Health & Occupational Safety

Reversing America’s Declining Health Trend Means Focusing in Equity

For the first time in decades, the current generation isn’t as healthy as the one that came before.” The theme for day five of National Public Health Week is “Be the Healthiest Nation in One Generation” and is dedicated to turning around the declining trend in health faced by Americans today. To address this trend, it’s important that we understand the barriers to good health faced by all people in the United States. At Farmworker Justice, we spend a lot of time contemplating migration as a social determinant of health. Specifically, we discuss the roadblocks that affect good health and quality of life and we think about ways to lift those roadblocks, either through advocating for policy change or through health promotion and education projects.

In terms of farmworkers, migration from their home to the U.S. has a lot to do with their health. Just a few factors related to migration that affect farmworkers include poverty, language, discrimination, and national policies.

Most farmworkers live at or below the poverty line. Health outcomes of people who live near the poverty line are worse than for those who enjoy higher incomes.
Eighty-one percent of farmworkers speak Spanish but immediately after arriving in the U.S. they need to navigate everything from grocery stores, public schools, housing, and health clinics almost entirely in English.
• Discrimination, both overt acts of discrimination and microagressions (every day, more subtle forms of discrimination), is associated with increased anxiety, anger, depression, and stress levels.
• Policy can be discriminatory when it is does not provide protections to workers equitably across professions. For example, many states do not require agricultural employers to provide workers’ compensation insurance coverage for farmworkers, even though agriculture is ranked among the most dangerous occupations by the U.S. Department of Labor.
• Policies that don’t seem to be about health, like immigration policy, can actually have a great impact on the health and wellbeing of our community members. For example, children who hear about deportations may constantly fear the separation of their families and people who cannot obtain driver’s licenses may avoid driving to a clinic.

Not only do poverty, language barriers, discrimination, and policy serve as enormous sources of stress, but they also stand in the way of accessing and receiving appropriate medical and mental health services. In addition, sixty-four percent of farmworkers are uninsured, so even when they do seek care, paying for it presents another barrier.

To reverse the decline in the nation’s health outcomes, it is important to address the barriers, social inequalities, and injustices that contribute to the decline. We must also recognize that the health of each individual is affected by the overall health of our communities so working toward better health outcomes for the entire community will create better health for each individual.

Farmworkers and our Food Safety System

The CDC estimates that each year roughly 1 in 6 Americans gets sick, 128,000 are hospitalized, and 3,000 die of foodborne illnesses. We’ve all seen the frightening consequences from fruits and vegetables contaminated with salmonella or listeria. Eating safe, healthy food, today's theme of National Public Health Week, is a basic building block of public health. While most conversations about this topic revolve around responding to outbreaks or creating more rigorous standards and surveillance by government agencies, few consider the important role of farmworkers in preventing foodborne illnesses.

Food safety advocates have long recognized that the working conditions and training of farmworkers can significantly affect food safety: overworked and underpaid farmworkers in the field are typically not encouraged to look out for safety concerns. If employers don't provide sanitary facilities, or fail to provide the necessary training or economic incentives to stop production when unsafe conditions exist, important opportunities to improve food safety are lost. 

Farmworker Justice is a co-founder of a unique collaboration between farmworker, environmental and consumer advocates, retailers, and farmers that aims to promote food safety and improve working conditions in the produce industry. The Equitable Food Initiative (EFI) has developed a set of food safety, labor, and pesticide standards and a training program to help farmworkers and farm owners and their managers work together to implement the standards. 

EFI's food safety standards recognize that farmworkers are often the first line of defense against contaminated food. Under the EFI system, workers receive training to recognize food safety risks and are encouraged to report unsafe conditions, improper practices or procedures in the field to their supervisor. It’s a common sense approach to food safety that benefits workers, growers, retailers and consumers: fresh fruits and vegetables grown and harvested in ways that respect workers can help reduce the potential for transmission of foodborne illness.

