Mexico & Caribbean: Migrations
Not long ago, "north" in Mexico meant well-to-do. A land of cattle and crops, northern Mexico was not only wealthier than other provinces in the country—it was also healthier. Today, however, the region that borders the United States remains relatively wealthy but no longer enjoys the health advantages one would expect. In the state of Sonora, in northwestern Mexico, life expectancy rates, once well above the national average, now hover around the median. Obesity and diabetes are on the rise, while high infant mortality rates are increasingly an urban, not a rural, problem. And violence—some but not all of it drug-related—is a growing threat across the region.
The change dates to the mid-1960s, when the Mexican government began introducing a new Border Industrialization Program aimed at boosting the manufacture of goods along the border for easy export to global markets, including the U.S. Multinational factories, or maquiladoras, moved into the region, and Mexicans from all parts of the country migrated north in search of work. With the implementation of NAFTA in 1994, the pace of migration only accelerated.
But while the population in the north kept growing, the standard of living didn't keep pace. Thanks to a centralized economy and lack of local taxation, profits generated by the maquiladoras left the region rather than being reinvested locally to build the area's urban infrastructure. Hardest hit were the region's old cities, where poor neighborhoods remained poor, and new areas of poverty took root. "The phenomenon, says SPH epidemiologist Siobán Harlow, who has been studying health outcomes in northern Mexico for over a decade, is called "accumulated urban deficit," and it's a key reason why so many city-dwellers in the region suffer from poor health.
While her research initially focused exclusively on the health of factory workers in northern Mexico, Harlow and her team have recently expanded their work to try to better understand the impact of export-led production on the region's population at large. Particular areas of interest are reproductive health and chronic disease. The researchers hope to find out the extent to which the population whose labor has largely driven economic growth in Mexico is reaping the benefit of that growth.
Harlow notes that, paradoxically, Mexico's maquiladoras have been an important component of economic development in the country overall. Together with population-wide health policies, this development has contributed to a nationwide decline in infant mortality and increase in life expectancy. Yet, says Harlow, "you see this particular phenomenon of uneven development in the north—industrial development but little investment in urban or health infrastructure." The result, she says, is a shift from a health benefit to a health deficit and a loss of the health benefit that urban settings traditionally have over rural ones.
Migrations: In the Caribbean
Throughout the Caribbean, seaside resorts cater to the whims and pocketbooks of tourists, who throng to the area in search of sun, sand, and pleasure. Tourism is so big these days that it has replaced agriculture as the primary source of revenue in the region and forced residents throughout the Caribbean to migrate from island interiors to coastal resorts in search of jobs. The health implications of this are enormous, says Mark Padilla, an assistant professor of health behavior and health education who is one of the first scientists to document the phenomenon of tourist-based labor migration in the Caribbean in a recent article in the American Journal of Public Health.
When island residents migrate to coastal resorts, they move from more traditional communities, with distinctive economic, social, and cultural milieus, into globalized enclaves that attract millions of tourists every year. "It's as if the islanders are going to another country," Padilla says.
The Dominican Republic alone—the island where Padilla has conducted most of his research—receives nearly four million tourists a year, equivalent to half its resident population. The growth in tourism and subsequent rise in tourist-based migration has meant new opportunities throughout the region for risky behaviors and sexual practices, including those that may increase the spread of HIV and other sexually transmitted diseases.
Numerous epidemiological studies have found links between island tourism and both sexually transmitted diseases and alcohol and drug consumption among locals. Padilla is not surprised. "Tourists are searching for certain kinds of experiences that have to do with drugs, alcohol, and sex—including prostitution. Local service providers learn how to make an informal income on the basis of that economic rationality."
To understand the phenomenon of tourist-based labor migration in the Caribbean and its impact on health, Padilla says researchers must take a contextual approach. "It's not about specifying and portioning off particular risk groups but talking about how broad populations are affected by contextual phenomena—social, cultural, geographic, and spatial."
He and a team of UM researchers are working with colleagues in the Dominican Republic to gather behavioral and social data from Dominican residents who migrate to coastal resorts for employment. The researchers have found that a high percentage of those who take jobs in tourist hubs also engage in sexual commerce with tourists. But Padilla is quick to point out that these individuals are not necessarily prostitutes in the traditional sense of the term. In many cases, they're simply hoping that a romantic liaison with a tourist may lead to a chance to emigrate or to increase their income through remittances from abroad—fantasies that rarely pan out.
The situation poses a public health concern, however. Epidemiologists have documented an association between HIV infection risk in rural Mexico and partners who migrate for work to the United States, and Padilla says it's reasonable to assume the same pattern exists in the Caribbean when workers migrate back and forth between their home communities and tourist enclaves. Often, he says, "you have married or partnered people in rural areas who leave their families to go for periods of time to work in a tourism area, where the entire context is about 'sexual escapism,' and who then return to their families. We know so little about how and whether this process contributes to HIV transmission among stable or married partners."
Padilla and his research team are disseminating their findings in professional journals and in the Dominican press in the hope that their work can help persuade tourism promoters to introduce HIV-prevention programs in resort areas. To date, promoters are reluctant to call attention to the risk of HIV for fear of alienating potential tourists, Padilla says. He's currently conducting research with policymakers in both government and the private sector to identify attitudes and practices that may pose barriers to HIV-prevention programs in tourism enclaves. <
To read the full text of Padilla's article in the American Journal of Public Health, visit http://ajph.aphapublications.org/cgi/content/short/100/1/70.