1. North Carolina’s Farmworkers
North Carolina Farmworker Health Program
Office of Rural Health and Community Care
NC Department of Health and Human Services

2. Overview Farmworkers in North Carolina
The North Carolina Farmworker Health Program
Internship and Service Learning Opportunities

3. Farmworkers in North Carolina
Demographics
Environmental and occupational health risks and other health concerns
Access to care issues

4. Agriculture
North Carolina’s agriculture ranks among the state’s most vital industries, contributing over $59 billion annually and representing 22% of North Carolina’s income.
At the heart of this industry are migrant and seasonal farmworkers whose hand labor is relied upon to plant, tend, and harvest tobacco, sweet potatoes, cucumbers, apples, bell pepper, Christmas trees, and a variety of other crops.
Each farmworker’s labor contributes annually over $12,000 in profits to North Carolina’s agricultural industry.
North Carolina ranks 6th in the nation for having the largest number of farmworkers (CA, TX, WA, FL, OR)
North Carolina ranks sixth in the nation in the number of migrant farmworkers.[i]
There are approximately 150,000 farmworkers and their dependents in North Carolina each growing season,4 but this estimate is believed to be low. In the United States there are two to three million farmworkers.[ii]
[i] Larson, A. Farmworker Enumeration Study, 2000
[ii] Report of the Commission on Agricultural Workers, 1992

5. North Carolina’s Farmworkers
There are approximately 92,603 farmworkers working in the state
63,956 Migrant; 7,671 are H2A
28,647 Seasonal
Employment Security Commission Estimate, 2006
North Carolina ranks 6th in the nation after CA, TX, WA, FL, OR
Numbers greatly underestimated, do not reflect dependents
- migrant (moving to work in agriculture)
seasonal (living year-round in the same location, working seasonally in agriculture)
There are approximately 150,000 farmworkers and their dependents in North Carolina each growing season,4 but this estimate is believed to be low. In the United States there are two to three million farmworkers

6. Some are… Migrant Farmworkers
62.5% have home base in Florida, Georgia or Mexico
90% of Latin-American descent
Mostly young, unaccompanied, poor Mexican-born men
Spanish-speaking, with little or no English
Less than 9 years of formal education, average 6th grade
Earn less than $11,000 per year
Today, an estimated of North Carolina farmworkers migrate to the state each year from a home base such as Florida, Georgia, or Mexico in search of temporary agricultural work and 37.5% are seasonal farmworkers who have settled permanently in the state and do farmwork for part of the year. Over 90% are Latinos. The remaining percentages are mostly African-American males, with a smaller amount being Native-Americans and whites. Of the Latinos, most are young, unaccompanied, Mexican-born men. A smaller number are women and children. As recent immigrants, the majority of farmworkers in North Carolina are Spanish-speaking, have less than nine years of formal education, and speak little or no English. Women tend to have even fewer years of schooling. Despite the prevalence of multiple wage earners in many households, low wages and unstable seasonal employment make farmworkers some of the state’s poorest laborers, earning less than $7,500 per year. (Triantafillou, 2003)

7. Migrant H2A Workers H2A is a guest worker visa
Contracted by farmer to enter country as farm laborers, either directly or through North Carolina’s Grower Association
Do not come with their family
Usually do not know where they will be working until they arrive
May stay for months

8. Some are… Seasonal Farmworkers
37.5% permanently reside in the state and work in agriculture for part of the year
Made up of African-Americans, some settled migrant workers of Mexican-American descent, and a few American Indians
Mostly low-income, poor population

9. Challenges Farmworkers Face
Geographic constraints (rural) and social isolation
Subject to extreme weather conditions and occupational hazards such as pesticides
Poor working & living conditions
Limited or no transportation
Limited or no access to phones
Work long hours, with little or no breaks
Subject to and dependant on farmer and/or crew leader
In normal times, the strain of daily life for farmworkers is difficult physically as well as economically. Working long hours during the peak agricultural season, they often earn below minimum wage because the season lasts for a short period of time.
For migrant farmworkers there can be a lag of several day or weeks between jobs as they travel from one state to another in search for work. When disasters strike, farmworkers can be left without jobs and income to support their families for the balance of the year. FW’s are not eligible for unemployment compensation.
Poverty: Nationally, farmworkers’ average annual income is $10,000-$12,000; for a family it is approximately $16,000.7 Past studies have shown that farmworkers on the East Coast earn about 35% less than the national average.[i]
Few wage protections: Most farmworkers are exempt from minimum wage laws, and all farmworkers are exempt from overtime provisions, despite long work days during peak harvest.[ii]
Hard work, little money: At 40 cents per bucket (5/8 bushel), a farmworker must pick and haul two tons of sweet potatoes to earn $50 in one day.[iii]
Few benefits: Despite pervasive poverty, less than one percent of farmworkers collect general assistance welfare nationwide. Only ten percent of farmworkers report having health insurance through an employer health plan. Fewer than four out of ten workers interviewed said that they would receive unemployment benefits if out of work.7
Hunger: Nearly five out of ten North Carolina farmworkers cannot provide enough food for themselves and/or their families.1
[i] Ward, L. East Coast Analysis of NAWS, 1998
[ii] Fair Labor Standards Act, 1938, 1978
[iii] US Dept. of Labor, Prevailing Wage Surveys, 2002

