Pan American Health Organization

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Pan American Health Organization

• Regional Office for the Americas for the
• World Health Organization

Celebrating 100 Years of Health
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Border Interactions and Diabetes
Atlanta, GA. Alfonso Ruiz, DVM, MS, PhD
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Chronology of Important Events in the History of
PAHO
1902 International Sanitary Bureau formed by
The First General International
Sanitary Convention of American States
1923 ISB renamed Pan American
Sanitary Bureau 1942 The U.S.-Mexico Border
Field Office is created in El Paso,
TX. 1948 Establishment of the World
Health Organization 1949 PASB became the WHO
Regional Office.
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PAHO as a Specialized Agency of the UN and
InterAmerican Systems
SpecializedAgency of the Organization
ofAmerican States
PAHO

• InterAmerican
• System

UN System
RegionalOffice of theWorld HealthOrganization
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U.S-Mexico Border Population
Ten States 70 million people
25 US counties 34 Mexican municipalities 24
Native American Nations 11.4 million people
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U.S.-Mexico Border Population highlights

• 55 of the population lives on the U.S. side
• 45 of the population lives on the Mexican side
• 70 of the U.S. border population is of Hispanic
  origin
• 47 of the border population is under 20 years of
  age

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Additional considerations

• Population growth rate (4.3 for Mexico and 1.8
  for U.S) higher than national rates
• ( 1.9) Mexico, (0.9) U.S.
• Large minority population in the U.S. border
  (average Hispanic population 40)
• Three larger Mexican cities, Juarez, Tijuana,
  Mexicali total 50 of Mexican Border population

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Estimated Border Population 1990-2010
Population estimated by de Cosio, G. U. S. Pop
Growth 1.8 - Mex Pop Growth 4.3
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U.S.-Mexico Selected Sister Communities 1993-1997
Annual Population Growth
1993-1997 Annual Population Growth
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US-Mexico BorderSocio-Economic Indicators
2,878 Maquila plants 1.8 million
employees

• Mexico exports to U.S. ? 86 billion (1997)
• ? 40 exports from 6 Mexican border states

• Inequities
• 6 Poorest U.S. counties
• Lower poverty rates in Mexican
• border states than the nation

Immigrants (New Settlements)
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BORDER CROSSINGS ON A REGULAR DAY
400 million legal crossing/year South to
North 3.8 million commercial truck
crossings/year South to North
Photo National Geographic, 1997
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Additional considerations
CONTRAST

• UNITED STATES
• High poverty levels on U.S. side of the border
• More than 30 of the Hispanic population
  uninsured
• Several border communities are designated
  Medically Under-Served Areas

• MEXICO
• Border cities of Mexico have higher
  socio-economic conditions
• 95of the population have access to health care
  services
• Gaps still remain particularly in rural areas

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Housing Conditions on the U.S.-Mexico Border
Colonias Symptom, not the problem

• Colonias are substandard developments lacking
  running water, sewage systems and often
  electricity. Unregulated subdivisions for
  under-educated consumers.

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Problems affecting disadvantaged border
communities

• Borders are frequently threatened by
• environmental problems and hazards
• Existence of international trade agreements that
  
• are implemented unsafely
• Vulnerable groups such as women, children and
• elderly are more at risk
• Substance Abuse and behavioral problems are more
  
• prevalent in border areas
• Malnutrition, obesity are common problems on
  both
• sides of the border

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TEN LEADING CAUSES OF DEATH ALONG THE U.S.
-MEXICO BORDER, 1997(in order of importance)

• U.S. ALL RACES
  MEXICO
• Disease of the heart ? Disease of the heart
• Cancer ? Cancer
• Cerebrovascular Dis ? Accidents
• Pulmonary Chronic ? Diabetes
• Accidents ? Perinatal Deaths
• Pneumonia/Influenza ? Cerebrovascular Dis
• Diabetes ? Cirrhosis
• Suicide ? Pneumonia/Influenza
• HIV/AIDS ? Homicides
• Homicide ? Intestinal Infectious Dis

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DiabetesScope of the Problem

• WHO estimated that by 2025 diabetes will increase
  between 150-200
• It is estimated that 5-14 of the total health
  expenditure will be used for diabetes
• Along the U.S.-Mexico border, diabetes mortality
  rates are higher than national figures.

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Scope of the Problem (cont.)

• In 1996 there were 161,000 diabetes hospital
  discharges with an average length of stay of 5.1
  days in the U.S.
• Diabetes is 2-3 times higher in Mexican Americans
  than in non-Hispanics
• Uncontrolled diabetes makes difficult treatment
  of infectious diseases (i.e., TB)

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Facts about diabetes among Hispanics

• In 1998, about 1.2 million Hispanic were known to
  have diabetes in the U.S.
• One in every four Mexican Americans age 45 and
  older has diabetes.
• Being overweight or physically inactive is a
  major risk for developing diabetes.
• Hispanics have higher incidence of developing
  diabetes complications

Source www.niddk.nih.gov/health/diabetes/pubs/hip
an/hipan.htm
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Distribution of the Hispanic Diabetic population
in U.S. (1982-1984)
Source www.niddk.nih.gov/health/diabetes/pubs/hip
an/hipan.htm
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Diabetes mortality rates in U.S.-Mexico Border
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Diabetes Mortality Rates El Paso, Texas,
1990-1998
Source soupfin.tdh.state.tx.us/cgi-bin/deathcgi R
ate per 100,000
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Diabetes Mortality Rates USA, Texas, El Paso,
Juarez, Chihuahua, and Mexico, 1998
Source PAHO. Mortality Profiles of the Sister
Communities on the United States-Mexico Border.
Wahsington, D.C. 1995-1997
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Diabetes Mortality Rates by RaceTexas and El
Paso, 1990-1994-1998
Diabetes Mortality Rates by RaceEl Paso, Texas
1990-1994-1998
Diabetes Mortality Rates by RaceTexas
1990-1994-1998
Source soupfin.tdh.state.tx.us/cgi-bin/deathcgi R
ate per 100,000
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Hispanic Diabetes Mortality Rates by ageEl Paso,
Texas, 1990-1994-1998
Source soupfin.tdh.state.tx.us/cgi-bin/deathcgi R
ate per 100,000
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Barriers that Affect Access to Health Care

• Lack of knowledge of how to access health care
• Language and cultural barriers
• Cost of care
• Need for training and distribution of health care
  providers
• Denial of access to services for undocumented
  (illegal status) individuals
• Availability of services
• Transportation

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Health Promotion Approach for Border Interventions
POPULATION HEALTH STATUS
--------------------
INDIVIDUAL FACTORS
HEALTH DETERMINANT FACTORS
CULTURE HEALTH HABITS EDUCATION
INDIVIDUAL CAPACITY AND ADAPTATIONS APTITUDES
COLLECTIVE FACTORS
SOCIO-ECONOMIC ENVIRONMENT
HEALTH SERVICES
PHYSICAL ENVIRONMENT
ACTION BASES
SUPPORT TOOLS AND MEANS RESEARCH, INFORMATION AND
PUBLIC POLICIES
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Borders are merging sites for cultures,
languages, ethnic groups, behaviors, but also
diseases. Then, any approach for disease
prevention and control must consider the whole
environment. Alfonso Ruiz