September 2015
Summary
Accomplishments Report
Collaborative Agreement
between
The U.S. Environmental Protection Agency, U.S.-Mexico Border 2020 Program, and
The U.S. Department of Health and Human Services, U.S.-Mexico Border Health
Commission (U.S. Section)
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Over the past two years, the U.S. Environmental
Protection Agency (U.S. EPA), U.S.-Mexico Border 2020
Program and the U.S. Section of the U.S.-Mexico Border
Health Commission (BHC), U.S. Department of Health
and Human Services have developed a strategy to
collaboratively address environmental and public health
challenges of mutual concern and priority in the border
region. Work is underway to revise and renew the current
agreement. This report highlights accomplishments that
were achieved under the 2013-2014 agreement, including:
• Established a Pediatric Environmental Health
Speciality Unit (PEHSU) along the border to assist
with medical information and advice on
environmental conditions that influence children's
health along the border.
• Conducted 14 promotor training courses over the past
two years in over eight cities along the Border
covering a range of topics including asthma,
pesticides, lead, water, and climate change.
• Worked together to develop and include language
regarding environmental health into Healthy Border
2020. The final report, published in June 2015,
includes asthma as a priority health topic and outlines
collaborations among BHC, EPA and counterpart
agencies in Mexico.
• Collaborated on curriculum development, team
projects, and environmental leadership for the annual
Leaders Across Borders initiative which helps build
binational capacity in the health and community
sectors.
• Leveraged binational expertise through active support
and promotion of EPA's Task Forces through meeting
participation and sharing meeting information with
stakeholders.
• Compiled environmental health data for the
California-Baja California border region in 2014-
2015 and initiated a parallel effort to be conducted for
the Arizona-Sonora border region.
Background
EPA and the BHC committed to working more closely to
advance environmental health priorities in the U.S.-
Mexico Border Environmental Program: Border 2020:
Fundamental Strategies on Working to Improve
Children's Health and Promoting Environmental Health.
Since 2011, EPA and the BHC have worked to identify
joint priorities and possible areas of collaboration. The
current collaborative agreement was officially adopted by
EPA and the U.S. Section of the BHC in August of 2014
and can be found on both the Border 2020 and BHC
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websites. Key actions within the agreement include intra-
agency collaboration during Border Binational Health
Week (BBHW) each October, a State of the Border
Environmental Health Report (to document status and
trends), collaborative support for the drafting of a new
Healthy Border 2020 Program within the Border Health
Commission, and the development of a Pediatric
Environmental Health Specialty Unit along the border.
Program Collaboration
Opportunities
The collaborative agreement identified three program
areas and six project priority areas as collaborative
opportunities and a starting point for collaboration.
Program Areas of Collaboration
1. Leaders across Borders
2. Community-based Healthy Border Initiatives
3. Healthy Border 2020
Project Areas of Collaboration
1. Chemical and Pesticide Exposure Prevention
2. Air Quality and Asthma Education Awareness
3. Pediatric Environmental Health Resource Units
4. Leverage Binational Expertise and Resources
5. Identify Project Funding and Leveraging
Opportunities
6. Data Sharing
Accomplishments
The summaries below provide details of accomplishments
achieved under the collaborative agreement. The
accomplishments are presented in the following general
order: 1) Launching Healthy Border 2020,2) Establishing
Pediatric Environmental Health Specialty Units (PEHSU)
along the border, 3) increasing environmental health
capacity, and 4) building leadership.
Healthy Border 2020
One of the key actions identified in the Collaborative
Agreement was the development of the BHC's Healthy
Border 2020 initiative and accompanying report to guide
border health efforts through 2020. EPA committed to
help draft environmental health language consistent with
Border 2020's commitment to leverage and collaborate
with BHC on common goals and in alignment with EPA's
Border 2020 Fundamental Strategies on "Working to
Improve Children's Health" and "Promoting
Environmental Health." EPA participated in several
Border Binational Technical Workgroup meetings and on
the drafting committee to assist with the development of
environmental health language for Healthy Border 2020.
The final Healthy Border 2020 framework was launched
on June 24, 2015.
