Experiences of Work at the Ventanillas de Salud: Promoting Occupational Safety and Health 54 th Jornada de Salud April 27, 2008 – Cuernavaca Michael Flynn Training Research and Evaluation Branch National Institute for Occupational Safety and Health, CDC

Disclaimer Any opinions, findings, conclusions, or recommendations expressed in this presentation are those of the presenter and do not necessarily reflect the views of NIOSH. Given current data limitations we will have to use information on Hispanics, Hispanic immigrants, and Mexican immigrants to get a better picture of the overall situation for Mexican immigrants.

About NIOSH –Created 1970 –National Institute for Occupational Safety & Health (NIOSH) research –Occupational Safety & Health Administration (OSHA) regulatory and enforcement

Overview Demographic Trends Scope of Occupational Safety and Health (OSH) Problems Among Mexican Immigrant Workers Challenges Ventanillas de Salud Pilot Project Questions

Hispanic Population Currently there are 42 Million persons of Hispanic descent in the U.S. Represents growth of 150% in past 25 years Almost half are foreign-born, the majority (64%) coming from Mexico By 2050, 25% of U.S. population will be Hispanic and make up 15% of the workforce.

Source: US Census Bureau: Census 2000

Hispanic Workers and OSH In 2001 Hispanic workers accounted for 10.9% of the work force but 15.2% of the total number of workplace fatalities Fatality rates for US born workers have declined to an all time low in recent years. Mexican-born workers are 27% of foreign-born workforce but account for 42% of all work related fatalities and recorded the highest fatality rate. Source: NIOSH Chart book, 2004

Fatal work injuries involving Hispanic workers, Number of fatalities NOTE: Data from 2001 exclude fatalities resulting from September 11 terrorist attacks

Fatal work injury rates for Hispanic workers, Fatalities (per 100,000 workers) All workers4.1 Hispanic workers4.9 Native-Born3.7 Foreign-Born5.9 Civilian Hispanic workers, Census of Fatal Occupational Injuries

Non-fatal OSH Injuries Between 1998 and 2000, Hispanic men had the highest overall relative risk (1.51) of non-fatal occupational injuries and illnesses. This compares to a relative risk of 1.07 for white, non-Hispanic men and of 1.40 for black, non- Hispanic men. Reason to believe disparities are even greater among immigrants due to lack of reporting

Barriers to OSH for Hispanic Immigrant Workers Lack of Knowledge –Safety rules and regulations in US –Unaware of some hazards or proper prevention –Access to appropriate OSH materials Lack of access to system –Complicated forms (language/reading level) –Fear of authorities –Unaware of services offered –Feeling trapped Lack of documents –Which name to use –W/O rights Economic need Unscrupulous Employers

Quotes So did they give you some kind of training on safety and precautions, etc.? No, none. Only when the boss is there. He only says "be careful" and that's it.

Quotes “I had a third degree burn. I told the manager that I burned myself…I told her to look at my burn but she said put mustard on it, mustard is very good for burns…they did not pay for my health insurance nor do they send me to the hospital. Nothing…{Did you go to the doctor?} I did not have money back then…A friend of mine went to Mexico and brought me penicillin shots and I shot myself. One first and the second shot a week later because I did not stop working. Sometimes I just covered the burn with a band aid and some ointment {The manager saw that?}…they knew about it and saw my burn but they only told me to put mustard because it heals burns and never told me to go to the doctor.”

NIOSH Activities Better understand the community –Understand immigrant perspective –Understand what facilitates and hinders safe behavior Over 40 focus groups conducted Develop Culturally Appropriate Materials –Content based on input from community and experts –Test reading level –Use multiple formats (written and digital) Disseminate information to the community –Develop trust –Reach ‘hidden’ workers

Dissemination Challenges –Population is ‘hard to reach’ NIOSH’s lack of experience Lack of infrastructure in new settlement areas –Immigrants often distrustful of U.S. Government Institutions –System is often complicated to understand and manage Language issues Numerous agencies, forms, laws, etc.

Current Dissemination Efforts Collaboration is essential –Media Telemundo –Pecados Ajenos –Mexican consular network Border project Ventanillas de Salud Dissemination Project

Advantages –Access to thousands of at risk workers –Provides ‘safe’ location –In person contact vs. TV or radio Help navigating system –Fits mission of NIOSH and IME

VDS Dissemination Project Pilot Project –4 Consulates with VDS –Develop several OSH materials Provide information –To promote personal behavior change –To improve access to system for larger problems –Evaluate which message and format work best –Provide data to evaluate NIOSH response capacity –Increase collaboration between NIOSH and SRE/IME Increase NIOSH capacity for helping Mexican immigrant workers Increase VDS capacity for providing information regarding OSH

Possible Outcomes/Future Projects Establish OSH as part of national VDS core curriculum Have OSH as regular part of health promotion activities sponsored by IME –Bi-national health week etc. Distribution of OSH materials in other consulates –Coordinated national campaign Expand OSH to other departments of the consulate network –Protection department

Questions

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