Health dilemmas at the borders--a global challenge.

The health and safety of border crossers and people who live in border areas are widely neglected. The remoteness of many communities living near international borders makes it difficult to provide them with services, and if a country's border controls are inadequate there is an increased risk from communicable diseases for its entire population. Substance abuse and associated behavioural problems can be more common in border regions for the same reason. Armed conflicts, economic pressures and natural disasters can precipitate the movement of refugees across borders and the disruption of local infrastructures. Environmental hazards tend to be heightened in border regions because of the dumping of waste, the pollution of the atmosphere by slow-moving vehicles, and the contamination of water by sewage. Furthermore, dangers may arise because of unsafe implementation of trade agreements and the movement of uregulated materials. There is an urgent need for health education and the promotion of family and individual health care in many border regions. A global initiative on health and safety at international borders is clearly needed. It should include needs assessment, new policies and action programmes.