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U.S. EPA-BHC
COLLABORATIVE AGREEMENT
ACCOMPLISHMENTS REPORT
Summary
This report summarizes the efforts completed under a 2015-2016
collaborative agreement between the U.S. Environmental Protection
Agency (U.S. EPA), U.S.-Mexico Border 2020 Program and the U.S.
Section of the U.S.-Mexico Border Health Commission (BHC), U.S.
Department of Health and Human Services. The work accomplished
under this agreement from September 2015 to September 2016 include
the following highlights:
•	Providing medical information and advice on environmental
conditions that influence children's health along the border
through the Pediatric Environmental Health Speciality Units.
•	Conducting 6 promotores training courses over the past year in 6
cities along the Border covering a range of topics including
asthma, pesticides, lead, water, and climate change. Two
Children's Environmental Health Symposia addressed vector-
borne disease including Rocky Mountain spotted fever and Zika.
•	Leveraging binational expertise through active support and
participation of EPA's Task Forces in meetings, sharing and
reporting out on meeting discussion with stakeholders.
•	Compiling environmental health data in a 2015-2016 report for the
Arizona-Sonora border region.
Background
EPA and the BHC have committed to working more closely to advance
environmental health priorities in the U.S.-Mexico Border Region.
The collaborative agreement addresses some of the Border 2020
program fundamental strategies such as working to improve children's
health and promoting environmental health. Since 2011, EPA and the
BHC have worked to identify joint priorities and possible areas of
collaboration. EPA and the U.S. Section of the BHC officially
launched the 2015-2016 agreement in September 2015 during the
National Coordinator's Meeting and it can be found on the Border
2020 website. Key actions within the agreement include intra-agency
collaboration during Border Binational Health Month (BBHM) in
October, Children's Environmental Health Symposia, a State of the
Border Environmental Health Report (to document status and trends),
promotora trainings, and building environmental health capacity.

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Program Collaboration
Opportunities
The collaborative agreement identified three
program areas and ten project priority areas
as collaborative opportunities.
Program Areas of Collaboration
1.	Public Health and Environmental
Leadership
2.	Building Environmental Health Capacity
3.	Strengthening Institutional Resiliency
and Accountability
Project Areas of Collaboration
1.	Lead Environmental Health Efforts in
the Border Region
2.	Leaders Across Borders
3.	Chemical and Pesticide Exposure
Prevention
4.	Pediatric Environmental Health
Specialty Units
5.	C ommunity-b ased Health B order
Initiatives
6.	Air Quality and Asthma Education
Awareness
7.	Climate Change
8.	Identify Project Funding and Leveraging
Opportunities
9.	Leverage Binational Expertise and
Resources
10.	Develop Public Access to Environmental
and Public Health Data
A number of the project areas for
collaboration are at different stages and will
continue to be an essential part of the newly
revised collaborative agreement.
Accomplishments
The summaries below provide details of
accomplishments achieved under the 2015-
2016 collaborative agreement. The highlights
presented include the following general
topics: chemical and pesticide exposure,
education and outreach efforts,
environmental and health data.
Chemical and Pesticide Exposure
Prevention
EPA and BHC have partnered with border
communities on numerous occasions over the
past few years to develop strategies to
identify sources of chemical and pesticide
exposure and to implement programs to
reduce exposure to lead, mercury, pesticides,
and heavy metals in the environment. Efforts
have included pesticide inspector training,
pesticide safety classes for promotores, and
stakeholder outreach. See descriptions
below.
Worker Protection Standard
implementation in Pauma Valley - Train
the Trainer Workshop for Promotores
On May 5, the Pesticides Office conducted a
Train the Trainer workshop on Pesticide
Safety for approximately twenty-five
promotores (Community Outreach/Health
Workers) in Pauma Valley, CA. The
interactive four-hour session focused on the
revisions to the Worker Protection Standard,
highlighting the importance of preventing
pesticide exposure and using an Integrated
Pest Management approach to control pests
in the home. Also participating were
representatives from the California
Department of Pesticide Regulation, the San
Diego County Agricultural Commissioner's
Office, the California Agricultural Labor
Relations Board, and the University of
California Pesticide Safety Education
Program. The goal of this training is to
inform the farmworker community about the
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safety provisions under the Worker
Protection Standard, and to empower them to
report pesticide illness and noncompliance
with the WPS to the local regulatory agency.
The event was organized in partnership with
the California Department of Public Health
Office of Binational Border Health and the
National Latino Research Center at
California State University San Marcos.
