Rural Border Health
The United States-Mexico border region is defined as the area of land being 100 kilometers (62.5 miles) north and south of the international boundary. It stretches approximately 2,000 miles from the southern tip of Texas to California, as set forth by the La Paz Agreement signed in 1983. This agreement not only defined the border region; it also permitted the federal environmental authorities in the United States and Mexico to undertake cooperative initiatives focused on environmental problems of the area.
The U.S. Census Bureau brief, The Hispanic Population: 2010, reported the counties with the highest concentrations of Hispanics are found along the southwestern border of the United States in Texas, New Mexico, Arizona, and California.
The Housing Assistance Council's Housing in the Border Colonias estimates that 5.6 million people reside in the border region with 1.7 million, or 29%, living in rural areas. According to The State of the Border Report: A Comprehensive Analysis of the U.S.-Mexico Border, this area has experienced a higher rate of migration than other parts of the United States, with a population growth rate nearly double what the country as a whole experienced over the period from 2000-2010. This accelerated growth in population has placed numerous burdens on the economic, social and health infrastructure of the region, taxing a region already faced with ongoing health and socioeconomic challenges, such as:
- High rates of poverty
- Linguistic and cultural barriers
- Restricted access to healthcare
- Lack of health insurance
- Limited water resources
- Shortage of healthcare workers
- High rates of unintentional injuries and poisonings
- Lack of suitable housing, clean water, and appropriate sewage systems
According to Addressing the Health Care Needs in the U.S.-Mexico Border Region, a policy brief from the National Rural Health Association, the U.S.-Mexico border region is predominantly rural, with 73% of the border counties designated as Medically Underserved Areas (MUAs) and 63% of the counties designated as Health Professional Shortage Areas (HPSAs) for primary medical care. The region is associated with higher mortality rates for hepatitis and diabetes-related illnesses, as well as high rates of certain diseases including tuberculosis, cervical cancer, and vaccine-preventable measles and mumps.
In spite of these health and social issues, there are some favorable health outcomes seen in the Hispanic border population, such as low death rates from heart disease and stroke, and low rates of infant mortality. For additional information on the health status among the border population, see Border Lives: Health Status in the United States-Mexico Border Region.
Frequently Asked Questions
- How can I find specific information about border health in my state?
- What key organizations are working to address the healthcare problems in the U.S.-Mexico region?
- What are the living conditions like for border populations and how do those conditions impact their health?
- What are the economic and social conditions that affect access to healthcare for the border population?
- What types of health conditions and infectious diseases are commonly found in the border region?
- What are some strategies that have been used to improve access to care in rural border communities?
- Are there recruitment incentive programs available to primary care physicians and other healthcare professionals who work in the United States along the U.S.-Mexico border region?
- What kinds of funding programs are appropriate for the ongoing development of healthcare programs and services in the U.S.-Mexico border region?
How can I find specific information about border health in my state?
Each border state operates a state office of border health, which can be contacted for state-specific information and resources.
April Fernandez, Chief
California Office of Binational Border Health
California Department of Public Health
5353 Mission Center Road, Suite 215
San Diego, CA 92108
What key organizations are working to address the healthcare problems in the U.S.-Mexico region?
The United States-México Border Health Commission (BHC) was created as a binational health commission in July 2000, with the signing of an agreement by the U.S. Secretary of Health and Human Services and the Secretary of Health of México. The mission of the U.S.-México Border Health Commission (BHC) is to provide international leadership to optimize health and quality of life along the U.S.-Mexico border. Strategic actions addressing the healthcare issues of the region can be found at the BHC Initiatives section of its website.
Arizona, California, New Mexico, and Texas all have state offices working to solve border health problems at the state level. Please see the How can I find specific information about border health in my state? for a listing of state border health offices.
