UCLA SCHOOL OF PUBLIC HEALTH COMMUNITY HEALTH SCIENCES Winter Quarter CHS 440

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1 UCLA SCHOOL OF PUBLIC HEALTH COMMUNITY HEALTH SCIENCES Winter Quarter CHS 440 COURSE TITLE: Public Health and National Security at the U.S.-Mexico Border SRS # INSTRUCTOR: Samuel J. Stratton, MD, MPH Department of Community Health Sciences (310) strattos@ucla.edu UNITS: Four (4) PREREQUISITES: FORMAT: Undergraduate or Graduate Standing; Registration in UCLA Extension Program One three-hour session per week with self-study and preparation prior to each session. Class sessions consist of: 1. Structured class discussions based on course readings. 2. Didactic lectures. 3. Case studies. 4. Literature review and discussion. Class preparation and study requirements: 1. Reading of identified text chapters and articles. 2. Focused literature review and presentation to class, topic approved by Instructor, minimum 5 references. 3. Mid-term examination, one hour essay format 4. Final paper, topic approved by Instructor, 10 pages minimum. TIME: Tuesday 1:00 3:50 PM LOCATION: COURSE COMMUNICATION: MyUCLA will be used for course communications COURSE OBJECTIVES Understand the concepts of borders and the common definitions and legal principles that exist with boundaries we call borders.

2 Page 2 Understand the public health challenges that exist when borders separate populations of differing cultures and economic status. Appreciate environmental health challenges along the US-Mexico Border and need for multinational health agency cooperation and communication. Understand the health impacts and challenges that arise with food and product import and export along the US-Mexico Border. Appreciate the differences in health care delivery methods and goals that exist across the US-Mexico Border. Understand the health impacts, both physical and behavioral, that occur with illegal activity and violence that occurs in areas along the US-Mexico Border. Understand the risks and difficulties that exist at the US-Mexico Border with regard to national security and terrorist activity. Appreciate the public health issues that center on free trade and mutual cooperation between nations at borders. SPECIFIC ASPH PUBLIC HEALTH COMPETENCY GOALS FOR COURSE: 1. Apply descriptive techniques commonly used to summarize public health data (A.5). 2. Interpret results of statistical analyses found in public health studies (A.9). 3. Describe the direct and indirect human, ecological and safety effects of major environmental and occupational agents (B.1). 4. Describe federal and state regulatory programs, guidelines and authorities that control environmental health issues (B.3). 5. Draw appropriate inferences from epidemiologic data (C.9). 6. Identify the main components and issues of the organization, financing and delivery of health services and public health systems in the US (D.1). 7. Explain methods of ensuring community health safety and preparedness (D.3). 8. Identify the causes of social and behavioral factors that affect health of individuals and populations (E.2). 9. Identify individual, organizational and community concerns, assets, resources and deficits for social and behavioral science interventions (E.3). 10. Describe steps and procedures for the planning, implementation and evaluation of public health programs, policies and interventions (E.5).

3 Page 3 COURSE READER/TEXTBOOK Textbook: Suggested: Will be provided by the course Instructor; None required, current textbooks addressing US-Mexico Border Health are outdated. Puro Border, LH Crosthwaite, JW Byrd, B Byrd (eds), Cinco Puntos Press, SUPPLEMENTAL READING Supplemental monographs and articles will be posted in PDF format on the MyUCLA website during the course. These articles will provide background and an introduction to topics presented in each upcoming session. It is important that supplemental reading material be reviewed prior to each session. Because of limited contact time in the classroom, lectures and discussions will develop upon the readings for that session. If you are unable to attend a class, supplemental readings should be read and questions used for class discussion will be ed to you to review and submit for class credit. COURSE REQUIREMENTS AND GRADING Course grade is by letter only. The grade will be based on a literature review presentation and written analysis (1-2 pages with references) for the four case studies conducted during the class. Attendance is expected at each class session, if you cannot attend a session; please contact the instructor for a possible excused absence. Final grades will be based on the following breakdown: 1. Literature review presentation and discussion 10% Each student is expected to present a 10 to 15 minute discussion of an article or paper related to border health and security. Discussion material may be obtained from the scientific literature, current printed news sources, or the Internet. Students should be prepared to relate their selected article to the topic of border health and security and should present a critical analysis of the concepts and conclusions presented in the reference article. Also, the applicability of the article to the field of public health should be discussed. At the first class session, specific elements expected of the presentations will be presented and students will sign up for specific dates to present their literature discussions (1-2 student presentations for each class session). 2. Case Study Analysis 40% (10% for each of four case studies) Case studies are used as a teaching method in the course. Short, directed case studies will be presented for discussion and review a week prior to the scheduled class meeting that is

