THE HEALTH STATUS OF
IMMIGRANT WORKERS IN
THE US
FROM THE SECTION ON UNDERSERVED
OCCUPATIONAL POPULATIONS (SUOP)
OF THE AMERICAN COLLEGE OF
OCCUPATIONAL AND ENVIRONMENTAL
MEDICINE
MAY 1, 2012
The Health Status of Immigrant Workers in the US: A Work In Progress
Section Title
Table of Contents
Page Number
INTRODUCTION
•
Abstract
•
Purpose
•
SUOP Target Population: Who Are They? Why?
•
Population Shifts in the US and Some Reflections
On Immigrant Workers In The US: Just The Facts, Ma’am!
3
4
5
6
7
THE OCCUPATIONAL AND PERSONAL HEATH STATUS OF IMMIGRANT
WORKERS IN THE SUOP TARGET POPULATION
• Why All The Fuss About Immigrant Workers in “3D Jobs And Their Families?
• The Occupational Health of Immigrants in the SUOP Target Population
• The Personal and Family Health of Immigrants in the SUOP Population
22
IMMIGRANT WORKER DEMOGRAPHICS
• The Demographics of All US Immigrants and Immigrant Workers
• The Demographics of the SUOP Target Population
• The Demographics of Undocumented Immigrant Workers
MIGRANT FARMWORKERS: A VERY SPECIAL CASE
• Perspectives on US Migrant Farmworkers
• Timeline of Farm Work and Immigration in the US: :”PLUS ÇA CHANGE…”
• Critical Questions About US Migrant Farmworkers
o Why focus on this population?
o What is a migrant farmworker?
o What do they do?
o How many are there?
o Where do they come from?
o What is their legal status?
o Where in the US do they go?
o How did they get here?
o Who Are They: Age/Gender/Language/Education?
o What Are Their Working Arrangements and How Are They Treated?
o How much do they make?
o What are/aren’t their benefits and protections?
o What about their housing?
o What about their occupational safety and health?
o What are their personal and family health issues?
9
10
16
19
23
25
28
30
31
33
36
2
The Health Status of Immigrant Workers in the US: A Work In Progress
o What are their family issues?
SUMMARY
NEXT STEPS
Table of Contents (Cont.)
61
63
ACKNOWLEDGEMENTS
65
BIBLIOGRAPHY AND RESOURCES
67
3
The Health Status of Immigrant Workers in the US: A Work In Progress
INTRODUCTION
4
The Health Status of Immigrant Workers in the US: A Work In Progress
Abstract
Many papers and reports have been written about the health status of immigrant workers in general in the US and, in
particular, about those immigrants who are doing the dirty, difficult, and dangerous jobs here that no one else wants to do
like farm labor. This paper explores the current demographics of this population and what is known about their health
status and their access to adequate healthcare. Though improved somewhat through the efforts of the Federal Migrant
Health Program and several effective national organizations such as the Migrant Clinicians Network, the Farmworkers’
Justice Fund, the National Center for Farmworker Health, the United Farmworkers, and others as well as numerous State
and local organizations, the occupational and personal health status and health care access of this population does not
appear to even approach what others in America enjoy. What’s more, the internal and external pressures that have
brought such workers to the US in the past is increasing, not diminishing, such that almost all of the job growth in the US
over the next few years will be attributable to the availability of immigrant workers. It is sad to have to report this, but the
evidence is undeniable.
5
The Health Status of Immigrant Workers in the US: A Work In Progress
Purpose:
The Section on Underserved Occupational Populations (SUOP) of the American College of Occupational and
Environmental Medicine (ACOEM) believes that there is a significant population of immigrant (foreign-born) workers in the
US and their families that continue to experience serious health status and health care access issues of a personal, family
and/or occupational nature and that these issues have significant implications for all of us now and in the future.
This population representing about a third of immigrant workers in this country are performing the least desirable, though
no less necessary jobs that no one else wants to do, that we all depend on to maintain our styles of living, and that
currently and in the future will fuel the growth of our economy. Though most of these people come to the US to seek and
achieve a better life for their families as many US immigrants before them have done, our need for the work that they do is
increasing due to shifts within our native born population and – at the same time - the pace of their immigration is
quickening at a dramatic pace due to changes in the global economy some of which we, ourselves, have caused and/or
1,2
accelerated and because of conflicts abroad.
3
Some have called this worker population and their families “The Invisible People” . Others have called them “The Mobile
4
Poor” . As we will demonstrate, this is a population that continues to be plagued by health status and health access
difficulties that have not improved significantly since the epic TV documentary expose done by Edward R. Murrow on
Thanksgiving Day, 1960 entitled “Harvest of Shame.” In some ways their plight has actually worsened. This despite the
genuine and significant efforts made by federal and state government agencies, many professional and non-governmental
agencies at all levels, and labor organizations, these issues seem to persist. We believe that in the words of the title of
signature song of the popular, New Orleans Jam Band, Galactic, “There is something wrong with this picture!”
The specific purposes of this White Paper are
• To identify, quantify, and describe the sub-populations within the US immigrant worker population that have
unacceptable, diminished health status, flawed access to health care as well as other health issues
• To discuss the historic, current, and future importance of these sub-populations of workers in the US and the
threats to our nation posed by their problematic health status
• To catalog, segment, and describe in some detail the extent and severity of these heath issues, to describe their
etiologic and contributing factors, and to explore some of the historic, current, and future attempts to overcome
them.
• To forecast some of the personal and societal implications if the current situation continues.
This white paper is NOT intended to identify or advocate for logistical or political solutions for the problems in this area
that we face as a society and that members of this population face in their daily lives. That is beyond the scope of this
effort.
1
http://www.fas.usda.gov/itp/policy/nafta/nafta.asp
http://www.fas.usda.gov/itp/cafta/cafta.asp
http://www.extension.org/pages/9960/migrant-farm-workers:-our-nations-invisible-population
4
Kugel and Zuroweste; “The State of Health Care Services for Mobile Poor Populations:History, Current Status, and Future Challenges”: Journal of
Health Care for the Poor and Underserved 21 (2010): 422–429
2
3
6
The Health Status of Immigrant Workers in the US: A Work In Progress
Our SUOP Target Population: Who Are They? Why?
5
In 2010 there were 36 million foreign-born residents in the US , 23.1 million of whom were in the civilian labor force,
6
making up 16.4 percent of the total workforce (see also below). This population includes naturalized citizens, legal
permanent residents, temporary migrants (including H-1B workers and students), refugees, asylum seekers, and, to the
extent to which they are counted, unauthorized immigrants. This population is expanding rapidly in numbers and in
geography.
In this paper we will be focusing our attention on one large segment of the immigrant workers in the US: those who are
working at the low end of the wage and status scale in jobs often referred to as “Three D” jobs because the work is
considered “dirty, dangerous, and difficult”. These jobs are also called “SALEP”—jobs that are Shunned by ALL Except
the very Poor. 7 The workers in these jobs typically experience greater occupational, personal, and family health risks but
because they lack skills, documentation, education, and language proficiency, these jobs are all that is available to them.
They continue to gravitate to these “Three D” jobs because of the loss of paying jobs in their home country and because
8
these jobs pay far more than the migrants can make in their countries of origin.
5
http://www.renewoureconomy.org/brookings
Immigrant Workers in the U.S. Labor Force, A. Singer, www.brookings.edu/papers/2012/0315_immigrant_workers_singer.aspx
7
Böhning WR, Stryk R. The impact of the Asian crisis on Filipino employment prospects abroad (SEAPAT Working Paper 1). International Labour Office,
1998.
8
Migration and Occupational Health: Understanding the Risks, Marc Schenker, October 2011; Migration Policy Institute Information Source,
http://www.migrationinformation.org/Feature/display.cfm?ID=856
6
7
The Health Status of Immigrant Workers in the US: A Work In Progress
Population Shifts in the US and Some Reflections On Immigrant Workers In The
US: Just The Facts, Ma’am!
To better understand the plight and population dynamics of our target population, we should first understand what are
arguably some of the greatest social and economic “tsunamis” in the history of the US, i.e. the dramatic and relentless
population shifts that are currently occurring in the US and which – for a variety of reasons - will continue unabated into
the foreseeable future.
• Primary among these shifts is the aging of our US population and the resulting effect that it has and will continue to
have on the availability of labor (of all types) in the US.
• Another and equally as dramatic shift is in the ethnic and country of origin composition of our society and our
workforce and the role that immigration has and will continue to play in that shift.
• Finally, there have and will continue to be shifts in the size and nature of our economy as a whole that can and do
affect the composition and concentrations of our workforce.
Some evidence of the size and import of these shifts:
• AGING OF THE US POPULATION, EXPANSION OF THE US ECONOMY, AND THE DEMAND FOR WORKERS:
9
o 60 million workers are between the ages of 41-59 . The first baby-boomers (born in 1946) will turn 65 in 2011,
though experts believe many will opt to retire at age 62 instead, moving up the start of the retirement wave to
10
2008 .
o 2005 projections estimate that from 2015-2020, the fertility rate in the U.S. will be 1.91 children per woman,
11
dropping below the “replacement level” (two children are considered replacement) .
o The baby boomer generation and presence of women in the workforce expanded the size of the workforce in past
decades; low fertility rates mean that expansion of the native-born workforce is unlikely within the next 20-30
12
years .
o The economy continues to expand; from 2002-2012, job growth in professional and related occupations will be
11
23.3% and in service occupations will be 20.1% . According to the Bureau of Labor Statistics, there will be 27
13
million new jobs between 2002-2012 requiring a high school diploma or less education .
o Population estimates indicate that immigrants will generate all net labor force growth in the next twenty years
13
because the size of the native-born population between the prime working ages of 25-54 will not grow .
• THE ETHNIC AND COUNTRY OF ORIGIN COMPOSITION OF OUR SOCIETY AND OF OUR WORKFORCE AND
THE ROLE THAT IMMIGRATION HAS AND WILL CONTINUE TO PLAY IN THAT SHIFT
o New immigrants (who entered the U.S. between 2000 and 2004) contributed at least 67% of the growth in the
civilian labor force over the past 3 years, exceeding their contribution to the labor force in the decade of the
14
1990s, which was a historical high for the U.S.
15
o Immigrants are :

1 in 9 U.S. residents,

1 in 7 U.S. workers,

1 in 5 low-wage workers, and

1 in 2 new workers
o The size of the U.S. work force increased by 16.7 million workers in the 1990s. Of these workers, 6.4 million were
16
immigrants (38%) .
o 90% of new job growth between 1996-2000 was due to immigrants in these states: Connecticut, Iowa, Kansas,
Maine, Massachusetts, Minnesota, Missouri, Nebraska, New Hampshire, New Jersey, New York, North Dakota,
17
Pennsylvania, Rhode Island, South Dakota, and Vermont .
9
Harry Holzer, “New Jobs in Recession and Recovery: Who Are Getting Them and Who Are Not?” May 4, 2005.
http://www.urban.org/urlprint.cfm?ID=9264.
10
Murray Gendell, “Boomers' Retirement Wave Likely to Begin in Just 6 Years.” Population Today, April, 2002.
http://www.prb.org/Content/ContentGroups/PTarticle/April-June2002/Boomers_Retirement_Wave_Likely_to_Begin_in_Just_6_Years.htm.
11
Ewing, “The Economics of Necessity: Economic Report of the President Underscores the Importance of Immigration,” p. 1.
12
Holzer, “New Jobs in Recession and Recovery” and The Aspen Institute. “Grow Faster Together or Grow Slowly Apart.” 2002. p. 13.
http://www.aspeninstitute.org/atf/cf/{DEB6F227-659B-4EC8-8F84-8DF23CA704F5}/DSGBROCHURE_FINAL.PDF.
13
Paral, “No Way In” and Bureau of Labor Statistics. “Job Outlook for People Who Don’t Have a Bachelor’s Degree.” Occupational Outlook Quarterly.
Winter 2004-5. p. 3. http://www.bls.gov/opub/ooq/2004/winter/art01.pdf.
14
Sum, Harrington, Khatiwade, et al, NEW FOREIGN IMMIGRANTS AND THE LABOR MARKET IN THE U.S.: THE UNPRECEDENTED EFFECTS OF NEW
FOREIGN IMMIGRATION TO THE GROWTH OF THE NATION’S LABOR FORCE AND ITS EMPLOYED POPULATION, 2000 TO 2004 (Center for Labor Market
Studies, Northeastern University, Jan. 2005).
15
Randy Capps, Michael Fix, Jeffrey S. Passel, Jason Ost, and Dan Perez-Lopez., Urban Institute, “A Profile of the Low-Wage Immigrant Workforce.”
Brief No. 4. November, 2003. p. 1, http://www.urban.org/UploadedPDF/310880_lowwage_immig_wkfc.pdf and Bureau of Labor Statistics (BLS). “Labor
Force Characteristics of Foreign-Born Workers Summary,” May 12, 2005. http://www.bls.gov/news.release/forbrn.nr0.htm.
16
Federal Reserve Bank of Dallas, “U.S. Immigration and Economic Growth: Putting Policy on Hold.” Issue 6, November/December 2003.
www.dallasfed.org/research/swe/2003/swe0306a.html.
8
The Health Status of Immigrant Workers in the US: A Work In Progress
o
o
o
o
o
o
o
18,
Twelve states owe at least 80% of their labor force growth between 2000 and 2004 to new immigrant workers .
During the 1990s, the immigrant population in “new immigrant” states grew twice as fast as the immigrant
19
population in the six states that receive the greatest number of immigrants
The most rapid growth in the number of undocumented migrants has been in states that previously had relatively small
20
foreign-born populations, including Arizona, Georgia, North Carolina, and Tennessee
Even with employment of possible qualified native workers, there would have been a shortage of 500,000 workers
in 13 occupational categories during the 1990s without non-citizen workers.
21
These categories [most of which could be classified as “3 D” jobs] included
 miscellaneous agricultural workers (shortage of 108,392 workers),
 maids and housekeeping cleaners,
 sewing machine operators,
 grounds maintenance workers,
 construction laborers,
 other production workers,
 cooks,
 painters,
 construction and maintenance,
 janitors and building cleaners,
 butchers and meat, poultry, fish processing workers,
 other metal workers and
 plastic workers, packers and packagers (hand), and packaging and filing machine operators and tenders.
New immigration is likely to contribute between one-third and one-half of the growth of the labor force through
2030. Between 2010 and 2030, first and second generation immigrants together are projected to account for all
22
growth in the U.S. labor force.
In summary and simply put, our economy seems to be dependent on immigrant labor now and for the foreseeable
future. The U.S. population is aging rapidly as the baby boom cohort enters old age and retirement. As a result,
our economy will increasingly depend upon immigrants and their children to replace current workers and fill new
jobs.
17
Federal Reserve Bank of Dallas, “U.S. Immigration and Economic Growth,” Bureau of Labor Statistics, “The role of foreign-born workers in the U.S.
economy,” Monthly Labor Review. May 2002. p. 14, http://www.bls.gov/opub/mlr/2002/05/art1full.pdf
18
Sum, Harrington, Khatiwade, et al, New Foreign Immigrants and the Labor Market in the U.S.: The Unprecedented Effects of New Foreign Immigration
on the Growth of the Nation’s Labor Force and Its Employed Population, , 2000 TO 2004 (Center for Labor Market Studies, Northeastern University, Jan.
2005).
19
Fix, Zimmermann, and Passel, The Integration of Immigrant Families in the United States (Urban Institute, July 2001).
20
Jeffrey S. Passel, Estimates of the Size and Characteristics of the Undocumented Population (Pew Hispanic Ctr., Mar. 2005).
21
Rob Paral. American Immigration Law Foundation Policy Center. “Essential Workers: Immigrants are a Needed Supplement to the Native-Born Labor
Force.” March 2005. pgs. 1-5. http://www.ailf.org/ipc/essentialworkersprint.asp.
22
Gelatt, Batalova, et al, Immigrants, Migrants, and Labor Force Trends: The Future, Past and Present (Migration Policy Institute, July 2006).
9
The Health Status of Immigrant Workers in the US: A Work In Progress
US IMMIGRANT WORKER DEMOGRAPHICS
10
The Health Status of Immigrant Workers in the US: A Work In Progress
THE DEMOGRAPHICS OF ALL US
IMMIGRANTS AND IMMIGRANT WORKERS:
HOW OUR NATION IS CHANGING AND WILL
CONTINUE TO CHANGE
11
The Health Status of Immigrant Workers in the US: A Work In Progress
•
IN GENERAL
o In 1970, immigrants made up approximately 5 percent of the population and 5 percent of the labor force.
o By 2010, immigrants were 16 percent of the labor force, but only 13 percent of the total population (SEE FIGURE
A BELOW).
o There appears to be a strong relationship between economic growth and job growth in that immigrant newcomers
are drawn to available jobs.
FIGURE A
•
SOME CHARACTERISTICS OF THE CURRENT US IMMIGRANT WORKER POPULATION
6
O
CITIZENSHIP STATUS:
 Naturalized US Citizens: Just over two in five (or almost 17.5 million) immigrants in the United States in 2010
were naturalized US citizens.
 Others: The remaining 56 percent of immigrants (or 22.5 million) included lawful permanent residents,
unauthorized immigrants, and legal residents on temporary visas, such as students and temporary workers.
 Unauthorized: Unauthorized immigrants, number about 11 million in the United States (and 8 million in the US
workforce). They are predominantly though not overwhelmingly male [Figure 3 and Table 5 below] Most are
from Mexico and Central America [Table 3 below]. Most locate in California, Texas, and Florida (presumably
to engage in agricultural work) [Table 4 below] and are overrepresented in low-skill, low-wage jobs
o
EDUCATION LEVEL (SEE FIGURE B BELOW): 29 percent of adult immigrants in the United States do not hold a
high school diploma, a stark contrast to 7 percent in the U.S.-born population.
o
SKILL LEVELS (SEE FIGURE B BELOW):
 While 60 percent of natives holding jobs are considered middle-skilled (those with a high school diploma plus
those with some college experience or an associate’s degree), the share is nearly 20 percentage points lower
for immigrants who are drawn to the U.S. economy by better opportunities than in their home countries.
 As the American population has become more educated, the demand for lower-skilled workers has been
increasingly met by immigrant labor.
FIGURE B
12
The Health Status of Immigrant Workers in the US: A Work In Progress
•
•
As recently as 1994, 72 percent of employed persons without a high school diploma were U.S.-born; 16 years
later they made up only 48 percent of the total.
IMMIGRANT REPRESENTATION BY INDUSTRY (SEE FIGURE C BELOW):
o IN GENERAL
 Immigrants supply a large number of workers in industries with a more mixed or primarily low-skilled
workforce.
 These industries include construction, food service, and agriculture where they represent approximately onefifth of all workers.
 The highest shares of immigrant workers are found in private households (49 percent of all workers) and in
the accommodation sector (31 percent).
o IN SPECIFIC INDUSTRIES: Among key sectors with lower- skilled workers, levels of attainment between
immigrants and natives diverge.
 AGRICULTURE:
 While the vast majority of immigrant workers in the agriculture sector are low-skilled (77 percent), the
same is true for only 29 percent of native workers. .
 Nearly 61 percent of immigrants in the agricultural sector are classified as “miscellaneous agricultural
workers, including animal breeders.”
 These workers require little more than on-the-job training, largely planting and harvesting crops, operating
farm equipment, and raising animals. While the common perception of this sector is that it is dominated
FIGURE C


by immigrant workers, this is true only at the low-skill end.
 The average age of agricultural workers is 29 years, with very few older than 60 years, and the vast
23
majority of these individuals and families live below the poverty line . Approximately 80% of migrant and
seasonal farm workers are men.
24
 Women are more likely to be U.S.-born than men, 34% and 15% respectively .
 In the agricultural sector, immigrant workers are most likely to work as farm workers (60.5% of all
immigrants), while native-born workers are most likely to work as ranchers or farmers. (35.5% of all
native-born)
ACCOMMODATION:
 Here, more than half of foreign-born workers lack a high school diploma; the same is true of only onequarter of their U.S.-born counterparts.
 In the accommodations sector, immigrant workers are nearly three times as likely as native-born workers
to work as maids and housekeeping cleaners. (39.7% and 15.9%, respectively)
CONSTRUCTION:
23
Holmes, S.M. (2006, October). An Ethnographic Study of the Social Context of Migrant Health in the United States, Plops Medicine, 3 (10): e448.
National Center for Farmworker Health, Inc. (N.D.) Migrant and Seasonal Farmworker Demographics Fact Sheet, http://www.ncfh.org/docs/fsmigrant%20Demographics.pdf
24
13
The Health Status of Immigrant Workers in the US: A Work In Progress

•
 This sector shows a similar disparity in educational attainment with 60 percent of immigrants at the lowskill end and the majority of native workers with at least a high school diploma.
 Laborers occupy the top spot (26 percent) among immigrant workers in construction.
 In construction, immigrant workers are most likely to work as laborers (25.6% of all immigrants) while
native-born workers are most likely to work as managers. (14.3% of all native-born)
FOOD SERVICE:
 In this sector, half of foreign-born workers and one-quarter of U.S.-born workers lack a high school
credential.
 In the food service industry, immigrants are more than twice as likely as native-born workers to work as
cooks (31.5% and 14.2%, respectively), but more than 40 percent less likely than native-born workers to
work as waiters or waitresses. (15.7% and 24.5%, respectively)
IMMIGRANT REPRESENTATION BY AGE AND GENDER (SEE FIGURE D BELOW):
25
o In 2010, approximately 51 percent of the entire US immigrant population was female .
o In 2010:
 less than 1 percent of the foreign-born population in the United States were under the age of 5;
 6 percent were 5 to 17;
 9 percent were 18 to 24;
 72 percent were 25 to 64; and
 12 percent were 65 or older.
o Overall, the total immigrant population in 2010 was older than the US-born population: The median age of
immigrants was 41.4 years, compared to 35.9 years among the US
FIGURE D: ENTIRE IMMIGRANT POPULATION, BY AGE AND SEX, FOR THE UNITED STATES: 2010
26
FIGURE X
FIGURE
D
25
26
http://www.migrationinformation.org/USfocus/display.cfm?id=886#2a
http://www.migrationinformation.org/DataHub/pyramids.cfm
14
The Health Status of Immigrant Workers in the US: A Work In Progress
•
IMMIGRANT REPRESENTATION BY GEOGRAPHY: IN WHAT STATES WERE IMMIGRANTS CONCENTRATED
IN 2010 (SEE FIGURE E BELOW)?
FIGURE E
•
IMMIGRANT REPRESENTATION BY GEOGRAPHY: WHAT STATES HAD THE FASTEST GROWING
IMMIGRANT POPULATIONS IN 2010 (SEE FIGURE F BELOW)?
