Community Assessment on Migrant and Seasonal Farmworkers in California

Community Assessment on Migrant and Seasonal Farmworkers in California

The paper will include a community assessment on migrant and seasonal farmworkers in California.  Discussion of demographics, environmental factors, and experiences that reflect migrant and seasonal farmworkers overall quality of life in the United States.  An overview of critical issues and health disparities that impact the quality of life for migrant and seasonal farmworkers.  Followed by an epidemiological assessment of primary health issues and the contributing factors to incidence and prevalence.  Summarized by how behavioral, and environmental factors influence access to government resource.

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Social Assessment

The agriculture industry in the United States is dependent on migrant, and seasonal farmworkers who are documented and undocumented (Ramos, 2018).  Estimated that there are between 1 and 2.7 million hired farmworkers in the United States that are year-around, migrant, seasonal, and H2-A guest program workers (“The Migrant / Seasonal Farmworker | Migrant Clinicians Network,” n.d.).  California is rank among Texas, Florida, Washington, North Carolina, and Oregon as one of the states with the highest farmworker populations(“United States Farmworker Factsheet | Student Action with Farmworkers,” n.d.).  They are responsible for tending, planting, and harvesting vegetables, fruits and other crops (Ramos, 2018).  Agriculture is considered a hazardous industry in the United States (“CDC – Agricultural Safety – NIOSH Workplace Safety and Health Topic,” 2018).  Injury rates are estimated to be as high as 12.5 per 100 farm workers among migrant, and seasonal farmworker and workers may under- report of injuries due to being undocumented fear of losing their job, not being able to provide for their families (Ramos, 2018).

The National Agriculture Workers Survey (NAWS), indicate that farmworkers in the United States are overwhelmingly Hispanic and with 21% female and 72% male (Mills, Dodge, & Yang, 2009).  A migrant and seasonal farmworker is 84 % foreign-born, and 53 % are working in the United States without documentation with a median age of 31 years old (Mills et al., 2009).  The differences between a seasonal and migrant farmworker are that migrant farmworker migrates from farm to farm for employment establishes a temporary home (Arcury & Quandt, 2007).  Both migrant and seasonal farmworker primary employment is in seasonal agriculture (Arcury & Quandt, 2007).

Compared to the general population migrant and seasonal farmworkers are considered a vulnerable population that is social, economically and a legally disadvantaged group (Ramos, 2018).  On average formal education completed by migrant and seasonal farmworker was eighth-grade (“Findings from the National Agricultural Workers Survey (NAWS) 2013-2014,” n.d.). Reported that 36% completed sixth grade or lower and 21% of farmworkers completed grades seven, eighth, and ninth (“Findings from the National Agricultural Workers Survey (NAWS) 2013-2014,” n.d.).  In English language skills, 27% farmworkers reported they could not speak English and 43% reported could speak somewhat  (“Findings from the National Agricultural Workers Survey (NAWS) 2013-2014,” n.d.).  Reading ability in English is limited to 38 percent not being able to read English and 31 percent of farmworkers reading very minimal (“Findings from the National Agricultural Workers Survey (NAWS) 2013-2014,” n.d.).

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The significant change that has occurred over time to the demographics of migrant and seasonal farmworkers is the increase of indigenous farmworkers in the United States.  Indigenous Farmworkers Study (IFS) estimates 165,000 indigenous farmworkers are residing in California and the majority originating from the states of Guerrero and Oaxaca in Mexico (“National Center for Farmworker health- Home,” n.d.).  Undercounted by official census, led to the increase of health disparities of the indigenous community with service providers unaware of their existence.  Secondly, Spanish is not their primary language according to the IFS reports that more than half of the individuals surveyed spoke Mixteco.  One in ten spoke Triqui, and one in four spoke Zapoteco and with a small number of participants speaking  Nahuatl or Chatino(“National Center for Farmworker health- Home,” n.d.).  Change in demographics of migrant and seasonal farmworkers has to be recognized to ensure that health interventions accommodate the unique cultural traits and language barriers of the indigenous farmworker population.

