Note: Jennie Mclaurin, MD, MPH, is a Senior Fellow at NACHC. She served the migrant and seasonal farmworker community as an outreach worker, pediatrician, CMO and national expert for over 30 years. This post coincides with the Conference for Agricultural Worker Health which kicks off this week in Seattle, WA.
“Tobacco pays my bills,” read the bumper stickers and billboards. Golden green stalks of leafy tobacco stretched for miles, punctuated by snowy cotton and sweet potato fields. Tractors in the road slowed down the daily commute. That scene welcomed me to work at an Eastern North Carolina clinic back in the 1980s. As a volunteer outreach worker during the summer of medical school, I saw what later became described as the social drivers of health: cinder block rooms crowded with bunk beds, wastewater in pools outside, lack of kitchen access or garbage pick-up, and lack of plumbing in much of the housing. Returning to the clinic as a newly minted pediatrician, I’d passed my boards but knew next to nothing about green tobacco sickness, pesticide exposure, heat illness, parasites and other common illnesses of the farmworker occupational workforce. Despite the fact that over 45,000 migrant and seasonal farmworkers spent half a year in our state, our health education systems never mentioned them.
Back then we referred to the clinic as a 329/330 center because those numbers referred to Congressional authorization for funding. Many health center colleagues know about the 330 designation, but few realize that the Migrant Health Act of 1962, signed by U.S. President John F. Kennedy, preceded Community Health Centers by several years. Thus, migrant health centers were 329 centers, and later, Community Health Centers, modeled after the migrant centers, were 330. The funding eventually consolidated. While many speak of “The Movement,” and credit H. Jack Geiger, MD, for its founding, the first movement was led by farmworkers, such as Cesar Chavez and Dolores Huerta and saw no distinction between civil rights and health care access.
Caring For Agricultural Workers Today
Health centers serve almost 900,000 migrant and seasonal farmworkers. All 50 states have migratory agricultural workers, who typically follow three patterns of travel. While the term “migrant streams” was once used, that is really a misnomer. Workers travel in small circuits, in nomadic journeys, and in point-to-point routes. Circuit migrants are often found in places like California’s Central Valley, where work is available throughout much of the year. It allows children and a parent to stay in one place as a home base and finish school. Nomadic workers are more likely to be single men, traveling far distances to wherever work can be found. They often send money back to their country of origin and are the most at risk for poor access to health care. Point-to-point workers may travel as family groups, but do cover long distances, such as from Texas to North Carolina to the Delmarva Peninsula. Their children often have truncated school years and see several health care providers as their “medical home.”
Experts in migrant health care have learned to provide immunizations on a fast-track schedule, supply instructions for keeping insulin safe while traveling, emphasize hand-carried portable records, and fill prescriptions with 90 day supplies. Some health centers that see point-to-point populations have shared services, so that a family can, for example, get eye care in Florida and dental care in North Carolina. It takes not just a village, but several villages, to provide continuity of care. Cultural humility, creativity, curiosity, compassion and an understanding of health literacy are essential for clinicians.
Agricultural Workers Are a Skilled Labor Force
Stereotypes still abound. Many use the term migrant pejoratively, so “agricultural worker” is a more formal designation. Not all are immigrants. About half are from a Spanish speaking country, with many children American born. Haitians, Russians, Vietnamese, Punjabis and others are also in the farmworker community. Migrant agricultural workers pay far more into the economy than they receive back. Taxes are garnished from wages but only about 11% of workers access tax-supported services. Agriculture vies with mining and construction as the most dangerous industry, and few farmworkers have disability coverage. Most are only paid if they are working, effectively making far less than minimum wage. Their work is skilled labor—an experiment in Washington State to halt immigration and use prisoners to pick orchard fruit resulted in huge harvest failures. About 175 health centers specifically serve migrant agricultural workers and their children. Many more may do so without requesting special funding. Because many adults perform other labor in the off-season, they are not always counted as agricultural workers. Around 30% of the population are children. Migrant Head Start and Migrant Education are other federal programs that collaborate with health centers. Migrant health centers have a strong record of providing what some see as new ideas: community health workers, or promotoras have been a backbone of operations for decades. Also common are food pantries, education programs, banking assistance, license/ID assistance, housing and clothing support, legal services, and recreation programs. If you want to live the dream of the Community Health Center Movement, start with a migrant health center.