Running head: LITERATURE REVIEW 1

Literature Review:

Border Health Issues at UTEP

Joseph Bencomo

University of Texas at El Paso

LITERATURE REVIEW 2

Abstract

Border health issues are currently affecting the University of Texas at El Paso. The issues, their

causes, and potential solutions will be explored through four research questions. The topics

covered are medical care usage, a lack of data on border health issues, a lack of general health

knowledge among border residents, and NAFTA’s influence on the border. A non-scientific

survey regarding border health issues impacting UTEP was conducted and analyzed. The

findings of the paper conclude that there is a need of binational cooperation for health issues

across the border, reform of NAFTA, and government programs are needed to promote data and

spread general health knowledge to border residents.

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Literature Review:

Border Health Issues at UTEP

Introduction

The University of Texas at El Paso is as close as approximately 300 yards, as the crow

flies, from Ciudad Juarez, Chihuahua, Mexico. The close proximity means that UTEP is directly

affected by health occurrences happening on both sides of the border between Mexico and the

US. The borderland’s (and UTEP’s) community health faces political, economic, cultural, and

environmental barriers. The border is undergoing rampant growth and going through major

changes. The introduction of NAFTA (North American Free Trade Agreement) have put a large

amount of trade through the border which has had a number of negative consequences to the

environment and border health. Constant border migration spreads diseases and medical

conditions, while politically, policymakers are unable to work beyond their borders. To better

understand the factors that are heavily impacting UTEP health, we may find a solution from

examining the following questions:

1. Is there a lack of medical care usage affecting UTEP health?

2. Is there a lack of data being conducted on health in the borderland?

3. Is a lack of general health knowledge affecting student health?

4. What has been NAFTA’s influence on the local region?

These questions will concise the focus of the factors affecting the local region, UTEP, and will

convey how UTEP’s student health could be improved through government regulation.

Medical Care Usage

Assimilation is not a quick process and many citizens may never successfully function

outside of their culture. Many first and second-generation Mexican residents are deeply rooted in
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Mexican culture. This may cause cultural barriers that affect the health of the region. Joel

Rodríguez-Saldaña claimed that the principal health problems at the U.S.-Mexico border are

characterized by disparities in health systems (2004). The author states that the disparities that

officials should be focused on are lower health standards and socioeconomic issues. Warner and

Jahnke (2003) support the claim of socioeconomic issues as many uninsured citizens do not have

a choice, but to go to Mexico for medical support and culturally many still choose to travel over

the border for health care.

Mexican medical care is a cheaper alternative and provides a backbone to community

health in the El Paso region and also to some students at UTEP. Rivera provides data to support

the view of the border as a complement rather as barrier. As well, the author provides evidence to

demonstrate to his audience the evolving health care in sectors in Mexican cities proximate to the

US border. Rivera’s thesis that there are medical services along the Mexican border was

extremely useful because it shed insight on the difficult problem of border health issues. The

method of Empirical Bayesian Kriging (p. 157) impacted my claim because this method gave me

a unique perspective on viewing border health issues. In the section Methods paragraph six

Rivera states “This approach is a geostatistical interpolation method that allows creating a

continuous surface based on the geographic location of each establishment in the data set”,

which provided the data set to prove to his audience that he has logos to back up his claim and

method. Seid, et al. (2003) claims that the majority of the Hispanic border population will travel

to Mexico for health care with factors including insurance and familiarity. With evolving health

care sectors in Mexican cities claimed by Rivera and the majority of border Hispanics using

Mexican health care, the overall community health should improve.

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Why are border residents traveling to Mexico for medical care? Seid, et al. (2003)

compared the availability of medical care to children of Latino farm workers. The article,

however, gives readers a deeper understanding when comparing medical care options between

the US and Mexico. In order to research the issue, the author surveyed close to 300 parents from

Head Start (a government program that provides education opportunities, health, and parental

involvement programs low-income families) in San Diego and Imperial counties. The results of

the research found that most medical care was used in Mexico; a few reasons being “cost,

accessibility, and perception”. Uninsured children were found to receive medical care in Mexico,

however even insured children were seen to be using Mexican medical care more than the US

options. Rivera (2017) claims that border crossings city present clusters of activity for medical

care usage; the author concludes that a binational integration mechanism for trans-border

healthcare is needed. The evidence provided by Rivera backs up the claim of the author by

providing an Empirical Bayesian Kriging and an analyzation further supporting the authors

claim.