The Border Infectious Disease Surveillance (BIDS) program is a binational infectious disease surveillance system for the Border Region. One example of the BIDS programs' work is a capacity building project for surveillance and diagnostic testing of coccidioidomycosis (Valley Fever) in the four-state region of Arizona and New Mexico in the U.S. and Chihuahua and Sonora in Mexico, which has been in progress since 2011. Special binational tuberculosis (TB) projects, which include continued treatment in Mexico, notification of cases, and related activities, occur in many places along the border. For additional information about these projects see: The U.S.-Mexico Border Infectious Disease Surveillance Project: Establishing Binational Border Surveillance.
What are the living conditions like for border populations and how do those conditions impact their health?
Typically rural border populations live in settlements called colonias. Although they may be thriving communities where the members support each other, colonias often exhibit substandard living conditions. Prior to the 1990s, in Texas where most colonias are located, landowners could sell land – usually land that was not tillable and often located on a flood plain – to low-income individuals and families seeking affordable housing. These lands were typically sold on a contract for deed without any infrastructure improvements such as potable water and wastewater systems. Often these properties did not have electricity, and there were no building codes in place to prevent the rapid expansion of substandard housing.
In Arizona, California, and New Mexico, the colonias are much older. In New Mexico, colonias date back to the 1800s. In Arizona and California, they developed in the first half of the twentieth century. These colonias evolved from old mining towns and in retirement communities where infrastructure and services were in place. However, the current infrastructure is aging and in need of upgrade.
One of the greatest public health concerns in these communities is the lack of wastewater systems and potable water. Many colonias do not have any type of sewer or drainage system. During heavy rains, sewage can collect in pools on the ground, causing a health hazard. Colonia residents who do not have potable water may rely on water drawn from unsafe wells or buy water in buckets from unknown sources, increasing their chances of exposure to a health hazard.
Other living conditions that impact health include unpaved roads that create dust, causing respiratory problems, as well as homes built in flood-prone areas that experience frequent flooding, which can contaminate the potable water systems. For additional information about the living conditions in colonias, see Housing in the Border Colonias and Texas Colonias: A Thumbnail Sketch of Conditions, Issues, Challenges and Opportunities.
What are the economic and social conditions that affect access to healthcare for the border population?
Several economic and social conditions affect access to healthcare for the residents of border colonias. Residents of colonias often experience poverty, working low-wage jobs without health insurance. The inability to pay for healthcare is a significant barrier. The shortage of healthcare providers significantly impacts access to healthcare by this population group. Often residents of rural border colonias have to travel long distances to healthcare facilities and fear losing wages for time spent away from work. In addition, inconvenient healthcare clinic hours and the lack of knowledge of what programs are available also restrict access to healthcare. For additional information, see Border Lives: Health Status in the United States-Mexico Border Region.
What types of health conditions and infectious diseases are commonly found in the border region?
According to the 2012 Annual Report: United States-México Border Health Commission the priorities of the U.S.-México Border Health Commission (BHC) are to promote awareness of the prevalence of the obesity epidemic, the risk factors associated with diabetes, reduce the burden of tuberculosis, and address the critical infectious disease issues. Reasons for the priorities include:
- 60% of the adult population in the U.S. border counties is overweight or obese, and 10% of the adult population reported having diabetes (Rural Border Health Chartbook, 2013).
- The U.S. border states report a tuberculosis incidence rate of 7.9 per 100,000 population whereas the United States as a whole reported a rate of 4.7 per 100,000 (TB in the U.S.-Mexico Border Region)
- Other infectious disease issues include the findings from the Texas Department of Health that hepatitis A, salmonellosis, dysentery, and cholera occur at much higher rates in the colonias than in Texas as a whole (Texas Colonias: A Thumbnail Sketch of Conditions, Issues, Challenges and Opportunities).
- In 2012 and 2013 the U.S. border states reported the highest rates of uninsured with Texas at 27%, New Mexico at 24%, California at 21%, and Arizona at 20% compared to the United States average of 18% (Access to Health Care in the U.S.-México Border Region: Challenges and Opportunities).
Currently, the border region is preparing for the possible arrival and local transmission of Zika and other arboviruses such as dengue and chikungunya that can be carried by the same vector, Aedes aegypti mosquitoes. CDC's Border Infectious Disease Surveillance program (BIDS) is working with the states in a response effort to address Zika through education, surveillance, laboratory testing, and communication with Mexico.