FIGURE F
TWO IN THREE IMMIGRANTS LIVED IN SIX STATES IN 2010;
15
The Health Status of Immigrant Workers in the US: A Work In Progress
•
IMMIGRANT REPRESENTATION BY GEOGRAPHY: IN WHAT COUNTIES WAS THE % OF IMMIGRANTS
HIGHEST IN 2000 (SEE FIGURE G BELOW)?
FIGURE G
16
The Health Status of Immigrant Workers in the US: A Work In Progress
THE DEMOGRAPHICS OF THE SUOP
TARGET POPULATION:
• BY COUNTRY OF ORIGIN,
• BY AGE AND GENDER,
• BY CITIZENSHIP STATUS,
• BY JOB CATEGORY, AND
• BY MIGRATION STATUS
17
The Health Status of Immigrant Workers in the US: A Work In Progress
•
IN GENERAL
The Immigrants in our SUOP target population described above come predominantly from Mexico (both
indigenous and non-indigenous) and Central America. The reasons are not hard to discern. Farmers in Mexico
are being driven off their land (as many as two million) due to the influx of subsidized agricultural products from
the US under NAFTA. The disappearance of agricultural jobs there has resulted in enormous pressures among all
segments of the Mexican workforce to “immigrate” to the US for jobs. The Mexican government itself has admitted
27
that 82% of the working population has less income that what is needed for a “basic subsistence” life.
What working class Mexicans face at home are millions being driven off the land, increasing unemployment in the
cities, young people with literally no job prospects, and deepening poverty throughout the country. In these
circumstances, Mexicans have three choices:
 work in the “informal sector” with no formal wages or benefits.
 work in the maquiladoras on the U.S.-Mexico border for wages of $1 an hour; or
 come to the U.S., with or without papers, to work whatever jobs they can find.
Today about 10% of Mexicans – some 12 million people – live in the U.S. Two-thirds of these immigrants have
arrived since NAFTA went into effect in 1994.
In 2010, 47 percent of the 40 million foreign-born population (about 18.8 million) reported having Hispanic or
Latino origins. Of the 50.7 million people in 2010 who identified themselves as having Hispanic or Latino ancestry,
only 37 percent (18.8 million) were immigrants. The majority of Hispanics in the United States are native-born US
citizens.
In 2006, Mexican workers sent $23.5 billion home, which was the country’s second biggest source of foreign
income after oil.
Perhaps due to the factors described above, within the Mexican émigré population, there are increasing numbers
of indigenous Mexicans coming into the US. They do not share customs or even language with the nonindigenous Mexicans who come here. They are from the southern, more remote parts of Mexico and speak
Mixtec, Zapotec, and Triqui.
In the case of Central America, the same set of factors is at play. The five Central American countries have even
weaker, more vulnerable economies than Mexico; they have fewer resources than Mexico; they have even worse
poverty levels than Mexico.
•
MEXICAN-BORN IMMIGRANTS BY AGE AND GENDER: 2010 (SEE FIGURE H BELOW) 28
FIGURE H
27
28
FIGURE Y: Mexican-Born
Immigrants in the US: Age
and Gender 2010
http://mhssn.igc.org/Brown_4-12-07.htm
http://www.migrationinformation.org/DataHub/charts/pyramid_3.shtml
18
The Health Status of Immigrant Workers in the US: A Work In Progress
•
MEXICAN-BORN IMMIGRANTS BY GEOGRAPHY: IN WHAT STATES WERE MEXICANBORN IMMIGRANTS CONCENTRATED IN 2010 (SEE FIGURE I BELOW)?
FIGURE I
•
MEXICAN-BORN IMMIGRANTS BY GEOGRAPHY: IN WHAT COUNTIES WAS THE
PERCENTAGE OF IMMIGRANTS HIGHEST IN 2000 (SEE FIGURE J BELOW)?
FIGURE J
19
The Health Status of Immigrant Workers in the US: A Work In Progress
THE DEMOGRAPHICS OF UNDOCUMENTED
IMMIGRANTS: BY COUNTRY OF ORIGIN, BY
AGE AND GENDER, BY CITIZENSHIP
STATUS, BY JOB CATEGORY, AND BY
MIGRATION STATUS
20
The Health Status of Immigrant Workers in the US: A Work In Progress
•
UNDOCUMENTED IMMIGRANTS BY COUNTRY OF ORIGIN (SEE FIGURE K BELOW)
FIGURE K
•
UNDOCUMENTED IMMIGRANTS BY AGE AND GENDER (SEE FIGURES L-1 AND L-2
BELOW)
FIGURE L-1
FIGURE L-2
21
The Health Status of Immigrant Workers in the US: A Work In Progress
•
UNDOCUMENTED IMMIGRANTS: BY DESTINATION IN US (PLEASE SEE FIGURE M BELOW)
The most rapid growth in the number of undocumented migrants, however, has been in states that previously
29
had relatively small foreign-born populations, including Arizona, Georgia, North Carolina, and Tennessee.
FIGURE M
The Future
To examine potential growth in the U.S. labor market, we can look at recent projections made by the U.S. Bureau of Labor
Statistics (BLS) of the occupations that are expected to grow the fastest and those expected to expand the greatest during
the 2010–2020 period. Among the 15 fastest-growing occupations, seven have high shares of foreign-born workers
currently employed in those jobs. This is higher than the share of the total labor force that is foreign-born. Among these
occupations, several construction jobs (many filled currently by immigrants and all low-skilled) are projected to be among
the fastest growing. Other low-skill occupations that have high shares of immigrant workers include home health aides (24
percent) and personal care aides (23 percent). All of these occupations are expected to grow by 42 percent or more
between 2010 and 2020 according to BLS projections. If current trends continue, we would expect to see these largely “3
D” occupations filled disproportionately by immigrants.
29
Jeffrey S. Passel, ESTIMATES OF THE SIZE AND CHARACTERISTICS OF THE UNDOCUMENTED POPULATION (Pew Hispanic Ctr., Mar. 2005).
22
The Health Status of Immigrant Workers in the US: A Work In Progress
THE OCCUPATIONAL AND PERSONAL
HEALTH STATUS OF THE SUOP TARGET
POPULATION: US IMMIGRANT WORKERS IN
“3D” JOBS
23
The Health Status of Immigrant Workers in the US: A Work In Progress
WHY ALL THE FUSS ABOUT IMMIGRANTS IN
“3D” JOBS?
24
The Health Status of Immigrant Workers in the US: A Work In Progress
Why All The fuss About Immigrants in “3 D”
Jobs?
Due to the overrepresentation of the foreign born in “dirty, dangerous, and difficult” jobs, immigrants, particularly the
unauthorized, can be at greater exposure than native born workers for workplace accidents, injuries caused by repetitive
movement and strain, and even death. The health costs for foreign-born laborers working under such conditions include
fatal and nonfatal injuries, toxic exposures, chronic illness or disease, and negative impacts on mental health.
What’s more, a number of other factors further expose immigrant workers and their families to further occupational,
personal, and family health risks. These factors include, but are not limited to
• poverty,
• non-native language abilities,
• migration,
• the lack of labor rights and opportunities for collective bargaining,
• reduced access to workers compensation protection,
30
• reduced protection against child-labor abuses (especially in agriculture) ,
• the lack of health insurance,
• the relative lack of access to health care, and
31
• poor access to family and other support systems.
Therefore, SUOP believes that there are several areas of serious concern for us and for the nation in re: immigrant
workers in the “3D jobs”:
• Their Occupational Health and Safety Status and Their Access to Quality OHS Services
• Their Personal Health Status and Their Access to Quality Healthcare
• Their Family Health Status and Their Access to Quality Family Healthcare
In the subsequent sections of this paper, we will be discussing and reporting on the current state of affairs with respect to
each of these concerns and – where possible – opining on the future of these issues if no new action is taken.
Again, it is NOT our intent to proffer solutions for what we find, but rather to assess and validate the quantity and severity
of health-related problems in the SUOP Target Population in the hope that, given the demographic shifts in our US
population and the likelihood of a continued influx of foreign-born workers to populate the “3D” jobs, by “naming the baby”,
we can more successfully and sustainably address the health related issues in that population that they and we will we
continue to struggle with.
30
“Young Migrant Workers Toil in U.S. Fields”; Karen Fanning; As Published in SCHOLASTIC NEWS, Online Edition. Copyright © 2007 by Scholastic
Inc.; http://208.106.244.178/pdfs/Part%201H-Young%20Migrant%20Workers%20Toil.pdf
31
Migration and Occupational Health: Understanding the Risks, Marc Schenker, October 2011; Migration Policy Institute Information Source,
http://www.migrationinformation.org/Feature/display.cfm?ID=856
25
The Health Status of Immigrant Workers in the US: A Work In Progress
THE OCCUPATIONAL HEALTH STATUS OF
US IMMIGRANT WORKERS IN “3D” JOBS
26
The Health Status of Immigrant Workers in the US: A Work In Progress
Despite the relative paucity of research on the occupational health of immigrants, many published studies and various
reports indicate a consistent pattern of higher occupational morbidity and mortality among immigrant workers, especially
those in in SUOP White Paper Target Population.
OCCUPATIONAL FATALITIES
Analysis of the US National Traumatic Occupational Fatality surveillance system (NTOF) showed an increase in
occupational fatalities among Hispanics in the 1990s, at the same time, the rate was decreasing among non-Hispanics
and blacks. This study also confirmed the presence of marked regional differences in occupational fatality rates, with
higher rates of occupational fatalities for all race or ethnic groups observed in Southern states.
The disproportionate share of occupational fatalities among immigrants in large measure relates to the types of
occupations immigrants choose. For example, in the United States, the three occupational groups with the highest rates of
occupational fatalities — transportation, construction, and agriculture — are the three groups with the highest proportion
of immigrant workers.
Only 8.0 percent of recorded occupational fatalities occur among women.
Consideration of occupational fatalities within specific occupations has also shown similar findings:
Construction: Overall, the risk of an occupational fatality among Hispanic construction workers was nearly twice the
8
risk among non-Hispanics. Another study of occupational fatalities in New Mexico from 1998 to 2002 analyzed two
different datasets and found that non-US citizenship was an independent risk factor for work-related deaths.
Agriculture: Fatalities in agricultural occupations rank among the highest for all workers in the United States, and
Hispanic immigrants dominate the agricultural workforce — particularly in the states of California, Texas, and Florida.
Thus, the finding of increased occupational fatalities among agricultural workers is consistent with an increased rate of
32
occupational fatalities among immigrant workers
Retail: Analysis of occupational fatalities in the retail trade industry from 1992 to 1996 found that workers had a
markedly increased risk of violent deaths compared with workers in other industries. The increased risk was
32
independently associated with being a foreign-born worker
•
•
•
•
•
•
Common explanations for the root causes of increased occupational fatalities among immigrant workers include the
following:
overrepresentation of immigrants in jobs with increased rates of injury and fatalities overall,
the assignment of more hazardous tasks to immigrant workers,
the failure of employers to invest in safety training and equipment for immigrant workers,
greater risk-taking by immigrant workers,
economic pressure to continue working despite chronic pain or illness, and
fear of and/or failure of workers who may have precarious job or immigration status to complain about unsafe conditions.
A common correlate of precarious work status among immigrant workers is psychological distress related to impact of
being isolated from family and community support, of inadequate living situations, and the economic effects of injuries.
This distress can and often does result in an exacerbation of chronic health problems and/or lower perception of one's
health.
NONFATAL OCCUPATIONAL INJURIES
In 2000, Hispanics comprised about 10.2 percent of the US workforce but accounted for 17.1 percent of occupational
injuries and illnesses. National data from the Bureau of Labor Statistics also show that Hispanic workers have greater
days away from work due to occupational injury or illness than all other race or ethnic groups. The four US industries with
the highest occupational injury rates are construction, agriculture, manufacturing, and transportation, and all of these
32
industries have a large and increasing proportion of immigrant workers in the United States
In a 2002 population-based study of 427 Hispanic immigrant workers in a Washington, DC suburb the occupational injury
rate was 70 percent above expected rates for US workers. The median lost time from work was 13 days and 29 percent of
the study's population had to change jobs because of the injury. Over one-half the subjects reported not having workers'
32
compensation and only 20 percent had medical insurance
32
Mexico-United States Migration Health Issues; First Edition; October 2005; ISBN 970-628-840-6
27
The Health Status of Immigrant Workers in the US: A Work In Progress
DAY LABOR
Day labor is a highly viable work option for many immigrants, especially the unauthorized. Day labor employment is
comprised of short-term, informal work agreements with employers and can entail a wide range of jobs, from construction
and maintenance to landscaping and garment production. Day labor is a form of precarious work for the large immigrant
labor pool performing contingent work, a practice that has increased with the downsizing and outsourcing of maintenance
and construction work.
Day laborers in the United States are predominantly young, male, Hispanic, unauthorized immigrants. Consistent findings
indicate increased rates of occupational injuries, lack of health insurance, and limited workers' compensation. Job
segregation by sex is common, with men dominating construction and maintenance jobs and women performing cleaning
and garment work.
A 2008 survey of day laborers found immigrant workers were one and a half to two times more likely than nonimmigrant
workers to report hazardous work conditions, controlling for type of workError! Bookmark not defined..
AGRICULTURE
The US agricultural workforce is also dominated by Hispanic immigrants who are predominantly male, poor, and
unauthorized. In California and other locations, over 85 percent of hired farm workers are Hispanic immigrants. Agriculture
has been recognized for years to have increased fatal and nonfatal injury rates plus a wide range of occupational
illnesses, including disorders of multiple organ systemsError! Bookmark not defined.. Agricultural work has a high
fatality rate, with 21.3 deaths per 100,000 workers per year, compared with the overall worker rate of 3.9. In addition,
those working in agriculture have an increased risk of toxic exposure as a result of poor or no use of PPE, poor availability
of information on chemicals that are being used, etc.
CLEANING
Female immigrants dominate cleaning occupations, both in commercial and residential settings. Recent research has
documented very high prevalence rates of severe neck and back pain among hotel cleaners associated with physical
workload, work intensification, and ergonomic stresses. Additionally, barriers to workers' compensation were apparent in
this population.
DATA COLLECTION ISSUES WHEN STUDYING OCCUPATIONAL HEALTH ISSUES IN AN
IMMIGRANT POPULATION
When conducting research on occupational health in an population of immigrant workers, researchers often have trouble
developing a valid sampling frame because of the large proportion of informal work arrangements, use of labor
intermediaries, short-term job placements, and absence of standard identification data (e.g., social security numbers)
among immigrant workers.
If the workers are migrating from job to job the data collection difficulties are multiplied ten-fold especially with respect to
follow up studies and follow up care activity.
In addition, even standard population-based surveys such as the Hispanic Health and Nutrition Examination Survey, or
HHANES, tend to exclude large segments of the population by their urban-focus, language of practice, or residential
stability requirements. Additionally, immigration status is frequently not recorded on surveys or may not be reported by
immigrants for fear of coming under enforcement scrutiny.
Language and culture are also barriers to successful research on immigrant populations, as subjects are frequently not
fluent in the dominant language and are thus excluded from research studies. Even bilingual studies may exclude
subjects fluent in different dialects or languages, especially when considering the increasing number of farm workers from
Mexico who speak only indigenous languages such as Mixtec, Zapotec, and Triqui.
28
The Health Status of Immigrant Workers in the US: A Work In Progress
THE PERSONAL HEALTH STATUS OF OF US
IMMIGRANT WORKERS IN “3D” JOBS AND
THEIR FAMILIES
29
The Health Status of Immigrant Workers in the US: A Work In Progress
CURRENT FACTORS THAT CAN AND DO NEGATIVELY AFFECT THE PERSONAL AND
FAMILY HEALTH STATUS OF THE SUOP TARGET POPULATION32
1. STRUCTURAL FACTORS
•
2.
Data collection on personal and family health issues as well as provision of care in this population is hampered by
the aforementioned obstacles, i.e. accurate, comprehensive data systems, language and dialect barriers, cultural
barriers, migration, etc.
• Undocumented status that leads to fear of reprisal and/or enforcement at care points
• Preference for alternative medicine practices, treatments, and practitioners
• Preference for home country medical care
• Relative lack of consistent access to public, personal and job-based health insurance. Nearly 15% of the total US
33
population is without health insurance, but among noncitizens, that rate is 43.8% and growing .
• Inconsistent or non-existent access to sufficient dental services despite significant demonstrated need
• Inconsistent or non-existent access to sufficient mental health services despite significant demonstrated need
• Severe poverty
• Reduced access to preventive services
• Relative lack of access to maternal and child health services, pap smears, mammograms, etc.
• Suboptimal access to proven methodologies and services such as promentores
• Reduced educational levels and access
• Reduced cyclical, so-called “permanent migration” patterns with an increase in unauthorized access
• Adult immigrants from Mexico are by far the least likely to have a place they usually go for medical care and the
least likely to regularly visit a doctor.
• A significant portion of the health care for undocumented immigrants comes through emergency departments.
This has increased the overall costs of health care; changed our focus from preventive care to emergency treatment;
contributed to delays in identifying illnesses until later, more advanced stages; and increased the level of disease
3333
within a community.
• Information about health and health care is transmitted more commonly by word-of-mouth
HEALTH BEHAVIORS
• Immigrants from Mexico are less likely he least likely to have had a colorectal exam in the past year. The great
majority of all immigrants age 50 and older have never had a colorectal exam.
• Immigrants from Mexico are less likely he least likely to have had a flu shot in the past year. Over half of
immigrants age 65 and older did not have an influenza immunization in the past year. Annual flu vaccine
initiatives are not adequately reaching Mexican immigrants.
• Mexican immigrant women have the lowest rates of obtaining pap smears and mammography exams. Breast
cancer remains the second most common cause of cancer deaths among women in the U.S. Recent Mexican
immigrants have the lowest rate of obtaining pap smears: one-third of women age 18-64 did not have the test in
the previous 3 years, the recommended period.
• Recent Mexican immigrants are the least likely to receive regular dental care even when it is available. The dental
care annual rate of recent immigrants is extremely low (30%).
• Immigrants from Mexico use E.R.s about half as often as the U.S.-born, whether white or Mexican American.
• Long-stay Mexican immigrants and U.S.-born Mexican Americans have higher rates of Diabetes than U.S.-born
whites.
• Higher percentages of long-stay Mexican immigrants and U.S.-born Mexican Americans report being in worse
health than do U.S.-born whites. It is unknown; however, if worsening health status is a result of years of difficult
labor and poverty, changing health behaviors like diet and smoking, or insufficient preventive medical care.
• Mexican immigrants do not routinely have access to and – for a variety of reasons – are less compliant with
Chronic Disease Management efforts on their behalf
• Immigrants are frequently the victims of toxic exposures with acute and/or chronic symptoms which can be
difficult to diagnose and manage.
• In addition, agricultural workers have increased rates of nonfatal injuries, chronic pain, heart disease, and
34
many cancers.
33
“Immigrant health care in the United States: What ails our system?”; Katherine G. Footracer, MS, PA-C, CMT; www.jaapa.com• APRIL 2009 • 22(4) •
JAAPA 33
34
Slesinger, D. (1992). Health status and needs of migrant farm workers in the United States: A literature review. The Journal of Rural Health, 8:227234.
30
The Health Status of Immigrant Workers in the US: A Work In Progress
MIGRANT FARMWORKERS: A VERY
SPECIAL CASE
31
The Health Status of Immigrant Workers in the US: A Work In Progress
MIGRANT FARMWORKERS:
SOME PERSPECTIVES
32
The Health Status of Immigrant Workers in the US: A Work In Progress
The situation with respect to the health and safety of migrant farmworkers can
only be described as the “perfect storm” of immigrant labor in the US: very hard,
dangerous, and unsafe work with high mortality, a forced dangerous and/or
deadly entrance path, few legal protections, health and emotional risks,
extremely poor access to health care, constant fear of discovery, no chance for
advancement, constantly moving from place to place, subjected to economic
and personal abuse, non-existent customer appreciation and feedback, etc. It’s
everything you want a job not to be!!
SOME RELEVANT QUOTES…
“People are not migrants by choice. We depend on misfortune to build up our force of migratory workers, and
when the supply is low because there is not enough misfortune at home, we rely on misfortune abroad to
replenish the supply.”
Harry S. Truman, 1951, Migratory Labor in American Agriculture, A Report of the President’s Commission on
74
Migratory Labor, Superintendent of Documents, U.S. Government Printing Office
“The apparent invisibility of production is a form of social forgetting, a politics of glossing over the real social
and economic relations that allow for our high standard of living. Considering the world of farm laborers
presents a powerful corrective to a society easily enamored with its own self-serving myths. Still, it is Americans’
deep rooted desire to believe in equality and the march of progress that makes farmworkers’ situation so
poignant, creating a discomfort born of our country’s failure to live up to its own ideals.” Those of us who are
privileged to interact with migrant patients during a time of need, when they may be at their most vulnerable and
fearful, can stand as the example of how they should be treated by society. We can indeed be a force for justice
for the health care of the mobile poor. DANIEL ROTHENBERG (Author of “With these Hands”)
“Every time we sit at a table to enjoy the fruits and grain and vegetables from our good earth, remember that they
come from the work of men and women and children who have been exploited for generations.”
CESAR CHAVEZ, CO-FOUNDER, UNITED FARM WORKERS
Farmworkers are some of our nation’s most vital workers, as their labor enables us to enjoy high quality, lowcost, fresh fruits and vegetables all year round. Despite farmworkers’ economic and cultural contributions to the
communities where they live and work, they continue to be the some of the lowest paid, least protected, and
35
unhealthiest workers in the United States .
“Before the free trade agreement the harvest was well paid, especially for corn and beans. But then, free trade
arrived and prices went down from there. A kilo of corn now costs a peso, and what’s a peso worth? Nothing…
36
less than a quarter. ” CRAVEN COUNTY FARMWORKER, NORTH CAROLINA
“These workers are doing work that American people will not do. We depend on farmworkers, and we can’t be in
business without them.”
37
SAMPSON COUNTY FARMER, NORTH CAROLINA
35
NCFI FARMWORKER FACT SHEET http://www.ncfarmworkers.org/resources/
NCFI FARMWORKER IMMIGRATION SHEET http://www.ncfarmworkers.org/resources/; Reference #7; National Farm Worker Ministry,
www.nfwm.org.
37
NCFI FACT SHEET ON MIGRANT FARMWORKER CONTRIBUTION TO NC ECONOMY; http://www.ncfarmworkers.org/resources/#Facts;
References #12: WRAL Focal Point, Migrant Housing Video, 2005.
36
33
The Health Status of Immigrant Workers in the US: A Work In Progress
A US TIMELINE ON AGRICULTURAL LABOR
PLUS ÇA CHANGE,
PLUS C'EST LA MÊME CHOSE !