Establishing a Pediatric Environmental
Health Specialty Units (PEHSU) along the
Border
The PEHSU is composed of public health experts in
children's environmental health charged with improving
the health of children by enhancing educational and
consultative services to clinicians, health professionals,
and the community and by providing evidence-based
information from a network of experts in environmental
health. The EPA provides funding to the Agency for Toxic
Substances and Disease Registry (ATSDR) under an inter-
agency agreement, and ATSDR contracts with the
American Academy of Pediatrics (AAP: PEHSU-East)
and the American College of Medical Toxicology
(ACMT: PEHSU-West) for further distribution to PEHSU
units.
One of the goals under the collaborative agreement was to
explore the possibility of establishing pediatric
environmental health specialty units along the border to
assist with medical information and advice on
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environmental conditions that influence children's health
along the U.S.-Mexico Border.
This goal was achieved in February 2015 when the
Southwest Center for Pediatric Environmental Health
(SWCPEH) was established in El Paso, Texas. The center
transferred from its former location at the University of
Texas Health Science Center in Tyler, Texas. It operates
under the Division of Medical Toxicology, Department of
Emergency Medicine, Paul L. Foster School of Medicine
and is located within the offices of its strategic partner, the
West Texas Regional Poison Center. It is staffed by
PEHSU core faculty, regional medical consultants, and
consulting toxicologist.
PEHSU Capacity Building
EPA and BHC have collaborated on PEHSU-provided
training courses for several years. As early as 2012,
doctors from the EPA Region 9 PEHSU provided advice
and pediatric information to Imperial Valley childcare
providers, caregivers, nursing staff and promotores on
pediatric environmental health priorities.
Another training was provided in Imperial Valley in 2013
when EPA hosted two very successful binational Pediatric
Environmental Health workshops in El Centro, California
on February 6th and 7th. The training reached
approximately 130 childcare providers, community health
workers, school nurses, Mexican officials, and high school
students with information about how to reduce children's
exposures to environmental contaminants in schools,
childcare facilities, homes, and neighborhoods. The
workshops were conducted by doctors funded by the
PEHSU's at the University of California, San Francisco
and the University of California, Irvine, (funded by EPA
and ATSDR), and doctors from the University of
California, Berkeley's Center for Environmental Research
and Children's Health, (funded by EPA and the National
Institute of Environmental Health Sciences (NIEHS)). The
training logistics were supported by the Border 2012
Program and EPA's Office of Children's Health Protection
(Clean, Green, and Healthy Schools Initiative).
Participants overwhelmingly evaluated the training
quality as "excellent."
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Chemical and Pesticide Exposure Prevention
EPA and BHC have partnered with border communities
on multiple occasions over the past few years to develop
strategies to identify sources of chemical and pesticide
exposure and to implement programs to reduce exposure
to lead, mercury, pesticides, and heavy metals in the
environment. Efforts have included pesticide inspector
training, pesticide safety classes for promotores, and
stakeholder outreach. See descriptions below.
Breaking Barriers Pesticide Inspector Training in San
Diego, California.
Approximately 35 inspectors from five counties and the
California Department of Pesticide Regulation
participated in the Breaking Barriers training by EPA in
San Diego, California on July 16, 2014. The course was
originally developed by EPA Region 4 (Atlanta) and was
adapted by EPA Region 9 specifically for staff of the
California County Agricultural Commissioners. The
purpose of the training is to break communication barriers
between pesticide inspectors and Latino farmworkers
during pesticide inspections. In addition to Spanish
language and information on Latino culture, this
interactive course includes basic interviewing techniques.
Promotora Outreach on Proposed Worker Protection
Safety Rules
In an effort to include the farmworker community in the
regulatory process, EPA presented proposed changes to
the Agricultural Worker Protection Standard to a group of
promotores (community health workers) in San Luis,
Arizona on August 1, 2014. The promotores are members
of Campesinos Sin Fronteras (farmworkers without
borders), a community-based organization. The
presentation was given in Spanish and in a Train-the-
Trainer format for the promotores to deliver the
information to their communities. The workshop also
included information on general pesticide safety focusing
on the importance of reading labels, how to prevent
pesticide exposure at home and in the workplace, and
where to report pesticide incidents.
