Public health risks in the San Diego-Baja California binational region demand urgent attention.  As the region becomes ever more integrated through cross-border economic partnership, commercial exchange, travel, and two-way migration, public health programs that work on only one side of the border are increasingly unable to prevent or respond to rising rates of infectious diseases, such as tuberculosis and HIV, chronic ailments, such as obesity, and, most urgently, the risks of bioterrorism, food contamination and other sources of transnational illness and threat. 

Numerous studies continue to document the problems facing the binational region, but the dilemma is only partly a question of awareness.  Rather, the challenge rests squarely with an institutional and political leadership stalemate that prevents turning knowledge into effective action.  Existing health programs are small and fragmented, no coherent, integrated strategy exists to attract sufficient resources to make a difference, and the public sector on both sides of the border appears in no position to lead the way forward. 

This Report highlights existing cross-border health deficits in the San Diego-Baja California border region, particularly in the areas of health care access and disease risks and identifies existing institutional barriers that are currently inhibiting expanded cross-border health coverage today.   The report identifies that the need for expanded cross-border health services is now more urgent than ever before and this need now goes beyond existing border area residents to the growing number of fixed income Americans now retiring in Baja California due to economic reasons.

In an effort to offer practical solutions to overcome existing barriers this report offers a strategic agenda for improving the quality of cross-border health.  Beyond the well acknowledged need to expand cross-border health research and to promote regulatory reform, the agenda includes the following specific recommendations; improve the leveraging of technology, particularly in the area of telemedicine; expand emergency cross-border health services; formalize cross-border anti-human trafficking protection teams; re-design disease-specific programs in the border area; and move beyond crisis to prevention as a strategy to expand the level of  financing of cross-border health services.

The report also issues a call for action, beginning with a Regional Health Summit led by private and non-governmental leaders.  The summit’s objective would be to initiate a community-wide campaign to identify coordinated strategies to raise the scale of investment and program engagement in cross-border health risks.  These strategies would address the key binational question:  What can be achieved working across the border that can not be achieved working separately on each side?

With this call to action, the International Community Foundation is inviting regional leaders to participate in the initial discussions that will lead to a Health Summit.  This Report is designed to start that process.  It provides background discussion on the nature of the problems that a binational health campaign must overcome and offers a few strategic ideas in hopes of stimulating discussion.  Specifically, binational strategies need to design programs that closely match the ways in which people, communities, and the economy work across borders.  To do so will require leadership that reaches across borders, overcoming an institutional mismatch between the way health programs are currently organized and paid for, and the ways in which individuals, families, workers and companies move, live and work on both sides of the border.    

This Report is part of a series through which ICF is addressing the profound implications of cross-border integration in the San Diego-Baja California binational region.  In its first report, Blurred Borders, ICF documented a range of policy issues that called for new perspectives and strategies requiring action from the private and non-governmental sector, philanthropy, and governments.  Health security was one of the most urgent of those issues because of both the urgent risks facing the region and the potential capabilities this binational community could organize to address the problems.

The San Diego-Baja California region has both the reputation and experience with innovation to dramatically improve the health security of the economy and community on both sides of the border.  A successful health campaign would also offer strategies of hope for other border regions that face similar problems but without the resources and inventiveness.  As recent federal strategies for preparedness against pandemic influenza have admitted, health security risks can not be stopped at borders.  Preparedness requires working across borders.  In our binational region, community well-being, economic prosperity, and personal health all demand reaching across current boundaries

Richard Kiy President and CEO International Community Foundation