Cooperation in health affairs between adjacent international communities: a successful model.

The border between the United States and Mexico presents a number of problems related to health that are simultaneously local and international. Large-scale government-to-government interactions have generally failed to achieve lasting cooperation on important health issues, with a few important exceptions. One reason for this may be that the issues have been complicated by much larger and more complex social, cultural, economic, and political differences. Another is that large organizations must each function according to their own mandates, goals, and procedures and may not mesh well with others, even with nominal counterparts. In 1981 we conceptualized a model for encouraging binational cooperation on small-scale local projects. The model incorporates three elements: a significant and difficult but soluble technical problem affecting both sides of the border (the "technocratic factor"), a mutually respected individual or team whose function is to facilitate communication and prevent misunderstandings (the "human factor"), and the actions of governments or institutions larger than the working groups (the "institutional factor"). Subsequently, we applied the model to water quality and to the distribution of sources of toxic substances in the border area, which met the criteria for the technocratic factor. Two highly respected figures in environmental health, one American and one Mexican, mediated between colleagues on either side of the border and facilitated the development of projects. Finally, after the projects had been under way long enough to have demonstrated their viability and personal interactions among the principals had become trusting and collegial, the institutional factor was admitted and major financial and administrative support obtained.(ABSTRACT TRUNCATED AT 250 WORDS)