Assessment of Environmental Health Data in
the California - Baja California Border Region
California Environmental Health Tracking Program
August 2015
Solicitation No. SOLTA14-008
CALIFORNIA	Dl IRI If*
ENVIRONMENTAL	UC/UTU
HEALTH TRACKING	HEALTH
PROGRAM	¦ INSTITUTE*
_ With support from the Border Environment Cooperation Commission and the United
'VterN1, States Environmental Protection Agency
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Table of Contents
Executive Summary	2
Introduction
•	Environmental Health in the California-Baja California Border Region	4
•	Overview of Select Environmental Health Indicators & Data Reporting	9
Health Indicators
•	Asthma	11
•	Cancer	14
•	Coccidioidomycosis - Valley Fever	15
•	Heat-Related Illness	16
•	Cardiovascular Disease	18
•	Lead Exposures	19
•	Maternal and Infant Health	21
•	Pesticide Exposures and Illness	23
Environmental Indicators
•	Air Contaminants	24
•	Climate Change	27
•	Drinking Water Quality	30
•	Green Spaces and Parks	33
•	Pesticide Use	36
•	Traffic	37
•	Toxic Emissions	41
Overall Findings & Models to Advance Environmental Health Surveillance	44
Appendix: Metadata for Health and Environmental Data Indicators	49
References	66
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Executive Summary
Executive Summary
The California-Baja California border region is connected by a common cultural history, family ties,
ecological resources, and economy. The region is characterized by its rapid population growth, the
movement of people and goods across the border and throughout the region, and industrial activities,
all of which present environmental challenges unique to this region.
These environmental challenges, coupled with underlying population vulnerabilities in the region,
greatly impact public health. In order to improve overall health of the region, more efforts are needed
to collect and report environmental health data, develop interventions to improve the environment and
community health, and evaluate these interventions over time to most positively impact health.
Specifically, we found that:
Many sources of environmental hazards uniquely impact the California border region
•	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
•	Climate change may seriously impact health, given the border region's hot and dry climate,
existing environmental hazards, and community vulnerabilities
•	Many areas in the border region, particularly in rural communities, continue to experience high
levels of drinking water contamination
•	Traffic is an important pollution source in the border region and is very concentrated at border
crossings and in urban areas of San Diego County
Because of these environmental hazards and underlying population vulnerabilities, many
residents continue to experience poorer than average health outcomes
•	Asthma continues to severely impact residents of Imperial County
•	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 (such
as a high proportion of outdoor laborers or low income)
•	Lead exposures continue to decrease, though compared to the California average, the
prevalence of young children with elevated blood lead levels is nearly two-fold in Imperial
County and slightly elevated in San Diego County
Better data will be imperative in the future to track, intervene upon, and monitor ongoing
environmental health conditions in the California-Baja California border region
•	Better data are needed to track, predict, and assess the impacts of climate change on health,
likely one of the greatest public health challenges in the coming decades
•	There is a need to collect data on the location of and contamination in water sources, public
drinking water systems, and well water, especially in rural communities
•	Valley fever is likely underreported, but will continue to pose a serious health risk into the future
•	Birth defects data are not systematically reported in Imperial and San Diego County
•	Pesticide illness and exposure data are likely underreported, and not currently amenable to
assessing long term health effects
•	Broadly speaking, environmental health data from Baja California were commonly limited or not
readily accessible, making it difficult to draw broad conclusions
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Ongoing and systematic environmental health surveillance networks are fundamental to assessing
health status overtime, conducting research, developing health programs and targeted interventions,
evaluating those programs, and ultimately improving public health. Although environmental health data
are collected on both sides of the border, data are often collected by different agencies, at varying
geographic resolutions, and reported with diverse metrics that may not be comparable across time or
geographic borders. Though environmental health data collection and reporting requires better
coordination across jurisdictions, the data should also remain responsive to community health needs. In
our assessment of available data resources, we found that:
•	Data metrics were often inconsistent, making data comparisons difficult throughout the border
region. Establishing consistent data standards for the region would allow for more meaningful data
comparisons and consistency in data metrics over time. These data standards should reflect regional
data needs, and be responsive to local community priorities as well.
•	Data were often not accessible to users. For maximum data accessibility, it is essential that data are
publicly available to users with varying levels of technical expertise, and in a machine-readable
format that is easy to extract, transform, and process.
•	Data documentation was often limited or non-existent. Standardized codebooks, data dictionaries,
and metadata are essential for increasing data accessibility.
•	Data from sub-state and sub-county/municipality geographies had limited availability. Greater
efforts should be made to collect and report data at geographies that are relevant to local
communities, while ensuring that data privacy is protected in these communities.
•	Greater coordination among agencies would allow for datasets to be accessed from a centralized
hub. Environmental health surveillance programs and open data portals can better serve users from
a single centralized data system.
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Introduction
Environmental Health in the California-Baja California Border Region
Overview
Data are essential for describing the state of environmental health in the California-Baja California
Border region and understanding how it compares to the surrounding region. Although environmental
health data are collected on both sides of the border, data are often collected by different agencies, at
varying geographic resolutions, and reported with diverse metrics that may not be comparable across
time or geographic borders. Coordinated binational environmental health surveillance will better
capture the region's environmental health status, inform public health interventions, and allow the
evaluation of border health initiatives. Though environmental health data collection and reporting
would benefit from better coordination across jurisdictions, the data should also remain responsive to
community needs.
The purpose of this report is to:
1.	Present an assessment of environmental health data and trends that have been highlighted as
priority needs along the California-Baja California border region
2.	Identify data gaps and needs in existing environmental health datasets
3.	Provide recommendations to more systematically share environmental health data along the
U.S.-Mexico border region
California-Baja California Border Region
The California-Baja California border region is connected by a common cultural history, family ties,
ecological resources, and economy. The region has experienced rapid population growth, the frequent
movement of people and goods across the border and throughout the region, and industrial activity, all
of which present small and large-scale environmental issues unique to the area, such as the shrinking of
the Salton Sea and pollution in the New River. In addition, communities along the entire border region
face consistently higher rates of unemployment, poverty, chronic disease, and percent uninsured.1
These challenges will have the greatest impact on disadvantaged, underserved, and vulnerable
communities, such as children, the poor, women, and the elderly living in the Border Region. Impacted
communities will likely continue to face many of these challenges into the future, and grapple with
important emerging hazards, such as climate change. Building coordinated and systematic
environmental health surveillance networks will be fundamental for assessing these changes over time
and positively impacting public health.
Population Growth
Across the entire U.S.-Mexico border from 2000 to 2010, the population increased 12% on the U.S. side
of the border, and by 18% on the Mexico side of the border (rates higher than each country's respective
national increase).2,3 Within the California-Baja California border region, there are over 6 million
residents, accounting for over 40% of the entire U.S.-Mexico border's population.4 The population of the
California-Baja California region is expected to increase to over 9 million individuals by 2030.5 Population
growth will continue to put pressure on the environment and environmental health, impacting air
quality, water services and wastewater treatment, and natural habitats.
Economic Growth and Environmental Hazards
The border region has been marked by large increases in economic integration and cross-border trading
over the past several decades, especially with the onset of the North American Free Trade Agreement
(NAFTA) in 1994. The growth has been so rapid that by 2006 the number of maquiladoras—industrial
facilities along the border region operating within a free-trade zone—more than doubled compared to
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pre-NAFTA, with the majority operating in Mexico. Major industries in the area, such as agriculture,
generate environmental hazards like pesticides, dust, particulate matter from agricultural burning, and
water pollutants from livestock operations. The rapid economic growth has contributed greatly to
myriad sources of pollution in the region, including facility emissions, shipping, and diesel truck traffic
and idling.6
Overall, trade has increased over 266% between Mexico and the U.S. since 1994, furthering economic
opportunity and population growth along the border region.4 However, this growth has also led to
increases in truck shipments across the border, higher demand on limited natural resources, and hasty
development to support rapidly growing communities. These challenges impact traffic, air quality, waste
production and disposal, and water quality.6
Emerging Environmental Health Challenges
In addition to the challenges represented by the region's rapid growth, the California-Baja California
region will continue to face unique environmental health challenges in the near and distant future.
Climate change will have a variety of impacts that will affect communities, the environment, and the
economy. The border region is most starkly defined by its arid landscape, and limited water resources
will continue to drive demographic, economic, and political processes. Rising seas, warming
temperatures, and changes in precipitation and upstream snowpack will all impact water scarcity, and
significant hydrologic stress has been predicted by the Secretarfa de Medio Ambiente y Recursos
Naturales (SEMARNAT).4 Some of the challenges related to climate change will directly impact health
(such as heat illness), while others may result in socioeconomic shifts that drive overall health
vulnerability and resilience (such as changes in industry, employment, and migration patterns). These
challenges will disproportionately impact the most vulnerable and disadvantaged communities
throughout the border region.
This report assesses demographic, health, and environmental data sources for the California-Baja
California region. For each content area discussed in this report, its relevance to environmental health is
explained, various available indicator data are presented, and data gaps are highlighted. Indicators were
chosen based on their overall relevance to environmental health surveillance, data availability, and
feedback from border health experts from governmental, academic, and non-governmental
organizations (NGOs) in the U.S. and Mexico. Recommendations are then given on how to better
integrate environmental health surveillance across the U.S.-Mexico border.
Geographic and Demographic Overview
The California-Baja California border is, at 150 miles, the shortest section of the nearly 2,000 mile U.S.-
Mexico border. It is also the most densely populated border region, with over 6 million residents. In
2010, over 25 million vehicles and nearly 15 million pedestrians crossed a port of entry (POE) in
California-Baja California, and over $41 billion USD worth of goods were shipped through the region.7
The California-Baja California border region is defined as jurisdictions in California and Baja California
within 100 kilometers of the border. This includes San Diego and Imperial Counties in California (note:
we have excluded for purposes of data collection very small portions of Orange and Riverside County
that fall within the 100 km region), and includes the municipalities of Playas de Rosarito, Tijuana, Tecate,
and portions of Mexicali and Ensenada. A detailed map of the study area is shown below (Map 1).
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Introduction
Imperial
County
l San
J Diego
San^Diego
County »
Catfjur/co
^Mexican
e> California, U
Baia California,
- Tijuana
V Municipality'
Tecate
Municipality
Mexicali
Municipality
Playas de
Rosarito'
Ensenada
Municipality
100' Kilometers
Map 1. Califorriia-Baja California border region and border crossings
¦ Border crossings
Border
Major roadways
[ 1 Cities
100km border buffer
Source: U.S. Census Bureau - https://www.census.gov/geo/maps-data/data/tiger-line.html Institute Nacional de Estadistica y
Geograffa (INEGI) - http://www.inegi.org.mx/est/scince/scince2010.aspx
Social and economic factors greatly impact a community's health and well-being, as well as their
preparedness and response to environmental hazards, natural disasters, and climate change. In the U.S.,
San Diego County has higher median income, higher educational attainment, and lower poverty rates
compared to California (Table 1 and Figure 1). Imperial County has much lower median income and
lower educational attainment compared to the state and San Diego County (Figure 1 and Figure 2). Over
80% of Imperial County self identifies as Hispanic or Latino, and nearly a third of residents speak English
'less than very well'.1
1 Speaking English less than "very well" is a metric used by the U.S. Census to describe level of English fluency
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Introduction
Table 1. Demographic data from the California border region

Imperial County
San Diego County
California
Total population (2010)
174,528
3,095,313
37,253,956
Hispanic or Latino, any race (2010)
140,271
991,348
14,013,719
Not Hispanic or Latino (2010)
34,527
2,103,965
23,240,237
Income & poverty (2012)



Median household income (US$)
$41,255
$63,373
$61,400
Persons below poverty
23.0%
13.9%
15.3%
Percent uninsured
21.6%
17.1%
17.8%
Speak English less than 'very well' (2012)
31.6%
16.1%
19.6%
Source: U.S. Census Bureau - http://factfinder.census.eov/.
Figure 1. Percent of population (25+ years) by educational attainment in California border region, 2012
50%
40%
30%
20%
10%
44.4%	42.9%
36.2%
I
19.0%

30.4%
27.1%
13.0%
11.1%
Did not graduate high High school graduate Associate's or
school	bachelor's
¦ Imperial County ¦ San Diego County ¦ California
Source: U.S. Census Bureau - http://factfinder.census.gov/.
Graduate or
professional
Figure 2. Percent of persons below poverty in the California border region, 2012
25%
20%
15%
10%
5%
0%




13.9%
15.3%











i
1
i
Imperial County San Diego County	California
Source: U.S. Census Bureau - http://factfinder.census.gov/.
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The majority of the Baja California border region population resides in urban areas in Tijuana and
Mexicali. Literacy rates in Baja California are much higher compared to Mexico as a whole, and
municipalities in Baja California also tend to have higher education rates compared to the rest of Mexico
(Table 2). Overall, residents in Baja California tend to have better economic outcomes compared to
Mexico as a whole, though rates of income below the minimum well-being line" and access to
healthcare services vary by municipality. Though direct comparisons cannot be made between U.S. and
Mexico census data, the demographic data are useful to describe underlying community vulnerabilities
that may result from income, race, education, poverty, and other social factors that impact health and
well-being.
Table 2. Demographic data from the Baja California border region, 2010

Ensenada
Mexicali
Playas de
Rosarito
Tecate
Tijuana
Baja
California
Mexico
Total population
466,814
936,826
90,688
101,079
1,559,683
3,155,070
112,336,538
Population 6+ years old
that can't read/write
6.1%
3.5%
4.2%
3.8%
3.5%
3.9%
7.8%
Average years in school
for population 15+years
8.9
9.6
8.5
8.9
9.2
9.3
8.6
Population with income
below minimum well-
being line
12.0%
9.0%
8.5%
4.8%
10.2%
9.8%
19.4%
Population without
health services access
27.2%
29.4%
37.9%
27.9%
41.0%
35.1%
31.8%
Source: Institutes Nacional de Estadistica y Geograffa - http://www3.inegi.org.mx/sistemas/biinegi/. Consejo Nacional de
Evaluation de Polftica de Desarrollo Social - http://www.coneval.gob.mx/Medicion/Medici%C3%B3n/Tablas-dinamicas-
municipales.aspx.
" The 'minimum well-being line', or 'Linea de Bienestar Minimo', is essentially used in the same way as the poverty
line in U.S. demographic data.
8
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Introduction
Overview of Select Environmental Health Indicators & Data Reporting
The following select environmental health data indicators were chosen to provide an overview of
environmental health conditions in the California-Baja California border region based on the authors'
experience operating the California Environmental Health Tracking Program (see inset below), as well as
from interviews conducted with content area experts with extensive knowledge, experience, and
expertise in border health issues.1" Some environmental health indicators were given lower reporting
priority if they were already included in other Border 2012 and Border 2020 initiatives (such as
indicators in the 2010 report "State of the Border Region Indicators Report", though there are some
data overlaps). The totality of these initiatives is crucial for gaining a broad understanding of
environmental health along the U.S.-Mexico border.
I Health Indicators
Environmental Indicators I
Asthma
Air Contaminants
Cancer
Climate Change
Coccidioidomycosis - Valley Fever
Drinking Water Quality
Heat-Related Illness
Green Spaces and Parks
Cardiovascular Disease
Pesticide Use
Lead Exposures
Traffic
Maternal and Infant Health
Toxic Emissions
Pesticide Exposure and Illness