National Public Health Week: Getting Ahead with Preventative Health Care

Day three of National Public Health Week is entitled “Get Out Ahead!” and is dedicated to prevention as a national priority. Community and migrant health centers across the United States serve the preventative and primary health care needs of many of the farmworkers who plant, tend, and harvest the nation’s crops. Farmworkers and their families encounter numerous barriers to accessing health care such as cost, transportation, language, and lack of sick leave, to name a few. Outreach is a critical component of health care delivery to farmworker communities. I spent several years as a farmworker health outreach worker in rural North Carolina. This personal experience working in farmworker health in a small community provides insight to health problems faced by farmworkers and the barriers they regularly face when seeking health care.

Let’s first start with some quick farmworker health facts. Agricultural work is low paying, physically demanding work. The Bureau of Labor Statistics ranked agriculture as the third most dangerous job in 2012. Many farmworker families live at or below the poverty level and approximately 64% are uninsured. Cancer, heart disease, stroke, and diabetes are among the top five causes of death for Latinos in the U.S. For farmworkers, specifically, many of whom are Latino, a recent study showed an elevated prevalence of anemia and obesity and stunting in children of farmworker families. The burden of these conditions can be lessened or prevented under the regular care of a physician. Lack of insurance limits the options that farmworkers have when they seek health care and it is sometimes a barrier to receiving care at all. Many turn to community and migrant health centers to receive preventative care where they are able to pay for health care on a sliding-fee scale based on their income. Outreach workers are a valuable part of the health care team at these health centers.

As an outreach worker, the farmworkers I served worked in the Christmas tree fields nine months of the year. Many traveled from Mexico year after year to do this work, leaving behind their homes and families to live with other farmworkers in old houses, trailers, or barracks that were provided by the growers that hired them.

My work entailed visiting farmworkers in their homes in the evenings after work, collecting their personal and contact information, asking questions about their health, and screening for diabetes, high blood pressure, and HIV. They would usually be cleaning up from work and taking turns in the kitchen so many of these conversations happened while they cooked dinner and made lunch for work the next day. I let them know their options for accessing health care in their community and explained the process for making and paying for appointments. During the day, I coordinated these appointments, making calls to farmworkers, clinics, and specialists. I drove farmworkers to appointments and provided Spanish-English interpretation. I learned about their home towns. I heard border crossing stories. I knew when their kids in Mexico were getting in trouble at school. Working in this capacity allowed me to spend the time necessary to gain the trust of farmworkers within our community. I used this insight to help doctors, nurses, dentists, and clinic administrators better understand the conditions that affect farmworkers’ health and adjust treatment plans to best fit the realities they face.

The outreach workers at community and migrant health centers connect farmworkers to important preventative health care services through education, case management, and building trust within the community. The work, while challenging, is extremely fulfilling. We recognize that regardless of where you live, everyone has a right to be healthy. Our nation’s farmworkers, who harvest the fruits and vegetables essential to our health, deserve access to quality health care.

National Public Health Week: Be Healthy from the Start

April 7th begins the 2014 National Public Health Week! Today’s theme, “Be healthy from the start,” is especially important when bringing awareness to the current state of farmworker health in this country. Today, we focus on farmworker children and access to health care.

Individuals with health insurance are more likely to seek medical care. In the U.S., a staggering number of farmworker children do not have health insurance. Data on farmworkers and their families are hard to collect because of the seasonal and migratory nature of farm work. For this reason, we focus on statistics that describe rural Latinos in the U.S.:

• 31% of rural Latino children are uninsured, compared to 15% of African-American children and 18% of non-Hispanic white children.
• Only 33% of first-generation immigrant children are continuously insured.
• Rural Latino children whose parents are immigrants are even more likely to lack health insurance, even though the majority of them qualify for enrollment in Medicaid or the Child Health Insurance program (CHIP).

Cancer, heart disease, stroke, and diabetes are among the top five causes of death for Latinos in the U.S. The burden of these conditions can be lessened or prevented under the regular care of a physician. Children with health insurance are more likely to have a regular source of health care than children without health insurance. Children who receive regular medical care may grow into adults that value preventative care.

