California/Mexico Health Issues

Mexican immigrants, both temporary and permanent, place special demands and obligations on California's health care systems. The Immigration and Control Act of 1986 has or will introduce new categories of temporary workers, some of whom will be eligible for residency, and thus public health benefits, after specified periods of time. More than one million applications have been submitted in California for amnesty under the Special Agricultural Worker Program (or SAW). The Replenishment Agricultural Worker Program (or RAW), intended to replace the anticipated numbers of SAW workers who will move out of the agricultural employment sector, may bring unknown numbers of Mexican workers to California in the three-year period 1990-1993, at the end of which such workers may apply for residence. The H-2A, or guest worker

program, also could bring many Mexican workers to California Under the H-2A program, employers must provide workers compensation insurance to such employees; however, health care unrelated to employment is not specified. It is anticipated by most immigration experts, however, that the new programs established in IRCA will do little to reduce illegal immigration of Mexican workers to California. Such workers, of course, have access only to limited public health services in the State.

The temporary nature of many immigrants from Mexico, and their transitory status throughout the State of California, poses special challenges to health systems on both sides of the border. The spread and treatment of infectious diseases is of particular importance. For example, especially in the border areas, tracking and consistency of essential long-term treatment of tuberculosis is a problem when patients move between two health systems. An emerging problem of critical importance is the increasing incidence of AIDS in the United States and Mexico, an issue that has to be dealt with jointly. Research is needed in this area, and the binational urgency of the problem is reflected in the fact that AIDS is evident in Mexico particularly in rural areas among sojourn U.S. workers. The spread of the disease in these cases has been attributed to heroin addiction acquired in the United States, and the accompanying risks associated with shared needles and sexual partners of drug users.

These conditions indicate that binational health issues must be given a higher priority in California, but more importantly, that binational cooperation is essential to deal effectively with such issues. The importance of temporary Mexican workers to California is evident. California's health policy, and U.S. immigration policy, however, continue to ignore the financial, moral, and public health implications of this fact.

Given the difficulties of interagency cooperation on an international scale, a less direct approach may be more practical. Mexico's medical schools, in which many U.S. students are enrolled, are closely connected with Mexican health service agencies. California's medical schools and their associated hospitals, a major source of care to the indigent, are closely connected to county and State health agencies. Increased and more formalized interactions between the two nations in health care issues could be accomplished through establishment of a "friendly network" based upon academic relationships between Mexican and Californian health sciences institutions. Such a network would be a valuable asset in dealing with a binational health crisis.

Beyond dealing directly with critical health issues, such a network can help California and Mexico in several other ways. Already some joint UC/Mexico programs are in place which provide opportunities to UC health sciences students to study in Mexico, to learn more about communicating with and treating the Mexican client. Several collaborative research programs between Mexican and UC health scientists in many fields have been in existence for years. But funding for such programs is very limited, and the critical economic condition of Mexican institutions of higher education and research inhibits their expansion.