United States– Mexico Border Area

INTRODUCTION was signed between the governments of Mexico and the United States with the goal of protecting, The United States–Mexico border region extends for improving, and conserving the environment along 3,141 km, stretching from the Gulf of Mexico to the the border (1), defines this area as the land within Pacific Ocean. The 1983 La Paz Agreement, which 100 km on either side of the international boundary.

Health in the Americas, 2012 Edition: Country Volume N ’ Pan American Health Organization, 2012 HEALTH IN THE AMERICAS, 2012 N COUNTRY VOLUME

FIGURE 1. United States–Mexico border region.

Mexico Border States United States Border States U.S.- Mexico border counties and Municipalities Country Mexico United States Mexico sister cities United States sister cities La Paz Agreement (100km) Latitude longitude (10 deg) Major rivers

Source: Elaborated by the PAHO United States-Mexico Border Office.

The border area includes 48 U.S. counties in 4 1 2 states and 94 Mexican municipalities in 6 states, 1 Arizona, California, New Mexico, and Texas. including 15 pairs of sister cities.3 2 Baja California, Coahuila, Chihuahua, Nuevo Leo´n, In order to manage its program designed to Sonora, and Tamaulipas. 3 improve health along the border, the U.S.-Mexico San Diego/Tijuana (California/Baja California), Calexico/Mexicali (California/Baja California), Yuma/ Border Health Commission (USMBHC) (2) limited San Luis Rı´o Colorado (Arizona/Sonora), Nogales/ the border area to the 44 U.S. counties and 80 Nogales (Arizona/Sonora), Naco/Naco (Arizona/Sonora), Mexican municipalities that have most of their Douglas/Agua Prieta (Arizona/Sonora), Columbus/Puerto population within the 100-km limit (see Figure 1). Palomas (New Mexico/Chihuahua), El Paso/Ciudad This constitutes a total population of approximately Jua´rez (Texas/Chihuahua), Presidio/Ojinaga (Texas/ 14.94 million people (7.45 million males and 7.49 Chihuahua), Del Rio/Ciudad Acun˜a (Texas/Coahuila), Eagle Pass/Piedras Negras (Texas/Coahuila), Laredo/ million females), about 7.44 million (3.68 million Nuevo Laredo (Texas/Tamaulipas), McAllen/Reynosa males and 3.76 million females) in the U.S. (3) and (Texas/Tamaulipas), Weslaco/Rı´o Bravo (Texas/ 7.50 million (3.77 million males and 3.73 million Tamaulipas), and Brownsville/Matamoros (Texas/ females) in Mexico (4) (see age and sex distribution Tamaulipas).

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FIGURE 2. Population structure, by age and sex,a United States border population in 2009 and Mexican border population in 2010. United States (2009) Mexico (2010)

85+ 85+ 80-84 80-84 75-79 75-79 70-74 70-74 65-69 65-69 60-64 60-64 55-59 55-59 50-54 50-54 45-49 45-49 40-44 40-44 35-39 35-39 30-34 30-34 25-29 25-29 20-24 20-24 15-19 15-19 10-14 10-14 5-9 5-9 0-4 0-4 6.00 4.00 2.00 0.00 0.00 2.00 4.00 6.00 6.00 4.00 2.00 0.00 0.00 2.00 4.00 6.00 Percentage Percentage Males Females Males Females

Source: United States Census Bureau (2009); Mexico National Institute for Statistics and Geography, Population and Housing Census (2010) a Each age group’s percentage represents its proportion of the total for each sex.

of the border population in Figure 2). Between 2000 The area has experienced continuous growth and 2010 the U.S. border population increased by since the 1940s associated with the 1942–1947 about 12% and the Mexican border population Bracero Program (laborers contracted in Mexico to increased by about 18%. work in the U.S. agricultural sector), the Border About 84% of the U.S.-Mexico border popula- Industrialization Program initiated in 1965, and the tion is urban. Mexico’s three largest urban munici- North American Free Trade Agreement (NAFTA) palities—Ciudad Jua´rez in Chihuahua, and Tijuana signed in 1993. Projected population growth rates in and Mexicali in Baja California—account for almost the border region exceed anticipated national average half of the total Mexican border population. Over growth rates for each country. If current trends 80% of the U.S. border population is concentrated in continue, the border population is expected to six counties: San Diego in California; Pima in increase to about 20 million people by 2020 (7). Arizona; and Cameron, El Paso, Hidalgo, and Webb Trade has also increased significantly, particularly in Texas. San Diego alone, the wealthiest of the U.S. since the NAFTA agreement came into force. For border counties, represents about 40% of the U.S. example, in 2008, cross-border land trade between the border population. About half of the U.S. border U.S. and Mexico totaled over US$ 293 billion, about population is Hispanic, primarily of Mexican three times the amount recorded in 1995; 13,300 ancestry (5, 6). commercial trucks crossed the border daily, up 70% The U.S.-Mexico border area represents a from 1995 (8). However, the region is experiencing binational geo-political system based on strong several challenges, including the situation of violence social, economic, cultural, and environmental con- on the Mexican side of the border, the deceleration of nections governed by different policies, customs, and the maquiladora industry, and reduced northbound laws. Important dimensions of this binational system illegal immigration stemming from both the slow- include commerce, tourism, sister-city familial ties, down in the U.S. economy and enhanced U.S. border Mexico’s assembly plants or maquiladoras (plants that immigration enforcement efforts. These factors may import components for processing or assembly by slow development and affect cross-border trade and Mexican labor and then export the finished pro- travel. Personal legal border crossings from Mexico to ducts), ecological services, a shared heritage, social the U.S. decreased from 313.8 million in 2006 to partnerships, and immigration. 229.7 million in 2010 (9). In addition, the number of

$700 HEALTH IN THE AMERICAS, 2012 N COUNTRY VOLUME apprehensions of unauthorized Mexican migrants in The African-American population along the the U.S. decreased from 1.17 million in 2005 to 0.45 U.S. border area in 2005–2009 comprised approxi- million in 2010 (10). mately 3.2% of the U.S. border population (3), Thepopulationonbothsidesoftheborderis located primarily in San Diego, California; Tucson, relatively young because of high fertility and a Arizona; and El Paso, Texas. continuous migratory flow (the population that This chapter examines health determinants and migrates north to the U.S. tends to be younger and health conditions along the border region. In healthier). About 30% of the Mexican border general, the issues are described at the state level, population and 24% of the U.S. border population with some specific examples given at the county/ is under 15 years of age. In 2007, the total fertility municipality level. For several conditions, direct rates in the Mexican border states ranged from 2.0 comparisons between the U.S. and Mexican sides of children per woman in Nuevo Leo´n to 2.2 in the the border cannot be made because the available states of Sonora, Chihuahua, and Coahuila, on a par information is not readily comparable. with Mexico’s national rate of 2.1. The total fertility rates in the U.S. border states in 2007 ranged from 2.2 in California to 2.4 in Texas and Arizona, higher than HEALTH DETERMINANTS AND the U.S. national rate of 2.1. The proportion of INEQUALITIES population over 60 years old is about 17% (55% females) on the U.S. side of the border and 7% (51% In 2009, the per capita gross domestic product females) on the Mexican side (4, 11). (GDP) for the Mexican border states ranged from Life expectancy at birth for U.S. border states in US$ 7,501 in Baja California to US$ 13,481 in 2007 ranged from 77.1 years in New Mexico (74.5 for Nuevo Leo´n, compared to US$ 8,143 for Mexico as males and 79.7 for females) to 81.0 years in California a whole. The per capita GDP for the U.S. border (78.6 for males and 83.2 for females), compared to states ranged from US$ 39,123 in New Mexico to 78.8 years for the U.S. (76.0 for males and 81.2 for US$ 50,871 in California, compared to US$ 45,989 females). For the Mexican border states, life expec- for the nation. The U.S. border region includes both tancy at birth in 2009 ranged from 76.3 years in one of the wealthiest and one of the poorest cities in Tamaulipas (74.0 for males and 78.7 for females) to the U.S.: in 2009, the per capita GDP of San Diego, 77.1 years (74.9 for males and 79.2 for females) in Baja California, was US$ 51,035 whereas the per capita California, compared to 75.3 years for Mexico (72.9 GDP of McAllen, Texas, was US$ 15,818 (18, 19, for males and 77.6 for females) (12, 13, 14, 15, 16). 20, 21). The native indigenous population along the The unemployment rate in the U.S. border Mexican border area in 2005 totaled approximately states for 2005–2009, measured as the population 16 130,000 people, located primarily in Baja California, years old or older who are in the labor force, was Tamaulipas, Chihuahua, and Sonora (17). The 6.8% in Texas, New Mexico, and Arizona, and 7.9% estimated Native American population during 2005– in California, compared to 7.2% for the nation. At 2009 along the U.S. border area was approximately the local level, the differences were more significant. 80,000 people, located primarily in California and San Diego, California, had an unemployment rate of Arizona (5). Five native indigenous groups have a 6.7% whereas in McAllen, Texas, it was 9.2%. For permanent land base that extends to both sides of the the Mexican border states, the unemployment rate in border: the Kikapu peoples in Coahuila, known as the 2010, measured as the labor force for the population Kickapoo in Texas and Arizona; the Kumiai peoples in 14 years old or older, ranged from 5.9% in Baja Baja California, known as the Kumeyaay in California; California to 8.7% in Chihuahua, higher than the and the Papago, Cucapa´, and Yaqui peoples in Sonora, 5.2% rate for the nation. It should be noted that in known as the Tohono O’odham, Cocopah, and Pascua Mexico there is a significant level of underemploy- Yaqui, respectively, in Arizona. ment that has not been reported. Unemployment

