Migrant Health 101
Presented by the BPHC-funded Cooperative Agreements:
Farmworker Health Services, Inc.
Farmworker Justice
Migrant Clinicians Network, Inc
Migrant Health Promotion, Inc.
National Association of Community Health Centers
National Center for Farmworker Health
1850’s to 1940’s
1850’s
Advances in crop production, machinery, transportation and refrigeration, increase
the demand for a migratory seasonal labor force
1930-1936
The Dust Bowl - Over-farming, poor soil management, and severe drought created
vast dust storms in the lower Great Plains. Farmers in this area became the new
migrants, traveling to California and other regions in search of work.
1942
The US and Mexico signed what came to be known as The Bracero Treaty. With
the onset of WWII and the need for greater military infrastructure, Mexican
citizens were recruited to alleviate the labor shortages in the agricultural fields
Thousands of impoverished Mexicans abandoned their rural communities and
headed north to work as Braceros.
1950’s
1950’s
1951 The Bracero Program is renewed
1952 An amendment is passed to the Immigration and Nationality Act that
creates the H-2 Program. This Program mirrored the Bracero Program.
1955 Social Security coverage is extended to migrant farmworkers
.
1960’s – 70’s
1962
The Migrant Health Act is enacted. It provides for financial and technical aid to
those public and private non-profit agencies that provide community health
services to migrant farmworkers and their families.
1970
Seasonal farmworkers are made eligible for grant-assisted services
1970
Reauthorization of Migrant Health Act mandates a National Advisory Council;
1980’s
1983
The Migrant and Seasonal Agricultural Workers’
Protection Act establishes the rights of migrant
farmworkers and the guidelines labor contractors must
follow to respect those rights.
1986
The Immigration Reform and Control Act institutes
penalties against employers that employ illegal immigrants.
The act also grants legal immigration status if they have
worked at least ―90 man days‖ between May 1985 and May
1986.
1986
The H-2A Program is created out of the
Immigration Reform and Control Act. It
provides foreign workers temporary legal
status. It leads to great controversy because the
1978 – Health education and social services
program
seems
allow
forfor possible
exploitation
are added
as services
eligible
grant
assistance
of farmworkers by employers.
1990’s to the Present
1992
The EPA’s Worker Protection Standard sets provisions for a safe working
environment for migrant farmworkers.
1996
The Health Centers Consolidation Act passes. This act consolidates
migrant health centers, healthcare for the homeless, health services for
residents of public housing, and community health centers.
2001
President George W. Bush introduces his Initiative to Expand Health
Centers, which seeks to double the number served by health centers.
2002
President Bush signs into law the Health Care Safety Net Amendments. It
reauthorizes the Health Centers Program through 2006, seeks to expand
services to rural communities, and authorizes the Community Access
Program.
National Advisory Council on
Migrant Health
The Council is legislatively
mandated to advise, consult with,
and make recommendations to
the Secretary of Health and
Human Services on the health
and well being of migrant
farmworkers and their families.
Fifteen members are appointed
by the Secretary to serve fouryear terms.
http://bphc.hrsa.gov/migrant/nacmh
Legislation
Section 330g of the Public Health Service Act
Migratory Agricultural Worker
– Principal employment is in agriculture
– Has been so employed within the last 24
months
– Establishes a temporary home for the purpose
of such employment.
Seasonal Agricultural Worker
– Principal employment is in agriculture on a
seasonal basis
– Does not migrate
Definition of Agriculture/Farmwork
Farming in all federal government branches include:
A) Cultivation and tilling of the soil
B) Production, cultivation, growing, & harvesting
of any commodity grown on, in or as adjunct to
the land
C) Preparation & processing for market and
delivery to storage or market, to carriers for
transportation to market (performed by a farmer
or on a farm)
(Health Center Consolidation Act of 1996, Section 330(g) –Public Law 104-299)
Qualifying Tasks
Hired laborers performing tasks related to
farming of the land including:
 Preparation
 Tilling
 Cultivation
 Growing
 Harvesting
 Preparation
 Processing
 Production
 Transportation
 Distribution
Performed by a farmer or on a farm.