Migrant and seasonal farmers a primary source of income is working seasonally in agricultural that often leads to a transit lifestyle.  Housing environments are substandard for migrant farmworkers and their families that are forced to live in trailers, full housing units, and barracks, housing units that have sanitation, electrical and structural problems during peak seasons (Arcury & Quandt, 2007).  Their living environment increases exposures to health risk for migrant and seasonal farmworkers and their families.  Migrant and seasonal farmworkers are at risk of fatal and nonfatal injuries related to musculoskeletal disorders, pulmonary disease,   pesticide exposure, stress and hearing loss (“CDC – Agricultural Safety,” 2018).  Their living environment creates barriers to accessing food, health care services, assistance services, and social support.

Women and children are incredibly vulnerable in this living environment.  Compared to 76 % of overall pregnant women in the United States 42% of female migrant workers received prenatal care during their first trimester of pregnancy (Connor, Layne, & Thomisee, 2010). Children of migrant and seasonal farmworker live on the farm in 2014 about 893, 000 youth lived on farms, and more than half worked on their farm (National Children’s Center for Rural and Agricultural Health and Safety, 2017).  Children are delayed in receiving immunization and are found suffer from vitamin A deficiency, chronic diarrhea, severe asthma, intestinal parasites, and chemical poisoning (Connor et al., 2010).  Childhood agriculture injuries occur every day, about 33 children get injured in agriculture-related incidents (National Children’s Center for Rural and Agricultural Health and Safety, 2017).  As well, it estimates that 60 % of 7,469, household reported youth getting injured on a farm and that was not working when it occurred (National Children’s Center for Rural and Agricultural Health and Safety, 2017).  Families typically do not have periodic screenings for development and growth and health promotion and disease prevention (Connor et al., 2010).  Medical attention is often required when the health condition has progressed or has created severe health complication resulting in high cost (Connor et al., 2010).

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Compared to the majority of the American population migrant farmworkers and seasonal farmworkers suffer higher rates of mortality and morbidity rates higher, due to the combination of lack of regulations, poverty, hazardous working conditions, and limited access to health care (“The Migrant / Seasonal Farmworker | Migrant Clinicians Network,” n.d.).  Migrant and seasonal farmworkers live below poverty level, they are unable to afford health insurance coverage because they do not meet the eligibility requirement to receive Medicaid due to citizenship status (Arcury & Quandt, 2007).  Food insecurity and hunger are substantially higher among unaccompanied male farmworkers and farmworker families than the average United States population(Arcury & Quandt, 2007).  Contributing to their high-risk diabetes and heart disease in farmworkers which can be a result of the food choices made due to limited income and accessibility.

Migrant and seasonal farmworker even though are economically deprived, migrant communities are rich in cultural and organizational traditions that help them to survive and work for a better life.  Their source of resilience is from strong ties to their communities of origin that often helps create a sense of community and support in which exists in different locations, on both sides of the border.  A central component of migrant and seasonal farmworkers is familism. Familism defines as the social patterns where the welfare of family prioritizes an individuals decisions, actions, and interest and take priority over the individual’s needs (Desmond & Turley, 2009).  The social pattern is manifest through three dimensions: one attitudinal that is express with values, beliefs, and dispositions that prioritize the welfare of the family; second behavioral is expressed with decisions, informed by one’s attachment to family ties; and lastly structural, by the spatial architecture of family networks (Desmond & Turley, 2009).  Familism is a critical component behind the emigration of a family member to the United States and their source of strength through hardships they face in establishing financial stability and a better future for the loved ones they left in their native country.

Facing similar challenges as other underserved population migrant and seasonal farmworkers regarding health care access have additional barriers of language, cultural differences, mobility, limited eligibility to funded health care programs, and lack of familiarity with local healthcare (The Migrant / Seasonal Farmworker | Migrant Clinicians Network,” n.d.). When working with migrant and seasonal farmworker patients, job insecurity creates a sense of helplessness that leads to chronic stress-related conditions and onset of depression (Simmons, Liebman, & Sokas, 2018).  The historical issue of the United States broken immigration policies have created a hostile environment for individuals who are undocumented and in the process of renewal of visa and applying for citizenship.  Currently, the political climate has negatively impacted the number of individuals that are accessing prevention and management resources for existing health conditions that can lead to long-term health effects(Connor et al., 2010).  Overall quality of life of migrant and seasonal farmworkers are often associated with the fear of the negative consequences related to the determination of employment, ineligibility or deportation (Connor et al., 2010).

