Addressing Regional Health Differences: Border Communities
As we continue to discuss regional variance in addressing population health care needs and creating innovative new models, we must consider the unique conditions of border communities. Almost 30% of the estimated 30 million people living in the border region live in rural areas, and no different from other rural populations, they are on average older, sicker, and poorer than those in urban areas. The average median income in the border region is less than $15,000.
As NRHA’s Border Health Initiative meets this week, and as Congressional discussion of border security continues, we must take time to discuss the unique challenges facing the rural communities along our country’s Southern border and the need for improved health security in these areas.
Diabetes, cancers, infant mortality and other preventable disease are all much higher among border populations. Additionally, due to busy, cross-border traffic, the transmission of numerous communicable diseases can be widespread.
Diabetes is significantly more common in rural areas, and it occurs even more in rural border communities at a rate over 30%, the highest in the nation. The HIV incidence rate continues to increase and the death rate from hepatitis ranks second in the nation; reduction of tuberculosis shows potential for the region.
This is likely related to higher rates of poverty coupled with poor infrastructure in the area, which contribute to health disparities in this highly migratory and recent immigrant population. The border region is also the home to a large Native American population, with nearly 1 million native people living in the four U.S. border states. Disparities persist for non-communicable diseases and other causes of death (e.g. cancers, diabetes, infant mortality, liver diseases, homicide and accidents).
According to the CDC, a study of the health of Hispanic Americans along the U.S. – Mexico border, 49% of participants in the study were obese, 34% were overweight; 34% had prehypertension and 19% had hypertension; and 88% participants were overweight or had high blood pressure. In one 12 year NIH study, the rate of diabetes prevalence increased from 13.2 to 19.6%, but the change was much more drastic in border states like Arizona, where the rate increased from 2.8 to 9.0% (6.2%).
Health Care Challenges
The number of uninsured or under-insured in the border region is higher than national average, and a high rate of uninsured or inability to pay for health care, combined with health care provider shortages in many regions, contribute to poorer health outcomes. Additional barriers to care lead to fragmented, rather than coordinated, care, and workforce shortages make localized care even more challenging.
This is why we are working to move forward and seek practical, sustainable, and bipartisan policy solutions to address rural health issues in the U.S.-México border region. Health disparities within the border region and between the border region and other rural areas of the U.S. lead to high health care costs for the taxpayer in terms of “lost productivity, greater health care needs, and increased morbidity and mortality.” Additionally, the high rates of communicable diseases, which are exacerbated by poor sanitation and infrastructure put neighboring urban and rural areas at risk.
United States-México Border Health Commission
Global health security has never been more critical to the well-being of the United States and its citizens than it is right now—diseases spread faster than ever before, new pathogens are constantly emerging, and antibiotic resistance is on the rise. The U.S.-México Border Health Commission leads critical efforts to combat the spread of infectious disease on the border as well as improve health outcomes. The Commission has a long record of disease prevention and health promotion, which includes infectious disease prevention, chronic and degenerative disease control, maternal and child health improvement and injury prevention.
The stated mission of the United States-México Border Health Commission (BHC) is to “provide international leadership to improve health and quality of life along the U.S.-México border. The BHC has the unique opportunity to bring together the two countries and their border states to address border health challenges by providing the necessary leadership to develop coordinated and binational actions that can improve the health and quality of life of all border residents.” The BHC was created in 2000, under then President Bill Clinton, and its work has been subsequently supported by both Presidents George W. Bush and Barack Obama.
Through cooperative agreements from the Department of Health and Human Services (HHS), the BHC is able to fund projects identified in the Healthy Border 2020 initiative. Currently, there are two primary annual activities: Border Health Month (BHM) and Leaders across Borders. The first, Border Health Month, is held in October, during which the BHC helps support health security and disease prevention activities on both sides of the border. It is estimated that about 1.6 million border residents, most of which are rural, have benefited from BHM.
The second initiative, Leaders across Borders, is a leadership development program focused on “building the binational leadership capacity of public health, health care, and other community professionals working to improve the health of communities in the U.S.-México border region.” Currently, the program has produced more than 120 alumni through seven cohorts. Additional critical BHC work, fostered by the states along the border include the U.S.-Mexico Border Reproductive Health Work Group and The Consortium of the Californias and Obesity Prevention Programs.
This week, NRHA wrote a letter to Congressional leadership requesting continued funding and support of the BHC. We look forward to the discussions we will have at the Border Health Initiative this week, and to finding bipartisan policy solutions to reduce costs, create opportunities, and coordinate care for those living in the rural border region. To read NRHA’s recent policy paper on Border Health, click here.