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© 2004 American Public Health Association
LETTER |
Stephen Waterman is with the Division of Global Migration and Quarantine, Centers for Disease and Prevention, Atlanta, Ga. Chandler Stolp is with the Inter-American Policy Studies Program, LBJ School of Public Policy, University of Texas, Austin.
Correspondence: Requests for reprints should be sent to Stephen Waterman, MD, California Office of Binational Border Health, PO Box 85524, Mail Stop P-511B, San Diego, CA 92138-5524 (e-mail: shw2{at}cdc.gov).
In their article on public health on the US–Mexico border following the passage of the North American Free Trade Agreement (NAFTA),1 Homedes and Ugalde begin with a flawed premise—that free trade agreements, and globalization more generally, should have positive impacts on public health, in step with increased commerce and an invigorated spirit of international cooperation.
This hypothesis is faulty for at least 2 reasons. First, NAFTA is only 1 of many milestones in a decades-long process of US–Mexican economic integration. To link NAFTA per se to the state of, or changes in, public health along the border is overstated. Second, NAFTA contained no provisions nor subagreements for medical services, let alone public health, as it did for environmental mitigation.
The authors’ interviews with public health stakeholders on both sides of the border reveal a disappointing lack of concrete public health accomplishments, as well as barriers to public health cooperation that have existed for many decades. As the authors accurately point out, these barriers include the obvious ones of different languages and vastly different health systems and infrastructure but also legal barriers to cooperation in sharing resources, cross-border travel, and even sharing of basic health information.
However, strides have been made. The US–Mexico Border Health Commission, created in 2000, has gradually begun to address some of the important public health problems and the barriers to their solution through advocacy and limited funding.2 The establishment of the commission is only 1 of many steps in what will be a long process of improving the institutional setting of crossborder cooperation in public health.
Without a carefully negotiated public health agreement between the 2 governments that lifts legal and administrative barriers and commits ongoing resources, such as were allocated to the North American Development Bank and the Border Environmental Cooperation Commission through NAFTA, advances in public health along the border will likely continue to lag.
References
1. Homedes N, Ugalde A. Globalization and health at the United States–Mexico Border. Am J Public Health. 2003;93:2016–22.
2. United States–Mexico Border Health Commission. Healthy Border 2010: an agenda for improving health on the United States–Mexico border. October 2003. Available at: http://www.borderhealth.org/document_library.php?curr=resources (PDF file). Accessed April 19, 2004.
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