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Shifting Landscapes An Overview of Farmworker Demographics and Health Issues in Florida and the Southeast

Shifting Landscapes An Overview of Farmworker Demographics and Health Issues in Florida and the Southeast. Erin Kay Sologaistoa, M.S. Southeast Migrant Health Coordinator Florida Association of Community Health Centers. The Southeast: Florida, Georgia, Alabama, Mississippi.

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Shifting Landscapes An Overview of Farmworker Demographics and Health Issues in Florida and the Southeast

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  1. Shifting LandscapesAn Overview of Farmworker Demographics and Health Issues in Florida and the Southeast Erin Kay Sologaistoa, M.S. Southeast Migrant Health Coordinator Florida Association of Community Health Centers

  2. The Southeast: Florida, Georgia, Alabama, Mississippi

  3. Geographic Area and Number of Counties U.S. Census, 2000

  4. MSFW Analysis - Florida Perspective: Florida vs. Maryland

  5. Population U.S. Census, 2000

  6. Ethnic Composition U.S. Census, 2000

  7. Poverty Levels U.S. Census, 2000

  8. Mexicans Cubans Guatemalans Central Americans South Americans American Blacks Caribbeans Haitians Puerto Ricans Asians Ethnic Diversity • SE has Fastest Growing Hispanic Population • FL Haitian Population doubled between 1990-2000 (182,000)

  9. Income Inequality There are extreme contrasts between rich and poor within small geographic areas. For example: • Palm Beach and Belle Glade • Naples and Immokalee

  10. Population Distribution

  11. Agricultural Acreage U.S, Census of Agriculture, 1997

  12. Most Important Commodities (Cash Receipts 2001) U.S, Census of Agriculture

  13. Rank in 7 Hand Crops from Top 25 Commodities (cash receipts 2001) U.S, Census of Agriculture

  14. Florida Agriculture • 2nd most important industry; generates $6.2 billion • One of the longest growing seasons in U.S.(9 mo.) • 3rd (after CA and TX) in hired farm labor • 5th in agricultural chemicals • 9th largest producer of farm commodities

  15. Major Agricultural Trends Growth in the Nursery, Greenhouse and Fern Industry: • The Southeast and Delta Regions had one of the largest increases in hired farm workers between 2001 and 2002 due to accelerating nursery and greenhouse activity (U.S. Census of Agriculture) • 9 of the 30 leading congressional districts for nursery and greenhouse crops are in Florida; one is in Georgia • This industry is dominated by women.

  16. Rapid Pace of Farm Land Sold For Development Between 2002 and 2003 Florida was one of ten states with the largest decreases in farm land, losing 100,000 acres (USDA) Major Agricultural Trends

  17. Population Growth

  18. Florida Growth • 650 people move to Florida a day; 1 million every 4 years(U.S. Census) • Between 1995 and 2025, population growth in CA, FL and TX will account for 45% of the net population change in the U.S.(U.S. Dept of Commerce, Economic and Statistics Service)

  19. Florida Stressors • High degree of ethnic diversity • High growth rate demands increases in infrastructure and services • Low property taxes • No personal income tax • Many homestead exemptions • Large number of retirees • Lack of resources for needed services • Low level of public investment in services

  20. Florida Rural Health Challenges • 982,544 medically underserved in 67 geographic regions • 13 entire counties MUP • 14 counties lack even one pediatrician • 33 counties lack even one OB/GYN • Highest % of elderly at 18.5% vs. the national average of 12.8%.

  21. Farmworker Demographics (Larson’s and/or BPHC Atlas of State Profiles)

  22. Florida Farmworkers • 82% Male • 86% Hispanic • 9% Black Non Hispanic • Mean Age of 30 • 39% Married with Children • 43% Single without Children (University of Florida Dept of Anthropology/ Florida Department of Community Affairs 2002)

  23. MSFW Analysis - Florida MSFW Total Population * Source: Larsons and NCFH

  24. Florida Farmworkers According to NAWS • 66% ≤ poverty • 42% consider Florida their permanent residence • 32% consider Mexico their permanent residence • Settled farmworkers spend an average of 11.5 months a year in Florida • Migrants spend an average of 6.3 months in Florida • 81% are uninsured • 6% have employer provided insurance

  25. Increasing numbers of 13-16 year old males (30% more in the past 3 years according to the Florida Farmworker Association) Increasing numbers of indigenous speakers from Southern Mexico and Central America Increasing numbers of South Americans Increasing numbers of Farmworkers in N. FL/ S. GA. Increasing numbers of educated Latin Americans who were not farmers in their countries Increasing numbers leaving farm work in a decreasing amount of time Decreasing numbers of migrant labor camps leading to increasing housing shortages Florida and Georgia Farmworker Demographic Trends

