Health & Occupational Safety

Health: National Farmworker Awareness Week 2017

Day 5 of National Farmworker Awareness Week focuses on farmworker health.  Farmworker Justice has been working to protect  farmworkers' access to health care through close monitoring of the Affordable Care Act (ACA) and the impacts any changes would have for farmworkers. 

Current efforts to replace the Affordable Care Act threaten to roll back important gains in health insurance coverage achieved for farmworkers and their families. By increasing costs for young, rural, low-income individuals, the failed American Health Care Act (AHCA) would have substantially reduced access to health insurance for farmworkers and their families.

The AHCA’s provisions, including eliminating the employer mandate, modifying the eligibility for tax credits, ending Medicaid expansion, and modifying the structure of Medicaid, would have left many farmworkers with higher costs and fewer options for health insurance. Lawfully present farmworkers, especially H-2A workers, would have lost their access to affordable health insurance due to the bill’s proposed changes in immigrant eligibility for tax credits. The AHCA proposed restricting eligibility for tax credits to individuals who met the “qualified alien” definition under the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA).

The ACA has provided farmworkers and their families a level of access to health insurance coverage that was previously unattainable.  While the ACA can be improved, efforts to eliminate provisions such as income-based subsidies, immigrant eligibility, Essential Health Benefits, and Medicaid expansion, will only impede access to health care to farmworker families. Farmworkers need greater, not reduced access to affordable health care.

OSHA’s New Safety Standard Excludes Farmworkers

Yesterday, 6 ½ years after proposing rules to update protections for workers from slip, trip, and fall hazards, OSHA issued a final fall-protection regulation that excludes workers on farms, ranches and dairies. Farmworker Justice is extremely disappointed that the final rule excludes agriculture from these important safeguards.
Worker injuries and deaths related to falls in agriculture are among the highest in all industries. OSHA’s explanation of the regulation repeatedly refers to the submission by Farmworker Justice as well as other worker advocates of extensive evidence to show the prevalence of falls in agriculture and that these injuries are easily preventable.

OSHA declined to include agricultural operations in the final rule, stating that the agency has not gathered and analyzed data and information necessary to support a rule. The agency had ample time – years -- to study farmworkers’ injuries and deaths resulting from falls from ladders and machinery and other hazards.
The agency did attempt to narrowly define what is covered under the agriculture exemption, stating that “if an operation performed on a farm is not an “agricultural operation” or integrally related to an agricultural operation, such as a food manufacturing or other post-harvesting operations, then the final general industry rule applies.”
Farmworker Justice will continue to help farmworkers advocate to end the history of discrimination in occupational safety standards and improve occupational safety and health in their workplaces. The full text of OSHA’s standard on “Walking-Working Surfaces and Personal Protective Equipment (Fall Protection Systems)” is available here. The comments submitted by Farmworker Justice are here

Dangerous State of Affairs: State Workers’ Comp Is Deteriorating, Says Labor Department Report

[Editor’s note: This guest blog post comes from Migrant Clinicians Network’s blog, “Clinician-to-clinician: A Forum for Health Justice.” The original blog post can be found here. Migrant Clinicians Network is a nonprofit focused on health justice for the mobile poor.]

By Amy Liebman, MPA, MA, Director of Environmental and Occupational Health, and Claire Hutkins Seda, Writer & Editor, Migrant Clinicians Network

Last week, the Labor the picture is even more complicated. They typically labor in jobs that regularly post the highest numbers of injuries each year, like farming, fisheries, industrial food processing, dairies, and construction. On top of that, they often have very low pay rates and job insecurity, due to the often temporary nature of their work. Consequently, their basic economic security is often in jeopardy, even without an injury at work. This critical segment of our country’s workforce -- the immigrants who build the roofs over our heads, harvest the vegetables on our dinner plate, and head to work to clean our office buildings while we head to bed -- is in dire need of sufficient protection considering their financial concerns and likelihood of injury. And, for some of those workers, the system doesn’t provide any protection at all.