Data and data infrastructure are typically more available along the U.S. side of the border, thus most
sub-state/sub-country data reported here are from the U.S. When feasible, efforts were made to collect
data from Mexico that were relevant to the prioritized environmental health content areas, as well as to
identify data gaps. Data are reported for the most recent year of data available at the time of this
assessment. Data comparisons are typically not possible between California and Baja California due to
variations in priority health outcomes, data metrics, collection, and reporting. Data indicators presented
here are not exhaustive of all data available, but were curated from disparate sources to provide an
overview of environmental health in the region.
As noted throughout the report, data are often unavailable at the neighborhood or sub-county/sub-
municipality level, a common gap for health and environmental health data, particularly in rural
communities. This limits the ability to assess indicators in local communities, or to assess specific
population vulnerabilities, in the absence of more robust, systematic, and ongoing data collection and
reporting. However, public health research has consistently shown the disproportionate impact of
various environmental hazards on low-income communities, communities of color, and specific
subpopulations such as children, the elderly, individuals with pre-existing health conditions, and
pregnant women. These disproportionate impacts and risks for specific populations are noted
throughout the report.
111 Interviews were conducted with experts from governmental, academic, and non-governmental organizations to
better identify environmental health challenges, data resources available, and data needs along the California-Baja
California border. Interviewees included April Fernandez (Chief of the Border Health Office, California Department
of Public Health), Dr. Margarito Quintero Nunez (Institute of Engineering - Universidad Autonoma de Baja
California), and Joy Williams (Research Director at the Environmental Health Coalition).
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How to Find More Detailed Data
Many users will want more detailed data to better fit their needs. Metadata—the more detailed
description of data sources, data metrics, and data quality and limitations—are included as an appendix
to this report (see "Appendix: Metadata for Health and Environmental Data Indicators"). A core
component of environmental health surveillance is maintaining and updating detailed and accessible
metadata documents. The metadata and this final report can serve as a guiding template in future
efforts to update and catalogue available environmental health data along the U.S.-Mexico border
region.
In addition, by going to the primary data sources documented in the metadata, data users can collect
their own data to make it more useful for their needs. For example, many maps displayed in this
document are either available online in a dynamic format, or the data can be downloaded for use in
geographic information system (GIS) software. Screenshots displayed in this report are intended to
provide the reader with a sample of the data that are available to them. For greater access to these
data, the reader is encouraged to access the tools in their dynamic online form.
The California Environmental Health Tracking Program (CEHTP) improves public health by providing
information on environmental health hazards and outcomes. CEHTP integrates environmental, health, and
other data sources to improve the utility of public health data and to inform public health policy and practice.
CEHTP makes data available on a variety of environmental hazards that may impact children's health,
including traffic, air pollution, water quality, and pesticides. For more information on CEHTP, visit
www.CEHTP.org. Visit www.cdc.gov/ephtracking to learn more about the National Environmental Public
Health Tracking Program.
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Health Indicators
Asthma
SUMMARY FINDINGS
•	The border region has many environmental hazards related to asthma, including high traffic
and air pollution, dust, and agricultural and industrial activities
•	Rates of asthma emergency department visits and hospitalizations continue to severely
impact residents of Imperial County
Asthma is a disease that affects the lungs. It is the most common chronic disease among children in the
U.S. and impacts over 5 million Californians. Asthma is characterized by ongoing inflammation of the
lining of the lung passages. This inflammation can be asymptomatic, or at other times the lung passages
may undergo spasms resulting in coughing, chest tightness, and wheezing. The severity of those
symptoms can range from mild to life-threatening. The World Health Organization estimates that 44% of
asthma may result from environmental exposures.8 Many hazards in our environment contribute to and
can exacerbate asthma, including air pollution, dust, agricultural burning, and various household hazards
(such as indoor mold, pests, pet dander, and household chemicals).
Lifetime prevalence of asthma indicates the extent of asthma diagnoses throughout the region (Figure
3), while emergency department (ED) visit rates (Figure 4) and hospitalization rates (Figure 5) are better
indicators of active asthma and asthma severity. Asthma ED visits and hospitalization rates are
consistently higher in Imperial County compared to both San Diego County and California, and childhood
asthma prevalence rates in Imperial County have consistently been among the highest in California.
There are starkly higher rates of asthma ED visits for Black and Hispanic children in San Diego compared
to White children (Figure 6), and asthma rates remain very high for all ethnicities in Imperial.
Figure 3. Lifetime asthma prevalence in the California border region - children age 0-17 years, 2001-12
30% t—
0% -|	1	1	1	1	1	
2001	2003	2005	2007	2009	2011-2012
— ¦ - Imperial County • San Diego County < California
Source: UCLA Center for Health Policy Research, California Health Interview Survey - http://www.chis.ucla.edu.
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Health Indicators
Figure 4. Asthma ED visits in the California border region - all ages, 2005-12
100
§ 80
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CD
Q.
T3
CD
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oj
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Health Indicators
Figure 6. Asthma ED visits among children (age 5-17 years old) by race/ethnicity, 2012
Black	White	Hispanic
¦ Imperial ¦ San Diego ¦California
Source: California Office of Statewide Health Planning and Development. Accessed at www.cehtp.ore/p/asthma.
Rates of clinical asthma diagnosis have been increasing in Baja California, while rates in Mexico have
held fairly steady (Figure 7). These rates are not adjusted by age. Rates of clinical diagnosis are not
publicly available at the municipality level. Data from Mexico cannot be compared to U.S. prevalence
data, as asthma incidence is only reported by first, second, and third tier health facilities, and there is
some uncertainty as to variations in diagnosis and/or case definition.
Figure 7. Asthma incidence rates in Baja California and Mexico - all ages, 2005-12
500 n
« 200 -
T3
3
&_
u
100 -
0 H	1	1	1	1	1	1	1	1	1
2004 2005 2006 2007 2008 2009 2010 2011 2012
—Baja California M Mexico
Source: Sistema Nacional de Vigilancia Epidemiologica - http://www.epidemioloeia.salud.eob.mx/anuario/html/anuarios.html.
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Health Indicators
Cancer
SUMMARY FINDINGS
•	Incidence rates of cancer are, overall, relatively similar in the border region compared to
California, with some small differences both higher and lower for several cancer types
•	Variations in cancer rates may result from differences in the demographics (such as age),
environmental exposures, genetics, and/or the complex relationship amongst these factors
Cancer is the general name for a large and diverse group of diseases characterized by cells that grow out
of control with the potential to spread to other parts of the body. If untreated, cancer may lead to
serious illness and death.
A combination of factors may play a role in the development of cancer, including genetics, the
environment, and parental exposures. Associations have been observed between various cancers and
many environmental factors, including indoor radon; diagnostic x-rays and CT scans; prenatal exposures;
house paint, glue, and solvent exposures; high levels of nitrate in drinking water; secondhand smoke;
residence on a farm; pesticides; air pollution; and occupational hazards. ' ' Exposure to carcinogenic
compounds can occur at many points throughout one's life, from parental exposure at the time of
conception, to childhood and adult exposures before the time of diagnosis, and exposures that may
occur at home, work, and elsewhere in the community.
The incidence rate of various selected cancers for which research has indicated some relation to
environmental hazards are shown in Table 3. Because the incidence of some cancers is relatively rare,
data are aggregated into a 5-year period to allow for stable incidence rate estimates. With the exception
of kidney cancer, the incidence rate of diagnosed cancers in Imperial County is slightly lower or the same
compared to California. It is unknown why there may be a lower incidence rate for some cancers,
though there may be some residents who travel to Mexico for cancer diagnoses and/or treatment, or it
could be indicative of a generally younger population (for whom cancer is a less frequent health
outcome). The incidence rate of breast cancer is slightly elevated in San Diego County compared to
California, while others are generally similar to slightly higher.
Table 3. Incidence rate of select cancers (per 100,000 persons), 2007-11

Imperial County
San Diego County
California
Bladder
13.5
18.5
18.8
Breast, female only
99.7
129.7
122.4
Kidney
19.1
14.9
14.2
Leukemia
11.5
12.7
12.4
Liver & bile duct
9.2
9.1
9.2
Lung & bronchus
45.2
51.4
49.5
Non-Hodgkin lymphoma
15.7
19.2
18.9
Thyroid
9.4
11.8
11.4
Source: California Cancer Registry. Accessed at http://www.cancer-rates.info/ca/index.php.
Incidence rates of these selected cancers were not readily available at the municipality level in Baja
California. Data were easily accessible for breast cancer (female only) incidence in Baja California, where
the incidence rate was 8.8 cases per 100,000 persons in 2012, lower than national average in Mexico of
17 cases per 100,000 persons (Sistema Nacional de Vigilancia Epidemiologica,
http://www.epidemiologia.salud.gob.mx/anuario/html/anuarios.html).
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Health Indicators
Coccidioidomycosis - Valley Fever
SUMMARY FINDINGS
•	Valley fever is a serious illness that may increase in frequency with climate change, and
incidence should be tracked into the future, though cases may be underreported
•	Though there are fewer cases in the border region compared to some Central Valley
counties, valley fever will continue to be a risk throughout the border region
Coccidioidomycosis, also known as valley fever, is an illness caused by the fungus Coccidioides. The
fungus lives in the soil and is found in parts of the southwestern United States, Mexico, and Central and
South America. People can be exposed to valley fever by inhaling fungal spores in the air and may
experience flu-like symptoms or pneumonia. Some patients develop a chronic lung infection, an
infection that spreads to other tissues, and other complications that can lead to severe disability or
death. Some populations - including individuals older than 60 years, those with weakened immune
systems, pregnant women, and Black and Filipino populations - are at higher risk for valley fever.12
The environment's impact on the distribution and prevalence of valley fever is still under investigation.
Data suggest that the spores grow best in soils after a heavy rain and disperse most effectively during
hot, dry conditions. Scientists believe that climate change has the potential to increase the prevalence of
valley fever, as rainfall is expected to have periods of greater intensity coupled with subsequent heat
events. Soil-disturbing construction activities may increase the release of these spores into the air; this
may place certain occupations (farmers, construction, outdoor laborers, etc.) at greater risk for
13,14
exposure.
The incidence rate of confirmed valley fever cases in 2013 in California was 8.6 cases per 100,000
persons. The reported incidence in Imperial and San Diego is much lower, at 2.2 and 2.9 cases per
100,000 persons, respectively. Many valley fever experts believe confirmed cases are underreported,
potentially due to a lack of symptoms or misdiagnosis.15 Rates of valley fever diagnoses over time are
shown in Figure 8 (note the unreliable estimates in Imperial Valley, a common occurrence in rural
areas). Data on the incidence of valley fever in Baja California were not available.
Figure 8. California county-specific coccidioidomycosis rates - all ages, 2009-12
Cases per 100,000 population
0.0	EH 24.0—74.0 Y///A Potentially unreliable rate, relative
mm q i	23 o ^H75 0	304 0	standard error 23 percent or more
Source: California Department of Public Health - http://www.cdph.ca.eov/healthinfo/discond/Paees/Coccidioidomvcosis.aspx
Solicitation No. SOLTA14-008
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Health Indicators
Heat-Related Illness
SUMMARY FINDINGS
•	Heat-related illnesses are expected to be an emerging public health priority as climate
change continues over the coming decades
•	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 underlying population
vulnerabilities (such as a high proportion of outdoor laborers or low income)
People suffer from heat-related illness when the body's natural temperature controls become
overwhelmed. The health impacts of extreme heat events range from mild heat cramps to death, and
damage can be done to an individual's brain or other vital organs. Certain populations, such as elderly
people living alone, face much greater health risks during heat waves.16 Climate change and our built
environment (defined as the constructed spaces in which people live, work, learn, and play) both
contribute to extreme heat. The effects of extreme heat are already being felt and are expected to
increase over time. During the 2006 California heat wave, there were 16,166 additional ED visits and
1,182 additional hospitalizations than usual in the state.17
Emergency department visits and hospitalizations due to heat are consistently much higher in Imperial
County compared to San Diego County and California (Figure 9 and Figure 10), and this pattern is
consistent amongst all age groups (Figure 11). This may be due to a combination of factors, such as
more intense heat events, less infrastructure to deal with extreme heat (such as shaded areas, air
conditioning access, and/or cooling centers), a higher proportion of outdoor laborers, and/or other
underlying population vulnerabilities (such as income, age, and/or transportation access).
Figure 9. Heat-related ED visits in the California border region - all ages, 2005-12
150
o
o
o
o"
o
CD
Q.
T3
CD
T3
(O
i
CD
CuO
<
120
90
60
30
0
A
. ' N
~
X