4 Page 4 scheduled for a specific case study. Students will be asked to refer to current literature, textbooks and other sources for information regarding the topic of the case study. A short written discussion will be submitted on the day of class for which a case study is reviewed. Each case study discussion paper should be a minimum of one page (typed, double spaced) and should also include citations to any references used. The written case study discussions will be combined to form 40% of the class grade. 3. Mid-Term Exam 15% A mid-term exam will be included in the course performance evaluation. The exam will be based on essay questions that gauge the depth of understanding and thought each student has developed for key issues of US-Mexico border public health. Students who regularly attend class will be most successful with the mid-term examination. The mid-term exam is also designed as a tool to initiate exploration of the topics covered in the remainder of the course. The mid-term exam will be conducted during class in week five of the quarter. The mid-term will be of one hour in duration. 4. Final Paper 35% A final paper will be required of each student. This paper will address a focused issue related to border health or security. Each paper is to be typed in 12 point font and of approximately ten (10) double-spaced pages in length. The paper must include relevant reference citations. Potential final paper subjects will be identified during initial class sessions. Prior to writing the paper, each student must discuss his or her choice of subject with an instructor. Proper grammar, spelling, and format are expected. The paper will be due during the final exam week of the quarter. GENERAL STATEMENT ON GRADING AND ASSIGNMENTS Most students will receive a grade of A or B in this course. An A grade is achieved by doing exceptional work in the course and contributing not only to one s own education but also to the education of all in the course (including the instructors). A C in the course indicates below standard achievement that usually results from lack of class attendance, ongoing tardiness, and lack of interest in class participation, not reading course materials and returning written assignments that reveal a lack of attainment of the majority of the course goals. For grading purposes, an A grade for an assignment is equal to 4.0 points, B equal to 3.0 points, C equal to 2.0 points, D equal to 1.0 points and F or incomplete equal to 0.0 points. Final class grade is calculated by average of individual assignment grades with the higher letter grade given (rounded up) for X.5 or higher fractional elements.

5 Page 5 NOTICE OF LANGUAGE FOR COURSE This course is unique in that many students are bi-lingual in both Spanish and English. Course instructors will be sharing teaching material that is both English and Spanish language in origin. While Spanish language presentations and materials are possibly appropriate in such a course; to insure uniformity and understanding by all students, the course will be conducted in English. Proper pronunciation of formal Latina/o names and terms used in the context of the class will be emphasized to be culturally respectful. STATEMENT OF CAUTION AND APPEAL At all times, respect of others and a mature attitude is expected of all course participants. Some topics covered in the course are of sensitive ethnic, gender, religious, and political natures. It is extremely important that all class participants observe the rights of others to speak and express their opinion on any matter in open discussion. Students are encouraged to ask for an immediate break to speak to the instructor if the discussion in progress is personally disturbing or offensive. Please notify the instructor in person, by phone, or by if at any time the course is falling below your expectations or you feel the course should be re-directed.

6 CLASS SCHEDULE Page 6 WEEK 1: January 8 Introduction and Course Overview Course overview What is a border? What crosses a border? What are Border security and terrorism issues in 2013? Why the Border is a unique Public Health environment Readings: 1. Mexican and Central American Immigrants in the United States: Health Care Access, Regents of the University of California and The Mexican Secretariat of Health (SSA), 2006 pages This reference placed in PDF format on MyUCLA WEEK 2: January 15 Social, Public Health, and Political History of the U.S.-Mexico Border A brief political history of the U.S.-Mexico border Medical history at the border abortion, plastic surgery, alternative care Cross-border cooperation for public health initiatives Literature Review presentations demonstration (Instructor) Lecture: Political History and Health at the U.S.-Mexico Border 1. Bastida E, Brown S, Pagan J. Persistent Disparities in the Use of Health Care Along the US-Mexico Border: An Ecological Perspective. Am J Public Health 2008;98: Homedes N, Ugalde A. Globilization and Health at the United States-Mexico Border. Am J Public Health 2003;93: Hildebrandt N, McKenzie DJ. Migration and Child Health 2005: The Effects of Migration on Child Health in Mexico, WHO Report, Dept of Economics, Stanford Unv. 4. Ramos R, Ferreira JB, Brouwer KC, et al. Social and Environmental Influences Shaping Risk Factors and Protective Behaviors in Two Mexico-US Border Cities, Health Place (NIH) 2009;15: WEEK 3: January 22 An Exploration of the Cultural Aspects of Physical and Mental Health The concept of culture and health Culture as a means for enhancing public health

