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To conduct accurate hired farm worker surveillance and research, a thorough understanding of the population in question as well as of U.S. agriculture is required. Specifically, the complex demographic and employment characteristics of the estimated 2.5 million people who perform hired agricultural work each year needs to be understood 1. Also needed is a thorough grasp of the changing conditions of U.S. agriculture. For example, in the last generation, there has been a dramatic shift from extensive crops, such as cereal grains, which typically require greater amounts of land, to intensive ones such as fruits, vegetables, and horticultural products, which use more pesticides and require more manual labor.
Other factors that may block effective tracking and evaluation of worker health status and exposure to workplace hazards include: workers' immigration status, opposition from farm owners and labor contractors, declining resources of migrant health centers, shortcomings of Workers' Compensation Insurance, limitations of current and previously used surveillance systems, and the political climate toward agricultural labor. With respect to the migrant health centers, a lack sufficient funding has hampered their ability to effectively serve hired farm workers. More importantly, many migrant clinicians do not possess the cultural or occupational knowledge that is necessary in assessing the health status of this population.
From a general discussion, the work group members isolated the obstacles that impede hired farm worker surveillance and placed them into six categories: worker factors, employer factors, clinic/clinician factors, Workers' Compensation Insurance factors, surveillance system factors, and political factors. They also proposed a set of solutions for overcoming these problems.
Depending on the particular region of the country, hired farm workers may include Mexicans, Guatemalans, Haitians, African-Americans, non-Hispanic Whites, Southeast Asians, Native Americans, and various Central American indigenous peoples. While some groups are represented in greater numbers, it is impossible to conduct accurate observation and provide effective injury and illness prevention to the entire hired farm worker community without information that accurately represents all of its members. Likewise, the wide variety of languages, ranging from Spanish to a number of indigenous tongues such as Mixteco and Zapotec, coupled with the high levels of functional illiteracy among hired farm workers, present additional obstacles for health surveillance programs.
The growing diversity of the hired farm worker population owes itself both to an increase in immigration as well as to a restructuring of U.S. agriculture. Over the past generation, changes in consumer eating habits and increased demand from abroad have spurred a tremendous boom in the fruit, nut, and fresh vegetable industries. U.S. agriculture has also witnessed a dramatic rise in the popularity of ornamental and nursery crops. In response to these new preferences, farm owners and operators have shifted their production focus away from extensive crops such as wheat, barley, and oats and expanded into the potentially more lucrative arena of fruits, fresh vegetables, and horticulture commodities. Indicative of this transformation are agricultural statistics that show from 1982 to 1992 farm cash receipts for fruit, vegetable, and nursery crops jumped from one-fifth to nearly one-third of all U.S. crop production. 2
Not only have these developments in U.S. agriculture brought an economic windfall to the industry as a whole; they have also created a greater need for manual labor. Even with improvements in farm machinery, growers of strawberries, grapes, and almonds still depend heavily on seasonal workers to prune trees and vines as well as harvest product. In California and elsewhere, the modernization of the workplace frequently involves shorter peak harvest periods, bigger crews, and consequently, shorter employment periods for workers. Despite this seasonality within agriculture, the notion that people enter the workforce for only part of year is a myth: eighty-nine percent of all hired farm work is done by people who spend the majority of the year working in agriculture. Moreover, most hired farm workers, due to a lack of skills or language ability, do not supplement their annual income by working in other sectors; rather, they subsist by stringing together a series of short-term agricultural jobs. These industry changes have, in turn, greatly influenced the health, safety, and livelihood of the entire hired farm worker population.
Coinciding with this demand for manual labor has been the arrival of large numbers of immigrants from Mexico, the Caribbean, Central America, and Southeast Asia who have provided farm owners and operators and labor contractors with an inexpensive, steady supply of workers. In just seven years, the proportion of foreign-born workers in the agricultural workforce has risen significantly from 60% in 1989 to 70% in 1995.3
Within this new demographic structure, the dominant group has become young Latino males, mostly of Mexican origin. Whereas U.S. born African-American and non-Hispanic Whites once comprised a significant proportion of hired farm workers, those born in Mexico now constitute 65% of the population.4 Similarly, women, while continuing to occupy a role in the workforce, are quickly being replaced by newly arrived, young Mexican males. According to data gathered from the National Agricultural Workers Survey (NAWS), the percentage of women doing hired farm work fell from 25% in 1989 to 19% in 1995. In planning future studies and interventions it will be important to consider these demographic changes.