10. Challenges Farmworkers Face
Language and cultural barriers
Unfamiliarity with US systems
Lack of information about resources
No health insurance or worker’s comp
Limited or no daycare services
Limited access to healthcare services
Farmworkers play a vital role in cultivating the food we eat everyday. North Carolina has one of the largest farmworker populations in the nation, yet these workers largely remain invisible. Even though 85% of our fruits and vegetables are harvested by farmworkers,[i] they often cannot afford enough food for their own families.[ii]
[i] Olivieri, VJ. US Dept. of Ag., 1993
[ii] Quandt, SAF. Public Health Reports, 2004

15. Occupational Health Issues
Pesticide exposure
Green Tobacco Sickness
Heat illness
Musculoskeletal strains and fractures
Dermatitis
Eye – Pterygium, trauma
Insect/Animal Bites

16. Other Health Concerns Motor vehicle accidents
Sexually Transmitted Diseases, particularly high risk for HIV/AIDS
Tuberculosis
Hypertension
Diabetes
Oral Health
Depression
Motor vehicle accidents

17. TOP CONCERN: Pesticide Exposure
 Estimate 10,000-20,000 cases/yr
 Exposure: Chronic, Acute

18. How Does it Happen? Accidental contact with spray (51%)
Residue on plants or produce (25%)
In soil or irrigation water
On pesticide equipment
In pesticide storage and handling areas
On work clothes and boots
In the home

19. Health Effects Where? When? Systemic poisoning: (inside the body) 43%
Skin injury: 31%
Eye irritation: 23%
Nose, throat irritation
When?
Acute – right away
Chronic- later

20. Acute Systemic Poisoning
Nausea, vomiting
Dizziness
Blurred vision
Increased salivation or drooling
Muscle cramps or twitches
Difficulty breathing
Unconsciousness
Pinpoint pupils

21. Chronic Effects of Pesticides
Allergic reactions
Effects on pregnant women, such as birth defects
Effects on reproductive system… infertility, miscarriage
Neurological problems.. . Anxiety, Parkinson’s disease, developmental delay, neuropathy
Increase in tumors... leukemia, lymphoma, myeloma, sarcoma, & in brain, testicle, stomach

22. There are children in the fields!

23. Access to Care Concerns
Significant barriers to health care
Language
Transportation
Geographical isolation
Cost (lack of insurance)
Knowledge of services
Hours of operation of clinic services
Fear
Lack of phone
Immigration status

24. Who is providing services?
NCFHP contract sites
Migrant and Community Health Centers
Rural Health Centers
Health departments
 Hospitals
 Free clinics

25. Reaching NC Farmworkers
NC Farmworker Health Program
Community Health Centers
Migrant Health Centers
Migrant Head Start Programs
Migrant Education Programs
Student Action with Farmworkers
North Carolina Grower’s Association
Farm Labor Organizing Committee- NCO
and other farmworker advocacy groups or health services providers

26. NCFHP Sites & FW Density
NCFHP has healthcare, dental, and specialty care sites across the state; particularly in areas with high density of farmworker populations.

27. North Carolina Farmworker Health Program’s Mission
…to improve the health of migrant and seasonal farmworkers and their families in the state
...working with and through a statewide network of service providers
The North Carolina Farmworker Health Program (NCFHP) is a statewide Migrant Health Voucher Program that began in 1993 with the support of federal funds from the Bureau of Primary Health Care. The program is located within the Office of Rural Health and Community Care (ORHCC) within the North Carolina Department of Health and Human Services. In 2003, NCFHP assumed responsibility for the Migrant Health Fee-for-Service program and the administration of dental contracts for migrant farmworkers. The Migrant Health Fee-for-Service Program was formerly known as the Migrant Health Program of the Division of Public Health.

28. We achieve our mission by…
Funding health centers and reimbursing private providers to provide health care and dental services to farmworkers
Building organizational and workforce capacity through training and technical assistance
Disseminating information about the needs and contributions of farmworkers in NC
Building relationships and collaborations to connect and leverage resources in the community.
Advocating for access to quality healthcare and a better healthcare system.

29. NCFHP Enabling Services Model
The program utilizes an enabling services “outreach” model to link farmworkers with services.
An outreach team works to…
Identify farmworkers
Share clinic information
Conduct health assessments
Provide health education
Provide case management
Link farmworker families with medical, dental, specialty and/or and social need services

30. Eliminating Barriers to Care
NCFHP funded sites…
Hire a Farmworker Health Coordinator and outreach staff that represent the racial and ethnic background of the farmworker population in your service area
Establish policies that outline culturally and linguistically appropriate service delivery focused to meet the needs of farmworker families
Determine method for communication between multiple sites and Farmworker Health Coordinator
Sometimes report suspected violations related to living or work environment when possible effect on health

31. Incorporating Outreach Staff
Orient agency staff (including providers) about farmworker health needs and the role of the outreach worker
Train front desk staff and eligibility officers to determine farmworker status
Document farmworker status of agency patients and services provided
Work with outreach team to communicate follow-up of high need patients (patient case management)
Assure participation of coordinator and/or outreach team at agency staff meetings.

32. Visit the Fields with your Outreach Team!

33. North Carolina Farmworker Health Program
Office of Rural Health and Community Care, NC DHHS
2009 Mail Service Center
Raleigh, NC 27609
(919)