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In this essay we will discuss the phenomenon of globalization as it relates to health. We will focus part of our reflections on one of the most dynamic regions of the planet: the United States and Mexico border, the largest and busiest frontier between the developed and the developing worlds, witness to at least one million crossings every day. [ABSTRACT FROM AUTHOR]

The research reported in this volume makes it clear that the causes and potential consequences of differential patterns of morbidity and mortality among African- Americans, Hispanics, and Asians are complex, and as yet incompletely understood. Perhaps the only categorical summary statement that one might make concerning the health of older Hispanics is that despite continuing socioeconomic disadvantages, Hispanics, like all other Americans, are living longer and in most cases healthier lives than in previous decades. Yet not all is well, and despite longer life spans, the research reported in this volume reveals that Hispanics and other minority Americans suffer significant morbidity and disability as the result of preventable causes that have their origin in the complex nexus of genetics, lifelong socioeconomic disadvantage, the exposure to environmental and social health risks, and inadequate medical care. Increased longevity in the presence of significant illness and disability means that older Hispanics have elevated levels of need for medical and social services that in many cases are not being addressed. [ABSTRACT FROM AUTHOR]

One of the most important challenges facing health systems is population aging. International estimates suggest that the aging process will increase the cost of health by 41% between 2000 and 2050, so that health spending could reach 11% of work GDP (United Nations, 2002). [ABSTRACT FROM AUTHOR]

One-fifth of the U.S. adult population does not have health insurance coverage and it is projected that the ranks of the uninsured will continue to grow due to increasing health care costs and rising health insurance premiums (DeNavas-Walt, Proctor and Lee, 2005; Gilmer and Kronick, 2001; Rowland, 2004). The U.S. uninsured population is not only relatively large (almost 46 million people) but it is not homogenously distributed across states and communities. Incidentally, the four Southwestern border states, California, Arizona, New Mexico, and Texas, are also the only states where the percentage of the total state population without health insurance coverage exceeds 18%. [ABSTRACT FROM AUTHOR]

In 2000, 35 million Hispanics resided in the U.S., an increase of 50% since 1990; 60% were of Mexican origin. By 2035, the Hispanic population is expected to comprise 20% of the U.S. population and 60% of the Texas population, making it the largest minority group (U.S. Census Bureau, 2001). Twenty-one percent of the U.S. population lives in border states. More than a third of these individuals, mostly minorities, live in medically underserved border communities characterized by poverty, pollution, and deprivation (U.S. Department of Health and Human Services, 2003). Starr County, the site of our previous diabetes intervention studies, is a Texas-Mexico border community that is the poorest county in Texas and one of the poorest in the U.S. (Texas Department of Health (TDH), 2002b). Starr County is representative of many border areas: The unemployment rate is 22%, almost six times that of the rest of the state. The ratio of population per general/family practiceMDis 7,657:1, compared to 3,789:1 for the rest of the state; the registered nurse ratio is 851:1, compared to 159:1 for the state (TDH, 2002b). [ABSTRACT FROM AUTHOR]

As the number of persons of Mexican descent in the United States has grown to more than 25 million, of whom more than 10 million were born in Mexico (U.S. Census. Bureau, 2005), the availability of medical care to this population and their relatives in the U.S. and in Mexico has increased in importance. Both in the U.S. and in Mexico there is increased attention to the issue of providing health insurance coverage for persons across borders and for families who may be separated by international borders or who commute across borders to work or who choose to live part of their lives in both countries. The availability of coverage may determine not only use of health care provider but also may have a significant impact on where individuals choose to live and to retire. Accordingly, it is worth reviewing some of the literature on cross border utilization of care and some of the cross border coverage initiatives that both the private sector and the Mexican government have initiated. The development of more seamless and transparent entitlements and responsibilities may be one necessary initiative to enhance the quality of life of aging populations in the U.S. and in Mexico. [ABSTRACT FROM AUTHOR]

The burgeoning of the aging population has been well documented (Rice and Feldman, 1983; Manton, 1991). In 1990, 12.7% of Americans were over the age of 65. By the year 2030, the total number of elderly over 65 is expected to be 64.6 million. The over 85-group is the fastest growing segment in the population with the number of centenarians (age 100 and older) also rapidly increasing. By the year 2050, this older cohort, 85 and older, is expected to comprise of 5.2% of the total population (U.S. Census, 1983). [ABSTRACT FROM AUTHOR]