34
The Health Status of Immigrant Workers in the US: A Work In Progress
Timeline of Farm Labor and Immigration 38
From slavery to the present day, our agricultural system has consistently relied upon the labor of displaced people who lack political power,
labor protections, voting rights, and the full benefits of citizenship. In addition, they have been separated from loved ones by an increasingly
militarized US-Mexico border. Farmworkers still confront these hurdles today38.
1600S–1800S: COLONIAL AMERICA & SLAVERY
•
•
•
White laborers brought from England as indentured servants were guaranteed passage to the colonies in exchange for years of hard
labor, usually in the fields.
Because they did not provide enough labor to support growing agricultural production for the export market, Africans were brought to
the colonies in slave ships where millions died.
Forced into slave labor in the fields, they formed the backbone of the US agricultural industry.
LATE 1860S–1870S: RECONSTRUCTION
•
•
The Thirteenth Amendment prohibited slavery and involuntary servitude, but many were forced back into low-wage sharecropping and
segregation under Jim Crow Laws from the 1870s well into the 1900s 39.
The System was called “peonage” and was outlawed. Did not actually stop until WW II. Was chronicled recently on PBS Documentary
entitled “Slavery By Any Other Name”
1860S–1930S: IMMIGRANTS IN CALIFORNIA
•
•
•
•
During the 1860s, large-scale farming brought Asian workers to supplement local and Mexican laborers.
By 1886, seven out of every eight farmworkers in California were Chinese.
When Chinese laborers began to organize, they were replaced by Japanese workers.
Filipinos replaced Japanese workers when they in turn began to organize39.
1880S: EAST COAST MIGRATION
•
•
Due to changes in agriculture, the end of slavery, immigration policy and fluctuations in employment opportunities, migrant labor
became an important part of East Coast agriculture.
French Canadians & Italian immigrants worked in the Northeast, and African Americans from the South began to migrate along the East
Coast 40.
WORLD WAR I
•
Because of a shortage of farmworkers during World War I, Congress passed the Immigration and Nationality Act in 1917, creating a legal
pathway for 73,000 Mexican workers to enter the U.S. 41
1930S: GREAT DEPRESSION, DUST BOWL YEARS
•
•
•
As a result of the 1917 legislation, many Mexicans continued to come the United States to find work even after the war. Then, in a
reversal of policy brought on by job losses during the Great Depression, the Immigration and Naturalization Service worked with
Mexican authorities to deport approximately 40,000 Mexican- Americans.
Over 300,000 Oklahomans, Texans, Arkansans, and Missourians settled in California during the 1930s 42. Hundreds of thousands of
40
farmworkers went on strike for higher wages in California, South Florida, and New Jersey .
Also in the 1930s, national labor laws were passed which excluded farmworkers and domestic workers from child labor protections,
overtime pay, minimum wage, and the right to organize.
1941–1964: IMPORTATION OF GUESTWORKERS
•
•
•
•
•
•
39 40
Over 100,000 European prisoners of war labored on farms in the Southeast. ,
Laborers from the Bahamas, Jamaica, and Barbados worked in sugarcane, citrus and vegetable production in Florida and on the East
Coast 43.
39
Italian farmworkers were replaced by Puerto Ricans in the Northeast .
Under the Bracero “Strong Arm” Program, Mexican farmworkers were imported by the federal government for work on farms and
railroads to supplement wartime labor shortages.
The Bracero Program was terminated under controversy in 1964, but the H2A Guestworker Program continues today, currently recruiting
over 20,000 workers each year for employment in agriculture 44.
During the economic boom that followed World War II, President Eisenhower expelled 1.5 million Mexican farmworkers, sixty percent of
whom were legal residents, through “Operation Wetback.” 45
1970S-1990S: NEW IMMIGRANTS
•
•
As African Americans moved into other industries, immigrants migrated towards jobs in agriculture.
39
Haitians began arriving in Florida during the 1970s, to be replaced in the 1980s by workers from Mexico and Central America .
38
NCFI FARMWORKER IMMIGRATION SHEET http://www.ncfarmworkers.org/resources/
NCFI FARMWORKER IMMIGRATION SHEET http://www.ncfarmworkers.org/resources/; Reference #4: Rothenberg, D. With These Hands: The
Hidden World of Migrant Farmworkers today. New York: Harcourt, Brace, & Co. 1998.
40
NCFI FARMWORKER IMMIGRATION SHEET http://www.ncfarmworkers.org/resources/; Reference #5: Hahamovitch, Cindy. The Fruits of Their
Labor: Atlantic Coast Farmworkers and the Making of Migrant Poverty, 1870-1945. University of North Carolina Press, Chapel Hill, NC, 1997
41
National Center for Farmworker Health, Inc. Available at: http://www.ncfh.org/?sid=36.
42
NCFI FARMWORKER IMMIGRATION SHEET http://www.ncfarmworkers.org/resources/; Reference #6: Poverty in the United States: An
Encyclopedia of History, Politics, and Policy, eds. Gwendolyn Mink and Alice O’Connor. Santa Barbara: ABC-Clio, 2004
43
NCFI FARMWORKER IMMIGRATION SHEET http://www.ncfarmworkers.org/resources/; Reference #2: U.S. Department of Agriculture, Agricultural
Marketing Service (USDA, AMS). Grain and Feed Market News, Various issues, 1992-2004.
44
NCFI FARMWORKER IMMIGRATION SHEET http://www.ncfarmworkers.org/resources/; Reference #11: Porter, Eduardo. Who Will Work the
Farms?, The New York Times. (Business/Financial Desk) March 23, 2006.
45
Hastings, Maribel. Legalizing Farm Workers: A Shared Necessity, Dec 10, 2009, Available at:
http://news.newamericamedia.org/news/view_article.html?article_id=56df00032f486e86384d8550b8c90c5e.
39
35
The Health Status of Immigrant Workers in the US: A Work In Progress
•
•
•
The 1986 Immigration Reform and Control Act (IRCA) granted residency to over three million undocumented immigrants, about half of
39
them farmworkers .
Many left farm work and were replaced by a new wave of undocumented workers.
H2A workers were denied permanent residency under IRCA12 though many had been coming to the United States legally for as many as
twenty years.
1994: NAFTA YEARS
•
•
NAFTA was signed, and two million Mexican agricultural jobs were lost due to heavily subsidized United States farm products imported
to Mexico 46.
This constituted a new factor pushing Mexican immigrants to the United States.
TODAY (2007)
•
•
•
Over 50% of immigrant farmworkers nationwide are not protected by legal documents 47.
Close to 90% of farmworkers are Spanish-speakers, the vast majority born in Mexico47.
More indigenous workers from rural Mexico and Central America are arriving, as well as guestworkers from Asia.
46
NCFI FARMWORKER IMMIGRATION SHEET http://www.ncfarmworkers.org/resources/; Reference #3: Mary Beth Lake; Sophia Murphy; Mark
Ritchie, “United States Dumping on World Agricultural Markets,” report by the Institute for Agriculture and Trade Policy, 2003, p.8.
NCFI FARMWORKER IMMIGRATION SHEET http://www.ncfarmworkers.org/resources/; Reference #8: U.S. Department of Labor. Findings from the
National Agricultural Workers Survey (NAWS) 2001 – 2002: A Demographic and Employment Profile of United States Farm Workers. Office of the
Assistant Secretary for Policy, Office of Programmatic Policy, Research Report No. 9. March 2005.
47
36
The Health Status of Immigrant Workers in the US: A Work In Progress
Some Critical Questions About US Migrant
Farmworkers: “The Invisible People”
37
The Health Status of Immigrant Workers in the US: A Work In Progress
Why Focus on This Population?
As mentioned previously the migrant farmworker population in the US (upon whom we depend so very greatly) are among
the least paid, hardest working, and least rewarded immigrant workers in the US. Nowhere is their plight more obvious
than in the statistics relating to their occupational and personal health status, their access to quality healthcare services,
and in the myriads of anecdotal horror stories one hears at meetings of migrant clinicians, occupational health providers,
and farm worker advocacy groups all over the US.
With but few exceptions, the story told of their health status and access to healthcare is almost the same today as it was
ten years ago, twenty years ago, and even 50 years ago at the time of “Harvest of Shame.” In many ways our relative lack
of progress in this arena makes one think of what Albert Einstein said when asked for the definition of insanity. His
answer: “It’s when you keep on doing the same thing and expect a different result.”
Given the huge changes, discussed earlier, in our US workforce and our increasing dependency on these workers, SUOP
believes that it is time for a reality check and a “sanity” check relative to the health status of and access to healthcare for
the migrant farmworker and his or her family.
If as we will show in this paper that we are still a long, long way from declaring victory in this war for the health of
migrants, SUOP would like to explore all possible avenues and potential partnerships to break the “Eisteinian Conundrum”
and make it possible when we write a follow-up report to this one to say that things really have changed.
A tall order indeed, but as William Shakespeare so accurately said, “Nothing Ventured, Nothing Gained.”
What Is A Migrant Farmworker?
•
•
•
•
•
A migrant farmworker is “an individual whose principal employment is in agriculture on a seasonal basis, and who, for
48
purposes of employment, establishes a temporary home.”
Today…migrants in the US have many occupations and participate in many industries in addition to farming (such as
construction, poultry and meat processing, and domestic services).
However, the term “migrant” in the US is most often interpreted as relating to farm workers harkening back to the
1930’s when “migrants” moved in large numbers from the dust bowl states to work in the agricultural fields of
California and the Pacific Northwest, encountering discrimination and hardship for themselves and their families the
whole way (as chronicled in the photography of Dorthea Lange, the writings of John Steinbeck, and the music of
Woody Guthrie and Cisco Huston).
For our purpose, then, a migrant farmworker is someone who works primarily in agriculture or an agriculture-related
49
industry, like food processing .
Migrant vs. seasonal:
o Migrant farmworkers travel from place to place to work in agriculture and move into temporary housing while
50
working ; Some "Migrant" farmworkers move from 'home base" communities in patterns known as "migrant
50
streams"
50
o Seasonal farmworkers work primarily in agriculture, but live in one community year-round
What Do Migrant Farmworkers Do?
•
•
•
•
Farmworkers play a vital role in cultivating the food we eat every day. Even though 85 percent of our fruits and
51
vegetables are harvested by hand, farmworkers remain largely invisible .
They all too frequently work for extremely low wages in unsafe environments with hazardous chemicals or waste,
31
dangerous machinery, sparse training, little protective gear, and few labor rights .
52
Agricultural labor includes planting, cultivating, harvesting and preparing crops for market or storage.
53
Other migrant farmworkers are employed in the fishing, construction, meat packing and dairy industries .
48
Arcury, T. and Quandt, S., Delivery of Health Services to Migrant and Seasonal Farmworkers. Ann Rev Publ Hlth 2007; 28:345-363.
http://www.hud.gov/groups/farmwkercolonia.cfm
NCFI US FARMWORKER FACT SHEET http://www.ncfarmworkers.org/resources/;Reference #1: Health Center Consolidation Act of1996, Section
330(g) – Public Law 104 – 299. Oct. 11, 1996.
51
“Harvest of Dignity,” http://pic.tv/harvest/farmworker-facts/
52
NCFI FARMWORKER IMMIGRATION SHEET http://www.ncfarmworkers.org/resources/; Reference #1: Health Center Consolidation Act of 1996,
Section 330(g) – Public Law 104 – 299. Oct. 11, 1996.
53
http://www.migrant.net/pdf/farmworkerfacts.pdf
49
50
38
The Health Status of Immigrant Workers in the US: A Work In Progress
•
•
•
•
With respect to their work, these workers are [gradually] moving from small fruit orchards and vegetable crops to
settings such as confined animal feeding operations (CAFOs), as well as meat-packing and other food processing
54
plants.
A need for low-wage workers in newer migratory industries such as landscaping, forestry, nurseries, construction,
54
fisheries, restaurants, hotels, and factory and warehouse work has also developed.
A 2007 study by the Oregon Center for Public Policy (OCPP) estimated that undocumented immigrants contribute
55
between $66 and $77 million in property taxes, state income taxes, and excise taxes annually in Oregon. The Social
Security Administration estimates that nationwide, undocumented workers contribute $7 billion in social security taxes
54
and $1.5 billion in Medicare taxes annually.
On average, the National Research Council estimates each undocumented immigrant will contribute approximately
54
$80,000 more per capita over his/her lifetime than he/she will consume in governmental services.
How Many Migrant Farmworkers Are There In The US?
•
•
•
•
Approximately 1.6 million migrant farmworkers work on American soil, harvesting fruits and vegetables for American
54
consumers, as well as for export, thus contributing to the American economy.
56
There are two to three million farmworkers in the United States.
The number of Mexican and other Latino farmworkers throughout the country, including the Northeast, has grown in
53
recent years due, in part, to programs like the H-2A guest worker plan .
Over 150,000 farmworkers and their dependents labor each year in North Carolina alone in crops including tobacco,
57,58
greenhouse and nursery, Christmas trees, vegetables and fruits.
Where Do They Come From?
•
•
•
•
•
•
Though it has at times changed (and will continue to change), at present it appears that the majority of this population
54
of workers is composed of Latinos (from Mexico and Central America) Error! Bookmark not defined..
Migrant farmworkers are primarily of Mexican origin but others come from Jamaica, Guatemala, Puerto Rico,
55
Honduras, the Dominican Republic, Haiti and other countries .
5953
81% of all farmworkers are foreign-born .
59
77% of all farmworkers were born in Mexico . They continue a long tradition of people from Mexico harvesting crops
in the southwestern United States, including those who came here through the historic “Braceros” program started in
59
the early 1940s to bolster our work force as “soldiers of the fields and railroads” to help the U.S. win World War II .
The demographics, ethnic composition, and even job categories of the “Mobile Poor” have been in a continuous state
54
of flux and are subject to “shifting political and economic winds”.
Immigration to the United States has increased notably since the 1994 signing of NAFTA, a free trade agreement that
60
has driven over two million Mexican farmers out of business.
What Is Their Legal Status?
•
An estimated 70% of migrant farmworkers (or 24% of all farmworkers) are undocumented, and the majority live below
61,62
the poverty line.
54
Kugel and Zuroweste, “The State of Health Care Services for Mobile Poor Populations:History, Current Status, and Future Challenges”: Journal of
Health Care for the Poor and Underserved 21 (2010): 422–429
55
Oregon Center for Public Policy, Undocumented Immigrants are Taxpayers Too: Issue Brief. April, 2006. Available at http://www.ocpp.org/cgibin/
display.cgi?page=issue060401immig.
56
NCFI US FARMWORKER FACTSHEET;http://www.ncfarmworkers.org/resources/#Facts; Reference #2-Report of the Commission on Agricultural
Workers, 1992
57
NCFI FACT SHEET ON MIGRANT FARMWORKER CONTRIBUTION TO NC ECONOMY; http://www.ncfarmworkers.org/resources/#Facts;
Reference #1: North Carolina Department of Agriculture and Consumer Services (2004). Major North Carolina Farm Commodities, accessed 10/23/2006
at: http://www.ncagr.com/stats/cashrcpt/commrank.htm and http://www.ncagr.com/stats/general/general1.htm& #3
58
NCFI FACT SHEET ON MIGRANT FARMWORKER CONTRIBUTION TO NC ECONOMY; http://www.ncfarmworkers.org/resources/#Facts;
Reference #3: 3 Larson, A. Migrant and Seasonal Farmworker Enumeration Profiles Study North Carolina, September, 2000.
59
www.migrant.net/pdf/farmworkerfacts.pdf
60
NCFI US FARMWORKER FACTSHEET;http://www.ncfarmworkers.org/resources/#Facts; Reference #5: Hemispheric Social Alliance “Lessons from
NAFTA: The High Cost of ‘Free Trade,” Hemispheric Social Alliance National Office, 2003.
61
Passel JS (for the Pew Hispanic Center). Unauthorized Migrants: Numbers and Characteristics. Published June 5, 2005. Available at
http://pewhispanic.org/reports/report.php?ReportID= 46.
39
The Health Status of Immigrant Workers in the US: A Work In Progress
•
•
•
•
The H-2 A visa program continues today, allowing foreign nationals to enter the U.S. for temporary agricultural work
and requiring that they return to their home country after a given amount of time. Many of these workers over-stay this
63
time period, thus becoming “undocumented” immigrants.
According to a 2005 survey, 53% of farmworkers are undocumented (without legal authorization), 25% are United
64
States citizens, and 21% are legal permanent residents.
65,66
Growers and labor unions say as much as 70 percent of younger field hands are illegal.
Based on March 2008 data collected by the Census Bureau, the Pew Hispanic Center estimates that unauthorized
immigrants are 4% of the nation's population and 5.4% of its workforce. Their children, both those who are
unauthorized immigrants themselves and those who are U.S. citizens, make up 6.8% of the students enrolled in the
67
nation's elementary and secondary schools
Where Do They Go in the US?
•
•
59
Migrant farmworkers and their families live and work in every state in the country .
The states with the highest farmworker population are California, Texas, Washington, Florida, Oregon, and North
68
Carolina.
Why Did They Come To The US?
Pull Factors
•
•
•
Because agriculture is one of the most dangerous and lowest-paying occupations in the United States, the US
69
agricultural industry cannot recruit citizens to fill much-needed jobs .
Rather than improve wages and conditions in the fields, the agricultural industry recruits workers abroad where there
70
are more laborers, fewer jobs, and much lower wages .
Workers are also lured to labor on United States farms by the promise of a better life for themselves or their children:
70
the “American Dream.”
Push Factors
•
•
Many people in developing countries face extreme poverty, lack of jobs, natural disasters, armed conflict, and civil
70
unrest.
As economic refugees, many immigrant farmworkers have made the difficult decision to leave their homes and
70
families in search of new possibilities in the United States.
Globalization
•
•
•
Economies are developing in increasingly interconnected ways and international trade is occurring at unprecedented
70
70
levels . This process of overlapping markets and free trade is called globalization .
International agreements like the North American Free Trade Agreement (NAFTA) have increased imports to
developing countries, but have not eliminated government subsidies for those products; this allows wealthy countries
7070
like the United States to sell some products below what they cost to produce .
71
Under NAFTA, the United States increased corn exports to Mexico by 240% , and during certain years was able to
72
sell corn 30% below its cost of production.
62
Hastings, Maribel. Legalizing Farm Workers: A Shared Necessity. Dec 10, 2009. Available at: http://news.newamericamedia.org/news/view_article.
html?article_id=56df00032f486e86384d8550b8c90c5e.
63
Historical and Contemporary Factors Contributing to the Plight of Migrant Farmworkers in the United States, Safina Koreishi, MD, MPH and Martin
Donohoe, MD, FACP; Social Medicine (www.socialmedicine.info) Volume 5, Number 1, March 2010
64
NCFI-US FARMWORKER FACTSHEET, http://www.ncfarmworkers.org/resources/#Facts, Reference #4: The National Agricultural Workers Survey,
US Dept of Labor, 2005
65
U.S. FARMERS GO WHERE WORKERS ARE: Mexico; Julia Preston; New York Times, Tuesday, September 4, 2007
66
Farm Workers; The Rising Farmworker Dream Fund (RFDF); http://www.risingfarmworkers.org/farmworkers/
67
A Portrait of Unauthorized Immigrants in the United States; Jeffrey S. Passel, Pew Research Center, April 14, 2009;
http://pewresearch.org/pubs/1190/portrait-unauthorized-immigrants-states
68
NCFI-US FARMWORKER FACTSHEET, http://www.ncfarmworkers.org/resources/#Facts, Reference #3: Larson, Alice. “Migrant Enumeration Study
Update,” Washington, DC, Office of Minority Health, 2000.
69
NCFI FARMWORKER IMMIGRATION SHEET http://www.ncfarmworkers.org/resources/. Reference #1: S.A. McCurdy, S.J. Samuels, D.J. Carroll,
J.J. Beaumont, and L.A. Morrin, Agricultural Injury in California Migrant Hispanic Farm Workers, American Journal of Industrial Medicine 44 (2003), pp.
225-235.
70
NCFI FARMWORKER IMMIGRATION SHEET http://www.ncfarmworkers.org/resources/
71
NCFI FARMWORKER IMMIGRATION SHEET http://www.ncfarmworkers.org/resources/. Reference #2. U.S. Department of Agriculture, Agricultural
Marketing Service (USDA, AMS). Grain and Feed Market News. Various issues, 1992-2004.
72
FARMWORKER IMMIGRATION SHEET http://www.ncfarmworkers.org/resources/. Reference #3. Mary Beth Lake; Sophia Murphy; Mark Ritchie,
“United States Dumping on World Agricultural Markets,” report by the Institute for Agriculture and Trade Policy, 2003, p.8.
40
The Health Status of Immigrant Workers in the US: A Work In Progress
•
Unable to compete with subsidized imports, over two million Mexican farmers have lost their jobs since 1994, and
73
many have sought employment in the United States as a means of survival .
How Did They Get Here?
•
•
For many in this population (the undocumented) just getting into this country poses huge health and safety risks that
74
many find just a part of doing business due to their extreme economic need. Many risk their lives to enter the U.S .
There were over 5,000 border crossing deaths reported along the U.S.-Mexico border between 1993 and 2009,
54
underscoring the extreme risks migrants take in order to just work.
Who Are They: Age/Gender/Language/Education?
•
•
•
•
•
The average farmworker age is only 31 years since it is difficult for older workers to perform such physically
59
demanding labor.
59
80% of farmworkers are men who often must leave their families behind while they seek work, and most are younger
60
than 31
59
Five out of six farmworkers are native Spanish speakers.
Most farmworkers are married and/or have children; yet almost six out of ten farmworkers live apart from their
64
immediate family members.
Low education levels: The median highest grade of school completed by farmworkers is sixth grade. Thirteen percent
64
of farmworkers have completed less than three years of schooling, and 13% have completed high school.
What Are Their Working Arrangements in The US and
How Are They Treated?
•
•
•
•
•
•
•
•
Nevertheless, it is estimated that about one sixth (17%) of workers performing seasonal agricultural services literally
“follow-the-crop,” and an additional 39% “shuttle” back and forth between a home base, most often in Mexico, and a
293
single, specific U.S. location where they find employment.
Turnover is very high among these workers. Roughly one third (32%) of the foreign-born workers had been in the
United States for two years or less. In other words, fully one quarter (26%) of the labor force had been replaced in just
293
twoyears .
Much farm work is seasonal and workers cannot earn money in bad weather, while waiting for crops to ripen, when
53 59
they are sick, or when traveling to their next job .
However, farmworkers are usually employed by farm owners or by “crew leaders,” who serve as intermediaries
75
between growers and workers.
As noted, once in the US, those in the “Mobile Poor” population are very likely to endure unfair labor practices and
76
77
unsafe workplaces. Numerous stories of the ill-treatment of migrant workers have been told.
Some employers may prefer migrant or even undocumented workers, whom they may see as willing to do more work
78
for less pay and having little or no recourse to the law.
In many ways, the plight of farmworkers is similar to that of the former slaves victimized in the post-Civil War period
(up until the time of WW II) under the “peonage” system recently and vividly chronicled in the PBS Special: “Slavery
79
By Any Other Name.”
