1. Race, risk, and the health care of migrant workers in south GA Gnat line news briefing 2-20-06

2. Who are migant farmworkers?

3. Origins of migrant labor 1942 US and Mexico sign Bracero program to fulfill agricultural labor needs (ended in 1964) initiated the three migrant streams East coast West coast Mid - western

4. Migratory agricultural workers in the U.S. Overview: 85% of fruits and vegetables in the US were cultivated and/or harvested by hand Migrant workers are a culturally and ethnically diverse population In GA the majority of farmworkers are Hispanic, poor, young, single men, undocumented Bureau of Primary Health Care: Migrant Health Program Fact Sheet

5. Profile of farmworkers in the U.S. ( National Agricultural Workers Survey 2000 ) Age: Median age 29 67% are less than 35 Foreign –born 81% Born in Mexico 95% Undocumented 52% Male 80% Parents with children 45% Income level below poverty 61%

6. Definitions of migrant and seasonal agricultural workers There is no one definition of migrant or seasonal farmworker Federal and state definitions vary by program; Migrant Health Program Department of labor The as a result migrant and seasonal farmworkers may be eligible for one program but not for another

7. Why are migrant farmworkers among the most medically vulnerable in the US ??

8. Immigration status Undocumented workers have limited social, economic, and health services Role of the grower Contracts with crew leader Hirers H2A temporary foreign farm workers Role of the crew leader

9. Health access barriers Migration: following the seasonal migration pattern families may move 4 or more times a year Dependence on crew leader: MFWs may not know their address how long they will work for the local farmer have limited transportation if brought by the crew leader to the job

10. Labor and economic conditions 2000 US Department of Labor Report to the congress Many farmworkers remain ineligible for unemployment benefits and workers compensation insurance Child labor: with parents consent children can work in agriculture at age 13 years (http://migration.ucdavis.edu)http://migration.ucdavis.edu

12. housing Inspected prior to occupancy by department of labor for non H2A workers Historically deplorable: Overcrowded Unsanitary – mold, insect infested, Unsafe – lead paint, close to fields Lack privacy Exposure to hazardous chemical after workers return home

14. Farm labor issues Pesticides & chemicals Work place risks; machinery, long hours Lack of sanitation in the fields

16. Common illness in migrant farmworkers TB STDs -- Prostitution HIV/AIDS – bringing problem home to Mexico diabetes Teen pregnancy Gastritis Skin rashes (due to exposure to harmful chemicals and pesticides Fungi problems Inadequate or non existent prenatal care Asthma and respiratory problems Alcohol abuse -- depression Work related accidents & illnesses (green tobacco illness)

17. What (if any) health care services can migrant farmworkers expect ??

18. Health legislation affecting migrant and seasonal workers 1996 The Personal Responsibility and Work Opportunity Reconciliation Act Links citizenship and immigration status to Medicaid and some social services Must be in U.S. 5 years legally before being eligible to apply for Medicaid In GA Medicaid eligibility for children who are documented Babies born healthy Fragmented health care services Public health services

19. GA’s farmworker health program GA’s farmworker health program provides migrant and seasonal farmworkers health care services through a patchwork of 6 migrant health centers throughout the state GA’s program is unique because of it’s combination of heath care centers There is no clear number of migrant and seasonal farmworkers in our state. Estimates of the number of m/sf in GA were developed 1996

21. Ellaville Primary Health Care Center Efforts Outreach services -- Serves five counties Migrant farm worker estimate 5000-7000 Served about 2400 MFWs in 2004 Offer primary health care services on a sliding fee scale Projects TB Immunization depression

23. Access does not always equal utilization

24. Socio-demographics & vulnerability Poverty Social isolation & marginalization Cyclical mobility Barriers to health care – Medically vulnerable

25. Cultural and cognitive barriers to health care Lack of continuity in health care Compliance barriers Cultural barriers Folk illnesses Language barriers Acute care oriented Inappropriate use of hospital emergency departments for primary care

26. continued Child care health issues: Immunization Child labor Day care Safety: car safety seats May have illness not prevalent in the US Measles TB Helminthic infestations

27. Children are the most vulnerable population

28. Special health care needs of children Need for a good start Healthy pregnancies have higher percentage of healthy babies Immunizations Education – attending, achieving, graduating Day care services Safety (safe homes, car safety seats) Preventative health care services: Well child check up Dental health contraceptive information

29. Growing health & social issues Settled out farmworkers & Non-agricultural undocumented workers Undocumented Strain on GA’s infrastructure Limited credit history makes buying a home difficult – over crowding Children brought here illegally by their parents have limited job future & recent proposed GA legislation my make it impossible to enroll in higher education Federal legislation: DREAM ACT

30. Why do migrant health issues matter??

31. Practical reasons to provide health care It’s cost effective An ounce of Prevention is worth a pound of cure To reduce or eliminate disparities in access to and use of health services Healthy workers keep us all healthy Immigrants and their children are our future The will be a major segment of the US workforce in the coming years

32. Moral reasons If you believe that we’re all in this together, we should care for those who provide nourishment for us