The Latino population in the United States represents one of the most rapidly growing and dynamic racial and ethnic groups in the country. For example, the Latino population in the U.S. increased by 58% between 1990 and 2000 compared to a growth of only 13% in the nation's overall population (Saenz, 2004). However, the Latino population, especially the Mexican and Puerto Rican populations, has consistently been close to the bottom of the socioeconomic hierarchy of the United States. Indeed, Mexicans have the lowest educational level among the major racial and ethnic groups in the country, while also, along with Puerto Ricans, having relatively high levels of poverty. [ABSTRACT FROM AUTHOR]

According to the year 2000 United States Census data, individuals from diverse racial and ethnic backgrounds are increasing, both in their absolute numbers and in their proportion to the general population. Among the elder population, the Latino population is projected to grow the fastest (Administration on Aging, 2000). In absolute numbers, it is expected that there will be over 13 million Latino elders by the year 2050. This would constitute or a change from 6% in 2003 of the population 65 and older, to 18% by 2050 (Federal Interagency Forum on Aging- Related Statistics, 2004). From this group, it is estimated that at least 4.5 million Latino elders will require Long-Term Care (LTC) (Markides, Rudkin, Angel, and Espino, 1997). [ABSTRACT FROM AUTHOR]

In this chapter the aim is to explore briefly how Mexican low-income households traditionally care for their elderly parent populations and to examine the intersection between changing demography, household structure, tenure, and dwelling arrangements. This chapter will inform how we start thinking about housing and parental care dynamics and the way they may be changing with the demographic changes of the last few decades. The demographic transition that began in the 1970s shifted the population age structure from one of heavy dependency of the young from the 1960s through 1980s to one in which dependency ratios are shared more equally between young and the older cohorts. Who will care for the elderly given the low level of formal care provision offered by the formal sector for the elderly in Mexico? In particular, how will low-income households earning less than the equivalent of $10 a day support and provide for their parents in old age? [ABSTRACT FROM AUTHOR]

Between Mexico and the United States there is a border more than 3,200 kilometers long. It is not only a political division between two countries, it also marks the encounter between development and underdevelopment, where two different cultures and lifestyles meet. In an apparent paradox, strong interrelations across the border are generated not in spite of differences but because of such disparities. Relationships go from north to south and from south to north. The intensity and regularity of these short-distance international relations characterize the life of the region in all aspects, from big business to family economy, permeating social perceptions and creating a new culture, driving demographics, and affecting health outcomes. In fact, the border as a division is at the same time a shared space that imposes special conditions on very concrete situations and problems that deserve bi-national attention and policies. [ABSTRACT FROM AUTHOR]

TheWorld Health Organization (WHO) defines the elderly as people aged 60 and older and reports that there are about 600 million elderly people in theworld(WHO, 1999). However, according to demographic projections, by the middle of the current century this number will increase to 2 billion. The situation in Latin American countries is similar; in the year 2025 there will be almost 40 million elderly people (WHO, 1999; PAHO, 2002a,b). In Mexico, statistics from the national census (INEGI, 2000) revealed that in the year 2000 there were almost seven million people 60 and older; and according to demographic projections, in the year 2050 one in every four Mexicans will be in this age group (CONAPO, 2001; Tuiran, 1999). Falling fertility and mortality rates and emigration to the Unites States account for Mexico's rapidly aging population. Increasing numbers of elderly people represent one of the most important challenges for Mexico, particularly with respect to health. [ABSTRACT FROM AUTHOR]

Numerous studies have shown that transfers of privately held resources across generations of the vertically extended family are common but vary in type and intensity with age and the life-cycle stage of the donor and/or recipient. Although resources typically flow from parent to child regardless of age in the United States, middle-aged adults have a heightened and substantial risk of making transfers to their kin in both ascending and descending generations. [ABSTRACT FROM AUTHOR]

In the United States the impact of socioeconomic status on racial and ethnic mortality differentials is undeniable. Researchers have consistently found that groups with higher levels of socioeconomic status, namely whites and Asian Americans, have better mortality outcomes than those with lower overall socioeconomic status, such as blacks and American Indians (e.g., Elo and Preston, 1996; Hayward, Miles, Crimmins, andYang, 2000; Hummer, Benjamins, and Rogers, 2004; Kitagawa and Hauser, 1973; Molla, Madans, and Wagener, 2004; Pappas, Queen, Hadden, and Fisher, 1993; Rogers, Hummer, and Nam, 2000). Indicators of socioeconomic status including income, education, employment status, occupation, and wealth have been found to be strongly associated with mortality risks among a variety of different populations and across time. [ABSTRACT FROM AUTHOR]

