Stress Factor

A new study will gauge the effects of tension on already-poor border health

In June, health experts descended upon cherry-blossomed Washington, D.C., to chew over a severe crisis 2,000 miles away, at the U.S.-Mexico border.

For those outside the conference's doors, the troubled border is mostly a distraction--a few fleeting images on the evening news, soon forgotten.

But inside the room, researchers, doctors and academics discussed a dire problem that's too often obscured by the emotionally charged issues of illegal immigration or security: On the border, communicable diseases such as hepatitis and tuberculosis run rampant. Water and air pollution is endemic. And quality health care among the region's largely uninsured farm workers is spotty at best.

Speaking to the Border Health Conference, Julie Gerberding, director of the U.S. Centers for Disease Control and Prevention, described it as a situation that Americans "should be ashamed of."

Back here in the Southwest, however, some believe there's yet another layer to this health crisis--one caused by the stress of simply living in a war zone.

That's the focus of a new study spearheaded by Joel Meister, a professor at the UA's Mel and Enid Zuckerman College of Public Health. Meister and his colleagues recently landed a $320,000 grant from the U.S. Occupational Safety and Health Administration, to research residents' stress levels.

He says that impacts range from people feeling too intimidated to seek health care, to the simple stress of constantly going through U.S. Border Patrol checkpoints. These effects are felt broadly, from health clinics and doctors' offices to the federal Women, Infants and Children assistance program.

"Some parents are not bringing their kids in for immunizations," says Meister. "And women may avoid visiting WIC offices, because they're afraid of what might happen--that they could be deported or arrested.

"We think the problem is real," he says. "Border security is having a tremendous impact upon farm workers and others in communities along the border."

Add that to the list of health woes for approximately 13 million people living along both sides of the border. According to the National Association of Community Health Centers, tuberculosis rates among American border residents are 271 percent higher than the national average, and incidents of hepatitis A are 694 percent higher.

Border farm workers ranked among the nation's greatest sufferers of mental and oral health problems, hypertension, cancer, asthma and muscular and skin disorders.

The problem is compounded by entrenched poverty throughout the region, and a lack of health insurance for--in some areas--up to 34.6 percent of residents. That's double the national average, and it takes a toll on the area's medical infrastructure, which suffers a severe shortage of doctors, nurses and hospitals. For those hospitals that do exist, serving the region's uninsured carries an annual price tag of $832 million.

The border region's lack of political clout has also hindered improvements. But that may be starting to change. In May, Texas Rep. Silvestre Reyes, a Democrat, introduced a bill providing money for local and state governments to improve the region's medical system. Co-sponsored by Arizona Rep. Jim Kolbe, a Republican, the measure would also reauthorize funding for the U.S.-Mexico Border Health Commission, and pay for a study of binational health-insurance programs.

But the tense backdrop for this still-paltry health infrastructure is an ever-increasing law-enforcement presence. Today, the border region teems with everyone from FBI and U.S. Drug Enforcement Agency operatives to Border Patrol agents and National Guard troops.

Over the past 15 years, the Border Patrol alone has nearly tripled in size to 11,000 agents, and President Bush has pledged another 6,000 by 2008.

Speaking before Congress in May, Border Patrol Chief David Aguilar called it a crucial expansion. "The nexus between our post-Sept. 11 mission and our traditional role is clear," he said. "Terrorists and violent criminals may exploit smuggling routes used by migrants to enter the United States illegally and do us harm."

Last spring, President George W. Bush also called for the deployment of National Guard troops to assist the Border Patrol. To date, about 6,100 troops have been stationed in the Southwestern states, including approximately 2,400 in Arizona.

Now, Meister and his researchers want to gauge how that buildup adds to the border's already endemic stress levels--and the health of residents. In particular, they'll focus upon the region's Hispanics, who are most likely to fit law-enforcement profiles of illegal immigrants.

It's all part of a health-care crisis that must be peeled like an onion to understand each layer. And one of those slices is now to be dissected, he says. "A group of us have been involved in border health for more than 20 years. We know these communities, and everybody knows that the border is a tense area."

To dissect that tension and its effects, seven full-time and part-time interviewers will visit the small towns of Gadsden, Somerton and San Luis, near the border of Arizona, California and Mexico. "The project will formally begin with a community wide-survey," Meister says. "We'll try to interview farm workers on their way from the fields, and local residents in those communities."

The study will involve 500 people, including random samples of 300 town residents and 200 individual farm workers." They'll be presented with a "general health questionnaire," he says. "They'll be asked about health care and where they get it, about insurance, and whether they are they here illegally.

"Factored in will be how Hispanic the people look," he says, assuming that those more ethnic in appearance may suffer more harassment and discrimination."

Once the data is gathered, the study team will then go back to residents for help in finding solutions, or to "create intervention, in terms of policy," he says. "Our ideas will be community driven."

But those solutions are sure to be complex--and controversial. Meister says that's to be expected. "It is political--the whole field of public health is about social justice. So you bet, it has political considerations."

The study will be completed by July 31, 2008, with results to be presented soon after.

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