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National Health Center Week 2019: Today's Focus-- Agricultural Workers

There are an estimated 4 to 4.5 million agricultural workers in the United States. Community health centers provide care to more than 900,000 migratory and seasonal agricultural workers and their families. Certain health centers, including three in Tennessee, receive federal funding through the Migrant Health Act to provide services that are tailored to break down barriers to health care for agricultural workers.

There are an estimated 4 to 4.5 million agricultural workers in the United States.[1] Community health centers provide care to more than 900,000 migratory and seasonal agricultural workers and their families.[2] Certain health centers, including three in Tennessee, receive federal funding through the Migrant Health Act to provide services that are tailored to break down barriers to health care for agricultural workers.

Despite the critical role migrant and seasonal workers play in Tennessee's $52 billion agriculture industry, they face a unique set of health risks that are largely attributable to their working conditions.[3] Agricultural workers are at risk for heat related illnesses, exposure to dangerous and toxic chemicals like pesticides, injuries from equipment, vector-borne diseases, and communicable diseases.[4] They also tend to experience high rates of chronic conditions such as asthma, diabetes, and high blood pressure. Agricultural workers are also at risk for mental health issues including anxiety and depression.[5]

When agricultural workers do get sick, many barriers prevent them from seeking and accessing health care. More than 70 percent of migratory and seasonal agricultural workers have incomes below the federal poverty guidelines and they are often paid hourly, daily, or piecemeal. Many migratory and seasonal agricultural workers do not have health insurance because their employer does not provide it, they cannot afford it, or they are undocumented and therefore not eligible for programs like Medicaid. For workers that do receive health insurance, it is typically only provided during the peak seasons they are employed in the agricultural industry. In addition to lacking health insurance, migratory and seasonal agricultural workers may not have access to other employee benefits such as sick leave and workers compensation, and they can't afford to forgo income from missing work.[6]

Since migratory and seasonal agricultural workers frequently relocate, they also may not be aware of resources in the community, like health centers, that can provide them with care. Some may find it difficult to find care they feel comfortable with because of cultural and linguistic barriers. Even if workers are aware of resources, they often find it difficult to access them because they often work in geographically isolated areas and may not have reliable transportation.

Tennessee health centers that receive federal funding to serve agricultural workers have devised creative programs to meet the unique needs of agricultural workers. Health centers focus on outreach to ensure that agricultural workers are aware of their services and also have access to them. As part of their mission, health centers serve all patients regardless of their insurance status or ability to pay, which can be critical for agricultural workers. Health centers rely on bi-lingual staff members and volunteers to engage in outreach, and often bring culturally competent health education and primary care to workers using mobile units.

One Tennessee health center partners with a university to provide nurse-led care to agricultural workers using a mobile unit. The care team travels to farms in the area on days when workers are unable to work in the fields due to weather conditions. Diabetes, high blood pressure, and joint-related pain are among the most commonly treated health conditions. Too often, the care team sees patients who have delayed care, which leads to worse health outcomes; for example, a patient who contracted gangrene from a foot injury, which eventually led to an amputation.[7]

Although the vast majority of agricultural workers are male, health centers also prioritize the care of their family members who face similar barriers to care. Two health centers provide programs for pregnant women to address ethnic disparities in maternal and infant health. Some of the services that health centers provide include assistance with insurance coverage for pregnant women and their children, prenatal classes, nutrition counseling, parenting education, and medical services such as ultrasounds, vaccines, and treatment for post-partum depression.

Health centers don't just focus on the health of agricultural workers and their families. They also work to provide and strengthen social support. For example, one health center operates a Promotora Program, a peer-led program that provides health education and advocacy for pregnant women and agricultural workers by going door-to-door. Health centers also provide services such as issuing non-governmental identification cards and connecting workers with social services organizations in the community. 

During National Health Center Week 2019, from August 4-10, health centers across the country and in Tennessee will be raising awareness of their mission and accomplishments. We invite you to show your support for the ways America's health centers are serving agricultural workers by joining us at a health center event in Tennessee. We look forward to seeing you!
 
[1] Health Care for Migratory and Seasonal Agricultural Workers - NACHC. 2019. NACHC. http://www.nachc.org/health-center-issues/special-populations/health-care-for-farmworkers/.
[2] Ibid.
[3] Amid Trump's Immigration Crackdown, Demand for Migrant Workers Increases in Tennessee. 2017. Tennessean.Com. https://www.tennessean.com/story/money/2017/07/18/demand-seasonal-migrant-workers-increases-tennessee-farms/412307001/.
[4] Rural Migrant Health Introduction - Rural Health Information Hub. 2019. Ruralhealthinfo.Org. https://www.ruralhealthinfo.org/topics/migrant-health#health-concerns.
[5] A Profile of Migrant Health: 2017. National Center for Farmworker Health. http://www.ncfh.org/fact-sheets--research.html.
[6] Ibid.
[7] Area Migrant Farm Workers Also Falling Into the Health Care Coverage Gap. 2016. Johnson City Press. https://www.johnsoncitypress.com/Health-Care/2016/05/15/Area-migrant-farm-workers-also-falling-into-the-health-coverage-gap.html?ci=stream&lp=2&p=1.

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