Farm labor positions in the U.S. are often filled by temporary, seasonal and migrant farmworkers, most of whom have roots in Mexico. These workers are neglected by the U.S. government and lack legal protections and basic services including health care.
According to Harald Bauder, academic director of the Ryerson Centre for Immigration and Settlement, they are part of a larger global migration phenomenon that produces labor segmentation whereby the labor market is divided into primary and secondary segments. In the secondary labor market, jobs are unstable and the market lacks enforcement of labor standards. It is evident that farmworkers are laboring in the secondary labor market.
Over the summer, I interviewed 58 farmworkers in El Paso, Texas about their access to health care. The farmworkers surveyed live and work in the U.S.-Mexico border area of West Texas and Southern New Mexico. The area studied contains approximately 12,000 farmworkers and, according to the New Mexico Center on Law and Poverty, the workers in question earn an average of $9,000 per year for a family of four. This is well below the annual income of $23,850, tagged as the poverty level for a family of four in 2014 by the U.S. Health and Human Services.
The abysmal wages earned by these farmworkers is even puzzling considering that, according to a 2012 report written by the New Mexico Center on Law and Poverty, the net profit in 2011 for New Mexico’s agricultural industry was $1.35 billion. The farmworkers primarily labor in the chile and onion fields, two of the biggest cash crops in New Mexico.
Manual labor in the fields is physically demanding and performed under harsh conditions. University of Texas at El Paso faculty members, Margaret Weigel and Rodrigo Armijos, have studied farmworkers on the U.S.-Mexico border and have reported that farmworkers are at increased risk for musculoskeletal injuries, pesticide poisoning, sunstroke and dehydration. Medical experts Eric Hansen and Martin Donohoe have also identified specific farmworker health issues as: 1) infectious disease; 2) chemical and pesticide-related illness; 3) dermatitis; 4) heat stress; 5) respiratory conditions; 6) musculoskeletal disorders and traumatic injuries; 7) reproductive health; 8) child health; 9) oral health; 10) cancer; and 11) social and mental health.
Despite the high risk nature of agricultural labor, persistent barriers to health care for migrant and seasonal farmworkers in the past 30 years have been identified by the National Association of Community Health Centers (NACHC), an advocacy group promoting access to basic health care through community health centers. The barriers are: 1) low income; 2) the need to travel from state to state for work purposes; 3) an inability to understand the language or navigate the health care system; and 4) immigration status.
The border farmworkers I interviewed over the summer in the border region were mostly over 50 years old, male and preferred to take the survey in Spanish. Most have not completed high school and have been performing farm labor over 20 years. The farmworkers mostly receive their health care in the U.S. but a significant number stated that they did not receive health care anywhere. A handful reported that they receive health care in Mexico.
Many workers stated that they had suffered an injury while working in the fields in the U.S. Of those that have been injured, the nature of the injury varied from back/neck injury to broken bones/sprains to other types. Some of the farmworkers stated that they had received cuts from knives or other sharp instruments used in the field. Of those that have been injured on the job, only 67% reported that they had received medical care for the injury and of those that were treated, only half reported that their employer had paid for their medical treatment.
The farmworkers were asked where they go most often if they are sick or need advice about their health. Most said they visited a clinic or health center but many also said that they went to a doctor’s office or the emergency room. When asked where they went for routine or preventive care, the majority reported that they either do not get preventive care or they have nowhere to go for this type of care. The most common reason cited for not having a usual source of medical care was the worker did not need a doctor. The second most common reason for no usual source of medical care was that it was too expensive or the worker did not have any insurance. Other reasons given by more than one worker were that they did not know where to go, they rely on family and friends or they self-treat.
Eighteen of the surveyed farmworkers stated that there have been occasions in the past 12 months when they did not get medical treatment because they could not afford it. Half of the farmworkers reported that they were “extremely worried” that they would not be able to pay their medical bills if they got sick or had an accident. The other half reported that they were “not at all worried.”
