Today, the economies of San Diego and Tijuana are more intertwined than ever before. Each day, roughly 50,000 vehicles and 25,000 pedestrians cross the border each day between our two border sister cities. Annually, over 56 million people cross our shared border, making it the busiest port of entry in the world.

According to Mexico’s 2000 Census, 27,386 residents of Tijuana and Rosarito self reported that their primary place of employment was in the United States, principally San Diego. Today, there are over 196,000 Americans now officially recorded as living in Baja California with over 75,000 living in the northern part of the peninsula.

In spite of these growing interdependencies, the San Diego-Baja California region faces some significant cross-border health care challenges. Yet, our binational region is experiencing a political and strategic impasse in developing effective cross-border measures to prevent and respond to ever mounting health risks.

From accelerating rates of infectious disease transmission (HIV/AIDs, tuberculosis) to fears of bio terrorism, continued failure to act together across borders threatens to ravage the well-being of the binational San Diego-Baja economy and community. What is needed is co-operated binational action.

  • Tijuana’s HIV infection rate is close to three times higher than Mexico’s national average.
  • Tijuana tuberculosis (TB) infection rate is among the highest in Mexico with between 50 to 100 cases per 100,000 people. Last year, Tijuana reported 600 cases of TB. San Diego reported 305 cases with an incidence of 10.3 cases per 100,000 over double the U.S. national average (5.1 cases per 100,000 people).

Clearly, more can and should be done by governments to better coordinate cross-border initiatives at the local, regional, state and federal levels. With on-going funding limitations, governments on both sides of the border are not well positioned to address the growing trans-boundary health care challenges alone. So, how should we pay for these critical cross-border health care needs?

One concept that has been around for years is the idea of a border-crossing fee. It has failed for many reasons, including disagreements over how the revenue will be distributed, the amount of the fee, and competing uses of the collected money.

Given the urgency of border health challenges now facing the San Diego-Baja California region, I feel that the time may be right for a plan that used a border crossing fee to generate funds for binational health programs, particularly in the area of health surveillance. Along the Texas border, border bridge-crossing fees have been around for years. So, why not assess a border crossing fee on San Diego’s land border to address some of the region’s unfunded mandates?

The fees could be placed under the authority of an independent, regionally focused health commission, and a cross-border leadership team, to be spent on health priorities throughout the region. A border crossing fee could pay for:

  • Improved cross-border emergency health services;
  • Expanded cross-border health surveillance and care particularly for infectious diseases;
  • Expanded anti-human trafficking efforts, with an emphasis on child prostitution;
  • Improved basic public health infrastructure.

Improving the health conditions in Baja California is a direct investment in the future of our cross-border regional economy that will produce a return benefiting small and large businesses alike. A healthy workforce is a productive workforce.

Absent a greater commitment by government, a health-focused border crossing fee is one practical way to pass on the cost of addressing some of our region’s critical health needs to the border’s most frequent crossers.

We can, of course, do nothing and let the status quo prevail, but in the end we will pay dearly for our indecision. Infectious diseases, after all, respect no political or geographic boundaries.

What do you think? E-mail me your thoughts.

For more details please check out ICF’s latest report, “Shared Destiny: Shaping a Binational Agenda for Health Priorities in the San Diego-Baja California Border Region.

To learn more about the International Community Foundation (ICF) and its funding initiatives along the border region and beyond visit


Leave a comment

We expect all commenters to be constructive and civil. We reserve the right to delete comments without explanation. You are welcome to flag comments to us. You are welcome to submit an opinion piece for our editors to review.

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.