Bordering on Unhealthy: Violence and Health on the U.S.-Mexico Border

March 14, 2014

Katherine E. Bliss, Senior Associate, Global Health Policy Center
Center for Strategic and International Studies

It’s dangerous – and downright unhealthy – to be a young man in Mexico these days. According to Mexico’s National Institute for Statistics and Geography, in 2011 homicide was the leading cause of death among men ages 15 to 34.  While murder is among the top causes of death for this age group in many parts of the world, Mexico’s homicide rate increased dramatically from 8.1 per 100,000, in 2007, to 23.7 per 100,000, in 2011, amid escalating violence connected to the federal government’s campaign against drug trafficking organizations. The violence has taken a particularly brutal toll on young Mexican men, who are the most likely to be recruited into the cartels’ activities, and raises the question of how the United States can collaborate with Mexico in addressing the issue.

Drug-related violence has increased over the past decade in Mexico for a variety of reasons, including the shift of trafficking to Mexico from Colombia following successful efforts since the 1980s to quash the movement of drugs there and, more recently, in reaction to the push by former Mexican president Felipe Calderón (2006-2012) to suppress the activities of organized crime groups. Estimates of the number killed during the Calderón administration range from 60,000 to 120,000. Most of the homicides have been concentrated in states that border the United States or are located along Mexico’s Pacific coast. It’s too soon to tell whether violence in Mexico is abating under the watch of President Enrique Peña Nieto, who took office at the end of 2012.

While Mexico’s homicide rates dramatize the most pernicious health effect of the ongoing conflicts, the drug war has had other, more subtle, implications for health in Mexico. Last fall Mexico’s Minister of Health, Mercedes Juan López stated that the violence costs Mexico between 8% and 15% of GDP per year, with a large percentage of the costs associated with insurance, medical care, and lost productivity. During a period in which Mexico has seen rising health care expenses associated with the country’s obesity and type 2 diabetes epidemics, the health expenses connected to the violence divert funds from these and other important programs.    

Significantly, the violence takes a toll on mental health on both sides of the border. One  2012 study focused on children of Hispanic origin living in poverty in El Paso, Texas, and Ciudad Juárez, in Mexico, between 2007 and 2010.  It was during this period that the estimated drug-related homicide rate in Ciudad Juárez rose from 0 per 100,000 to 229 per 100,000. Children who were exposed to violence during the study period showed higher rates of anxiety, depression, and substance abuse, as well as aggression and rule-breaking behavior. Mexico has undertaken a program of improving access to mental health services, with a push to reduce stigma and discrimination associated with mental health treatment and to integrate mental health services into mainstream health services, but progress is slow.  In 2011 only 2% of the federal health budget was devoted to mental health, and most services were for adults, not children.  

The increased threat of violence along the border also impedes the access of families on both sides to a broad range of health care services and places the many uninsured U.S. citizens who travel to Mexico for lower cost health care and access to medicines, in harm’s way. One study estimated that between 30% to 50% of pharmacies in Ciudad Juárez and Tijuana have closed in recent years because of violent conditions.   Last year The Lancet reported that the demand for lower cost Mexican pharmaceuticals in places like South Texas has also led to a secondary form of cross-border drug trafficking – that of prescription medicines – with the emergence of underground markets for the products, as well.   And, as experts at a 2010 CSIS conference on health and the U.S-Mexico border noted, the violence also creates situations in which people are afraid to spend time outside, both limiting their ability to exercise and access nutritious food and contributing to higher rates of chronic diseases.    

The capture and killing (on March 9) of Nazario “el Chayo” Moreno González, head of the Mexico-based drug trafficking organization known as La Familia Michoacana, and the arrest (on February 22) of Joaquín “el Chapo” Guzmán Loera, head of the Sinaloa drug cartel and one of the most wanted criminals in Mexico since his escape from a federal prison in 2001 point to the potential for increased violence and death, as conflicts within and among the cartels are likely to escalate if they perceive opportunities to secure a greater slice of the estimated $60 billion a year drug trade.

Beyond reducing the demand for drugs north of the Rio Grande, there are a few practical steps the United States can take to address the challenge of violence and health, particularly in the border region: 

• Support research to better understand the health implications of the violence on both sides of the border and share lessons about what works best in helping children, adolescents, and adults deal with the effects.

• Facilitate dialogue among state and federal health and regulatory agencies, perhaps through the U.S.-Mexico Border Health Commission, to gather information about the new traffic in prescription drugs from Mexico to the United States and identify policy options to address it.

• Share the lessons learned from U.S.-based crime and homicide prevention programs, including urban mentoring programs for young men identified “at risk” of being killed, that may be relevant in the border context.

At their bilateral meeting last month in Toluca, Mexico, on the margins of the North American Leaders Summit, Presidents Obama and Peña Nieto reaffirmed their commitment to cooperate on issues related to border security. Since 2008 the United States has delivered more than $1.2 billion to Mexico through the Merida Initiative in order to fund a broad range of programs focused on strengthening law enforcement, judicial institutions, and civil society organizations. With the potential for increased violence following the recent  capture of “el Chapo” and killing of “el Chayo,” the health effects of violence along the border should be high on the bilateral foreign policy agenda, as well. 

(Photo: Pepe Rivera, 2011)