Mexican health care has become a backbone for border community health and likely

Mexican UTEP students. Introducing a cross-culture program between the US and Mexico could

improve community health by increasing medical care usage in the US by first and second-

generation Mexican residents.

Lack of Data

A lack of data or research in any field constricts any understanding into the issue. It

appears that there is a major lack of data in border health issues. With a quickly growing

population, health issues must be addressed sooner before they turn into outbreaks affecting

residents and students. Environmental effects affecting the border between the US and Mexico,
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however the primary focus is on one major border health issue, lack of data. Carter, et al (1996)

explores health impacts caused by environmental influence such as “high instances of… cancer

and lupus in a neighborhood in Nogales, Arizona” (p. 593) as well as “a general concern that the

border region is seriously contaminated with hazardous waste chemicals”. The major problem

concerning these issues is that there is a general lack of data from the area. In order to address

these issues, “accurate and effective information that helps determine what type of intervention

or prevention actions are necessary” needs to be conducted and organized. A section of the

journal article is based on the environmental effects (which go hand in hand with health effects)

that have taken place in the borderland by NAFTA. The journal article also states that the main

issue affecting the borderland is a lack of data, however another source would extend that.

Amanda Atkinson (1994) claims that “Officials at the state level are barely beginning to learn of

the many effects NAFTA is likely to have upon public health and environmental issues in the

border state”. Solutions can only be made when the problem is known. Without knowing the

problem (data), the borderland, even El Paso, may fall into further issues that could have been

prevented.

A lack of data obstructs the health issues that could potentially, if not currently, harm the

borderland and UTEP. Cecilia, et al. (2016) claimed that TB, dengue, HIV rates have been

increasing on the border between the US and Mexico... The challenge of growing epidemics on

the border is that diseases do not know borders and interdependence of health agencies as well as

an understanding of cultural perceptions and knowledge is the key to preventing outbreaks.

Health in border communities can improve by a high level of collaboration and an increase in

public health research. According to Homedes and Ugalde (2003), salmonella, leprosy, and

rabies are becoming endemics, however there is no mention of this issue by Cecilia, et al (2016).
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Both sources state that dengue and tuberculosis is also a growing concern and that a lack of

binational policy is responsible to the concerning growth.

Lack of General Health Knowledge

A lack of education on general health knowledge could be affecting local health. Ramos,

May, and Ramos of “Environmental Health Training of Promotoras in Colonias along the Texas–

Mexico Border” (2001) claim that there are 1800 colonias (settlements of varying sizes along the

border on the Texas-Mexico border) with most of them having a “lack [of] basic water and sewer

systems, paved roads, and safe and sanitary housing” (p. 568); the amount of residents in the

colonias goes beyond 500,000 with 98% of the residents being Hispanic (p. 568). The colonias

hold a very large number of average persons per household, 5.5 and also hold a high percentage

of poverty, 35.8%. These averages more than double the national average. The rampant growth

and settling of the Texas borderland has “raised health concerns in this region” (p. 568). The

study addressed the border health issues of the area with promatoras, lay community educators

who are able to “translate [government, education, medical, and social services] … into

culturally meaningful instruction that empowers community self-development” (p. 568). The

study aimed to provide “culturally relevant activities aimed at enhancing environmental health

prevention and intervention in the Hispanic colonias” (p. 569). The study was broken up into

four different phases. The first phase was to assess the situation in the colonias. The second

phase provided the creation and teaching of a curriculum based upon training the promatoras.

The third phase sent the promatoras to “culturally relevant environmental health education

through home-based education in Spanish and group sessions at the Community Resource

Centers” (p.570). The fourth phase is conducting a post-outreach assessment of the study. While

the study is ongoing, the authors believe that the use and promoting of promatoras will “improve
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disease prevention, behavior modifications, and health promotion related to the environment in

this region of Texas” (p. 570). According to Brown and Kouzakanani (2002), change should

come from culturally competent behavior interventions; promatoras are exactly that. Promatoras

are able to provide cross cultural lines and give health education without straining familiarity,

language barriers, and use the community as an asset.