$701 UNITED STATES–MEXICO BORDER AREA rates for the two nations are not readily comparable services in the Mexican border cities ranged from (18, 19, 20, 21). 78% of the households in Nogales, Sonora, to over The education level of U.S. border residents is 95% of the households in Tijuana and Mexicali in lower than the national U.S. average, but there are Baja California; San Luis Rı´o Colorado, Naco, and regional differences. For example, in 2009, in San Agua Prieta in Sonora; and Acun˜a and Piedras Diego, California, 6.8% of the population between Negras in Coahuila. Access to sewer services ranged 25 and 64 years old had an education level below the from 84% in Reynosa and Rı´o Bravo in Tamaulipas ninth grade and 22.1% had completed a four-year to over 95% in Naco, Nogales, and Agua Prieta in university degree. In contrast, in Brownsville, Texas, Sonora; Acun˜a and Piedras Negras in Coahuila; and 27.6% had an education level below the ninth grade Ojinaga in Chihuahua (4). Sewer services may and only 10% had a university degree. In the U.S. as represent wastewater collected but not treated prior a whole, 6.4% had an education level below the ninth to discharge. grade and 17.4% had a university degree. The In U.S. border cities, over 98% of the house- education level on the Mexican side of the border holds have access to piped drinking water and treated is more homogeneous. In 2010, between 25% and wastewater services (3). However, access to these 30% of the border population had completed primary services is still a challenge in rural border colonias. school (up to sixth grade) and about 10% had a Colonias are mostly unincorporated housing devel- professional degree, similar to Mexico’s national opments located primarily along the New Mexico average of 32% and 10.7%, respectively (4, 18, 20, and Texas borders; they are characterized by high 21). poverty rates and may lack basic community infra- structure. In 2010 in the six most populous Texas border counties with colonias, there were 519 colonias THE ENVIRONMENT AND HUMAN housing approximately 126,000 residents who lacked SECURITY some basic services and an additional 400 colonias with approximately 50,000 residents who lacked all ACCESS TO CLEAN WATER AND SANITATION basic services (22).

Water is a limited resource in several parts of the border region. Population growth along with eco- SOLID WASTE nomic development places increasing stress on water quantity and quality. The International Boundary and Millions of scrap tires have accumulated in 46 known Water Commission (IBWC) is a bi-national govern- tire piles throughout the border region. As the result mental organization charged with identifying and of a strong market for used tires, millions of tires from solving boundary and surface water issues arising along the U.S. are imported to Mexico for reuse. Scrap tire the border between the U.S. and Mexico. In particular, piles create breeding grounds for mosquitoes, rodents, IBWC is responsible for preserving, protecting, and and other vectors of disease. In addition, tire pile fires delivering the waters of the Colorado and Rio Grande are difficult to extinguish and can emit noxious fumes rivers. The IBWC is not authorized to work on for months. From 2004 through 2009, almost 6.9 transnational, groundwater issues. million scrap tires were removed from 12 areas on the Access to drinking water and sanitation services Mexican side of the border region as part of the U.S.- has improved significantly in urban areas on the Mexico Border 2012 Environmental Program. The Mexican side of the border, but it is still one of the majority of these tires were used as fuel in cement most significant physical environmental determi- kilns. Pilot road paving projects and other innovative, nants of health in the rural areas of both sides of the experimental reuse projects were also implemented border. In 2010, access to piped drinking water (23, 24).

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AIR POLLUTION household pesticide. This product is licensed for industrial agricultural application, but is illegally The most common and harmful air pollutants in the packaged and sold to residents for household use. In border region include suspended particulate matter 2007, a research group of the University of Texas

(PM10, or particulate matter that is 10 m in diameter Health Science Center at Houston (School of Public or less, and PM2.5, particulate matter 2.5 m in Health) reported that in a survey conducted in the diameter or less) and ground-level ozone. For Lower Valley of El Paso County, Texas, about 90% example, San Diego exceeded the U.S. ozone standard of participants used pesticides in their homes. Of for 24 days in 2008 and Imperial Valley, California, these, about 10% admitted using illegal products exceeded the standard for 15 days in 2006. In (27). addition, Imperial Valley exceeded the U.S. PM10 standard for 20 days in 2007, Nogales (Arizona and Sonora) exceeded the standard for 45 days in 2006, ROAD SAFETY and Ciudad Jua´rez/El Paso exceeded it for 48 days in 2006. A number of measures, such as stricter Road traffic accidents constitute a major public standards on motor vehicle emissions, cleaner fuels, health concern in the border region—they are the vehicle anti-idling programs, and road paving, have leading cause of death for school-aged children in been implemented in the border region to reduce the Mexico (28) and for people between the ages of 5 sources of ozone and particulate matter (23). and 34 years in the United States (29). In 2009, traffic-related mortality rates in Mexican border states ranged from 8.1 deaths per 100,000 population PESTICIDES in Baja California to 26.2 in Sonora, compared to 14.0 for the nation. In the U.S. border states, traffic- California and Arizona have significant agricultural related mortality rates ranged from 8.3 in California industries in their border areas and maintain to 18.0 in New Mexico compared to 11.0 for the reporting systems that track pesticide use. nation (30). According to the U.S. National According to the California Department of Highway Traffic Safety Administration (31), the Pesticide Regulation (25), the amount of pesticides U.S. border states reported a consistent decrease in applied in California border counties dropped by traffic-related mortality rates during 2005–2009. 32% from 2006 through 2009, from about 3.1 Long-term declining trends in the U.S. have been million kg to 2.1 million kg. Dry winters and springs associated with behavioral and vehicle safety pro- and a shift from broad-based pesticides to newer, grams and the issuance of federal motor vehicle more targeted products account for part of the safety standards, such as the Texas Teens in the decline. On the other hand, the amount of pesticides Driver’s Seat program. The declining trend since applied in Arizona border counties increased by 36% 2007 has coincided with the slowdown of the U.S. from 2005 through 2009, from about 635,000 kg to economy (31), and areas that experienced greater 862,000 kg. Between 2006 and 2008, the California increases in unemployment rates recorded higher border counties reported 161 definitive or probable decreases in fatalities. illness/injury incidents related to pesticide exposure, of which only 54 incidents involved pesticides intended for use in agricultural production. The VIOLENCE data suggest that most cases of pesticide exposure occur in the household setting and primarily The increase of violence in Mexico, mainly in the involved household pesticides (26). northern cities, has been associated with the imple- A major concern on both sides of the border is mentation of national policies to crack down on the use of polvo de avio´n or methyl parathion as a organized crime and drug trafficking. In the six largest

$703 UNITED STATES–MEXICO BORDER AREA border cities, with an approximate population of 5.3 Starr, Cameron, and Hidalgo in Texas and the million inhabitants, the number of homicides related Mexican municipalities of Matamoros, Valle to organized crime increased from 390 (7.3 deaths per Hermoso, Rio Bravo, Reynosa, Dı´az Ordaz, 100,000 population) in 2007 to 3,585 (67.5) in 2010 Camargo, and Miguel Alema´n in Tamaulipas. The (32). In the respective U.S. sister cities with a hurricane caused flooding, power outages, evacuation population of 5.5 million inhabitants, the phenomenon of about 20,000 people, two deaths on the Mexican was the opposite, with a decrease in the number of total side of the border, and estimated losses of US$ 1.2 homicides from 192 (3.5 per 100,000 population) in billion on the U.S. side (38, 39, 40). 2007 to 156 (2.8) in 2009. The reasons for this decline In April 2010, the Mexicali Valley experienced are unclear. The most dramatic difference in the an earthquake measuring 7.2 on the Richter scale. number of homicides was between Ciudad Jua´rez, Mexicali in Baja California and El Centro in Chihuahua, with a mortality rate of 167 deaths per California were the most affected cities. The earth- 100,000 population, and its sister city of El Paso, quake was felt as far away as San Luis Rı´o Colorado Texas, with a rate of 2 in 2009 (33, 34, 35, 36). In in Sonora. Despite the magnitude of the event, there response to the situation in Ciudad Jua´rez, the federal were only two deaths and relatively few injuries. The government launched a violence prevention program in damage reported included the disruption of the 2010 called ‘‘Todos Somos Jua´rez, Reconstruyamos la Mexicali-Tijuana highway, structural collapse of Ciudad’’ (‘‘We Are All Jua´rez; Let’s Rebuild Our City’’) public buildings and private homes, partial evacua- with an investment of over US$ 300 million and over tion of 17 hospitals on both sides of the border, 160 social interventions (32). disruption of utilities, and gas leaks (41). One of the most significant phenomena of social violence occurring on the Mexican side of the border has been the increase in feminicide, defined CLIMATE CHANGE as the killing of women and girls. A study conducted from 2006 to 2008 showed that feminicides in The U.S. Global Change Research Program (42) Ciudad Jua´rez, Chihuahua, increased from 19 in reported in 2008 that the average temperature in 2006 to 111 in 2008. To address this phenomenon, the southwestern region of the U.S. has increased the Government has implemented national legisla- about 0.8 uC from a 1960–1979 baseline and tive measures such as the Law on the Right of estimated further increases in average temperatures Women to a Life Free of Violence in Chihuahua and by 2090 ranging from 3.2 uC to 5.6 uC above the the General Law of Women’s Access to a Life Free baseline. Rising temperatures decrease upstream of Violence aimed at reducing systematic female mountain snowpack and precipitation and increase homicides (37). the evaporation rate of available water. This affects the water sources for rivers and reservoirs in the region and, as a consequence, the availability of DISASTERS water for human consumption. Increases in temperatures were also reported in the northern The most significant natural disasters that affected Mexico border region. Assuming a scenario of the border region during 2006–2010 were a flood, a average economic growth for Mexico, average major hurricane, and an earthquake. The 2008 temperatures would increase between 1.5 uC and flooding in Presidio, Texas/Ojinaga, Chihuahua, 3.0 uC and precipitation would decline between was unprecedented. Floodwaters inundated 3.5% and 15% countrywide between 2010 and 2100, Ojinaga’s wastewater treatment plant, sending sew- with the greatest impacts being seen in the northern age into the Rio Grande. border region. Water supplies in this region are In July 2008, Hurricane Dolly hit the coast of already stressed and are projected to become the Gulf of Mexico and affected the U.S. counties of increasingly scarce in the next 50 years (43).

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HEALTH CONDITIONS AND TRENDS New Mexico (65). For the same 2006–2008 period in Mexico, teen birth rates were 11% higher than the HEALTH PROBLEMS OF SPECIFIC POPULATION national average (70 live births per 1,000 females age GROUPS 15–19 years) in three of the six border states: Chihuahua (76), Baja California (77), and Coahuila Maternal and Reproductive Health (77).

