Nuestra Casa: An advocacy initiative to reduce inequalities and tuberculosis along the US-Mexico border.

IntroductionThe study of borders includes the study of social disparities. Borders create unique challenges and opportunities for social workers and public health professionals to address social inequalities and health disparities between groups. At borders, health risks and diseases travel and kill at will. These differences can affect how frequently a disease affects a group, how many people get sick, or how often the disease causes death. Healthy People 2020 defines a health disparity as "a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory and physical disability; sexual orientation; gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion" (1). From a health equity standpoint, we have the ability and responsibility to advocate for and provide culturally and linguistically appropriate services, and to promote policies that improve community health (2).The US-Mexico border region is a distinct geographic, economic, cultural and social area that is affected by systematic social and economic injustice. This is evidenced by social and economic problems that are apparent throughout the region, including poverty, health disparities, social inequities, and lowwage assembly, service, seasonal, and agricultural employment. Endemic poverty co-exists with institutional racism, gender violence and structural violence (systematic oppressions). The area, while populated by resilient families and communities that have confronted governmental neglect and social isolation, is at the periphery of the American and Mexican economies (3).The border spans almost 2,000 miles from the Pacific Ocean to the Gulf of Mexico and includes four US states, six Mexican states, 44 U.S. counties, and 80 Mexican municipalities. The border region, defined as the area within 62.5 miles of either side of the boundary, is home to approximately 13 million individuals and to 26 US federally recognized Native American tribes (4). Each country has a distinct system of policies and health care practices, each with a disproportionate share of health, environmental risks, and diseases. It is unlikely that any other binational border has such variability in health status, services, and utilization. Lower socioeconomic and educational levels, migration, immigration, and rapid industrial development accompanied by population growth from the implementation of the North American Free Trade Agreement in 1994 helps to explain some of the present complexity in this particular borderland (5). The policies, norms, and regulations of one side of the border are not applicable to the other. On the border, the developed and developing regions merge and mix to combine some of the best and worst of both worlds.In some places, only a sign or a fence marks the border. In other places, the border is reinforced with barbed wire or tall steel fences (6). Although each nation operates under distinct legal and political systems as well as different health care and public health systems, the U.S.-Mexico border region is mutually dependent, sharing environmental, social, economic, cultural, and epidemiologic characteristics. Extensive family and cultural ties are shared by many of the people in the borderland. Health inequalities along the border especially affect indigenous and immigrant populations, who are vulnerable as a result of low socio-economic status, lack of health insurance, linguistic and cultural barriers, and limited access to healthcare and social services (5,7). If the U.S.-Mexico border region were considered a state, the region would be comprised of the following characteristics: 1) rank last in access to health care; 2) second in death rates due to hepatitis; 3) third in deaths related to diabetes; 4) last in per capita income; 5) first in the number of school children living in poverty; and 6) first in the number of school children who are uninsured (8). …