Paula Worby, School
of Public Health
October 12 marked
the beginning of the Binational Health Week, a series of
health promotional services for Mexican migrants provided
by a partnership between the state of California and the
government of Mexico. On October 18 and 19, one of its activities,
the Binational Forum on Migrant Health: Tenemos Historia. Hacemos
Futuro, We Share a History. We'll Make the Future, took
place at the UC Berkeley campus. Xochitl Casteñada
of the California Policy Research Center introduced the conference
with one of its main messages: improving health and guaranteeing
care for Mexican migrants to the U.S. is a matter of recognizing
the fundamental contribution they make to both the U.S. and
the Mexican economy.
The conference brought
together health officials, agency directors, university researchers,
and other distinguished participants from Mexico and California.
It was the culmination of the week's activities that took
place throughout California.
Approximately 3.2 million
Mexicans are living and working in California, yet Mexican
migrants face significant obstacles in accessing even the
most basic services. In a keynote address, Dr. Jose Antonio
Santos Preciado, a Mexican health official, discussed the
Mexican government's Vete Sano, Regresa Sano, Leave
Healthy, Come Home Healthy, program for workers and families
on the move. Santos Preciado argued that with a highly mobile
population back and forth between the two countries, only
binational cooperation could ensure the continuum of care
and services. Likewise, he suggested, where services and
health surveillance are not coordinated, serious illnesses
and social problems such as TB, HIV, and substance abuse
will cause suffering and high social and economic costs on
both sides of the border.
To further an understanding
of cross border and migrant health, Professor Sylvia Guendelman
from UC Berkeley's School of Public Health emphasized that
it is misleading to focus only on how migrants "import" health
problems. Research comparing birth outcomes for Mexican-born
women, Mexican-American women, and white women born in the
U.S., she said, shows that many immigrant practices are healthier
prior to influence from U.S. culture. Promoting research
and efforts to maintain these positive health behaviors--such
as better diet and helpful social support--is good for migrant
health and conceivably the health of other groups in the
U.S.
Other panelists pointed
out gaps in services for specific issues such as mental health
and substance abuse. Concerning mental health, programs can
be misdirected when they fail to take into account that Latino
workers often rely on rural, Spanish speaking practitioners
instead of mental health programs. In the case of substance
abuse, policy continues to be based on a punitive, criminal
approach instead of pursuance of the link between mental
health and substance abuse.
A 1999 study for the
California Program on Access to Care shows that most farmworker
families make less than $10,000 per year and that 42% of
those surveyed live in dwellings shared by two or more households.
This is a reminder of the gross disparities for migrant workers
in the U.S.
In a session dedicated
specifically to infectious diseases (HIV, other sexually
transmitted diseases, and TB) panelists presented both sobering
statistics and intriguing initiatives. For example, in the
case of HIV there is an understudied relationship between
the high risk for infection of male migrants in the U.S.
and the increasing rates of heterosexual transmission of
HIV to women in migrant-generating Mexican communities. However,
the Mexican government's AIDS program, CONASIDA, represented
at the conference by a pioneer researcher, Carlos Magis Rodríguez,
can point to the fact that Mexico's current HIV estimated
prevalence is lower than neighboring countries, including
the U.S. Given increased support for culturally appropriate
programs for migrants, this positive track record could continue.
UC Professor Kurt Organista promoted the use of community
knowledge and peer influence to create and distribute fotonovelas,
comic books, to migrant men and sex workers. Professor María
Gudelía Rangel Gómez of El Colegio de la
Frontera Norte discussed using the shelters set up for
migrants in border cities as sites for conducting both disease
prevention and surveillance.
Overall, researchers
and agency leaders concurred that while certain areas need
further research, the greatest efforts need to go toward
the implementation of programs known to work well and subjection
of them to rigorous evaluation. The policies are in place,
argued Andres Jimenez, Director of the California Policy
Research Center, at the event press conference, but political
will and coordination are still necessary to make them relevant.
There are more than one million Mexican-born workers supporting
the California economy; it is time to better coordinate the
services created on their behalf. Attending to migrant health
is both a moral obligation and crucial for the Mexican and
Californian economies. In this regard, conference organizers
pointed out, the Binational Health Week and the Binational
Forum on Migrant Health are merely the beginning and a punta
de lanza, launching point, for what needs to follow.
