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ENVIRONMENTAL HEALTH POSTGRADUATE PROGRAMS
ENVIRONMENTAL HEALTH Victoriano Garza Almanza PAHO/ WHO 1997 Introduction A considerable number of different human diseases have a direct association with man and the environment that surrounds him. There is a growing concern in the US-Mexico Border related to harm done to the environment shared by the two nations. This has resulted from development that occurred in the past, during the processes of regional progress, and currently during the industrialization process, accelerated urbanization the exhaustion or deterioration of resources associated with technical changes that came about with the implementation of the North American Free Trade Agreement (NAFTA). The concern of the US-Mexico border communities is mainly health problems originated by the polluted environment in which they live. Environmental health problems along the US-Mexico Border are of a different nature, such as: emergent diseases associated with biologically contaminated water, such as cholera; presumably associated with chemical contamination of water, such as anencephalia or lupus erythematosus; lead in blood caused by soil contamination, or dengue due to Aedes aegypti or Aedes albopictus infestations. Although environmental problems are widely identified in this region, there is not a register that would describe them and all their characteristics, nor an epidemiological identification of their health impact on the border population. Also, the sources for measuring pollution sources, standardization regulations regarding these sources, and the health risk assessment due to environmental deterioration are different between Mexico and the United States. Simultaneously with the above referred, the border is a transition area between two countries that are culturally, politically and economically different. This, to a great extent, has made reaching a solution difficult. Not a general solution to environmental issues, but concrete approximations to specific problems. Particularly, each sister cities’ population along the US-Mexico Border has basic infrastructure or environmental damage problems that are unique, such as adequate water supply and treatment, disposal of excreta and solid wastes, importation/exportation of toxic substances, and air that is full of harmful particles, pesticides and others which pose a public health risk. Strategy for Binational Environmental Improvement Although from the ecological point of view, natural resources that are shared in the border have a homogeneous identity, from the urban and rural points of view there are differences: (1) infrastructure for basic sanitation, and (2) there are official environmental health programs on both sides of the international border line. Negotiations and the approval of the North American Free Trade Agreement opened an opportunity for those interested in shared protection of the ecosystems between Mexico and the United States, and to implement efforts to reach a joint solution for environmental health in the region. The central problem of environmental protection in the border presented by the environmental agencies of the two countries is based on: a) Improvement and expansion of service coverage on the U.S. side, to promote the search for a joint environmental solution in the region. This would result in a balanced effort of binational environmental improvement. To accomplish the above, the US and Mexican Governments established the NADBANK/BANDAN to finance environmental health projects, as well as a Commission (BECC/COCEF) to provide technical advise to the border communities on aspects related to project development. However, a good part of the priorities of the Integral Border Environmental Plan (IBEP/PIAF) came from the binational Commission through a series of binational public hearings in 1991. These priorities were not included in the new strategy BECC/COCEF in which research, education, or dissemination of information, played an important role in the improvement of environmental quality in the region. To take care of the border community that claimed that IBEP/PIAF did not go any further than a mere diagnosis, during 1994/1995 the US Environmental Protection Agency (EPA), promoted and carried out a series of training and research activities focused on binational problems. This effort accomplished Mexico’s involvement and participation and the plan of activities was expanded to a binational level. Therefore, in 1996 the so called Border XXI Program started, its strategy was designed as follows: (a) to include public participation. (b) to strengthen local and regional agencies and (c) to have a better interagency and international cooperation. So that Border XXI Program would accomplish its objectives, there were nine Binational Work Groups established. One of those Groups is on Environmental Health represented by Health and Environmental Officials from the Federal levels of the United States and Mexico, who deemed pertinent to identify: (1) Training opportunities on environmental health existing in the region and (2) some binational cooperation models on environmental health too. Environmental Health The Work Group on Environmental Health considered that the basic objectives of Border XXI on this issue were:
