Health & Occupational Safety

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. 
 

Farmworker Justice Rises

Today, Farmworker Justice will rise. We will rise in solidarity with the Alianza Nacional de Campesinas (Alliance of Women Farmworkers) and others all over the world to end violence against women. We will rise as a part of One Billion Rising.

One Billion Rising, an international event that aims to bring attention to the issue of violence against women, will take place on February 14, 2013. The event is organized by V-Day, a non-profit organization founded by Eve Ensler, the playwright of the Vagina Monologues. Why One Billion Rising? Because approximately one billion women have been victims of violence around the world. Among these women are farmworkers.

Farmworker women and girls in the United States are at high risk of sexual violence and sexual harassment in the fields. Indigenous women are especially vulnerable. Many have limited Spanish proficiency and are discriminated against due to their ethnicity or language. According to a report last year from Human Rights Watch, women in the fields are subjected to rape, coercive sexual conduct, groping, and verbal harassment from foremen, supervisors, farm labor contractors and others who have the power to hire and fire workers. Few women report these abuses. They fear employer retaliation. They lack information about their rights in the workplace. They are ashamed of telling others about what happened to them. They fear that reporting may reveal their documentation status and/or the documentation status of loved ones. They lack the resources to complete the lengthy and complicated reporting process.  

Quantifying the economic impact of occupational injuries and illnesses in the United States

As farmworker advocates, we understand the emotional, physical and economic toll of occupational injuries and illness on farmworkers. Recently, a report came out that detailed the cost of occupational injuries and illness in the US. Paul Leigh, from the University of California, Davis conducted an economic analysis focused on low-wage occupations, defined as jobs that pay an hourly rate below $11.18.

More Pesticides Mean More Risks for Farmworkers & Their Children

As farmworkers plant, weed, irrigate, and harvest our fruits and vegetables, they are at constant risk for exposure to dangerous pesticide residues. These residues cling to plants and are easily absorbed into the soil. Farmworkers are continuously exposed as they engage in their daily work tasks.

 

Pesticide Perils: Children at Risk

Last week the Pesticide Action Network North America (PANNA) released a report entitled A Generation in Jeopardy: How Pesticides are Undermining our Children’s Health and Intelligence highlighting the disturbing connections between pesticide exposure and an alarming array of health risks, particularly for young children.

National Health Center Week: FJ & Migrant Health Centers

Throughout the week, Farmworker Justice highlighted the role of community and migrant health centers in the health and well-being of our nation’s farmworkers. Unfortunately, these health centers are under-utilized by farmworkers and their families. In fact, it is estimated that only 20% of farmworkers seek services at health centers. The barriers farmworkers face to access healthcare are numerous: poverty, insurance coverage, immigration status, transportation, fear of employer retaliation, limited English proficiency, lack of information…and the list goes on.

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