7 Individual philosophy effects on public health Page 7 Lecture: In place of a class meeting, class members are asked to tour the permanent collection of the Museum of Latin American Art in Long Beach. Arrangements for touring the museum will be made and class members are invited to tour the museum at any open time during the week. From Puro Border (in class reader): The Border is the Place Where We Live: Everything is going to be Different WEEK 4: Janaury 29 Imported Foods and Materials: Public Health Impacts Globalization of the food supply Inspection and surveillance Security implications 1. NAFTA: Preamble and Chapter 1 (Objectives and General Definitions), U.S. Government Printing Office, Waterman S, Stolp C, The North American Free Trade Agreement and Public Health at the US-Mexico Border, Am J Public Health 2004;94: Handley MA, Hall C, Sanford E, et al, Globalization, Binational Communities and Imported Food Risks: Results of an Outbreak Investigation of Lead Poisoning in Monterey County, California Am J Public Health Weigle MM, Armijos RX, Hall YP, Ramirez Y, Orozco R, The Household Food Insecurity and Health Outcomes of U.S.-Mexico Border Migrant and Seasonal Farmworkers, J Immigrant Minority Health 2007;9: Feng S, Krueger AB, Oppenheimer M, Linkages Among Climate Change, Crop Yields and Mexico-US Cross-border Migration, PNAS 2010;107: Suggested Reading: Puro Border Ropa Usada, page WEEK 5: February 5 Public Health Emergencies at the Border PAHO, and NGOs and the US-Mexico Border Public Health implications of cross border disasters Environmental Protection Health Department structure U.S. and Mexico MID-TERM EXAMINATION: A 1-hour essay type exam will be included in this class session.

8 Page 8 Student Literature Review presentations Case study #2: Flooding in Baja, Mexico 1. United States-Mexico Border Health Commission, Health Care Reform and the U.S.-Mexico Border: Challenges and Opportunities, Dec History and Structure of the Pan American Health Organization. 3. EPA, Advances in U.S.-Mexico Strategic Alliance for Sustainable Emergency Preparedness, May WEEK 6: February 12 General Population Health and Naturally Occurring Infections at the US-Mexico Border Overview of the problem- surveillance and reporting Environmental factors Migration and infections Student Literature Review presentations Case Study # 3: H1N1 1. Mexico s General Health Law, Title 8, Chapter II (2005). 2. H1N1 reports from the Centers for Disease Control and Prevention (MMWR) and the World Health Organization. 3. Deiss R, Garfein RS, Lozada R, et al, Cross-border Mobility Influences Tuberculosis Diagnosis and Treatment Interruption among Injection Drug Users in Tijuana, Mexico, Am J Public Health 2009;99: The Challenge of Global Health, Foreign Affairs, Jan/Feb, Balcazar H, Alvarado M, Cantu F, et al, A Promotora de Salud Model for Addressing Cardiovascular Disease Risk Factors int eh US-Mexico Border Region, Public Health Research Practice and Policy 2009;08_0020.htm. 6. O Rourke KO, Goodman KJ, Grazioplene, et al, Determinates of Geographic Variation in Heliobacter pylori Infection Among Children on the US-Mexico Border, Am J Epidemiology 2003;158: Averhoff F, Zucker J, Vellozzi C, et al, Adequacy of Surveillance to Detect Endemic Rubella Transmission in the United States, CID 2006;43 (Suppl 3):S151S157.

9 Page 9 WEEK 7: February 19 Environmental Health Challenges at the Border Transportation of hazardous materials and waste Border water quality Environmental contamination lead Pesticide flow across borders Student Literature Review presentations Lecture: The Environmental Epidemiology of Lead Poisoning of Children in El Paso and Juarez 1. A Blueprint for Action on the U.S.-Mexico Border 13 th Report of the Good Neighbor Environmental Board to the President and Congress of the United States, June U.S. Canal Project Raises Tensions on Mexico Border, Reuters Freeman NCG, Shalat SL, Black K, et al, Seasonal Pesticide Use in a Rural Community on the US/Mexico Border, J Exposure Analysis and Environmental Epidemiology 2004;14: Shalat SL, Donnelly KC, Freeman NCG, et al, Non-dietary Ingestion of Pesticides by Children in an Agricultural Community on the US/Mexico Border: Preliminary Results, J. Exposure Analysis and Environmental Epidemiology 2003;13: Lauer FT, Mitchell LA, Bedrick E, et al, Temporal-Spatial Analysis of U.S.- Mexico Border Environmental Fine and Coarse PM Air Sample Extract Activity in Human Bronchial Epithelial Cells, Toxico Appl Pharmacol 2009;238:doi: /j.taap Suggested Reading: Puro Border The Place of Wilderness, pages WEEK 8: February 26 Health Delivery Issues At the US-Mexico Border Health Differentials at the U.S.-Mexico Border Health Access at the U.S.-Mexico Border Student Literature Review presentations Case study #4: Is Health Care a Commodity? Readings: 1. Mexican and Central American Immigrants in the United States: Health Care