Farmworker Justice is working to diminish the disparity in health care coverage experienced by rural Latino children in the U.S. In the coming weeks, we will be rolling out a program called Conexiones: Connecting Rural Latino Families to Medicaid and CHIP. Four community-based organizations in Florida, North Carolina, California, and Arizona will work with Farmworker Justice to train promotores de salud (lay health workers) to conduct outreach in their communities. They will educate their peers on the eligibility requirements for enrollment in Medicaid and CHIP and help to connect them to state and local resources. In two years, the promotores de salud are expected to reach over 14,000 rural Latinos with information on Medicaid and CHIP, which will increase health care coverage of children in their communities substantially.

This program utilizes the promotores de salud model because these community health workers are extremely effective in engaging in outreach in their communities, especially with hard-to-reach populations. Often sharing the same language and cultural background as those receiving their outreach efforts, they know best where to find their fellow community members and how to effectively deliver important messages about health and in this case, access to health care.

Taking a Closer Look at Farmworkers and Cancer

 According to a 2010 poll, cancer is the disease most feared by American adults. And rightfully so, as the National Cancer Institute’s surveillance program reported that same year that over 13 million Americans were living with cancer. Farmworkers number over two million in the U.S. and are predominantly of Latino or Hispanic ethnicity. Even though cancer incidence and death rates for Latinos are lower than for non-Hispanic whites and, in fact, are declining, U.S. Latinos have higher rates of cancer caused by infections, such as cancer of the stomach, liver, uterine cervix, and gallbladder. Furthermore, while Latina women in the U.S. have lower rates of breast cancer than non-Hispanic women, they actually have a 20% greater risk of dying from the disease, making breast cancer the leading cause of cancer mortality among Latina women.

Farmworkers are not only at increased risk for developing cancers caused by infections and cancer mortality, they also experience higher exposures to cancer-causing chemicals through the pesticides they apply to crops and come into contact with during planting, weeding, pruning, and harvesting. Making the link from pesticide exposure to cancer diagnosis is difficult, as the time between exposure and diagnosis may be years; however, research is beginning to show an association. For example, a 2012 study of Canadian women who had been exposed to cancer-causing and hormone-altering chemicals while on the job found that women who worked in agriculture had a significantly higher risk of breast cancer later in life.

Farmworkers in the U.S. experience conditions both on and off the job that affect their health. Several underlying factors contribute to this, including immigration status, language, family separation, and poverty. Seventy percent of farmworkers are migrants from Mexico who speak Spanish or an indigenous language and at least 50% lack authorized immigration status. Half are under the age of 31 and most are unaccompanied by any family members (61%). Many farmworkers report that poverty and lack of opportunity in their home country was their main motivation for migrating.

These underlying factors are reinforced by policy which influences social norms and both govern the communities where farmworkers settle. Ultimately, restrictive immigration policies decrease farmworkers’ ability to speak up about dangers on the job, increase exposure to dangers, and inhibit their ability to seek medical treatment, either for pesticide exposures or to prevent infections that cause cancers.

National and state-level policies around immigration and the rights of immigrants contribute to disparities in cancer rates. Not only do they put more farmworkers in harm’s way, they create an environment in which discrimination is normalized and unnoticed, increasing feelings of fear, stress, negative coping behaviors, and affecting daily living and working conditions. They create an environment in which the odds are stacked against escaping these conditions.

When we think about the underlying factors affecting our health we begin to question what we’ve always been told – that opportunity is distributed equally. Motivation, persistence, and determination, which are prerequisites for making the journey from Latin America to the U.S., might not be enough to rise above and break through the strong and ever present external forces that hold us firmly within our socio-economic status and directly affect our quality of life and health.

Why are insurance enrollment numbers low for farmworkers and their families?

Under the Affordable Care Act, many farmworkers and their families could benefit from health insurance offered in their state’s marketplace. The plans will cover a range of services from preventative care to ER visits to maternity care. If eligible, they will likely qualify for subsidies to reduce the cost of health insurance premiums and co-pays. Yet few farmworkers are enrolling in the marketplaces. Generally, enrollment numbers for Latinos are low. Covered California, the state marketplace for California, reported that fewer than 1,000 Latinos enrolled in coverage during October. There are several reasons for these low enrollment numbers. Both in the state- and federal-run marketplaces, Latinos are finding it difficult to access information and apply for health insurance. Additionally, many immigrant families are reluctant to reveal the immigration status of family members when applying for insurance coverage.

