Challenges and Opportunities in Border Health1

Approximately 11.5 million people reside in the 42 counties and 39 Mexican municipalities located along the U.S.-Mexico border, and 86% of those people reside in 14 pairs of sister cities, metropolitan areas divided by the international border (1). Border residents share similar resources and environmental problems: issues of great concern include air quality, water quantity and quality, and animal control. The communities along the border are economically and socially interdependent, with more than 1 million legal northbound crossings every day. The need to establish cooperation between the United States and Mexico for improving health has led to collaborative initiatives between the public and private sectors (1). The principal health problems at the U.S.-Mexico border are characterized by disparities in health systems (2), which result from the lower health standards and socioeconomic conditions of Mexican border communities compared with U.S. border communities. Health-system disparities produce differences in and barriers to health care access and use (3,4). Documented cases that demand the creation of programs across the U.S.-Mexico border show different rates in the prevalence of infectious disease, including hepatitis A, salmonella, tuberculosis, dengue fever, and Helicobacter pylori infection (5,6). The magnitude and relevance of infectious disease as a major concern along the U.S.-Mexico border have prompted the establishment of binational agreements, such as the U.S.-Mexico Border Infectious Disease Surveillance Project, with the purpose of enhancing the effectiveness of infectious disease prevention (7). On the other hand, populations on both sides of the border share the impact of diseases — such as obesity and diabetes — resulting from similar lifestyle changes. The prevalence rate for diabetes along the U.S.-Mexico border is nearly 50% higher than the rate for the rest of the United States, and Hispanics are more vulnerable to suffering the burden of chronic complications because of genetic, economic, social, behavioral, and psychological factors. This issue of Preventing Chronic Disease includes an introduction and overview (8) as well as additional articles on the Border Health Strategic Initiative (Border Health ¡SI!), a comprehensive community approach to diabetes prevention and control primarily concentrated in Yuma and Santa Cruz counties in Arizona. Border Health ¡SI! is based on models of community capacity building and community change and was established through a partnership between several border community groups and the University of Arizona. In addition to being comprehensive and community oriented, Border Health ¡ SI! was designed to be acceptable to stakeholders, effective in fostering …