Such pressures make workers reluctant to miss work and afraid of losing their jobs if they take time off to get medical
80
care and create a work force less likely to report workplace safety and wage violations, less likely to have access to
81
training and protective equipment, and less likely to seek medical attention.
73
FARMWORKER IMMIGRATION SHEET http://www.ncfarmworkers.org/resources/. Reference #4. Rothenberg, D. With These Hands: The Hidden
World of Migrant Farmworkers today. New York: Harcourt, Brace, & Co. 1998.
74
Kugel and Zuroweste; “The State of Health Care Services for Mobile Poor Populations: History, Current Status, and Future Challenges”: Journal of
Health Care for the Poor and Underserved 21 (2010): 422–429;
75
NCFI-US FARMWORKER FACTSHEET, http://www.ncfarmworkers.org/resources/#Facts
76
Kugel and Zuroweste; “The State of Health Care Services for Mobile Poor Populations:History, Current Status, and Future Challenges”: Journal of
Health Care for the Poor and Underserved 21 (2010): 422–429; Reference #21-23
77
Kugel and Zuroweste; “The State of Health Care Services for Mobile Poor Populations:History, Current Status, and Future Challenges”: Journal of
Health Care for the Poor and Underserved 21 (2010): 422–429; Reference #24
78
Kugel and Zuroweste; “The State of Health Care Services for Mobile Poor Populations:History, Current Status, and Future Challenges”: Journal of
Health Care for the Poor and Underserved 21 (2010): 422–429
79
“Slavery By Any Other Name,” http://www.slaverybyanothername.com/
80
Kugel and Zuroweste; “The State of Health Care Services for Mobile Poor Populations:History, Current Status, and Future Challenges”: Journal of
Health Care for the Poor and Underserved 21 (2010): 422–429; Reference #25.
41
The Health Status of Immigrant Workers in the US: A Work In Progress
•
•
•
•
•
•
Many remain undocumented and thus even more vulnerable to the immigration enforcement system and – even
82
worse – to unscrupulous and predatory practices of labor contractors and coyotes.
Migration is highly stressful, as the facts recounted here suggest. In addition, migrant workers are often separated
83
from their families, traveling on their own with no support.
A migrant farmworker’s health status is often affected by environmental and occupational exposure (often
unknowingly) to hazardous chemicals, dangerous and repetitive work activities, to unsanitary housing and to onerous
working conditions, i.e. long days with sun and heat exposure, no access to sanitary facilities, high work content
78
involving bending and stooping or work at full arm extension, etc.
Many large food corporations have consolidated under the pressures of globalization. They subsequently underpay
their growers and maintain poor working conditions in order to achieve a competitive advantage in the global food
market. This situation has led to forced labor, beatings, sweatshop conditions, and modern-day slavery, which will be
84
discussed in further detail below.
According to a statement written by the Robert F. Kennedy Memorial Center for Human Rights, on behalf of the
National Economic and Social Rights Initiative and the Coalition of Immokalee Workers (CIW), in Florida, [about
migrant conditions in areas of Florida] inhumane working conditions are widespread:
“Sweatshop conditions in the fields are pervasive; violence and various forms of intimidation are common;
and wages have plummeted while slavery has become more prevalent. Workers are pushed into severe
poverty and dangerous working conditions, including up to 14 hour days for wages significantly below the
84
official poverty rate.”
Though outlawed almost 150 years ago in the United States, there have been six recent slavery court cases brought
84
against growers in Florida.
How Much Do They Make?
•
•
•
•
•
•
59
12% of all farmworkers earn less than the minimum wage .
85
Farmworkers’ average annual income is $11,000; for a family it is approximately $16,000 . This makes farm work the
86
second lowest paid job in the nation (after domestic labor) . Farmworkers on the East Coast earn about 35 percent
51
less than the national average
From 2001-2004, 29% of hired crop workers interviewed in the Department of Labor's National Agricultural Workers
87
Survey (NAWS) had family incomes that were below the federal poverty level .
Farmworkers are often paid piece-rate by the bucket; in some states they earn as little as 40¢ for a bucket of
tomatoes or sweet potatoes. At that rate, farmworkers have to pick around two tons of produce (125 buckets) to earn
88
$50 .
Though farmworker wages have increased slightly over the last decade, after adjustment for inflation they have
89
actually decreased by 5% .
According to a recent study, nearly five out of ten farmworker households in North Carolina cannot afford enough food
90
for their families .
81
Kugel and Zuroweste; “The State of Health Care Services for Mobile Poor Populations:History, Current Status, and Future Challenges”: Journal of
Health Care for the Poor and Underserved 21 (2010): 422–429; Reference #’s 21 and 26-30
82
Fact Sheet: The Exploitation of Undocumented Workers;http://www.drummajorinstitute.org/library/report.php?ID=105
83
Kugel and Zuroweste; “The State of Health Care Services for Mobile Poor Populations:History, Current Status, and Future Challenges”: Journal of
Health Care for the Poor and Underserved 21 (2010): 422–429;
84
Economic and Social council, Subcommission on Human Rights. 57th session, item 6(b) of the provision agenda 15, July 2005.
85
NCFI US FARMWORKER FACT SHEET http://www.ncfarmworkers.org/resources/; Reference #4: U.S. Department of Labor. Findings from the
National Agricultural Workers Survey (NAWS) 2001 – 2002: A Demographic and Employment Profile of United States Farm Workers. Office of the
Assistant Secretary for Policy, Office of Programmatic Policy, Research Report No. 9. March 2005.
86
NCFI US FARMWORKER FACT SHEET http://www.ncfarmworkers.org/resources/; Reference #7: Jack L. Runyan. “Hired Farmworkers’ Earnings
Increased in 2001 But Still Trail Most Occupations.” Rural America 17:3. Fall 2002.
87
http://www.hud.gov/groups/farmwkercolonia.cfm
88
NCFI US FARMWORKER FACT SHEET http://www.ncfarmworkers.org/resources/; Reference #8: Employment Security Commission. 2002.
Assessment of Need for Agricultural Services and Prevailing Wage Surveys.
89
NCFI FACT SHEET ON MIGRANT FARMWORKER CONTRIBUTION TO NC ECONOMY; http://www.ncfarmworkers.org/resources/#Facts; Reference
#2: Overview of America’s Farmworkers (n.d.) from the National Center for Farmworker Health’s website, at: http://www.ncfh.org/aaf_02.php; National
Center for Farmworker Health (n.d.). Facts About Farmworkers, http://www.ncfh.org/docs/fs-Facts%20about%20Farmworkers.pdf
90
NCFI FACT SHEET ON MIGRANT FARMWORKER CONTRIBUTION TO NC ECONOMY; http://www.ncfarmworkers.org/resources/#Facts;
References #8: Quandt, SA, Arcury, TA, Early J, Tapia J, Davis JD (2004). Household food security among migrant and seasonal latino farmworkers in
North Carolina. Public Health Reports Nov-Dec;119(6):568-76.
42
The Health Status of Immigrant Workers in the US: A Work In Progress
What Are The Protections and Benefits For Adult
Farmworkers?
•
•
•
•
WAGE PROTECTIONS:
o Most farmworkers are exempt from minimum wage laws, and all are exempt from overtime provisions, despite
91
long work days during peak harvest .
o Minimum wage: The Fair Labor Standards Act of 1938 (FLSA) originally excluded all farmworkers, and was
92
amended in 1978 to mandate minimum wage for workers on large farms only
o Overtime pay: The FLSA has never been amended to provide overtime for farmworkers, and only a few states
92
have passed laws requiring it.
WORKERS COMPENSATION:
o Only 13 states require employers to provide workers’ compensation coverage to migrant and seasonal agricultural
83
workers to the same extent as other workers.
o For many of these workers injured or exposed on the job, the resource available to most American workers,
workers compensation is just not available.
o In North Carolina most growers are exempt from laws requiring Workers’ Compensation for farmworkers who are
93
injured on the job
OTHER BENEFITS:
o Despite pervasive poverty, less than 1 percent of farmworkers collect general assistance welfare nationwide.
51
o Only 10 percent of farmworkers report having health insurance through an employer health plan .
o Fewer than 4 out of 10 workers interviewed said that they would receive unemployment benefits if out of
work.Error! Bookmark not defined. Despite their poverty, most farmworkers are not eligible for social services.
Less than one percent of all farmworkers use general assistance welfare, only two percent use social security,
85
and fewer than 15% are Medicaid recipients
OTHER LABOR RIGHTS:
o Labor organizing: Farmworkers were excluded from the National Labor Relations Act of 1935, which protects
92
workers acting collectively to form union.
o There is no protection under North Carolina or federal law for farmworkers to organize a union, work overtime,
94
take sick leave, or for those who are laid off from their jobs.
o HUNGER: Nearly 5 out of 10 North Carolina farmworkers cannot afford enough food for themselves and their
51 95
families .
91
http://www.ncfarmworkers.org/learn/introduction-to-farm-work/
NCFI US FARMWORKER FACT SHEET http://www.ncfarmworkers.org/resources/
93
NCFI FACT SHEET ON MIGRANT FARMWORKER CONTRIBUTION TO NC ECONOMY; http://www.ncfarmworkers.org/resources/#Facts;
References #10: NCGS 97-13(b)
94
Overview of America’s Farmworkers (n.d.) from the National Center for Farmworker Health’s website, accessed 10/6/2006 at:
http://www.ncfh.org/aaf_02.php; National Center for Farmworker Health (n.d.). Facts About Farmworkers, accessed November 20, 2006 at:
http://www.ncfh.org/docs/fs-Facts%20about%20Farmworkers.pdf
95
Quandt SA, Arcury TA, Early J, Tapia J, Davis JD (2004). Household food security among migrant and seasonal latino farmworkers in North Carolina.
Public Health Reports Nov-Dec;119(6):568-76.
92
43
The Health Status of Immigrant Workers in the US: A Work In Progress
What Are The Protections and Benefits For Child
Farmworkers?
•
Each year, an estimated 300,000 to 800,000 children toil under the hot sun while working on farms
across the United States. 96 Though their labor contributes to the U.S. agriculture industry and
undoubtedly helps put food on the tables of many Americans, child agriculture laborers do not
benefit from their time spent in the fields. Instead, these children are at risk of losing their childhood,
their health and their education 97.
•
The International Labour Organization defines child labor as work that:
o Deprives children of their childhood, their potential and their dignity, and is harmful to physical and
mental development.
o Is mentally, physically, socially or morally dangerous and harmful.
o Interferes with their schooling by depriving them of the opportunity to attend school, obliging them to
leave school prematurely, or requiring them to attempt to combine school attendance with excessively
98
long and heavy work.
CHILD LABOR LAWS
o
Children working in agriculture do not receive the same
protections provided to other working youth. The following are a list of laws that govern youth employment in
agriculture and how they compare to children working in other occupations under the Fair Labor Standards Act
99
(FLSA).
 Children ages 16 and above may work in any farm job at any time including performing hazardous work.
Children in other occupations cannot perform hazardous work until age 18.
 Children working in agriculture can work unlimited hours outside of school hours. Children working in all other
occupations have strict limits on the amount of time they can work outside of school.
 The standard minimum age for children being able to work in agriculture is 14. The standard minimum age for
children being able to work in all other occupations is 16.
 Children even younger than 12 are permitted to work in the fields as long as they have their parent’s
permission, with no restrictions on hours except that they cannot work during school hours. Children working
in all other occupations are permitted few exceptions to the standard minimum age. They have strict limits on
hours, such as not more than 3 hours on a school day and not more than 8 hours on a non-school day.
o Despite the laws, children of all ages can be found working in the fields.
CHILD FARMWORKER PAY, PROTECTION AND OTHER BENEFITS
o
Children who work more than 40 hours per week in agriculture are not entitled to overtime pay. Children
working in all other occupations are not allowed to work more than 40 hours a week.
o
Children who work in the fields are exempt from minimum wage provisions in certain cases. Children
working in all other occupations are required to be paid minimum wage.
o
Though child agriculture workers risk their health, life and education when working on farms, they are often
severely underpaid or paid nothing for their labor.
o
Growers often pay farmworkers piece rate wages. This works well for stronger quicker workers, but hurts
100
slower ones such as children. As a result, many children can only make as little as $2 to $3 an hour.
o
The National Agricultural Workers Survey (NAWS) found that agricultural workers aged fourteen through
101
seventeen earned just over $4 an hour, on average.
o
In some cases, children who are entitled to minimum wage earnings work alongside their parents but are
not paid any wage especially when parents are paid on a piece-rate basis.
•
•
96
Human Rights Watch, Fingers to the Bone: United States Failure to Protect Child Farmworkers.
Washington: Human Rights Watch, 2000.
97
NCFH Fact Sheet on CHILD LABOR; 2009; http://www.ncfh.org/?pid=5
98
International Labour Organization, International Programme on the Elimination of Child Labour, “ About child labour”, Available Online at
http://www.ilo.org/ipec/facts/lang--en/index.htm
99
U.S. Department of Labor (2007). Child Labor Requirements in Agricultural Occupations Under the Fair Labor Standards Act. Available at
http://www.dol.gov/esa/whd/regs/compliance/childlabor102.pdf
100
Association of Farmworker Opportunity Programs. (2007). Children In The Fields: An American Problem. Available Online at
http://www.afop.org/CIF%20Report.pdf
101
National Agricultural Workers Survey 2001-2002, Washington, D.C.: U.S. Department of Labor, 2005.
44
The Health Status of Immigrant Workers in the US: A Work In Progress
Where employers are aware that children are working in this way, they are required by law to pay the
102
children for this work. However, often times these children are not paid at all.
CHILD FARMWORKERS: HOW MANY ARE THERE?
o The Department of Labor posits that 6% of all farmworkers were between the ages of 14 to 17 years old, which
means somewhere between 180,000 and 300,000.
96
o The United Farm Workers of America (UFW) has cited estimates as high as 800,000.
o The U.S. Department of Agriculture’s National Agricultural Statistics Service (NASS) stating that 431,730 youth
103
between the ages of 12 and 17 are hired for agricultural work annually.
o
•
What About Their Housing?
•
•
•
•
•
•
•
Across the United States, migrant farmworkers face severely rundown housing, overcrowding issues, and high
10487
.
housing costs
104
33% of farmworkers live in moderate to severely substandard housing
104
About 33% of farmworkers pay more than 1/3 of their income for housing
104
Areas in the US with the most serious farmworker housing problems" are Florida and the Northwest.
104
The 52% crowding rate for farmworkers is 10 times the national average
104
88% of farmworkers are estimated to be Hispanic; 45% have children
Housing effects: Poor migrant housing conditions lead to increased prevalence of lead poisoning, respiratory
105
illnesses, ear infections and diarrheaError! Bookmark not defined..
What About Adult Farmworker Occupational Safety and
Health?
•
•
•
The agriculture industry is one of the most dangerous occupations in the United States. While farmworkers face workplace
hazards similar to those found in other industrial settings, such as working with heavy machinery and hard physical labor,
they also face unique occupational hazards including pesticide exposure, skin disorders, infectious diseases, lung problems,
hearing and vision disorders, and strained muscles and bones. Lack of access to quality medical care makes these risks even
greater for the three million migrant and seasonal farmworkers who work in the fields every year. 106
FATALITIES
107
o In 2007, for every 100,000 agricultural workers in the U.S. there were 25.7 occupational deaths in agriculture.
This compares to an average rate of 3.7 deaths for every 100,000 workers in all other industries during this same
108
year.
109
o From 1992 to 2006, 423 agricultural workers were reported to have died from exposure to environmental heat.
o Along with construction, mining, fishing and hunting, the agriculture industry had the highest worker fatality rate in
108
2007. The time period from 1992 to 2002 had an annual average of 806 occupational deaths.
INJURY AND ILLNESS RATES
110
o Agriculture is consistently ranked as one of the three most dangerous occupations in the United States .
o In 2006, the agriculture industry the second highest rate of occupational injuries and illness resulting in lost days
111
of work of any industry. Only construction was higher.
o Every day, about 243 agricultural workers suffer lost-work-time injuries, and about 5 percent of these result in
112
permanent impairment.
102
Oxfam America, Like Machines in the Fields: Workers without Rights in American Agriculture (Boston: Oxfam America, 2004),
National Farm Medicine Center et al., Benchmarking Report: Hiring and Safety Practices for Adolescent Workers in Agriculture (Marshfield, WI:
Marshfield Clinic, 2004), Available at: http://www.marshfieldclinic.org/nfmc/Pages/Proxy.aspx?Content=MCRFCenters-NFMCnccrahsbenchmarkreport.1.pdf.
104
Facts About Farmworkers and Colonias, Dept of Housing and Urban Development, http://www.hud.gov/groups/farmwkercolonia.cfm
105
National Center for Farmworker Health. http://www.ncfh.org/docs/00-10%20-%20monograph.pdf
106
NCFH Fact Sheet on OCCUPATIONAL HEALTH AND SAFETY; 2009; http://www.ncfh.org/?pid=5
107
Worker Health Chartbook 2004, Chapter 3, Focus on Agriculture. Available Online at http://www.cdc.gov/niosh/docs/2004-146/ch3/ch3-1.asp.htm
108
Worker Health Chartbook 2004, Chapter 3, Focus on Agriculture. Available Online at http://www.cdc.gov/niosh/docs/2004-146/ch3/ch3-1.asp.htm;
Figure 3.2, Fatal Agricultural Injuries. http://www.bls.gov/iif/oshwc/cfoi/cfch0006.pdf
109
Heat-Related Deaths Among Crop Workers — United States, 1992–2006; MMWR; June 20, 2008 / Vol. 57 / No. 24
cdc.gov/mmwr/preview/mmwrhtml/mm5724a1.htm
110
NCFI FACT SHEET ON MIGRANT FARMWORKER CONTRIBUTION TO NC ECONOMY; http://www.ncfarmworkers.org/resources/#Facts;
References #11: Where does your food dollar go? Ag. Council of America, and Lilly P., NC State University, n.d.;
111
Kandel, William (2008) “A Profile of Hired Farm Workers, A 2008 Update.” United States Department of Agriculture. Available online at
http://www.ers.usda.gov/publications/err60/err60.pdf.
103
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•
PESTICIDE EXPOSURE
o Farmworkers are often exposed to pesticides during their daily work, which include substances that prevent,
destroy or repel pests. Because some pests have systems similar to the human system, some pesticides also can
harm or kill humans. The term pesticide also encompasses herbicides, fungicides, and various other substances
113
used to control pests.
o Farmworkers frequently encounter pesticides through direct contact with the chemicals, contact with pesticide
114
residue on treated crops or equipment, and drift of pesticides into untreated areas. Farmworkers can also
transport pesticides from the fields into their homes through residue on their clothing, boots and skin. This puts
the farmworker’s entire family at risk, especially because pesticide residue in the home is not degraded by the sun
115
or rain.
o A 2006 study on farmworkers in California found that acute effects of pesticide exposure include headache,
116
nausea, eye irritation, muscle weakness, anxiety and shortness of breath.
o Studies indicate that pesticide exposure is associated with chronic health problems such as:
 Respiratory problems
 Memory disorders
 Dermatologic conditions
 Cancer
 Depression
 Neurologic deficits
 Miscarriages and infertility
117
 Birth defects 14
118
o In severe cases, pesticide exposure can lead to convulsions, coma and death.
o Law violations by employers are estimated to contribute to 41% of pesticide poisonings in California, including
failure to provide useable safety equipment, absence of washing/decontamination facilities, and lack of
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fieldworkers‟ access to pesticide training or information.
o A study in California tracked farmworkers who handle organophosphate (OP) or carbamate (CB) pesticides.
Under that program, workers who regularly handle those pesticides have blood tests before the spray season
begins to determine their normal levels (“baselines”) of an important chemical in their nervous systems called
cholinesterase. During the spray season, they have follow-up tests to track whether exposures are depressing
their cholinesterase levels, and thereby putting them at risk of injury. Of the 611 workers tested, 59 (9.65%) had
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depressions at a dangerously high level of more than 20%.
o Another study in 2003 found pesticides in the urine of 92% of the 213 farmworkers tested. This same study
examined 571 farmworkers and found that:
 96 % of 571 farmworkers studied reported exposures to pesticides at work.
 63.4% said pesticides touched their clothes: 33 % daily, 30.4% once in a while
 53.3% said pesticides touched their skin: 28.6% daily, 24.7% once in a while
 51.6% said they breathed in pesticide dust: 19.7% daily, 31.9% once in a while
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 17.3% said they were dusted or sprayed with pesticides: 2.5% daily, 14.8% once in a while
o A 2002 study examined take-home organophosphorus pesticide exposure among agricultural workers and found
pesticides in dust samples from 85% of farmworkers‟ homes and 87% of farmworkers had pesticides in dust
samples in their vehicles. In addition, 88% of farmworker children had organophosphate metabolites in their
122
urine.
o Pesticide risks: Farmworkers suffer from the highest rate of toxic chemical injuries and skin disorders of any
110
workers in the country, as well as significant rates of eye injuries .
112
National Institute for Occupational Safety and Health. (2008). NIOSH Safety and Health Topic: Agricultural Safety. Available Online at
http://www.cdc.gov/niosh/topics/aginjury/
113
U.S. Environmental Protection Agency. (2008). Agriculture: Pesticides. Available online at http://www.epa.gov/agriculture/tpes.html
114
Strong, Larkin, et al,. (2008). Factors Associated With Pesticide Safety Practices in Farmworkers. American Journal of Industrial Medicine, 51. p. 6981.
115
Thompson B, Coronado GD, Grossman JE, Puschel, K, Solomon CC, Islas I, Curl CL, Shirai, JH, Kissel, JC, Fenske, RA. (2003). Pesticide takehome
pathway among children of agricultural workers: Study design, methods, and baseline findings. J Occup Environ Med 45:42–53.
116
Centers for Disease Control and Prevention. (2006). Worker Illness Related To Ground Application of Pesticide-Kern County, California, 2005.
Morbidity and Mortality Weekly Report, 55(17).
117
Arcury, TA, Quandt, SA, Mellen, BG, 2003. An exploratory analysis of occupational skin disease among Latino migrant and seasonal farmworkers in
North Carolina, Journal of Agricultural Safety and Health 9(3):221–32.
118
Human Rights Watch, (2002). Backgrounder: Child Labor in Agriculture. HWR World Report 2002: Children's Rights. Available Online at
http://hrw.org/backgrounder/crp/back0610.htm Accessed on 8-27-08
119
Reeves M, Schafer KS. Greater risks, fewer rights: U.S. farmworkers and pesticides. Int J Occup Environ Health 2003;9:30–9.