  26. Florida Farmworker Issues • Increasing unemployment and under employment • Lack of housing • Highest number of labor contractors leading to abuse and lack of grower accountability • Lack of driver’s licenses and fear of deportation • Worker’s Comp reform allowing insurance companies to contest every claim has caused fewer MSFW to file ($80 million five years ago to $25 million today) • Barrier to higher education caused by social security number requirement

  27. Lack of knowledge about Florida specific pesticides especially for ornamentals (organo phosphates) Treated strictly as an agricultural issue with little involvement by the DOH Lack of buffer zones between fields and living quarters, schools and communities (Methyl bromide) Lax laws requiring growers to inform workers about pesticide risks and safety measures Lax enforcement of existing laws Conflict of interest created because the Dept. of Agriculture enforces laws created by Agriculture committees run by agricultural interests Pesticides

  28. Florida and Georgia Frequent Diagnosis • Diabetes • Hypertension • Heat Stroke • Farm Injuries (104 fatalities in Florida) • Vehicle Accidents • Muscle Strain • Dermatitis • Repetitive Motion Injuries • Eye Injuries • Green Tobacco Sickness

  29. Florida Farmworker Health Issues and Trends • HIV in young, male population • Lack of early access to prenatal care • Teen Pregnancy • Lack of Mental Health Services • Lack of Dental Services • Domestic Violence • **Growing number of free clinics (Gaps)

  30. Community and Migrant Health Centers in the Southeast

  31. Florida FQHC Locations

  32. Southeast FQHC Users

  33. Southeast FQHC Provider Breakdown

  34. MHC/CHC Grantee Delivery Areas & MSFW Population Data sources: MSFW Enumeration Profiles Study – FL, Larson, 9/2000; BPHC web site, 5/2003, and FACHC update, 5/2003 NCFH

  35. Florida Intended Expansions Through 2007 • 28 sites • 118 providers • 146,450 patients • 12,000 MSFW • 10 EMC • 5 behavioral health sites • 11 dental sites (Florida State Strategic Plan)

  36. Is Florida Getting its Share of the Pie?

  37. Barriers to Care • Lack of • Accurate data on farmworkers • Access to specialty services • Comprehensive language access strategy • Transportation • Workforce Shortages • State and County boundaries • High cost of pharmaceuticals for those ≤100% of poverty • Penalties for non participation in collaboratives where none exist • Need for clinicians to inquire about type of work performed by MSFW

  38. A Closer Look at Some Barriers to Care Florida Workforce Shortages • Physicians • Nurses • Bi-lingual Psychologists/Psychiatrists • Dentists

  39. A Closer Look at Some Barriers to Care Workforce Shortages • 31rst in number of RNs per 100,000 • Will need 34,000 additional nurses by 2006 ( HRSA) • Imports 90% of its new physicians each year • 50% received their education in other countries • Third in percentage of practicing physicians educated in other countries

  40. A Closer Look at Some Barriers to Care Lack of Access to Specialty Services such as • Radiology • Specialized Blood work, • Cat scans • Surgical specialties • ENT

  41. A Closer Look at Some Barriers to Care Barriers to Accessing Specialty Services • High cost of malpractice insurance means specialists aren’t willing to take the risk, especially with patients that have a low rate of compliance • Many specialists require patients to present a Social Security card

  42. A Closer Look at Some Barriers to Care Transportation • Not viewed as cost effective : Liability insurance 9000$ per Van • Transportation to specialists is particularly difficult Language Access • No comprehensive strategy for addressing language access

  43. Recommendation #1 Make It Easier For Specialists To Work With FQHCs • Increase the number of specialists that can participate in Medicaid • Afford liability immunity (FTCA coverage) to specialty and secondary care providers who provide services to the uninsured • Encourage states to increase Medicaid payments for specialty care, acknowledging that Medicaid patients are sicker and the potential problems are greater.

  44. Recommendation #2 Increase Funding For: • Pharmaceuticals • Dental • Chronic diseases such as diabetes, hypertension and cancer • Capital Outlay • Loan forgiveness for FQHC practitioners, including bi-lingual mental health professionals

  45. Recommendation # 3 and #4 • Ensure agencies receiving BPHC funding are coordinating with FQHCs to ensure continuity and avoid “piecemeal, sporadic” care. • Develop a nationally accessible computerized record tracking system.

  46. Recommendations #5 Research • The changing needs of settled farmworkers moving into new industries such as construction and landscaping • Pesticides in Florida, especially in the greenhouse and nursery industries • Adolescent health including teenage pregnancy, HIV and STDs

  47. Recommendation #6 and #7 Advocate for the right of non-citizens to hold a driver’s license Encourage the recruitment of farmworkers into the health care field. • Work with the Department of Education to eliminate barriers to secondary and post secondary education, such as the Social Security number requirement.

  48. Contact Information Erin Kay Sologaistoa Migrant Health Coordinator Florida Association of Community Health Centers 433 N. Magnolia Drive Tallahassee, Florida 32308 Phone:(850)942-1822 Fax: (850)942-9902 erin@fachc.org www.fachc.org

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