71% of farmworkers speak Spanish as their dominant language. Spanish speakers are encountering numerous challenges to enrollment. Spanish language websites for both federal and state marketplaces have been slow in implementing online enrollment tools, and some are still not fully operational. And in California, a state where 32.8% of the population is Latino, the paper application is not yet available in Spanish. Furthermore, some states have placed burdensome requirements on navigators - individuals who are trained and certified to help people in the community find insurance plans. Such laws have discouraged some community-based organizations from assisting with outreach and enrollment efforts. There are several ways to apply for health insurance – by phone, online, on paper, or in person with the help of a navigator or application assister. While many Spanish speakers may be more comfortable applying for health insurance in person, all of these options should be available to them.

For immigrant families, barriers to enrollment go beyond issues related to access. In focus groups that we conducted with farmworkers over the summer, many had concerns about sharing sensitive information required for enrollment. Among the top concerns is that information about immigration status could be used to find and deport undocumented family members. On October 25, Immigration and Customs Enforcement (ICE) issued a memo stating that information included in the marketplace application will not be used for immigration law enforcement purposes. Despite these assurances from ICE, fear and misinformation remain. Some navigators have told individuals that they should be careful because their information can be shared with immigration enforcement authorities. One-third of U.S. citizen children of immigrants live in “mixed-status families,” households that include members with a different immigration status. In farmworker communities, 24% of farmworker families are mixed-status. Reassurances for mixed-status families are crucial to boost Latino and farmworker enrollment.

Over the next several months, marketplace websites will continue to improve and more options will be available for the enrollment of Spanish-speakers. We are hopeful that with more options, farmworker communities will see improved access to affordable and preventative healthcare.

Expanding Access to Healthcare for Farmworkers: ACA Open Enrollment Starts Today

Today is the first day of open enrollment for the new health insurance marketplaces. Today, millions of currently uninsured and underinsured individuals living in the U.S. will have the opportunity to purchase affordable, high-quality health insurance. But a lot of work lies ahead.

According to a recent poll conducted by the Kaiser Family Foundation, 67% of the uninsured and 51% of the general public do not have enough information about the law to know how the Affordable Care Act will impact their families. Additionally, 74% of the uninsured and 64% of the general public do not know that open enrollment begins Oct. 1. These statistics are not surprising. In focus groups we conducted with farmworker community-based organizations across the country, the majority we spoke with knew very little about the ACA. And a lot of what they had heard was false information. For example, a promotora de salud/community health worker in California told me she heard that in 2014, a person without health insurance who visits the ER will not only be responsible for the medical bill but will also be assessed a fine.

Misinformation is rampant in farmworker and immigrant communities. This leads to fraud and abuse by scammers who take advantage of this confusion and lack of information. Across the country, community-based organizations and community health centers are reaching out to communities through navigators - people trained to educate community members about the ACA, connect them to resources, and help people enroll in health insurance coverage. Campesinos Sin Fronteras, a farmworker-community based organization in San Luis, Arizona, will have navigators to help the area’s farmworkers understand the ACA. But more needs to be done. 

Farmworker Justice is developing materials for farmworkers on the ACA, including pamphlets, fact sheets, and a training curriculum for outreach workers about the ACA. We are also working with community based-organizations in California, Arizona, Florida and North Carolina to connect eligible farmworker children to CHIP and other health insurance coverage.
Today is an exciting day but we must not forget that it is only the beginning. Please contact us if you have questions or are interested in working with us to expand access to healthcare for our nation’s farmworkers and their families.

