Ninth Annual Maternal and Child Health Epidemiology Conference / December 10-12, 2003
MIGUEL ESCOBEDO: Buenos días; Good morning. I will attempt to do this in 15 minutes or less, so I will try to hurry. First of all, what I’d like to do is give you a scattering of data on health indicators that will basically become compatible with what our other previous speakers have indicated to us with regard to border populations. I will talk a little bit about the differences in healthcare systems between our two countries, and then explore possible solutions. I’d like to being with a press release that was evident last week after Thanksgiving. Tells a story of two infant twins, three months old that died of whooping cough. These cases were not reported. They were found after the fact. And to make a long story short, this is an issue where there was a teenage mother involved who happened to be living with an aunt across the border in Suez Juarez. The infants were seen repeatedly by the healthcare system, and despite this, one of them died in their sleep. The mother rushed him to the hospital. And the other one died shortly thereafter.
Well, what explains this? I think a lot of the speakers have talked about conditions. We know that we make the majority of the population on the border, those of us that are Hispanic, but I think a real important issue, and I know Joe’s talked about this, has to do with the restricted and lack of access to healthcare coverage, and what you see there is basically the fact that both in the U.S. and on the Mexican side, certainly access is very, very restricted. Just to give you an example, 35 percent of all Hispanics in the U.S. don’t have access to health insurance, but only 21 percent in the general population. The other issue has to do with the fact that in Mexico, things are not that much better, as you can see. Texas, also, we’re at 41 percent, so this is a very serious problem for all of us.
In terms of preconception health indicators: we’re not doing too bad, actually, when it comes to AIDS, both in Texas and New Mexico. In terms of preconception health indicators, I think all of you have heard about the neurotube defect cluster that was identified in Lower Valley in Texas. Despite this, in 1997, only 15 percent of women that we surveyed were taking folic acid, a proven remedy to prevent neurotube defects project. In Dona Ana County, which, by the way, is Los Cruces, New Mexico, which borders Texas, conditions, with that respect, seem to be a little bit better. The Preventive Health Services Task Force, as we all know, recommends yearly mammograms for females 40 and over, and yet, despite this, only 29 percent of those targeted women are getting annual mammograms. New Mexico, Dona Ana County, seems to be doing a little bit better, as you can see there. Family planning services: only 42 percent of women in El Paso and 56 percent in Dona Ana County have access to these services. And again, the data is a little bit old, but it has really not changed that much. And it’s pretty much the same for other services, as you can see here. Perinatal utilization, prenatal care: only 40 percent of women in ’99, 2000, were getting prenatal care in El Paso, and 13 percent in Dona Ana County. Again, this speaks to the issue of restricted access and some reorganizational and political changes that I will touch upon in a little bit, later on.
Let me direct you to the bottom where it says “teen births.” I think Joyce may have touched upon this, but we do have a serious problem both in Texas and New Mexico with a large proportion of births, babies born to teenage mothers, and the problem has actually gotten worse in the last couple of years and we know that we are certainly higher than the national average. Here’s the data that I was talking to you, neurotube defects, and as you can see there, the rates really are higher both for anencephaly and spina bifida, more so in the lower Rio Grande Valley, which would be Webb, Hidalgo and Cameron County. Not as much in El Paso. And I think we took care of the issue of the folic acid, or lack of taking folic acid, because we have implemented a lot of educational campaigns to try to remedy that. I took this data from the government website in Mexico and it basically shows that the infant mortality rates for some of the border states that you see there hover around the low 20s. When you look at the infant mortality rate per 100,000 live births, and let me see--how does this laser work?
NAOMI KISTIN: You just have to hit this thing--
MIGUEL ESCOBEDO: Okay.
NAOMI KISTIN: --and point to (inaudible) screens of the--
MIGUEL ESCOBEDO: Well, let me just point at this one. Okay. What you can see there is that the infant mortality rate in the country of Mexico is a little bit over 700. When you look at Mexico--and this is border, the border got chopped off--it’s actually higher than the country of Mexico. Now go over into the other side and you look at the U.S. border states and the infant mortality is less than 200, which is actually lower than the rest of the U.S. So what this basically means is that the Mexican border rates on the Mexican side is 22 percent higher than in Mexico, whereas in the U.S., those border rates are 60 percent lower than in the U.S., and again, this speaks to the issue that Dr. Clement was talking about. In Texas we have actually labeled this as a Hispanic paradox because we don’t seem to understand why it happens, but I think it has to do, clearly, with what Dr. Clement was saying in terms of the health status indicators for Hispanic women. And even though those of us that are in the healthcare business would like to think that we make the difference, it’s really other factors.
Now childhood vaccination rates is something that I think is a good measure of how well we do in public health. The fact of the matter is that, again, as Joyce and others have pointed out, we aren’t doing too good in that respect, and both Texas and New Mexico are consistently at the lower 10 percent, I think. I heard New Mexico was 49th. Texas had the honor of being 50 a couple of years back. And there’s a whole host of issues for that, but we do know that the system in Mexico is somewhat different because in Mexico, they basically cast a very wide net and emphasize wide coverage when in doubt. Now the way Maternal Child Health services in Mexico are delivered also has a different twist because they are legally mandated, just like our detainees in this country, and they are provided through a system that is under the direct control and direction of the Public Health Department in Mexico cities. These services are provided through neighborhood health centers, and even though the private sector performs limited services, they are important, and for this reason, since you have a very centralized system, it really lends itself to being able to carry out mandates that really make it much easier to implement vaccination programs. And here’s an example of the National Health Week in Mexico. It’s a poster that exemplifies it. And this is really a big thing in Mexico. Three times a year they close shops. The police, the teachers, everybody volunteers, and they do mass vaccination and preventive services.
Now I think I’m preaching to the choir here by telling you that the services in the U.S. are somewhat different and they vary from state to state. It’s a partnership between public and private providers. The difficulty is when this ping-pong ball effect happens, I think that a lot of our populations really suffer and a lot of our industries really failed in Texas when the public sector gave the services to the private sector. I think it is also fair to note that we, on the Texas and the U.S. side, provide a lot of services to particularly OB patients from Mexico, emergency OB services that ladies get through the checkpoint, and of course we don’t ask questions because it’s an emergency, but that’s a real issue that needs to be resolved. Again, this is from the government website. I told you that Mexico had excellent vaccination rates and I think this data bares it out. Ninety-nine percent, can’t quarrel with that. And again, for women’s health services in Mexico, you see how they are structure and organized. I will tell you if it weren’t for our friends in Mexico who provide some of those services to people, to folks, women in the U.S. that can’t access those services, we’d be in bad shape. So I think we need to thank them for that. Well, on that basis, I made a listing of some of the trans border challenges that we have, difference in system. The U.S. is decentralized. Mexico is centralized. Client confidentiality, HIPAA requirements, immigration, legal issues, and then the lack of providers that I think was touched upon as well.
Fortunately, we do have some very innovative programs that are actually making a difference and their functioning basically to coordinate information, access, and case management. As an example, the bi-national, TB Card Project, which some of you may have heard, and we helped launch, basically is a portable record that lists not the name, very confidential, but vital information on the patient. The card in turn links the provider down the road to a toll free number that has access to a very large database to provide information. This project has been implemented all over the border. And again, the idea here is that this is for TB, but it could be adopted for immunizations, for schedules, and other problem health areas. And then I’d like to close too with another important project: the Border Infectious Disease Surveillance Project, which I can tell you was very critical in helping us deal with a lot of cross border communication with respect to public health preparedness, the West Nile virus outbreak that we saw that spilled over into Mexico. This was the vehicle that facilitated our communication. Thank you.