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

1. Race, risk, and the health care of migrant workers in south GA Gnat line news briefing 2-20-06

2. Who are migant farmworkers?

3. 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

4. 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

5. 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%

6. 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

7. Why are migrant farmworkersamong the most medically vulnerable in the US ??

8. 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

9. 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

10. 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)

12. 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

14. Farm labor issues • Pesticides & chemicals • Work place risks; machinery, long hours • Lack of sanitation in the fields

16. 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)

17. What (if any)health care servicescanmigrant farmworkersexpect ??

18. 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

19. 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

21. 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

23. Access does not always equal utilization

24. Socio-demographics & vulnerability • Poverty • Social isolation & marginalization • Cyclical mobility • Barriers to health care – • Medically vulnerable

25. 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

26. continued • Child care health issues: • Immunization • Child labor • Day care • Safety: car safety seats • May have illness not prevalent in the US Measles TB Helminthic infestations

27. Childrenare the most vulnerable population

28. 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

29. 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

30. Why do migrant health issues matter??

31. 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

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