Health and human security in border regions.

Region of the Americas has a very large equity gap, and the United States– Mexico border is no exception, as indicated by the gradient between the two countries and between communities along both sides of the border. For example, the average household income in San Diego, California, United States (US$ 60 000), is about double that in McAllen, Texas, United States (US$ 30 000), and there is an abysmal difference between the average household income along the northern Mexican border states (US$ 10 000) and the southern U.S. border states (US$ 40 000) (1). With release of the Human Development Report 1994: New Dimensions of Human Security (2), it became increasingly clear that external aggression is not the only danger menacing the world today. The report introduced a new concept of human security centered on people and the elements that affect their quality of life. Thus, a broader vision of human security is seen to underlie the health determinants and take into account the interdependence of the risk and protective factors that affect people and communities everywhere. This perspective recognizes the multi-dimensional relationships between these factors as well as the interaction between economic development, poverty reduction, sustainable development, democratic governance, and the rule of law, including respect for human rights, peace, and security (3). The broader concept of human security should draw on input from both the public and private sectors, including government organizations and civil society groups, and calls for states to ensure the survival, livelihood, and dignity of their inhabitants. The new paradigm centers on the security of people and on the responsibility of states to " protect the vital core of all human lives in ways that enhance human freedoms and human fulfillment " (4). This idea is of vital importance for U.S.–Mexico border communities, nestled between two countries, two cultures, and two governmental systems. Many are dealing with new threats such as climate change, environmental deterioration, and food insecurity as well as with epidemics and diseases such as tuberculosis, HIV/AIDS, and diabetes. This complex health scenario poses serious challenges for communities struggling to provide an integrated, well-coordinated response. The human security concept calls for strategies to protect people from critical and pervasive threats and to empower them to take charge of their lives. This is a fundamentally new way of thinking about a range of challenges that include hunger, poverty, ill health, poor education, armed conflict, …