While state-based workers& Department put out a report on state-based workers’ compensation rules. The report calls for an increased federal role in workers’ comp to ensure that injured workers are provided with adequate insurance benefits to keep them afloat while they heal -- the original intent of workers’ comp. “Recent years have seen significant changes to the workers’ compensation laws, procedures, and policies in numerous states, which have limited benefits, reduced the likelihood of successful application for workers’ compensation, and/or discouraged injured workers from applying for benefits,” the report reads, calling out denial of claims that were previously compensated and a decrease in cash benefits as examples of the weakening of workers’ comp around the country. Such changes challenge the insurance system’s effectiveness in providing a timely return of the worker to work and may diminish the ability for public health officials to understand trends in injuries in order to address ongoing hazards, through a review of workers’ claims.

For immigrant workers,rsquo; comp laws have existed in the US since 1911, the laws when first enacted didn’t cover all workers; those employed in agriculture were mostly excluded from most workers’ comp laws, leaving them out of the insurance system entirely.

Today,14 states require employers to provide agricultural workers the same workers’ compensation insurance as workers in other industries. (See MCN’s Pesticide Reporting and Workers’ Comp in Agriculture Map to see state-by-state requirements.) So, for farmworkers, who have been excluded by the state systems, federal involvement may be the only way to gain more inclusion. For those farmworkers who are covered, the increasingly weak and broken workers’ comp system is two steps forward and one step back.

We at Migrant Clinicians Network applaud the Labor Department’s report in calling out the weakening state workers’ compensation systems. We call on states across the US to both augment its rules to allow for farmworkers to benefit from workers’ comp, while simultaneously fortifying its safety net to assure that workers’ comp can effectively protect injured workers of any industry.

Resources:
Learn more about workers’ comp for farmworkers, state-by-state on Migrant Clinicians Network’s Workers’ Comp and Pesticide Exposure Reporting map, here.

Read the Labor Department’s report, here.

Learn more about workers’ comp in the US today in ProPublica/NPR’s 2015 investigative reports, here.


 

FJ Celebrates Farmworker Health Day

Since their inception, community and migrant health centers have proven to be a vital access point to health care for farmworkers and their families. The Migrant Health Act of 1962 and Economic Opportunity Act of 1964 set in motion the network of locally driven, federally supported health centers that exist today. By having patient representation on the board of directors and partnering with other local organizations, health centers are able to evolve to meet the needs of farmworkers. As a result, health centers are often the most viable, affordable, and culturally competent providers of primary care for farmworkers.

Farmworkers face a number of barriers to care. In focus groups conducted by Farmworker Justice last year, many workers and promotores de salud discussed barriers such as transportation, language access (including availability and quality of interpretation services), cost, and clinic operating hours. They are also a highly mobile population who may need care coordination across multiple states.

Migrant health centers work to mitigate these challenges by performing enabling services such as outreach, translation, and case management. With farmworkers on their boards of directors, they are able to institute policies to respond to the needs of the community. For example, in recognition of the transportation barriers in rural communities, many migrant health centers have mobile clinics at farmworker labor camps, with some even arranging transportation to the clinic. Additionally, because most farmworkers lack health insurance and their average wages are near the federal poverty line, health centers offer care on a sliding fee scale.

In response to an FJ needs assessment survey last year, almost universally, workers, promotores de salud and community organizations cited the local health center as a critical source of primary care for farmworkers and their families when asked about health care access in their communities. Promotores reported that the health centers were very engaged with getting information and educational materials out in the community. Workers found the providers to be compassionate. However, according to data from the Bureau of Primary Health Care, in 2014, community and migrant health centers only served approximately 20% of the nation’s farmworkers and their family members.

To increase farmworker utilization of health center services, FJ participates in the AgWorker Access 2020 Campaign, led by the National Association of Community Health Centers and the National Center for Farmworker Health. The goal of the initiative is for health centers to serve 2 million farmworkers and their families by 2020. FJ provides training and technical assistance to health centers to help them address the factors that affect farmworkers’ access to health services. FJ also leverages partnerships with community-based farmworker organizations, legal services providers, Migrant and Seasonal Head Start, and other farmworker-serving organizations to strengthen relationships between the health center and the community it serves. 