Race/ethnic differences in mortality constitute a fundamental form of inequality in the United States. Black Americans live fewer years than whites, and the disadvantage for blacks in chances for long life is a long-term historical pattern. National mortality estimates for Hispanics show that longevity of individuals in this group is equivalent to and sometimes exceeds those for whites, despite Hispanics' stark socioeconomic disadvantages (National Center for Health Statistics 2001). Trend data for Hispanics spanning several decades are not available. [ABSTRACT FROM AUTHOR]

Elderly Mexican Americans are one of the fastest growing groups of elderly in the United States. It is estimated that by 2050 older people of Mexican origin will constitute more than one million persons (Day, 1996). The rapid growth of the Mexican American population in the U.S. is due in part to immigration (Stephen, Foote, Hendershot, and Schoenborn, 1994; Larsen, 2004). Many of the elderly in this ethnic group migrated from Mexico in their youth, yet few studies have evaluated the long-term effects of migration on health status in old age. Some research (Angel, Buckley, and Sakamoto, 2001; Buckley, Angel, and Donahue, 2000) has suggested that duration of residence in the U.S. may be associated with changes in health status and that there may be gender differences in the effects of migration. [ABSTRACT FROM AUTHOR]

It has long been recognized that nativity status may have a strong relationship to health (Marmot, Adelstein, and Bulusu, 1984; Kasl and Berkman, 1983). Evidence from United States data sources shows that immigrants have generally lower agespecific mortality than members of the same ethnic group born in the United States (Singh and Miller, 2004; Singh and Siahpush, 2001, 2002). This relationship may come about in part because international migration is selected on good health, and return migration on poor health (Palloni and Morenoff, 2004). There is also some evidence that in the U.S. and other settings immigrant/native differentials in health arise because of differences in socio-cultural characteristics and health-related behaviors (Marmot and Syme, 1976; Antecol and Bedard, 2006). [ABSTRACT FROM AUTHOR]

Over the last 20 years or so there has been mounting evidence that Hispanics as a group as well as Hispanic populations from individual countries are characterized by relatively favorable mortality profiles despite generally disadvantaged socioeconomic profiles (Markides and Coreil, 1986; Markides, Rudkin, Angel, and Espino, 1977; Markides and Eschbach, 2005; Franzini, Ribble, and Keddie, 2001; Palloni and Morenoff, 2001; Sorlie, Rogot, and Johnson, 1993). The advantage shown in vital statistics is greatest, though such data likely underestimate mortality rates because of misclassification of Hispanic ethnicity on death certificates (Sorlie, Rogot, and Johnson, 1992). [ABSTRACT FROM AUTHOR]

Because the theme of this conference is Hispanic health, it is inevitable that the issue of the "Hispanic paradox" will again make an appearance. In this short intervention I offer a few reflections with two goals in mind. The first is to try to convince the reader that the scientific problem associated with the Hispanic paradox is unsolvable, at least by the means available. The best we can do is to put forward a set of plausible conjectures, none of which can be completely falsified by empirical evidence of the sort we can realistically collect. The most immediate conclusion from this appraisal is that it is too optimistic and/or premature to hope that by insisting on studying this problem we will either move the field forward or learn anything useful to illuminate the determinants of healthy aging. We may learn something along the way about the benefits of using some data sets over others, the role of some set of determinants, and the nature of some migration processes, but we will not answer the questions with which we started (this idea is posed more precisely below). [ABSTRACT FROM AUTHOR]

Hispanics are redefining the character and look of United States of America. The rate of high immigration from Mexico and other Latin American countries and the higher fertility by native-born Americans has made Hispanic Americans the fastest growing demographic group in the country. Hispanics now outnumber African Americans as the nation's largest minority category. From 2000 through the end of 2001, the Hispanic population grew to 37 million, increasing 4.7 percent, while the black population increased by only 2 percent during the same period, to 36.1 million (U.S. Census Bureau, 2003). Hispanics account for nearly 13% of the U.S. population, which now numbers 284.8 million (U.S. Census Bureau, 2003). [ABSTRACT FROM AUTHOR]