Healthy communities, healthy economies: San Diego becomes new hub for cross-border health education.

It began as a conversation that took place between Dr. George Palade, former dean for Scientific Affairs at UCSD, and Mary Walshok, dean of UCSD Extension. More than a decade ago, on the UCSD campus, Palade and Walshok spoke of a vision to develop cross-border research and education partnerships in order to improve health conditions along the United States-Mexico border. The programs launched by Palade and Walshok's precept conversations have attracted state and federal attention and have become a hub for a variety of high profile cross-border programs.

Born from that conversation is a cluster of border health initiatives that creates a network where information and education are exchanged between the United States and Mexico; a cluster that combines knowledge and know-how in a region that's becoming increasingly global. The cluster began with one small, regionally focused program--the Border Health Education Network (BHEN) funded by the U.S. Department of Health and Human Services' Health Resources and Services Administration--and over the years it has been transformed into larger, globally focused initiatives.

Acting as the springboard for more to come, the community-based BHEN provides education and training services for healthcare professionals, including physicians, nurses, allied health professionals, public health specialists, paramedics, community health workers, medical schools, and nursing and public health students based in the binational California/Baja California region. Managed by UCSD Extension in partnership with the Universidad Autonoma de Baja California and the Border Health Initiative of Project Concern International, BHEN was established to create a cross-border affiliation of healthcare professionals to share information that is of benefit to practitioners and public health advocates on both sides of the border.

"Educating healthcare professionals on both sides of the border is important because it upgrades skills, capabilities, and knowledge, and provides opportunities for sharing of information, development of cooperative relationships, and solutions to health problems affecting the border region," says Elizabeth Santillanez, executive manager of BHEN.

"The United States-Mexico border region is a binational area in which two countries with diverse economies and social structures meet together, and where there is a tremendous flow of two-way cross-border migration," Santillanez continues. "Economic, social, and familial networks bind the region together, while disparities in age and ethnic composition, income, education, and poverty affect the health status and quality of life in the populations living along the border."

Santillanez says that stated simply, the purpose of BHEN is to improve the quality of healthcare services within the region in order to improve the overall quality of life for all residents of the border.

Relationships forged by BHEN have led to the development of cooperative solutions for addressing healthcare needs in the California/Baja California border region. BHEN's primary focus is addressing needs in the areas of trauma and emergency services, substance abuse prevention, HIV/AIDS, and tuberculosis treatment and prevention. BHEN also has provided leadership training for healthcare professionals involved in border health services in the region.

"Border health issues are important because disease does not recognize geographic boundaries," Santillanez says. "All along the United States-Mexican border, it is estimated that there are about 800,000 to 1.1 million legal border crossings per day. As a result, cooperative solutions need to be developed to address the healthcare needs of the regional border-wide population."

Although anchored in the San Diego region, UCSD's cross-border initiatives have an international reach as the platform broadens to include collaboration on emergency health responses related to the security of the United States and Mexico. Recently, UCSD Extension was awarded a contract and the resources to administer the California Office of Binational Border Health (COBBH). The purpose of this state-funded office is to address health policy and healthcare delivery in the cross-border region. Additionally, COBBH supports research in bioterrorism detection and prevention. Food safety--a serious concern to many in recent months--and immigrant health also are examined by COBBH.

"As we become an increasingly integrated economy and society, the flow of people and services in the cross-border region will continue to increase," says Walshok. "This means that healthcare providers throughout Southern California will need to better understand the values and healthcare practices of their increasing Mexican patient population. In turn, healthcare providers in Baja California will be interacting more with the healthcare needs of people throughout the cross-border region using services on the Mexican side of the border."

In addition, says Ricardo Jimenez, interim director of COBBH, "The demands of homeland security on the healthcare systems of our cross-border region are enormous. Through agencies such as ours, it is possible to build strong professional ties and share professional practices and complementary services to guarantee the health and safety of citizens on both sides of the border."

Walshok adds, "What is critical about all these new initiatives is that in addition to providing education and training services in the public health, medical, and nursing arenas, we are in a position to support needs assessments, policy analysis, and capacity building on both sides of the border. That is why a program of this nature is well suited to a research university such as UCSD."

At the federal level, UCSD Extension manages California's involvement with the United States-Mexico Border Health Commission, an office established by the U.S. Department of Health and Human Services and the Mexican Ministry of Health. The commission is dedicated to providing international leadership to optimize health and quality of life along the United States-Mexico border. Members of the commission include Rosemarie Marshall Johnson, M.D., border health advocate for the California Medical Association; and Lawrence E. Kline, senior consultant, Division of Chest and Critical Care Medicine, Scripps Clinic Medical Group, and medical director, Scripps Clinic Sleep Center.

"Our entire cluster of cross-border health measures is a model of cross-border partnerships committed to educating, training, and problem solving," says Walshok. In the future, UCSD Extension's cross-border efforts will include nationwide education and training.