Migrant & Seasonal Farmworkers
by State
0-5,000
5,001-10,000
10,001- 20,000
20,001-30,000
30,001-50,000
50,001-100,000
100,001-200,000
200,001-300,000
300,001-500,000
Alice Larson Enumeration
1,300,000
Studies 1993, 2000, 2003
Qualifying Crops
Grains and Nuts
Vegetables
Nursery work
Fruits
Commodities
Federal Definitions
Department of
Education
Health and Human Services
Migrant Health
Crops
Nurseries
Dairy farms
Poultry
Livestock,
Lumber/Fores
try
Fisheries
Crops
Nurseries
Cannery *
Packing *
Department of
Labor
Migrant
Head Start
Crops
Crops
Greenhouse Greenhouses
s Nurseries Nurseries
Dairy farms
Poultry
Livestock
(Industrial
*On-site or near
Classification
the farm
System, codes
111-112)
Migrant Characteristics - Mobility
Historical notion of movement in ―Streams‖
•East Coast
•Midwest
•Western
Migrant Characteristics - Mobility
Reality is that movement is based on circumstance
Restricted Circuit
• Following crops in
one area.
• Often centered
around a home base.
• Usually a couple
adults from the
household move to
work but they come
home frequently.
Migrant Characteristics - Mobility
Reality is that movement is based on circumstance
Point-to-Point
• Moves from a ―home
base‖ to a work
location far away.
• Often goes back to
the same work location
year after year.
• Often a whole family
travels together.
Migrant Characteristics - Mobility
Reality is that movement is based on circumstance
Nomadic
• Travels to wherever
there is work.
• Usually does not know
when or to where s/he
will next move.
• Generally foreign
born, young, single men
working in the United
States and sending
money home.
Migrant Farmworker Families
General Characteristics
• Vast majority are Mexican and
Central American recent immigrants
• From landless rural poor families
• Young population
• Poorly educated, many not be literate
in or even speak Spanish
• Limited English proficiency (LEP)
• Many undocumented
Farmworker Migration Today
• Increase in the number of H2 workers nationally
• More males traveling alone
• Fewer families traveling together
• More are establishing themselves in rural
communities as seasonal workers
• Less trans-border crossing
• Engaging in other industries during the off season
such as construction, meat processing and dairy
Source: Passel, 2006
Farmworker Migration Today
• New sending
communities
• New receiving
communities
• Less available
housing (more
dispersion of
population)
Migrant Health
Barriers to healthy lifestyles
• Cultural issues such as language, literacy,
medical knowledge, health care practices and
beliefs, and dietary practices
• Social support absent because of social exclusion
• Access to health foods that are important for
weight maintenance and disease control/
prevention
Migrant Health
Barriers to healthy lifestyles
• Poverty, with unreliable transportation, lack of
insurance, inability to buy services and supplies,
and substandard housing
• Job security is limited and increases the
possibility that workers will remain in a
dangerous or questionable job to remain
employed
Migrant Health
Barriers to healthy lifestyles
• Migration causing discontinuity of care
• Political considerations associated with
immigration status of the patient and family
• Racism that motivates policies or actions that
frighten members of particular racial/ethnic
groups.
• Confusion about US Health Systems
US Dept of
Health & Human Services
Health Resources and Services
Administration
Elizabeth Duke, PhD
Bureau of Primary Health Care
Minority and Special Populations
Central Office TTA Cooperative Agreements
Farmworker Health Services
Farmworker Justice
Migrant Clinicians Network
National Association of
Community Health Centers
National Center for
Farmworker Health
Migrant
MigrantHealth
HealthPromotion
Promotion
Public Health Section 330 Programs
330e - Community Health Center
330g - Migrant Health Center
Voucher Programs
330h - Health Care for the Homeless
330i - Public Housing
Numbers of health centers
• The BPHC is now supporting over 1,300
health care grantees including community
and migrant, homeless, school based and
public housing health centers distributed
across the country, with over 5,000 clinic
sites.
• There are currently 154 Migrant Health
Center grantees.
Health Center Funding
Health Center budgets range between
$500, 000 and $25 million.
The Bureau provides no more than
28% of the health centers total
budget. For every dollar provided by
the Bureau, the health center must
raise three additional dollars.