Access to healthcare impacts the overall health for migrant and seasonal farmworkers associated with high cost, lack of culturally competent care and inadequate or no insurance coverage.  Farmworkers associated cost and time with transportation to care, co-pays, and prescriptions (Levy, Holmes, & Mariscal, n.d.).  Culturally competent care related to limited or no interpreter services and knowledge in folk care or traditional remedies (Levy et al., n.d.).  Migrant and seasonal farmworkers use of traditional home remedies and seek health care in Mexico due to convenience, cost, being familiar with treatments, and perceived understanding of needs(Levy et al., n.d.).  Lack of insurance and unfamiliarity with the United States health care system, where to find health information, and the perception that providers would not be able to understand their healthcare barriers (Levy et al., n.d.).  Due to work demands, the convenience of availability of services often led to delay in seeking treatment after a workplace injury or to treat sickness due to not wanting to lose earnings (Levy et al., n.d.).

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Multiple physical stressors that seasonal and migrant farmworker face as of a result of strenuousness of farm work, documentation status concerns, coupled with family separation, and insecurity of work opportunities (“The Migrant / Seasonal Farmworker | Migrant Clinicians Network,” n.d.).  Migration to the United States can result to mental health concerns, including anxiety, depression, post-traumatic stress disorder, substance abuse, and suicidal ideations (“The Migrant / Seasonal Farmworker | Migrant Clinicians Network,” n.d.).  It is no surprise that one in four migrant and seasonal farmworkers are diagnosed with a chronic health condition that does not account for those who have not been diagnosing (Connor et al., 2010).  The frequently cited adverse health issues for migrant and seasonal farmworkers are dental problems, persistent musculoskeletal pain, itching or irritated eyes, nervios (a condition related to anxiety), and persistent stomach ache (D. Villarejo & S. A. McCurdy, 2008).

There is a significant gender difference in the prevalence of self-reported health complaints and healthcare coverage within migrant and seasonal farmworkers (D. Villarejo & S. A. McCurdy, 2008).  Overall 73% of female participants and 74% of male participants lack health insurance (D. Villarejo & S. A. McCurdy, 2008).  For men that had healthcare coverage, it was through their employer and the opposite case for women who used government-sponsored coverage (D. Villarejo & S. A. McCurdy, 2008).  Also, men were more likely to report that their current employer offered health insurance plans, but among women, employers did not offer health insurance (D. Villarejo & S. A. McCurdy, 2008).  The majority of the workers decline health insurance because they could not pay the premiums(D. Villarejo & S. A. McCurdy, 2008).  Women workers were likely to report hand pain, stomachs pain, and neck pain compared to men (D. Villarejo & S. A. McCurdy, 2008).  Most prevalent work-related health conditions for both female and male high were water eyes followed by skin irritations, headaches, and blurry vision(D. Villarejo & S. A. McCurdy, 2008).  Least common work-related health conditions were dehydration, numbness, dizziness, vomiting, and diarrhea(D. Villarejo & S. A. McCurdy, 2008).

Epidemiological

Mental illness among migrants and seasonal farmworkers vary widely; it is essential to recognize that structural and situational influences they face demonstrably affect their mental state.  Due to the living and working conditions, for migrant and seasonal farmworkers have an increased their risk to experience depression and moderate to high levels of stress(Chaney, Burke, Rager, & Ward, 2011).  Research indicates that one and four migrant and seasonal farmworkers suffer from two psychiatric disorders episode in their lifetime, nearly twice the prevalence of the general American adult population(Chaney et al., 2011).  Depressive systems reported 19.7% female and 21% male are related to legal residence status, language conflict, lack of social support, and discrimination increase the risk for migrant and seasonal farmworkers to develop severe psychiatric disorders, such as depression (Chaney et al., 2011).  The long list of stressors and its adverse effects on life expectancy Latinos are less likely to seek mental health service (Chaney et al., 2011).  Stress and depression can lead to a physiological effect on the body by increasing the chances of health conditions such as arthritis, asthma, heart disease, and diabetes(Chaney et al., 2011).  Negative coping behavior associated with smoking, substance use, binge eating and lack of exercise (Chaney et al., 2011).  The direct and indirect effects of stress and depression can disrupt the ability to do personal responsibilities at work and home for migrant and seasonal farmworkers to do (Chaney et al., 2011).  As health practitioners working with a migrant population it is vital to have a solid grasp of the relationship between the occurrence of depression, stress, and coping behaviors have on an individual and the impact that it has on societal health is crucial in creating health promotion and intervention programs (Chaney et al., 2011).

