California-Mexico Health Initiative

Introduction Established in 2001 and housed at the California Policy Research Center within the University of California Office of the President, the California-Mexico Health Initiative (CMHI) has the mission to coordinate resources in the United States and Mexico for the purpose of increasing access to health services, reducing health disparities, and enhancing the cultural competency of health care personnel to address unmet health needs of the Mexican-origin population living and working in the United States. 27 other states in the United States and three provinces in Canada endorsed this effort in 2005. Sponsoring the first three rounds of a Special Call for Proposals on Migration and Health that has funded 21 binational teams of researchers involving ten UC campuses, and is now expanding to other universities. Launching jointly with the Mexican National Institute of Public Health the Network for Research on Migration and Health for the Americas (REMIS). Publishing and distributing three editions of the Spanish-English Dictionary of Health Related Terms. Creating a University of California medical student immersion and exchange program that has trained 67 students and a promotoras exchange that has trained over 85 community health workers. This report highlights CMHI s major achievements in its fifth year in the areas of trainings, resource development, access to health care, research, and policy. Mexican ballet folklorico perform during Binational Health Week 2005 CMHI builds towards its mission through training, research, public service, and policy with the ultimate goal of creating systems change. CMHI sponsors binational research on health and migration, organizes training and exchanges, develops culturally competent health education materials, coordinates county-based health promotion taskforces, negotiates binational agreements, and leverages research for more efficient and effective public policy. Trainings A. Promotoras Program CMHI s binational Promotoras Exchange Program was designed for promotoras to build their knowledge of health care systems in both the United States and Mexico and to develop skills to provide culturally competent care. In January 2005, 10 promotoras from Mexico traveled to various locations in California through this program, and the exchange culminated in a two-day conference with more than 100 of their U.S. peers. Participants had a chance to experience first-hand the context and communities in which their peers operate and migrants live. The Initiative mobilizes existing networks to reorient and expand their work into the immigrant health arena. An essential part of this strategy consists of transforming health from a topic merged with disease to one associated with joyful celebration of culture and builds resilience within immigrant communities. Another important CMHI strategy is the convening of policymakers from both ends of the migrant stream, in order to convince both sides that the health of immigrants is a viable piece of the bilateral agenda and should be elevated as a policy priority. CMHI s initial programs have evolved into a binational movement to improve the health of the Mexican-origin people within academic, policy, and medical service domains. Highlights of the organization s first five years include: Establishing an annual Binational Health Week that began in seven California counties in 2001 and in 2005 reached over 238,000 underserved Latinos. Thirty nine California counties, Promotoras participate in a training excercise at the 2005 Binational Promotoras Conference in Salinas, California

The Second Edition of CMHI s Promotoras Manual on Mental Health: Tales of Coming and Going was printed in early 2005 and was used in numerous trainings throughout 2005. CMHI created a second promotoras manual on Occupational Health and Safety, which focuses on the health risks facing immigrant workers in agriculture, construction, and meat packing/food processing. Promotoras are taught how to sensitize workers to these risks, how to best protect themselves and their families from such hazards as pesticide poisoning, and how to gain access to protection and treatment services even if they lack documentation. B. Jornadas (Informative Health Journeys) The Jornadas Program is a week-long immersion for U.S. healthcare providers and administrators that focus on immigrant health care and the health care system of Mexico. Altogether, 78 people participated in two Jornadas held in 2005. Participants visited state hospitals, urban and rural health centers, and not-for-profit health clinics, and had the opportunity to observe services being provided and interact with health promotion personnel. These two Jornadas, one in Guadalajara during March and the other in Zacatecas during September, were organized in collaboration with the Institute for Mexicans Abroad, the Mexican Secretariat of Health, the State of Jalisco, California health professionals visit a clinic in Zacatecas, Mexico the State of Zacatecas, MEXFAM, and Planned Parenthood. C. Medical Student Exchange Program CMHI s annual Medical Student Exchange Program includes students from University of California medical and nursing schools and academic institutions in Mexico. This exchange serves as an opportunity to foster medical students interest in the health care needs of Mexican immigrants and to train future physicians to provide care to Spanish-speaking patients in a culturally competent manner. In 2005, UC medical and nursing students competed in a rigorous application process at their home institution, and in July, 14 of them traveled to Cuernavaca, Mexico and experienced four weeks of immersion studies. They received medical training and Spanish-language instruction, and experienced hospital rotations. The Medical Student Exchange Program was cosponsored UC medical student receives training in Cuernavaca, Mexico by UC MEXUS, the UC Office of the President s Office of Health Affairs, IMSS, and Mexico s Secretariat of Health. Resource Development A. Spanish-English Dictionary of Health Related Terms The Third Edition of the Spanish-English Dictionary of Health Related Terms was released in September 2005 and 42,000 copies were distributed. In addition to expanding the existing 16 chapters, the new edition includes a new chapter on emergency and disaster preparedness. The dictionary now includes over 13,000 terms (including 4,000 new ones) related to general health terminology, body parts, signs and symptoms, communicable as well as chronic diseases, maternal and child health, nutrition, environmental and occupational health, dental health, mental health, and domestic violence. Also added were an illustration section and a separate phrase section on instructions, personal data, and medical history. Other collaborating agencies include the California Department of Health Services, Illinois s Department of Human Services, the Mexican Institute of Social Security (IMSS), the Mexican National Institute of Public Health (INSP), the Mexican Children s Hospital, the Mexican Secretariat of Foreign Affairs, the Mexican Secretariat of Health, Scripps Mercy Hospital Chula Vista/AHEC-CalPEN, the University of California at Davis, and the United States-Mexico Border Health Commission (USMBHC). B. Reference Guide To Insurance Programs In California And Mexico In 2005 the California HealthCare Foundation and CMHI jointly produced the Third Edition of the Guide to Health Programs available in California and Mexico. Over half a million copies were dis- 2