NYT "Tacking Health Care Costs onto CA Farm Produce" Doesn't Tell the Whole Story

Today’s New York Times article, “Tacking Health Care Costs Onto California Farm Produce” discussed the impacts of the Affordable Care Act (ACA) on California farmers, their labor contractors and farmworkers. Farmworker Justice recognizes that affordability may be a challenge for farmworkers but believes that every farmworker deserves the opportunity to obtain health insurance.

The article fails to point out that many large agricultural employers may in fact be exempt from the employer mandate due to the seasonal worker exception. Under the seasonal worker exception, employers with more than 50 employees but with a largely seasonal workforce will not have to offer health insurance to their full-time employees. Further, small employers will be eligible for tax credits to offset the cost of providing health insurance to their employees. Growers who do fall under the mandate will have to offer health insurance to their employees. It’s up to individual farmworkers, not contractors who claim to speak on their behalf, to decide if they can afford the cost of the premium. If a worker deems that this payment is a hardship, he/she can apply for various waivers from the individual mandate. 

Currently, at least 64% of farmworkers are uninsured. Many farmworkers, because they lack authorized immigration status, are ineligible for Medicaid and are unable to purchase private insurance through the health insurance marketplaces. Most immigration reform proposals being considered in Congress would continue to deny these options to new immigrants for the foreseeable future, if not permanently. Like workers in other industries, farmworkers and their families have healthcare needs. They work in one of the most dangerous industries in the country. They should have access to primary and preventative care. Their wages are already low and the added burden of poor health and unaffordable healthcare should not drive them further into poverty. The costs of maintaining a safe workplace and providing affordable healthcare are a cost of doing business for US employers, and agricultural employers should not shift these costs onto taxpayers.

Farmworker Justice has created a fact sheet on ACA and how it will affect access to healthcare for farmworkers and their families, available here. You may also contact Alexis Guild  for further information. 

You can find the link to the full  New York Times article here.

Farmworker Justice Celebrates National Health Center Week

August 11 - 17th  is National Health Center Week – a celebration of the services and contributions of community health centers to the health and well-being of millions of people across the United States. Community and migrant health centers provide affordable, high-quality primary preventative healthcare to medically underserved populations, including farmworkers and their families.

Why are migrant health centers important? The barriers to healthcare for farmworkers are numerous, including poverty, cultural and linguistic differences, transportation, and immigration status. An estimated 64% of farmworkers lack any form of health insurance. Migrant health center services are tailored to meet the needs of farmworkers and their families. Mobile clinics bring clinicians to the fields and outreach workers provide health education to community members.

The Affordable Care Act (ACA) creates new opportunities for farmworkers to access healthcare.  Farmworker Justice has created a fact sheet on the ACA and farrmworkers which is available here.  Some farmworkers will be eligible for tax credits in the health insurance marketplaces to lower the cost of monthly premiums, while others may be newly eligible for Medicaid. But regardless of their insurance coverage, these health centers can provide medical care for farmworkers and their families.

Health centers will play a pivotal role in the implementation of the Affordable Care Act. In 2010, $11 billion over five years was set aside to support the expansion of community health center services. Many community health centers are designated as “essential community providers” and will be a part of the provider network for health insurance plans offered in the state health insurance marketplaces. Health centers will also have personnel, known as navigators, dedicated to help patients and community members understand and enroll in health insurance. Inside the clinic and out in the fields, the navigators will be trained to talk with farmworkers about health insurance options under the ACA.

Farmworker Justice supports the mission of community health centers– to provide high quality care to underserved populations in the US. Our nation’s farmworkers, the men and women who harvest the fruits and vegetables we eat, deserve healthcare that is affordable, accessible and culturally competent. 

Celebrating Agricultural Worker Health Day - A Focus on FJ's Partnership with Migrant and Seasonal Head Start and Migrant Health Centers

Marcos, Lilia and their three children share an apartment close to town. Marcos works in the strawberry fields and has a schedule that often fluctuates with the changing tasks through the season. Lilia works at a landscaping company that has pretty consistent yet long hours and is a 45 minute drive from her home. Although Marcos works in close proximity to their home his hours, too, are long. Their two youngest children attend the local Migrant Head Start Center and their oldest is at the neighborhood elementary school.


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