As for children age 17 and under, their numbers have risen somewhat over the last decade. In 1989, NAWS research estimated their proportion of the hired work force to be 4% while in 1995 the figure increased to 8%.5 Their presence in agriculture directly relates to the industry's low wages with many families needing the supplemental income that a child can provide. Even extremely young children can be found at the workplace as many parents lack other daycare options.
Coming from primarily rural areas in their native countries, foreign-born farm workers usually know only their native language, possess only a few years of formal education, and, increasingly, lack authorization to work in the U.S. According to NAWS data, average educational attainment is just six years while the proportion of undocumented farm workers has risen to an estimated 37% up from 7% in 1989. 6
These numbers reflect not only the failure of the Immigration Reform and Control Act of 1986 (IRCA) but also a high and possibly growing turnover rate among hired farm workers. Low wages and poor benefits combined with the high frequency of injuries and accidents make agricultural work unappealing, especially to subsequent generations of hired farm workers. Studies of California hired farm workers reveal that only 3% of hired farm worker children intend to work in their parents' profession.7 For first generation hired farm workers the rate of attrition is also high. Based on NAWS information, in 1995, 18% of the farm workers were newcomers to U.S. agriculture.8 At this rate, the average stay for a worker ranges between five and six years. As older, experienced farm workers continue to leave the industry because of health problems or better economic opportunities, the quantity of undocumented immigrants is bound to increase. Illustrating this point, the NAWS indicates that of those 18% of workers who were new arrivals, 70% lacked work authorization.
Regardless of the boom in labor intensive agriculture or of the increase in worker turnover, immigration has created a labor surplus and widespread unemployment and underemployment. IRCA, designed to curtail the entry of undocumented immigrants, actually stimulated a new wave of immigration that continues today. The granting of temporary resident status to over one million hired farm workers through the Seasonal Agricultural Worker and General Amnesty Program permitted many, who might not have stayed, the opportunity to settle and work permanently in the United States. As the majority of these grantees acquired permanent residency status, they carved out immigration paths and opened the way for family members and friends from their native towns and villages, most of whom lack work authorization. Furthermore, poor enforcement of the law's employer sanctions provision allowed growers and labor contractors to continue their preference of using inexpensive, undocumented workers.
Taking all of this demographic information together, today's hired agricultural labor force consists of both domestic-born and foreign-born workers, migrating and settled seasonal workers, and a sizeable foreign-born transnational population that spends part of the year abroad and part of it working in the U.S. Current estimates from the U.S. Department of Labor indicate that about four of ten hired farm workers migrate to find employment. About three in ten fall into the transnational category and seasonally shuttle migrate between their native town and a specific location in the U.S. Only one in ten of all hired farm workers engages in "follow the crop migration." Of course, these statistics vary from community to community as each region's hired farm worker population adapts to an area's characteristics.
Undocumented workers present several additional problems not only because they are typically the most exploited, but also because they are the least likely to seek out help and often refuse to participate in interviews or health screenings due to their status. Driven out by either political instability, economic crises, or both, these newcomers to U.S. agriculture arrive eager for any opportunity no matter how low the wage or how poor the conditions. Because their status may prevent them from receiving public assistance or obtaining benefits such as state disability insurance, undocumented workers frequently tolerate employer abuses and do not report injuries or illnesses.
Even workers legally authorized to work in the U.S. may not disclose all of the information about the origin of an injury or illness for fear of reprimand or retaliation by their employer. Problems with field sanitation, machine safety, or pesticide training represent just some of the topics that hired farm workers may fear discussing because of possible employer retributions. Hence, the attitude to endure and survive in order to maintain a job and an income source is quite prevalent. Even women who are pregnant often do not inform their supervisors or employers about their pregnancy reasoning that they would be replaced with another willing unemployed farm worker.