Maternal mortality rates for the U.S. border states in Child Health (0–4-year-olds, except for two U.S. 2008 ranged from 8.1 maternal deaths per 100,000 live states that do not report on 1–4-year-olds, only on births (8 deaths) in Arizona to 22.2 (90 deaths) in 1–14-year-olds) Texas, compared to 12.7 (548 deaths) for the nation in 2007. In Arizona, the rate may not be statistically In 2008, infant (children under 1 year of age) reliable because of the low number of deaths. Texas mortality rates for the U.S. border states ranged from had the highest rate of maternal deaths consistently 5.1 infant deaths per 1,000 live births in California from 2005 to 2008. Among African-American women and New Mexico to 6.3 in Arizona, lower than the living in U.S. border states, maternal mortality was 6.6 infant mortality rate for the country as a whole. about twice the national rate. For the Mexican border With the exception of 2002 and 2005, infant states, maternal mortality rates in 2008 ranged from mortality rates have remained statistically the same 30.1 (24 deaths) in Nuevo Leo´n to 62.9 (40 deaths) in or decreased significantly each successive year from Chihuahua, compared to 59.7 (1,167 deaths) for the 1958 through 2008. The leading causes of infant nation. Chihuahua consistently recorded the highest death in U.S. border states were congenital mal- rate among the border states from 2005 to 2008 (12, formations, deformations, and chromosomal 44, 45, 46). abnormalities; disorders related to short gestation Early prenatal care (percentage of live births and low birthweight; sudden infant death syndrome; whose mothers received prenatal care in the first maternal complications of pregnancy; newborns trimester) for the U.S. border states in 2008 was 52.0% affected by complications of placenta, cord, and in New Mexico, 58.4% in Texas, 79.4% in Arizona, membrane; and unintentional injuries. In all four and 80.7% in California, compared to 71% for the states the infant mortality rates for African nation. A review of border counties in California Americans were the highest of all racial/ethnic showed that early prenatal care in San Diego (2006– groups, ranging from 6.7 in New Mexico to 17.7 2010 median household income of US$ 63,069) was in Arizona (14, 45, 54, 55). comparable to the level provided throughout the state Infant mortality rates for the Mexican border (82%), whereas in Imperial County (median house- states in 2008 were about double those of the U.S. hold income of US$ 38,685) it was about 53%. border states but lower than the national average for Prenatal care visits (number of visits for pregnant Mexico. They ranged from 10.6 infant deaths per women) for the Mexican border states in 2004–2009 1,000 live births in Nuevo Leo´n to 13.4 in ranged from 7.3 visits per pregnancy in Sonora to 8.5 Chihuahua, compared to 15.2 for the nation. in Baja California and Nuevo Leo´n. More than 95% of These rates were about 20%–25% lower than they infants in all six Mexican border states received at least were in 2000. The leading causes of infant death one prenatal care visit (47, 48, 49, 50, 51). were certain conditions originating in the perinatal Teen pregnancy and childbearing is a signifi- period; congenital malformations, deformations, and cant issue in the U.S.-Mexico border region (52, 53). chromosomal abnormalities; accidents; pneumonia During 2006–2008, teen birth rates were about 50% and influenza; intestinal infectious diseases; acute higher than the national average for the U.S. (42 live respiratory infections; and septicemia (28, 56). births per 1,000 females age 15–19 years) in three of Mortality rates of children 1–4 years of age for the four border states: Arizona (60), Texas (63), and U.S. border states in 2008 were 21.3 deaths per

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100,000 population (23.4 for males and 19.1 for MORTALITY females) in California and 36.8 (47.2 for males and 26.2 for females) in New Mexico, compared to 28.6 In 2008, age-adjusted mortality rates in the four U.S. (31.3 for males and 25.7 for females) for the nation border states ranged from 650.1 deaths per 100,000 in 2007. For California, this represents a decrease of (764.4 for males and 556.4 for females, 2000 U.S. about 20%–25% from the rate in 2000. Texas and standard population) in California to 907.9 (982.7 Arizona reported data for children 1–14 years of age, for males and 832.7 for females) in New Mexico, and mortality rates in 2008 were 19.7 deaths per compared to 758.7 (901.0 for males and 643.7 for 100,000 population of this age group (21.9 for females) for the nation. These rates are about 10%– males and 17.5 for females) in Texas and 19.7 (22.3 15% lower than 2002 rates. Crude mortality rates for males and 17.0 for females) in Arizona. The ranged from 612.0 deaths per 100,000 population in leading causes of death for both age groups and sexes California to 740.4 in New Mexico, lower than the were unintentional injuries, malignant neoplasms, 813.3 for the nation. Mortality rates were the highest congenital malformations, and assault (homicide) for African Americans, ranging from 710.7 in (45, 55, 57, 58). Arizona to 979.3 in Texas (12, 14, 55, 62). In 2008, deaths among male children 0–4 years In 2008, age-adjusted mortality rates in the six of age in the Mexican border states ranged from Mexican border states ranged from 620 deaths per 4.0% of the total number of deaths in Coahuila to 100,000 (760 for males and 500 for females, World 6.3% in Tamaulipas, lower than the 6.6% for the Health Organization world standard population) in nation. Deaths among female children 0–4 years of Tamaulipas to 810 (990 for males and 620 for age ranged from 3.9% of the total number of deaths females) in Chihuahua, compared to 650 (770 for in Coahuila to 8.4% in Baja California, compared to males and 530 for females) for the nation. For several 6.5% for the nation. The leading causes of death for states, the rates have increased from previous years. both genders were unintentional injuries, congenital For example, between 2005 and 2008 age-adjusted malformations, malignant neoplasms, intestinal mortality rates in Chihuahua increased from 750 to infectious diseases, and septicemia (59, 60). 810. Crude mortality rates ranged from 460 deaths per 100,000 population in Baja California to 630 in Indigenous Peoples Chihuahua, compared to 510 for the nation (63). Table 1 describes the 10 leading causes of death for Available health data specific for indigenous groups the Mexican border states in 2008 and U.S. border are limited. In 2009, a study of Native American states in 2007. residents of Arizona showed that this population ranked poorly on maternal and reproductive health measures. On average, indigenous populations are MORBIDITY 19.5 years younger than white non-Hispanics. They also had high mortality from alcohol-induced causes Communicable Diseases (62.1/100,000 population age-adjusted to 2000 standard), diabetes (54.2), influenza and pneumonia Vector-borne Diseases (42.7), motor vehicle accidents (36.9), and from other unintentional injuries (92.6). However, they In 2010, 1,021 cases of West Nile virus infection ranked better than average on mortality rates for were reported in the U.S.; 38% of these cases were in several chronic diseases (Alzheimer’s disease, lung the four U.S. border states: Arizona (167 cases and cancer, breast cancer, prostate cancer, colorectal 15 deaths), California (111 cases and 6 deaths), New cancer, chronic lower respiratory diseases, and Mexico (25 cases and 1 death), and Texas (89 cases coronary heart disease), tobacco use, and incidence and 6 deaths). El Paso reported 30% (27 cases) of the of genital herpes among women giving birth (61). cases in Texas. The 28 deaths in border states

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TABLE 1. Ten leading causes of death, United States and Mexican border states, 2007 and 2008.

U.S. border states (2007) Mexican border states (2008)

Cause of death Mortality per Cause of death Mortality per 100,000 population 100,000 population

1. Diseases of the heart 162.5–168.8 1. Diseases of the heart 78.0–112.2 2. Malignant neoplasms 150.5–164.4 2. Malignant neoplasm 52.9–76.5 3. Unintentional injuries 31.8–67.5 3. Diabetes mellitus 45.0–87.4 4. Cerebrovascular diseases 34.8–41.0 4. Homicides 7.6–75.2 5. Chronic lower respiratory diseases 33.9–44.9 5. Unintentional injuries 25.9–55.0 6. Diabetes mellitus 18.3–34.2 6. Cerebrovascular diseases 20.4–29.7 7. Alzheimer’s disease 16.3–32.4 7. Chronic liver disease and cirrhosis 17.6–29.8 8. Influenza and pneumonia 13.5–17.9 8. Influenza and pneumonia 8.2–15.8 9. Chronic liver disease and cirrhosis 10.6–18.9 9. Conditions originating in the perinatal period 7.4–16.3 10. Suicide 9.9–20.4 10. Chronic obstructive pulmonary diseases 9.1–16.5

Sources: United States, Centers for Disease Control and Prevention. Deaths, percent of total deaths, and death rates for the 15 leading causes of death: United States and each state [Internet]; 2007. Available at: http://www.cdc.gov/nchs/data/dvs/LCWK9_2007.pdf. Accessed on 29 December 2011. Me´xico, Sistema Nacional de Informacio´n en Salud. Principales causas de mortalidad general por entidad federativa [Internet]; 2008. Available at: http://sinais. salud.gob.mx/mortalidad. Accessed on 29 December 2011. represent nearly half (49%) of the total deaths from have sizable dengue control programs, but the U.S. West Nile virus infections reported in the U.S. in has more limited and inconsistent programs to that 2010. From 2006 to 2010, the number of reported end. West Nile Virus cases and deaths in the U.S. border Rocky Mountain spotted fever (RMSF), caused states decreased by about half (64, 65). In the by Rickettsia rickettsii, is a tick-borne disease with Mexican border states only one West Nile virus case, epidemic potential that has been reported in U.S.- in Nuevo Leo´n in 2010, was reported. However, the Mexico border areas. During 2010, 1,682 cases of number of cases reported on the U.S. side of the RMSF were reported in the United States. Arizona border, with markedly similar ecology, suggests that reported 41 cases during this time period (69), all West Nile virus may be a health concern along both associated with tribal lands and transmission from sides of the border (66). Rhipicephalussanguineus, the brown dog tick (70). Nuevo Leo´n, Sonora, and Tamaulipas are the The disease has also been reported along the Mexican border states with the highest risk for Mexican side of the border. During 2009–2010, dengue fever. In 2010, Nuevo Leo´n reported 12,464 over 1,000 cases of RMSF were reported in Mexicali, cases of dengue fever and 141 of dengue hemor- Mexico. The Mexicali outbreak was also linked to rhagic fever, Sonora reported 3,588 and 191 cases, transmission by Rhipicephalussanguineus, and spread respectively, and Tamaulipas reported 1,361 and 186 through infected ticks by stray and free-roaming cases, respectively (66). The last reported continental dogs (71) Subsequent surveillance efforts have dengue activity on the U.S. side of the border was in suggested that sporadic RMSF cases, likely asso- south Texas in 2005, when a local case of dengue ciated with the brown dog tick, are widespread hemorrhagic fever was reported in Brownsville, throughout many Mexican border states. Texas. The number of cases in the U.S. may be underreported, however (67, 68). Beginning in 2009, Vaccine-preventable Diseases all dengue infections diagnosed in the U.S. have been reportable to the U.S. Centers for Disease Childhood immunization programs have been a Control and Prevention. Most Mexican border states success in both countries and in the border area