91.0
	4	
' ~ • «.
B
¦
~
•

	^ %


12.9
~
1 1 1 1
i
1
i i
2005 2006 2007 2008 2009 2010 2011 2012
— ~ - Imperial County	San Diego County	< California
Source: California Office of Statewide Health Planning and Development. Accessed at www.cehtp.ore/p/climate change.
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Health Indicators
Figure 10. Heat-related hospitalizations in the California border region - all ages, 2000-12
40 T	
o
o 30
o"
o
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
—» -Imperial County	San Diego County < California
Source: California Office of Statewide Health Planning and Development. Accessed at www.cehtp.org/p/climate change.
Figure 11. Heat-related ED visits by age group in the California border region, 2005-12
120 	
California	Imperial County	San Diego County
~ <5y ~ 5-17y D18-34y B35-64y ¦ 65+y
Source: California Office of Statewide Health Planning and Development. Accessed at www.cehtp.org/p/climate change.
Data specific to heat-related illnesses were not available for Baja California. There are, however, some
national measures of heat illness reported in weekly bulletins on extreme temperatures.IV Data are not
summarized in a format that can be easily queried.
IV http://www.epidemiologia.salud.gob.mx/informes/informesh/2014/temperaturas/temperaturas-semanas.html
Solicitation No. SOLTA14-008
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Health Indicators
Cardiovascular Disease
SUMMARY FINDINGS
•	Rates of cardiovascular disease have generally been decreasing throughout California
•	Cardiovascular disease remains elevated in Imperial County compared to California
Cardiovascular disease (CVD) results from damage to the vessels that supply blood to the heart. If the
vessel damage becomes severe enough to cut off blood flow or cause spasms in the arteries, a
myocardial infarction (more commonly known as a heart attack) may occur. Cardiovascular disease is
the leading cause of death in California and the nation, and the second leading cause of death in
Mexico.18
CVD is associated with several environmental factors, including air pollution, chemical exposures, and
environmental tobacco smoke. Air pollutants associated with CVD include ozone, particulate matter,
carbon monoxide, and sulfur dioxide. These hazards result from multiple sources in the border region,
including industrial emissions, shipping, traffic, dust, and agricultural practices. The elderly and patients
with pre-existing illness will be more susceptible to environmental hazards related to CVD.19,20
The rate of hospitalizations from myocardial infarctions (Ml) in 2012 is much higher in Imperial County
(40.0 cases per 100,000 persons) compared to San Diego County (21.4 cases per 100,000 persons) and
California (27.2 cases per 100,000 persons). Since the year 2000, hospitalizations from myocardial
infarction have been decreasing across all three areas (Figure 12).
Figure 12. Hospitalizations due to Ml in the California border region - adults (age 35+), 2000-12
100
80
60
39.9
40
27.2
20
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Health Indicators
Lead Exposures
SUMMARY FINDINGS
• Lead exposures continue to decrease throughout California, though the prevalence of young
children with elevated blood lead levels is nearly two-fold in Imperial County, and slightly
elevated in San Diego County, compared to the California average
Lead is a natural mineral that has been used in many products and is harmful to humans. Although the
United States has taken many steps to remove sources of lead exposure (it was banned from pain in
1977 and from gasoline in 1996), lead is still present in our environment. And there is no known safe
level of lead in the blood, as measured by blood lead levels (BLL). Common sources of lead include lead-
based paints from pre-1978, lead contaminated soil, lead contaminated dust from paint, take-home
occupational exposures, and imported goods (such as cosmetics, household items, and food).21
Lead exposures can cause headaches, stomach aches, loss of appetite, and fatigue. Higher amounts of
lead exposure can damage the nervous system, kidneys, and other major organs—very high exposures
can lead to seizures or death. Lead poisoning is particularly harmful for a child's nervous system and
brain, as they are still undergoing complex neurological and physiological development. It can lead to
lifelong neurological impairments, learning difficulties, reduced IQ, and behavioral problems.22,23,24 An
assessment by the California Environmental Health Tracking Program found that lifetime costs resulting
from lead exposures total $8-11 billion dollars for each annual birth cohort in California.25
In Imperial County in 2011, 4.8% of children <6 years old tested for elevated BLL had levels greater than
4.5 micrograms per deciliter of blood (ng/dL). In San Diego County, 3.1% of children <6 years old had
elevated BLL; and in California, 2.5% of children below 6 year olds screened had elevated BLL. Tested BLL
are generally decreasing, but Imperial County has consistently higher BLL (Figure 13). These data
predominantly account for at-risk children who were most likely to be screened for elevated BLL, and
the data do not reflect the total average burden of elevated BLL.
Figure 13. Percent of children (<6 years) with elevated blood lead levels above 4.5 ng/dL, 2007-11
15% -r—
10%
5%
k 3.1%
2.5%
4.8%
0%
2007
2008
2009
2010
2011
Imperial County	San Diego County + California
Source: California Lead Poisoning Prevention Program. Accessed at www.cehtp.ore/p/lead
19
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In 1990, Mexico began phasing out leaded gasoline and introduced unleaded fuels.26 Leaded gasoline
was completely phased out in Mexico by 1997, but other means of exposure still exist. Lead paint, lead
glazed pottery, and candies with lead are still widely prevalent in Mexico.27,28 There is no national
program that monitors lead exposures, so data are not available for average population BLLs in Mexico.
Recent research suggests that lead exposure remains a national public health concern.29
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Health Indicators
Maternal and Infant Health
SUMMARY FINDINGS
•	Rates of preterm birth and term low birthweight are similar in the border region compared
to California averages
•	Data on birth defects are not systematically reported in Imperial and San Diego Counties
Prematurity and growth retardation are commonly used as measures of maternal and infant health.
Prematurity occurs when a baby is born too early. Infants are considered preterm when they are born
before completing 37 weeks (about 8.5 months) of pregnancy. Growth retardation (or term low
birthweight,) occurs when a fetus grows insufficiently while in the womb and is small for the child's
gestational age. Infants that are born preterm or with a low birthweight are at higher risk of dying in the
first year of life and of having developmental problems throughout life. Preterm birth and term low
birthweight have been associated with various environmental hazards, including lead,30 particulate
matter,31 pollution from diesel combustion,32'33 and some pesticides.34,35
The prevalence of preterm birth is slightly elevated in Imperial County and California in comparison to
San Diego County. These trends are consistent over time, with some slight decreases since 2007 (Figure
14). The prevalence of low birthweight is slightly lower in Imperial and San Diego Counties compared to
California (Figure 15), and it's consistent over time.
Figure 14. Percent of births that are preterm in the California border region, 1996-2010
14%
12%
10%
8.3%
I 8.3%
' 7.6%
8%
6%
4%
2%
0%
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
— ¦ -Imperial County	San Diego County < California
Source: California Department of Public Health, Office of Vital Statistics. Accessed at www.cehtp.org/p/mih.
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Health Indicators
Figure 15.Percent of births that are term low birthweight in the California border region, 1996-2010
10%
8% -¦
6%
4%
2%
0%

„ f* ~
2.1%
2.0%
1.9%
	1	1	1	1	1	1	1	1	1	1	1	1	1	1	1
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
— ¦ -Imperial County	San Diego County < California
Source: California Department of Public Health, Office of Vital Statistics. Accessed at www.cehtp.org/p/mih.
Birth defects are another key indicator of infant health. Birth defects are one of the leading causes of
infant death. Some birth defects, such as Down syndrome, can affect multiple organs. Infants born with
birth defects may be at increased risk of premature birth, illness, and long term disability. Many birth
defects are believed to have complex multiple causes, including both genetic and environmental factors,
and scientists estimate that 60% of birth defects have causes that are unknown. More research is
needed to understand the links between the environment and birth defects. Common environmental
hazards that may be related to birth defects include air pollution, pesticides, arsenic, disinfection
byproducts, plastics, and solvents.36,37
Data on birth defects are not systematically collected for San Diego and Imperial Counties (data in
California are only available for 8 Central Valley counties).
There are some data available for birth defects and low birthweight in Baja California. Rates of
anencephaly and cleft lip are elevated in Baja California compared to Mexico Table 4. In 2009 the
proportion of low birthweight in Baja California (4.6%) was slightly lower compared to all of Mexico
(5.2%) (data not shown). Data by municipality were not readily accessible.
Table 4. Birth defects in Baja California and Mexico, 2012
Birth defects per


10,000 children under


lyr(2012)
Baja California
Mexico
Anencephaly
4.0
1.1
Spina bifida
2.3
1.3
Cleft lip
5.4
6.3
Source: Sistema Nacional de Vigilancia Epidemiologica - http://www.epidemiologia.salud.gob.mx/anuario/html/anuarios.html.
Sistema Nacional de Informacion en Salud - http://www.sinais.salud.gob.mx/descargas/zip/anuario2009.zip.
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Health Indicators
Pesticide Exposures and Illness
SUMMARY FINDINGS
•	Pesticide exposures and illness are likely underreported, and data are likely biased towards
acute effects
•	Pesticide illness data are not currently amenable to assessing long term health effects
Pesticides (including herbicides and insecticides) are a common environmental pollutant in many
communities in California, particularly in agricultural areas. Over the past several decades there has
been increasing research on the potential health effects associated with pesticide use. Pesticides have
been associated with abnormal neurological development in children, attention deficit and hyperactivity
disorder, reductions in IQ, and deficits in perceptual reasoning and memory.38'39'40,41,42,43
Pesticide exposure is more likely in places where people spend time in or near areas where pesticides
are applied. (Exposure to pesticides can also occur through food consumption itself.) The potential for
pesticide exposure is of particular public health concern amongst vulnerable groups, including
individuals with pre-existing health conditions, such as asthma. The risk for exposure is elevated in many
communities and among certain populations. An analysis of pesticide use near schools found that
Hispanic children were 91% more likely to attend schools in the top quartile of nearby agricultural
pesticide use.44 Children from lower socioeconomic backgrounds (e.g., low-income children, ethnic
minorities, or children subject to multiple environmental exposures) may experience stronger
neurological effects from environmental hazards.45'46
Possible, probable, and definite cases of pesticide exposure are reported by the California Pesticide
Illness Query (CalPIQ), an online database query from the California Department of Pesticide
Regulations. In 2012, there were 11 reported cases (possible, probably, or definite) of pesticide illness in
Imperial County, 60 in San Diego County, and 981 in California. Reporting is likely to be incomplete since
not all pesticide exposures and illnesses will be diagnosed as such, and are likely underreported by those
exposed. The reporting systems are biased toward acute effects of pesticide exposures that invoke the
most immediate symptoms, rather than delayed acute effects or chronic health effects that may occur
long after the pesticide exposures occurred.
In Mexico, pesticide exposures are reported as "pesticide intoxication" and are a reportable condition.
Data are not publicly available at the municipality level. In 2012 in Baja California, the incidence rate of
diagnosed pesticide intoxication was 0.48 cases per 100,000 persons, compared to 3.5 cases per 100,000
persons in Mexico (Sistema Nacional de Vigilancia Epidemiologica,
http://www.epidemiologia.salud.gob.mx/anuario/html/anuarios.html).
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Environmental Indicators
Air Contaminants
SUMMARY FINDINGS
•	Air pollution continues to be a pervasive hazard in the border region with myriad sources,
such as traffic, agricultural and industrial pollutants, unpaved roads, and a drying Salton Sea
•	Imperial County has more days each year classified as unhealthy to very unhealthy
compared to San Diego County
Air contaminants are air-borne compounds that affect human health in both indoor and outdoor
environments. Air pollution can negatively impact human health through both direct exposure of
individuals (breathing in the compound) and the myriad health consequences that will result from global
climate change. Air pollutants have wide ranging impacts on health, including poor birth outcomes,
decreased lung function (including asthma and acute respiratory diseases), cardiovascular disease, and
neurological effects.47,48 The California Air Resources Board (CARB) estimates that air pollution causes
around 9,200 premature deaths each year in California.49 Children, the elderly, those with pre-existing
health conditions (asthma, CVD, etc.), and those who are active outdoors are most susceptible to the
negative health effects of air pollution.48 In addition, low-income and communities of color often live
closer to sources of air pollution, leading to disproportionate exposure.
Air contaminants can be divided into several broad categories based on their regulatory classification,
impact, or source.
•	Criteria Air Pollutants include six compounds regulated and monitored in California and by the U.S.
EPA under the Clean Air Act. These compounds include ozone, particulate matter (PM2 5 and PM10),
carbon monoxide (CO), sulfur dioxide (S02), nitrogen dioxide (N02), and lead.
•	Toxic Air Contaminants (TACs) and Hazardous Air Pollutants (HAPs) are compounds considered
hazardous to human health and are designated at the state (TACs) and federal (HAPs) level.
Together, TACs and HAPs include several hundred compounds, many of which are not regularly
monitored and often lack data for ambient air concentrations.
•	Greenhouse gases include air emission compounds that contribute to global warming.
•	Indoor air contaminants are compounds prevalent in indoor environments, such as mold, volatile
organic compounds, radon, environmental tobacco smoke, and others.
Major regional sources of air pollution include:
•	Vehicular traffic, particularly near border crossings
•	Off-road vehicles, unpaved roads, agricultural, and other dust-generating sources
•	Environmental sources, such as the drying of the Salton Sea, which allow seabed dust to be
carried into the air and contribute to poor air quality (these dust particles are also contaminated
with agricultural and industrial waste products, such as pesticide residues)
•	Emissions from agricultural, industrial, and shipping activities
The Air Quality Index is commonly used to convey how clean air is from the perspective of human
health. In 2014, in comparison to San Diego County, Imperial County had more days with an AQI defined
as unhealthy or very unhealthy.
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Environmental Indicators
Breakdown of AQI over total
Imperial County
H Good
Moderate
Unhealthy for
Sensitive Groups
¦	Unhealthy
¦	Very Unhealthy
Source: U.S. EPA Air Quality Index Report www.ep3.Eov/airdata/ad rep aai.html
CARB collects and distributes data on ambient air quality for California. In Mexico, analogous data are
collected by the Secretarfa de Proteccion al Ambiente de Baja California (SPABC-the State Secretariat
of Environmental Protection) and reported to U.S. EPA for distribution.5 Some concern has been
expressed regarding the validity of data from current border area monitors in Baja California. *
Particulate matter data by census tract and the locations of air monitors documented in U.S. EPA's
AirData annual summary files are shown in Map 2.
number of days in 2014
San Diego County
Imperial County
San Diego County
Map 2. Percentile rank
of
particulate
matter
air monitor sites
N
(PM2.5) by census tract and location of
l^eXi40liMMesniCiPality

80 Kilometers
i-cubed, USD^^SGSp
IGP, swisstopo, andthe SIS
¦¦¦¦¦¦
EPA AirData -
Particulate matter percentile by census tract
<25
>	25 to 50
>	50 to 75
>75
Border
PM monitors with data reported by EPA
Sources: CalEnviroScreen 2.0 http://oehha.ca.gov/ei/ces2.html. U.S.
http://agsdrl.epa.gov/aasweb/aastmp/airdata/download files.html.
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Emission inventories identify and catalogue sources of air pollution and are important for identifying
ways to improve air quality. Sources may include stationary, area-wide, and mobile sources. For
example, in 2012 in Imperial County, CARB estimated that 0.51 tons of PM2.5and 0.75 tons of PM10 were
emitted by on-road motor vehicles per day (3.08 tons PM2.5 per day and 5.96 tons PM10 per day were
emitted in San Diego County ).52 CARB point source emissions data showed 41 emitters in Imperial
County and 238 emitters in the San Diego County (U.S. EPA 2011 National Emissions Inventory,
http://www.epa.gov/ttnchiel/net/2011inventorv.html).
The emissions inventory for Baja California is collected by SPABC and made available via their website,
which contains documents summarizing greenhouse gas emissions for Baja California53 and an emissions
inventory for the municipality of Mexicali.54 However, there is no similarly accessible local-level dataset
for particulate matter readily available online for Baja California.
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Environmental Indicators
Climate Change
SUMMARY FINDINGS
•	Climate change may have very serious health impacts in the border region given its hot and
dry climate, existing environmental hazards, and community vulnerabilities
•	Data are needed to better track, predict, and assess the impacts of climate change on health
Climate change will have myriad health impacts beyond the likely substantial increase in heat-related
illnesses and deaths. Other, more indirect health impacts may result from the degradation of drinking
water supplies that can result from salt water intrusion from sea level rise. Broader disruptions in
health, economic, and social systems may result from changes in ecological patterns and resource
scarcity.55 The migrations of human populations can be a particularly challenging event along any
geopolitical boundary, but this movement of populations may also be an effective adaptation strategy to
climate change.56
Climate change will impact air quality as increased temperatures and sunlight increase levels of dust and
ozone. Increased temperatures and carbon dioxide levels may contribute to the increased production of
allergenic pollens and mold spores. And intermittent patterns of heavy rain followed by elevated heat
may also play a role in exposures to fungal spores that cause valley fever.
High temperatures, strong winds, and dry conditions that result from climate change will increase fire
risks for some communities. Wildfires can cause significant declines in air quality and can also have
severe impacts related to burns, smoke inhalation, displacement from one's home, and the traumatic
stress of experiencing a disaster.
As the climate changes, extreme weather events are expected to occur more frequently. Examples
include droughts, caused by a lack of precipitation, and floods, caused by an abundance of precipitation.
Changes in water runoff patterns will alter food and water supplies (as witnessed in California's current
drought) and may influence the spread of vector-borne diseases (e.g. dengue fever). Flood events can
devastate communities and result in drownings, infections, displacement from one's home, and long-
lasting health effects related to emotional stress and trauma.
The health effects of climate change are expected to have the greatest impact on children, the elderly,
individuals with pre-existing conditions, and low-income communities. These populations may be more
susceptible to infectious disease, have the greatest vulnerability during extreme weather events, and
possess the fewest resources necessary to recover and adapt to such events.
Prospective data on projected environmental impacts, as well as analyses looking at past heat waves
and other similar events, are needed to better understand which populations may be at greatest risk in
the future. Though much more research is needed on climate change and health, there have been
substantial data improvements in climate change projections.
Cal-Adapt, a site developed by UC Berkeley and California Energy Commission, provides information
about how climate change might affect California at the local level by maintaining high resolution
geographic data on climate change projections in California. Cal-Adapt predicts monthly and annual
changes in temperature, precipitation, snowpack, soil moisture, humidity, wind, and fire risk over time.
The models are produced using high and low emissions scenarios. Cal-Adapt includes average annual
temperature projections through 2099 (Exhibit 1). As shown in the images below, the changes in
27
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Environmental Indicators
temperature are expected to be greater in inland communities compared to coastal areas. More
detailed data can be downloaded from the tool, and the user can select various options from within the
queryable interface.
San Diego County
Pafima Valli
Sohta Yst
Temperature
Rise
Map data ©2015 Google, INEGI 20 km l
j Terms of Use Report a map
J SAN DIEGO COUNTY
The information in the chart below corresponds to the
selected area on the map (outlined in orange).
Historical Average	57.4 F
Low-Emissions Scenario: 60.5 °F +3.1 °F
High-Emissions Scenario: 63.2 °F +5.8 °F
Exhibit 1. Cal-Adapt projections for change in annual average temperature from baseline to end of
century for Imperial and San Diego Counties
Observed and Projected Temperatures
1900 1980 2000 2020 2040 2000 2080
—	Low Emissions Scenario
—	High Emissions Scenano
—	Historic Measurements
Imperial County
u IMPERIAL COUNTY
The information in the chart below corresponds to the
selected area on the map (outlined in orange).
Historical Average
Low-Emissions Scenario:
High-Emissions Scenario:
75.4 °F
79.2	°F +3.8 °F
82.3	°F +6.9 °F
Observed and Projected Temperatures
Temperature
Rise
4 2 *F
Mexican

