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Pan American Health Organization

Pan American Health Organization. Regional Office for the Americas for the World Health Organization. Celebrating 100 Years of Health. Border Interactions and Diabetes. Atlanta, GA. Alfonso Ruiz, DVM, MS, PhD. Chronology of Important Events in the History of PAHO.

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Pan American Health Organization

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  1. Pan American Health Organization Regional Office for the Americas for the World Health Organization Celebrating 100 Years of Health

  2. Border Interactions and Diabetes Atlanta, GA. Alfonso Ruiz, DVM, MS, PhD

  3. Chronology of Important Events in the History of PAHO 1902 International Sanitary Bureau formed by The First General International Sanitary Convention of American States 1923 ISB renamed Pan American Sanitary Bureau 1942 The U.S.-Mexico Border Field Office is created in El Paso, TX. 1948 Establishment of the World Health Organization 1949 PASB became the WHO Regional Office.

  4. PAHO as a Specialized Agency of the UN and Inter–American Systems SpecializedAgency of the Organization ofAmerican States Inter–American System PAHO UN System RegionalOffice of theWorld HealthOrganization

  5. U.S-Mexico Border Population Ten States: 70 million people 25 US counties 34 Mexican municipalities 24 Native American Nations 11.4 million people

  6. U.S.-Mexico Border Population highlights • 55% of the population lives on the U.S. side • 45% of the population lives on the Mexican side • 70% of the U.S. border population is of Hispanic origin • 47% of the border population is under 20 years of age

  7. Additional considerations • Population growth rate (4.3% for Mexico and 1.8% for U.S) higher than national rates ( 1.9%) Mexico, (0.9%) U.S. • Large minority population in the U.S. border (average Hispanic population 40%) • Three larger Mexican cities, Juarez, Tijuana, Mexicali total 50% of Mexican Border population

  8. Estimated Border Population 1990-2010 Population estimated by de Cosio, G. U. S. Pop Growth 1.8% - Mex Pop Growth 4.3%

  9. U.S.-Mexico Selected Sister Communities 1993-1997 Annual Population Growth 1993-1997 Annual Population Growth

  10. US-Mexico Border:Socio-Economic Indicators 2,878 Maquila plants: 1.8 million employees • Mexico exports to U.S. = $86 billion (1997) •  40% exports from 6 Mexican border states • Inequities • 6 Poorest U.S. counties • Lower poverty rates in Mexican • border states than the nation Immigrants (New Settlements)

  11. BORDER CROSSINGS ONA REGULAR DAY 400 million legal crossing/year South to North 3.8 million commercial truck crossings/year South to North Photo: National Geographic, 1997

  12. UNITED STATES High poverty levels on U.S. side of the border More than 30% of the Hispanic population uninsured Several border communities are designated “Medically Under-Served Areas” MEXICO Border cities of Mexico have higher socio-economic conditions 95%of the population have access to health care services Gaps still remain particularly in rural areas Additional considerations CONTRAST

  13. Housing Conditions on the U.S.-Mexico Border Colonias: Symptom, not the problem • Colonias are substandard developments lacking running water, sewage systems and often electricity. Unregulated subdivisions for under-educated consumers.

  14. Problems affecting disadvantaged border communities • Borders are frequently threatened by environmental problems and hazards • Existence of international trade agreements that are implemented unsafely • Vulnerable groups such as women, children and elderly are more at risk • Substance Abuse and behavioral problems are more prevalent in border areas • Malnutrition, obesity are common problems on both sides of the border

  15. TEN LEADING CAUSES OF DEATH ALONG THE U.S. -MEXICO BORDER, 1997(in order of importance) • U.S. ALL RACES MEXICO • Disease of the heart Disease of the heart • Cancer  Cancer • Cerebrovascular Dis Accidents • Pulmonary Chronic  Diabetes • Accidents Perinatal Deaths • Pneumonia/Influenza Cerebrovascular Dis • Diabetes Cirrhosis • Suicide  Pneumonia/Influenza • HIV/AIDS Homicides • Homicide Intestinal Infectious Dis

  16. DiabetesScope of the Problem • WHO estimated that by 2025 diabetes will increase between 150-200% • It is estimated that 5-14% of the total health expenditure will be used for diabetes • Along the U.S.-Mexico border, diabetes mortality rates are higher than national figures.

  17. Scope of the Problem (cont.) • In 1996 there were 161,000 diabetes hospital discharges with an average length of stay of 5.1 days in the U.S. • Diabetes is 2-3 times higher in Mexican Americans than in non-Hispanics • Uncontrolled diabetes makes difficult treatment of infectious diseases (i.e., TB)

  18. Facts about diabetes among Hispanics • In 1998, about 1.2 million Hispanic were known to have diabetes in the U.S. • One in every four Mexican Americans age 45 and older has diabetes. • Being overweight or physically inactive is a major risk for developing diabetes. • Hispanics have higher incidence of developing diabetes complications Source: www.niddk.nih.gov/health/diabetes/pubs/hipan/hipan.htm

  19. Distribution of the Hispanic Diabetic population in U.S. (1982-1984) Source: www.niddk.nih.gov/health/diabetes/pubs/hipan/hipan.htm

  20. Diabetes mortality rates in U.S.-Mexico Border

  21. Diabetes Mortality Rates El Paso, Texas, 1990-1998 Source: soupfin.tdh.state.tx.us/cgi-bin/deathcgi Rate per 100,000

  22. Diabetes Mortality Rates: USA, Texas, El Paso, Juarez, Chihuahua, and Mexico, 1998 Source: PAHO. Mortality Profiles of the Sister Communities on the United States-Mexico Border. Wahsington, D.C. 1995-1997

  23. Diabetes Mortality Rates by RaceTexas and El Paso, 1990-1994-1998 Diabetes Mortality Rates by RaceEl Paso, Texas 1990-1994-1998 Diabetes Mortality Rates by RaceTexas 1990-1994-1998 Source: soupfin.tdh.state.tx.us/cgi-bin/deathcgi Rate per 100,000

  24. Hispanic Diabetes Mortality Rates by ageEl Paso, Texas, 1990-1994-1998 Source: soupfin.tdh.state.tx.us/cgi-bin/deathcgi Rate per 100,000

  25. Barriers that Affect Access to Health Care • Lack of knowledge of how to access health care • Language and cultural barriers • Cost of care • Need for training and distribution of health care providers • Denial of access to services for undocumented (illegal status) individuals • Availability of services • Transportation

  26. Health Promotion Approach for Border Interventions POPULATION HEALTH STATUS -------------------- INDIVIDUAL FACTORS HEALTH DETERMINANT FACTORS CULTURE HEALTH HABITS EDUCATION INDIVIDUAL CAPACITY AND ADAPTATIONS APTITUDES COLLECTIVE FACTORS SOCIO-ECONOMIC ENVIRONMENT HEALTH SERVICES PHYSICAL ENVIRONMENT ACTION BASES SUPPORT TOOLS AND MEANS RESEARCH, INFORMATION AND PUBLIC POLICIES

  27. “Borders are merging sites for cultures, languages, ethnic groups, behaviors…, but also diseases. Then, any approach for disease prevention and control must consider the whole environment.” Alfonso Ruiz

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