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In the past, the 20 years Latinos that account for 34 % of newly diagnosed AIDS cases in 2000, and represent 30.8% of the California population (Sanchez et al., 2004).  California Department of Health Services reported that the percentage of Latino AIDS cases has increased from 36.5% in 1995 to 47.7% in 2000 (Sanchez et al., 2004).  Among the cumulative number of  AIDS cases in December 2003, Mexico ranks third regarding accumulated AIDS case with 72,864 after the United States and Brazil (Sanchez et al., 2004).  The two leading high-risk group are men who have sex with men and injection drug users (Sanchez et al., 2004). To address, this epidemic among migrant farmworkers it needs to be understood that AIDS data does not reflect total HIV infections it is essential to establish an accurate assessment of Mexicans and new immigrant population in California. Understanding the transmission dynamics within the population will help create culturally competent health intervention programs that can be used both in the United States and Mexico.

Obesity-related health conditions such as hypertension, type 2 diabetes and hyperlipidemia are prevalent among migrant and seasonal farmworkers (Weigel, Armijos, Hall, Ramirez, & Orozco, 2007). The prevalence of food insecurity in vulnerable low-income, minority groups, and Hispanics is double the national average (Weigel, Armijos, Hall, Ramirez, & Orozco, 2007).  The Hispanic household is 21.7% food insecure compared to 11.9% of the general U.S. population. (Weigel et al., 2007).  Food security in households has an impact on health and nutritional implication.  Households that are food insecure have lower quality diets, iron-deficiency, and reduce micronutrient intake (Weigel et al., 2007).  These households are likely to consume higher caloric foods that lead to weight gain and excess energy intake (Weigel et al., 2007).  Adults and children that face food insecurity have poorer mental health status and are more likely to have lower self-esteem, stress and anxiety, emotional distress, depressive symptoms, and social isolation (Weigel et al., 2007). The rates of food insecurity have increased in the United States, and it is critical to understand as a public health advocate the adverse mental health outcome linked food insufficiency(Weigel et al., 2007).  Adding on to the already high level of stress due to difficult working and living conditions, to low wages, unstable employment, workplace violence, and linguistic isolation, and for some fear of deportation (Weigel et al., 2007).

Cancer among migrant and seasonal farmworkers were significant for uterine corpus cancers, leukemia, stomach, and cervix and advanced stages of diagnosis compared to other Hispanics in California (Mills et al., 2009).  In the United States one-quarter of all pesticide sales occur in California for crops like tree fruit, row vegetables, and grapes, require extensive treatment with chemicals that result in direct chemical contact for farmworkers who have to tend the crops (Mills et al., 2009).  Migratory nature of the population makes it challenging to link cancer particularly lymphatic and hematopoietic cancers related exposure to pesticides that occur excessively in migrant and seasonal farmworker population (Mills et al., 2009).  Several chemicals appear to be associated with elevated cancer risk in farm workers, notably the use of the phenoxyacetic acid herbicide(Mills et al., 2009).  Unfortunately, cancer survival is significantly impacted by the stage that the disease is diagnosed (Mills et al., 2009).  Importance to recognize that several chemicals used in agriculture are associated with elevated cancer risk in farm workers (Mills et al., 2009).  Advocacy for regulation of pesticides in agriculture and education for migrant and seasonal farmworkers to know their rights and where to report exposure can help better monitor this health issues.