120
Farm worker Pesticide Project (2006), “More Messages From Monitoring” available on line at http://www.fwpp.org/media/?id=30
121
Thompson, et al, “Pesticide Take-Home Pathway Among Children of Agricultural Workers: Study Design, Methods, and Baseline Findings,” Journal of
Occupational and Environmental Medicine, 45:1 pp 42-53, (2003).
122
Curl et al (2002), “Evaluation of Take-Home Organophosphorus Pesticide Exposure among Agricultural Workers and Their Children”, Environmental
Health Perspectives 110(12):787-792, December 2002:
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The Health Status of Immigrant Workers in the US: A Work In Progress
Mass poisonings of hired farmworkers has been reported. One of the most serious incidents over the past decade
was described by the Centers for Disease Control and Prevention. In that accident, 34 workers had a lengthy
exposure in a field that had recently been treated with carbofuran, a cholinesterase-inhibiting carbamate
123
pesticide. The field had not been posted with warning signs; posting is required by California law.
o A review article examining pesticide illnesses and injuries among California’s hired farm workers found that skin
124
disorders dominate the illnesses, although eye and systemic effects are also common .
HEAT AND SUN EXPOSURE
o Heat and Sun Exposure Farmworkers work under the sun’s harsh and hot rays for 10-to-12 hours a day, often
with little access to shade or water. Heat stress occurs when hot weather and muscle activity cause body heat to
rise. This condition can lead to dehydration, electrolyte imbalance, neurological impairment, multi-organ failure,
125
and death.
o From 1992 to 2006, 423 workers in agriculture and non-agricultural industries died from heat exposure.
o Crop workers have an average annual heat-related death rate of .39 per 100,000 workers, compared with .02 for
126
all U.S. civilian workers.
o In the 2005 National Agricultural Workers Survey (NAWS), 20 percent of the farmworkers reported having no
access to drinking water and cups.
o Working under the sun also exposes farmworkers to long hours of ultraviolet radiation, which puts them at a
127
higher risk for developing skin cancer.
o Though sunscreen use can help lower this risk, a 2005 study of 326 male farmworkers found that only 2.8 percent
127
reported to have ever used sunscreen and only 19.3 percent knew what sunscreen was. More than 90 percent
did not wear sunglasses or any sun-protective eye equipment. 75 percent reported not wearing a wide-brimmed
127
hat, which leaves the ears, neck and face exposed to ultraviolet rays.
o Another danger for farmworkers is that pesticides are absorbed through hot, sweaty skin more quickly than
128
through cool skin.
HAZARDOUS TOOLS AND MACHINERY
o From 1992-2001, the leading cause of fatal occupational injuries in the agriculture industry was farm tractors,
129
which accounted for 2,165 farmworker deaths.
129
o Deaths from other machines and tools include :
o Trucks, at 795 deaths
o Harvesting machines, at 253 deaths
o Mowing machines, at 228 deaths
o General agriculture machines, at 168 deaths
o As for non-fatal injuries in agriculture, machinery was the leading source from 1993 to 1995, with 99,402 reported
130
injuries.
o 41,777 injuries from hand tools
o 24,590 injuries from tractors
INFECTIOUS DISEASES
o Infectious diseases among the farmworker population are caused by poor sanitation and crowded conditions at
131
work and housing sites, including inadequate washing and drinking water.
o In the 2005 National Agricultural Workers Survey (NAWS), 5% of the farmworkers reported having no access to
water for washing, while 7% had no access to toilets in the fields, both of which the U.S. Department of
132
Agriculture calls significant percentages.
o A 2006 study of farmworkers in North Carolina found that 46 percent of farmworkers lived in very crowded and
unsanitary conditions. Conditions such as these increase farmworkers‟ exposure to environmental toxins and
131
communicable diseases.
o
•
•
•
123
Centers for Disease Control and Prevention; 1999. Farm worker illness following exposure to carbofuran and other pesticides— Fresno County
California, 1998; MMWR 48(6):113–16
124
Das R, Steege A, Baron S, Beckman J, Harrison R. 2001. Pesticide-related illness among migrant farm workers in the United States, Int. J. Occup.
Environ. Health 7(4):303–12
125
Rao, Pamela. (2008). Heat stress among farmworkers: A preventable cause of injury and death. Public Health Without Borders, Abstract #176730
126
Luginbuhl, RC., et al. (2008). Heat-Related Deaths Among Crop Workers --- United States, 1992-2006, MMWR, 57 (24), p. 649-653.
127
Salas, Ricardo. (2005). Sun-Protective Behaviors California Farmworkers, Journal of Occupational and Environmental Medicine, 47, p. 1244-1249.
128
U.S. Environmental Protection Agency. (2007). Agriculture: Heat Stress in Agriculture. Available Online at
http://www.epa.gov/agriculture/thel.html#Heat%20Stress%20in%20Agriculture
129
Worker Health Chartbook (2004), Chapter 3, Focus on Agriculture, Fatal Agricultural Injuries, Figure 3.6. Available Online at
http://www.cdc.gov/niosh/docs/2004-146/ch3/ch3-1.asp.htm
130
Worker Health Chartbook (2004), Chapter 3, Focus on Agriculture, Nonfatal Agricultural Injuries, Figure 3-19. Available Online at
http://www.cdc.gov/niosh/docs/2004-146/ch3/ch3-2.asp.htm Accessed Sep. 10, 2008
131
Early, Julie, (2006). Housing Characteristics of Farmworker Families in North Carolina, Journal of Immigrant & Minority Health April, 8 (2). P. 173184.
132
National Agricultural Workers Survey 2001-2002, Washington, D.C.: U.S. Department of Labor, 2005
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The Health Status of Immigrant Workers in the US: A Work In Progress
Farmworkers are six times more likely to develop tuberculosis when compared with other workers, and rates of
133
positive TB results between 17% and 50% have been reported throughout the United States.
o The prevalence of parasitic infestation is an indicator of the health, social, and economic conditions within a
community. One study of 422 migrant farmworkers and their families found a prevalence of parasitic infestation of
134
11.4%.
o Migrant workers are also at increased risk for urinary tract infections, partly as a result of a lack of toilets at the
workplace and stringent working conditions that promote chronic urine retention. Urinary retention in turn
encourages bacterial growth and stretches and weakens the bladder wall; this in turn promotes chronic infections
135
or colonization.
MUSCULOSKELETAL INJURIES
o Because farm labor consists of constant bending, twisting, carrying heavy items, and repetitive motions during
long work hours, farmworkers often experience musculoskeletal injuries. Furthermore, workers are often paid
136
piece-rate, which provides an incentive to work at high speed and to skip recommended breaks.
o Farmworkers most often report pain in the shoulders, arms, and hands. The most common injuries that cause
farmworkers to miss work are: sprains and strains, accounting for 30 percent of missed work, and back pain at 25
137
percent.
111
o From 1999 to 2004, almost 20 percent of farmworkers reported musculoskeletal injuries.
RESPIRATORY ILLNESSES
o Because agricultural work takes place in rural areas, farmworkers are exposed to organic and mineral dusts,
138
animal and plant dusts, toxic gases, molds and other respiratory irritants.
139
o All of these have been associated with respiratory illnesses, such as asthma and chronic bronchitis.
o Farmer’s Lung, an allergy-related disease, is caused by breathing in dust from moldy hay, straw, corn, silage,
grain or even tobacco. The disease can be a sudden attack or a slow, progressive disease that can cause
140
permanent lung damage, physical disability and even death.
o Farmworkers have a significantly higher death rate for a number of respiratory conditions, including
hypersensitivity pneumonitis (proportionate mortality more than 10 times higher than expected), asthma,
141
bronchitis, histoplasmosis, tuberculosis, pneumonia, and influenza.
o Farmworkers who work in the following areas are most at risk for respiratory illnesses:
o Dusty fields and buildings
o Handling of moldy hay, grain, corn, etc…
o Working in silos or with feed
142
o Working around bird droppings or dust from animal hair, fur, or feathers
o Lung disease in farm workers has now been linked to the industrialization of farming, animal raising, and
143
forestry . Exposure to hazardous agents potentially harmful to the respiratory tract is virtually universal:
organic dust, allergens, chemicals, particulate matter, and toxic gases
SKIN DISORDERS
o The agriculture industry has the highest incidence of skin diseases when compared with all other industrial
144
sectors.
o In 2003, the U.S. annual incidence of skin diseases was: 30.0 workers per 10,000 workers in the crop production
sector 18.5 workers per 10,000 workers in the agriculture industry 4.9 workers per 10,000 workers in all private
144
industry sectors combined.
o
•
•
•
133
Arcury, Thomas A., Quandt, Sara A. (2007) Delivery of Health Services to Migrant and Seasonal Farmworkers. Annual Review of Public Health 28
p.345-363
134
Bechtel,Gregory A. (1998). “Parasitic Infections Among Migrant Farm Families”, Journal of Community Health Nursing, 15; 1-7.
135
National Rural Health Care Association, The occupational health of migrant and seasonal farmworkers: Report summary, Kansas City, MO: National
Rural Health Care Association, 1986
136
Earle-Richardson, Guilia, et al. (2003). Occupational Injury and Illness Among Migrant and Seasonal Farmworkers in New York State and
Pennsylvania, 1997-1999: Pilot Study of a New Surveillance Method, American Journal of Industrial Medicine, 44:37-45.
137
Centers for Disease Control and Prevention, (2001), Simple Solutions: Ergonomics for Farmworkers, Available online at
http://www.cdc.gov/niosh/pdfs/01-111.pdf
138
Faria, Neice, et al. (2006). Farm Work, Dust Exposure and Respiratory Symptoms Among Farmers, Rev Saúde Pública 2006;40(5)
139
Radon, K, Monso, E, Weber, C, Danuser,B, Iversen,M, Opravil,U, et al, Prevalence and risk factors for airway diseases in farmers - summary of
results of the European Farmers' Project, Ann Agric Environ Med. 2002;9:207-13.
140
Farm Safety Association, (2002) Fact Sheet: Farmer's Lung. Available Online at http://cdc.gov/nasd/docs/d001601-d001700/d001609/d001609.pdf
Accessed Sep. 8, 2008
141
Department of Health and Human Services, (2007), Respiratory Disease in Agricultural Workers: Mortality and Morbidity Statistics, DHHS (NIOSH)
Publication Number 2007-106.
142
Grisso, Robert, et al, (2005), Respiratory Protection in Agriculture, Biological Systems Engineering (442)601, Available online at
http://cdc.gov/nasd/menu/topic/grain.html Accessed Sep. 8, 2008
143
do Pico GA, 1996, Lung (agricultural/rural), Otolaryngol. Head Neck Surg. 114 (2):212–16
144
Bureau of Labor Statistics, Illness rates by category of illness – detailed industry – 2004, U.S. Department of Labor [cited 3 October 2006] (available
from http://www.bls.gov/iif/ oshwc/osh/os/ostb1482.pdf).
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The Health Status of Immigrant Workers in the US: A Work In Progress
Skin disorder risk factors that are characteristic of farm work include wet working conditions, hot and humid
145
climates, and exposure to hazardous chemicals and plants.
o A 2006 study of farmworkers in North Carolina found that 77.7 percent of male farmworkers were diagnosed with
a skin disease, with nail fungus being the most commonly diagnosed disease, followed by foot fungus and
146
acne. This study also found that the odds of farmworkers having a skin disease were 80% higher for those with
less than six years of education.
o A 2003 study revealed that 37 percent of Latino migrant and seasonal farmworkers reported having a skin
disease sign or symptom in the past two months. This is much higher than the 10.4 percent of the general
147
population who reported having a skin disorder in the past year.
EYE INJURIES
o Farmworkers encounter multiple eye irritants in their work environments, including dust, sand, tools, branches,
148
allergenic agents, pesticides, wind, sun, water, and insects.
o These foreign objects can cause infections, allergic reactions, eye irritations, and corneal and other eye trauma.
Chronic irritation and sun can cause cataracts, a clouding of the eye lens, and pterygium, a growth that obstructs
149
the cornea.
o Agricultural workers experience eye injuries and illness at a rate of 8.7 per 10,000 workers. This is more than two
150
times higher than the rate of 3.8 per 10,000 for general workers in the U.S.
OTHER CONCERNS
o The health costs for foreign-born laborers working under such conditions [described above] include fatal and
nonfatal injuries, chronic illness or disease, and negative impacts on mental health. In addition, the migrant’s
151
temporary social and physical environments can negatively affect his or her health and well-being.
o Migration itself is highly stressful, as the facts recounted here suggest. In addition, migrant workers are often
83
separated from their families, traveling on their own with no support.
o Health status is also affected by exposure to unsanitary housing and to onerous working conditions, i.e. long days
with sun and heat exposure, no access to sanitary facilities, high work content involving bending and stooping or
work at full arm extension, etc.
o In one study Mexican farm workers who had returned to their home villages after ending their work experience in
U.S. agriculture report a wide range of symptoms that they attribute to their workplace exposures such as
152
musculoskeletal pain, dermatitis, and respiratory illness.
o
•
•
What About Occupational Safety and Health for Child
Farmworkers?
•
HIGH FATALITY RATES AMONG CHILD FARMWORKERS
o While children make up only a tiny fraction of the agricultural work force, they account for 20 percent of all deaths
153
on the job in agriculture.
154
o Between 1995 and 2002, 907 youth died on farms, or 43 deaths for every 100,000 children.
o The Centers for Disease Control and Prevention label agriculture the most dangerous industry for young workers
in the United States, accounting for 42 percent of all work-related fatalities of young workers between 1992 and
155
155
2000. Fifty percent of these victims were younger than 15 years old.
145
Belsito D V. (2005). Occupational contact dermatitis: etiology, prevalence, and resultant impairment/ disability, J Am Acad Dermatol: 53: 303–313.
Krejci-Manwaring, J., et al,. (2006), Skin Disease Among Latino Farmworkers In North Carolina, Journal of Agricultural Safety and Health, 12 (2), P.
155-163.
147
Arcury, Thomas A., Quandt, S.A. (2003). An Exploratory Analysis of Occupational Skin Disease Among Latino Migrant and Seasonal Farmworkers in
North Carolina. Journal of Agricultural Safety and Health, 9. p. 221-232.
148
Forst, L, Lacey S, Chen HY, Jimenez R, Bauer S, Skinner S, et al. (2004). Effectiveness of community health workers for promoting use of safety
eyewear by Latino farm workers, American Journal of Industrial Medicine, 46:607-613
149
Luque, John. (2007). Implementation Evaluation of a Culturally Competent Eye Injury Prevention Program for Citrus Workers in a Florida Migrant
Community, Progress in Community Health Partnerships, 1-4, p. 359-369.
150
Bureau of Labor Statistics, Incidence rates for nonfatal occupational injuries and illnesses involving days away from work per 10,000 fulltime workers
by industry and selected parts of the body [Table R6], http://www.bls.gov/iif/oshwc/osh/case/ostb1662.pdf.
151
Kugel and Zuroweste, “The State of Health Care Services for Mobile Poor Populations: History, Current Status, and Future Challenges”, Journal of
Health Care for the Poor and Underserved, 21 (2010): 422–429, Reference #3
152
Mines RA, Mullenax, N, Saca, L. 2001. The Binational Health Survey: An In-Depth Study of Farmworker Health in Mexico and the United States.
Davis, CA: Calif. Inst. Rural Stud.
153
Harvest of Dignity: Farmworker Facts, Posted on June 10th, 2011 by Alejandra Okie, http://pic.tv/harvest/farmworker-facts/
154
Injuries to Youth on U.S. Farm Operations, 2004, (2007), Centers for Disease Control and Prevention, NIOSH. Available Online at
http://www.cdc.gov/niosh/docs/2007-161/pdfs/2007-161.pdf Accessed on Sep. 2, 2008
155
Preventing Deaths, Injuries, and Illnesses of Young Workers, (2003), National Institute for Occupational Safety and Health. Available online at
http://www.cdc.gov/niosh/docs/2003-128/2003-128.htm
146
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•
156
SPECIFIC OCCUPATIONAL HEALTH AND SAFETY RISKS AND CONSEQUENCES AMONG CHILD
FARMWORKERS
O HEAT AND SUN
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 Children often work in fields where the temperature is well above 100 degrees Fahrenheit.
 The Environmental Protection Agency has confirmed that children are more susceptible to heat stress than
157
adults.
 80 percent of a person’s lifetime sun exposure occurs before the age of 18 and one bad sunburn during
158
childhood could double the risk of developing skin cancer in the future.
 Excessive heat exposure can lead to death.
O MUSCULOSKELETAL INJURIES
159
 The risk of injury for child agricultural workers is four times higher than children in other workplaces.
 Farm work is characterized by constant bending, twisting, carrying heavy items, and repetitive motions during
160
long work hours, all of which contribute to musculoskeletal injuries.
 Because children are still developing physically, this exertion places an even greater stress on their bodies
and can result in long-term consequences. Adolescents also undergo growth spurts, which may decrease
flexibility and increase their susceptibility to a variety of musculoskeletal injuries, such as bursitis, tendonitis,
161
sprains, and carpal tunnel syndrome.
O PESTICIDES
 The Human Rights Watch found children who reported working in freshly sprayed fields, and even working
while the fields were being sprayed. Children interviewed reported symptoms of exposure including
headaches, fever, dizziness, nausea, rashes and diarrhea. In severe cases, pesticide exposure can lead to
convulsions, coma and death. Long term effects also include cancer, brain damage, sterility or decreased
162
fertility, and birth defects.
 The health threat to children from pesticides health threat is greater than to adults because of their small body
163
mass and state of rapid physical and cognitive development. Children can have less-developed metabolic
systems than adults and break down pesticides at slower rates. Also, they can engage in hand-to-mouth
164
behaviors that increase their risk of ingesting pesticides.
 Not one of the children interviewed by Human Rights Watch had received training about the dangers of
pesticides, safety measures, or what to do in case of exposure. Some did not even know what pesticides
162
were.
O HAZARDOUS TOOLS AND MACHINERY
 Farmworker labor routinely requires the use of knives, hoes, ladders and other tools, as well as work on or
around heavy machinery. 27,600 injuries, or 3.1 injuries every hour, occurred to youth who lived on, worked
on, or visited U.S. farms in 2004.25 The most common types of injuries were broken bones, cuts, sprains, and
165
the most commonly injured body parts were arms, hands, feet and ankles.
 In 1998, children under the age of 16 suffered 3,069 non-fatal injuries from tractors, 3,035 machinery-related
injuries, and 5,444 vehicle-related injuries on farms. More than 70 percent of the tractor and vehicle-related
injuries occurred while children were operating the machines, and virtually all of the machinery-related injuries
166
happened while children were operating the equipment. Other injuries include falls off of ladders or other
Human Rights Watch. Fingers to the Bone: United States Failure to Protect Child Farmworkers. Washington: Human Rights Watch, 2000.
157
United States Environmental Protection Agency, "A Guide to Heat Stress in Agriculture," EPA-750-b-92-001, May 1993 p. 1
Arizona Department of Health Services (2003). Arizona’s Children and the Environment: A Summary of the Primary Environmental Health Factors
Affecting Arizona’s Children. Arizona: Office of Environmental Health, Available Online at http://www.azdhs.gov/phs/oeh/pdf/gov_chldrn_hlth_rpt.pdf
159
BLS (2000), Report on the youth labor force. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, pp. 58–67.
160
Association of Farmworker Opportunity Programs, (2007), Children In The Fields: An American Problem, Available Online at
http://www.afop.org/CIF%20Report.pdf
161
M.S. Vela Acosta and B. Lee (eds.), Migrant and Seasonal Hired Adolescent Farmworkers: A Plan to Improve Working Conditions (Marshfield, WI:
Marshfield Clinic, 2001), p. 11.
162
Human Rights Watch, (2002), Backgrounder: Child Labor in Agriculture. HWR World Report 2002: Children’s Rights. Available Online at
http://hrw.org/backgrounder/crp/back0610.htm
163
Weiss, B., Amler, S., & Amler, R.W. (2004), Pesticides, Pediatrics, 113, 1030-1036
164
McCauley, LA, Anger WK, Keifer, M, Langley R, Robson, MG, Rohlman, D., (2006). Studying health outcomes in farmworker populations exposed
to pesticides. Environ Health Perspect 114:953-960.
165
Injuries to Youth on U.S. Farm Operations, 2004. (2007). Centers for Disease Control and Prevention, NIOSH. Available Online at
http://www.cdc.gov/niosh/docs/2007-161/pdfs/2007-161.pdf Accessed on Sep. 2, 2008
166
National Institute for Occupational Safety and Health, National Institute for Occupational Safety and Health Recommendations to the U.S.
Department of Labor for Changes to Hazardous Orders, Cincinnati, OH: DHHS (NIOSH), 2002. http://www.cdc.gov/niosh/docs/nioshrecsdolhaz/pdfs/dolrecomm.pdf.
158
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O
o
elevated surfaces; being entangled, crushed or dismembered by machinery; and cuts and sprains from using
167
farm tools designed for adult hands and strength.
165
 The majority of the 907 child deaths on U.S. farms from 1995 to 2002 were due to machinery (23%)
 Child farmworkers’ relative inexperience increases their chances of accidents and injury, as well as the
168
fatigue that comes from long hours of hard work in harsh conditions.
OTHER OCCUPATIONAL HEALTH RISKS AMONG CHILD FARMWORKERS
 A study conducted by Human Rights Watch found that many young farmworkers are forced to work without
access to toilet facilities, hand washing facilities, and adequate drinking water, the three most basic sanitation
169
requirements.
 The lack of hand washing facilities contributes to pesticide poisoning and bacterial infections, while the lack of
169
adequate drinking water can lead to dehydration and heat illness.
CHILD FARMWORKERS: EDUCATION DEPRIVATION
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 Child farmworkers may attend three to five different schools per year as they migrate from farm to farm.
This disrupts school work and social integration.
 Constant mobility makes it hard for farmworker children to complete their education. On average, the highest
grade completed by farmworkers is seventh grade with only 13% of farmworkers completing 12 years of
171
schooling.
 According to a five year examination of the National Agricultural Workers Survey results, more than a third of
farmworkers ages 14 to 17 dropped out of school. While 17 percent of these young farmworkers went to
school at a grade level lower than their age peers. Likewise, the children of farmworkers were educationally
disadvantaged. One quarter of school-aged children of farmworkers were behind in grade or had dropped out
172
of school.
167
Association of Farmworker Opportunity Programs, (2007), Children In The Fields: An American Problem. Available Online at
http://www.afop.org/CIF%20Report.pdf
168
Human Rights Watch, Fingers to the Bone: United States Failure to Protect Child Farmworkers. Washington: Human Rights Watch, 2000.
169
NCFH Fact Sheet on Child Labor, 2009, http://www.ncfh.org/docs/fs-Child%20Labor.pdf
170
Martinez, Yolanda G. et al., ―Voices from the Field: Interviews with Students from Migrant Farmworker Families, ‖, The Journal of Educational
Issues of Language Minority Students, 14, (Winter 1994), http://www.ncela.gwu.edu/pubs/vol14/martinez.htm.