What are some strategies that have been used to improve access to care in rural border communities?
According to Border Lives: Health Status in the United States-Mexico Border Region, a U.S.-México Border Health Commission report, the most important issue to resolve is the strain placed on access to primary care, preventive care, and specialty care due to the rapidly growing border population. The development of a sufficient and culturally sensitive healthcare workforce has not been able to keep up with the population growth.
One of the more successful approaches to improving access to healthcare in the rural border region is for healthcare facilities to use the community health worker (CHW, also known as promotora de salud) model. CHWs facilitate education and advocate for healthy change. CHWs act as a bridge for the border community to the providers of healthcare and human services.
Another approach is to support and develop Health Center Program grantees, often called Federally Qualified Health Centers (FQHCs) or community health centers (CHCs), that are federally funded through the Bureau of Primary Care, as authorized under section 330 of the Public Health Service Act. These Health Center Program grantees serve underserved communities or special populations including migrant and seasonal farmworkers, persons experiencing homelessness and residents of public housing. Most importantly, they provide healthcare to everyone regardless of their ability to pay out-of-pocket expenses or whether they have health insurance.
Also, school-based health centers (SBHC) operate in the border region as a partnership between the school and a community health organization, such as a community health center or FQHC. SBHCs enable children with acute or chronic illnesses to attend school, but also work to improve their overall health and wellness of all school children through health screenings, health promotion, and disease prevention activities. Both FQHCs and SBHCs are actively working to address healthcare issues that are found in the border region. For additional information about Health Centers, see HRSA's What is a Health Center? and RHIhub's topic guide Federally Qualified Health Centers.
Are there recruitment incentive programs available to primary care physicians and other healthcare professionals who work in the United States along the U.S.-Mexico border region?
More than half of the counties located in the U.S.-Mexico border region are federally designated as a Medically Underserved Areas (MUAs) and/or a Health Professional Shortage Areas (HPSAs), making a large portion of this region eligible for participation in the National Health Service Corps (NHSC) program. The NHSC offers scholarships and loan repayments programs for primary care medical, dental, and mental or behavioral health professionals in exchange for a 2-year obligation to work in an approved NHSC site that is a HPSA or MUA. For more information about the NHSC and other types of loan forgiveness and loan repayment programs for students and healthcare professionals willing to work in rural and underserved areas, see RHIhub's topic guide Scholarships, Loans, and Loan Repayment for Rural Health Professions.
The Conrad State 30 Program addresses physician shortages in rural areas by allowing U.S. state health departments to request J-1 Visa Waivers for foreign physicians who agree to work in federally designated Health Professional Shortage Areas or medically underserved areas. This program is only available to international medical graduates who have completed their residency or fellowship in the United States and waives the 2-year home residency requirement allowing the physician to stay in the U.S. See the RHIhub's topic guide Rural J-1 Visa Waivers.
States in the border region may offer specific funding programs to support the recruitment of physicians and/or other healthcare providers to rural communities, including border areas, by granting student loan reimbursements, scholarships, or stipend payments to eligible professionals. For a list of these programs, see the Funding & Opportunities section for each state in the border region.
What kinds of funding programs are appropriate for the ongoing development of healthcare programs and services in the U.S.-Mexico border region?
The border region faces many challenges restricting access to healthcare not only due to the shortage of providers but also due to several adverse factors, or social determinants of health. These adverse factors include:
- Limited English proficiency
- Inadequate housing
- Poor sanitation
- Limited water supply
Funding programs focused on addressing these challenges and/or reducing or eliminating the social factors that contribute to poor health would be most appropriate in effecting change in this region. Visit the following topics within RHIhub Funding & Opportunities section for programs that address key social factors:
- Cultural competency
- Housing and homelessness
- Limited English proficient
For a list of state-specific programs see the Funding & Opportunities by State section for each state in the border region.
Last Reviewed: 3/23/2017