Adding to this idea of "suffer-sacrifice" is a general lack of health care services for low-income people. Since the majority of a hired farm workers' wages go to food, clothing, and shelter, health care usually falls near the bottom of personal priorities. Consequently, many workers return to Mexico for treatment or in some cases, rely on home remedies. In either case, this reduces the number of verified cases available for occupational health surveillance.
On those occasions when a worker has suffered a serious accident or becomes gravely ill, he or she will utilize the available resources. Unfortunately, many farm workers in this situation do not return for follow-up care, and the clinics lose continuity with the patient. Thus, it is extremely difficult to chart a hired farm worker's health status and then make inroads for prevention.
The beliefs and attitudes of many hired farm workers also impede their understanding of factual definitions of health and physical well-being which, subsequently, hinders health surveillance programs. An important example pertains to answering questions concerning levels of chronic pain. Farm workers often have trouble responding to these types of health questions because many of them view pain as a normal part of work and will only seek care when the condition becomes severe or disabling. This same issue carries over to preventive measures designed to reduce the incidence of musculoskeletal injuries or other hazardous work exposures. Frequently, workers do not understand the association of a problem with its source because of cultural misunderstandings.
In other instances, cultural philosophies can hamper treatments for health problems. For instance, ointments, herbal remedies, and massages are the typical solutions for a variety of injuries and illnesses. With respect to indigenous peoples such as Mixtecs, many hold serious reservations about visiting a clinic. Even when such services are available, these groups may prefer to see a tribal doctor or midwife. Another issue of cultural confusion involves language and the ability of both medical personnel and farm workers to understand each other.
The last area of concern regarding worker factors affecting health surveillance pertains to hired farm workers' knowledge of government and low cost private services. Specifically, laws like Workers' Compensation Insurance, the Worker Protection Standard, and the Federal Field Sanitation Standard are often unknown to them. This lack of awareness combined with language barriers, embarrassment, transportation problems, and fear of the government keep many hired farm workers from reporting incidents or seeking aid for a serious health problem. While volunteer or low-income migrant legal services can educate workers about their rights and serve as advocates, relatively few quality organizations exist. In recent years, Congress has substantially reduced funding for these programs and placed restrictions on the kinds of activities that advocates can use in representing their clients.
All of these issues greatly contribute to the difficulties in accurately monitoring the heath status of hired farm workers. The increasing proportion of undocumented hired farm workers among the entire workforce simply compounds the problems already present. This particular situation results in two significant problems: first, there has been an increase in the number of hired farm workers who are untrained and unaware of the laws designed to protect them (and therefore more prone to occupational injuries and illnesses), and second, because undocumented workers either do not qualify for or utilize the health care services available, a large group of hired farm workers is underrepresented in health surveillance data.
Compounding the workers' lack of knowledge about occupational safety and health regulation is the reality that many farm owners and operators do not report incidents to the proper authorities. Out of fear of increased insurance rates or fines from government agencies, many farmers hide behind the labor contractors who employ a sizeable portion of the hired farm workers. In California, one in three hired farm workers reports being employed by a labor contractor who typically pay lower wages than farm owners.9 NAWS data from the fiscal year 1990-1991, show that in California employees of labor contractors received only $4.45 per hour, the lowest median earnings when compared with employees of all types of farm operators.10
Large-scale agricultural operations that require a labor force of one hundred or more workers during the peak season depend heavily on labor contractors to procure and manage employees. Through this system, farm owners and operators often shift their responsibility as employers to the farm labor contractors, which in turn, frequently allows the former to escape any penalties that result from violations of health, safety, wage, and hiring laws.
As for the labor contractors, they receive very little scrutiny and their training is oftentimes suspect. In spite of the Migrant and Seasonal Agricultural Worker Protection Act, which states that all labor contractors must be registered with the U.S. Department of Labor, there are no minimum requirements for obtaining a credential. Moreover, many of these contractors do not possess any more knowledge regarding occupational safety and health regulations than the hired farm workers themselves.
