Homework: Addressing the health needs of immigrant/migrants

Homework: Addressing the health needs of immigrant/migrant farmworkers

Maria Elena Ruiz

“It’s ironic that those who till the soil, cultivate and harvest the fruits, vegetables, and other foods that fill your tables with abundance have nothing left for themselves.”

Cesar Chavez

Over 55 million Americans (20%), many of lower socioeconomic status, are living in rural areas with limited access to health care and at greater risk for poor health ( Institute of Medicine, 2005 ). These include almost 4 million farmworkers who harvest our crops and contribute to our bountiful food supply, yet they are at greater risk for poverty and occupational dangers with little to no access for nutritional, housing, health, and basic environmental safety.

Historical context of migration: Farmworkers

Despite recent media attention, the migration of foreign-born workers to the United States is not a new phenomenon. Instead, the in-migration of migrant workers to the United States has occurred over many decades with peaks and flows dependent on economic and sociopolitical factors from the sending (primarily Mexico) and receiving country (United States). However, not all Mexican-origin workers have had to cross borders “sin papeles” (without documentation). For many older generations, no legal documents were required, as U.S. boundaries encroached south into Mexican territory several times. As the U.S. border shifted south, families living in the annexed territory became U.S. residents, while others left in the constricted Mexican regions remained Mexican citizens. This pattern divided some families between two countries; some became U.S. citizens, while others had to request permits in order to visit relatives in “el norte” (the United States).

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At other times, some Mexican residents were invited to migrate north when young male workers were recruited to support the U.S. economy. During the first wave of 1910 to 1921, as the United States entered World War I, over 700,000 Mexican workers were brought into the United States as agricultural workers ( National Farm Worker Ministry, n.d ). These workers were systematically excluded from receiving labor benefits, including the right to unionize, receive overtime pay, worker protection, and other benefits. This exclusionary pattern of selective labor restriction set the stage for the exploitation of farmworkers and ill will that persists among some generations.

As a result, many generations of Mexican workers in the United States and Mexico have a long history with the guest worker and Bracero Program of the 1940s, with conflicting views on whether the programs offered positive opportunities or exploited immigrant workers. For older generations, such programs “had a jaded history with regard to worker treatment and implications for their health status, but on the other hand, afforded them the opportunity for U.S. citizenship” ( Ruiz, Phillips, Kim & Woods, 2016 , p. 11).

The bracero program (1942–1964)

During World War II, the United States initiated a binational Farm Labor Agreement with Mexico (Bracero Program), formally enticing thousands of men with promises of visas and agricultural jobs. Drawn by the prospects for work and residency, thousands of Mexican nationals crossed into the United States, leading to massive exploitation and abuse by agricultural owners and immigration and law enforcement officials. By 1954, the Operation Wetback (anti-Mexican), backed by agricultural growers, businesses, and the U.S. Border Patrol, gained prominence. This led to thousands to millions of arrests, including deportation of some U.S. citizens ( Blakemore, 2018 ). By 1964, when the Bracero Program ended, over 4.5 million agricultural workers had arrived in the United States. Multiple factors led to the demise of the program, including the anti-immigrant climate, complaints of human rights abuses, poor housing and work conditions, unpaid salaries, and high fees for unsanitary housing and food ( UNCO.edu, n.d ).

The rise of the united farmworkers union

During the Bracero Program, Cesar Chavez and Dolores Huerta advocated for reforms and joined Filipinos in their organizing efforts, founding the National Farm Workers Association, later changed to the United Farm Workers (UFW) of California. Supported by faith organizations, college students, and key politicians (including Senator Robert Kennedy), the UFW went on to become not only a California-based powerful force for farmworkers, but also a national cause for Latino immigrants. Fueled by the civil rights era of the 1960s and the “La Causa” movement of the UFW, it became a major driving force, advocating for class, economic, gender, indigenous and migrant social justice issues.

Chavez is also recognized for various accomplishments that improved the living and working conditions for farmworkers, including demands for basic human rights such as housing, potable water and toilets in the fields, rest periods, and higher salaries for men as well as for the growing number of women and children who toiled in the fields along with their parents. An experienced farmworker, Chavez also brought attention to the backbreaking trauma inflicted by the bending movement associated with the short-handle hoe. Through his sociopolitical efforts, the short hoe was declared unsafe in 1975, a major landmark for fieldworkers. Chavez’ charismatic non-violent approach and ability to link faith, civil rights, and social justice contributed to his status as a civil rights icon. Later, Dolores Huerta gained recognition as co-founder of the UFW.

Today, agricultural workers continue to be imported under an expanded temporary guest worker program, with over 200,000 workers approved last year alone ( Gutierrez, Wallace, & Castañeda, 2004 ).

