1. Susan Bauer, MA, MPH Executive Director Community Health Partnership of Illinois sbauer@chpofil.org October 18, 2012 What Price Our Produce? The Impact of Farming on the Health and Wellbeing of Our Children

2. www.chpofil.org

3. Community Health Partnership of Illinois: Four Decades Serving Farmworkers, Rural Communities  Primary Health Care Clinics (FQHC): Aurora, Woodstock, Kankakee, Rantoul, Mendota*, Harvard*  School/Head Start based Services  Environmental/Occupational Health Promotion  Chronic Disease Management  Cancer Prevention and Screening  Peer-led Health Promotion/Advocacy  Patient Majority Governing Board

4. Trouble on the Farm: NRDC 1998 Report Pre-WWII life on the farm = healthy living Today pervasive use of pesticides on farms, + exurban encroachment = potential for higher exposure to toxins for farm, rural, exurban children Increased consciousness re: health risks to children who consume products treated with agricultural chemicals Increasing body of evidence that those risks are compounded by environmental exposures for children on, near farms that use agricultural chemicals on crops (Lu et. al, 1999)

5. “FOOD FOR THOUGHT”  Agriculture consistently ranks among top 2-3 most hazardous jobs in US, yet least regulated, fueled by the “Great American Agrarian Myth”  Occupational health risks are indistinguishable from environmental health risks  Child labor is alive and well, tragically Children as young as 16 can (and do) perform hazardous jobs Children as young as 12 can work on any farm Younger children can (and do) work legally with permission of parent www.chpofil.org

6. What Realities Do Migrant Farmworkers Face Every Day? 1.5-3 million farm laborers in the US; 65,000 in Illinois (6% are children (90,000-180,000 based on 2000 NAWS) Workers (including children), lack legal protections, immigration status, very low income, uninsurable 80+ farms/nurseries in Kane County

7. www.chpofil.org Systemic Barriers to Healthy, Safe Farms  OSHA/IDPH Field Sanitation only and only for farms with 11/10+ workers, IL does not cover workers who do not travel from home (e.g., local teen detasslers)  EPA Worker Protection Standard Delegates enforcement to Depts. of Ag. Child Labor Laws inadequate to protect children

8. Realities of Migrant Farmworkers that Impact Health Status Nat’l Ag Worker Survey (2000)  Young (50%<31; 6% <18)  Male (75%)  Immigrants from Mexico (71%) CHP UDS (20110  Uninsured, Uninsurable (93% AGE 20+  Sub-poverty wages (90%) www.chpofil.org

9. IMPACT ON CHILDREN WHO LIVE NEAR FARMS Study of 109 children, median house dust concentrations for organophosphates in house dust were 7 times higher for agricultural family children than others. * Median concentrations of pesticide metabolites in agricultural children’s urine were 5 times higher than for other children. * Proximity to farmland increased exposures. “In some cases the distinction between farmland and residence is blurred, as when a home is in the midst or on the boundary of an orchard…” (Lu et al, 1999, Washington state)

10. www.chpofil.org What is Being Done to Address the Problem?  Blueprint for Protecting Children in Agriculture (Marshfield Clinic, WI)  Regulatory Reform (Ag Child Labor Hazardous Occupation Orders, NIOSH)  Proposed CARE Act (Children’s Act for Responsible Employment)  Exposure Prevention Education (NRDC, MCN,NCFH)  Peer-Led Health Education and Advocacy: Community Health Workers Promotores/as de Salud (Health Promoters)

11. WHILE WE CONTINUE TO FIGHT FOR MEANINGFUL REFORM IN AGRICULTURE PRACTICES/LAWS, WHAT CAN WE DO TODAY?  Initiated in 1996 with NIOSH occupational health research grant  Preceded by many years of assistance from MHP  First step: gain support of clinical staff  Tailored to special needs of MSFW population

12. www.chpofil.org Leadership Development Around Health and Wellness  Community health educators, advocates  National Award in 2005  Expanded to three clinic sites (Aurora)  Grounded in principles of Popular Education (Paolo Freire)

13. Underlying Principles of CHP’s Promotores de Salud Program  Asset-based Model of Community Assessment, Response  Community is not the “object” of the intervention, but a key partner in the delivery of the intervention  Most effective strategies to modify risk perception, behavior are created, delivered by the community

14. Who Are Our Promotores de Salud? Farmworkers with:  Natural leadership skills  Trust of their peers  Interest in health, safety  Desire to learn and share what they learn  Everyday interaction with target community  Support of family to make commitment necessary to do their work

15. Promotores’ Roles and Activities  Research (administer surveys, recruit participants, review tools, conduct intervention/observations) Promote safe workplace practices with managers  Health Promotion (one on one, small group “platicas”)  Model desired behavior (e.g., Protective Eyewear)  Referrals/Transportation for Appointments  ID, communicate to clinic unmet individual, community needs

16. - Antiquated US child labor laws, and inadequate regulation and enforcement of Ag protective laws, at worst have proved fatal, and at a minimum compromise the health and wellbeing of children who work or live on farms Urgent need to expand our locus of concern re: pesticide exposure in child consumers to include children involved in crop production, and those who live on or near farms that employ harmful chemical in crop production - Work to pass the CARE Act www.chpofil.org CLOSING THOUGHTS

17. www.chpofil.org

18. RESOURCES and REFERENCES http://www.marshfieldclinic.org/nccrahs http://www.nrdc.org/health/kids/farm/farminx.asp http://www.cdc.gov/niosh/topics/childag http://www.hrw.org/support-care www.farmworkerjustice.org www.ncfh.org www.migrantclinician.org www.migranthealth.org www.spcpweb.org