As a beginning to start implementing a 5-year plan of action, the work group deemed necessary to carry out an inventory of advanced environmental health education opportunities along the United States-Mexico Border and then strengthen research and training capabilities. Under the previous criteria, between April and May 1997, there was an inventory of postgraduate education on environmental health carried out on the US-Mexico border region, and some binational cooperation models were identified in which advanced training, research or surveillance are the core of joint work. Opportunities for Environmental Health Postgraduate Education In response to environmental health problems along the US-Mexico Border, and due to the growing requirements of the population, numerous universities from both sides of the binational region were urged to: (1) strengthen their postgraduate programs on environmental and similar areas, or (2) establish new environmental programs. As expected, there is a contrast between the two sides of the border for advanced education offered in environmental health and related areas. On the Mexican side, training on environmental health is focused more on similar areas and less on environmental health. On the U.S. side there is a great opportunity for environmental health education. In five of the six Mexican Border States there are educational programs that are adequate. In the four US Border States there are programs that are specific for advanced education and training of human resources. That is, Mexican education programs are more oriented towards environmental engineering, while the US educational programs place more emphasis on environmental epidemiology or on environmental toxicology. Environmental training programs in the North of Mexico are oriented to provide human resources for the service area and to the maquiladora industry sector. As a result, advanced research on specific environmental health issues is practically non-existent in higher education institutions in the North. Research on this area has been carried out by the Secretariat of Health or by an agency from the center of Mexico such as CINVESTAV or the University of San Luis Potosí. Due to the above, Mexico has placed more emphasis on short training courses for continued education, called "the rapid option," in detriment of advanced higher education programs. The demand for short training is greater, but not so for those courses that require a full time commitment from the students. On the US side, the NAFTA/TLC opened an opportunity for all areas of advanced environmental health education, including the health component. However, the highest progress made is observed in California and to a lesser degree, almost unnoticed, in New Mexico. Although US universities such as San Diego State, the University of Arizona, New Mexico State, UT El Paso, UT Houston and others, have academic and/or scientific agreements with Mexican universities such as the Autonomous University of Baja California, the University of Sonora (UNISON), the Autonomous University of Ciudad Juárez, the Technological Institute of Monterrey or the Autonomous University of Nuevo León, on the specific subject of environmental health, no relationship can be appreciated. The main reason for not having an academic/scientific association on environmental health in the border region is that there aren’t enough human resources trained on the Mexican side, and that those interested on the US side have language barriers and understanding their potential mexican counterparts, and they avoid contact. Consideration should be given to the fact that most postgraduate programs on environmental health offered in the US Southern States, require that physicians participate to get a certification by the American Medical Association. This makes the participation of the Mexican physicians almost impossible. To do joint research it is necessary to train human resources on the Mexican side, and to establish environmental health education programs in situ to revert this process. So that advanced environmental health education programs may progress, appropriate alternatives should be designed. For example, a Doctors’ Degree in Engineering is being established at the Autonomous University of Ciudad Juarez, jointly with the New Mexico State University at Las Cruces, and one of its options is environmental health. Students, and university professors will receive classes through teleconference; or in other cases, they will go to Las Cruces. Lectures will be on a binational interest issue. Binational Cooperation on Environmental Health Far from what many people think, US-Mexico cooperation on environmental issues is as old as the United States-Mexico Border Health Association (USMBHA/AFMES). The first cooperation agreements were fostered by the USMBHA/AFMES. The following is a brief chronicle of this type of cooperation:
Binational US-Mexico cooperation on environmental health has had many historical manifestations. The best part of its development and maturity has been during the last 7 years; however, all this experience has not been sufficient to find better avenues and continuous productive understanding. There are several ways of carrying out this relationship: (1) through a binational impartial instrument that could be present along the entire border, free of changes imposed by governmental administration transitions, and that would have the authority for orientation and/or intervention, such as the USMBHA/AFMES, (2) because of the call for specific binational projects that it finances, like Border XXI, (3) through the promotion and fostering of specific binational activities, such as sponsorship of some foundations, or (4) through the promotion and support to small independent initiatives which are already working, such as university research assistance or to ONG’s. One of the most satisfactory experiences carried out by the PAHO Field Office/US-Mexico Border has been the transfer from the US to Mexico of the Health Assessment methodology of the US Agency of Toxic Substances and Disease Registry. This transfer was done in two phases:
On this case, the Environmental Health Program of the Field Office/US-Mexico Border coordinated activities with the US and Mexican parts. It participated in the identification of the site in which the methodology would be applied, and suggested the site where the study should be carried out. Later, due to the ties established in this process, better understanding of other areas was accomplished. As one of the results, the manual on Health Assessment was translated to Spanish. |
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