1900 1980
Map data ©2015 Google, INEGI 20 km
Terms of Use Report a map
2000 2020 2040 2000
Low Emissions Scenario
•	High Emissions Scenario
•	Historic Measurements
Source: Cal-Adapt, Local Climate Snapshots http://cal-adapt.org/tools/factsheet/
The Programa Estatal de Accion Ante el Cambio Climatico de Baja California (PEACC - Baja California's
State Program of Action Against Climate Change) produces the Climate Database of Northwestern
Mexico, a database for climate change in the region. Figure 16 shows projections for precipitation and
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Environmental Indicators
temperature change for both B1 (low) and A2 (high) emissions scenarios (data shown are not available
for download). Data from PEACC and Cal-Adapt are not directly comparable.
Figure 16. Average precipitation change and temperature change for B1 and A2 emissions scenarios
Precipitation projections
B1: emisiones bajas	A2: emisiones altas
CD
CM
o
CM
I
o
o
CNJ
CD
CD
O
CN
i
o
cx>
o
CNJ
Temperature projections
B1: emisiones bajas
A2: emisiones altas
42i	^
-123 -120 -117 -114 -111 -108 -123 -120 -117 -114 -111 -108
Source: Programa Estatal de Accion ante el Cambio Climatico de Baja California -
http://peac-bc.cicese.mx/datosclim/dcbc.php.
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Environmental Indicators
Drinking Water Quality
SUMMARY FINDINGS
•	Many areas in the border region, particularly in rural communities, continue to experience
high levels of drinking water contamination
•	Maintaining water quality is imperative in the hot and dry border region where water is
limited and the population continues to grow
•	Better data are needed to track the location of and contamination in water sources, public
drinking water systems, and well water
Drinking water may contain natural and man-made contaminants that are a risk to human health. The
presence of contaminants in water may contribute to adverse acute or long-term health effects,
including gastrointestinal illness, reproductive problems, cancer, and neurological disorders.
Common water contaminants (such as disinfection byproducts, arsenic, nitrate, and lead) can have
health effects in children, adults, and in utero. The U.S. EPA sets maximum concentration levels for
hazardous compounds. An individual's overall risk of developing a water-related illness will depend on
many factors: the specific contaminant, the concentration and potency of that contaminant, how the
contaminant enters the body (for example, whether by drinking or showering), and the person's
individual susceptibility. Vulnerable populations, such as the elderly, children, and pregnant women, are
more likely to suffer ill effects than the rest of the population.
The main strategies for preventing water-related illness are to protect water sources (i.e., water
supplies), provide effective and reliable water treatment, and monitor water quality. Federal laws and
regulations are in place at the state level to implement these strategies for community water systems.
Many small community water supplies and private domestic wells, predominantly in rural areas, are not
covered by the Safe Drinking Water Act (SDWA). Therefore, these communities may not have the same
level of safety assurance as larger drinking water systems. Monitoring drinking water hazards and
exposures in both rural and urban communities remains an important task and considerable challenge
for environmental health surveillance.
There is no complete geographic map of public drinking water systems for California. Recently, CEHTP
developed a tool to collect public data on the location of drinking water systems. This tool facilitates the
creation, collection, and vetting of digital maps for every public water system in California. Over 90% of
the population of California is represented by the over 2,500 water system boundaries uploaded or
created using the tool. Compiling a complete digitized database of public drinking water systems will
allow for better emergency planning and preparedness, spur important research, and improve
communication among utilities with respect to water quality and conservation. A sample image of
drinking water system boundaries collected by the tool in San Diego and Imperial Counties are shown
below (Map 3).
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Environmental Indicators
¦padre L
DAMMWD
[san[diego]
eciw>f1
[BRAWL'EYj
¦CITYtOFj
-jHELIXW
-WATER!
[DISTRICT?
¦imperial*
Irrigation]
¦district!
,OTAY WATER
W PI STRICT#
[IMPERIAL*
¦CITYjOFj
EL CENTRO
fcciTYtOFM
[C A LEXIC ON
CITY OF .
2 i-cubed. USDA. USGS.
IGf£.swisstopo. and .theffei;
•Sri. Digitalto
toap'ping.
Wumty^j
"User-
Map 3. Water system boundaries for San Diego and Imperial Counties (only select major water systems
are labeled, including the Imperial Irrigation District and City of San Diego)
San Diego County	Imperial County
Source: California Environmental Health Tracking Program http://cehtp.org/page.jsp7page kev=762
Irjaena^jinty
Mexicali Municipality
San Diego
Tijuana Municimlity
\	i
» Border
¦¦ Water system boundaries
— Major roadways
Border
Water system boundaries
Major roadways
Using data from CEHTP's tool to collect drinking water system boundaries, California EPA's Office of
Environmental Health Hazard Assessment (OEHHA) modeled census tract-level summaries of drinking
water quality for all of California (Map 4). This indicator takes into account relative concentrations of
different contaminants and whether multiple contaminants are present. A higher index number
indicates higher contaminant levels. More details are available in CalEnviroScreen documentation
Counties
Me x ^.^Municipality
80 Kilometers]
ieoEye, i-cubed, USD$S®3§1[
JGN, IGP, swisstopo. a'ntf-thefSi!
Map 4. Drinking water contaminant index percentile by census tract in San Diego and Imperial
Drinking water contaminant
index percentile by census tract
~	<25
~	>25 to 50
¦l> 50 to 75
¦ >75
Border
M Bodies of water
— Major highways
Source: CalEnviroScreen 2.0 - http://oehha.ca.gov/ei/ces2.html.
Solicitation No. SOLTA14-008
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Environmental Indicators
Potable water quality data (water intended for drinking) are not readily available online for Mexico.
However, the Comision Nacional del Agua (CONAGUA - the National Water Commission) prepares and
publishes water quality data for several different indicators at select sampling sites. The data provides
information on the quality of water supply stored for provision to systems for treatment and
distribution, but is not an indicator of endpoint quality of water intended for consumption (purified,
bottled, at the tap, etc.).
Map 5 below shows "Biochemical Oxygen Demand" (one measure of water quality) at selected sampling
sites across the municipality of Tijuana (total suspended solids, chemical oxygen demand, and a number
of other water quality metrics are also available). Data are not directly comparable to water quality data
shown by CalEnviroScreen.
Rosaril
20T Ki lo meters
etrr apping" Aeiogrid IGNH'CjP^s^'s.sfe
Tecate Municipality
Map 5. Biochemical oxygen demand at select sampling sites in Tijuana and surroundings
San Diego County
o v-' S
-	
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Environmental Indicators
Green Spaces and Parks
SUMMARY FINDINGS
•	Green spaces and parks are a valuable community resource that promote physical activity,
social well-being, and climate change adaptation
•	It will be important to increase public availability of high quality parks and green spaces
amidst the pressures of a growing population
Access to green space (defined as an area of grass, trees, or nature for recreational or aesthetic
purposes) is an important component for the promotion of community health and well-being.58,59 Green
spaces can be divided into land cover and park areas. Land cover refers to the type of vegetation or
environment covering the ground. Parks and recreational areas are places designated by government or
other agencies for people to gather for social and recreational activities.
Land cover
Trees and vegetation improve a location's suitability for humans, and positively impact water runoff,
flood risks, air quality, and temperature, '' Vegetative cover is particularly important for climate change
mitigation and adaptation, and will change with transformations in local climate. Understanding these
changes will be critical to intervening upon health impacts related to climate change. The European
Space Agency recently released data considered to be the highest resolution global land cover dataset.
Although other land cover datasets are available from both U.S. and Mexican governments,61 2 the ESA
GlobCover 2009 data include both countries in a single uniform dataset at high spatial resolution.
The eastern portion of the California-Baja California border region has very little vegetative coverage
apart from agriculture, whereas the western portion (San Diego County, Tijuana, Ensenada) have more
abundant vegetative coverage (Map 6). More urbanized areas notably lack vegetative cover.
Map 6. Vegetative land cover along the California-Baja California border region, 2009
San Diego
Mexical
Vegetative areas
^Urbanized areas
¦ Vegetative areas
~ Areas without vegetation
^ Border
80 Kilometers
Source: turopean Space Agency, GlobCover2009. Accessed a http://earthengine.googie.org
33
Solicitation No. SOLTA14-008
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Environmental Indicators
Parks and recreational areas
City parks and other public spaces are important for health in ways relating to recreation, physical
activity, community social connections, stress reduction, and heat-island mitigation.63,,64Geographic data
for park boundaries and recreational areas are often available from government agencies.
For California, the California Protected Areas Data Portal (CPAD), produced and coordinated by the
Greenlnfo Network, provides publicly available geographic data on outdoor open spaces that are
protected by government agencies for public use. These areas are controlled by a mix of city, county,
and state agencies, and include locations such as state parks, beaches, plazas, athletic fields, regional
parks, and other open spaces. The dynamic CPAD mapping tool allows for queries narrowed by type of
protected area, location, or other keyword and also includes options to display administrative
boundaries and school locations. A snapshot of the tool (available at www.calands.org/map) is shown
below (Exhibit 2).
Exhibit 2. California Protected Areas Data Portal showing park areas (and their designated jurisdiction) in
San Diego and the Imperial Valley
San Diego area
Calexico
San Diego

City

County

Federal

Non Profit

Private

Special District

State
"i
Source: California Protected Areas Database - http://calands.org/data
In Mexico, geographic data for similar types of spaces are available from the Institute Nacional de
Estadfstica y Geografia (INEGI - The National Institute of Statistics and Geography) and the Sistema para
la Consulta de Informacion Censal 2010 (SCINCE - the 2010 System for Consultation of Census
Information). "Areas verdes" (i.e., "green areas") include parks, playgrounds, sports playing areas, and
other recreational areas. A view of Tijuana near the San Ysidro border crossing is shown in Map 6.
Solicitation No. SOLTA14-008
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Environmental Indicators
Map 6. "Green areas" near San Ysidro border crossing in Tijuana
San Diego County
San Diego County
uana Municipali
Tijuana Parks
~ Parks
Border

Tijuana International Airport
n
*
Tijuana Municipality
o 0.5 <50 1
¦' '¦ ¦'
80« 0.75 1.5	/ 3 Kilometers

