According to the United States Public Health Service, there are an estimated 3.5 million migrant and seasonal farmworkers in the United States—men, women, and children who work in all fifty states during peak periods of agriculture. A migrant farmworker is an individual who moves from a permanent place of residence in order to be employed in agricultural work. Seasonal farmworkers perform similar work but do not move from their primary residence for the purpose of seeking farm equipment.
Migrant farmworkers tend to be either newly arrived immigrants or individuals with limited skills or opportunities. Although American agriculture depends on the labor of these workers, employment is usually of short duration and requires frequent moves. Many men travel without their families, and most workers return during the winter to a home base, usually in Florida, Texas, California, Puerto Rico, or Mexico. Migrant farmworkers are predominantly Latino (78 percent); 2 percent are African American, 18 percent Caucasian, less than 1 percent Caribbean, and less than 1 percent Asian. Almost half have less than a ninth grade education, and many speak little or no English. Children of migrant farmworkers often change schools several times a year.
Most migrant farmworkers earn annual incomes below the poverty level and few receive benefits such as Social Security or worker's compensation. The transient nature of their work often prevents them from establishing any local residency, excluding them from benefits such as Medicaid and foot stamps. The majority of migrant farmworkers are either U.S. citizens or legal residents of the United States. Some foreign workers enter the United States under guest-worker
Farm work is considered to be second only to mining in the rating of most hazardous occupations. There is a high exposure to pesticides through topical exposure, inhalation, and ingestion, resulting in the highest rate of toxic chemical injuries of any group in the United States. Farm injuries, exposure to heat and sun, and poor sanitation in the fields are other factors that contribute to the dangers of this work. Every year nearly three hundred children die and twenty-four thousand are injured in farm work.
Housing regulations attempt to provide decent living conditions for migrant workers, but housing is often overcrowded, poorly maintained, and lacking in ventilation, bathing facilities, and safe drinking water. These conditions contribute to an increased risk of accidents, sanitation-related diseases, and infectious diseases. Several studies have shown a 40 percent positivity rate in tuberculosis testing of migrant populations. One migrant farmworker group was found to have a 5 percent incidence of HIV (human immunodeficiency virus) infection. Another study showed that 78 percent had parasitic infections.
Health care problems faced by migrant farmworkers are similar to those of other disadvantaged populations, but the factors of poverty, mobility, difficult living and working conditions, and cultural isolation put them more at risk for illness and injury. Those who work with migrant farmworkers find that, not only do common disease conditions occur more frequently, but they are often more severe because they are allowed to progress to more advanced stages before accessing care.
Unstable living and working conditions, conflicts arising from the process of acculturation, perceptions of mental illness, isolation, and discrimination all contribute to a high incidence of metal-health problems among migrant farmworkers. A 2000 study documented a 26.7 percent incidence of psychiatric disorders among a sample of male Mexican farmworkers in California. A national survey of migrant women showed that approximately 20 percent had experienced physical or sexual abuse during the previous year. These same factors make migrants more vulnerable to substance abuse, depression, and self-medication.
In 1962, President John F. Kennedy authorized the creation of a system of health care services specifically for migrant and seasonal farmworkers. The Migrant Health Program continues to be administered as part of the Bureau of Primary Health Care within the Health Resources and Services Administration, and consists of a national network of migrant health clinics. Studies have found, however, that these services were reaching less than 15 percent of the farmworkers in the United States.
It is a challenge to provide health care to the transient migrant farmworker in the context of the traditional health care system. Migrant health centers must attempt to provide health care services that are sensitive to the unique cultural, financial, and occupational needs of farmworkers. Staff must be able to communicate in the languages of the farmworkers, and clinic services must be offered in the evening, since farmworkers will not risk a loss of wages or employment by seeking care during work hours. Transportation services are often an essential component of migrant health programs.
Migrant health programs employ outreach programs to make services more available to farmworker patients. Clinicians often travel to farmworker camps in the evenings to assess and triage health problems. Multidisciplinary care is typical—nurses, health educators, nurse practitioners, physician assistants, nurse midwives, physicians, dentists, and others collaborate to provide necessary services. Lay health advisors are often recruited from the ranks of the farmworkers population and trained in basic preventive medicine. These individuals help to reinforce preventive health concepts through teaching, triage, and referral.
Providing continuity of care is a constant focus in migrant health care programs. A farm-worker may only be in one location a few weeks or months, so for services that require long-term attention, such as prenatal care or treatment of diabetes, follow-up must be carefully planned. Portable records with detailed treatment information are often given to farmworkers to present to other
EDWARD L. ZUROWESTE
Alderete, E.; Vega, W. A.; Kolody, B.; and Aguilar-Gaxiola, S. (2000). "Lifetime Prevalence of Risk Factors for Psychiatric Disorders among Mexican Migrant Farmworkers in California." American Journal of Public Health 90:608–614.
Centers for Disease Control and Prevention (1992). "Prevention and Control of Tuberculosis in Migrant Farm Workers: Recommendations of the Advisory Council for the Elimination of Tuberculosis." Morbidity and Mortality Weekly Report 41:1–13.
Dever, G. E. A. (1991). Migrant Health Status: Profile of a Population with Complex Health Problems. Austin, TX: National Migrant Resource Program, Inc.
Johnston, H. (1985). Health for the Nation's Harvesters: A History of the Migrant Health Program in Its Economic and Social Setting. Farmington Hills, MI: National Migrant Worker Council, Inc.
Migrant Clinicians Network (1997). Practice-Based Research Network on Domestic Violence and Migrant Farmworkers. Austin, TX: Migrant Clinicians Network.
Power, J. G., and Byrd, T., eds. (1998). U.S.-Mexico Border Health: Issues for Regional and Migrant Populations. Thousand Oaks, CA: Sage.
Rivara, F. P. (1985). "Fatal and Nonfatal Farm Injuries to Children and Adolescents in the United States." Pediatrics 76:567–573.
Rothenberg, D. (1998) With These Hands: The Hidden World of Migrant Farmworkers Today. New York: Harcourt Brace.
United States Department of Labor (1994–1995). National Agricultural Workers Survey. Washington, DC: Author.