Pesticide Safety Training for Promotores
On October 28, 2014, EPA conducted a workshop on
Pesticide Safety for 22 promotores (Community Health
Workers) in Calexico, California during Border Binational
Health Week. The interactive session highlighted the
importance of preventing pesticide exposure at home and
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in the workplace, with a focus on safety provisions for
farmworkers and using an Integrated Pest Management
approach to control pests in the home. Also participating
for the benefit of the participants, were the agencies that
regulate pesticides in California, including the Department
of Pesticide Regulation and the Imperial County
Agricultural Commissioner's Office, as well as the
California Department of Public Health's (CDPH's)
Office of Binational Border Health, and the Mexican
Consulate's Ventanillas de Salud.
Pesticide Safety Training - Making a Visible
Difference in Communities
On August 13, 2015, EPA conducted a workshop on
Pesticide Safety for twenty-one promotores (Community
Outreach/Health Workers) in Brawley, California. The
interactive four-hour session highlighted the importance
of preventing pesticide exposure at home and in the
workplace, with a focus on the safety provisions for
farmworkers under the Worker Protection Standard, and
using an Integrated Pest Management approach to control
pests in the home. The promotores were very engaged and
benefited from the attendance of the three agencies that
regulate pesticides in California. These included EPA,
California Department of Pesticide Regulation, and two
pesticide inspectors from the Imperial County
Agricultural Commissioner's Office. The training
participants represented various local organizations and
were provided with teaching materials to carry the
pesticide safety message to their communities. This Train
the Trainer workshop is part of a comprehensive outreach
strategy in EPA for Spanish-speaking farmworkers, and a
commitment under EPA's "Making a Visible Difference
in Communities Initiative." The event was organized by
the California Department of Public Health's Office of
Binational Border Health with support from the California
Agricultural Labor Relations Board, and it was hosted by
Comite Civico del Valle Inc., a non-profit community-
based organization in Imperial County, California.
Air Quality and Asthma Education
Awareness
EPA and BHC committed to working with BHC to
building capacity on environmental asthma trigger, air
quality and asthma education and awareness. Two
examples of such projects are described below.
Promoting Children's Environmental Health:
Imperial Valley Asthma Forum
Consistent with binational efforts to improve children's
environmental health along the border, and in concert with
Children's Health Month and Border Binational Health
Week, EPA participated in the third annual Stop and
Listen Asthma Forum in El Centro, California on October
30, 2013. EPA, in partnership with the Imperial Valley
Child Asthma Program and the BHC convened the event
to highlight the severe asthma issues that plague Imperial
County and to identify solutions to mutually explore and
address. EPA provided opening remarks and listened to
presentations by local high school students focused on
asthma and the health impacts of border air quality on the
community. A panel of judges evaluated the presentations
and awarded prizes, which were provided by the Imperial
County Air Pollution Control District.
Imperial Valley Child Asthma Program (IVCAP)
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The Healthy Breathing
Healthy Homes Project is
working with families and
physicians to promote
education on indoor air and
asthma triggers in the home.
The $55,000 program is
supported by EPA, IVCAP, El
Centro Regional Medical
Center (ECRMC), and Border Environment Cooperation
Commission (BECC). As of August 2015, approximately
half of the targeted 80 low income families living in
underserved communities of Imperial County have been
reached. The project runs through approximately February
2016.
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EPA Supports Asthma Awareness Efforts in Imperial
County.
EPA staff participated in the annual Stop and Listen
Asthma Forum on November 13th, 2014 to raise awareness
and education about asthma and potential disparities in the
Imperial Valley. Local high schools competed for the
prestigious annual award by showcasing presentations on
asthma public service announcements to a panel of judges
composed of representatives from the City of Brawley,
Imperial County, NGO executive directors, Assembly
member Perez and Senator Juan Vargas' offices, local
doctors and school and hospital administrators. The panel
of judges scored and selected the winners, which are
funded by the Imperial County Air Pollution Control
District. EPA delivered remarks at the event and
encouraged participants to actively participate in border
task force meetings to provide input on air quality issues
in the Imperial County/Mexicali region. The event was
organized by the Imperial Valley Child Asthma Program
(IVCAP) and sponsored by various local, state and
community organizations.