$707 UNITED STATES–MEXICO BORDER AREA itself. Immunization coverage in 2009 with a females (5.0) and African Americans had the highest complete vaccine series in the U.S. border states rate (36.8) (78). In 2008, New Mexico reported (four doses of diphtheria, tetanus, and pertussis 1,458 new cases of HIV and 4,356 new cases of [DtaP] vaccine; three of polio; one of measles, AIDS (88% males) (79). California reported 29,939 mumps, and rubella [MMR]; three doses of new cases of HIV and 138,013 of AIDS (89% males) Haemophilus influenzae type b vaccine; three of (80). hepatitis B; and one dose of varicella vaccine by a In 2007, reported new cases of HIV in the child’s second birthday) ranged from 84.2% in New Mexican border states ranged from 12 in Coahuila to Mexico to 87.9% in California. It should be noted 91 in Tamaulipas; reported new cases of that same that some border counties had significantly lower year ranged from 5 in Coahuila to 85 in Baja coverage. For example, the coverage in Imperial California, with a mortality rate between 3.1 deaths County, California, and Don˜a Ana County, New per 100,000 population in Coahuila to 9.5 in Baja Mexico, was 65% and 57%, respectively. The cover- California (81). age improves to over 95% by the fifth birthday In 2010, the incidence rates of congenital because of compulsory vaccination laws for school syphilis reported in the Mexican border northern entry. Coverage of fully immunized children 1–4 states were among the highest in the nation. Rates years old in the six Mexican border states by the end were the highest in Baja California (0.3 per 1,000 of the second quarter of 2009 ranged from 93.9% in population under 1 year) and Sonora (0.21), compared Chihuahua to 99.4% in Tamaulipas (72, 73, 74). to 0.03 for the nation (82) In the U.S. border states in In 2007, the incidence of acute hepatitis A and 2010, congenital syphilis ranged from 0.0 cases per hepatitis B in the U.S. border states was 1.6 and 1.1 100,000 live births in New Mexico to 25.3 in Texas, cases per 100,000 population, respectively, in compared to 8.7 for the nation (83). California; 2.4 and 1.3 in Arizona; 0.6 and 0.7 in New Mexico; and 1.1 and 3.1 in Texas. For 2006– Tuberculosis 2010, the six Mexican border states reported 13,553 cases of hepatitis A and 557 cases of hepatitis B, with Tuberculosis (TB) continues to be a concern along Sonora having the highest number of hepatitis A the border. For the U.S. border states, in 2009, cases (4,329 cases, 162 cases per 100,000 population) California reported the highest incidence rate in the and Tamaulipas having the highest number of region (6.7 cases per 100,000 population), followed hepatitis B cases (132 cases, 4 cases per 100,000 by Texas (6.1), Arizona (3.5), and New Mexico population) (4, 75, 76). (2.4). California had the highest incidence rate in the continental U.S. and the highest number of cases HIV/AIDS and Other Sexually-transmitted Infections (2,470) in the nation. However, the rate was about 13% lower than the 2005 state rate. The decrease has In 2009, along the U.S. side of the border, Arizona been less among foreign-born persons, who comprise reported a total of 676 (587 males and 89 females) about 60% of all reported cases (84, 85). newly reported cases of HIV/AIDS, with an The six Mexican border states reported TB incidence rate of 10.2 cases per 100,000 population incidence rates higher than the national average of and a death rate of 1.6 deaths per 100,000 13.5 cases per 100,000 population in 2007. Baja population (77). Texas reported a total of 4,230 California reported the highest incidence rate (38.3) (3,289 males and 941 females) newly reported cases and the highest number of cases (1,147) in the of HIV infection, with an incidence rate of 17.1 border area and the nation, followed by Tamaulipas (26.5 for males and 7.6 for females). African (32.4 and 1,011), Sonora (26.1 and 644), Chihuahua Americans had the highest incidence rates of HIV (18.4 and 612), Nuevo Leo´n (18.1 and 783), and infection (62.7) in Texas. In addition, males had a Coahuila (16.7 and 430). With the exception of higher incidence rate of AIDS (15.6/100,000) than Sonora, these rates were significantly lower than the

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2002 rates. In Sonora, the incidence rate increased population), none of the border states surpassed about 18% between 2002 and 2007 (86). national incidence rates. The age-adjusted mortality rates for the top five cancer sites were: lung and Emerging Diseases bronchus (37.8–47.6 deaths per 100,000 U.S. standard population), female breast (20.1–22.6), The first two H1N1 influenza sentinel cases in the prostate (19.1–24.5), colon and rectum (14.5–16.4), border area were detected and confirmed in San and pancreas (9.4–10.4) (90, 91). For the Mexican Diego and Imperial Valley, California (87). border states of Chihuahua and Sonora, in 2008 the California reported 596 fatal H1N1 influenza cases mortality rates for the top three cancer sites were: between April 2009 and August 2010. In 2009, lung and bronchus (11.1 and 13.0 deaths per 100,000 Mexico reported 2,074 confirmed cases in Baja population), female breast (6.8 and 6.9), and colon California (54.77/100,000 population), 1,142 in and rectum (4.9 and 5.7) (28). Chihuahua (34.23), 398 in Coahuila (15.63), 3,902 in Nuevo Leo´n (90.76), 2,377 in Sonora (105.55), Diabetes and 2,281 in Tamaulipas (71.28) (66, 88). For the Mexican border states in 2009, the rate of Chronic, Noncommunicable Diseases new cases of type 2 diabetes mellitus ranged from 346 cases per 100,000 population in Sonora to 621 in Cardiovascular Diseases Coahuila, compared to 397 for the nation. Only Sonora had an incidence rate below the national In 2008, the crude mortality rates due to heart average (76). For the U.S. border states in 2009, the disease in the Mexican border states ranged from age-adjusted rate of new cases of diabetes ranged 78.0 deaths per 100,000 population in Baja from 860 in California and New Mexico to 1,010 in California to 112.2 in Sonora and Chihuahua, Arizona, compared to 840 for the nation. Between compared to 86.9 for the nation. The main 2000 and 2009, the number of adults diagnosed with contributor to heart disease mortality was mortality diabetes since 1994 increased 49.5% in Arizona, 43% from ischemic heart disease (28). For the U.S. border in Texas, 37% in New Mexico, and 32% in states in 2007, the crude mortality rates due to heart California. Native Americans, African Americans, disease ranged from 162.5 deaths per 100,000 and Hispanics have higher rates after adjusting for population in Arizona to 168.8 in California, lower population age differences. For example, the 2009 than the 204.3 for the nation. These rates were about death rate from diabetes for Native Americans in 15% to 18% lower than the 2003 rates (89). Arizona was about 245% higher than the state rate for total population (61, 92, 93). Malignant Neoplasms Nutritional Diseases Malignant neoplasms continue to be either the second or third leading cause of death in all four U.S. Obesity and all six Mexican border states. For the U.S. border states in 2007, the age-adjusted incidence In 2010, the age-adjusted percentage of adults who rates for the top five cancer sites were: prostate were obese (body mass index > 30) in the U.S. (120.0–151.7 cases per 100,000 population), female border states ranged from 24% in California to 31% breast (99.9–122.2), lung and bronchus (44.5–61.9), in Texas, compared to 33.8% for the nation. In 2009, colon and rectum (34.3–43.9), and corpus and uterus the prevalence of obesity among low-income chil- (not otherwise specified) (18.7–22.4). With the dren aged 2 to 4 years was 10%–15% in Arizona and exception of the incidence rate for female breast New Mexico and 15%–20% in California and Texas, cancer in California (122.2 cases per 100,000 compared to about 15% for the nation (94, 95).

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A survey conducted in 2006 (95) indicated that in Chihuahua, compared to 15.1% for the nation (98). the prevalence of abdominal obesity in adults in the For the U.S. border states, the prevalence of heavy Mexican border states ranged from 76.9% in Baja drinking in men (defined as consuming an average of California to 82.9% in Tamaulipas (the highest of more than two drinks per day) ranged from 5.2% in the nation). Excessive weight gain, obesity, and New Mexico to 6.9% in California, compared to 5.7% abdominal obesity have increased among adults for the nation. The prevalence of heavy drinking compared to a 2000 national study. Among the consumption in women (consuming an average of many possible explanations cited for the increases more than one drink per day) ranged from 3.5% in were factors related to urbanization, increased access New Mexico to 4.9% in California, compared to 4.2% to unhealthy foods, and lack of opportunities for for the nation (99, 100, 101). physical activity.