Making a Visible Difference in
Communities - Worker Protection and
IPM in Imperial County: The EPA Region
9 Pesticides Office held two outreach events
in Imperial County on May 4, 2016. The first
was for the Farmworker Services Coalition of
Imperial County on the revised Worker
Protection Standard (WPS). Hosted by the
California Employment Development
Department in El Centro, the event included
representatives from various state and local
agencies, as well as the regulated community.
An inspector from the Imperial County
Agricultural Commissioner's Office was also
in attendance to answer questions about local
pesticide use enforcement. The second event
was held at Brawley High School, where
approximately 60 students learned about
EPA, Integrated Pest Management, and some
of the key changes in the WPS that directly
impact their community.
Worker Protection outreach in Yuma, AZ:
At an event hosted by the Mexican Consulate
on May 2, the Pesticides Office presented
information on the revised Worker Protection
Standard (WPS) to representatives from
various community organizations, agencies,
and the regulated community. An inspector
from the Arizona Department of Agriculture
was in attendance to address specific local
enforcement questions.
Making a Visible Difference in Imperial
County - Reducing Exposure to Pesticides
Approximately 25,000 lbs. of pesticides and
their containers were collected from over 30
growers in the Imperial Valley on May 26,
2016. EPA supported the effort with
$150,000 awarded to the California
Department of Pesticide Regulation (DPR)
through its continuing Pesticide Cooperative
Agreement. The Imperial County
Agricultural Commissioner's Office
conducted the event, preventing exposure to
unwanted pesticides and pesticide containers
in this community.
Air Quality and Asthma Education
EPA and BHC committed to working with
BHC to build environmental health capacity
on asthma triggers, air quality, and asthma
education and awareness. Examples of such
projects are described below.
EPA Contributes to Success of 6th Annual
Imperial Valley Environmental Health
Leadership Summit
Approximately 300 community members and
representatives from federal, state, local, and
tribal agencies participated in the 6th Annual
Imperial Valley Environmental Health
Leadership Summit. Matthew Tejada,
Director of the EPA Office of Environmental
Justice, represented EPA in a panel
discussion on how government agencies can
make a visible difference in communities
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through environmental justice. Mr. Tejada
spoke of the importance of partnerships
across levels of government and
organizations to help cultivate healthy and
sustainable neighborhood solutions. The
panel also included leaders from the
California Department of Toxic Substances
Control (DTSC), Physicians for Social
Responsibility, and CalEPA. The Summit
took place at Brawley Union High School in
Imperial Valley, an EPA "Making a Visible
Difference" community. Summit topics also
covered asthma, climate change, the Salton
Sea, pesticides, and citizen science.
Francisco Donez of EPA Region 9 co-led a
workshop on diesel pollution health impacts
and emissions reduction programs. Between
sessions, Mr. Donez also staffed an outreach
booth to share related information and
materials to summit participants. EPA also
contributed contractor support for
multimedia, workshop supplies, summary
and evaluation, and implementation logistics.
Priyanka Pathak of the EPA Region 9 Air
Division and Jeremy Bauer of the EPA San
Diego Border Office participated in planning
calls and served as moderators during the
summit.
Imperial Valley Child Asthma Program
(IVCAP)
childcare centers and outreach at 17 health
fairs and community events were held. EPA,
IVCAP, El Centro Regional Medical Center
(ECRMC), and Border Environment
Cooperation Commission (BECC) supported
the $55,000 program and the project were
completed in February 2016.
Environmental Health and Asthma
Awareness in Low-income Housing
Communities of Imperial County
The Imperial Valley Child Asthma Program
(IVCAP), under a $98,518 EPA-funded
Border 2020 grant, is convening community
environmental health and asthma awareness
fora to build asthma management capacity in
low income communities in Imperial County.
To date, IVCAP has convened four fora
through which they have enrolled 21 families
into one-on-one asthma intervention sessions
and provided 13 referrals to asthma
specialists. Under the same grant, IVCAP has
also begun planning workshops to train
maintenance workers to recognize and
address asthma triggers in low income
housing. IVCAP is working directly with the
Brawley Housing Authority District and
Calexico Housing Authority to organize the
training workshops and reach the appropriate
staff and maintenance workers. All activities
are expected to be completed by March 2017.