A
~§w/testopo. apdtfiinGJs/.
Source: Institute Nacional de Estadistica y Geografia http://www.inegi.org.mx/est/scince/scince2010.aspx
Solicitation No. SOLTA14-008
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Environmental Indicators
Pesticide Use
SUMMARY FINDINGS
•	Pesticides are a common environmental hazard in Imperial County, and can lead to air, soil,
and water contamination
•	The longer-term health effects of pesticides are widely acknowledged in scientific literature,
but poorly tracked in clinical data because of their often long latency and complex etiology
A pesticide is any substance used to kill or repel insects (insecticides), weeds (herbicides), rodents/small
mammals (rodenticides), mold (fungicides), bacteria, or viruses. While all individuals should avoid
exposure to pesticides to the greatest extent feasible, children are more susceptible to pesticide
exposure and the health effects of pesticides compared to adults. Vi 67 Pesticides can have a variety of
health effects depending on their physical properties, including cancer, reproductive and developmental
effects, impacts on nerve cell activity, respiratory effects, and eye and skin irritation, among others.
California's Department of Pesticide Regulation (CDPR) maintains the Pesticide Use Reporting (PUR)
Database. Data are reported by pesticide and by crop type at 1-square mile sections for pesticide
applications to agricultural fields, parks, golf courses, cemeteries, pastures, and along transportation
rights-of-way. The image below shows CEHTP's Pesticide Mapping Tool and pesticide use near the San
Diego metro area and the Imperial Valley (Exhibit 3). The Imperial Valley is a major agricultural area and
has substantial amounts of pesticide applied in the region. The pesticide mapping tool allows the user to
interactively browse data by pesticide, crop, year, and unit of measurement.
Data on pesticide use were not available for Baja California.
iTortuga
Centrri
-6-alexico
San-Marcos
Escondido
Ramona
[ncinuns
Sol ana Pieacrr
Poway
Lakeside .«*'
La Mesa
Chula Vista
Exhibit 3. Pesticide use reported in the Imperial Valley, California 2012, summed pounds, 2012
San Diego area	Imperial Valley
Slab City
La Pluma
Amos
North Algot
Wilderness
Source: CDPR Pesticide Use Reporting System. Accessed at http://www.ehib.org/tool.isp7tool key=18.
IA JOLLA
)r
vmu
Olay Counfy Open
Space Preserve
Coronado
Jamul
<1,673
(0-50th pet)
1.673 -
6.843
(50th-75th pet)
> 6.843
(75th pet»)
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Environmental Indicators
Traffic
SUMMARY FINDINGS
•	Traffic is an important pollution source in the border region, with very concentrated traffic
near the border crossings and high traffic density in urban areas of San Diego County
•	Unpaved roads in Imperial County and other rural areas can allow for increased dispersal of
road dust, and greater pollution generated by vehicular traffic
Cars and trucks produce pollutants that are harmful to health, including diesel particulate matter (PM),
nitrogen oxides (NOx), carbon monoxide (CO), and volatile organic compounds (VOCs). These pollutants
have a wide variety of health effects, including but not limited to asthma, heart disease, cancer, poor
birth outcomes, and premature death.68 Those living closest to busy roadways are likely to have
disproportionate exposures and health outcomes from traffic pollutants, as are individuals with pre-
existing conditions. Low-income communities and communities of color are often most likely to reside
near freeways and other busy roadways.69,70
Vehicular traffic is associated with other health outcomes related to noise (such as stress and
cardiovascular disease) and injuries from collisions. Indirect health effects may occur as individuals near
busy roadways may walk or bike less due to high traffic volumes, leading to consequences of physical
inactivity (such as obesity and diabetes).71
CEHTP has an online tool that can be used to estimate traffic exposure within a given distance from any
geographic, and produces a variety of traffic metrics using different criteria and adjustment techniques.
Traffic metrics are calculated within a user-defined radius from a single point (such as a street address).
Using the Traffic Tool, analyses can be conducted to estimate the environmental effects of traffic within
a given area. Combined with other traffic data models, this can help investigators quickly understand
local traffic, its community impact, and future planning efforts.
The most widely used metric, "sum of all length-adjusted traffic segments", is the best generalizable
traffic metric for understanding traffic density within a given road segment (Exhibit 4). Other more
detailed metrics are also available (Exhibit 5).
Traffic density can also be summarized at the census tract level to better convey its impact across a
broader community. Traffic density percentiles by census tract in San Diego are shown together with
border crossing locations in Map 7.
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Environmental Indicators
Exhibit 4, Traffic volumes for a major intersection in Calexico, Imperial County
BackgroundJJ^Enterjluffei^arametersJJ Spatial Linkage Results
Metric
(si) Sum of all length-adjusted traffic volumes within buffer (vehicle-knihr)
(sg) Sum of all Gauss-adjusted traffic volumes within buffer (vehicles/day*)
(111) Length-adjusted traffic volume of highest segment within buffer (vehicle-
km/hr)
Show more metrics
* average annual daily traffic
Value
2,416
118.349
995
Hacienda Dr
KincaTtKr
Forevf 21
Las Flores Dr
Starbucks »
Arguelles St
Food 4

-@4200-
T2Wgb'
/ockwood
'Elementary Schc
Sheridan s
Map | Satellite |
Kincaid St
C K Clarke St
Terms of Use Report a map error
^nearest segment to buffer center ^?=segment with lnghest traffic volume in buffer
Hide Buffer
Source: CEHTP Traffic Tool - http://www.ehib.org/traffic tool.isp.
Exhibit 5. Detailed traffic metrics for an intersection in downtown San Diego
San Die jo C
W B St
7. C- Sr
els The
WE St
Balboa T
\
W-6-i">«oo
W4D0*
Metric
g (si) Sum of all length-adjusted traffic volumes within buffer (vehicle-km/hr)
% (nu) Unadjusted traffic volume of nearest segment within buffer (vehicles/day*)
(ngl) Gauss- and length-adjusted traffic volume of nearest segment within buffer
(vehicle-km/hr)
(ndist) Distance to nearest segment within buffer (meters)
(hgl) Gauss- and length-adjusted traffic volume of highest segment within buffer
(vehicle-km/hr)
(hu) Unadjusted traffic volume of highest segment within buffer (vehicles/day*)
rear- (hg) Highest Gauss-adjusted traffic volume segment within buffer (vehicles/day*)
Th (sg) Sum of all Gauss-adjusted traffic volumes within buffer (vehicles/day*)
(hi) Length-adjusted traffic volume of highest segment within buffer (vehicle-
km/hr)
(ndir) Direction to nearest segment within buffer (degrees ccw** from east)
(sgl) Sum of all Gauss- and length-adjusted traffic volumes within buffer (vehicle-
km/hr)
Map data C2015 Google
Source: CEHTP Traffic Tool.
Accessed at http://www.ehib.org/traffic tool.isp.
(su) Sum of all unadjusted traffic volumes within buffer (vehicles/day*)
Tetmsofuse i (hdir) Direction to highest segment within buffer (degrees ccw** from east)
(ng) Gauss-adjusted traffic volume of nearest segment within buffer
(vehicles/day*)
(hdist) Distance to highest segment within buffer (meters)
(nl) Length-adjusted traffic volume of nearest segment within buffer (vehicle-
km/hr)
*average annual daily traffic
**ccw=counter clockwise
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Environmental Indicators
Map 7. Traffic density for the border region by census tract
ianks Ranch
Poway
County
nicipality
Eucalyptus Hills
Santee Lakesid
inte r Gardens./^
>ison Canyon
Jamul
SanDiego area
\ Riverside
RamonaSan Djego Country Estates
19 M es
20 Kilometers
Potrero
Traffic density percentile
by census tract
<25
I I > 25 to 50
> 50 to 75
M>75
) Border crossings
	Major highways
Calipatria
Westmorland
Mexiqali Municipality
20 Kilometers
Calexico
19 Miles
Imperial County
Brawley
Holtville
0	4.75
Traffic density percentile i^ley El Centi
by census tract
~ <25	Heuei
¦ >25 to 50
> 50 to 75
M> 75
(•) Border crossings
	Major highways
Sources: CalEnviroScreen 2.0 - http://oehha.ca.gov/ei7ces2.html.
Ur'
Imperial
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Environmental Indicators
Border crossings between California and Baja California have very high levels of traffic (Table 5). The
pollution and noise from this concentrated traffic can impact nearby communities, border crossing
workers, and other border crossers on foot and in vehicles.72 There are six border crossings along the
Baja California border region that generate vehicular traffic, mostly from commercial trucks and
personal vehicles. Long wait times at the border crossings can further exacerbate pollution as cars sit
idling. Otay Mesa and San Ysidro remain the busiest border crossings for vehicles in the California-Baja
California border region (Figure 17).
Table 5. Numbers of border crossings from Baja California into the United States*
Port name
Andrade
Calexico
Calexico East
Otay Mesa
San Ysidro
Tecate
Trucks
0
0
325,243
810,193
0
52,239
Trains
0
0
252
205
0
0
Buses
0
0
2,785
41,222
57,171
237
Personal vehicles
453,079
4,071,666
3,399,697
6,910,219
11,946,060
812,540
Pedestrians
800,176
4,567,333
310,344
3,415,957
7,925,371
743,666
*Zero values may occur where data cannot be recorded due to a lack of facilities, such as no rail crossing at the port of entry.
Figure 17. Number of personal vehicles and pedestrians crossing at California-Baja California border
crossing points, 2014
12,000,000
& 10,000,000
(u
8,000,000
6,000,000
a! 4,000,000
.a ' '
2,000,000
Andrade Calexico Calexico Otay Mesa San Ysidro Tecate
East
¦ Pedestrians ¦ Personal Vehicles
Source: Bureau of Transportation Statistics -
http://transborder.bts.eov/proerams/international/transborder/TBDR BC/TBDR BC lndex.html.
Traffic data were available for some roads in Baja California, but not readily accessible for use in
mapping software. Traffic count data are currently provided in PDF form without geospatial reference.
Border crossing data for border entry into Mexico are not readily available online.
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Environmental Indicators
Toxic Emissions
SUMMARY FINDINGS
•	There is a high concentration of facilities required to report to the Toxic Release Inventory in
San Diego County
•	There are many facilities along the Baja California border required to report with the
Registro de Emisiones y Transferencias de Contaminantes in Mexico
The U.S. EPA Toxic Release Inventory (TRI) Program tracks the management of various toxic chemicals
that are hazardous to human health. The program includes industries that must identify and publicly
report on toxic chemicals, and their management and release into the environment. Toxic chemicals
include those that are known to cause cancer or other chronic human health effects, have significant
adverse acute health effects, or have significant adverse environmental effects. Mandatory reporting
facilities typically include larger facilities involved in manufacturing, mining, power generation, chemical
manufacturing, and hazardous waste treatment.
The TRI database includes annually reported geospatial information about facilities and more than 650
toxic chemicals. The Facility Registry System (FRS), also maintained by the U.S. EPA, contains more
general information on the facilities, sites, or places of environmental interest that are subject to
regulation. A sample of TRI data is shown for the city of San Diego and surrounding areas is shown in
Maps 8 and 9.
Map 8. TRI facilities located in the California border region
Tijuana Munic kjity
Mgjc ir.al is M u n ic i pa I ity .
Facility locations, 2013 TRI
* Emitting Facility (TRI)
~~Cities
>nK-j2qC ¦ .40, I	80 KilometerSI
i-cubed, USCSSMBB
liia JGN. IGP, swisstopo, aW'the-ifi:
Sources: U.S. EPA TRI - http://www2.epa.eov/toxics-release-inventorv-tri-program/tri-data-and-tools.
Solicitation No. SOLTA14-008
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Environmental Indicators
16 Miles
>11 Kilometers
Facility locations, 2013 TRI
* Emitting Facility (TRI)
Pop. density by census tract, people/sq km
~	<= 1,000
~	1,001 -3,000
M3,001 -5,000
M5,001 -10,000
M 10,001 -20,000
— Major roadways
Sources: U.S. EPA TRI - http://www2.epa.gov/toxics-release-inventorv-tri-program/tri-data-and-tools.
Map 9. TRI facilities located in the city of San Diego, with population density
The Registro de Emisiones y Transferencias de Contaminantes (RETC -the Registry of Transfers and
Emissions of Pollutants), a program of SEMARNAT, is analogous to the U.S. EPA TRI Program. RETC is
usually paired with the TRI as a comparable resource. Facility locations in the Baja California border
region and Tijuana are shown in Maps 10 and Map 11, respectively.
Map 10. RETC facilities located in the Baja California border region
Mexican Municipality
Ensena
40 Miles
80 Kilometers
Es^DigitalGlobe
etrn a p pi riqsAe rog rid
the Gl
eBGommtanit
Facility locations, 2013 RETC
* Emitting facilities (RETC)
~ Cities
Source: Secretaria del Medio Ambiente y Recursos Naturales - http://appl.semarnat.gob.mx/retc/retc/index.php.
Solicitation No. SOLTA14-008
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Environmental Indicators
EV5I Ki Io me t e rs]
Map 11. RETC facilities located near the city of Tijuana and population density
San Diego County
icipality
Facility locations, 2013 RETC t
* Emitting facility (RETC)
Pop. density by AGEB, people/sq. km *'jHf.	' j3H|HmH'mh£!S8
~ <=3,000	¦ , , . ¦ i ,	i 'e'
(=13,001 -5,000	X	" '
-5,°°i. 10,000
-10,001-15,000
™>= i,5ooi
Source: Secretaria del Medio Ambiente y Recursos Naturales http://appl.semarnat.gob.mx/retc/retc/index.php.
Solicitation No. SOLTA14-008
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Conclusions
Overall Findings & Models to Advance Environmental Health Surveillance
Core Findings
Overall, the California-Baja California border region faces many environmental health challenges related
to its unique geography and social, cultural, and political history. Imperial County, in particular, has
many persistent environmental health disparities. We found that:
Many sources of environmental hazards uniquely impact the California border region
•	Air pollution continues to be a pervasive hazard in the border region with myriad sources, such
as traffic, industrial pollutants, unpaved roads, and the drying Salton Sea
•	Imperial County has more days each year classified as unhealthy to very unhealthy compared to
San Diego County
•	Climate change may have very serious health impacts in the border region given its hot and dry
climate, existing environmental hazards, and underlying population vulnerabilities
•	Many areas in the border region, particularly in rural communities, continue to experience high
levels of drinking water contamination
•	Agricultural pesticides are a common environmental hazard in Imperial County
•	Traffic is an important pollution source in the border region, with very concentrated traffic near
the border crossings and high traffic density in urban areas of San Diego County
Because of these environmental hazards and underlying population vulnerabilities, many
residents continue to experience poorer than average health outcomes
•	Asthma continues to severely impact residents of Imperial County
•	There are fewer valley fever cases in the border region compared to some Central Valley
counties, but it will continue to pose a risk as the climate changes
•	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 underlying population
vulnerabilities (such as a high proportion of outdoor laborers or low income)
•	Cardiovascular disease remains elevated in Imperial County, and slightly lower in San Diego
County, when compared to California
•	Lead exposures continue to decrease throughout California, though compared to the California
average, the prevalence of young children with elevated blood lead levels is nearly two-fold in
Imperial County, and slightly elevated in San Diego County
Better data will be imperative in the future to track, intervene upon, and monitor ongoing
environmental health conditions in the California-Baja California border region
•	Better data are needed to track, predict, and assess the impacts of climate change on health,
likely one of the greatest public health challenges in the coming decades
•	Greater priority should be placed on the need to collect the location of and contamination in
water sources, public drinking water systems, and well water, especially in rural communities
•	Heat-related illnesses are expected to continue to be an emerging public health priority
•	Valley fever is likely underreported, but it will continue to be a serious health risk into the future
•	Birth defects data are not systematically reported in Imperial and San Diego County
•	Pesticide illness and exposure data are likely underreported, and not currently amenable to
assessing long term health effects
•	Data are not systematically reported for pesticide use on buildings and structures
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Despite these many challenges, it is also noted that the region has rich data that can assist in
determining environmental health priorities, developing community-specific interventions, and
evaluating their impact over time. In order to maximize existing data infrastructure to improve
environmental health, the systematic and ongoing collection and reporting of relevant environmental
health indicators must be prioritized.
Environmental Health Data Needs
In our survey of environmental health data for the California-Baja California border region, we found
that there were opportunities to improve environmental health data surveillance throughout the region.
The challenges encountered were consistent with the challenges faced by the authors of this report in
the establishment and maintenance of the California Environmental Health Tracking Program.
•	Data metrics were often inconsistent, making data comparisons difficult throughout the border
region. Environmental and health data for various content areas are collected and reported
differently by multiple agencies. Inconsistent data metrics may be a result of differing data priorities,
funding, or the context within which the data are collected. Establishing consistent data standards
for the region would allow for more meaningful data comparisons and consistency in data metrics
over time. These data standards should reflect regional data needs and be responsive to local
community priorities as well.
•	Data were often not accessible to users. Some data were not publicly accessible, data queries were
not supported on modern web browsers, or data were delivered in formats that were not user-
friendly (such as relational databases or PDF documents). For maximum data accessibility, it is
essential that data are publicly available across multiple web-browsers, to users with varying levels
of technical expertise, and in a machine-readable format that is easy to extract, transform, and
process.
•	Data documentation was often limited or non-existent. Standardized codebooks, data dictionaries,
and metadata are essential for increasing data accessibility for a wide range of users and tracking
data over time.
•	Data from sub-state and sub-county/municipality geographies had limited availability. Greater
efforts should be made to collect and report data at geographies that are relevant to local
communities, while ensuring that data privacy is protected in these communities.
•	Greater coordination among agencies would allow for datasets to be accessed from a centralized
hub. Environmental health surveillance programs and open data portals can better serve users from
a single centralized data system.
To maximize data utility, data must be relevant and responsive to community stakeholders,
accompanied by linguistically and audience-appropriate messaging, and reported in a timely manner in
publicly accessible formats, such as easily queryable online data systems with maps, charts, and
downloadable data tables. Very few datasets are currently available in such a format from both sides of
the U.S.-Mexico border, making it difficult for users to easily ascertain a complete picture of
environmental health trends throughout the border region.
Environmental health surveillance programs act collaboratively and independently across political
jurisdictions to track, collate, and report disparate datasets related to the environment and health in a
45
Solicitation No. SOLTA14-008
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Conclusions
manner that is relevant and actionable for impacted communities. The Center for Disease Control and
Prevention's National Environmental Public Health Tracking Program (National EPHT) can serve as a
model for environmental health surveillance across the U.S.-Mexico border region.
National Environmental Public Health Tracking Program:
A Model for Environmental Health Surveillance across the Border Region
In January 2001, the Pew Environmental Health Commission issued the report "America's Environmental
Health Gap: Why the Country Needs a Nationwide Health Tracking Network." The report highlighted
that no systems were in place at the federal or state level to track exposures or health outcomes related
to environmental hazards. In response, in 2002, the U.S. Congress provided funding to the Centers for
Disease Control and Prevention (CDC) to develop the National Environmental Public Health Tracking
Program (www.ephtracking.cdc.gov). Currently, 26 U.S. states and New York City are funded to
participate in the National EPHT. Two U.S.-Mexico border states - California and New Mexico - are
already members of the National EPHT.
CDC's National Environmental Public Health Tracking Program
AK
HI
August 2014
The network of states participating in the National EPHT support the ongoing collection, integration,
analysis, and interpretation of data on environmental hazards, exposures, and environmentally-related
diseases at the state level. Common health effects tracked by participating states include asthma, heat
illness, cancer, heart disease, carbon monoxide poisoning, childhood lead poisoning, birth defects, and
reproductive outcomes. Environmental hazards tracked include air and water quality, pesticide
exposure, climate change, and toxic substance releases
In addition, states often function as laboratories within the National EPHT, tracking various health and
environmental data that are particularly relevant for their communities. For example, many states in the
northeastern United States actively collect and report data on algae in water bodies, while states in the
more arid western United States have initiated projects on drinking water data. These locally-initiated
HAP LEGEND
at lYacMto NeCaar* Grantee ICHyl
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data surveillance efforts often serve as models for other states that see a similar data need in their
communities, lowering the overall cost of enabling data collection within a given content area.
California Environmental Health Tracking Program (CEHTP)
The California Environmental Health Tracking Program (CEHTP) was one of the original National EPHT
grantees. CEHTP regularly collaborates with diverse stakeholders that include community organizations,
local and state government, academic researchers, and urban planners who utilize the CEHTP tools and
services for public health surveillance, research, policy, education, and advocacy.
Much of CEHTP's success over the past decade is related to the relationships it has built with its data
stewards, the robust group of advisory members who offer recommendations on making data relevant
to their own work, and a willingness to expand its data resources to meet community needs. Specifically
in California, CEHTP expertise has informed cutting-edge public health projects such as:
>	Mapping community vulnerabilities to climate change
>	Evaluating the association between pesticides and health
>	Conducting statewide mapping of breast cancer at the sub-county level
>	Estimating the amount of agricultural pesticides used near public schools
>	Developing dynamic and interactive data tools that
1.	Can link pesticide or traffic data to various health outcomes
2.	Allow for the easy visualization and querying of pesticide use data
3.	Crowd-source the collection and visualization of drinking water system boundaries
The projects listed above are in addition to CEHTP's central function to collect, clean, communicate, and
disseminate core environmental health data in a queryable form on its website. Those data are available
at www.CEHTP.org.
Recommendations for Successful Environmental Health Surveillance
The decade-long experience in developing and maintaining a successful National EPHT can help inform
the development of a U.S.-Mexico EPHT program. Based on the lessons learned from the CDC's
experience, the following recommendations should be considered:
1.	Determine the needs of a U.S.-Mexico EPHT program
Although the broad goal of developing an environmental health surveillance system is to improve
the health of all communities, assessing the specific needs of communities and jurisdictions along
the U.S.-Mexico border is essential. Current efforts like the U.S. Border 2020, border health reports
(like this one), and working with key stakeholders (see Recommendation #2) should all be
considered when establishing program and community needs.
2.	Identify and engage diverse bi-national stakeholders
The success of the National and California EPHT Programs rely on the inclusion of a network of
diverse stakeholders that have been engaged at every phase of the development and ongoing
maintenance of the Network. In California, stakeholders have represented local, state, and national
government; academic researchers; health affected groups and advocates; non-governmental
organizations; community-based organizations; and urban planners. Stakeholder input is solicited
through needs assessments, focus groups, surveys, key informant interviews, and regular in-person
meetings and webinars. Establishing an advisory group to guide the development and
implementation of any U.S.-Mexico EPHT Program would be essential. Some key government
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stakeholders would likely include: BECC, U.S. EPA, PAHO, CDC, all U.S. and Mexico Border States,
SEMARNAT, INEGI, INSP and Mexican government equivalents. Non-governmental and community-
based environmental health organizations along the border should be engaged early on as well.
3.	Set up appropriate governance, infrastructure, and funding mechanisms
The structure and governance of the U.S.-Mexico EPHT program should allow the program to be
flexible and responsive to new environmental health threats as they emerge, while also meeting
local community needs. Within the National EPHT program, for each state/city grantee a principal
investigator (PI) is required. Each PI is a member of a governance committee headed by the CDC,
and the governance committee discusses and votes on which topics will be part of the surveillance
system. Subject matter experts from the funded states/cities, along with other national experts,
form working groups on each topic and provide data recommendations to the governing committee.
The topics of each work group would depend on the priorities of the U.S.-Mexico EPHT program and
data availability. Adequate and consistent funding is essential to continue to develop data for
emerging environmental health threats, while maintaining existing infrastructure.
4.	Establish data sharing agreements (DSA) and/or memorandums of understanding (MOU)
Once the priority topics have been selected and accompanying data sources identified, it is crucial to
establish relationships with data stewards and determine the type of DSA and/or MOU necessary
when transferring and sharing data. Within the National EPHT Program, DSAs vary by grantee, data
steward, and data source. The National EPHT has developed templates for DSAs and MOUs that can
be shared and adapted for a U.S.-Mexico EPHT program.
5.	Develop consistent data and measures
To ensure consistent data by geography and over time, the National EPHT has developed nationally
consistent data and measures (NCDMs) that each grantee is responsible for compiling, submitting to
CDC, and displaying on each grantee website (or portal). For each NCDM, grantees developed
standard how-to-guides and other documentation that can also be shared and adapted for the U.S.-
Mexico program. In addition to NCDMs, each U.S. or Mexico state involved should have the
autonomy to compile and display data relevant to their specific population. This ensures that data
remain locally relevant, while also serving broader regional needs.
6.	Develop a web-based platform to disseminate data
One of the key successes for the National EPHT Program and all grantees was the development of a
website (i.e. portal) to publicly display and disseminate NCDMs. The National and State portals were
launched in 2009, and they continue to evolve as content is added and technology advances. EPHT
has been recognized as one of the first "open data pioneers" in its commitment to democratizing
data. This is done by providing an abundance of non-confidential data on the EPHT portals to the
public, extensive messaging on each content area, and information on how to use the data.
7.	Develop data communication, dissemination, and capacity-building strategies among stakeholders
In addition to web-based data dissemination, building the capacity of stakeholders to access,
understand, and utilize the data is an essential component of National EPHT's success. This may
include conducting trainings, demonstrations, and presentations targeted towards key stakeholder
groups. This is an extremely important function of environmental health surveillance, especially
when there is concern about misinterpretation or misuse of the data.
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Appendix
Appendix: Metadata for Health and Environmental Data Indicators
Health Indicators
Asthma
Indicator: Prevalence of asthma - California, U.S.
Definition
Lifetime prevalence of asthma
Dates
Available
2001-2011
Geography
State and county
Date Sources
& Availability
California Breathing, the California Asthma Surveillance Program, presents the asthma
prevalence indicators bv countv for adults and children http://www.californiabreathing.org/
Original data comes from the California Health Interview Survey (CHIS). Full CHIS survey results
are also available online: http://ask.chis.ucla.edu/main/default.asD
Format: PDF, CSV, Excel
Units &
Coverage
Units: Rate
Coverage: California - statewide
Notes & Data
Limitations
CHIS is a population-based telephone health survey designed to provide estimates for all
counties and major racial and ethnic groups. The survey covers both adults and children, every
two years. Self- report survey. No address level data.
Asthma
Indicator: Age-adjusted rates of hospitalizations & emergency department (ED) visits due to asthma - California,
U.S.
Definition
Emergency department (ED) visits and hospitalizations with a principle diagnosis of Asthma (ICD-
9: 493.0-493.9)
Dates
Available
ED: 2005-2012
Hospitalizations: 1998-2012
Geography
State, county, and zip code
Date Sources
& Availability
The Office of Statewide Health Planning and Development (OSHPD provides a comprehensive
source of hospital discharge information for all inpatient admissions statewide
California Environmental Health Tracking Program (CEHTP) utilizes OSHPD data to provide a data
query that allows the user to create tables, charts, and maps using data on hospitalization and
emergency department visits. Rates and counts are available by age group, race/ethnicity,
countv, and vear at www.cehtp.org/p/asthma.
Format: PDF, HTML, CSV, Excel, and JSON
Units &
Coverage
Units: Age-adjusted rate per 10,000
Coverage: California-statewide (except federal hospitals)
Notes & Data
Limitations
OSHPD annually compiles data from all hospitals to create the patient discharge database (PDD)
and emergency department (ED) database. Data are released annually.
There is a six month lag for the patient discharge and emergency department datasets. Patient
addresses are not reported; data are only collected by zip code.
Imperial County has a significantly smaller population than San Diego County, and when
comparing trends between the two, one should keep in mind that smaller populations
characteristically tend to be more statistically more volatile than large ones. A small numerical
49
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difference could result in a comparatively large percentage change.
Cancer
Indicator: Age-adjusted incidence rates of selected cancers - California, U.S.
Definition
Aggregated five year rate (2007-2011) of newly diagnosed (bladder, breast-female only, kidney,
leukemia, lung & bronchus, liver & bile duct, thyroid, and non-Hodgkin lymphoma) cancer cases
among all ages.
Dates
Available
1988-2012
Geography
State and county
Date Sources
& Availability
California Cancer Registry (CCR) collects information on cancer cases throughout California. The
CCR is California's statewide population-based cancer surveillance system.
Data on cancer in California are available at: http://www.ccrcal.org/. Data auerv produces maps
and tables by county and statewide.
Format: CSV, PDF
Units &
Coverage
Units: Age-adjusted rate per 100,000
Coverage: California-statewide (except federal hospitals)
Notes & Data
Limitations
Lag time between diagnosis and reporting. Data available by county and state only.