Half of the farmworkers surveyed had not spoken to a medical professional in the past twelve months. The farmworkers were asked whether, in the past twelve months, they had received a flu shot, whether they had their blood pressure taken, whether their cholesterol or heart were checked, and whether they had spoken to a medical professional about their diet. The responses indicate that more than half of the farmworkers did not receive these basic health measures in the past year. Other findings from the study were that those farmworkers who treated in an emergency room had an increased access to health care and those farmworkers who were treated in Mexico, had an increase in the number of times they have seen a doctor in the past 12 months.
In my survey, farmworkers were asked to assess their own health and asked to rate their satisfaction with their access to health care. The farmworkers displayed optimism in these categories with the majority rating their own health as good or excellent and a majority being “somewhat satisfied” or “extremely satisfied” about their access to health care. When asked to rank the importance six issues: 1) fair wages; 2) family; 3) food and shelter; 3) job stability; 4) job safety; and 6) education, most listed fair wages as the most important issue.
The findings lend support to the conclusion that farmworkers are medically underserved in the border region. More than half (64%) of the farmworkers surveyed did not receive basic health screening measures in the past year and only half of the farmworkers have spoken to a medical professional in the past twelve months. Most of the workers do not receive any preventive health care. These results mirror the findings of Hansen and Donohoe: “Migrant and seasonal farmworkers are vital to our nation’s economy and diverse culture, yet they constitute a marginalized and underserved population with many unmet socioeconomic and health care needs.”
The findings of the border study also show that the majority of the workers are missing out on health screenings and preventive health care that might reveal medical needs. It is not surprising, therefore, that most of the workers feel that their health is good and that they do not rank access to health care as an important issue. While the surveyed workers might not perceive that they have unmet health needs, 29% were treated in an emergency room in the past 12 months and 22% of the workers seek treatment in Mexico. This indicates that the farmworkers in the U.S. are not getting health services they need and are forced to find their own health care in the segmented social and economic structure.
“The low utilization patterns among farmworkers are not a reflection of limited health care needs,” wrote Peter Shin and Sara Rosenbaum, health policy experts at George Washington University in Washington, D.C, nearly a decade ago. “Migrant and seasonal farmworkers are often in poor health and they are at elevated risk for an enormous range of injuries and illnesses due to the nature of their jobs.”
Scholars and advocates have been calling for change arguing that collaborative partnerships that provide health care services to migrant farmworkers must be driven by social justice priorities.
In 2009, Thomas Arcury and Sara Quandt, researchers with Wake Forest School of Medicine, wrote: “For farmworkers, social justice includes working and living in environments in which health and safety hazards are addressed, being paid a living wage, living in communities free of discrimination, and having access to health, education and social services.”
The time that I spent last summer talking to the farmworkers convinced me that they are extremely hard-working and resilient. They face each day with an incredible work ethic and a positive outlook. Yet they are not receiving even a fraction of the support to which they are entitled insofar as their health is concerned. In fact, it is my belief that by reporting their own health to be “good” or “excellent,” they are merely displaying a coping mechanism of not dwelling on that which they cannot improve. Without reliable access to basic health monitoring, these workers are forced to minimize their health concerns while they focus on surviving their daily work schedule.
A stronger public health infrastructure is needed to serve the marginalized and underserved migrant and seasonal farmworkers. The regional study I conducted last summer shows that in this particular area of the border, farmworkers who labor in U.S. fields have more opportunity to see a doctor in Mexico.
This means that the U.S. uses the labor of migrant farmworkers but does not provide adequate medical treatment options for them. As noted by Sandy Smith-Nonini, professor of anthropology at the University of North Carolina-Chapel Hill, the dependence of the agribusiness food system on cheap labor is combined with a presumption that we have an expendable flow of immigrant labor to harvest U.S. crops. The presumption is flawed because the health of farmworkers is not expendable and farmworkers should be afforded the same access to health care as other U.S. workers.
Marianne L. Bowers writes for Frontera NorteSur.