tributed. The bilingual guide includes updated information about public and private health programs, and their contact information. The easy-to-read document also includes descriptions of public and private health insurance programs and other services for the low-income population for which Mexican-origin migrants and immigrants may be eligible. C. Photography Project on Immigrants and Health Care In 2005, CMHI s collaboration with renowned artist, photographer, and folklorist Almudena Ortiz resulted several photography exhibits that garnered media attention. Ortiz was commissioned to photograph the daily lives of Mexican farmworkers and their strategies for seeking health care. Research A. Research Grant Awards CMHI s research grant program has the primary aim of providing seed funds for binational research on migration and health. The third round of grants for the UC MEXUS- CMHI Special Call for Proposals on Migration and Health Issues in Mexico and California was awarded in August 2005 to 8 binational research teams. In July 2005, CMHI sponsored a two-day evaluation meeting during which 13 teams of researchers presented their preliminary results and received technical assistance on ways to make their findings accessible to policymakers. Other attendees included all major program sponsors, government representatives, and potential future funders. B. Research Network on Migration and Health in the Americas Commemorative Mural of Binational Health Week 2005 In October 2005, networks created through the Call for Proposals led to the creation of the Network for Research on Migration and Health for the Americas (REMIS in its Spanish acronym), launched jointly by CMHI and the Mexican National Institute of Public Health. REMIS is a network of researchers and research institutions devoted to health and international migration issues. The network facilitates funding opportunities from international agencies and provides an interface between researchers and policymakers. Its mission is to contribute to the health improvement of immigrants and their families through research collaboration, dissemination, and interdisciplinary dialogue. Over 150 researchers from 40 institutions are joining the network. C. Binational Researchers Directory The directory was updated and distributed electronically to 800 Mexican and U.S. researchers in October 2005. Among its many uses, the Binational Researchers Directory enables researchers in Mexico and the United States to find and form teams with counterparts on the other side of the border. Public Service: Access To Health Care A. Binational Health Week Binational Health Week has grown tremendously over the past five years. This expansion was due in large part to growing local and regional partnerships and networks of organizations and people committed to improving the health of immigrants. These include all 45 Mexican consulates in the U.S., clinics, community-based organizations, and Mexican hometown associations. In the five years since its establishment, hundreds of organizations and thousands of volunteers have made Binational Health Week s mission their own. The diverse network of volunteer power behind Binational Health Week depends on sustaining the dedication, goodwill, and follow-through of a great number of participants at all levels. During this time, Binational Health Week has also spread to 26 other U.S. states plus the District of Columbia and three Canadian provinces. In 2005, CMHI served as the coordinating agency for Binational Health Week on a national level. However, this tremendous growth should be credited to the efforts of the Institute for Mexicans Abroad (IME) and other organizations that saw Binational Health Week in California as a model to replicate and institutionalize in their regions. Through their hard work, Binational Health Week has become a sustainable movement. In 2005, California Binational Health Week coordinators organized events geared toward certain underserved populations, in par-