Objectives in Healthy People 2020 address health disparities in migrant and seasonal farmworkers associated with limited health care access and lack of occupational safety and health.  Healthy People 2020 objectives are to increase access to quality and comprehensive health care services (“Access to Health Services | Healthy People 2020,” n.d.).  Focuses on three components that are insurance coverage, access to health services, and timeliness of care (“Access to Health Services | Healthy People 2020,” n.d.).  Also obtaining necessary prescription drugs and include oral health care (“Access to Health Services | Healthy People 2020,” n.d.).  Addressing these three components in migrant and seasonal farmworkers population by providing culturally competent care that accommodates their work schedules will improve health status and increase preventative care for a chronic disease.  Due to the hazardous work, that migrant and seasonal farmworkers Health people 2020 objective based on occupational safety and health goal is to promote the health of people at work with early intervention and prevention (“Occupational Safety and Health | Healthy People 2020,” n.d.).  The workplace is where individuals spend a quarter of their life, and by preventing injuries, illness and death can help the overall quality of life for migrant and seasonal farmworkers (“Occupational Safety and Health | Healthy People 2020,” n.d.).

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Across the country, farmworkers are getting empowerment to improve their living and working conditions.  Agencies and institutions are a focus on addressing the multitude of health disparities, political injustice, and environmental barriers of migrant and seasonal farmworkers.  In the state of California organizations like La Cooperativa Campesina de California Corporation a statewide association that operates more than 80 locally-engaged, bilingual offices implementing and administering farmworker service programs (“About La Cooperativa,” n.d.).  The programs that they offer are education and employment, support services, emergency service, advocacy and awareness, and low-income weatherization program (“About La Cooperativa,” n.d.).  The non-profit organization called California Human Development a leader in the War on Poverty for nearly five decades.  First inspired in service to our state’s farmworkers, CHD now serves people of low income from many walks of life-giving 25,000 people a year in 31 Northern California counties a hand up in pursuit of the American Dream.  Migrant Clinicians Networka nonprofit organization that creates practical solutions at the intersection of poverty, migration, and health.  Engages in the research, develops appropriate resources, advocates for migrants and clinicians, engages outside partners and runs programs that support clinical care on the frontline of migrant health.  There are also organizations that help to empower and provided migrant farmworker adequate support in improving work conditions. Treeplanters & Farmworkers United located in northwest Oregon’s is a union for farmworkers,  and reforestation workers, that empowers farmworkers to take action against systematic exploitation.  United Farm Workers founded by Cesar Chavez and Dolores Huerta and brought national attention to farmworkers wages and working conditions in the 1960s and has since won union contracts in states across the country.

Transitory nature of agriculture combined with the high levels of poverty, lack of documentation make migrant and seasonal farmworker populations vulnerable to chronic health diseases and challenging to research.  The behavioral factors that influence migrant and seasonal farmworkers health issue are a result of cultural differences and their perceived severity of work-related injuries.  Farmworker uses a variety of non-pharmacologic and pharmacologic methods to cure non-work-related and work-related injuries and illnesses to avoid missing work due to illness (McCullagh, Sanon, & Foley, 2015).  Farm laborer perceived the musculoskeletal injuries were just consequences of hard work (McCullagh et al., 2015).  Often healthcare services are available but financially impossible instead low cost approached is used to maintain good health purchasing over-the-counter, homemade remedies and non-medicinal treatments (McCullagh et al., 2015).  Cultural related behavior often impacts health issues in migrant and seasonal farmworkers.

Immigration status has an environmental impact on migrant and seasonal farmworkers socioeconomic status, that creates a hostile relationship with local and national policies (Castañeda et al., 2015).  This status affects neighborhood safety, housing conditions, and labor protections and excludes migrant and seasonal farmworkers from using resources that other US resident receives (Castañeda et al., 2015). Immigrants experience the same challenges as low-income communities of color, but face discrimination and violation of labor right that results in lower self-worth (Castañeda et al., 2015). Also choosing not to interact with government services due to fear of deportation or family separation (Castañeda et al., 2015).

The chronic stress that migrant and seasonal farmworkers face through work and living environment and the impacts of the lack of legal status, racial discrimination, and general exclusion affects mental health and physical health. Multiple public health issues need to be researched and address to ensure that migrant and seasonal farmworkers receive adequate healthcare access and labor rights.

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As stated by Cesar Chavez, Co-Founder of United Farm Workers it is essential for us to remember that every time we nourish our bodies that the agriculture industry is exploiting millions of migrant and seasonal farmworker.

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