Mental Disorders HEALTH POLICIES, THE HEALTH SYSTEM, AND SOCIAL PROTECTION The rate of suicide deaths has declined in the United States–Mexico border region over the past decade, HEALTH SYSTEMS AND SERVICES but remains relatively high in certain states and communities. In 2007, New Mexico had the highest In the United States, the health care system is rate of suicides among U.S. border states (20.4 characterized by a demand model and health care is deaths per 100,000 population), followed by Arizona delivered through a fee-for-service system. Health (16.0), Texas (10.2), and California (9.9), compared services are provided primarily by nonprofit institu- to 11.3 for the nation, rendering suicide the 10th tions and private entities. Native Americans also leading cause of death in this geographical region. receive services through the public Indian Health Almost four times as many males as females died by Service. In 2008–2009, private health insurance suicide in the U.S. and it was the third leading cause coverage ranged from 44% in New Mexico to 53% of death for young people ages 15 to 24 (89, 96). For in California. Public health insurance such as the Mexican border states, in 2008 Sonora had the Medicare (for an individual over 65 years of age who highest rate of suicides (7.6 deaths per 100,000 has been a U.S. citizen or permanent legal resident for population), followed by Chihuahua (6.9), Coahuila five years) covered 9%–12% of the population and (5.8), Nuevo Leo´n (5.6), Tamaulipas (4.5), and Baja Medicaid (for low-income and disabled U.S. citizens California (4.1), compared to 4.4 for the nation, or permanent legal residents) covered 15%–19% of the corresponding to about 23% of the suicides for the population. The uninsured population in the border nation. About 80%–90% of suicides were males in states was higher than for the nation as a whole, from Mexican border states (63, 97). 19% in California to 26% in Texas, compared to 17% for the nation. The uninsured population in the three Risk and Protection Factors most populous border counties of Texas was 33% (102, 103); with this high percentage of population lacking Alcoholism health insurance, Texas faces a significant challenge of uncompensated health care. In 2008, Texas hospitals In 2008, the prevalence of heavy drinking in men reported US$ 13.6 billion in uncompensated care (defined as having more than five drinks per occasion) charges (104). The federal Patient Protection and in the Mexican border states ranged from 23.6% in Affordable Care Act of March 2010 put in place a Baja California to 47.5% in Nuevo Leo´n, compared to comprehensive health insurance reform to expand 39.1% for the nation. The prevalence of heavy health insurance coverage (105). drinking in women (having more than four drinks In Mexico, health is considered a constitutional per occasion) ranged from 9.6% in Coahuila to 14.1% right, but there is no universal health care coverage.

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Public and private institutions provide health care Maintaining the health workforce in the border services. In 2009, the uninsured population in the region faces a number of challenges, including a lack of Mexican border states ranged from 20% in Nuevo medical and public health higher education institu- Leo´n to 28% in Baja California, lower than the 34% tions. There are 19 schools offering medical education for the nation. An insurance system known as and 12 schools offering graduate degrees in public ‘‘Seguro Popular’’ became available in 2002 to provide health in the U.S. border states and 19 medical schools health service coverage, through voluntary enrollment, and 15 public health programs in the Mexican border for persons who are not affiliated to the country’s social states. New investments in health education have been security scheme (106). Between 2002 and 2009, more made in the U.S. border counties since 2006. For than 500,000 families from border municipalities and example, a new master in public health program was over 2 million families from the border states enrolled started at the University of Texas in El Paso in 2008 in this system (107). and a medical school was created in El Paso, Texas in The U.S. and Mexican health care systems have 2009 (109). It has been equally challenging to attract a various programs and projects in place to promote health workforce within the border region. health services along the border. For example, the For the U.S. border states in 2009, the number Binational Health Week and Border Binational of hospital beds ranged from 1.9 per 1,000 population Health Week promote public health care, outreach, in California (0.4 in state/local government facilities, and immunization services every October, reaching 1.2 in nonprofit facilities, and 0.3 in for-profit vulnerable groups along the border. The Ventanillas de facilities) to 2.5 in Texas (0.4 in state/local govern- Salud (health stations) program provides on-site health ment facilities, 1.1 in nonprofit facilities, and 1.0 in advice and outreach at Mexican Consulates in the U.S. for-profit facilities), compared to 2.6 for the nation to low-income and Hispanic migrant families unfa- (0.4 in state/local government facilities, 1.8 in non- miliar with the U.S. health system. It was launched in profit facilities, and 0.4 in for-profit facilities). San Diego and Los Angeles in 2002 and has expanded Hospital admissions ranged from 91 per 1,000 to include all 50 consular offices in the U.S. (108). population in New Mexico to 107 in Arizona, compared to 116 for the nation, and hospital emergency room visits ranged from 286 per 1,000 HUMAN RESOURCES population in California to 413 in New Mexico, compared to 415 for the nation (102). In the Mexican The number of professionally active physicians per border states in 2009, the number of beds in facilities 10,000 civilian population for the U.S. border states of the National Health System (excluding facilities of in 2008 ranged from 21.5 in Texas to 26.2 in the Secretary of National Defense) ranged from 0.6 California, lower than the 27.7 for the nation. In per 1,000 population in Baja California to 1.0 in Texas, most border counties are federally designated Sonora, compared to 0.7 for the nation (107). as medically underserved areas (having too few primary health care providers). In 2007, the number of professionally active dentists per 10,000 civilian KNOWLEDGE, TECHNOLOGY, population ranged from 4.6 in Texas and New INFORMATION, AND HUMAN RESOURCE Mexico to 7.6 in California, compared to 6.0 for the MANAGEMENT nation. In 2010, the number of registered nurses per 10,000 population ranged from 64.4 in California to EVIDENCE-BASED PRACTICE AND INFORMATION 70.1 in Texas, compared to 86.0 for the nation (102). ACCESS The number of physicians per 10,000 population for the Mexican border states in 2009 ranged from 14.6 Since 2008, the U.S. Health Resources and Services in Baja California to 20.2 in Sonora, compared to Administration has been working closely with 16.9 for the nation (107). academic institutions, health sciences libraries, and

$711 UNITED STATES–MEXICO BORDER AREA the U.S. National Library of Medicine to assess the Commission (BECC) and its sister institution, the need and implementation of evidence-based practice North American Development Bank (NADB) (113); approaches that contribute to strengthening health the Border 2012 Environmental Program (114); the systems and improving health care in the border Border Governor’s Conference (115); the Border region (110). As a result, Frontera Collaboration Legislative Conference (116); the Coalition of (‘‘Border Collaboration’’) was created to bring Border Mayors; and PAHO/WHO’s U.S.-Mexico together members of the Border Virtual Health Border Office. Library and the National Network of Libraries of The U.S.-Mexico Border Health Commission Medicine in the U.S. border states to improve the was created as a binational health commission in July evidence-based practice skills and information access 2000 and was charged with providing leadership to of health professionals working in rural clinics and optimize health and quality of life along the border. community health centers (111). Commission membership includes the Minister of Health of Mexico and the U.S. Secretary of Health, the chief health officers of the 10 border states, and HEALTH INFORMATION TECHNOLOGY prominent health professionals from both nations. During 2006–2010 the Commission held several In the U.S., substantial progress has been made research forums (117), established expert panels, toward the establishment of the National Health sponsored activities each year for the National Infant Information Infrastructure, particularly in setting Immunization Week and Vaccination Week in the standards to harmonize information systems and Americas, supported a tuberculosis working group, enhance interoperability. Since 2003, the U.S. and established a tuberculosis consortium. Each year Department of Health and Human Services has the Commission has sponsored activities for the allocated over US$ 40.6 million to northern and Binational Border Health Week, including work- southern border states for this purpose. Combined shops and seminars on topics such as health allocations for Arizona, California, New Mexico, diplomacy, tobacco policy, and diabetes prevention and Texas exceed US$ 30.5 million for the U.S. (86). Border State Early Warning Infectious Disease The Binational Health Councils (BHC) were Surveillance Project (EWIDS) (112). In the U.S.- originally established as local chapters of the U.S.- Mexico border area, EWIDS and the Border Mexico Border Health Association, which stopped Infectious Disease Surveillance Program collabora- operations in 2010. There are 16 Councils, consist- tion demonstrated its relevancy during the 2009 ing of volunteer members from local health services H1N1 influenza pandemic through exchange of and community organizations from both sides of the surveillance findings, distribution of laboratory border. In June 2008, the Councils defined border- supplies, availability of highly trained technical staff, wide health priority areas for 2009–2011. Most and training of public health personnel. Councils identified TB and issues associated with diabetes, obesity, and nutrition among their prio- rities. At least half of the Councils identified dengue HEALTH AND INTERNATIONAL fever; the Early Warning Infectious Disease COOPERATION Surveillance program; issues relating to mental health, substance abuse, and domestic violence; and There are several transnational agreements, alliances, HIV/AIDS and other sexually-transmitted infec- and partnerships along the U.S.-Mexico border. The tions as issues of leading concern (118). most notable are the U.S.-Mexico Border Health The Border Environment Cooperation Com- Commission (86); the Binational Health Councils; mission and the North American Development the International Boundary and Water Commission Bank were created as interdependent institutions (IBWC); the Border Environment Cooperation in 1993 under a side agreement to NAFTA. Both

$712 HEALTH IN THE AMERICAS, 2012 N COUNTRY VOLUME entities were intended to improve environmental Strategies such as Healthy Border 2012, an initiative conditions along the U.S.-Mexico. They work of the U.S.-Mexico Border Health Commission with communities and project sponsors to develop, (119) and the Border 2020 Environmental Program finance, and build sustainable projects that address (120), administered by Mexico’s Secretariat for human health and environmental needs. Between the Environment and Natural Resources 1995 and 2010 the Border Environment (SEMARNAT) and the U.S. Environmental Cooperation Commission certified 175 projects—93 Protection Agency (EPA), will set important in Mexico and 82 in the U.S.—with an estimated benchmarks to improve health and quality of life total cost of US$ 3.924 billion. These projects along the border. Finally, increasing investments in provided access to safe and sanitary water infra- health education, including the establishment of new structure, increased wastewater management effi- medical and public health schools in the area, will ciency, enhanced proper waste disposal, and provide much needed opportunities for young improved air quality related to paving to approxi- professionals to stay and work in the border mately 7.2 million border residents (113). region.