FJ is proud to celebrate Health Center Week and is committed to working with health centers to continue their strong tradition of providing health care in farmworker communities.
 

Zika Virus and Migrants: What do clinicians need to know?

[Editor’s note: This guest blog post comes from Migrant Clinicians Network’s active blog, “Clinician-to-clinician: A Forum for Health Justice.” Migrant Clinicians Network is a nonprofit focused on health justice for the mobile poor.

Dairy Workers’ immigration status: An occupational safety hazard?


[Editor’s note: Today’s guest blog is from our colleagues at Migrant Clinicians Network, a nonprofit organization founded by migrant health clinicians that strives to improve the health care of migrants and other mobile poor populations through innovation and clinical excellence. A link to the original blog on MCN’s website can be found here.]


By Amy Liebman, MPA, MA, Migrant Clinicians Network

The American dairy farm has changed. The idyllic small family farm still gracing many milk cartons -- a few cows, rolling green hills, a red barn -- has largely been replaced by big farms with hundreds of cows milked by immigrant workers, many of whom lack the paperwork to legally work in the US. As clinicians and researchers, we wondered how this growing group of workers is faring. Our new research underscores serious health risks that these dairy workers take while they work to get milk into our cereal bowls.

As farms consolidated in the last few decades, dairy farmers, needing a new workforce, turned to immigrant workers, largely Latino. A recent survey of US dairy farms showed that about 62% of US milk is produced by immigrant workers, many of whom are unauthorized. The dairy farmers have little choice. In a Milwaukee Wisconsin Journal-Sentinel article in July entitled “Wisconsin Dairy Farmers Push for Immigration Reform,” dairy farmers voiced their struggle in finding qualified and interested workers. “If our immigrants left, we would have to dispense of everything, I guess," noted John Rosenow, a Buffalo County dairy farmer with 550 dairy cows.

Because the consolidation happened relatively recently, little data on the health and safety of dairy workers are available. At the end of 2015, we published an article in the American Journal of Industrial Medicine that gives some insight on dairy farm life, directly from the immigrants who work there. The new paper, entitled “Immigrant Dairy Workers’ Perceptions of Health and Safety on the Farm in America’s Heartland,” presents the workers’ own perspectives, garnered through five focus groups in Wisconsin on health hazards and injuries. Some of the results were predictable: farm work is dangerous, particularly for immigrants with little or no experience with large animals, and who may not be able to communicate well with farmers or supervisors because of language barriers. Cows were a major source of injury. While some injured workers received appropriate worker compensation benefits, others were instructed to deny work-relatedness. Some employers covered medical injury costs out-of-pocket, whereas others did not.

One finding was particularly noteworthy: workers identified immigration status as an occupational hazard, making them more vulnerable and putting them at further risk at the workplace. That is, lacking documentation is similar to other hazards such as lack of knowledge of workplace chemicals or insufficient health and safety training -- all of these increase the likelihood of injury on the job. While we did not set out to ask about documentation status, the workers from focus groups routinely brought it up. We conclude that this important finding in worker health and safety emphasizes the need for broader immigration reform.

Turns out, many dairy farmers agree with the need for immigration reform. The American Dairy Coalition, along with many regional dairy producer organizations, has come out strongly for comprehensive immigration reform at the federal level.

The results of this data were used to develop Migrant Clinicians Network’s bilingual, low-literacy worker health and safety program. The program, called Seguridad en las Lecherias, uses a train-the-trainer methodology to give workers basic skills and education needed to be safe on the farm. We’ve trained 850 workers thus far on nearly 70 farms and the curriculum has been disseminated throughout the US. These important steps toward improved health and safety are welcomed by workers and farmers alike, but more is needed.

As clinicians, we have a role to play in recognizing the implications of immigration status on the health of our patients. We also recognize the importance of immigration reform in improving the health of the people who are connected to us as neighbors, as providers of our food, and as fellow humans. As long as this population of workers remains vulnerable as a result of their status, all of us need to work to reduce that vulnerability.