171
National Agricultural Workers Survey 2001-2002, Washington, D.C.: U.S. Department of Labor, 2005.
172
Samardick, R., Gabbard, S. M., & Lewis, M. A., (2000), Youth employment in agriculture. In U.S. Bureau of Labor Statistics, Report on the youth labor
force: Revised (pp. 52-57). Washington, DC: U.S. Department of Labor.
51
The Health Status of Immigrant Workers in the US: A Work In Progress
What About Farmworker Personal and Family Health
Status and Healthcare Access
•
•
BARRIERS TO HEALTHCARE ACCESS
o Limited insurance: Only ten percent of farmworkers report having employer-provided health insurance.Error!
Bookmark not defined.
o Because of their extreme mobility efforts to track health status and do necessary follow up (continuity of care) are
173
very difficult, if not impossible.
o Undocumented children who come to the U.S. with their parents are excluded from non-emergency health care
63
(except immunizations), unless they are able to be seen at a migrant health center, or a safety-net clinic.
o A pilot mammography screening program in the state of Washington suggested that the main barrier to the use of
this service by hired farm worker women was simply cost. This hypothesis was tested by offering the women a
voucher covering the full cost. The important result was that 88% of women with vouchers obtained a screening
174
within 30 days, but only 17% of those without vouchers did so.
o Obstacles to health care: Barriers to receiving health care include lack of transportation, limited hours of clinic
175
service, cost of health care, limited or no interpreter service, and frequent relocation in search of farm work.
176
Farmworkers are not protected by sick leave and risk losing their jobs if they miss work. Error! Bookmark not
defined.
o Though immigrant children use less ambulatory and emergency services, when emergency services are used, the
amount spent is more than that spent on non-immigrant children. This may indicate that immigrant children are
sicker when accessing emergency care, since they were denied cheaper, upstream preventive health measures
177
that could have been provided in the outpatient setting.
o Information about health and health care is transmitted more commonly by word-of-mouth than through the
178
media.
o What happens when there are so many barriers to health care? Providers find that individuals present with
advanced health care problems, the ultimate cost of treatment is higher, the outcomes of treatment are poorer;
4
and morbidity and mortality rates are higher. Clinicians attempting to serve this population experience a parallel
set of stresses, finding themselves in the midst of tension between overwhelming disparities and what they know
4
is just . They are called upon to go the extra mile to develop understanding, trust and resources for patients who
4
come to them with complex needs.
AVAILABILITY OF CARE / PERCEIVED NEED
o In addition, access to quality care for the Mobile Poor remains quite problematic and is hampered by language,
culture, and even dialect barriers, lack of health insurance, fear of discovery and reprisal, fear of lost employment,
4
4
etc. It is estimated that less than 20% of farmworkers have adequate access to health care .
o The rest are at the mercy of a hodgepodge of care delivery points or have no access at all to care or other
4
needed services such as transportation, interpretation, financial assistance, preventive services, etc.
o Medical needs include detection, treatment, and control of infectious diseases such as HIV and tuberculosis;
maternal and child health care (including pregnancy care and immunizations); recognition, treatment, and
prevention of pesticide poisoning; and prevention and management of chronic health conditions, such as heart
179
disease, diabetes, and cancer
o Most farm workers appear to access health care services only when absolutely necessary. The CAWHS found
that nearly one third (31%) of male workers interviewed had never visited a medical clinic or doctor. And only half
291
(48%) had been to medical clinic or doctor within the previous two years.
179
o Though Migrant Health Clinics provide an important service, they cover only 12-15% of this population.
173
A Portrait of Unauthorized Immigrants in the United States; Jeffrey S. Passel, Pew Research Center;April 14, 2009;
http://pewresearch.org/pubs/1190/portrait-unauthorized-immigrants-states
174
Skaer,TL, Robison, LM, Sclar, DA, Harding GH. 1996. Financial incentive and the use of mammography among Hispanic migrants to the United
States. Health Care Women Int. 17(4):281–91
175
National Center for Farmworker Health. http://www.ncfh.org/docs/00-10%20-%20monograph.pdf
176
National Advisory Council on Migrant Health. 1993 Recommendations of the National Advisory Council on Migrant Health. Rockville, MD: U.S.
Department of Health and Human Services, Bureau of Primary Health Care, May 1993.
177
Mohanty, S, Woolhandler, S, Himmelstein, D, Pati, S, Carrasquillo, O, and Bor, D. Health Care Expenditures of Immigrants in the United States: A
Nationally Representative Analysis. Am J Publ Hlth. 2005,95:1431-1436.
178
Communication Facts: Special Populations: Migrant Workers in the United States - 2008 Edition, American Speech and Hearing Association,
http://www.asha.org/Research/reports/migrant_workers/
179
Hansen, E, and Donohoe,M., Health Issues of Migrant and Seasonal Farmworkers,J, Healthcare Poor Underserved, 2003,14:153-163
52
The Health Status of Immigrant Workers in the US: A Work In Progress
[Another] study found that the Index of Medically Underserved (IMU), a federally defined index used to determine
possible eligibility for health service funds, averaged 61.1 in the hired farmworker communities versus 83.4 in all
urban areas of the state. An IMU figure below 62 is the trigger for eligibility for possible official designation as
291
This makes farmworkers officially medically underserved.
“medically underserved”.
o The California Agricultural Worker Health Survey (CAWHS) found that one fifth (18%) of those who sought
291
medical care went to Mexico to obtain those services.
o Migrant farmworkers have worse health outcomes than other workers in the United States, and often lack access
63
to needed health care.
o Several papers describe model programs to bring services directly to labor camps and other isolated, rural
communities lacking services. One report identified ten types of unmet needs and proposed a mobile program to
180
reach workers . Another describes the success of using a mobile clinic, staffed with family nurse practitioners,
181
registered nurses, and other health care workers . Another innovation is the development of bi-national (Mexico182
United States) patient tracking . Since so many migrant workers seek medical care in Mexico, even while
working in the United States, and many others return to their home villages each year, bi-national tracking has
291
become essential.
o Twenty-one states have started using state only funds to cover pregnant women and immigrant children [largely
183
as a preventionary cost-saving measure].
184
FOLK MEDICINE
o
•
o Folk medicine is the mixture of traditional healing practices and beliefs that involve herbal
medicine, spirituality and manual therapies or exercises in order to diagnose, treat or prevent an
ailment or illness. 185
O
HISTORY
The Mayas of Central America and Southern and Central Mexico (2000 BCE to 250 AD) 186 had a
very holistic view of illness and healing. Health was viewed as a balance that occurred between
your physical condition, nature, the cosmos, etc. and different components were used to improve
health such as medicinal plants, religions ceremonies and spiritual guides. 187
188
 The Aztecs of Central Mexico (1300 AD to 1519 AD and the post-conquest period) also had
extensive practices with contemporary medicine. For example, they treated headaches by inhaling
tobacco and other herbs and scabies were treated by washing the skin and applying avocado. 189


O
“Mestizos” (a term used in Mexico) refers to the subculture, practices and beliefs that have resulted from the
190
historical mixture of the indigenous and Spanish cultures, since 1519.
 In other parts of Latin America, the term is “Ladino” and studies frequently suggest that this word is used
191,192,193
among the former and current Mayan regions of the Americas.
TYPES OF FOLK MEDICINE PRACTICES AND PRACTITIONERS


180
Folk medicine is practiced by a majority the Mexican population while in Mexico, especially among
the poor and uninsured. 194 It is therefore no surprise that these beliefs survive and resurface once
people and populations cross international borders.
There are many types of alternative or folk medicine practices and practitioners among the Hispanic
community”
Decker SD, Knight L. 1990. Functional health pattern assessment: a seasonal migrant farmworker community. J. Community Health Nurs., 7(3):141–
51
181
Stein LM. 1993. Health care delivery to farmworkers in the Southwest: an innovative nursing clinic. J. Am. Acad. Nurse Pract., 5(3):119–24
Velasco-Mondragon HE, Martin J, Chacon-Sosa F. 2000, Technology evaluation of a USA-Mexico health information system for epidemiological
surveillance of Mexican migrant workers. Rev. Panam. Salud Publica 7(3):185–92
183
King M. Immigrants in the US Health Care system, Five Myths that Misinform the American Public, June 7, 2007, Available at
http://www.americanprogress.org/issues/2007/06/im migrant_health_report.html.
184
NCFH Fact Sheet: Folk Medicine, www.ncfh.org/index.php?pid=238.
185
NCFH Fact Sheet: Folk Medicine, www.ncfh.org/index.php?pid=238. Reference #1: World Health Organization, Traditional Medicine. 2008. Available
online: http://www.who.int/mediacentre/factsheets/fs134/en/
186
Coe, Michael D. The Maya (6th edition). 1999
187
Dr. Hugo Icu Peren, Revival of Maya Medicine and Impact for its Social and Political Recognition (in Guatemala). Guatemalan Association of
Community Health Services, 2007
188
Hooker, Richard, Washington State University. The Civilizations in America: The Mexica/ Aztecs. 1996. Website:
http://public.wsu.edu/~dee/CIVAMRCA/AZTECS.HTM
189
Nguyen, Paula. Aztec Medicine. Pacific Lutheran University, Available online: http://www.plu.edu/~nguyenpb/home.html
190
Chance, John K., On the Mexican Mestizo, 1979, Latin American Research Review, Vol. 14, No. 3.
191
Little-Siebold, Christa, Beyond the Indian-Ladino Dichotomy: Contested Identities in an Eastern Guatemalan Town, 2001, The Journal of Latin
American Anthropology, Vol. 6, No. 2.
192
Early, John D. Revision of Ladino and Maya Census Populations of Guatemala, 1950 and 1964, 1974, Demography, Vol. 11, No. 1
193
Hervik, Peter. Narrations of Shifting Maya Identities, 2001. The Bulletin of Latin American Research, Vol. 20, No. 3.
194
Gameren, Edwin van, Health Insurance and Use of Alternative Medicine in Mexico, Health Policy, Vol. 98, 2010.
182
53
The Health Status of Immigrant Workers in the US: A Work In Progress
•
O
A “Sobador” is a manual therapist who offers chiropractic or physical therapies. 195 Sobadores
are popular in the South Texas Hispanic community
o because there is a common cultural understanding regarding spirituality and healing that
harbors trust between the patient and the sobador, and
o second, because the heavily agricultural area often results in workers suffering from
occupational or workplace injuries.195
• Herbalism is also a common practice where components of a plant or plants (berries, root,
leaves, etc.) are used for their medicinal properties. 196 A person who practices herbalism is
called a yerbero. Some examples of medicinal herbs include chamomile (manzanilla) which is
taken as a tea for its calming properties, aloe vera (zabila) which is used topically on the skin to
cure bites, rashes, etc. and eucalyptus (eucalipto) is used as a tea to alleviate and help
symptoms associated with the common cold. 197
• Curanderismo is seen as a combination of the above mentioned practices with a few other
components. The practice also assumes a social network of a relative or relatives who can
diagnose the illness and act as curandero, a relationship between illness, healing and religion,
and an underlying belief and trust among the Hispanic community about symptoms, healing
practices and the source of illness. 198 A few common ailments that a curandero can diagnose
and treat are:
o mal de ojo (evil eye): Mal de ojo is defined as an illness that is inflicted due to envy. When
the glances of admiration of a stronger person are inflicted on another for too long, usually
on a child, it is said that mal de ojo occurs. 199 The associated symptoms include high fever,
fretfulness, headaches and crying.199 For treatment, an egg must be rubbed among the
child’s body, while prayer is conducted.199
o susto (fright sickness): Susto results from a startling or frightful occurrence or scare which
has caused the soul to temporarily leave the body.199 The symptoms associated with it
include loss of appetite and weight, lack of motivation and listlessness. The treatment of
susto involves sweeping the body with herbs three times while prayer is conducted.199
o mollera caida (fallen fontanelle)198 :The condition in which the soft spot on top of a baby’s
head is marked with an indentation.198 It is believed to be caused by bouncing a baby too
roughly or removing a nipple or bottle from the baby’s mouth too suddenly. It is also marked
by the baby having a bulging palate, fever, vomiting and crying.198 The treatment involves
applying salve to the baby’s head and pressing on the baby’s palate.198 It is important to note
here how a curandero’s diagnosis may be very much in line with those of contemporary
medicine, despite how the treatment process may differ.
THE HEALTHCARE PERSPECTIVE
 The differences in medical and cultural perspectives that must be overcome by health center staff.
 Use of alternative or folk medicine is difficult to determine because patients are very often afraid
that healthcare professionals will judge or ridicule them for their belief systems. 200
 Many patients claim that they do not inform their doctors of alternative medicine or alternative
treatments simply because their doctors do not ask about them.200
 Patients also report that they would appreciate
• their doctors asking what home remedies they are using as treatment,
• their doctors remaining open-minded, and
• their doctors having an understanding of folk medicine.200
195
Hinojosa, Servando Z., The Mexican American Sobador, Convergent Disease Discourse, and Pain Validation in South Texas, Human Organization,
Vol. 67, No. 2, 2008.
196
University of Maryland Medical Center, Herbal Medicine, 2009, Available online: http://www.umm.edu/altmed/articles/herbal-medicine-000351.htm
197
Holland, Koren, Medicinal Plants of the Migrant Workers, Gettysburg College, 1996, Available online:
http://www.ncfh.org/?plugin=ecomm&content=item&sku=4145
198
Krajewski-Jaime, Elvia R., Folk Healing among Mexican American Families as a Consideration in the Delivery of Child Welfare and Child Health Care
Services. Child Welfare, Vol. 70, No. 2. 1991.
199
Baer, Roberta and Bustillo, Marta, Susto and Mal de Ojo among Florida Farmworkers: Emic and Etic Perspectives. Medical Anthropology Quarterly,
Vol. 7, No. 1. 1993.
200
Shelley, Brain, et. al., ‘They Don’t Ask me so I Don’t Tell Them’: Patient-Clinician Communication about Traditional, Complementary and Alternative
Medicine, Annals of Family Medicine, Vol. 7, No 2.
54
The Health Status of Immigrant Workers in the US: A Work In Progress

Also, alternative or traditional medicine within the Latino culture is deeply rooted in spirituality and
religion. 201 In the United States, discussing the basis of illness from a spiritual perspective with a
doctor or clinician may not always be a welcome gesture.

•
A study published in 2010 which interviewed 96 Latino immigrants regarding traditional medicine and religion
concluded that 75% thought prayer was an important part of healing. 90% said they frequently pray for their
201
health or the health of their families.
o One factor relating to health among Mexican immigrants that deserves special attention is the widespread belief
that injections of vitamins and antibiotics, often performed at low cost by lay persons, is conducive to good health
202
and superiorto what is available in conventional medical care in the United States.
204
TUBERCULOSIS
o Tuberculosis (TB) is an infectious disease that continues to be a significant global health problem,
especially among migrant and seasonal farmworkers, who are at greater risk for becoming
infected with TB than the general population.203 Efforts to control TB have had some success,
leading to a world-wide decline of new TB cases; however this decline has not been seen in the
migrant farmworker population.204
o
o
o
o
o
o
o
o
o
In 1992 tuberculosis was reported among hired farm workers at a rate six times higher than in the general
working-age population, and federal health authorities issued a series of recommended actions by public health
205
officials.
High levels of PPD positivity in farmworkers in the US have been found in an number of studies:
203
 between 17 percent and 50 percent in one study of farmworkers throughout the United States.
206
 44% in a sample in which 5% were also HIV-positive , suggesting that reduced immunity is an important
factor in the increased prevalence of tuberculosis; and
207
 30% in a sample of migrant farm workers who were recruited to participate in a health education program.
Farmworkers have a significantly higher risk of dying from TB. A 2001 study of more than 26,000 farmworkers
208
found significant excesses of tuberculosis-caused deaths, and a 2002 government report showed agricultural
workers and farmworkers to have the second and third highest rates of respiratory TB deaths out of all industries
209
and occupations.
The crowded living and working conditions, as well as the lifestyle common for migrant farmworkers, lead them to
204
have increased chances of developing tuberculosis during their lifetime.
210
It is well recognized that rates of tuberculosis increase in stressed populations, such as in times of war.
People with compromised immune systems are at a high risk for TB infection. This includes people with
211
HIV/AIDS, those who are malnourished and injection drug-users. Farmworkers have a high incidence of all of
these problems.
212
The TB burden among the foreign-born is nine times higher than the rate of persons born in the United States.
Many farmworkers enter this country from areas of the world where tuberculosis rates are much higher than the
213
U.S., such as …Latin America [especially Mexico]…
Ethnicity is also an indicator of higher rates of tuberculosis. In 2006, 83 percent of all TB cases in the United
States were among racial and ethnic minorities, with Hispanics having the largest percentage of total cases for
214
the third consecutive year at 30 percent.
201
Ransford, H. Edward, et. al., Health Care-Seeking among Latino Immigrants: Blocked Access, Use of Traditional Medicine and the Role of Religion.
The Journal of Health Care for the Poor and Underserved, Vol. 21, No. 3. 2010.
McVea, KL. 1997. Lay injection practices among migrant farmworkers in the age of AIDS: evolution of a biomedical folk practice. Soc. Sci. Med.
45(1):91–98
203
Arcury, Thomas A., Quandt, Sara A. (2007) Delivery of Health Services to Migrant and Seasonal Farmworkers. Annual Review of Public Health 28
p.345-363
204
NCFH Fact Sheet on TB; 2009; http://www.ncfh.org/?pid=5
205
Cent. Disease Control, 1992, Prevention and control of tuberculosis in migrant farm workers, Recommendations of the Advisory Council for the
Elimination of Tuberculosis, MMWR Recomm. Rep.,41(RR- 10):1–15
206
Villarino, ME, Geiter, LJ, Schulte, JM, Castro, KG. 1994. Purified protein derivative tuberculin and delayed-type hypersensitivity skin testing in migrant
farm workers at risk for tuberculosis and HIV co-infection.
207
Poss, JE, 2000, Factors associated with participation by Mexican migrant farmworkers in a tuberculosis screening program, Nurs. Res., 49(1):20–28
208
Colt, Joanne S. et al., (2001), Proportionate Mortality Among US Migrant and Seasonal Farmworkers in Twenty-Four States, American Journal of
Industrial Medicine, 40 p.604-611
209
National Institute for Occupational Safety and Health, (2002), The Work-Related Lung Disease Surveillance Report, 2002 [Online], Available:
http://www.cdc.gov/niosh/docs/2003-111/2003-111.html [14 July 2008]
210
Styblo K. Epidemiology of tuberculosis. In: Selected Papers (volume 2). Hague (Netherlands): The Royal Netherlands Tuberculosis Association,
1991.
211
Gardam, Michael A., et al. (2003) Anti-tumour necrosis factor agents and tuberculosis risk: mechanisms of action and clinical management. The
Lancet Infectious Diseases 3-3. p.148-155.
212
CDC. Reported Tuberculosis in the United States, 2006. Atlanta, GA: U.S. Department of Health and Human Services, CDC, September 2007.
213
World Health Organization, (2008), Global Tuberculosis Control: Surveillance, Planning, Financing [Online], Available:
http://www.who.int/tb/publications/global_report/en/index.html [9 July 2008].
202
55
The Health Status of Immigrant Workers in the US: A Work In Progress
Treatment of Tuberculosis in migrant farmworkers presents special problems because of the need for long-term
treatment or preventive efforts, contact examinations, population mobility, fear of deportation, cost of treatment,
215
and other barriers to health care.
o A mobile lifestyle characterized by constant residential change makes knowledge of health services difficult. This
216
mobility also makes follow-up care, which is very necessary in treating TB, more difficult to provide. It can take
six months to one year to kill all TB bacteria. When treatment is interrupted, patients are more likely to develop
217
MDR-TB.
o Language barriers and limitation in knowledge about tuberculosis among farmworkers may contribute to
218
misunderstandings about the importance of screenings and if identified, completing the treatment regimen.
o A 1996 report by the CDC stated that single drug resistant tuberculosis rates are 1.7 – 5 times higher among
foreign-born Hispanic patients compared to Hispanics born in the United States. Similarly, prevalence of multi219
drug resistant strains of tuberculosis was 6.8 times higher among foreign-born Hispanics.
220
ORAL HEALTH
o
•
o According to an analysis of migrant health center encounter data in 2007, dental care ranked as
one of the top 3 health problems migrant farmworkers were treated for. 221 However, statistics
show that a large percentage of migrant farmworkers and their children do not seek regular
dental care and suffer from complications linked to dental carries or gum disease. In addition,
research has consistently shown that farmworkers of all ages have a level of oral health far worse
than what is found in the general population.220
•
o A 2007 study found that 80 percent of farmworkers had not received dental services within the past year. Of those
222
who did, almost all were serviced in Mexico.
o The most common barriers to receiving proper oral health care are cost, time, urgency (aka lack of prevention), and
223,224,225,226
language.
o One study found that oral health was one of the major health problems facing the migrant and seasonal farmworker
population, as well as one of the most unmet needs in farmworker health services. The same study found that 52
percent of farmworkers reported dental caries and 33 percent reported missing teeth. Oral sensitivity and gum
problems were other common problems reported by 40 percent of those interviewed and 30 percent reported
227
fractured or broken teeth.
o Migrant farmworker children are 48 percent more likely to have decayed teeth surfaces and 47 percent less likely to
228
have filled surfaces than U.S. school children.
o In a study of 125 farmworker children under the age of 4 in Yakima, Washington, published in 1992, 29.6 % of the
229
children had Baby Bottle Tooth Decay.
230
MATERNAL HEALTH
Due to mobility, the pregnant farmworker woman and infant child face great obstacles in obtaining
… care. Likewise, once born, the health of farmworker children is one of the poorest of any group in
the country… The migratory lifestyle, language barriers, poor living conditions, and a lack of
214
CDC, Reported Tuberculosis in the United States, 2006, Atlanta, GA: U.S. Department of Health and Human Services, CDC, September 2007
Centers for Disease Control, Tuberculosis and Migrant Farm Workers, Austin: National Migrant Referral Project, June 1985
216
Arcury, Thomas A. and Quandt, Sara A. Delivery of Health Services to Migrant and Seasonal Farmworkers. (2006) Annual Review of Public Health
28, p. 345-363. Accessed online through Annual Reviews, arjournals.annualreviews.org.
217
Centers for Disease Contro,. (18 May 2008), Tuberculosis Facts: TB Can Be Treated [Online], Available:
http://www.cdc.gov/tb/pubs/tbfactsheets/cure_eng.htm [14 July 2008]
218
Centers for Disease Control, (1992 June 19), National Action Plan to Combat Multidrug-Resistant Tuberculosis, Morbidity and Mortality Weekly
Report, 41 [Online] Available: http://www.cdc.gov/MMWR/preview/MMWRhtml/00031159.htm [2008, August h 18].