Cancer
Indicator: Crude incidence rate of malignant neoplasm of the breast - Baja California, Mexico
Definition
Rate of new cases of breast cancer in women aged 25 years and older.
Dates
Available
1995-2012
Geography
National and state
Date Sources
& Availability
Statistical data on morbidity are compiled and analyzed through the Sistema Nacional de
Vigilancia Epidemiologica- which is overseen by the Direccion General de Epidemiologia.
Reported for all first-secondary and third tier care facilities Data available annually.
One of the 110 reportable illnesses. Can query annual morbidity reports:
http://www.epidemiologia.salud.gob.mx/anuario/html/anuarios.html.
1.	Counts available for age group by state
2.	Population distribution available by age group by state
3.	Crude rates available by age group by state
Format: PDF
Units &
Coverage
Units: Rate per 100,000 women aged 25 years and older
Coverage: Nationwide
Notes & Data
Limitations
Data are not publicly available at the municipality level. Demographic data are limited

Heat Illness
Indicator: Age-adjusted rates of hospitalizations & emergency department (ED) visits due to heat - California,
U.S.
Definition
Hospitalizations & ED visits with a principle diagnosis of a heat-related illness
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Heat related ICD-9 principle diagnoses include:
992.0	Heat stroke and sunstroke
992.1	Heat syncope
992.2	Heat cramps
992.3	Heat exhaustion from water depletion
992.4	Heat exhaustion from salt depletion
992.5	Heat exhaustion, unspecified
992.6	Heat fatigue, transient
992.7	Heat edema
992.8	Other specified heat effects
992.9	Unspecified effects of heat and light
E900.0 Health effect caused by excessive heat due to weather (e.g. sunstroke/heatstroke)
E900.9 Effect from unknown cause of excessive heat

Only hospitalizations and emergency department visits occurring during May-September are
counted.
Dates
Available
ED: 2005-2012
Hospitalizations: 1998-2012
Geography
State, county, zip code
Date Sources
& Availability
The Office of Statewide Health Planning and Development (OSHPD) provides a comprehensive
source of hospital discharge information for all inpatient admissions statewide
California Environmental Health Tracking Program (CEHTP) utilizes OSHPD data to provide a data
query that allows the user to create tables, charts, and maps using data on hospitalization and
emergency department visits. Rates and counts are available by age group, race/ethnicity,
countv, and vear at www.cehtp.org/p/climate change.
Format: PDF, HTML, CSV, Excel, and JSON
Coverage
Units: Age-adjusted rate per 100,000
Coverage: California-statewide (except federal hospitals)
Notes & Data
Limitations
OSHPD annually compiles data from all hospitals to create the patient discharge database (PDD)
and emergency department (ED) database. Data are released annually.
There is a six month lag for the patient discharge and emergency department datasets. Patient
addresses are not reported; data are only collected by zip code.
Imperial County has a significantly smaller population than San Diego County and when
comparing trends between the two one should keep in mind that smaller populations
characteristically tend to be more statistically volatile than large ones. A small numerical
difference could result in a comparatively large percentage change.

Cardiovascular Disease
Indicator: Age-adjusted rates of hospitalizations due to myocardial infarctions (Ml) - California, U.S.
Definition
Hospitalizations with a principle diagnosis of myocardial infarctions (ICD-9: 410) for adults over
the age of 35.
Dates
Available
ED: 2005-2012
Hospitalizations: 1998-2012
Geography
State, county, zip code
Date Sources
& Availability
The Office of Statewide Health Planning and Development (OSHPD) provides a comprehensive
source of hospital discharge information for all inpatient admissions statewide.
California Environmental Health Tracking Program (CEHTP) utilizes OSHPD data to provide a data
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query that allows the user to create tables, charts, and maps using data on hospitalizations.
Rates and counts are available by age group, race/ethnicity, county, and year at
www.cehtp.org/p/heart attacks

Format: PDF, HTML, CSV, Excel, and JSON
Coverage
Units: Age-adjusted rate per 10,000 adults over the age of 35.
Coverage: California-statewide (except federal hospitals)
Notes &
Data
Limitations
OSHPD annually compiles data from all hospitals to create the patient discharge database (PDD)
and emergency department (ED) database. Data are released annually.
There is a six month lag for the patient discharge and emergency department datasets. Patient
addresses are not reported; data are only collected by zip code.
Imperial County has a significantly smaller population than San Diego County and when
comparing trends between the two one should keep in mind that smaller populations
characteristically tend to be more statistically volatile than large ones. A small numerical
difference could result in a comparatively large percentage change.