Amy Liebman, MPA, MA, is Director of Environmental and Occupational Health at Migrant Clinicians Network, a nonprofit committed to health justice for the mobile poor. Read MCN’s active blog at http://www.migrantclinician.org/community/blog.html.

Digging Deeper: The Expanding H-2A Program in Florida & Worker's Access to Health

NPR recently aired a story, “Guest Workers, Legal Yet Not Quite Free, Pick Florida’s Oranges” that featured an H-2A worker, otherwise known as an agricultural guestworker.
In an interview at the beginning of the program, a grower of Florida citrus said that he started using H-2A workers to avoid competing for workers who were asking for a higher wage. The farm didn’t want to pay an extra nickel a box that farmworkers asked for and that a competing grower was offering. This frank statement reveals the fundamental problem with the temporary foreign worker program.
The guestworkers don’t ask for wage increases. Why? Because as the story reveals, guestworkers don’t have the freedoms that we take for granted in this country.

H-2A guestworkers may only work for the one employer that obtained a visa for them. When the job ends, they must return to their homeland. If they want to return to the U.S., they must hope that the employer will invite them back and apply for a visa. The workers have no independent ability to apply to the U.S. government for an H-2A visa. Technically, they hold a “non-immigrant” status. And the law refers to these human beings as being “imported” by employers. As if they are commodities.

In this restricted, temporary status, the workers will not usually challenge unfair or illegal conduct, or even ask for a raise. They feel lucky to have the job. And why not? Usually, the wage they earn in the U.S. is a lot higher than they would make in their own country. So they will often work to the limits of human endurance. Growers will say how “reliable” they are, but what is really going on in many cases is that these workers are under such pressure that they are extraordinarily productive.

This imbalance of power also manifests itself in the workers’ access to health care. Although all H-2A workers are covered under workers’ compensation insurance, most are reluctant to seek medical care, especially for a work-related injury or illness. In FJ’s report, No Way to Treat a Guest, Javier*, a worker in North Carolina, described how he became poisoned by pesticides while working in the tobacco fields. When he felt so sick that he could not work, he phoned a local clinic outreach worker to take him to the hospital. The hospital sent him back with a note that he could not work in tobacco. As a result, his employer sent him back to Mexico without the medical or financial assistance he was entitled to under workers’ compensation. Nine months after his injury, Javier still felt too sick to work to support his family, but could not afford specialized care to aid his recovery.

The NPR story does a good job of demonstrating the lack of economic freedom in guestworker programs. There is also a fundamental lack of political freedom. No matter how many years the guestworkers are brought back to the U.S., they never earn the right to become an immigrant or a citizen. Guestworkers don’t vote. But the employers vote. And the employers give campaign contributions. And the employer lobby Congress and the Administration to lower the required wage rates and other obligations under the H-2A program.

The H-2A program is supposed to prevent employers from undermining the wages and working conditions of U.S. farmworkers’ job terms. But the law and regulations generally don’t work. The lack of economic and political bargaining power on the part of the guestworkers is just too much to overcome.

We are a nation of immigrants, not a nation of guestworkers. The workers we need in this country – and we need farmworkers – should be given the opportunity to be immigrants and citizens. Because the majority of farmworkers are undocumented immigrants, Congress should pass immigration reform that creates such opportunities and grants farmworkers the economic and political freedoms on which this country was founded.


*Not real name
 

Reflecting on Rural Health Week

Last week we celebrated rural health week. Keeping our rural communities healthy is key to building a stronger America. Farmworkers and their families are essential members of our rural communities, but they are among the most underserved when it comes to health care and health insurance. The men and women who harvest the fruits and vegetables that keep us healthy deserve to be healthy themselves.

Under the Affordable Care Act, gains have been made to increase health care access for farmworkers and their families. Health centers, community-based organizations, and others have undertaken vast efforts to educate and enroll farmworkers in health insurance. Most farmworkers who are eligible to purchase health insurance in the Marketplaces qualify for financial assistance to lower the cost of premiums. Some workers are newly eligible for Medicaid in states that expanded Medicaid eligibility. For those who are not eligible, education efforts provided new linkages to health care that may not have existed before. In addition, dedicated funding through the ACA enabled health centers to expand their services in rural communities.