ticular, agricultural workers and indigenous groups. California events that focused on outreach to agricultural workers numbered 199; 36 were held at farmworker labor camps in California. Fifty events were specifically targeted to reach indigenous populations in California. Binational Health Week 2005 Results in California 114 cities and towns in California held activities (231 total cities/towns in the U.S. and Canada). Health-promotion activities reached an estimated 114,000 Mexican migrants and immigrants in California (238,600 total). At least 403 events took place in 39 California counties (792 events total). In California, 40 mobile units brought health services to those in need. At least 270,000 pieces of health education materials were distributed. At least 1,786 local media events took place in California. Over 130 newspapers covered Binational Health Week events including the New York Times, the Washington Post, the Los Angeles Times, the Sacramento Bee, and La Opinion. The main Spanish-language television stations, Univision and Telemundo, aired Binational Health Week stories. B. Health-Promotion and Disease- Prevention Campaigns for Agricultural Workers CMHI organized four agricultural worker health campaigns in 2005: dental health, mental health, occupational health and safety, and an HIV/AIDS awareness campaign. Altogether, approximately 280 promotoras attended workshops held during these campaigns. Policy A. U.S. Mexico Migration: Health Issues Report At the California launch of Binational Health Week, held at the Mexican General Consulate of Los Angeles, the University of California, CONAPO, and Mexico s Secretariat of Health, with the support of The California Endowment, released the findings of a landmark study on health trends among Mexican immigrants living in the United States. The report publicized, among other findings, that recent immigrants from Mexico are half as likely to use emergency rooms as U.S.-born whites and Mexican Americans. The report was widely discussed in the press and among policymakers. Over 100 media outlets covered this event and 3,500 copies were distributed. B. Binational Policy Forum CMHI served on the planning taskforce for the Binational Policy Forum titled Trans-national Health of Mexican Immigrants in North America: Bridging Communication for Action that took place in Chicago on October 11 and 12. The Forum provided health policymakers, researchers, and community-based organizations an opportunity to exchange research and data and engage in networking. The 12 workshops held during the Forum were attended by 650 people. C. Fact Sheets on Health Issues Affecting Latinos CMHI contracted with a graphic designer to create a new layout for the Fact Sheets on Health Issues Affecting Latinos. The fact sheets were also updated and peer reviewed by UC researchers. In 2005, CMHI printed 27,000 fact sheets: Demographic Profile of Mexican Immigrants in the United States Health Service Disparities Among Mexican Immigrants Health Insurance Coverage in the United States Latino Population Diabetes in the U.S. Latino Population Occupational Health and Safety Agricultural Workers Mental Health D. NAWS Report Health Insurance Fact Sheet In July 2005, the report The California Farm Labor Force: Overview and Trends from the National Agricultural Workers Survey (NAWS) was released to the public. This report was a result of collaboration between the California Office of Binational Border Health, CMHI, the California Program on Access to Care (CPAC), and the U.S. Environmental Protection Agency Region 9. A policy briefing was subsequently held

by CPAC with CMHI participation in Sacramento to assist policy makers faced with decisions related to agricultural workers health issues. Major media outlets covered this event. E. Binational Health Insurance In conjunction with CPAC, CMHI has continued to work on developing a Binational Health Insurance product. During summer 2005, CMHI conducted a survey in Los Angeles at the Copa de Federaciones soccer tournament, organized by Mexican Hometown Associations to determine participants willingnessto-pay for this type of health insurance. This venue provided a unique opportunity to survey Mexican-origin populations from states with the highest migration rates to California. Analysis of these surveys was completed in fall 2005 and a report of the findings titled Willingness to Pay for Cross-Border Health Insurance between the United States and Mexico was finished in January 2006. F. Childhood Obesity Conference CMHI provided assistance for the organization of CPAC s April 2005 conference, Childhood Obesity Among Latino Immigrant Families. The conference, which focused on a binational understanding of childhood obesity among Latinos, developed over a two-year period and included more than 120 participants representing health care and policy researchers, public decision-makers, health care leaders, and committed individuals from the private sector. Future and Expansion CMHI with the support of regionally-based social and service networks, and academic and political institutions, has in its first five years served as a catalyst in facilitating dialogue and action towards improving health care for underserved migrants and immigrants. In 2006 and beyond, CMHI will take the lessons learned from its first phase of program startup and implementation and move to institutionalize and expand its projects. As CMHI goes forward, it will not only continue to carry out and improve its existing work but also break ground with innovative new projects. In the coming three years, CMHI plans to utilize its existing regional coalitions to implement a state-wide campaign to insure eligible Latino children into California s Healthy Families and Medi-Cal programs. The Initiative is also expanding its work to include immigrants whose countries of origin lie in Central America, starting with El Salvador and Guatemala. Finally, CMHI intends to focus on building stronger partnerships with the Mexican National Board of Science and Technology (CONACYT), the Mexican Binational Migrant Education Program (PROBEM), and other universities, in order to develop education programs and curriculums on migration and health. California-Mexico Health Initiative California Policy Research Center University Of California Office Of The President 1950 Addison Street, Suite 203 Berkeley, California 94720-7410 Phone 510.643.6243 Fax 510.642.7861 Email cmhi@ucop.edu www.ucop.edu/cprc/cmhi.html Latino children receive health information in San Mateo, California 5