Situation Analysis Issues and Challenges

SITUATION ANALYSIS
ISSUES AND CHALLENGES

The situational analysis of public health issues along the border is made to take into consideration the current priorities, challenges and opportunities in the development of the Work-plan.  The next paragraphs represent only an abstract of such analysis highlighting only the main issues.  

1.  Non-communicable diseases and risk factors are of major importance in the U.S.-Mexico Border. Data from the Diabetes Border study shows the prevalence of obesity ranging from 33-41% and for diabetes between 14-16% among men and women on both sides of the Border[i]. Among the more important challenges is the implementation of a Border wide NCDs (non-communicable diseases) prevention strategy that will strengthen preventing measures, improve surveillance of behavior risk factors, establish healthy public policies, and implement comprehensive and innovative cost-effective interventions to strengthen health care and community participation.

2. Facilitating, strengthening and maintaining multisectoral binational partnerships and alliances is a fundamental challenge in addressing the social determinants of health, the Healthy Border 2010 objectives, the MDGs (Millennium Development Goals) and other priorities in the context of the framework of the Health Agenda for the Americas 2008-2017[ii]. Enhancing information systems to monitor these commitments, especially to reduce disparities in the most vulnerable populations such as migrants and indigenous groups is critical to improving health on the Border.

3.  Road injuries are among the highest causes of death along the Border and the first cause of death among young people. Violence, mental illness, psychosocial problems, suicide, depression and substance abuse (alcohol, tobacco and drugs) are major contributors to the burden of disease and disability for the US-Mexico Border communities. A critical challenge is mobilizing resources to support the implementation of the Safe and Healthy Sister Cities initiative[iii], a cross-sector binational collaboration strategy that promotes public policies, social mobilization, health education and generates information for action.

4. Preliminary data results of an analysis commissioned by PAHO shows that HIV-AIDS on the Border is a critical issue with rates ranging from 10-15 per 100,000 population on the U.S. Border states and from 2-5 per 100,000 population on the Mexico Border states[iv]. TB is a growing concern, especially HIV and TB co-infections as well as multi-drug resistant TB.  Addressing the complex social and behavioral risk factors and conditions underlying these diseases is a crucial challenge for the Border public health institutions.

5.  The Border 2012 environmental health program[v] addresses important issues and challenges to reduce water and soil contamination, air pollution, exposure to organic compounds, heavy metals and pesticides; preventing and controlling dengue, wild rabies and West Nile virus, and fostering sustainable development as well as strengthening emergency and disaster preparedness (including acts of terrorism and pandemic influenza). 

6. Access to health services, especially primary health care, strengthening the public health workforce and the essential public health functions are major challenges on the U.S.-Mexico Border. Among these, the need to increase culturally competent human resources for health is critical. PAHO’s Border Office is supporting the design of a binational observatory to monitor this situation and recommend possible actions to take.

7.  Limited access and fragmented sources of information for policy and decision making is a major issue in planning and implementation of the most cost-effective interventions.  The differences in data collection and availability in both countries ( U.S. and Mexico) present major challenges in data analysis and dissemination of evidence for policy and programs.  The need for greater evaluation of the interventions and the dissemination of best practices is paramount. PAHO is working with the USMBHC in strengthening health research and establishing a binational information platform.

8.  There are many experiences of health research among key stakeholders on the US-Mexico Border, many are long standing and continuing academic partnerships.  The need to strengthen health research is critical, especially binational initiatives in the context of a Border wide research agenda. The major challenges are the translation of knowledge and reducing the gap between knowledge and practices. The EVIPNet (Evidence-Informed Policy Networks in Latin America and the Caribbean)[vi] is an important initiative that is beginning to provide some support to the Border in addressing this issue.

9.  The diffusion of innovations and the dissemination of information of the multiple activities in public health and health care on the Border are major challenges. This prompted the PAHO Border Office to implement a US-Mexico Border Virtual Health Library (BVHL)[vii] which was created by consensus (MOU) of various partners, particularly academic institutions. Information and knowledge management is critical for increased access to scientific-technical information by stakeholders, as well as their participation in sharing information to a Border wide audience.

10. The complexity of the U.S.-Mexico Border requires major efforts of all institutions to strengthen coordination, communication, consensus and clarity of who does what, when and where. The collaboration with the U.S.-Mexico Border Health Commission (USMBHC), the U.S.-Mexico Border Health Association (USMBHA), the Border Environmental Cooperation Commission (BECC), Governors and Legislators and other partners, as well as resource mobilization, is fundamental to improve the health and quality of life of the population on the Border.