Symposium on Border Health - February 2007
By Eduardo J. Sanchez, MD, MPH
Even as we build new walls to separate the United States and Mexico, our nations are bound by shared history, shared hopes, and family blood. The U.S.-Mexico border region encompasses 10 states, 14 sister cities, and more than 12 million people - half of them along the Texas-Mexico border. The sister cities are not divided by the border, but rather united by it. In fact, 85 percent of the population on the Texas side of the border is Latino. From a medical perspective, these cities are single epidemiological entities, so planning, surveillance, and response efforts must be cross-border cooperative efforts.
While I served on the United States-Mexico Border Health Commission, we established the Healthy Border 2010 initiative, which set forth two overarching goals: to improve quality and increase years of healthy life and to eliminate health disparities. To reach those goals, we must improve access to primary care, expand immunization coverage, reduce infant mortality, improve prenatal care, and reduce teen pregnancy. The fertility rate along the border is 50 percent higher than the national rate, the child poverty rate is double, and the high school dropout rate for Latinos along the border is triple the rate for whites.
Other specific challenges targeted by the commission include reducing the rate and mortality of breast and cervical cancer and diabetes. The latest report from the Centers for Disease Control and Prevention projects that the number of Hispanics with diabetes will increase by 481 percent by 2050. Such stark projections drive home the necessity of increasing our efforts to prevent disease and promote healthy behaviors.
Half of the 1,000 or so babies born every day in Texas are Hispanic. More than a third of them are likely to grow up in working families who cannot afford health insurance. State and national data show Hispanic high school graduation rates to be 10 to 20 percent lower than overall graduation rates. This may prove to be the most telling health disparity of all, because adults between ages 18 and 65 with fewer than 12 years of education have almost three times the mortality rate of those with 13 or more years of education.
Survey data show evidence-based school and community intervention programs in El Paso have dramatically reduced obesity among fourth- and eighth-grade students in comparison to other border counties with similar demographics. This is an important first step toward reversing the projection that one-third of all Hispanics born after 2000 will develop type 2 diabetes. Improving health literacy, improving graduation rates, and developing a more ethnically diverse cadre of health care professionals will go a long way toward redressing disparities that will otherwise, in the long run, harm us all.
Beyond that, I believe that we as physicians must strive to provide every patient with compassionate, culturally considerate, competent care. They deserve nothing less.
Dr. Sanchez is the immediate past commissioner of the Texas Department of State Health Services. He now is the director of the Institute for Health Policy at TheUniversityofTexas Health Science CenteratHouston.
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