head of child health in Mexico and director of the “Go Healthy, Return Healthy” program, said the initiative brings to the U.S. some of the techniques that have made Mexico’s public health system highly regarded. Those include very public community outreach activities, which have helped achieve a 98% immunization rate.

In Mexico, the thrice-yearly National Public Health Weeks--such as one that began Sunday--bring vaccinations to the homes of millions of people. More than 11 million injections will be given in Mexico this week for childhood diseases, in programs supported by nearly 180,000 volunteers.

Similar efforts are being carried out this week in the seven California counties, with a focus on messages about cervical and breast cancer, immunizations and diabetes. The goal is to reach some of the more than 3 million Mexicans living and working in the state, especially the 1 million agricultural laborers.

Frenk, the health secretary, said that in the past, Mexico did not clearly understand the differences between treating stable and migrant populations. The new program acknowledges that migrants carry health problems with them as they leave home--and bring back ailments such as AIDS when they return from the United States.

Now officials are developing preventive and information programs in 502 towns in the 10 Mexican states that produce the most migrants, including Jalisco and Guanajuato.

The effort will also respond to the seasonal moves of the workers. For example, it calls for information and immunization campaigns in August and September, when migrants often leave home to work during the harvest season. It prepares for treating the workers when they return home at year’s end or Easter.

Frenk said the new model demands a high level of coordination with U.S. authorities. And it will require new levels of trust from illegal migrants that the health information won’t be used against them, he said.

“The ideal would be a well-coordinated system in which we could say to the U.S. authorities: ‘There goes a migrant who has tuberculosis. Care for him,’ ” he said. “Some day not too far in the future, there will be electronic clinical histories on a card with an intelligent chip, and the person will carry it. But this will require much trust on the part of illegal migrants.”