SYNTHESIS AND PROSPECTS REFERENCES

This chapter shows that differences in economic 1. United States of America and United Mexican development persist between both sides of the U.S. States. La Paz Agreement: agreement between Mexico border region and that significant differences the United States of America and the United persist along the U.S. side of the border. Water Mexican States on cooperation for the protec- supplies in the area are already stressed and are tion and improvement of the environment in projected to become increasingly scarce in the next the border area. La Paz, Baja California, 50 years due to climate change. In general, health Me´xico; 1983. conditions have improved since 2005. However, 2. United States-Mexico Border Health Com- since 2008, there has been an increase of violence mission. Healthy Border 2010. An agenda for along the Mexican side of the border, associated improving health on the United States- primarily with the implementation of national Mexico border. El Paso, TX, and Mexico. policies to crack down on organized crime and drug U.S.-Mexico Border Health Commission; trafficking. In addition, the low immunization 2003. coverage, limited access to health care services, 3. United States, Census Bureau. 2009 American limited primary care providers along the U.S. side Community Survey 1-year estimates [Internet]; of the border, precarious health of indigenous 2009. Available at: http://factfinder.census.gov/ populations, public health emergencies, and high servlet/CTGeoSearchByListServlet?ds_ rates of certain health conditions such as childhood name5ACS_2009_1YR_G00_&_lang5en&_ obesity, diabetes, teen pregnancy, and tuberculosis ts5327254662201 Accessed on 29 December along both sides of the border continue to be of 2011. great concern. 4. Instituto Nacional de Estadı´stica y Geografı´a. Increasing investments in physical infrastruc- Censo de Poblacio´n y Vivienda 2010. ture as a result of security concerns in the U.S.- Cuestionario ba´sico [Internet]; 2010. Available Mexico border area may benefit health and develop- at: http://www3.inegi.org.mx/sistemas/ ment in the region. In addition, the health care TabuladosBasicos/Default.aspx?c527302& reform in the U.S. and the increasing investment in s5est Accessed on 29 December 2011. the Seguro Popular system in Mexico are expected to 5. United States, Census Bureau. 2005–2009 increase access to health care along the border. American Community Survey 5-year estimates

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[Internet]; 2009. Available at: http:// 13. New Mexico Department of Health. Data and factfinder.census.gov/servlet/CTGeoSearchBy confidence limits for life expectancy at birth by ListServlet?ds_name5ACS_2009_5YR_ year and sex, New Mexico and US, 1990–2006 G00_&_lang5en&_ts5327416478743 [Internet]; 2011. Available at: http://ibis. Accessed on 29 December 2011. health.state.nm.us/indicator/view_numbers/ 6. Pew Hispanic Center. State and County Data- LifeExpect.Year.Sex.html Accessed on 29 bases and Demographic Profiles [Internet]; December 2011. 2009. Available at: http://pewhispanic.org/ 14. California Department of Public Health. Birth states/ Accessed on 29 December 2011. and Death Records, 1997–2008 [Internet]; 7. Peach J, Williams J. Population Dynamics 2008. Available at: http://www.cdph.ca.gov/ of the U.S.-Mexican Border Region. Un- data/statistics/Documents/VSC-2008-0405. published, forthcoming SCERP monograph. pdf Accessed on 29 December 2011. San Diego: SCERP/SDSU Press; 2003. 15. Henry J. Kaiser Family Foundation. Arizona: Available at: http://www.scerp.org/population. Life expectancy at birth (in years), 2007 htm Accessed on 29 December 2011. [Internet]; 2007. Available at: http://www. 8. El Colegio de la Frontera Norte & Woodrow statehealthfacts.org/profileind.jsp?ind5784& Wilson International Center for Scholars, cat52&rgn54 Accessed on 29 December Mexico Institute. Strategic guidelines for 2011. the competitive and sustainable development 16. Mexico, Consejo Nacional de Poblacio´n. of the U.S.-Mexico transborder region. Proyecciones de la poblacio´ndeMe´xico, Monterrey, Nuevo Leo´n, Mexico: Border 2000–2050 [Internet]; 2009. Available at: Governors Conference; 2009. http://www.conapo.gob.mx/ Accessed on 29 9. Research and Innovative Technology December 2011. Administration. Bureau of Transportation 17. Mexico, Comisio´n Nacional para el Desarrollo Statistics. Border crossing/entry data: query de los Pueblos Indı´genas. Sistema de indica- detailed statistics [Internet]; 2010. Available dores sobre la poblacio´n indı´gena de Me´xico at: http: //www.bts.gov/programs/ [Internet]; 2005. Available at: http://www.cdi. international/transborder/TBDR_BC/ gob.mx/localidades2005/estados/mexi.htm TBDR_BCQ.html Accessed on 29 December Accessed on 29 December 2011. 2011. 18. United States, Bureau of Economic Analysis, 10. United States Department of Homeland National Economic Accounts [Internet]; 2011. Security. Data and Statistics [Internet]; 2011. Available at: http://www.bea.gov/national/ Available at: http://www.dhs.gov/files/ index.htm#gdp Accessed on 29 December statistics/data Accessed on 29 December 2011. 2011. 11. Martin JA, Hamilton BE, Sutton PD, Ventura 19. Mexico, Instituto Nacional de Estadı´stica y SJ, Mathews TJ, Kirmeyer S, et al. Births: final Geografı´a. Encuesta Nacional de Empleo y data for 2007 [Internet]. CDC National Vital Seguridad Social [Internet]; 2010. Available at: Statistics Reports 2010;58(24):1–86. Available http://www.inegi.gob.mx/est/contenidos/ at: http://www.cdc.gov/nchs/data/nvsr/nvsr58/ espanol/metodologias/encuestas/hogares/ nvsr58_24.pdf Accessed on 29 December concepeness09.pdf Accessed on 29 December 2011. 2011. 12. Texas Department of State Health Services. 20. Banamex. Datos de la divisio´n econo´mica y 2008 Mortality [Internet]. Available at: social [Internet]; 2011. Available at: http:// http://www.prod.dshs.state.tx.us/CHS/ www.banamex.com/estudios_finanzas/ VSTAT/latest/nmortal.shtm/ Accessed on 29 finanzas/sector_productivo.htm Accessed on December 2011. 29 December 2011.

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21. Consejo Nacional de Evaluacio´n de la Polı´tica teendrivers_factsheet.html Accessed on 29 de Desarrollo Social. Informe de evaluacio´nde December 2011. la polı´tica de desarrollo social en Me´xico. 30. United States, Centers for Disease Control Me´xico, DF: CONEVAL; 2008. and Prevention. Injury prevention and control: 22. Office of Texas Secretary of State. The data and statistics. Ten leading causes of death Colonia Initiatives Program. Tracking the and injury, 2007 [Internet]; 2009. Available progress of state-funded projects that benefit at: http://www.cdc.gov/injury/wisqars/ colonias. Final report in response to Senate LeadingCauses.html Accessed on 29 Bill 99 by Senator Judith Zaffirini and December 2011. Representative Ryan Guillen. 82nd regular 31. United States, National Highway Traffic session, Texas Legislature; 2010. Safety Administration. An analysis of the 23. United States Environmental Protection significant decline in motor vehicle traffic Agency and Secretarı´a de Medio Ambiente y fatalities in 2008. Washington, DC: Recursos Naturales. State of the border NHTSA; 2010 (DOT.HS.811. 346. 2010). region 2010. Border 2012: U.S.-Mexico 32. Me´xico, Presidencia de la Repu´blica [Internet]. Environmental Program. Indicators Report; Todos Somos Jua´rez. Available at: http://www. 2011. todossomosjuarez.gob.mx/ Accessed on 29 24. United States Environmental Protection December 2011. Agency and Secretarı´a de Medio Ambiente y 33. San Diego Association of Governments. Recursos Naturales. Border 2012: U.S.-Mexico Thirty years of crime in the San Diego region: Border scrap tire inventory. Summary report 1981 through 2010 [Internet]; 2011. Available [Internet]; 2007. Available at: http://www. at: http://www.sandag.org/uploads/ epa.gov/Border2012/docs/ScrapTireInventory publicationid/publicationid_1572_12834.pdf Summary_05-16-07.pdf Accessed on 29 Accessed on 29 December 2011. December 2011. 34. Texas Department of Public Safety. Crime in 25. California Department of Pesticides Regula- Texas 2007: Chapter 9. Crime by jurisdiction tion. California Full Use Reporting System [Internet]; 2007. Available at: http://www. [Internet]; 2010. Available at: http://www. txdps.state.tx.us/crimereports/07/citch9.pdf cdpr.ca.gov/ Accessed on 29 December 2011. Accessed on 29 December 2011. 26. Arizona Department of Agriculture. Arizona 35. Texas Department of Public Safety. Crime in Full Use Reporting System [Internet]; 2011. Texas 2008: Chapter 9.Crime by jurisdiction Available at: http://www.azda.gov/ Accessed [Internet]; 2008. Available at: http://www. on 29 December 2011. txdps.state.tx.us/crimereports/08/citCh9.pdf 27. Saller J, Reyes P, Maldonado PA, Gibbs Byrd Accessed on 29 December 2011. TL.Children’s exposure to pesticides used in 36. Texas Department of Public Safety. Crime in homes and farms. Journal of Environmental Texas 2009: Chapter 9. Crime by jurisdiction Health 2007;69(7): 27–31. [Internet]; 2009. Available at: http://www. 28. Mexico, Sistema Nacional de Informacio´nen txdps.state.tx.us/crimereports/09/citCh9.pdf Salud. Principales causas de mortalidad general Accessed on 29 December 2011. por entidad federativa [Internet]; 2008. 37. Cervera LE, Mona´rrez Fragoso JE. Sistema de Available at: http://sinais.salud.gob.mx/ informacio´n geogra´fica de la violencia en el mortalidad/ Accessed on 29 December 2011. municipio de Jua´rez, Chihuahua: Geo-refer- 29. United States, Centers for Disease Control and enciacio´n y su comportamiento espacial en el Prevention. Teen Drivers: Fact Sheet contexto urbano y rural; 2010. [Internet]; 2010. Available at: http://www. 38. Stormpulse. Hurricane Dolly [Internet]; 2008. cdc.gov/motorvehiclesafety/teen_drivers/ Available at: http://www.stormpulse.com/