This opposition to fair working conditions and wages reflects the agriculture industry's longstanding preference for cheap labor and minimal government regulation. To this end, both farmers and labor contractors have resorted to employing indigenous people from Guatemala or Mexico who often work for far less than other groups and are used to drive down the wages of the entire work force. In recent years, employers have lobbied for large-scale guest worker programs that would guarantee a steady supply of workers while relieving the industry of temporary employee shortages. Enactment of such programs could serve to further depress industry wages and hinder efforts to improve workplace conditions.
Indicative of the decline in real wage rates is the increase in the number of farm workers living below the poverty line. NAWS data maintains that between 1990 and 1995 the number of hired farm workers who reported incomes below the poverty line jumped from 50% to 61%.11 As for regulations involving pesticides and equipment safety, farmer owners and operators have continuously campaigned to restrict the intervention policies of state and federal agencies despite the risks that chemical exposures and other workplace hazards pose to the farmers themselves and to their families.
When hired farm workers do suffer severe injuries or arrive at the point where their chronic pain has become intolerable, they usually seek care at a local clinic. These clinics vary from migrant health care centers to rural outreach services. Often these health care providers offer farm workers a relatively inexpensive solution for treating illnesses or injuries. For various reasons, however, these clinics only provide health care services to approximately 20% of the full population of hired farm workers.
One area of concern involves the lack of occupational medicine training among clinicians. In many instances, rural health care providers possess neither the knowledge nor the training to record a proper medical history of a person's work exposure or the incident that led to the injury or illness. Furthermore, migrant clinicians either do not have access to prevalence data for specific kinds of injuries and illnesses or are unaware that such data exists. In other cases, either time constraints or an employer's unwillingness to cooperate prevent a physician from learning more about the origin of an individual's particular health problem. As a result, the migrant health clinic usually sees the hired farm worker on only the one occasion, and the clinician loses any opportunity to examine the long-term effects of a given injury or illness.
Financial burdens due to cutbacks in migrant clinic funding have prevented many clinics from improving their health care services or expanding their knowledge about these types of patients. Without sufficient dollars, many migrant health clinics cannot invest in the laboratory equipment necessary to make correct evaluations of work-related illnesses and injuries such as a pesticide exposure. In addition, many large companies maintain contracts with private physicians and refer their employees who become injured or ill while working to them. This removal of a significant amount of hired farm workers from the patient pool treated by migrant health clinics creates further economic difficulties for the clinicians. With the few hired farm workers that are left, the significant amount of paperwork involved with Workers' Compensation claims, coupled with low reimbursement and the fear of litigation, may deter them from accepting such cases.
As mentioned earlier, the other obstacle blocking successful intervention by clinics and rural health facilities is of cultural origin. Primarily due to language and cultural differences, farm workers and clinicians may have trouble communicating with each other. Differences in terminology can affect a clinician's ability to take an accurate health history from a farm worker. In addition, many hired farm workers hold biases against western medicine and as a result, do not readily accept the advice of health care providers.
In those states that make it compulsory for employers to carry Workers' Compensation Insurance for their hired farm workers, the system effectively gathers data on job-related injuries and illnesses. However, due to insurance industry preference Workers' Compensation Insurance is a state option and not federal law. Only eleven states currently treat all seasonal agricultural workers the same as workers in other industries under the law. Another twenty states require coverage of only a portion of the hired farm labor force, which varies from state to state depending on each one's particular set of employer exemptions. As for the other nineteen states, any coverage through Workers' Compensation Insurance is at the discretion of the individual employer. 12
In states like California, where Workers' Compensation Insurance applies to agricultural employees in the same manner as to workers in other industries, hired farm workers are entitled to indemnity and payment of medical bills. The only potential exception to this rule pertains to undocumented workers. In their case, states such as California have attempted to exclude them from public benefits under the 1996 Federal Welfare Reform Act, so far unsuccessfully. With respect to indemnity and compensation for injury, the amount of restitution is determined by the individual states, which in some cases may be less than adequate.