Environmental Health Promotor Workshops
EPA staff have been planning a series of outreach and
education efforts to occur in 2015 on environmental health
along the U.S.-Mexico Border in collaboration with BHC
and CDPH with support from the PEHSU. These efforts
include a series of one-day workshops designed for
"promotores" or community health workers. During these
interactive workshops, participants will learn about the
connection between environmental exposures and health
and how to identify and address environmental health risks
commonly found in communities near the U.S.-Mexico
Border. Specific topics to be covered include:
• Air quality and asthma
• Water Quality
• Pesticides
• Lead
• Climate Change
Dates: August 26-27 in Laredo, Texas; September 1 in
Chula Vista, California; September 2 in El Centro,
California; September 11 inElPaso, Texas; September 15
in Nogales, Arizona; and September 29 in McAllen,
Texas.
Border Binational Health Week (BBHW)
Border Binational Health Week (BBHW) occurs annually
each October to promote sustainable partnerships that can
address border health challenges. EPA regional offices
have engaged with BHC on a variety of activities related
to BBHW. The activities, which are described throughout
this report, have included working with local NGOs on
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Border Environmental Health Data
Compilation
One of the key priority actions identified during the
development of the collaborative agreement was the
development of a "State of the Border Environmental
Health Report" to document status and trends.
EPA has made progress on the compilation of
environmental health data. A Border 2020 Grant was
awarded in December 2014 to the Public Health Institute
to compile and analyze existing border environmental
health data, to create a comprehensive snapshot of border
environmental health in the California Border Region and
to make recommendations on how to obtain additional
data and coordinate with Mexico on data gaps. A final
report was submitted on August 10, 2015. Some of the
findings in the report included:
• Air pollution continues to be a pervasive hazard in the
border region with myriad sources, such as traffic,
industrial pollutants, unpaved roads, and drying
seabeds.
• Asthma emergency room visits, hospitalization rates,
and childhood asthma prevalence are consistently
higher in Imperial County compared to the rest of
California.
• Rates of clinical asthma diagnosis have been
increasing in Baja California, while rates in Mexico
have held fairly steady.
• Imperial County has very high rates of heat-related
illness, likely a result of the combination of high heat,
limited infrastructure to deal with extreme heat, and
population vulnerabilities.
In August 2015, the Sonora Environmental Research
Institute, Inc. was awarded a Border 2020 Grant to
complete a similar report for the Arizona-Sonora border.
Leaders across Borders
EPA and BHC collaborated on the annual Leaders across
Borders initiative to help build binational capacity in the
health and community sectors. Leaders across Borders
seeks to provide participants with advanced leadership
development through self-evaluation, new leadership
skills, and enhanced cultural competency. Participants
engage in meaningful team projects and strengthen and
sustain their binational professional networks. EPA
contributions have included curriculum development,
team projects, and environmental leadership. Candidates
are selected to participate in the learning program. 2015
marks the program's fifth iteration, and binational health
professionals have been selected to participate.
Task Forces and COBINAS
EPA and BHC committed to identify opportunities to
share information and identify and address regional
concerns and priorities, taking into account input from
the Border 2020 task forces, local stakeholders, and the
binational health councils (COBINAS). EPA and BHC
leveraged binational exerptise through active support and
promotion of EPA's Task Forces through meeting
participation and sharing meeting information with
stakeholders, including COBINAS. BHC members from
New Mexico attended and presented at the Education
Task Force and Environmental health Task Force
meeting in spring 2015 in El Paso, Texas.
Children's Environmental Health Symposiums
Collaborative planning has begun for two children's
environmental health symposiums to be convened in late
2015 and early 2016. Sessions are being planned for health
care providers, academics, community health workers,
policy makers, social workers, and community leaders.
The first symposium will take place in El Paso, Texas on
September 24-25, 2015 and the second is planned for
January 2016 in San Diego, California.
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