Migrant farmworkers: Demographic profile

Unlike earlier generations of Latinos who tended to migrate to well-established communities supportive by large ethnic enclaves, newer subgroups are diversifying non-traditional states and migrating to regions throughout the United States, including the Midwest and the northeastern coast. Most farmworkers are from Mexico (76%) and are Spanish-speaking males (70%), with increasing numbers of indigenous workers with unique cultural, language, social, and diverse health needs ( Association of Farmworker Programs 2017 ). Despite some prevailing stereotypes, 27% of farmworkers are U.S. born, up to one-third are U.S. citizens, and over half (59%) have lived in the United States over 10 years ( National Center for Farmworker Health [NCFH], 2014 ). Average individual incomes range from $15,000 to $19,000 annually, with family income ranging from $17,000 to almost $20,000. Overall, the majority are subsisting at high poverty levels, with limited access to food, housing, and health care, with a life expectancy of 49, or 30 to 40 years below the national average ( Hansen & Donohoe, 2003 ).

Migrant farmworkers: Occupational health

Despite the accomplishments of the UFW, the conditions under which farmworkers live and work continue to be a major source of shame in this country. Over 30 years ago, the landmark report The Occupational Health Risks of Migrant and Seasonal Farmworkers ( Farmworker Justice Fund, 1986 ) documented the health risks and paucity of research on the health of farmworkers. The report not only noted the multiple health risks of agricultural workers; including skin, eye, respiratory and musculoskeletal conditions, gastrointestinal and renal problems, and infectious disorders, but also traumatic equipment-related injuries. The report highlighted the third-world living conditions that farmworkers toil under in a first-world country as the United States. Violations included the lack of sanitation facilities and potable water, pesticide exposures, equipment hazards, crowded unsanitary housing conditions often without indoor plumbing, child labor abuses, plus other environmental and access barriers that exacerbated chronic conditions made worse by the inhumane housing and work conditions and lack of health access.

Cesar Chaves, Dolores Huerta, and the UFW may have brought attention to the plight of immigrant farmworkers as early as the 1960s. Over 50 years later, research continues to document the numerous health risks and abuses faced by the largely invisible and impoverished farmworkers.

Epidemiological studies: Update

Agricultural work is one of the most dangerous occupations in the United States, yet gaps in research persist, as limited attention has been given to the association between rural living, farmworking, and migration. For limited English-speaking migrant workers, the occupational risks are even higher, due to the nature of seasonal work, language and cultural differences, inadequate training, and protective equipment as well as lack of protective measures ( Ramos, Fuentes, & Trinidad, 2016 ). Even when eligible for governmental support, workers may not report unsafe working conditions or may postpone health care due to fear or threats of deportation ( Perez-Escamilla, Garcia, & Song, 2010 ).

Despite the comprehensive landmark report published in 1986, updated epidemiological studies continue to document the long-term health risks by not only individuals who toil in the fields, but also their families and surrounding communities. Newer research also documents the long-term damage related to pesticide exposure, including reproductive organ damage to women, as well as congenital birth disorders in children and various types of cancers ( McCauley et al., 2006 ). Migrant Health Centers also report a greater need for family-focused care for women and children, along with greater needs for dental care, hearing, and vision care due to equipment noise and traumatic injuries ( NCFH, 2014 ).

Emerging issues also call attention to rising mental health needs due to stress and loss of family and social support networks, as well as sexual harassment and violence against women in the fields ( Galvez, Mankowski, McGlade, Ruiz, & Glass, 2011 ).

A call for social justice and social determinants of health approach

Farmworkers have been economically exploited and politically excluded from basic human rights protection and public services. The gaps in research call for an integrative approach that encompasses not only a rural versus urban examination of disparities, but for a social justice approach that incorporates race/ethnicity, migration, and culture.

Medical care alone cannot close the inequality gap or improve the living and sociopolitical environment that farmworkers toil under (Castaneda et al., 2014). Instead of relying on a downstream systematic approach where we seem to be applying temporary band aids to major ills and superficial fixes, nurses and other health providers may find an upstream approach more effective for attacking the roots of the problem in order to address the racism, inequities, and the multiple social factors confronting farmworking communities ( Braverman, Egerter, & Williams, 2011 ). Nurses are the foremost trusted health workforce in the nation; the public depends on nurses to advocate and bring about public policy changes.

TAKING ACTION: Health care in the fields

Almost 15 years ago, I volunteered with a mobile van program, providing health care to agricultural workers in the fields. Through an arrangement with agricultural owners, the van would roll into the beautiful fields where crop workers were tilling the crops, and we would park off to the side, away from the public’s view. I always wondered why we needed to park a distance away from the entrance to the buildings. Were the health workers, like the field workers, to remain invisible?