Environmental Health Promotor
Workshops
EPA staff planned a series of outreach and
education efforts for 2015 and 2016 on
environmental health along the U.S.-Mexico
Border in collaboration with the BHC, the
Border Environment Cooperation
Commission (BECC), and the California
Department of Public Health (CDPH), with
support from the PEHSU. These efforts
included a series of one-day workshops
designed for "promotores" or community
health workers. Topics included
The	Healthy
Breathing Healthy
Homes Project aims
to improve childhood
asthma outcomes by
providing home
assessments and
education to 106 low-
income families in eight target communities
about managing indoor asthma triggers. This
project also provided Healthy Homes training
for 30 community health workers and
promotores. In addition, 158 participants
attended a Stop and Listen Asthma Forum on
November 19, 2016. As part of this program,
19 asthma 101 information sessions at
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indoor/outdoor air quality and asthma
triggers, pesticides exposure, lead exposure,
water quality, and climate change. During
these interactive workshops, participants
learned about the connection between
environmental exposures and health and how
to identify and address environmental health
risks commonly found in communities near
the U.S.-Mexico Border. The workshops also
included group activities to facilitate
exchange of information and ideas among
attendees and to encourage professional
networking. Attendance exceeded
expectations and attendees included
promotores from both the U.S. and Mexico.
Simultaneous interpretation was provided.
The training was well-received, and
participants requested that EPA follow up
with additional training and information,
potentially through a regular newsletter.
Training materials are available on the
Border 2020 website.
Dates of the workshops: August 24, 2016 in
Harlingen, Texas; September 1, 2015 in
Chula Vista, California; September 2, 2015
in El Centro, California; September 11, 2015
in El Paso, Texas; September 15, 2015 in
Nogales, Arizona; and September 29, 2015 in
McAllen, Texas.
Launching a Healthy Homes Initiative in
Harlingen
Through funding from EPA Region 6's Lead
Based Paint and support from the Children's
Health and US-Mexico Border Programs,
three border communities were able to
receive Healthy Homes Training in 2016.
The trainings, which were provided by a
small grant to the University of Texas School
of Health Science Center in Houston, took
place in June (El Paso, Texas) and August
(McAllen and Harlingen, Texas).
Approximately 103 persons received the
training in these communities. Unlike the El
Paso and McAllen trainings which focused
on the initial "Healthy Homes Training"
Curriculum, persons who attended the
Harlingen training received training on "How
to start a Healthy Homes Initiative in your
Community". The training covered materials
that empowers stakeholders who have
already taken the initial Healthy Homes
training with tools that they can use to launch
a healthy homes program within their
community.
Border Binational Health Month (BBHM)
Border Binational Health Month (BBHM)
will be held during the month of October.
The U.S.-Mexico Border Health Month's
goal is to promote sustainable partnerships
that can address border health challenges.
Anticipated outcomes include increased
community and inter-agency networking
relationships, information sharing and
educational opportunities, and awareness of
the BHC and other state and local initiatives.
Border Environmental Health Data
Compilation
One of the key priority actions identified
during the development of the collaborative
agreement was the development of a "State
of the Border Environmental Health Report"
to document status and trends.
Border 2020 Grantees Identify Trends,
Opportunities for Improvement in
Environmental Health Data in the
California-Baja California and Arizona-
Sonora Border Regions
In 2014 and 2015, Border 2020 awarded
grants to two organizations to compile and
assess existing environmental health data in
the California-Baja California and Arizona-
Sonora border regions, respectively. Grant
awardees were charged with compiling and
analyzing existing border environmental
health data, creating a comprehensive
snapshot of border environmental health in
the region, and making recommendations on
how to obtain additional data and coordinate
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with Mexico on data gaps. The Public Health
Institute submitted their final report on
California-Baja California on August 10,
2015. The report found that air pollution
continues to be a pervasive hazard in the
border region with myriad sources, such as
traffic, industrial pollutants, unpaved roads,
and a drying inland seabed.
Asthma emergency room visits,
hospitalization rates, and childhood asthma
prevalence are consistently higher in Imperial
County compared to the rest of California.
Rates of clinical asthma diagnosis have been
increasing in Baja California, while rates in
Mexico have held fairly steady.
Moreover, 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.
The Sonora Environmental Research
Institute, Inc. (SERI), is currently finalizing
its report, awarded under a 2015 grant.
Preliminary findings note an overall decrease
in blood lead levels in children living in all
four Arizona counties in the border region
between 2005 and 2015. However, data were
based on a low screening rate (around 20%)
and the state has plans to increase the
screening rate to 85%. The findings also
noted that approximately 4 percent of
children attending schools in the Arizona
border region are served by a water supply
with at least one Safe Drinking Water Act
violation. Additional information is needed
to assess those served by private wells (5
percent of the population).
Work continues to evaluate information on
additional areas of concern including
mercury, pesticides poisoning, air quality,
asthma rates, and asthma hospitalizations in
the border regions of Arizona and Sonora.