Cardiovascular Disease
Indicator: Crude Incidence rate of ischemic heart disease - Baja California, Mexico
Definition
Crude rate of new cases with a clinical diagnosis of ischemic heart disease (ICD-10:120-125).
Dates
Available
1995-2012
Geography
National and state
Date Sources
& Availability
Statistical data on morbidity are compiled and analyzed through the Sistema Nacional de
Vigilancia Epidemiologica, which is overseen by the Direccion General de Epidemiologia.
Reported for all first, secondary, and third-tier care facilities. Data available annually.
One of the 110 reportable illnesses. Can query annual morbidity reports:
http://www.epidemiologia.salud.gob.mx/anuario/html/anuarios.html.
1.	Counts available for age group by state
2.	Population distribution available by age group by state
3.	Crude rates available by age group by state
Format: PDF
Units &
Coverage
Units: Rate per 100,000 people over the age of 14
Coverage: Nationwide
Notes & Data
Limitations
Data not publicly available at the municipality level. Demographic data are limited.

Lead Poisoning
Indicator: Percent of children (aged less than 6yrs) tested with blood lead levels above 4.5 |ig/dL- California,
U.S.
Definition
Percent of children who have been screened (blood lead tested) for lead poisoning and had
blood lead levels greater than 4.5 ng/dL.
Dates
Available
2007-2011
Geography
State and county
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Date Sources
& Availability
These data are from the statewide database for childhood lead poisoning, the Response and
Surveillance System for Childhood Lead Exposures (RASSCLE II) maintained by the California
Childhood Lead Poisoning Prevention Branch.
http://www. cdDh.ca.gov/Drograms/clDDb/Pages/default.asDX
California Environmental Health Tracking Program (CEHTP) utilizes CLPPB data to provide a data
query that allows the user to create tables, charts, and maps using data on cancer rates. Rates
and counts are available bv countv, and vear at www.cehtD.org/o/lead
Format: PDF, HTML, CSV, Excel, and JSON
Units &
Coverage
Units: Percent
Coverage: California - statewide
Notes & Data
Limitations
Data is only for children screened and does not indicate the total burden of childhood lead
poisoning.

Maternal and Infant Health
Indicator: Percent of preterm births - California, U.S.
Definition
Number of babies born prior to 37 completed weeks of pregnancy.
Dates
Available
1998-2011
Geography
State and county
Date Sources
& Availability
These data are based on birth and death certificate records compiled by the California Center for
Health Statistics (CHSI), Office of Health Information and Research.
California Environmental Health Tracking Program (CEHTP) utilizes CHSI data to provide a data
query that allows the user to create tables, charts, and maps using data on preterm birth rates.
Rates and counts are available bv race/ethnicitv, countv, and vear at www.cehtD.org/o/mih.
Format: PDF, HTML, CSV, Excel, and JSON
Units &
Coverage
Units: Percent
Coverage: California - statewide
Notes & Data
Limitations
Currently, data only publicly available at the county and state level.

Maternal and Infant Health
Indicator: Percent of babies born with low birth weight - California, U.S.
Definition
Number of babies weighing less than 2,500 grams (about 5.5 pounds) born after 37 completed
weeks of pregnancy divided by the number of singleton births (i.e. no twins, triplets, etc.) born
after 37 completed weeks of pregnancy.
Dates
Available
1998-2011
Geography
State and county
Date Sources
& Availability
These data are based on birth and death certificate records compiled by the California Center for
Health Statistics (CHSI), Office of Health Information and Research.
California Environmental Health Tracking Program (CEHTP) utilizes CHSI data to provide a data
query that allows the user to create tables, charts, and maps using data on preterm birth rates.
Rates and counts are available bv race/ethnicitv, countv, and vear at www.cehtD.org/o/mih.
Format: PDF, HTML, CSV, Excel, and JSON
Units &
Units: Percent
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Coverage
Coverage: California - statewide
Notes & Data
Limitations
Currently, data only publicly available at the county and state level.

Maternal and Infant Health
Indicator: Percent of babies born with low birth weight - Baja California, Mexico
Definition
Number of babies born weighing less than 2,500 grams (about 5.5 pounds) born after 37
completed weeks of pregnancy divided by the number of live births born after 37 completed
weeks of pregnancy.
Dates
Available
2000-2009
Geography
National and state
Date Sources
& Availability
Raw data available through SINAIS
http://www.sinais.salud.gob.mx/descargas/zip/anuario2009.zip
Format: Excel
Units &
Coverage
Units: Percent
Coverage: Nationwide
Notes & Data
Limitations
Data not publicly available at the municipality level. Demographic data are limited.

Birth Defects
Indicator: Crude incidence rate of selected Birth Defects - Baja California, Mexico
Definition
Number of new cases with a clinical diagnosis of:
Anencephaly (ICD 10: Q00.0)
Spina Bifida (ICD 10: Q05)
Cleft Lip with cleft palate (ICD 10: Q05, Q35-Q37)
Dates
Available
1995-2012
Geography
National and state
Date Sources
& Availability
Statistical data on morbidity are compiled and analyzed through the Sistema Nacional de
Vigilancia Epidemiologica, overseen by the Direccion General de Epidemiologia. Reported for all
first, secondary, and third-tier care facilities. Data available annually.
One of the 110 reportable illnesses. Can query annual morbidity reports:
http://www.epidemiologia.salud.gob.mx/anuario/html/anuarios.html.
1.	Counts available by state
2.	Population distribution available by state
3.	Crude rates available by state
Format: PDF
Units &
Coverage
Units: Rate per 1,000 children under 1 year of age
Coverage: Nationwide
Notes & Data
Limitations
Data are not publicly available at the municipality level. Demographic data are limited.
Pesticide Exposure
Indicator: Pesticide Illness Reports -California	
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Definition
Number of pesticide illness cases.
Only cases classified as definitely, probably, and possibly related to pesticide exposure are
included.
A possible relationship indicates that health effects correspond generally to the reported
exposure, but evidence is not available to support a relationship.
A probable relationship indicates that limited or circumstantial evidence supports a relationship
to pesticide exposure.
A definite relationship indicates that both physical and medical evidence document exposure
and consequent health effects.
Dates
Available
1992-2012
Geography
State and county
Date Sources
& Availability
CalPIQ-California Pesticide Illness Query-retrieves data from the Department of Pesticide
Regulation's (DPR) Pesticide Illness Surveillance Program (PISP) database. CalPIQ is accessible at:
http://apps. cdDr.ca.gov/calDia/
Format: Excel
Units &
Coverage
Units: Counts
Coverage: California - statewide
Notes & Data
Limitations
Reporting is likely to be incomplete. The reporting systems are biased toward acute effects of
pesticide exposures rather than chronic effects.

Pesticide Exposure
Indicator: Crude incidence rate of Pesticide Intoxication-Baja California, Mexico
Definition
Rate of new cases with a clinical diagnosis of pesticide intoxication (ICD-10: T 60).
Dates
Available
1995-2012
Geography
National and State
Date Sources
& Availability
Statistical data on morbidity are compiled and analyzed through the Sistema Nacional de
Vigilancia Epidemiologica, overseen by the Direccion General de Epidemiologia. Reported for all
first, secondary, and third-tier care facilities. Data available annually.
One of the 110 reportable illnesses. Can query annual morbidity reports:
httD://www.eDidemiologia.salud.gob.mx/anuario/html/anuarios.html.
1.	Counts available for age group by state
2.	Population distribution available by age group by state
3.	Crude rates available by age group by state
Format: PDF
Units &
Coverage
Units: Rate per 100,000
Coverage: Reported by all first, secondary, and third-tier care facilities
Notes & Data
Limitations
Data are not publicly available at the municipality level. Demographic data are limited.

Coccidioidomycosis - Valley fever
Indicator: Incidence rate of Coccidioidomycosis- California, U.S.
Definition
Rate of confirmed coccidioidomycosis cases
Dates
Available
2001-2013
Geography
State and county
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Date Sources
& Availability
Valley fever is a reportable disease in California. The California Department of Public Health
(CDPH) maintains the reporting system for reportable communicable disease cases. An annual
summary of communicable diseases is released every year.
http://www. cdDh.ca.gov/healthinfo/discond/Pages/Coccidioidomvcosis.asDX
Format: PDF
Units &
Coverage
Units: Rate per 100,000
Coverage: California - statewide
Notes & Data
Limitations
Surveillance is passive and relies on reporting by clinicians and laboratories.

Border Deaths
Indicator: Migrant Deaths by border sector
Definition
Border crossing deaths located either inside the target zone or outside of the target zone if
Border Patrol was directly involved in the incident. The target zone includes 45 countries on or
near the border of CA, AZ, NM, and TX.
Border Patrol classifies deaths into sectors based on the Border Patrol station that recorded the
death
Dates
Available
1998-2014
Geography
Data reported by Border Patrol Sectors (9) which includes 45 counties on or near the border in
CA, AZ, NM, TX.
Date Sources
& Availability
U.S. Customs and Border Protection.
htto://www. cbD.gov/sites/default/files/documents/BP%20Southwest%20Border%20Sector%20D
eaths%20FY1998%20-%20FY2014 O.odf
Format: PDF
Units &
Coverage
Units: Counts
Coverage: The southwest border of the United States.
Notes & Data
Limitations
Very likely to be underreported. Only those deemed to be "border crossing" deaths and within
the target zone are counted. A border crossing death is a death that occurred while attempting
illegal entry. Definition of a border crossing death may be inconsistently applied across sectors.
Cause of death is not available publicly.
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Environmental Indicators
Basemap and Demographic Data - California, U.S.
Definition
Basemap data and a selection of other general GIS data relevant to the border area
Dates
Available
Various
Geography
Various
Data Sources
& Availability
•	Regional GIS Data Warehouse, San Diego Association of Governments (SANDAG):
http://www.sandag.org/index.asp?subclassid=100&fuseaction=home.subclasshome
•	GIS Library, Southern California Association of Governments (SCAG):
http://gisdata.scag.ca.gov/Pages/GIS-Librarv.aspx
•	TIGER/Line Shapefiles and TIGER/Line files, US Census Bureau:
https://www.census.gov/geo/maDS-data/data/tiger-line.html and
https://www. census.gov/geo/maDS-data/data/tiger-data. html
•	Available Data Layers, US- Mexico Border Environmental Health Initiative (BEHI):
http://borderhealth. cr.usgs.gov/datalavers. html
•	Map Files, Commission for Environmental Cooperation (CEC):
http://www.cec.org/Page.asp?PagelD=924&ContentlD=2336
•	U.S. population estimates available at Factfinder (U.S. Census Bureau):
http://factfinder.census.gov/
Units and
Coverage
Units: Various
Coverage: Nationwide
Notes & Data
Limitations
This is a small selection of the total available data.

Basemap and Demographic Data - Baja California, Mexico
Definition
Basemap data and a selection of other general GIS data relevant to the border area
Dates
Available
Various
Geography
Various
Data Sources
& Availability
•	Baja California BaseMap, Comision Nacional para el Conocimiento y Uso de la Biodiversidad
(CONABIO):
http://www.conabio.gob.mx/informacion/metadata/gis/bcaprgn.xml? httpcache=ves& xsl
=/db/metadata/xsl/fgdc html.xsl& indent=no
•	CONABIO also maintains a portal for dynamic data viewing and downloading (shapefile
format): http://www.conabio.gob.mx/informacion/gis/
•	Topographic Maps, Instituto Nacional de Estadistica y Geografia (INEGI):
http://www3.inegi.org.mx/sistemas/productos/ (search for cartas topograficas)
•	A catalog to look up dataset availability is found here:
http://www.inegi.org.mx/geo/contenidos/topografia/productos geograficos.aspx
•	Censo de Poblacion y Vivienda (2010), Sistema para la consulta de informacion censal,
Instituto Nacional de Estadistica y Geografia (INEGI):
http://www.inegi.org.mx/est/scince/scince2010.aspx
•	Available Data Layers, U.S.- Mexico Border Environmental Health Initiative (BEHI):
http://borderhealth.cr.usgs.gov/datalavers.html
•	Map Files, Commission for Environmental Cooperation (CEC):
http://www.cec.org/Page.asp?PagelD=924&ContentlD=2336
•	Roadways: available from INEGI via the Red Nacional de Caminos
(http://www3.inegi.org.mx/sistemas/biblioteca/ficha.aspx?upc=702825278724) or from
INEGI(http://www.inegi.org.mx/est/scince/scince2010.aspx)
•	Mexico 2010 population estimates at Censo de Poblacion y Vivienda 2010:
http://www.inegi.org.mx/sistemas/consulta resultados/iter2010.aspx
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Units and
Coverage
Units: Various
Coverage: Nationwide
Notes & Data
Limitations
This is a small selection of the total available data.

Air Quality
Indicator: County level Air Quality Index (AQI)- California, U.S.
Definition
Air Quality Index (AQI)
Dates available
1980-2015
Geography
State, city (selected cities), or county
Data Sources
& Availability
1980-2015: Air Quality Index Report at U.S. EPA
http://www.epa.gov/airdata/ad rep aai.html
Format: CSV
Units and
Coverage
Units: Air Quality Index, calculated using air monitor pollution measurements (categories: good,
moderate, unhealthy for some groups, unhealthy, very unhealthy)
Coverage: Nationwide, using applicable monitors in select locations (not all large cities have AQI
measurements)
Notes & Data
Limitations
Network of air monitors used to calculate AQI for areas is sparse in areas of Imperial County and
San Diego County.

Air Quality
Indicator: Air quality at sampling points - U.S. and parts of CA/BC border area
Definition
Air quality for contaminants sampled in Baja California, Mexico and California, U.S.
Dates
Available
2005-2015
Geography
Point locations
Data Sources
& Availability
EPA Air Quality System (AQS):
http://aasdrl.epa.gov/aasweb/aastmp/airdata/download files.html
Format: CSV
Units and
Coverage
Units: ppm or Air Quality Index (0 to >300, where >100 is harmful to certain groups)
Coverage: Nationwide (AQS)
Notes & Data
Limitations
Air sampling is sparse and imperfect.
Data in U.S. EPA file includes Baja California air monitors in Mexicali and Tijuana.
Additional resource: Cal EnviroScreen shows measures of specific air quality indicators, such as
ozone and particulate matter at the census tract level. Available statewide for California:
http://oehha.ca.gov/ei/ces2.html.