Education is the key to boosting local health. Brown and Kouzekanani claim that (2002)

change must come from culturally competent behavior interventions. The study claims that

“major national initiatives” should begin with “culturally competent behavior interventions” (p.

267). Culturally competent behavior is behavior that allows people to successfully function

cross-culturally. A major obstacle of culturally competent behavior from being achieved is the

language barrier. In the state of Texas, “the availability of bilingual Hispanic nurses… the ratio

of resident to registered nurse is… 169:1” (p. 267). Cultural barriers of the border were also

influencing the patients; an example given is “inappropriateness for a woman to walk alone in a

neighborhood” (p. 266). Environmental issues also affect border residents with diabetes such as

“no access to gym facilities”, “few areas in the community with paved sidewalks” (p. 266), “high

temperatures that are common in the South Texas area, sometimes >110°” (p. 266), and “no

enclosed malls available for walking, individuals find it difficult to exercise on a regular basis”

(p. 266). The largest influencing factor was education on the medical condition. While education

was the largest factor, Seid et al. (2003) has similar findings to the smaller factors affecting

diabetic border residents. Seid et al details that cost, accessibility, and perception play a key role

in a lack of medical care usage in the US. Brown and Kouzakanani list no access to gym

facilities and rarity of paved sidewalks as reasons affecting these residents. Seid et al (2003)

provides that environmental factors could play a more critical role rather than education on the
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issue, however that was reasoned on medical care usage and not the overall issue. Knowledge on

health could play a more significant role on community health.

Providing local educational programs from UTEP or from the government similar to the

“Environmental health training of promotoras in colonias along the Texas–Mexico border” study

could promote local health.

NAFTA’s Influence

NAFTA is the North American Free Trade Agreement which came into effect in 1993.

The purpose of NAFTA was to promote easier trade between North American countries. Further

studies need to be done to see the past and current environmental influence NAFTA has had on

the environment. Atkinson (1994) claims that, “NAFTA has the potential to affect public health

and environmental issues in border states in many ways” (p. 23). A few of the ways stated can be

summarized as a pro-environmental law that gets in the way of NAFTA could be destroyed, other

pro-environmental could be changed to better convenience NAFTA, states must enforce their

environmental laws due to an environmental side agreement that was signed by NAFTA, and

increased trade could further burden the “already burdened” environmental infrastructure on the

border. The author summarizes that while the potential for danger of negative environmental

impacts are present from NAFTA, environmental provisions are being placed and promoted by

NAFTA. Atkinson claims that while some efforts are being put in place, “Officials at the state

level are only beginning to learn of the many effects likely to have upon public health and

environmental issues in border states”. The efforts placed by NAFTA to conserve the

environment are not going to be enough and public health could be affected by the effects of

heavy trade through the border region. A lack of data on NAFTA’s health impact to the border is

also explored by another author. Carter et al discusses that not only are we unaware of NAFTA’s
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environmental health impact, but there is a general lack of data that exists on border health.

NAFTA’s influence is a portion to a larger problem (lack of data) that is affecting the impending

danger of border health issues that go unnoticed until it is too late.

NAFTA has brought barriers of bureaucracy rather than an easier manner for binational

cooperation. Homedes and Ugalde (2003) claim that globalization has not inspired cooperation

between Mexico and the US to create health policies to address health problems affecting the

border. The border population contains close to 12 million people between “42 US counties and

39 Mexican municipalities” (THE SETTING, Homedes and Ugalde). The border “population

grows 3 times faster than in the rest of the country” (THE SETTING, Homedes and Ugalde); the

border population “is expected to double by the year 2020” (THE SETTING, Homedes and

Ugalde). Both sides of the border use the same essential resources such as water and air quality

as well animal control. Due to the rate of growth and lack of binational policy, cases of

salmonella and shigella are four times higher than the national average, however there is an

