Border Health Strategic Initiative: Overview and Introduction to a Community-based Model for Diabetes Prevention and Control

This article describes an effort to develop and implement a comprehensive, community-based approach to diabetes prevention and control in selected communities along the U.S.-Mexico border. The U.S. state of Arizona shares a border with the Mexican state of Sonora. The four Arizona counties on this border are Cochise, Santa Cruz, Pima, and Yuma. In 1996, the University of Arizona and the Arizona Department of Health Services conducted a diabetes survey in the city of Douglas, Cochise County, in conjunction with its U.S. community partners and Mexican counterparts (1). This partnership led to the formation of a diabetes working group in Douglas. In 1998, members of this working group and other stakeholders formed the community advisory board of the newly funded Prevention Research Center (PRC) at the University of Arizona. In 1999, the PRC community advisory board urged university faculty to focus on studies that prevent or control diabetes. As members also of border communities, community advisory board members felt the personal impact of diabetes among Hispanics. Hispanic Americans are now the largest and fastest growing minority group in the United States, with an estimated growth from 30 million (or 11% of the U.S. population) in 1998 to 97 million (or 25% of the U.S. population) by 2050 (2). In 2000, approximately 2 million of the 30 million Hispanic Americans were diagnosed with diabetes — 1.9 times the rate seen in non-Hispanic whites (2). Among Hispanic Americans aged >50 years, 25% to 30% have diagnosed or undiagnosed diabetes (2). Risk factors for diabetes (e.g., family history of diabetes, gestational diabetes, obesity, physical inactivity) are more common among Hispanic whites than non-Hispanic whites (2). Mexican Americans, who make up 64.3% of the total U.S. Hispanic population and live primarily in the south-central and southwestern United States, have the highest rate of diabetes among Hispanic Americans (1). They are twice as likely to have diabetes and have higher rates of diabetic nephropathy, retinopathy, and peripheral vascular disease than non-Hispanic whites (2)