10 Page 10 Access, Regents of the University of California and the Mexican Secretariat of Health (SSA), 2006 pages (Available on MyUCLA) 1. Bustamante AV, Ojeda G, Castaneda X, At the Intersection of Health, Health Care, and Policy, Health Affairs 2008;27: Blendon et al, Disparities in Health: Perspectives of a Multi-Ethnic, Multi- Racial America, Health Affairs Spiegel, Yassi, Lessons from the Margins of Globalization: Appreciating the Cuban Health Paradox, JPHP, Jan Delgado E, Castrucci BC, Fonseca V, et al, Lessons Learned From a Binational Survey to Examine Women s Health Status in the US-Mexico Border Region, Prev Chronic Dis 2008;5 (CDC Online). 5. Marsiglia FF, Kulis S, Rodriguez GM, et al, Culturally Specific Youth Substance Abuse Resistance Skills: Applicability Across the U.S.-Mexico Border, Res Soc Work Pract 2009;19: Balcazar H, Alvarado M, Cantu F, et al, A Promotora de Salud Model for Addressing Cardiovascular Disease Risk Factors in the US-Mexico Border Region, Prev Chronic Dis 2009;6 (CDC Online). WEEK 9: March 5 Social Health Issues at the US-Mexico Border Social health differentials at the U.S.-Mexico border The missing women of Juarez Human Trafficking across the U.S.-Mexico Border HIV/HPV knowledge and attitudes at the U.S.-Mexico Border Diet and Health at the US-Mexico Border Student Literature Review presentations Structured Class Discussion of the readings for the week 1. Trujillo, Slavery in the 21 st Century, Americas, April, Quinones S, May Our Daughters Come Home/Nuestra Hijas De Regreso A Casa, Puro Border, 2003, Cinco Puntos Press, El Paso pgs Brouwer KC, Lozada R, Cornelius WA, et al, Deportation Along the U.S.- Mexico Border: Its Relation to Drug Use Patterns and Accessing Care, J Immigr Minor Health 2009;11:doi: /s Gray JR, Sandoval JA, A Disease Without Borders: The Impact of HIV and Migration on Families Living Along the U.S.-Mexico Border, U.S.-Mexico Border Project May Fernandez ME, McCurdy SA, Arvey AR, et al, HPV Knowledge, Attitudes, and Cultural Beliefs Among Hispanic Men and Women Living on the Texas- Mexico Border, Ethn Health 2009;14: Espinosa de los Monteros K, Gallo L, Elder J, et al, Individual and Area-

11 WEEK 10: March 12 Border Security and Terrorism Page 11 Based Indicators of Acculturation and the Metabolic Syndrome Among Low- Income Mexican American Women Living in a Border Region, Am J Public Health 2008;98: Health Impacts of Violence and Lack of Security at the US-Mexico Border Terrorism hazards along the U.S.-Mexico border: 1. What is the risk of terrorism along the U.S.-Mexican Border? 2. Ranking of terrorism risks 3. Identify agencies and groups responsible for terrorism risk assessment and mitigation at the borders Mitigation actions to limit terrorist exposure at borders: 1. The Israel experience 2. Oceans and air control at borders 1. The Border is Wide, Harper s Magazine, October, Hakim, Is Washington Losing Latin America? Foreign Affairs, Jan/Feb, Casey N, Mexico Under Siege, Wall Street Journal, Aug Luhnow D, de Cordoba J, Mexican forces Find 72 Migrants Slain at Ranch, Wall Street Journal, Aug Sapkota S, Kohl HW, Gilchrist J, et al, Unauthorized Border Crossings and Migrant Deaths: Arizona, New Mexico, and El Paso, Texas , Am J Public Health 2006;96: Banks LW, Our Lawless Mexican Border, Wall Street Journal, April FINAL EXAM WEEK: Final Exam: A final paper will be required of each student. This paper will address a focused issue related to border health or security. Each paper is to be approximately ten (10) double-spaced pages in length. The paper must include relevant reference citations. Potential final paper subjects will be identified during initial class sessions. Prior to writing the paper, each student must discuss his or her choice of subject with the Instructor.