219
Centers for Disease Control, (1996), Characteristics of Foreign-Born Hispanic Patients with Tuberculosis -- Eight U.S. Counties Bordering Mexico,
1995 [On-Line], Available: http://www.cdc.gov/mmwr/preview/mmwrhtml/00044624.htm
220
NCFH Fact Sheet On Oral Health,2009, http://www.ncfh.org/?pid=5
221
Centers for Disease Control. “Oral Health for Adults,” Available at: www.cdc.gov/Oral Health/publications/factsheets/adult.htm.”
222
Quandt, S.A., Hiott, A.E., et. al., (2007), “Oral Health and Quality of Life of Migrant and Seasonal Farmworkers in North Carolina,” Journal of
Agricultural Safety and Health, (13)1:45-55.
223
Lombardi, G.R., (2002), Dental/Oral Health Services, Migrant Health Issues, Monograph Series, 1, 1-8
224
Lukes, S.M., Miller, F.Y., (2002), Oral Health Issues Among Migrant Farmworkers, The Journal of Dental Hygiene, 76, 134-140.
225
Nurko, C., Aponte-Merced, L., Bradley, E.L., Fox, L., (1998), Dental Caries Prevalence and Dental Health Care of Mexican-American Workers'
Children, 65, 65-72.
226
Entwistle, B.A., Swanson, T.M.,1989, Dental Needs and Perceptions of Adult Hispanic Migrant Farmworkers in Colorado, Journal of Dental Hygiene,
63, 286-292.
227
Quandt, S.A., Hiott, A.E., et. al. (2007) “Oral Health and Quality of Life of Migrant and Seasonal Farmworkers in North Carolina.” Journal of
Agricultural Safety and Health. (13)1:45-55.
228
Quandt, S.A., Clark, Heather, et. al., (2007), Oral Health of Children and Adults in Latino Migrant and Seasonal Farmworker Families, Journal of
Immigrant and Minority Health.
229
Weinstein, P., Domoto, P., Wohlers, K., Koday, M., (1992), Mexican-American Parents with Children at Risk for Baby Bottle Tooth Decay: Pilot Study
at a Migrant Farmworkers Clinic, 59, 376-383.
215
56
The Health Status of Immigrant Workers in the US: A Work In Progress
sufficient financial resources or health insurance make access to healthcare and the continuity of care
incredibly difficult. 230
o
o
o
SOME RELEVANT DATA:
231
 In 2005, Latinas had the highest birth and fertility rates in the U.S.
231
 23.1 live births per 1,000 Latina women, compared with 12.4 for non-Latino women
231
 99.4 births per 1,000 Latina women aged 15 to 44 years, compared to 60.4 for non-Latino women
 Women of Mexican origin had the highest fertility rate of all populations, with 107.7 births per 1,000 women
231
aged 15 to 44 years.
 In 2005, for mothers of Mexican origin, 5.53 out of every 1,000 infants less than one-year-old died, an
232
increase from the year 2000 (5.43).
 The CDC found the prevalence of anemia in [all] pregnant women to be 10.2 percent, with Hispanic women
233
having the second highest rate.
 With an uninsured rate of 39 percent, Latina women ages 15 to 44 were three times more likely to be
234
uninsured than non-Latina white women at 14 percent.
 Farmworker parents have an average of two children less than 18-years-old. Of these farmworker parents, 66
235
percent are accompanied by their families, and women were two times more likely to be accompanied.
 97 percent of farmworker mothers were accompanied by their children, compared to 55 percent of farmworker
235
fathers.
 Farmworker parents who had authorization to work inside the U.S. were twice as likely to be accompanied by
235
family as were parents who lacked authorization.
PRENATAL CARE AND PEDIATRIC CARE AMONG FARMWORKERS
 In a 2005 study, only 42 percent of migrant and seasonal farmworker women reported accessing prenatal
care services early on in their pregnancy (within the first 3 months). Compare this with the 76 percent of
236
women who access early prenatal care nationally.
 Data from the Pregnancy Nutrition Surveillance System found that of 4,840 migrant women monitored, 52
percent (1,835) had less than recommended weight gain throughout their pregnancies 23.8 percent had
undesirable birth outcomes, 6.7 percent had low birth weight, .7 percent had very low birth weight, 9.9 percent
237
had preterm births, while 6.5 percent were small for gestational age.
 A study done by Alan Dever found that migrant clinics had twice as many visits with children younger than 15
years of age as ambulatory care settings in general. Overall, 43.9% of the migrant workers surveyed had
more than one morbidity. The highest rate of co-morbidity was for those patients younger than 5 years of age
and older than 64 years of age. In this same study, 61% of migrant children seen at migrant health clinics had
238
at least one health problem while 43% had two or more problems.
 Another study found that 53% of farmworker children had an unmet medical need according to their
239
caretakers. This is twenty-four times higher than that reported for U.S. children overall (2.2%)…
 A study examining the diet of Mexican-origin migrants found that 61.2% of the diets were deficient in Vitamin
240
A; 30.6% deficient in Vitamin C; 57.1% deficient in calcium, and 42.8% deficient in Riboflavin.
 Twenty-one states have started using state only funds to cover pregnant women and immigrant children
183
[largely as a preventionary cost-saving measure].
OH&S HAZARDS FOR EXPECTANT FARMWORKER MOTHERS
 The occupational hazards of farm work (prolonged standing and bending, overexertion, extremes in
temperature and weather, dehydration, chemical exposure, and lack of sanitary washing facilities in the fields)
230
NCFH Fact Sheet on MATERNAL AND CHILD HEALTH; 2009; http://www.ncfh.org/?pid=5
Martin, JA, Hamilton, BE, Sutton, PD, Ventura, SJ, Menacker, F, Kirmeyer, S, Munson, ML., (2007), Births: Final data for 2005, National vital statistics
reports, vol 56, no 6, National Center for Health Statistics.
232
Mathews, TJ, MacDorman, MF,(2008), Infant mortality statistics from the 2005 period linked birth/infant death data set, National vital statistics reports,
vol 57, no 2, Hyattsville, MD: National Center for Health Statistics.
233
Centers for Disease Control and Prevention, (2007), Preconception and Interconception Health Status of Women Who Recently Gave Birth to a LiveBorn Infant, MMWR, 56(SS10),1-35.
234
March of Dimes PeriStats, United States Quick Facts: Health Insurance Overview, Available online at
http://www.marchofdimes.com/peristats/tlanding.aspx?dv=lt&reg=99&top=11&lev=0&slev=1
235
National Agricultural Workers Survey 2001-2002, Washington, D.C.: U.S. Department of Labor, 2005
236
Rosenbaum, Sarah; Shin, Peter, (2005), Migrant and Seasonal Farmworkers: Health Insurance Coverage and Access to Care, Kaiser Commission
on Medicaid and the Uninsured.,Available online at http://www.kff.org/uninsured/upload/Migrant-and-Seasonal-Farmworkers-Health-InsuranceCoverage-and-Access-to-Care-Report.pdf
237
Centers for Disease Control and Prevention.,April 4, 1997, Morbidity and Mortality Weekly Report, Pregnancy-Related Behaviors Among Migrant
Farm Workers: Four States, 1989-1993, 46(13):283-286, http://www.cdc.gov/mmwr/preview/mmwrhtml/00047114.htm.
238
Dever, G.E.A., (1991), Profile of a Population With Complex Health Problems. Austin, Texas: Migrant Clinicians Network
239
Weathers, Andrea & Etal., (2003), Health Service Use by Children of Migratory Agricultural Workers: Exploring the Role of Need for Care, Pediatrics,
Vol. 111, No. 5, May 2003.
240
Thomas, E.C., (1996), Bitter Sugar: Migrant Farmworker Nutrition and Access to Service in Minnesota, St. Paul, MN: The Urban Coalition
231
57
The Health Status of Immigrant Workers in the US: A Work In Progress
•
can lead to spontaneous abortion, fetal malformation, or growth retardation and abnormal postnatal
241
development.
 Exposing pregnant farmworkers to pesticides puts unborn children at risk for various severe physical and
242
neurological developmental abnormalities such as facial/ cranial malformation and missing limbs.
 Parents working with pesticides often carry contaminated clothes, shoes and hats which then reaches
children via household dust found in cars and common living areas. In a study involving urine samples, almost
all children (88%) whose parents worked with pesticides tested positive for pesticide metabolites in their
243
system.
 Further, problems for expectant farmworker mothers and their children:
244
 85% of farmworker housing units are typically over-crowded
245
 high levels of anxiety, depression and suicidal attempts are commonly present in women , and
246
 overwhelming occurrences of farm injuries in both adults and children have been documented.
o OTHER PROBLEMS FOR MIGRANT FARMWORKER MOTHERS
 Another problem is that cultural brokers are needed [but usually unavailable] to assist in overcoming cultural
247
and linguistic barriers.
 Some Mexican immigrant women of indigenous origin encounter significant barriers to accessing health care
248
while in the United States such as language and culture differences as well as proper health behaviors .
 As the numbers of indigenous migrants increases, this will present difficult challenges to a health care system
that is already struggling to accommodate non-English speakers.
 It is further complicated by the fact that many Mexican indigenous cultures do not have a written language.
CHILD HEALTH
o Children of migrant farmworkers have higher rates of pesticide exposure, malnutrition and dental disease than the
general population. Children of migrant farmworkers are also less likely to be fully immunized than other
249
childrenError! Bookmark not defined.
o Programs to provide health insurance to all uninsured children have provided relatively little benefit to the families
250
of hired farm workers .
251
o Many children are employed along with their parents . Thus, these children face both occupational health risks
as well as personal health risks.
o A comprehensive health screening among nearly all (92%) of the children of the city of McFarland, a
predominately farmworker community in California’s San Joaquin Valley, found that over two thirds of the children
252
(70%) required a medical referral . The need for these referrals was subsequently positively associated with
253
poverty status, with lack of health insurance, and with lack of a regular physician .
o Studies of the health status of the children of hired farmworkers include several negative findings:
254
 late childhood immunization in South Carolina,
255
 a substantial fraction in Florida who were positive for anti-Hepatitis A virus,
256,257
 a large segment of children with psychiatric disorders,
241
Gwyther, Marni E., & Jenkins, Melinda, (1998), Migrant Farmworker Children: Health Status, Barriers to Care, and Nursing Innovations in Heath Care
Delivery, Journal of Pediatric Health Care, March/April 1998.
Chelminski, A. N., Higgins, S., Meyer, R., Campbell, D., Pate, W. and Rudo, K., (2004), Assessment of Maternal Occupational Pesticide Exposures
during Pregnancy and Three Children with Birth Defects: North Carolina, North Carolina Health and Human Services Departmen,. 2006.
243
Thompson, B., Coronado, G.D., Grossman, J.E., Puschel, K., Solomon, C.C., Islas, I., Curl, C.L., Shirai, J.H., Kissel, J.C. and Fenske, R.A., Pesticide
Take-Home Pathway among Children of Agricultural Workers: Study Design, Methods and Baseline Findings, Journal of Occupational and
Environmental Medicine, Vol. 45, 1. 2003.
244
The Housing Assistance Council, (2000), Abundant Fields, Meager Shelter: Findings from a Survey of Farmworker Housing in the Eastern Migrant
Stream, Washington, DC.
245
Hovey, J.D. and Magana, C.G., (2003), Suicidal Risk Factors Among Mexican Migrant Farmworker Women in the Midwest United States, Archives of
Suicide Research, Vol.7, 2003.
246
Committee on Injury and Poison Prevention and Committee on Community Health Services, (2001), Prevention of Agricultural Injuries Among
Children and Adolescents, American Academy of Pediatrics, 2001.
247
Larson,K, McGuire, J, Watkins,E, Mountain,K. 1992, Maternal care coordination for migrant farmworker women: program structure and evaluation of
effects on use of prenatal care and birth outcome, J. Rural Health, 8(2):128–33
248
Bade B, 1993, Problems Surrounding Health Care Utilization for Mixtec Migrant Farmworker Families in Madera, California, Davis, CA: Calif. Inst.
Rural Stud.
249
National Center for Farmworker Health. http://www.ncfh.org/docs/00-10%20-%20monograph.pdf
250
Davidoff, AJ, Garrett,B., 2001, Determinants of public and private insurance enrollment among Medicaid-eligible children, Med. Care, 39(6):523–35
251
Wilk, VA.,1993, Health hazards to children in agriculture, Am. J. Ind. Med, 24(3):283–290
252
Dep. Health Serv, 1992, McFarland Child FARM WORKER HEALTH 191 Health Screening Project, 1989. Draft Rep.,Calif. Dep. Health Serv.,
Emeryville, CA
253
Smith,MW, Kreutzer,RA, Goldman,L, Casey-Paal, A, Kizer, KW, 1996. How economic demand influences access to medical care for rural Hispanic
children, Med. Care, 34(11):1135–48
254
Lee, CV, McDermott, SW, Elliott, C., 1990, The delayed immunization of children of migrant farm workers in South Carolina, Public Health
Rep.,105(3):317–20
255
Dentinger, CM, Heinrich, NL, Bell, BP, Fox, LM, Katz, DJ, et al., 2001, A prevalence study of hepatitis A virus infection in a migrant community: Is
hepatitis A vaccine indicated?
242
58
The Health Status of Immigrant Workers in the US: A Work In Progress
258
•
 significant evidence of child abuse and neglect,
259
 iron deficiency, and
260
 large numbers of children with untreated dental caries.
o In addition, recently, studies have revealed the presence in the homes of hired farm workers and of farmers of
261
detectable levels of the restricted materials chlorpyrifos and parathion in the state of Washington, and of
262
azinphos-methyl in the Oregon . These agents have the potential to lead to adverse health outcomes.
263
HIV/AIDS
O PREVALENCE
 The overall Hispanic/Latino estimates are the nearest reliable comparison. In 2009, there was among
264
Hispanics: 7,347 new diagnoses of HIV, and 6,719 AIDS diagnoses.
 Latinos are disproportionately affected by HIV; in 2009, Latinos represented only 16% of the total United
265
States population and 20% of new HIV infections.
O RISK FACTORS AND BEHAVIORS
 Migrant lifestyle factors (poverty, low income, sub-standard housing, limited access to healthcare, limited
266
English proficiency, mobile lifestyle, loneliness, and social isolation) contribute to HIV/AIDS exposure.
 Certain behaviors also put migrant workers at risk for contracting HIV/AIDS: including sex with prostitutes,
267
inconsistent condom use, and alcohol and drug abuse.
 Migration between Mexico and the United States has recently been highlighted as a source of rising HIV/AIDS
rates in Mexico. Mexican officials now estimate that 30 percent of their country’s HIV/AIDS cases are caused
268
by migrant workers returning from the United States.
 Mexican migrant women, as well as migrant’s wives who remain in their country of origin, are vulnerable to
contracting HIV due to risky behaviors of their male sex partners, which include intravenous drug use,
269
prostitution use without condoms, unprotected sex between men, and needle sharing
O BARRIERS
 In a recent study Health workers concluded that openly discussing sex and sexuality is received with a lot of
discomfort among this rural farmworkers. This adds to people deterring from actively seeking contraceptives
270
or practicing safe-sex behavior.
O UNPROTECTED SEX
264
 Unprotected sex with prostitutes common among farmworkers.
 A study of migrant male farmworkers in San Diego found that 70 percent of sexually active farmworkers
271
reported sex with a sex worker, of which only 23 percent reported using condoms.
 As for Mexican migrant women, a 2003 study found that of respondents who had two or more sexual
272
partners, only 25 percent reported using a condom during sex.
O OTHER FACTORS IN HIV TRANSMISSION
256
Kupersmidt, JB, Martin, SL.,1997, Mental health problems of children of migrant and seasonal farm workers: a pilot study, J. Am. Acad. Child
Adolesc. Psychiatry, 36(2):224–32
257
Marti, SL, Kupersmidt, JB, Harter, KS, 1996, Children of farm laborers: utilization of services for mental health problems, Community Ment. Health J.,
32(4):327–40
258
Larso,OW3rd, Doris J, Alvarez,WF, 199,. Migrants and maltreatment: comparative evidence from central register data, Child Abuse Negl.,14(3):375–
85
259
Ratcliffe,SD, Lee, J, Lutz, LJ, Woolley, FR, Baxter, S, et al., 1989, Lead toxicity and iron deficiency in Utah migrant children, Am. J. Public Health,
79(5):631–33
260
Nurko, C, Aponte-Merce, L, Bradley, EL, Fox, L., 1998, Dental caries prevalence and dental health care of Mexican-American workers’ children,
ASDC J. Dent. Child, 65(1):65–72
261
Fenske, RA, Lu, C, Barr, D, Needham, L., 2002, Children’s exposure to chlorpyrifos and parathion in an agricultural community in central Washington
State, Environ. Health Perspect, 110(5):549–53
262
McCauley, LA, Lasarev, MR, Higgins, G, Rothlein, J, Muniz, J, et al., 2001, Work characteristics and pesticide exposures among migrant agricultural
families: a community- based research approach, Environ. Health Perspect, 109(5):533–38
263
NCFH FARMWORKER FACT SHEET ON HIV/AIDS,www.ncfh.org/docs/fs-HIV_AIDS.pdf, DECEMBER, 2011
264
Rao, Pamela, et. al., (2008), HIV/ AIDS and Farmworkers in the US.
265
Centers for Disease Control and Prevention, HIV Among Latinos, (November 2011 A), vailable online:
http://www.cdc.gov/hiv/resources/factsheets/pdf/latino.pdf
266
Espinoza, Lorena, et. al., (2009), Increases in HIV Diagnosis at the US-Mexico Border, 2003-2006.
267
Statewide AIDS Services Delivery Consortium Advisory Group, (2007), Migrant and Seasonal Farmworkers: Health Care Access and HIV/AIDS in
this Population.
268
UNIDOS Network of Capacity Building Assistance Providers, AIDS and Migrants: Solutions and Recommendations, 2004
269
Painter, Thomas M., (2007), Connecting The Dots: When The Risks Of HIV/STD Infection Appear High But The Burden Of Infection Is Not Known-The Case Of Male Latino Migrants In The Southern United States, Centers for Disease Control and Prevention.
270
Branch, Meredith, et al., Prevention of Unintended Pregnancy and HIV/ STIs among Latinos in Rural Communities: Perspective of Health Care
Providers, 2010, Health Care for Women International, Vol. 31, No. 8.
271
Sanchez, Melissa A., The Epidemiology of HIV Among Mexican Migrants and Recent Immigrants in California and Mexico, 2004, Journal of Acquired
Immune Deficiency Syndrome, Volume 37, Number 4.
272
Fitzgerald, Keri et. al., (2003), HIV/ AIDS Knowledge among Female Migrant Farm Workers in the Midwest, The Journal of Immigrant Health, Volume
5, Number 1.
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The Health Status of Immigrant Workers in the US: A Work In Progress

•
•
•
•
Amateur tattooing common and there is very little knowledge of the transmission of blood-borne illness
273
contracted through needle sharing.
 Another important element is that there is a cultural perception that encourages self-medication and the lay
274
health injection of vitamins and antibiotics as a treatment for illness.
VIOLENCE
o Domestic Violence and Partner Abuse
 Barriers of language, culture, and poverty make it difficult for many health care professionals to recognize
275
abuse and provide care for battered farm worker women.
 It is increasingly clear that there is a serious problem in the farm worker community that needs additional
291
attention: family violence .
276
 Battered farmworker women through groups such as Lideras Campesinas have found strength in collective
277
support as they seek to remedy the violence they face in their homes.
o Child Abuse
278
 One report has found evidence of child abuse in farmworkers families.
 A positive association has also been found between exposure to family and nonfamily violence and various
279
emotional and behavioral problems among farmworker children.
MENTAL HEALTH
o Nationally, 40% of farmworkers are depressed and 30% experience anxiety. Causes of strain on mental health
include isolation, limited social support, separation from family members, job and financial stress, poor housing
280
and unhealthy working environments.
CHRONIC HEALTH CONDITIONS
o CAWHS: The California Agricultural Worker Health Survey (CAWHS) was the first statewide, population-based
291
health needs assessment to report on chronic health conditions among hired farm workers.
o OBESITY AND HIGH CHOLESTEROL: In California, obesity was found, in all age cohorts, to be in higher
prevalence among hired farm workers than among Mexican Americans, the general population, or Mexicans
residing in their own country. High serum cholesterol was also found, in all age cohorts, in higher prevalence
among hired farm workers than among the first two comparison groups, except in recently arrived immigrants
281
[..the “healthy migrant effect”?].
o DIET: The diet of Mexican migrant farm workers seems to deteriorates in the first several years after coming to
the United States to work, and is possibly related to the deterioration of chronic health indicators. In a cohort study
in California, nutritional content was found to decline markedly among the diet of these immigrants during their
282
first year in the United States.
o SUBTANCE ABUSE: The fact that cirrhosis is a leading cause of death among a large sample of hired farm
workers indicates that substance abuse, notably alcohol consumption, is also a serious problem in this
291
population
o RESPIRATORY DISEASE: One study found elevated levels of chronic respiratory symptoms (coughs, wheezing,
sputum production) in hired farm workers. Other studies indicate that respiratory disease is associated with
283
farmworker workplace exposures.
OTHER CONDITIONS
o Incidences of diseases of the ear, nose, and throat have been found to be significantly higher when compared to
284
the general population.
285,286
o High incidence of parasitic worms in two studies reported.
273
Smith, Shari et. al., Tattooing Practices in the Migrant Latino Farmworker Population: Risk for Blood-Borne Illness, 2009, The International Journal of
Dermatology, Volume 48.
274
Pylypa, Jen, Self-Medication Practices in Two California Mexican Communities, 2001, The Journal of Immigrant Health, Volume 3, Number 2
275
Rodriguez R, 1993, Violence in transience: nursing care of battered migrant women, AWHONNS Clin. Issues Perinat. Womens Health Nurs.
4(3):437–40
276
Stanley E., 1993, Female farmworkers raise issues, El Sol del Valle (Fresno Bee), Fresno, CA
277
Rodriguez, R.,1999, The power of the collective: battered migrant farmworker women creating safe spaces, Health Care Women Int., 20(4):417–26
278
Larson, OW3rd, Doris J, Alvarez, WF, 1990, Migrants and maltreatment: comparative evidence from central register data, ChildAbuse Negl. ,
14(3):375–85
279
Martin, SL, Gordon, TE, Kupersmidt, JB, 1995, Survey of exposure to violence among the children of migrant and seasonal farm workers, Public
Health Rep, 110(3): 268–76
280
Hovey, J.D., and Magaña, G.G., (2000), Acculturative stress, anxiety and depression among Mexican immigrant farmworkers in the Midwestern
United Status, Journal of Immigrant Health, 2(3), 119-131.
