Race, risk, and the health care of migrant workers in south GA

Gnat line news briefing 2-20-06

Who are migant farmworkers?

Origins of migrant labor

1942 US and Mexico sign Bracero program to fulfill agricultural labor needs (ended in 1964)

initiated the three migrant streams

East coast

West coast

Mid - western

Migratory agricultural workers in the U.S. Overview:

85% of fruits and vegetables in the US were cultivated and/or harvested by hand

Migrant workers are a culturally and ethnically diverse population

In GA the majority of farmworkers are Hispanic, poor, young, single men, undocumented

Bureau of Primary Health Care: Migrant Health Program Fact Sheet

Profile of farmworkers in the U.S. (National Agricultural Workers Survey 2000) Age:

Median age 29 67% are less than 35

Foreign –born 81% Born in Mexico 95% Undocumented 52%

Male 80% Parents with children 45% Income level below poverty 61%

Definitions of migrant and seasonal agricultural workers There is no one definition of migrant or seasonal

farmworker

Federal and state definitions vary by program; Migrant Health Program Department of labor

The as a result migrant and seasonal farmworkers may be eligible for one program but not for another

Why are migrant farmworkers

among the most medically vulnerable

in the US ??

Immigration status

Undocumented workers have limited social, economic, and health services

Role of the grower Contracts with crew leader Hirers H2A temporary foreign farm workers

Role of the crew leader

Health access barriers

Migration: following the seasonal migration pattern families may move 4 or more times a year

Dependence on crew leader: MFWs may not know their address how long they will work for the local farmer have limited transportation if brought by the

crew leader to the job

Labor and economic conditions

2000 US Department of Labor Report to the congress Many farmworkers remain ineligible for unemployment

benefits and workers compensation insurance Child labor: with parents consent children can work in

agriculture at age 13 years

(http://migration.ucdavis.edu)

housing

Inspected prior to occupancy by department of labor for non H2A workers

Historically deplorable: Overcrowded Unsanitary – mold, insect infested, Unsafe – lead paint, close to fields Lack privacy Exposure to hazardous chemical after workers

return home

Farm labor issues

Pesticides & chemicals Work place risks; machinery, long hours Lack of sanitation in the fields

Common illness in migrant farmworkers TB STDs -- Prostitution HIV/AIDS – bringing problem home to Mexico diabetes Teen pregnancy Gastritis Skin rashes (due to exposure to harmful chemicals and

pesticides Fungi problems Inadequate or non existent prenatal care Asthma and respiratory problems Alcohol abuse -- depression Work related accidents & illnesses (green tobacco illness)

What (if any)

health care servicescan

migrant farmworkersexpect ??

Health legislation affecting migrant and seasonal workers

1996 The Personal Responsibility and Work Opportunity Reconciliation Act Links citizenship and immigration status to Medicaid and

some social services Must be in U.S. 5 years legally before being eligible to

apply for Medicaid

In GA Medicaid eligibility for children who are documented Babies born healthy Fragmented health care services

Public health services

GA’s farmworker health program

GA’s farmworker health program provides migrant and seasonal farmworkers health care services through a patchwork of 6 migrant health centers throughout the state

GA’s program is unique because of it’s combination of heath care centers

There is no clear number of migrant and seasonal farmworkers in our state. Estimates of the number of m/sf in GA were developed 1996

Ellaville Primary Health Care Center Efforts Outreach services --

Serves five counties Migrant farm worker estimate 5000-7000 Served about 2400 MFWs in 2004 Offer primary health care services on a sliding

fee scale Projects

TB Immunization depression

Access does not always equal

utilization

Socio-demographics & vulnerability

Poverty Social isolation & marginalization Cyclical mobility Barriers to health care –

Medically vulnerable

Cultural and cognitive barriers to health care

Lack of continuity in health care Compliance barriers Cultural barriers

Folk illnesses Language barriers Acute care oriented Inappropriate use of hospital emergency

departments for primary care

continued

Child care health issues: Immunization Child labor Day care Safety: car safety seats

May have illness not prevalent in the US

MeaslesTBHelminthic infestations

Children

are the most vulnerable population

Special health care needs of children

Need for a good start Healthy pregnancies have higher percentage of

healthy babies Immunizations Education – attending, achieving, graduating Day care services Safety (safe homes, car safety seats) Preventative health care services:

Well child check up Dental health

contraceptive information

Growing health & social issues

Settled out farmworkers & Non-agricultural undocumented workers Undocumented Strain on GA’s infrastructure Limited credit history makes buying a home

difficult – over crowding Children brought here illegally by their parents

have limited job future & recent proposed GA legislation my make it impossible to enroll in higher education

Federal legislation: DREAM ACT

Why do

migrant health issues matter??

Practical reasons to provide health care

It’s cost effective An ounce of Prevention is worth a pound of

cure To reduce or eliminate disparities in access to

and use of health services Healthy workers keep us all healthy Immigrants and their children are our future

The will be a major segment of the US workforce in the coming years

Moral reasons

If you believe that we’re all in this together, we should care for those who provide nourishment for us