“endemic” of dengue, leprosy, rabies and tuberculosis on both sides of the border (THE

SETTING, Homedes and Ugalde). NAFTA being signed has brought a large influence to the

border, however the NAFTA did not include a chapter on health repercussions. Globalization The

border could benefit from policymaking for health issues included with the increased trade and

consequences of increased trade across borders. The conclusions of the study indicated that

NAFTA actually brought “additional bureaucratic hurdles” that prevent policymakers from

successfully building binational healthcare policies. The study goes on to state “NAFTA only

works for the large corporations, and for nobody else” (CONCLUSIONS, Homedes and Ugalde).

Border populations are growing as are border health issues. Globalization has brought more

limitations between binational policymaking; this has allowed border health issues to go
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unaddressed. Rivera (2017) can extend Homedes and Ugalde’s claim by providing a solution to

the issue. Rivera states that a binational integration mechanism is needed for trans-border

medical care, however binational mechanism programs (that go beyond medical care usage) for

education or promotion of local health could also favor student health.

Despite attempts, NAFTA has not improved medical care along the border. Warner and

Jahnke claim that despite rapid growth caused by NAFTA (North American Free Trade

Agreement) and programs established to improve community health, access-to-care has not

improved. The authors attribute poor access to health to poverty to a “lack of insurance, limited

infrastructures, lack of providers and of a culturally sensitive health care delivery system” (p. vii)

and use logos by providing tables and figures (pp. iii-v) to further bolster their claim. To add to

the claim that access-to-care has not improved, Atkinson (p. 60) suggests that in order to

“maximize the opportunity to protect local health and the environment in the border states”

legislation and “regulatory oversight” are the answer.

Primary Research

UTEP Medical Care Usage Survey

Students who have used Health and Wellness Center Students who have not
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The UTEP Health Care Usage survey was a non-representative sample attempting to seek

the student usage of the UTEP Health and Wellness Center. Twenty students at the University of

Texas at El Paso were surveyed on the morning of March 28, 2018. Students were chosen at

random. The survey found that many students have not used the UTEP Health and Wellness

Center on campus with reasons such as “I try to tough it out, I just don’t think to, I rarely go to

the doctor”. The findings coincide with studies done by Escarce and Kapur that Hispanics have

“fewer physician visits than their white counterparts” (Escarce. Kapur., 2006); with UTEP being

predominantly Hispanic at 77.4% of enrollment ethnicity, the UTEP Health Care Usage Survey

unscientifically finds that the Hispanic student population may not being using medical care at

UTEP due to cultural barriers which negatively affects the overall community health of UTEP.

Conclusion

Border health issues are directly affecting student health at the university of Texas at El

Paso; these issues are going unaddressed and are in clear need of change. There is a lack of data

on borderland health. A focus on studying community health in the borderland could provide

clarity on the issue and bring about procedures for change. NAFTA has brought many economic

changes to the border, but increased trade has also brought many negative health consequences.

With a large number of first and second-generation residents, (both uninsured and insured)

residents are crossing the border into Mexico for medical care; Mexico’s low cost of medical

care and Mexican-American cultural barriers have allowed Mexico to become the support that

many students and residents rely on. Government regulation aimed at cross-culture programs

could improve community health (and UTEP directly) by tearing down cultural barriers by

integrating residents more into the community through education, research grants into border

health issues could provide insight into preventing epidemics and treating currently existing
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issues, regulating NAFTA to clear bureaucratic obstacles that favor trade over environment/

health, and programs improving health care in the US could prevent residents from crossing the

border for health care.

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References

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Resources & Environment, (1), 23.

Brown, S. A., Garcia, A. A., Kouzekanani, K., & Hanis, C. L. (2002). Culturally competent

diabetes self-management education for mexican americans. Starr County Border Health

Initiative, 25(2)

Carter, D. E., Pena, C., Varady, R., & Suk, W. A. (1996). Environmental health and hazardous

waste issues related to the U.S.-mexico border.. Environ Health Perspect, 6, 590-594.

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from http://cierp2.utep.edu/development/utepbythenumbers41013.pdf
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