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hurricane-dolly-2008 Accessed on 29 47. Texas Department of State Health Services. December 2011. Onset of prenatal care within the first trimester 39. United States, Federal Emergency Manage- in Texas, 2008 [Internet]; 2011. Available at: ment Agency. Texas Hurricane Dolly [Inter- http://wwwprod.dshs.state.tx.us/chs/vstat/ net]; 2008. Available at: http://www.fema.gov/ latest/t12.shtm Accessed on 29 December news/event.fema?id510347 Accessed on 29 2011. December 2011. 48. Arizona Department of Health Services. 40. United States, National Oceanic and Atmos- Prenatal care in Arizona. 2009 Fact Sheet pheric Administration. National Hurricane [Internet]; 2009. Available at: http://www. Center [Internet]; 2011. Available at: http:// azdhs.gov/phs/owch/pdf/factSheets/ www.nhc.noaa.gov/ Accessed on 29 December PrenatalCare2009.pdf Accessed on 29 2011. December 2011. 41. Magan˜a Gonzalez A. 4 de Abril: Mexicali, 49. Lucile Packard Foundation for Children’s despue´s del terremoto. Comisio´n de Biblioteca Health. Prenatal Care. Infants whose mothers y Asuntos Editoriales. Me´xico, DF: Senado de received prenatal care in the first trimester la Repu´blica; 2011. 1995–2009 [Internet]; 2009. Available at: http: 42. United States, Global Change Research //www.kidsdata.org/data/topic/dashboard. Program. Regional climate impacts: southwest aspx?cat559 Accessed on 29 December 2011. [Internet]; 2008. Available at: http://www. 50. New Mexico Department of Health. Data and globalchange.gov/images/cir/pdf/southwest. confidence limits for prenatal care in the first pdf Accessed on 29 December 2011. trimester by county, New Mexico and United 43. Mexico, Secretarı´a de Hacienda y Cre´dito States, 2008–2009 [Internet]; 2011. Available Pu´blico y Secretarı´a de Medio Ambiente y at: http://ibis.health.state.nm.us/indicator/ Recursos Naturales. La economı´a del cambio view_numbers/PrenCare.Cnty.html Accessed clima´tico en Me´xico. Sı´ntesis [Internet]; 2009. on 29 December 2011. Available at: http://www.cambioclimatico.gob. 51. Mexico, Encuesta Nacional de la Dina´mica mx/images/stories/PDF/sintesis2009.pdf Demogra´fica 2009. Metodologı´a y tabulados Accessed on 29 December 2011. ba´sicos [Internet]; 2009. Available at: http:// 44. United States, Health Resources and Services coepo.jalisco.gob.mx/XLS/Encuestas/ Administration. Women’s health USA 2010. ENADID2009.pdf Accessed on 29 December Maternal mortality [Internet]; 2010. Available 2011. at: http://mchb.hrsa.gov/whusa10/hstat/mh/ 52. Kost K, Henshaw S, Carlin L. U.S. Teenage pages/237mm.html Accessed on 29 Pregnancies, Births and Abortions: National December 2011. and State Trends and Trends by Race and 45. Arizona Department of Health Services. Ethnicity [Internet]; 2010. Available at: http:// Arizona Health Status and Vital Statistics www.guttmacher.org/pubs/USTPtrends.pdf 2008 Report [Internet]; 2010. Available at: Accessed on 29 December 2011. http://www.azdhs.gov/plan/report/ahs/ 53. Consejo Nacional de Poblacio´n. Principales ahs2008/toc08.htm Accessed on 29 December indicadores de salud reproductiva (ENADID 2011. 2009). Me´xico, DF: CONAPO; 2009. 46. Mexico, Sistema Nacional de Informacio´nen 54. Texas Department of State Health Services. Salud. Razo´n de mortalidad materna y defun- Summary of infant deaths, deaths under one ciones maternas por an˜o de registro y entidad year of age, by age, race ethnicity and sex. de residencia habitual, 2002–2008. INEGI y Texas, 2008 [Internet]. Available at: http:// Direccio´n General de Informacio´n en Salud; www.dshs.state.tx.us/chs/vstat/latest/t29.shtm 2008. Accessed on 29 December 2011.

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55. New Mexico Department of Health. New http://www.azdhs.gov/plan/report/ahs/ Mexico Selected Health Statistics Annual ahs2009/toc09.htm Accessed on 29 December Report 2008. The State Center for Health 2011. Statistics. Bureau of Vital Records and Health 63. Mexico, Sistema Nacional de Informacio´nen Statistics [Internet]; 2008. Available at: Salud. Defunciones y tasa de mortalidad http://nmhealth.org/VitRecHealthStats/ general (cruda y estandarizada) por sexo, segu´n reports/2008_AR.pdf Accessed on 29 entidad federativa de residencia habitual December 2011. [Internet]; 2008. Available at: http://sinais. 56. Instituto Nacional de Estadı´stica y Geografı´a. salud.gob.mx/mortalidad/ Accessed on 29 Tasa de mortalidad infantil por entidad December 2011. federativa, 2000 a 2011 [Internet]. Available 64. United States, Centers for Disease Control and at: http://www.inegi.org.mx/sistemas/sisept/ Prevention. Statistics, Surveillance, and Default.aspx?t5mdemo55&s5est&c523602 Control. Final 2010 West Nile Virus Human Accessed on 29 December 2011. Infections in the United States [Internet]; 57. Texas Department of State Health Services. 2010. Available at: http://www.cdc.gov/ Texas Vital Statistics. Summary of 2008 Vital ncidod/dvbid/westnile/surv& Statistics [Internet]; 2011. Available at: http:// controlCaseCount10_detailed.htm Accessed wwwprod.dshs.state.tx.us/chs/vstat/latest/data. on 29 December 2011. shtm Accessed on 29 December 2011. 65. City of El Paso Department of Public Health. 58. California Department of Public Health. Age- Notifiable Conditions Report: December 2010 specific death rates by sex. California, 2003– [Internet]; 2011. Available at: http://www. 2009 [Internet]; 2009. Available at: http:// elpasotexas.gov/health/epidemiology.aspon www.cdph.ca.gov/data/statistics Accessed on Accessed on 29 December 2011. 29 December 2011. 66. Mexico, Sistema Nacional de Vigilancia 59. Mexico, Sistema Nacional de Informacio´nen Epidemiolo´gica. Informacio´n preliminar al Salud. Distribucio´n porcentual de las defun- corte de la semana epidemiolo´gica No. 52 ciones de hombres por grupos de edad, segu´n del 2010. INAVE/DGAE/CENAVECE/ entidad federativa de residencia habitual Secretarı´a de Salud; 2010. [Internet]; 2008. Available at: http://sinais. salud.gob.mx/mortalidad/ Accessed on 29 67. United States, Centers for Disease Control and December 2011. Prevention. Dengue fever seroprevalence and 60. Mexico, Sistema Nacional de Informacio´nen risk factors, Texas-Mexico Border, 2004 Salud. Distribucio´n porcentual de las defun- [Internet]. Emerg Infect Dis J 2007;13(10): ciones de mujeres por grupos de edad, segu´n 1477–1483. Available at: http://www.cdc.gov/ entidad federativa de residencia habitual eid/content/13/10/pdfs/1477.pdf Accessed on [Internet]; 2008. Available at: http://sinais. 29 December 2011. salud.gob.mx/mortalidad/ Accessed on 29 68. United States, Centers for Disease Control and December 2011. Prevention. Dengue Hemorrhagic Fever. U.S.- 61. Arizona Department of Health Services, Mexico Border, 2005 [Internet]. MMWR Bureau of Public Health Statistics. Health 2007;56(31):785–789. Available at: http:// status profile of American Indians in Arizona: www.cdc.gov/mmwr/preview/mmwrhtml/ 2009 data book. Phoenix: Arizona Depart- mm5631a1.htm Accessed on 29 December ment of Health Services; 2009. 2011. 62. Arizona Department of Health Services. 69. Arizona Department of Health Services. Arizona Health Status and Vital Statistics Rocky Mountain Spotted Fever. Arizona 2009 Report [Internet]; 2009. Available at: Statistics. Available at: http://azdhs.gov/phs/

