opinion

Commentary: Not Doing its Job on the Border

by state Sen. Eliot Shapleigh

The U.S.-Mexico Border Health Commission has been a disappointment: The Border region continues to have some of the worst health outcomes and socioeconomic indicators in the nation.

Posted on March 14, 2008

Honorable Michael O. Leavitt
Secretary of Health and Human Services
U.S. Department of Health and Human Services

William R. Steiger, Ph.D.
Special Assistant to the Secretary for International Affairs
U.S. Department of Health and Human Services

Rosaly Correa-de-Araujo, M.D., M.Sc., Ph.D.
Delegate for Secretary Leavitt
Director, Office of the Americas/Office of Global Health Affairs
U.S. Department of Health and Human Services

RE: U.S.-Mexico Border Health Commission

Dear Secretary Leavitt, Dr. Steiger and Dr. Correa-de-Araujo:

At its inception in July 2000, the U.S.-Mexico Border Health Commission (BHC) developed a mission to "provide international leadership to optimize health and quality of life along the U.S.-Mexico border." The BHC's seven primary responsibilities are to develop polices and plans, communicate with constituents, mobilize partnerships, monitor and identify border health problems, serve as a repository of information, provide information needed to support decision making, and engage in functions relevant to addressing border public health issues.

As a fifth generation El Pasoan and Texas Senator who proudly represents El Paso, Texas, I write to tell you that the BHC has been a failure and to ask you to write to tell me what you plan to do about it. The BHC has been a disappointment for the following reasons:

· The BHC's budget is not large enough to make a significant impact on the health of border residents.

· The BHC has not maintained data regarding the initiatives they have started; the Department of State Health Services was not even able to provide the dates of specific events.

· Because reliable data has not been gathered, the BHC is unable to produce any relevant outcome measures. There is no way to determine the impact of their projects.

First, let's benchmark where we are today, eight years after the BHC was created. Of all 50 states, Texas ranks 50th in the number of insured residents. The statistics along the Border are even grimmer. More than 30 percent of residents in seven Border counties are uninsured. Webb County has the highest rate at 38.11 percent.

(See image 1 on side of page)

The Border region continues to have some of the worst health outcomes and socioeconomic indicators in the nation. The Texas Comptroller of Public Accounts defines the Texas Border region as the 43 counties east of I-37 and south of I-10. Today, it is safe to say that the Texas Border is the "Ground Zero of Health in America." Consider the following:

· 29 percent of Border residents are uninsured; compare with the Texas rate of 24.5 percent and the national rate of 16 percent.

· One of out of four children living in the Border region do not have health insurance. Nationally, only 12 percent of children are uninsured.

· 26 percent of Border residents live below the federal poverty level compared to 17.5 percent statewide and 12.5 percent nationally.

· 34.4 percent of children in Texas Border counties are in families living below the federal poverty level—more than twice the national rate of 16%.

· Diabetes complications account for 52 deaths per 1,000 deaths in the Border region—almost twice the statewide average of 29.5 per 1,000 deaths.

· Tuberculosis infections occur more often along the Border—8.96 per 100,000 residents compared to Texas at 6.7 and the U.S. at 4.6 per 100,000.

· 9 people per 100,000 in the Border region are infected with Hepatitis A—three times the statewide average of 3 per 100,000.

· Liver disease causes 13 out of every 1,000 deaths in the Border region and 10 per 1,000 in Texas.
More mothers in the Border region receive either belated or no prenatal care. 21 percent of mothers along the Border do not start care during the first trimester compared to 16 percent for the nation.

· Medicaid pays for a higher proportion of pregnancies in the Border region. Nationally, 41 percent of births are paid for using Medicaid. In the Border region, Medicaid covers 65 percent of all births.

Furthermore, an inadequate number of health care providers along the border limit accessibility to services necessary to maintain good health. According to the Department of State Health Services, the Border region has fewer health care professionals per 100,000 residents than non-Border regions.

Direct Care Physicians per 100,000, 2007

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· Direct Patient Care Physicians: Metropolitan Border Areas, 145.2; Non-metropolitan Border Areas, 70.7; Metropolitan non-Border Areas, 170.7; Non-metropolitan non-Border Areas, 88.7
· Primary Care Physicians: Metropolitan Border Areas, 53.3; Non-metropolitan Border Areas, 36.1; Metropolitan non-Border Areas; 72.2; Non-metropolitan non-Border Areas, 54.5
· Physician Assistants: Metropolitan Border Areas, 13.3; Non-metropolitan Border Areas, 15.2; Metropolitan non-Border Areas, 17.1; Non-metropolitan non-Border Areas, 13.0
· Nurse Practitioners: Metropolitan Border Areas, 14.2; Non-metropolitan Border Areas, 8.1; Metropolitan non-Border Areas, 22.3; Non-metropolitan non-Border Areas, 14.4
· Registered Nurses: Metropolitan Border Areas, 468.9; Non-metropolitan Border Areas, 224.5; Metropolitan non-Border Areas, 715.3; Non-metropolitan non-Border Areas, 465.1
· Dental Hygienists: Metropolitan Border Areas, 18.6; Non-metropolitan Border Areas, 8.4; Metropolitan non-Border Areas, 42.8; Non-metropolitan non-Border Areas, 30.5
· Dentists: Metropolitan Border Areas, 15.7; Non-metropolitan Border Areas, 11.8; metropolitan non-Border Areas, 41.1; Non-metropolitan non-Border Areas, 25.2

Dentists per 100,000 Population, 2007

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To date, the BHC can not demonstrate how its activities during the past eight years have made any significant improvements in the health or quality of life of Border residents. The BHC appears to be facing several problems, including the need for role clarification, credibility, enhancement of the bi-national relationship between the U.S. and Mexico sections, and creation of a method of resource allocation that is sustainable.

Similar to the past five years, the BHC had a budget of $4 million in FY 2007. By way of comparison, the earmarks for the International Fund for Ireland, the Sparta Teapot Museum in North Carolina, and a single hiking and biking trail in Western Virginia were $13,500,000; $500,000; and $1,000,000 respectively. The goal should be to maximize health outcomes like inoculations, access to quality care and prenatal care, and to at least reach the level of funding that other domestic commissions have attained. The Appalachian Regional Commission has two programs that address the organization's four goals and awards grants to several hundred local organizations a year to provide services with a FY 2007 budget of $65 million. Other examples of domestic commissions include the Denali Commission and the Delta Regional Authority with FY 2007 budgets of $53 million and $12 million respectively.

For the five million Texans who call the Border "home," we want to know why you permit such disparities to continue; by any objective measure, the U.S.-Mexico Border Health Commission has been a failure. You have created a façade, which provides the appearance of progress, when in fact you have sponsored and permitted failure. We want an answer. Specifically, we, who represent the Border, want to know what you plan to do to address the failures of this Commission and to provide us your timetable for success. I look forward to your written reply. The people of our region deserve nothing less.

Very truly yours,

Senator Eliot Shapleigh
800 Wyoming, Suite A
El Paso, Texas 79902
1-800-544-1990
1-915-544-1990
1-915-544-1998 fax