Reports included recommendations for
improving future data collection to maximize
data availability and utility including
identifying and engaging diverse bi-national
stakeholders, establishing data sharing
agreements, and developing consistent data
and measures.
Dr. Aminata Kilungo, lead investigator and
Director of Research and Development for
SERI, presented these and other preliminary
findings in January 2016 at the EPA-
sponsored U.S.-Mexico Border Symposium
on Protecting Children's Environmental
Health. The final report is anticipated by
February 2017.
Children's Environmental Health
Symposiums
In January 2016, a children's environmental
health symposium took place in San Diego,
California. The intended audience for these
sessions were health care providers,
academics, community health workers,
policy makers, social workers, and
community leaders. Several other Children's
Health Symposiums were held including
Brownsville, Texas on August 25, 2016,
Mexicali, Baja California on September 27,
2016 and Nogales, Sonora on October 14,
2016. These symposiums will have a focus
on vector borne diseases, including the Zika
Virus.
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U.S. EPA, Partners Convene Symposium
to Discuss Children's Environmental
Health Risks in U.S.-Mexico Border
Region and Identify Solutions
U.S. EPA, in collaboration with the Agency
for Toxic Substances and Disease Registry,
BECC, the U.S.-Mexico Border Health
Commission, the California Department of
Public Health, and other partners held a 1.5-
day symposium: Protecting Children's
Environmental Health in the U.S.-Mexico
Border Region, on January 27-28, 2016 in
San Diego, California. The symposium
featured six plenary presentations, six sets of
Attendees participating in one of six plenary sessions.
136 attended the symposium.
concurrent presentations, and a poster
session. Topics included government and
community based initiatives, fundamentals of
federal grants, ongoing challenges in border
communities, including air quality, water
quality, climate change, and vector-borne
diseases, industrial pollution, environmental
asthma triggers, pesticides, lead, mercury,
and toxic chemicals in personal care
products.
The EPA invited symposium attendees to
participate in a 3-hour facilitated roundtable
discussion after the symposium's closing
session to identify actionable
recommendations to help guide future
collaborative work in the border region. The
session generated 42 recommendations by
L
Protecting Children's
Environmental Health
January 27-28. 2016
Symposium organizers Jackie (left) and Jeremy (right).
more than 40 symposium attendees.
Symposium presentations, proceedings, and
a summary of the roundtable discussion are
available at the Border 2020 website.
Brownsville Symposium
Over 130 doctors, nurses, promotoras, and
public health professionals attended a one-
day event on August 25, 2016 in Brownsville,
Texas in the second children's health
symposium sponsored by EPA Region 6.
Thirty experts presented on issues such as
asthma, lead and mercury exposure, climate
change impacts on children's health and a
dozen other topics.
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EPA, partners convene binational
symposia exploring environmental and
health aspects of vector-borne disease
On September 27, 2016 the EPA Region 9
U.S.-Mexico Border program and the
Autonomous University of Baja California
convened a binational environmental health
symposium in Mexicali, Baja California
focused on vector-borne disease, including
Zika virus, in collaboration with Border 2020
partners, CDC and their Mexican
counterpart, CENAPRECE, among others.
On October 14, the EPA Border program
convened a similar symposium in Nogales,
Sonora at the Technical Institute of Nogales,
organized in collaboration with El Colegio de
la Frontera Norte (COLEF), and other Border
2020 partners, again including CDC and their
Mexican counterpart, CENAPRECE, among
others.
Speakers at the two symposia included over
30 experts from the U.S. and Mexico, and
over 360 attended, including medical
students, faculty, health practitioners, and
government officials among them. Session
topics included preventative measures to
combat Zika, integrated pest management,
and adaptation to the spread of vectors due to
climate change. In his opening remarks, Jeff
Scott, Director of the EPA Region 9 Land
Division, asked participants to commit to
addressing sources of vectors by keeping
their homes and environment clean and free
of trash and standing water. Mr. Scott also

Students sign pledge poster committing to keep their homes
and environments clean and free of trash and standing
water to prevent the spread of mosquitos.
asked participants to pass on their new
knowledge in the weeks and months
following the symposium to their colleagues,
family, and community. In evaluations for
the events, 98 percent of respondents
indicated that they learned something new,
and more than 95 percent said that they intend
to share their new knowledge. The EPA
Border Office will send a follow-up
evaluation to attendees to confirm
symposium outcomes and follow-through.
The agendas and presentations are available
online at the Mexicali and Nogales symposia
websites.
¦
Jeff Scott, Director of Land Division, EPA Region 9,
welcomes symposium participants and discusses his
hopes for the event.
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