How Many Receive Health Care
758,894
3 Million
MSFW Population
MSFW Served
Source: UDS 2006
Service Adaptations
Voucher programs
 Mobile Units
 Lay health promoters (promotoras)
 Outreach programs
 Family visits
 Bridge case management
 Portable medical record and ID card/ bracelet
 Complementary and Alternative Medicine use
 Must address cultural health beliefs
 Culturally sensitive education for providers
 Must be in appropriate language and literacy levels
 Collaboration with other service providers such as
schools and day care centers

How to Find the Closest Clinic
 Migrant and Community HC list
http://ask.hrsa.gov/pc/
 The Clinicians Migrant Health Directory:
order at MCN 512-327-2017
 Migrant Health Referral Directory: Order
it by calling NCFH, Inc. at 1-800-531-5120
 Free Clinic Directory: To order a copy call
540-344-8242
http://medkind.com/Scripts/Modules/Mod
ule6/A1.idc?Code
Answering the need
• Farmworker Health Services
www.farmworkerhealth.org
• Migrant Health Promotion
http://www.migranthealth.org/
• National Association of Community Health
Centers
www.nachc.com
• Farmworker Justice
www.farmworkerjustice.org
• National Center for Farmworker Health
www.ncfh.org
• Migrant Clinicians Network
www.migrantclinician.org
• Regional Migrant Health Coordinators
Regional Coordinators
Seth Doyle
James O’Barr
Rosa Navarro
Andy Martinez
Pedro Martinez
Erin Sologaistoa
Migrant Health Promotion builds on community strengths to improve health in
farmworker and border communities. Our programs provide peer health
education, increase access to health resources and bring community members
together with health providers, employers and policymakers to create positive
changes. Community leaders, called Promotores and Promotoras, provide the
inspiration, direction and vision necessary to build stronger, healthier
communities — from within.
Michigan
224 West Michigan Avenue
Saline, MI 48176
P (734) 944-0244
F (734) 944-1405
Texas
Relampago School
PO Box 337
Progreso, Texas 78579
P (956) 565-0002
F (956) 565-0136
www.migranthealth.org
Farmworker Justice is a nonprofit organization that seeks to empower migrant
and seasonal farmworkers to improve their living and working conditions,
immigration status, health, occupational safety, and access to justice.
Using a multi-faceted approach, Farmworker Justice engages in litigation,
administrative and legislative advocacy, training and technical assistance,
coalition-building, public education and support for union organizing.
1126 16th St., NW, Suite 270
Washington, DC 20036
202-293-5420 voice
202-293-5427 fax
www.farmworkerjustice.org
FHSI offers a wide range of customized services which benefit
community-based organizations that are committed to improving
the health and well being of farmworkers.
By partnering with FHSI, organizations can expect to attain:
 A better understanding of farmworker needs and
how to address those needs;
 Increased access to care and reduced health
disparities;
 Strengthened continuity and quality of outreach
program;
 Maximized use of financial and staffing resources.
East Coast Office
Farmworker Health Services, Inc.
1221 Massachusetts Ave., NW, Suite 5
Washington, D.C. 20005
Phone: (202) 347-7377
Fax: (202) 347-6385
Executive Office
Farmworker Health Services, Inc.
405 14th Street, Suite 807
Oakland, CA 94612
Phone: (510) 268-0091
Fax: (510) 268-0093
www.farmworkerhealth.org
A force for justice in health care for the mobile poor
MCN is a national, not-for-profit organization founded in 1984 by clinicians
working in migrant health. With nearly 2,000 members, the organization is the oldest
and second largest clinical network serving the underserved. MCN’s goal is to
improve health care of migrants and other mobile poor populations by providing
support, technical assistance, and professional development services to clinicians
MCN Main Office
Migrant Clinicians Network
P.O. Box 164285
Austin, TX 78716
(512) 327-2017 phone
(512) 327-0719 fax
www.Migrantclinicians.org
The National Center for Farmworker Health (NCFH), established in 1975, is dedicated to
improving the health status of farmworker families by providing information services and
products to a network of more than 500 migrant health center service sites in the United
States as well as other organizations and individuals serving the farmworker population.
The National Center for Farmworker Health, Inc. is a private, not-for-profit corporation
located in Buda, Texas whose mission is "to improve the health status of farmworker
families through appropriate application of human, technical, and information resources."
1770 FM 967
Buda, TX 78610
(512) 312-2700
(800) 531-5120
www.ncfh.org
Founded in 1970, the National Association of Community Health Centers, Inc.
(NACHC) is a non-profit organization whose mission is to enhance and expand
access to quality, community-responsive health care for America’s medically
underserved and uninsured. In serving its mission, NACHC represents the
nation’s network of over 1,000 Federally Qualified Health Centers (FQHCs)
which serve 16 million people through 5,000 sites located in all of the 50 states,
Puerto Rico, the District of Columbia, the U.S. Virgin Islands and Guam.
7200 Wisconsin Ave., Suite 210
Bethesda, MD 20814
Phone: 301-347-0400
Fax: 301-347-0459
www.nachc.org
Migrant Stream Forums
Migrant Stream Forums and
National Farmworker Conference
• East Coast sponsored by North Carolina
Community Health Center Association
• Midwest sponsored by the National
Center for Farmworker Health
• Western sponsored by Northwest
Primary Care Association
• Annual Conference sponsored by
National Association of Community
Health Centers