Regarding the surveillance of job-related illnesses and injuries of hired farm workers, states like California do so through a system that assigns employers to an industrial classification and individual employees to a risk category within the specific industry. This, in turn, enables a state's insurance bureau to monitor prevalence of injuries and illnesses within each agriculture sector such as work in deciduous tree fruit or stock farm. The lack of availability in Workers' Compensation Insurance in all states reduces the system's ability to serve as a sufficient collector of hired farm worker occupational safety and health data on a nationwide basis.
Other factors that affect the system's capacity for surveillance include unreported injuries and illnesses that occur when hired farm workers return to their native countries for treatment. This is commonly the case with unauthorized workers who may simply wait until they can seek medical attention in Mexico. In other instances, hired farm workers either are unfamiliar with the existence of the Workers' Compensation Insurance law and its applicability to them, or they are persuaded by an employer, such as a labor contractor, not to report the injury or illness. Due to these situations, a sizeable and unknown portion of hired farm worker injuries and illness goes unreported under Workers' Compensation Insurance.
Even for those health surveillance systems already in place, there are additional obstacles that hinder their effectiveness. To begin with, a debate exists over the idea that farm work or any job associated with this enterprise is healthy. While clinicians and other medical professionals, who directly deal with hired farm workers when they become ill or injured, challenge this notion, health studies have consistently shown that this population is young, fit, and has lower than average high-risk behaviors such as smoking or excessive alcohol consumption.
Based on this latter perception, funding for health surveillance projects has on occasion been inadequate. Without the necessary dollars, it is impossible for health projects to enlarge their scope and cover greater portions of the hired farm worker population. Likewise, insufficient funding prevents the development of new data collection systems that use more active surveillance techniques to document problems that are never seen at clinical facilities.
The constant change of an already complex agriculture industry adds to the problems facing surveillance programs. With the introduction of new tools, pesticides, machines, and work processes, hired farm workers continually encounter new risks of disease and injury. Thus, those surveillance systems that do not or cannot adjust to these new realities will fail to gather accurate data on the entire spectrum of hired farm workers.
Quite often politics compound the problems already present among workers, employers, clinicians, and regulatory acts. Anti-immigrant legislation like California's Proposition 187 and the federal government's 1996 Illegal Immigration Reform and Immigrant Responsibility Act constitute just two examples of public policy that have made it more difficult to conduct effective occupational surveillance of hired farm workers. This systematic targeting of groups based on immigration status and national origin makes many hired farm workers already uncertain about reporting their work-related injuries or illnesses less likely do to so. Moreover, this type of legislation simply increases the marginalization of hired farm workers.
To bridge the language and culture gaps between hired farm workers and health investigators, the continued use of promotoras or lay health workers, chosen from the hired farm worker community and trained on basic health promotion, should be a point of focus. As for increasing worker awareness with respect to legal rights and promoting better wages and working conditions, more support is needed for organized labor and unionization.
To counter the negative political campaigns waged by the agricultural industry, hired farm worker supporters need to target everyone affected by poor working conditions. This means making consumers and families of farm operators more cognizant of the realities present in the agricultural workplace. From this standpoint, it is essential to draw the attention of the general public to such key issues as pesticide use and exposure. As for state and federal governments and their respective agencies, substantial improvements need to be made such as raising the minimum wage, universalizing Workers' Compensation Insurance for all agricultural employees, improving Unemployment Insurance coverage, and increasing the level of migrant clinic funding.
Increased levels of enforcement, stronger regulatory efforts, and greater cooperation among federal, state, and county agencies are also essential to insure farm owner and labor contractor compliance with state and federal laws. Targeted federal and state health and safety enforcement efforts conducted in a high profile manner over a multi-year period would lessen the abuse of hired farm workers and improve workplace health and safety.
In summary, the obstacles present in monitoring the health status and occupational exposures of hired farm workers will require a multi-faceted set of solutions.
This document is in the public domain and may be freely copied or reprinted.
NOTE: This document is provided for historical purposes only.
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