At first, I was impressed with the beauty of the fields, and the support from the growers that welcomed our health services. I quickly began to question if the farmworkers were using their breaks or lunchtimes or perhaps losing invaluable time allotted for picking crops, thus losing some of their salary.

An eye-opening experience arose when I requested to use the bathroom and I was directed to the “honey buckets” (portable toilets). A fieldworker suggested I might not want to visit these. At some sites, the portable toilets were nearby; at others, they were a good distance away from our view. Some had soap and water, many were malodorous. Some health staff used these “facilities” (same ones used by the field workers). A few times, the growers (company owners) would invite us to use the indoor, clean facilities inside the building (facilities provided for the business company staff).

As I spent more time in the fields, my sorrowful and ethical concern rose as I witnessed the separate and unequal facilities for the migrant workers: no visible drinking water, limited breaks, no visible shade nor sitting areas for the workers who toil, 6 to 7 days per week for minimum pay. Some colleagues expressed that these were great improvements from what was previously available. I thank the health staff for their passion and patience, but these continue to be inhumane third-world conditions in a first-world country.

I first became involved with the UFW and “La Causa” in California as a teenager, drawn by the civil rights movement many years ago, collecting supplies while caravanning Delano in central California. Viewed through my lenses, not much has changed in more than 40 years. Some colleagues may see these improvements as the glass half full and rising. I see the glass as half empty and in urgent need of repair.

As an immigrant, Latina, university professor, Advanced Practice Nurse, researcher, and social justice leader and advocate, I would hope nurses and all health workers would dig deeper for a more just society and advocate for more than a Band-aid approach in our system of health care.

Discussion questions

1. 1. Discuss a downstream approach that nurses may rely on to decrease pesticide-related health risks. What upstream approach may be more constructive?

2. 2. Some individuals may express concern that immigrants are taking jobs away from American citizens. Provide an example of one occupation where this has occurred.

3. 3. List a local or national labor and health care policy that nurses can develop to improve the health of farmworker rural communities?

References

Association of Farm Worker Programs. Where are they now: Migrant farm workers 2017; Retrieved from https://afophs.wordpress.com/2017/01/24/where-are-they-now-migrant-farm-workers .

Blakemore E. The largest mass deportation in American history 2018; Retrieved from www.history.com/news/operation-wetback-eisenhower-1954-deportation .

Braverman P., Egerter S., Williams D.R. The social determinants of health: Coming of age Annual Review of Public Health 2011;32: 381-398.

Castaneda H., Holmes S.M., Madrigal D.S., de Trinidad Young M., Beyler N., Quesada J. Immigration as a social determinant of health Annual Review of Public Health 2015;36: 375-392.

Farmworker Justice Fund. The occupational health risks of migrant and seasonal farmworkers 1986; National Rural Health Association Washington, DC.

Galvez G., Mankowski E.S., McGlade M., Ruiz M.E., Glass N. Work-related intimate partner violence among immigrants from Mexico Psychology of Men & Masculinity 3, 2011;12: 230-246.

Gutiérrez V.F., Wallace S.P., Castañeda X. Demographic profile of Mexican immigrants in the United States Health Policy Fact Sheet 2004; Retrieved from www.researchgate.net/publication/242491308_Demographic_Profile_of_Mexican_Immigrants_in_the_United_States .

Hansen E, Donohoe M. Health issues of migrant and seasonal farmworkers Journal of Health Care for the Poor and Underserved 2, 2003;14: 153-163.

Institute of Medicine. Quality though collaboration: The future of rural health 2005; National Academies Press Washington DC.

McCauley L., Anger W., Keifer M., Langley R., Robson M., Rohlman D. Studying health outcomes in farmworker populations exposed to pesticides Environmental Health Perspectives 6, 2006;114: 953-960.

National Center for Farmworker Health. A profile of migrant health: An analysis of the uniform data system 2010 2014; Retrieved from www.NCFH.org?fact-sheets–research.html .

Perez-Escamilla R., Garcia J., Song D. Health care access among Hispanic immigrants: ¿Alguien esta escuchando? American Anthropological Association 1, 2010;34: 47-67.

Ramos A., Fuentes A., Trinidad N. Perception of job-related risk, training, and use of personal protective equipment among Latino immigrant hoc CAFO workers in Missouri Safety 25, 2016;2: 3-11.

Ruiz M., Phillips L, Kim H., Woods D. Older Latinos: Applying the ethnocultural gerontological nursing model Journal of Transcultural Nursing 1, 2016;27: 8-17.

UNCO.edu. (n.d.). The Bracero Program. Retrieved from www.unco.edu/colorado-oral-history-migratory-labor-project/pdf/Bracero_Program_PowerPoint.pdf .

Homework: Addressing the health needs of immigrant/migrant farmworkers