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oids/vector/rmsf/stats.htm Accessed on 21 http://www.cdc.gov/mmwr/PDF/ss/ss5803. February, 2011. pdf Accessed on 29 December 2011. 70. McQuiston JH, MA Guerra, MR Watts, E 76. Mexico, Secretarı´a de Salud. Carpeta de Lawaczek, C Levy, WL Nicholson, J informacio´n estrate´gica por estado [Internet]; Adjemian, DL Swerdlow. Evidence of expo- 2010. Available at: http://www.dgepi.salud. sure to spotted fever group ricketttsiae among gob.mx/boletin/morbilidad/carpetas_morbi/ Arizona dogs outside a previously documented dIciembre/cEstrategicas_dIciembre.pdf outbreak area. Zoonoses Public Health 2011; Accessed on 29 December 2011. 58:85–92. 77. Arizona Department of Health Services. 71. Sanchez R, Alpuche C, Lopez-Gatell H, Soria Arizona Health Status and Vital Statistics C, Estrada J, Olguin H, Lezana MA, 2009 Report: Human Immunodeficiency Virus Nicholson W, Eremeeva M, CDC Infectious (HIV) and Acquired Immunodeficiency Disease Pathology Branch, G Dasch, M Syndrome (AIDS) [Internet]; 2009. Available Fonseca, S Montiel, S Waterman, J at: http://www.azdhs.gov/plan/report/ahs/ McQuiston. Rhipicephalussanguineus-associated ahs2009/pdf/text3c.pdf Accessed on 29 Rocky Mountain spotted fever in Mexicali, December 2011. Mexico: observations from an outbreak in 78. Texas Department of State Health Services. Texas HIV Surveillance Report. 2009 Annual 2008–2009. Abstract #75, presented at the Report [Internet]; 2009. Available at: http:// 23rd Meeting of the American Society for www.dshs.state.tx.us/hivstd/reports/default. Rickettsiology, Hilton Head, South Carolina, shtm Accessed on 29 December 2011. 15–18 August 2009. 79. New Mexico Department of Health. New 72. California Department of Public Health. 2008 Mexico HIV/AIDS Annual Surveillance immunization assessment results [Internet]; Report 2008 [Internet]; 2008. Available at: 2010. Available at: http://www.cdph.ca.gov/ http://nmhealth.org/ERD/HealthData/HIV/ programs/immunize/Pages/2008Immunization HIV_annual_report_2008.pdf Accessed on 29 AssessmentResults.aspx Accessed on 29 December 2011. December 2011. 80. California Department of Public Health. HIV/ 73. New Mexico Department of Health. Data and AIDS surveillance in California [Internet]; confidence limits for childhood immunization 2008. Available at: http://www.cdph.ca.gov/ coverage with 4:3:1:3:3:1. Rates by county, programs/aids/Documents/HIVAIDSMerged 2010 [Internet]. Available at: http://ibis. Dec08.pdf Accessed on 29 December 2011. health.state.nm.us/indicator/view_numbers/ 81. Mexico, Consejo Nacional de Prevencio´ny Immun431331CASA.Cnty.html Accessed on Control del VIH/SIDA. Panorama epidemio- 29 December 2011. lo´gico del VIH/SIDA e ITS en Me´xico. 74. Mexico, Secretarı´a de Salud, Subsecretarı´ade Me´xico, DF: CONASIDA; 2007. Prevencio´n y Promocio´n de la Salud. 82. Mexico, Direccio´n General de Epidemiologı´a. Cobertura de vacunaccion sectorial por tipo Casos registrados en los Sistemas Especiales de de biolo´gico, y esquemas completos segu´n Vigilancia Epidemiolo´gica Incidencia de casos censo nominal por municipio en menores de confirmados de Sı´filis conge´nita 2010. 5an˜os. Secretarı´a de Salud, CeNSIA, Available at: http://www.dgepi.salud.gob.mx/ PROVAC; 2009. anuario/html/anuarios.html. 75. United States, Centers for Disease Control 83. Centers for Disease Control and Prevention. and Prevention. Surveillance for acute vital 2010 sexually transmitted diseases surveillance. Hepatitis, United States 2007 [Internet]. Available at: http://www.cdc.gov/std/stats10/ MMWR 2010;58(SS3):1–35. Available at: tables/41.htm.

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84. United States, Centers for Disease Control 91. United States, Centers for Disease Control and and Prevention. Reported tuberculosis in the Prevention, National Program of Cancer United States, 2009 [Internet]; 2010. Available Registries. Top 10 cancer sites 2007, both at: http://www.cdc.gov/tb/statistics/reports/ male and female, U.S. (all races) [Internet]; 2009/table20.htm Accessed on 29 December 2007. Available at: http://apps.nccd.cdc.gov/ 2011. uscs/ Accessed on 29 December 2011. 85. United States, Centers for Disease Control 92. United States, Centers for Disease Control and and Prevention. Trends in tuberculosis. United Prevention. Age-adjusted percentage of U.S. States, 2010 [Internet]. MMWR 2011;60 (11): adults who were obese or who had diagnosed 333–337. Available at: http://www.cdc.gov/ diabetes [Internet]; 2009. Available at: http:// mmwr/preview/mmwrhtml/mm6011a2.htm www.cdc.gov/diabetes/statistics/index.htm Accessed on 29 December 2011. Accessed on 29 December 2011. 86. United States—Mexico Border Health 93. United States, Centers for Disease Control and Commission. Proceedings Report of the U.S.- Prevention. Diabetes Data and Trends. Mexico Border Tuberculosis Consortium National Center for Chronic Disease [Internet]; 2010. Available at: http://www. Prevention and Health Promotion, Division borderhealth.org/files/res_1828.pdf Accessed of Diabetes Translation. Atlanta: CDC; 2009. on 29 December 2011. 94. United States, Centers for Disease Control and 87. United States, Centers for Disease Control and Prevention. U.S. obesity trends [Internet]; Prevention. Update: Swine Influenza A 2010. Available at: http://www.cdc.gov/ (H1N1) Infections, California and Texas, obesity/data/trends.html Accessed on 29 April 2009 [Internet]. MMWR 2009;58 December 2011. (Dispatch):1–3. Available at: http://www.cdc. 95. Barquera S, Campos-Nonato I, Herna´ndez- gov/mmwr/preview/mmwrhtml/ Barrera L, Flores M, Durazo-Arvizu R, Kanter mm58d0424a1.htm Accessed on 29 December R, et al. Obesity and central adiposity in 2011. Mexican adults: results from the Mexican 88. California Department of Public Health. National Health and Nutrition Survey 2006. H1N1 Influenza [Internet]; 2010. Available Salud Publica Mex 2009;51(4):S595–S603. at: http://www.cdph.ca.gov/data/statistics/ 96. National Institute of Mental Health. Suicide Pages/H1N1Graphs.aspx Accessed on 29 in the U.S. Statistics and prevention, 2009 December 2011. [Internet]; 2010. Available at: http://www. 89. United States, Centers for Disease Control and nimh.nih.gov/health/publications/suicide-in- Prevention. Deaths, percent of total deaths, the-us-statistics-and-prevention/index.shtml and death rates for the 15 leading causes of Accessed on 29 December 2011. death: United States and each state [Internet]; 97. Mexico, Instituto Nacional de Estadı´stica y 2007. Available at: http://www.cdc.gov/nchs/ Geografı´a. Estadı´stica de suicidios de los data/dvs/LCWK9_2007.pdf Accessed on 29 Estados Unidos Mexicanos [Internet]; 2009. December 2011. Available at: http://www.inegi.gob.mx 90. United States, Centers for Disease Control and Accessed on 29 December 2011. Prevention. National Program of Cancer 98. Mexico, Consejo Nacional contra las Registries. Death rates: age adjusted cancer Adicciones. Encuesta Nacional de Adicciones death rates for the 10 principal sites with [Internet]; 2008. Available at: http://www. highest rates within state and sex [Internet]; conadic.salud.gob.mx/pdfs/ena08/ENA08_ 2007. Available at: http://apps.nccd.cdc.gov/ NACIONAL.pdf Accessed on 29 December uscs/.Accessed on 29 December 2011. 2011.

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99. United States, Centers for Disease Control [Internet]; 2010. Available at: http://www. and Prevention. Prevalence and trends data— seguro-popular.gob.mx/ Accessed on 29 California. 2008 alcohol consumption December 2011. [Internet]; 2008. Available at: http://apps. 107. Mexico, Instituto Nacional de Estadı´stica y nccd.cdc.gov/BRFSS/sex.asp?state5CA& Geografı´a. Me´xico en cifras por entidad feder- cat5AC&yr52008&qkey54413&grp50 ativa y municipio [Internet]; 2010. Available at: Accessed on 29 December 2011. http://www.inegi.org.mx/sistemas/mexicocifras 100. United States, Centers for Disease Control and Accessed on 29 December 2011. Prevention. Prevalence and trends data nation- 108. Instituto de los Mexicanos en el Exterior. wide (states, DC, and territories). 2008 alcohol Ventanilla de Salud [Internet]; 2010. Available consumption [Internet]; 2008. Available at: at: http://www.ventanilladesalud.org Accessed http://apps.nccd.cdc.gov/BRFSS/sex.asp? on 29 December 2011. cat5AC&yr52008&qkey54413&state5US 109. Ambriz L. PAHO/WHO Knowledge Manage- Accessed on 29 December 2011. ment Communication and Research Activities 101. United States, Centers for Disease Control and along the U.S.-Mexico Border. Tijuana, Baja Prevention. Prevalence and trends data—New California: Pan American Health Organization; Mexico. 2008 alcohol consumption. [Internet]; 2011. 2008. Available at: http://apps.nccd.cdc.gov/ 110. United States, Health Resources and Services BRFSS/sex.asp?state5NM&cat5AC& Administration. Affordable care update yr52008&qkey54413&grp50 Accessed on [Internet]; 2011. Available at: http://www. 29 December 2011. hrsa.gov/about/affordablecareact/index.html 102. StateHealthFacts.org. Health insurance cover- Accessed on 29 December 2011. age of the total population [Internet]; 2009. 111. Pan American Health Organization/World Available at: http://www.statehealthfacts.org/ Health Organization. U.S.-Mexico Border comparetable.jsp?typ51&ind5125&cat53& Virtual Health Library: Frontera Collaboration sub539 Accessed on 29 December 2011. for Evidence-Based Practice: About the 103. United States Census Bureau. Health insur- Frontera Collaboration Project [Internet]; ance. 2009 ACS estimates on uninsured 2011. Available at: http://www.infofrontera. population at or below 138% of poverty org/php/level.php?lang5en&component534& [Internet]; 2011. Available at: http://www. item510 Accessed on 29 December 2011. census.gov/hhes/www/hlthins/data/acs/up-to- 112. United States, Department of Health and 138-pov.html Accessed on 29 December 2011. Human Services, Office of the Assistant 104. Texas Health and Human Services Secretary for Preparedness and Control. Public Commission. 2008–2009 report on residual Health Emergency [Internet]. Available at: http: uncompensated care costs [Internet]; 2011. //www.phe.gov/about/Pages/default.aspx Available at: http://www.hhsc.state.tx.us/ Accessed on 29 December 2011. reports/2011/Rider-40-0111.pdf Accessed on 113. Border Environment Cooperation Commission. 29 December 2011. Annual Report 2010 [Internet]; 2010. Available 105. United States, Department of Health and at: http://www.cocef.org/english/index.html Human Services. Health Reform and the Accessed on 29 December 2011. Department of Health and Human Services 114. United States, Environmental Protection [Internet]; 2011. Available at: http://www. Agency. U.S.-Mexico Border 2012 [Internet]; healthreform.gov/health_reform_and_hhs. 2011. Available at: http://www.epa.gov/ html Accessed on 29 December 2011. usmexicoborder Accessed on 29 December 2011. 106. Mexico, Comisio´n Nacional de Proteccio´n 115. Conferencia de Gobernadores Fronterizos. XXIX Social en Salud. Salud Seguro Popular Conferencia de Gobernadores Fronterizos en

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