281
Villarejo, D, Lighthall, D, Williams, D III, Souter, A, Mines, R, et al., 2001, Access to Health Care for California’s Hired Farm Workers: A Baseline
Report, Univ. Calif., Berkeley: Calif. Program Access Care, Calif. Policy Res. Cent.
282
Ikeda, J, 1990, Food Habits of Farmworker Families, Tulare County, California, 1989, Visalia, CA: Univ. Calif. Coop. Ext. Serv.
283
Schenker, MB., 1996, Preventive medicine and health promotion are overdue in the agricultural workplace, J. Public Health Policy, 17(3):275–305
284
Communication facts- http://www.asha.org/research/reports/migrant_workers.htm 7/15/2011
285
Bechtel, GA,1998, Parasitic infections among migrant farm families, J. Community Health Nurs.,15(1):1–7
286
Ciesielski, SD, Seed, JR, Ortiz, JC, Metts, J.,1992, Intestinal parasites among North Carolina migrant farmworkers, Am. J. Public Health, 82(9):1258–
62
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The Health Status of Immigrant Workers in the US: A Work In Progress
61
The Health Status of Immigrant Workers in the US: A Work In Progress
What Are Their Family Issues?
•
•
•
•
•
•
•
In their search for a better life for their families they may move several times and work in many jobs before they are
able either to secure a steady job and settle in an accepting community or to save enough to return to their home
54
country to begin a new life there.
287
Frequent moves and the need to have them contribute to family income make school attendance difficult.
The average migrant child may attend as many as three different schools in one year. For many children it takes roughly
three years to advance one grade level. 288
53
There is only a 50.7% high school graduation rate among migrant teenagers .
A 1994 study showed that 60% of migrant students in the United States drop out of school (down from 90% reported in the
1970s) 289
At least one-third of migrant children work on farms to help their families; others may not be hired directly but are in
53
the fields helping their parents . By the time a migrant child is 12, he/she may work in the fields between 16-18 hours
290
per week (9), leaving little time for school work .
However, the California Agricultural Worker Health Survey (CAWHS) data show that in California, more than half
(52%) of the combined worker and accompanying family members are under the age of 25, and more than two thirds
(70%) are younger than 35. Thus, resident hired farm worker families have a significantly larger share of children and
of women of childbearing age than are found in the general population. This implies that maternal and child health
291
care is of proportionately greater importance for U.S. hired farm workers.
287
Migrant Farmworkers in the US, BOCES,Genesco, 1993, http://www.migrant.net/pdf/farmworkerfacts.pdf
NCFI US FARMWORKER FACT SHEET, http://www.ncfarmworkers.org/resources/, Reference #8: Employment Security Commission, 2002,
Assessment of Need for Agricultural Services and Prevailing Wage Surveys.
289
NCFI US FARMWORKER FACT SHEET, http://www.ncfarmworkers.org/resources/, Reference #10: Andrade de Herrara, V. “Education in Mexico:
Historical and Contemporary Educational Systems,” in J. L. Flores, ed. Children of La Frontera: Binational Efforts to Serve Mexican Migrant and
Immigrant Students. (pp. 25-59), Charleston, WV: ERIC Clearinghouse on Rural Education and Small Schools, 1996.
290
NCFI US FARMWORKER FACT SHEET, http://www.ncfarmworkers.org/resources/, Reference #9: David Bell, “The Nation’s Invisible Families Living
in the Fields,” Migration Education Messages and Outlook, 1994.
291
THE HEALTH OF U.S. HIRED FARMWORKERS, Don Villarejo, Annu. Rev. Public Health, 2003, 24:175–93
288
62
The Health Status of Immigrant Workers in the US: A Work In Progress
o
SUMMARY
63
The Health Status of Immigrant Workers in the US: A Work In Progress
SUMMARY
Much has been written about the existence in the US of an
“invisible” population of workers that for some time has
been performing the dirty, dangerous, and difficult jobs that
no one else wants to do, many of which (such as farm work)
are essential for maintaining our lifestyle and for our
survival.
To say that we have not done right by them is a gross
understatement.
Nowhere is this truer than in the health status and
healthcare arena. What we chronicle in this report is the
undeniable and truly reprehensible picture of neglect and
indifference to the health needs of this population that
staggers the imagination and which calls out as loudly as
possible for root cause analysis, introspection, and
sustainable correction.
This is true if for no other reason than that our dependence
on this inexpensive source of manpower is now one of the
pillars upon which the growth of our economy depends. If
not for them, our economy becomes stagnant.
Let this serve as a wake-up call!!
64
The Health Status of Immigrant Workers in the US: A Work In Progress
NEXT STEPS
65
The Health Status of Immigrant Workers in the US: A Work In Progress
WHAT NEXT?
Action steps to correct the problems chronicled in this White
Paper are required but are beyond the scope of this work.
SUOP will be working with others to find and implement as
many of the sustainable corrective actions to these problems
as possible and we invite you to join us!!
66
The Health Status of Immigrant Workers in the US: A Work In Progress
ACKNOWLEDGEMENTS
67
The Health Status of Immigrant Workers in the US: A Work In Progress
ACKNOWLEDGEMENTS:
We would like to thank and acknowledge the encouragement and assistance of the following organizations for
reviewing and contributing to this Report:
•
•
•
The Migrant Clinicians Network (MCN) and their staff. Special thanks are due their Director of External Relations, Amy
Lieberman
The Farmworkers Justice Fund (FJF). Special thanks are due Bruce Goldstein, their CEO.
The American Association of Occupational Health Nurses (AAOHN). Special thanks are due Grace Paranzino, a member of
their Board of Directors
We also wish to acknowledge and thank the multiple organizations, agencies and individuals whose
informational resources were used in the production of this document. We have tried to duly note those
contributors throughout this document, without disrupting the format and flow of its message. Indeed, the very
purpose of this document is to amplify the message and expand the audience of those organizations, agencies
and individuals quoted and referenced herein. This document is intended for use in limited educational settings,
and will not be used for any commercial purposes.
We would also like to thank the authors (individual, organizational, and governmental) of the countless relevant
and authoritative articles, fact sheets, and reports which are quoted and cited (as accurately as possible) in this
White Paper and without which we would not have been able to complete this work. We support, applaud and
appreciate your work!
Warm regards,
Joseph A. Fortuna, MD, SUOP
Scott Morris, MD, SUOP
James Tacci, MD, JD, MPH, SUOP
68
The Health Status of Immigrant Workers in the US: A Work In Progress
BIBLIOGRAPHY AND RESOURCES
69
The Health Status of Immigrant Workers in the US: A Work In Progress
BIBLIOGRAPHY AND RESOURCES
These represent the primary “core” information sources from
which we compiled and wrote the SUOP White Paper. Where
appropriate these and other sources are cited in the footnotes.
“Anchor” Journal Articles
1. 1957: The Migrant and the Rest of Us, Otis Anderson, Public Health Reports, Vol.72:No.
6, June. 1957
2. 1958: The Public Health Program for Migrant Workers, Norma Robinson, Public Health
Reports, Vol. 73, No. 9, September 1958 (Available at
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1951626/pdf/pubhealthreporig000210091.pdf)
3. 1991: Profile of a Population With Complex Health Problems, G.E. Alan Dever, PhD,
MCN Monograph Series (Available at www.ncfh.org/docs/00-10%20-%20monograph.pdf)
4. 2000: The Health Condition of Migrant Workers, Edgar Leon, PhD, MSU (Available at
http://www.ncfh.org/pdfs/4985.pdf)
5. 2000: The Ones The Law Forgot: Children working In Agriculture, Shelley Davis and
James B. Leonard (Available at
http://www.eric.ed.gov/ERICWebPortal/search/detailmini.jsp?_nfpb=true&_&ERICExtSea
rch_SearchValue_0=ED469298&ERICExtSearch_SearchType_0=no&accno=ED469298)
6. 2003: Migrant and Seasonal Farm Workers, Eric Hansen & Martin Donohue , JHCPU,
Vol. 14, No. 2 • 2003 (Available at
http://phsj.org/files/Migrant%20and%20Seasonal%20Farm%20Worker%20Health/Migrant
%20and%20Seasonal%20Farm%20Workers%20-%20JHCPU.pdf)
7. 2003: The Health of U.S. Hired Farmworkers, Don Villarejo, Annual Review of Public
Health, 2003, Vol. 24: 175-93 (Available at www.ncfh.org/pdfs/6122.pdf)
8. 2003: North Carolina's Migrant And Seasonal Farmworkers, Stephanie Triantafillou, NC
Med J, Vol64:No. 3, May/June 2003 (Available at www.ncfhp.org/pdf/stephanie.pdf)
9. 2005: Immigrant Workers at Risk: The Urgent Need for Improved Workplace Safety and
Health Policies and Programs, AFL-CIO (Available at www.ncfh.org/pdfs/6000.pdf)
10. 2007: Delivery of Health Services To Migrant and Seasonal Farmworkers, Thomas Acury
& Sara Quandt, Annual Review of Public Health, 2007.28:345-63 (Available at
http://www.annualreviews.org/doi/abs/10.1146/annurev.publhealth.27.021405.102106?jo
urnalCode=publhealth)
11. 2009: Immigrant Health Care in the United States: What Ails Our System?, Katherine G.
Footracer, JAAPA, Vol.22, No.4, April, 2009 (Available at
http://www.jaapa.com/immigrant-health-care-in-the-united-states-what-ails-oursystem/article/130524/)
12. 2009: ‘They Don’t Ask Me So I Don’t Tell Them’: Patient-Clinician Communication About
Traditional, Complementary, and Alternative Medicine, Brian M. Shelley, et al, ANNALS
OF FAMILY MEDICINE, VOL. 7, NO. 2, MARCH/APRIL 2009 (Available at
www.annfammed.org/content/7/2/139.full.pdf)
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The Health Status of Immigrant Workers in the US: A Work In Progress
13. 2010: A Global Perspective of Migration and Occupational Health, Marc Schenker,
American Journal of Industrial Medicine, March 2010.
14. 2010: The State of Health Care Services for Mobile Poor Populations: History, Current
Status, and Future Challenges, KUGEL-ZUROWESTE, Journal of Health Care for the
Poor and Underserved 21 (2010): 422–429 (Available at
www.clinicians.org/images/upload/JHCPU_mobile.pdf)
15. 2010: Historical and Contemporary Factors Contributing to the Plight of Migrant
Farmworkers in the United States, Safina Koreishi & Martin Donohoe, Social Medicine
Volume 5, Number - 66 - 1, March 2010 (Available at
http://www.socialmedicine.info/index.php/socialmedicine/article/viewFile/343/1041)
16. 2010: The Health of California’s Immigrant Hired Farmworkers, Don Villarejo, et al,
AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 53:387–397 (2010) (Available at
http://www.cpca.org/cpca/assets/File/Policy-and-Advocacy/Active-PolicyIssues/MSFW/2010-Health-of-CA-Immigrant-Farmworkers.pdf)
17. 2011: Migration and Occupational Health-UNDERSTANDING THE RISKS, Marc
Schenker, igration Information Source, Migration Policy Institute, October, 2011
(Available at http://www.migrationinformation.org/Feature/display.cfm?ID=856)
Fact Sheets
1. 1993: Migrant Farmworkers in the US, BOCES Genesco Migrant Center, (Available at
www.migrant.com)
2. 2001: United States Farmworker Fact Sheet-2001, Student Action With Farmworkers
(Available at http://www.seattleglobaljustice.org/wp-content/uploads/fwfactsheet.pdf)
3. 2005: Immigrants in the Workforce-Some Fast Facts, National Council of State
Legislatures (Available at www.ncsl.org/issues-research/.../immigrants-in-theworkforce.aspx)
4. 2005: Health Policy Fact Sheet, Health Service Disparities Among Mexican Immigrants,
Steven P. Wallace, Verónica F. Gutiérrez, Xóchitl Castañeda, CALIFORNIA-MEXICO
HEALTH INITIATIVE | CALIFORNIA POLICY RESEARCH CENTER UNIVERSITY OF
CALIFORNIA | OFFICE OF THE PRESIDENT (Available at
http://www.healthpolicy.ucla.edu/pubs/files/2005cmhi_health_disp.pdf)
5. 2007: Facts About Immigrant Workers, National Immigration Law Center (Available at
http://www.cdph.ca.gov/programs/cpns/Documents/NetworkFSO-ToolkitBasics-INationalImmigrationLawCenterFSPHandout.pdf)
6. 2007: NCFI United States Farmworker Factsheet (Available at
http://www.ncfarmworkers.org/resources/)
7. 2007: NCFI Farmworkers and Immigration (Available at
http://www.ncfarmworkers.org/resources/)
8. 2007: NCFI North Carolina Farmworker Health Facts (Available at
http://www.ncfarmworkers.org/resources/)
9. 2007: NCFI Farmworkers' Vital Contribution to North Carolina's Economy (Available at
http://www.ncfarmworkers.org/resources/)
10. 2008: Communication Facts: Special Populations: Migrant Workers in the United States2008 Edition, American Speech-Language-Hearing Association (Available at
http://www.asha.org/research/reports/migrant_workers.htm)
11. 2008:Facts About Colonias and Farmworkers, HUD – 2008 (Available at
http://www.hud.gov/groups/farmwkercolonia.cfm)
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12. 2009: Migrant and seasonal Farmworker Demographics (Available at
http://www.ncfh.org/docs/fs-Migrant%20Demographics.pdf)
13. 2009: NCFH Maternal Health and Child Health Fact Sheet (Available at
http://www.ncfh.org/docs/fs-MATERNAL%20FACT%20SHEET.pdf)
14. 2009: NCFH Child Labor Fact Sheet (Available at http://www.ncfh.org/docs/fsChild%20Labor.pdf)
15. 2009: NCFH Indigenous Workers Fact Sheet (Available at http://www.ncfh.org/docs/fsIndigenous_farmworkers.pdf)
16. 2009: NCFH Occupational Health and Safety Fact Sheet (Available at
http://www.ncfh.org/docs/fs-Occ%20Health.pdf)
17. 2009: NCFH Tuberculosis Fact sheet (Available at http://www.ncfh.org/docs/fsWhat%20is%20TB.pdf)
18. 2009: NCFH Oral Health Fact Sheet (Available at http://www.ncfh.org/docs/fsORAL%20HEALTH%20FACT%20SHEET.pdf)
19. 2011: NCFH Folk Medicine and Traditional Healing Fact Sheet
20. 2011: NCFH HIV/ AIDS Farmworker Factsheet (Available at http://www.ncfh.org/docs/fsHIV_AIDS.pdf)
21. 2011: NCFH FACTS ABOUT FARMWORKERS (Available at http://www.ncfh.org/docs/fsFacts%20about%20Farmworkers.pdf)
22. 2011: Fact Sheet - CDC Disparites and Inequalities Report-US 2011, CDC, Office of the
Director (Available at -2011FactSheet (Available at
http://www.cdc.gov/mmwr/pdf/other/su6001.pdf)
23. 2011: Hotel housekeepers are getting hurt (Available at www.hotelworkersrising.org)
“Anchor” Reports
1. 1992: Hired Farmworkers-Health and Well Being At Risk, Report to Congressional
Requesters, US General accounting Office, February, 1992 (Available at
http://www.ncfh.org/pdfs/2780.pdf)
2. 2001: Migrant Health Monograph Series, National Center for Farmworker Health, Inc.,
Buda TX (Available at http://www.ncfh.org/docs/00-10%20-%20monograph.pdf)
3. 2001: 2001 Quality Health Services for Hispanics- The Cultural Competency Component2001, HRSA (Available at
http://www.hrsa.gov/culturalcompetence/servicesforhispanics.pdf)
4. 2001: The Bounty of Food-The Poverty of Health 2001, The California Endowment CEO
Task Force on Agricultural Worker Health, 2001 (Available at
http://www.calendow.org/uploadedFiles/bounty_of_food.pdf)
5. 2002: A Demographic and Health Snapshot of the US Hispanic-Latino Population, The
National Centers for Health Statistics Centers for Disease Control and Prevention
Department of Health and Human Services (Available at
http://www.cdc.gov/nchs/data/hpdata2010/chcsummit.pdf)
6. 2004: The Health and Nutrition of Hispanic Migrant and Seasonal Farmworkers,
Katherine L. Cason, Anastasia Snyder, Ph.D., and Leif Jensen, Ph.D., The Center for
Rural Pennsylvania (Available at
http://www.rural.palegislature.us/migrant_farm_workers.pdf)
7. 2005: Migrant and Seasonal Farmworkers Access to Health Care, Sara Rosenbaum and
Peter Shin, Center for Health Services Research and Policy, The George Washington
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University (Available at http://www.kff.org/uninsured/upload/Migrant-and-SeasonalFarmworkers-Health-Insurance-Coverage-and-Access-to-Care-Executive-Summary.pdf)
8. 2005: Mexico-United State Migration Health Issues, Parts I, II, and III, Elena Zúñiga,
Steven P. Wallace, Salvador Berumen, Xóchitl Castañeda, The Ministry of Health and
the National Population Council (Consejo Nacional de Población-CONAPO) of the
Government of Mexico, and the University of California through the California-Mexico
Health Initiative of the California Policy Research Center, Office of the President, and
the UCLA Center for Health Policy Research (Available at
http://www.healthpolicy.ucla.edu/pubs/Publication.aspx?pubID=155)
9. 2008: Immigrant Health Care Legislative Toolkit, Mary’s Center for Maternal and Child
Care Available at
http://www.maryscenter.org/sites/default/files/Legislative%20Toolkit.pdf)
10. 2010: Border Lives- Health Status in the United States- Mexico Border Region, United
States-Mexico Border Health Commission (Available at
http://www.borderhealth.org/files/res_1534.pdf)
11. 2010: Official Estimates of Undocumented Immigrants in the US, Michael Hoefer, Nancy
Rytina, and Bryan Baker, DHS Office of Immigration Statistics (Available at
http://www.dhs.gov/xlibrary/assets/statistics/publications/ois_ill_pe_2010.pdf)
12. 2011: The Immigrant Worker In America-2011, Audrey Singer, The Brookings Institute
(Available at
http://www.brookings.edu/~/media/Files/rc/papers/2012/0315_immigrant_workers_singer
/0315_immigrant_workers_singer.pdf)
13. 2011: The Immigrant Worker In America-2011-APPENDIX The Brookings Institute
(Available at
http://www.brookings.edu/~/media/Files/rc/papers/2012/0315_immigrant_workers_singer
/0315_immigrant_workers_appendix.pdf)
14. 2011: Building Bridges to Enhance Pesticide Safety:Findings and Recommendations, A
Report by Farmworker Justice 8/15/2011, Farmworkers Justice Fund,
http://www.farmworkerjustice.org
15. 2011: No Way To Treat A Guest, Farmworkers Justice Fund, 2011 (Available at
http://farmworkerjustice.org/images/stories/eBook/pages/fwj.pdf)
16. 2011: DANGEROUS EXPOSURE: FARMWORKER CHILDREN AND PESTICIDES, The
Fields:Health & Safety Programs Annual Publication, Association of Farmworker
Opportunity Programs, Volume I, 20 (Available at http://afop.org/wpcontent/uploads/2010/07/Annual_Publication_FINAL_English1.pdf)
Bibliographies:
1. Farmworkers Justice Fund Books About Farmworkers:
http://www.farmworkerjustice.org/resources-publications/bibliography
2. Annotated Bibliography of Publications, Films, and Web Sites Relating to Farmworkers,
2001:
http://www.fachc.org/pdf/mig_Annotated%20bibliography%20of%20farmworker%20books,
%20films%20and%20resources.pdf
3. HEALTH CARE FOR CHILDREN OF IMMIGRANTS: Annotated Bibliography, Health Care
and Children in Immigrant Families Project, NCSL, January 2007:
http://www.ncsl.org/print/immig/BibJan07.pdf
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4. Immigrant Workers Research Publications, Wake Forest School of Medicine, 2012:
http://www.wakehealth.edu/Research/Family-Medicine/Immigrant-Workers-ResearchPublications.htm
5. Bibliography on Migrant Farm Workers in North America, Katie Hinnenkamp, Justice For
Migrant Farmworkers: http://www.justicia4migrantworkers.org/NAfarmworkersbiblio.pdf
6. Farmworkers Justice Fund Books About Farmworkers:
http://www.farmworkerjustice.org/resources-publications/bibliography
Videos & Movies:
1. Harvest of Shame with Edward R. Murrow, 1960, CBS:
http://www.cbsnews.com/video/watch/?id=7087479n
2. Harvest of Dignity, PIC.tv, 2012: http://pic.tv/harvest/video/harvest-of-dignity/
3. “A Day Without A Mexican”: http://www.cnn.com/2012/03/02/opinion/garcia-illegalimmigrants/index.html
4. Videos and Cassettes About The Migrant Experience:
http://www.fachc.org/pdf/mig_Videocassettes%20and%20Films%20About%20the%20Mi
grant%20Experience.pdf
5. “A Better Life”, 2011: http://www.imdb.com/title/tt1554091/
6. “American Harvest”: www.americanharvestmovie.com/
7. “Immokalee U.S.A.), Substream Independent Films, 2007:
http://www.wsws.org/articles/2009/jan2009/immo-j19.shtml
8. Annotated Bibliography of Publications, Films, and Web Sites Relating to Farmworkers,
2001:
http://www.fachc.org/pdf/mig_Annotated%20bibliography%20of%20farmworker%20boo
ks,%20films%20and%20resources.pdf
9. The Fight In The Fields, Cesar Chavez and the Farmworkers’ Struggle:
http://www.pbs.org/itvs/fightfields/
10. The Migrants, CBS,1974: http://www.imdb.com/title/tt0071839/
Resource Guides:
1. Farmworkers Justice Fund Health and Safety Resources:
http://www.ncfarmworkers.org/resources/#Directory
2. Farmworkers Justice Fund Promotores Training Modules:
http://www.farmworkerjustice.org/training-modules
3. National Center For Farmworker Health Library and Resource Center:
http://www.ncfh.org/?sid=38
4. National Center For Farmworker Health Leadership and Training Center:
http://www.ncfh.org/?sid=38
5. National Center For Farmworker Health: Links and Resources:
http://www.ncfh.org/?sid=42
6. National Center For Farmworker Health: Health Education Center:
http://www.ncfh.org/?sid=40
7. Association of Farmworker Opportunity Programs (AFOP): Media Center:
http://afop.org/children-in-the-fields/view-multimedia/
8. Migrant Clinicians Network Clinical Systems Toolbox:
http://www.migrantclinician.org/tools-and-resources/toolbox_intro.html#
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9. Migrant Clinicians Network Resources: http://www.migrantclinician.org/tools-andresources/resources_intro.html
10. North Carolina Farmworker Institute Resources:
http://www.ncfarmworkers.org/resources/
11. North Carolina Farmworker Institute Resource Directory:
http://www.ncfarmworkers.org/wp-content/uploads/2010/04/Resource-Directory2010B.jpg
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