We would like to thank Waterman and Stolp for their interest in fostering the discussion on US–Mexico border health issues, and the Journal for allowing us to clarify one of the most important concepts developed in our December 2003 article. As we mentioned (p2017, first paragraph), and as Waterman and Stolp say in their letter, there was nothing purposely included in NAFTA to enhance collaboration on health-related issues with counterparts on the other side of the border. But this issue is beside the point. The argument we make is that NAFTA has not facilitated the erasing of the constraints that impede collaboration between health workers. We show that in a few instances it has increased them. Our conclusion is that globalization, as exemplified by NAFTA, benefits not the health of the people, but that of the transnational corporations. Looking at the impact of NAFTA in Canada, Labonte has arrived at similar conclusions.1 The contribution of our fieldwork is to detail how this occurs at the US–Mexico border. Other free trade agreements—the Free Trade Area of the Americas Agreement, the US–Central American Free Trade Agreement, the US–Australia Free Trade Agreement, the pending US–Morocco Free Trade Agreement, and others—do include health-related clauses, and the overwhelming assessment by experienced health organizations and observers in the field is that if Congress approves these agreements the damage to the health of these countries will be great.2–8 The need for binational collaboration is well recognized, and several agencies have invested considerable resources with different levels of success. Witnesses to these efforts agree on the slowness of these processes. A good example is the US–Mexico Border Health Commission: the idea was conceived in 1990, the creation of such a commission was approved by the US government in 1994, the commission was established in July 2000, its first official meeting was held in November of the same year, and the bylaws were approved in February 2003. As we explained in our article, executives of binational agencies need to take a deeper look at the context in which they are operating to be successful. If contextual constraints to their success are not systematically addressed, progress in US–Mexico border health will continue to be slow, marred with difficulties, and expensive in terms of both human and economic resources.
Read full abstract
Aug 1, 2004
Rajesh Singh 