Yet despite these gains, we must acknowledge that barriers and challenges persist. Due to various factors, including the seasonal nature of their work, the size of their workforce, and immigration status, many farmworkers do not have employer-provided health insurance or are ineligible for health insurance in the Marketplaces. Many farmworkers, the majority of whom are foreign born, receive inaccurate or confusing information about health insurance, ACA requirements, and tax credits. Further, applying for health insurance is a complicated process that requires the assistance of a navigator or in-person assister.

Open enrollment is happening now! We encourage advocates and others who work with farmworkers to connect with health centers and others providing enrollment assistance. Farmworkers and others in rural communities deserve full access to health care and health insurance. Farmworker Justice developed materials for farmworker families to help them understand the ACA and connect them to in-person assistance in their area. These materials can be downloaded from our website.  

Supreme Court Ruling on Affordable Care Act Helps Keep Farmworkers Covered

Farmworker Justice applauds the Supreme Court's decision to uphold the Affordable Care Act's (ACA) provision to provide subsidies (in the form of tax credits) to consumers who bought health insurance through the federally-facilitated health insurance marketplaces (Healthcare.gov). The subsidies are essential to ensure that farmworkers and their families have access to affordable health insurance. The Court's decision ensures that the millions of people can stay covered on their health insurance plans without fear that their premiums will suddenly become unaffordable.

Nearly 6 million people nationwide are enrolled in health insurance through the marketplaces. Among low-income adults, there was a 6% decrease in the uninsured rate in 2014. For Hispanic individuals, there was approximately a 5% decrease in the uninsured rate. While we do not have data on the number of farmworkers who enrolled in health insurance under the ACA, many farmworkers who did enroll were first-time enrollees who received substantial subsidies to lower the cost of health insurance.

Currently, 34 states, including many states with significant farmworker populations (such as North Carolina, Florida, and Texas) use healthcare.gov. The Court's ruling ensures that farmworkers who live and work in these states will continue to have opportunities to enroll in affordable, comprehensive health insurance. Farmworker Justice will work with our partners across the country to provide information on the ACA to further facilitate farmworker enrollment in health insurance. 

Study Estimates that 77% of Agricultural Injuries are Unreported

A recent study by health economists at the University of California at Davis and Old Dominion University estimates that over three quarters of all agricultural nonfatal injuries and illnesses are not included in official counts kept by federal agencies. The study, which was published in the April edition of the Annals of Epidemiology, used several sources of data to estimate the undercounting and considered various factors that affect whether or not an injury or illness is ever reported.

The official count of agricultural injuries and illnesses in 2011 on both crop and animal farms, reported by the Bureau of Labor Statistics, is 32,100; however, this number does not include injuries or illnesses sustained by workers on farms with less than 11 employees, by contracted workers, or family members. It also does not account for failures to report injuries. When conservative adjustments are made, the estimated number of job-related injuries and illnesses experienced by agricultural workers in 2011 rises to 143,436.

Agricultural injuries and illnesses take many forms from falls, cuts, and lifting injuries to chemical exposures, vehicle and machinery accidents, and even chronic pain associated with repetitive movement and ergonomic issues. These conditions disproportionately affect migrant and seasonal farmworkers and, with this study, we now know that these injuries are even more widespread than previously reported.

Lack of reporting and undercounting of injuries and illnesses have serious consequences for farmworkers, many of whom do not receive information on how to prevent, avoid, and care for injuries or how to report violations of their labor rights. Agriculture, as an industry, is dangerous. The most affected individuals belong to a workforce that is less able to advocate for its basic rights. This information is not new, but as we are better able to measure how dangerous agricultural occupations are, we can use this data to implement safety measures and better support the people who experience the risks associated with work in agriculture.

Accurate injury and illness reporting will justify stronger policy to protect this valuable workforce, including increasing educational programs to inform farmworkers of the risks to their health, help them prevent injuries, and to exercise the basic rights and protections afforded to all workers in the United States. Comprehensive immigration reform will also support farmworkers and decrease agricultural injury by increasing access to information and removing barriers to health care.
 

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