Air Quality
Indicator: Air quality at sampling points - Baja California, Mexico
Definition
Air quality for contaminants sampled in Baja California, Mexico and California, U.S .
Dates
Available
1997-2008 and 2011-2015
Geography
Point locations
Data Sources
& Availability
1997-2008: Calidad del Aire-Concentraciones historicas (Air Quality-Historical Concentrations),
Instituto Nacional de Ecologia y Cambio Climatico (INECC). Downloadable by city - not all cities
represented: http://www2.inecc.gob.mx/dgicurg/calaire/tend/horarias/concentra.php
Format: Excel
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2005-2015: Baja California Calidad del Aire (Air Quality):
http://www.spabc.gob.mx/dependencia/GestionAmbiental/id/404
Format: Not available for download. Displayed as values.
Units and
Coverage
Units: ppm or Air Quality Index (0 to >300, where >100 is harmful to certain groups)
Coverage: Baja California- statewide
Notes & Data
Limitations
Data for Baja California is also recorded by U.S. EPA monitors that are maintained by SEMARNAT.
Air sampling is sparse.

Air Quality
Indicator: Emissions inventory - California, U.S.
Definition
Locations of facilities emitting toxic and criteria air pollutants with amounts
Dates
Available
1987-2012
Geography
Point locations
Data Sources
& Availability
Facility Search Engine, California Air Resources Board (CARB)
http://www.arb.ca.gov/app/emsinv/facinfo/facinfo.php
Format: CSV
Units and
Coverage
Units: pollutant amounts in tons/year
Coverage: Nationwide
Notes and
Data
Limitations
Data may include gaps.

Air Quality
Indicator: Emissions inventory - Baja California, Mexico
Definition
Locations of facilities emitting toxic and criteria air pollutants with amounts
Dates
Available
2005
Geography
Point locations
Data Sources
& Availability
Inventario de Emisiones (Emissions Inventory), Secretaria de Proteccion al Ambiente, Baja
California:
Mexicali, general emissions inventory:
http://www.spabc.gob.mx/views/files/tmp/c5e078c89220bfa7ae9fcec643160531.pdf
Baja California, Greenhouse Gases
http://www.spabc.gob.mx/views/files/tmp/2b07fc4a8301d5e7fdca42c991333fcc.pdf
Format: PDF
Units and
Coverage
Units: Various
Coverage: Baja California- statewide
Notes & Data
Limitations
We know that this dataset is considered incomplete based on other work by the CEHTP in
Imperial County.

Climate Change
Indicator: Temperature and precipitation changes - California, U.S.
Definition
Temperature and precipitation changes
Dates
Available
1950-2099
Geography
raster data (surface)
Data Sources
1950-2099 (past and future projections)
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& Availability
•	Average, max, or min temperature by month or year
•	Available using 4 different models: CCSM3, CNRM, GFDL, and PCM1
•	Two emissions scenarios: A2 and B1
Cal-Adapt: http://cal-adapt.org/data/download/
Format: GeoTIFF, ASCII Grid
Units and
Coverage
Units: Temperature: degrees Celsius; precipitation: mm
Coverage: California-statewide
Notes & Data
Limitations


Climate Change
Indicator: Temperature and precipitation changes - Baja California, Mexico
Definition
Temperature and precipitation changes
Dates
Available
Temperature: 1923-2009
Precipitation: 1922-2008
Projections (Temperature & Precipitation): 2010-2099
Geography
Point locations: data by station and state (146 stations in Baja California)
Data Sources
& Availability
Northwestern Mexico's Climate Database. Programa Estatal de Accion ante el Cambio Climatico,
Baia California. Base de datos climaticos del noroeste de Mexico. http://peac-
bc.cicese.mx/datosclim/dcbc.php
•	Observed temperature (also available as max and min temperature): http://peac-
bc.cicese.mx/datosclim/descargardatos/BC/temperaturaGeneral.txt
•	Precipitation: http://peac-
bc.cicese.mx/datosclim/descargardatos/BCS/precipitacionGeneral.txt
Projections (under scenarios B1 and A2) for 2010-2099:
•	Annual average temperature (also available as max and min temperature): http://peac-
bc.cicese.mx/datosclim/images/images/unoSG.png
•	Annual average precipitation: http://peac-
bc.cicese.mx/datosclim/images/images/tresSG.png
Format: Text, PNG
Units and
Coverage
Units: Temperature: deg. C, precipitation: mm
Coverage: Northwestern Mexico, also includes modeling on U.S. side
Notes & Data
Limitations
More information: http://peac-bc.cicese.mx/
Data are available for the northwestern regions of Mexico.

Water
Indicator: Water Systems - California, U.S.
Definition
Drinking water system service areas
Dates
Available
Updated 2015
Geography
Water systems (polygons)
Data Sources
& Availability
Water Systems Geographic Reporting Tool, California Environmental Health Tracking Program:
http://cehtp.org/page.isp7page kev=762
Format: Shapefile
Units and
Coverage
Units: N/A
Coverage: California-statewide
Notes & Data
Limitations
Current water system boundaries recorded in the system cover over 90% of the population of
California, according to US Census data and geographic boundaries.
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Water
Indicator: Water quality - California, U.S.
Definition
Water quality indicators (drinking or otherwise)
Dates
Available
Updated October 2014
Geography
Census tract averaged water quality.
Data Sources
& Availability
Cal EnviroScreen 2.0, Office of Environmental Health Hazard Assessment
http://www. oehha.ca.gov/ei/ces2. html
Format: Shapefile, KML
Original water quality data at State Water Resources Control Board:
http://www.waterboards.ca.gov/drinking water/certlic/drinkingwater/EDTIibrarv.shtml
Units and
Coverage
Units: Drinking water contaminant index
Coverage: California-statewide
Notes & Data
Limitations
Methods for calculation of drinking water contaminant index available at OEHHA:
http://www.oehha.ca.gov/ei/pdf/CES20FinalReportUpdateOct2014.pdf

Water
Indicator: Water quality - Baja California, Mexico
Definition
Indicator relating to water quality (drinking or otherwise)
Dates
Available
2003-2013
Geography
Point locations where water quality is measured
Data Sources
& Availability
Surface water quality data at Sistema Nacional de Informacion del Agua, Comision Nacional del
Agua:
http://www.conagua.gob.mx/CONAGUA07/Contenido/Documentos/CALIDAD AGUA 2013.xlsx
Format: Excel file
Units and
Coverage
Units: map uses several indicators, listed and available here:
http://www.conagua.gob.mx/Contenido.aspx?nl=3&n2=63&n3=98&n4=98
Coverage: Nationwide
Notes & Data
Limitations
Further information may be available via the Subgerencia de Informacion Geografica del Agua
(SIGA): http://siga.cna.gob.mx/

Green Spaces
Indicator: Green areas, land cover- California, U.S and Baja California, Mexico
Definition
Green spaces determined by land cover data
Dates
Available
2009
Geography
Global raster data
Data Sources
& Availability
GlobCover, European Space Agency.
High resolution land cover data available for 2009 via Google Earth Engine
(https://earthengine.g00gle.0rg/#w0rkspace). Includes 22 land cover classes and a aualitv
assurance layer.
Original data available from the European Space Agency
(https://earth.esa.int/web/guest/home).
Units and
Coverage
Units: Land cover classes (by raster)
Coverage: Global
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Notes & Data
Limitations
Uses 22 land cover classes defined by the United Nations Land Cover Classification System and
used globally (http://www.fao.org/docrep/008/v7220e/v7220e00.HTM)

Green Spaces
Indicator: Green areas, recreational spaces - California, U.S.
Definition
Lands that are owned in fee and protected for open space purposes by almost 1,000 public
agencies or non-profit organizations.
Dates
Available
2014
Geography
Polygons
Data Sources
& Availability
California Protected Areas Data Portal: California Protected Areas Database (CPAD):
http://www.calands.org/data
Format: Shapefile
Units and
Coverage
Units: N/A
Coverage: California - statewide
Notes & Data
Limitations
These data are not determined using satellite data.

Green Spaces
Indicator: Green areas, recreational spaces - Baja California, Mexico
Definition
Green areas
Dates
Available
2010
Geography
Polygons
Data Sources
& Availability
Instituto Nacional de Estadistica y Geografia: Censo de Poblacion y Vivienda 2010: Sistema para
la Consulta de Informacion Censal (SCINCE version 05/2012) - servicios:
http://www.inegi.org.mx/est/scince/scince2010.aspx
Format: Shapefile
Units and
Coverage
Units: N/A
Coverage: Nationwide
Notes & Data
Limitations
These data are not determined using satellite data.

Pesticide Use and Crops
Indicator: Pesticide use - California, U.S.
Definition
Use of pesticides in defined geographic subdivisions
Dates
Available
2014
Geography
Polygons (area) by counties, townships, and sections
Data Sources
& Availability
Agricultural Pesticide Use Web Mapping Service, California Environmental Health Tracking
Program: http://www.ehib.org/tool.isp7tool kev=18
Format: Visual tool only
Units and
Coverage
Units: Summed pounds, acres treated, or pounds per acre of a given pesticide (or all pesticides)
Coverage: California-statewide
Notes & Data
Limitations
Original data for this tool are available from the California Department of Pesticide Regulation,
at http://www.cdpr.ca.gov/dprdatabase.htm assigned to Public Land Survev Svstem (PLSS)
subdivisions (http://www.blm.gov/ca/st/en/prog/cadastral/gcdbpage.html).
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Pesticide Use and Crops
Indicator: Cropland data - Baja California, Mexico
Definition
Crop land data
Dates
Available
N/A
Geography
Cropland data available at municipality level
Data Sources
& Availability
Several sources of information may be useful in learning about crop land:
•	Land use and vegetation from INEGI (includes varying types of agricultural usage but not
specific crop data): http://www.inegi.org.mx/geo/contenidos/recnat/usosuelo/
•	Crop data at municipality level from Servicio de Informacion Agroalimentaria y Pesquera
(SIAP): http://www.siap.gob.mx/cierre-de-la-produccion-agricola-por-cultivo/.
Units and
Coverage
Units: N/A
Coverage: Nationwide
Notes & Data
Limitations
Very little geospatial data is publicly available regarding pesticide use in Baja California.

T raff ic
Indicator: Traffic volume - California, U.S.
Definition
Annual Average Daily Traffic, or other comparable measure, for roadways
Dates
Available
2004 (current version - 2014 data will be available in the next version of the tool)
Geography
Traffic volume at a specific point
Data Sources
& Availability
Traffic Volume Linkage Tool, California Environmental Health Tracking Program
http://cehtp.org/page.isp7page kev=136
Format: Metrics available for a given point via web tool. Data in spreadsheet form by request.
Units and
Coverage
Units: Variety of units, related to AADT (annual average daily traffic count)
Coverage: California-statewide
Notes & Data
Limitations
CalEnviroScreen includes a traffic exposure relative score at the census tract level:
http://oehha.ca.gov/ei/ces2.html
California Department of Transit (CalTrans) data available here for major roadways at points
(shapefile) on the Caltrans Traffic Census database:
http://www.dot.ca.gov/ha/tsip/gis/datalibrarv/Metadata/AADT.html or in other file formats:
http://www.dot.ca.gov/ha/traffops/saferesr/trafdata/index.htm.
CalTrans data only includes roads of functional class 1, 2, and 3.
Most datasets only include major roads, or estimates of minor roadway traffic. In general, traffic
volume data is inconsistently sampled and often estimated.

T raff ic
Indicator: Traffic volume - Baja California, Mexico
Definition
Annual Average Daily Traffic, or other comparable measure, for roadways
Dates
Available
2004-2015
Geography
Traffic volumes at given points on roadways
Data Sources
& Availability
Traffic data are not dynamically available for Baja California. Sources list traffic data for major
roads to be joined with geographic roadway data (see basemap and demographic data section).
2004-2015: Datos Viales, Secretaria de Comunicaciones y Transportes
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http://www.sct.gob.mx/fileadmin/DireccionesGrales/DGST/Datos-Viales-

2015/02 BAJA CALIFORNIA.pdf with data guide:
http://www.sct.gob.mx/fileadmin/DireccionesGrales/DGST/Datos-Viales-

2015/00 INTRODUCCION.pdf

Format: PDF
Units and
Coverage
Units: TDPA (Transito diario promedio anual, or annual average daily traffic)
Coverage: Nationwide, major roads
Notes & Data
Limitations
Traffic data are limited and only major roadways are included. Private vendors, such as
TrafficMetrix (KSS Fuels) may provide geographically joined traffic data for Mexico.

T raff ic
Indicator: Documented border crossings - California-Baja California border
Definition
Border crossings at the California-Baja California border
Dates available
1995-2014
Geography
Available at border crossing points
Data Sources
& Availability
U.S. Department of Transportation, Bureau of Transportation Statistics Border Crossing/Entry
Data. Query Detailed Statistics:
http://transborder.bts.gov/programs/international/transborder/TBDR BC/TBDR BCQ.html

Format: CSV

Locations of border crossings given via RITA National Transportation Atlas Database:
http://www.rita.dot.gov/bts/sites/rita.dot.gov.bts/files/publications/national transportation at

las database/2012/index.html
Format: Shapefile
Units and
Coverage
Units: Number of [vehicle or person units: trucks, loaded trucks containers, empty truck
containers, trains, loaded rail containers, empty rail containers, train passengers, buses, bus
passengers, personal vehicles, personal vehicle passengers, pedestrians] per [time unit: month
or year] per border crossing
Coverage: All border crossing points
Notes & Data
Limitations
Data comes from U.S. authorities (crossings from Mexico into the U.S.).
Average border crossing wait times available at third party site:
http://traffic.calit2.net/border/border-crossing-wait-times-map.php#

Current border crossing wait times available here: http://bwt.cbp.gov/

Toxic Sites
Indicator: Toxic sites - California, U.S.
Definition
Locations of facilities emitting toxic substances
Dates
Available
1987-2013
Geography
Point locations
Data Sources
& Availability
Toxic release Inventory (TRI), U.S. EPA http://www2.epa.gov/toxics-release-inventorv-tri-
program/tri-basic-data-files-calendar-vears-1987-2013
Format: CSV
Units and
Coverage
Units: N/A
Coverage: Nationwide
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Notes & Data
Limitations
There are missing locational data in both KML and CSV files for California.
Toxic Sites
Indicator: Toxic sites - Baja California, Mexico
Definition
Locations of facilities emitting toxic substances
Dates
Available
2004-2013
Geography
Point locations
Data Sources
& Availability
Registro de Emisiones y Transferencias de Contaminantes (RETC), SEMARNAT:
http://appl.semarnat.gob.mx/retc/retc/index.php
Format: Excel with DMS lat/long coordinates
Units and
Coverage
Units: N/A
Coverage: Nationwide
Notes & Data
Limitations
Number of sites calculated according to registration information, i.e., if a city was listed.
However, some locations have no city listed but may still be located within a city boundary.
Therefore, numbers may be slight underestimates
RETC data includes brief description of site, for example: Fabricacion de equipo no electronico
para uso medico, dental y para laboratorio (manufacturing of non-electric dental, medical, and
lab equipment), Transporte por ductos de productos refinados del petroleo (duct transport of
refined petroleum products), Fabricacion de herrajesy cerraduras (manufacturing of ducts and
locks), Fabricacion de envases de carton (manufacturing of cardboard boxes).
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