Access to Healthcare for Access to Healthcare for Migrant and Seasonal Migrant and Seasonal

Farmworkers (MSFW) and Farmworkers (MSFW) and their families in Oregon & their families in Oregon &

WashingtonWashingtonShannon ParisShannon Paris Oscar Ramos Oscar Ramos

HE 407 Migrant HealthHE 407 Migrant HealthInstructor : Daniel Lopez-Cevallos, PhD, MPHInstructor : Daniel Lopez-Cevallos, PhD, MPH

Western Oregon UniversityWestern Oregon University

IntroductionIntroduction

MSFW’s are an MSFW’s are an indispensable aspect indispensable aspect to the U.S 200 billion to the U.S 200 billion agricultural industry.agricultural industry.

OR - 60 billionOR - 60 billion WA – XX billionWA – XX billion

Role of FarmworkersRole of Farmworkers

Thousands of Thousands of workers harvest the workers harvest the bountiful produce, bountiful produce, assuring the country assuring the country have at their table have at their table accessibility to accessibility to delicious, healthy, delicious, healthy, affordable foodsaffordable foods

What they do …What they do …

Working in the heat, Working in the heat, cold and raincold and rain

Bent over and Bent over and crouched most of the crouched most of the timetime

Tilling soilTilling soil Planting seedsPlanting seeds Transplanting seedlingsTransplanting seedlings

Removing weedsRemoving weeds Applying pesticides Applying pesticides Staking and pruning Staking and pruning

plantsplants Harvesting cropsHarvesting crops Packing cropsPacking crops Preparing for the Preparing for the

marketmarket

What we owe to themWhat we owe to them It would be It would be prudentprudent for for

our society to ensure our society to ensure that this vulnerable, that this vulnerable, economically economically disadvantaged, hard-disadvantaged, hard-working group of working group of people and their people and their families, have in return, families, have in return, accessible health careaccessible health care..

State of OregonState of Oregon Oregon has an estimated Oregon has an estimated

174,484 MSFW’s and 174,484 MSFW’s and their families (State of their families (State of OR Migrant Health)OR Migrant Health)

Largest concentration found in the fertile Willamette & Hood River Valleys.

Most MSFW’s do not have health coverage.

State of WashingtonState of Washington Washington has an Washington has an

estimated 186,976 estimated 186,976 MSFW’s and their MSFW’s and their families (Farmworker families (Farmworker Enumeration Study)Enumeration Study)

Largest concentration are Largest concentration are found in the middle of the found in the middle of the state and as just like in state and as just like in Oregon, most do not have Oregon, most do not have health coverage.health coverage.

MSFW’s Health ProblemsMSFW’s Health Problems

MSFW’s experience a higher incidence of MSFW’s experience a higher incidence of health problems due to the following factors:health problems due to the following factors: Lack of health insurance (cannot get it)Lack of health insurance (cannot get it) Economic factors (low pay)Economic factors (low pay) Poor living conditions (unsafe housing)Poor living conditions (unsafe housing) Hazardous exposure on the job (agriculture is the 2nd most Hazardous exposure on the job (agriculture is the 2nd most

dangerous occupation in the U.S.)dangerous occupation in the U.S.) The life expectancy of a migrant farmworker The life expectancy of a migrant farmworker

is 49 years, compared to the national average is 49 years, compared to the national average of 73 (CDC 1998)of 73 (CDC 1998)

MSFW’s Major Health ProblemsMSFW’s Major Health Problems diabetesdiabetes

hypertensionhypertension

cardiovascular disease cardiovascular disease

cancer cancer

tuberculosistuberculosis

anemiaanemia

parasitic infectionsparasitic infections

mental healthmental health

substance abusesubstance abuse

malnutrition malnutrition

dental problems dental problems

musculoskeletal problemsmusculoskeletal problems

dermititis dermititis

chemical poisoning chemical poisoning

Obstacles for Health Care AccessObstacles for Health Care Access

MSFW’s and their families face many MSFW’s and their families face many obstacles in regards to Health Care Access in obstacles in regards to Health Care Access in Oregon and Washington. Oregon and Washington.

Obstacles are socio-economic and lack of Obstacles are socio-economic and lack of information in natureinformation in nature

Obstacle: Poverty and Lack of Obstacle: Poverty and Lack of Health InsuranceHealth Insurance

Two of the most important factors as Two of the most important factors as MSFW’s are usually undocumented MSFW’s are usually undocumented workers.workers.

Subject to abuse by frivolous employers:Subject to abuse by frivolous employers: Pay them well below the minimum wagePay them well below the minimum wage Do not offer them health insurance.Do not offer them health insurance.

Obstacle: Distance from health care Obstacle: Distance from health care facilities and lack of transportation facilities and lack of transportation

Many MSFW work and live in locations Many MSFW work and live in locations where the closest health care facility is where the closest health care facility is many hours away.many hours away.

This problem is compounded as many of This problem is compounded as many of them lack transportation and have to rely them lack transportation and have to rely on friends and sadly on their bosses on friends and sadly on their bosses (major reason why they do not complain) (major reason why they do not complain) to get to some helpto get to some help. .

Obstacle: Lack of Knowledge About Obstacle: Lack of Knowledge About Available ServicesAvailable Services

They do not know what kind of health They do not know what kind of health care services are available to them and care services are available to them and their families, whether they have or lack their families, whether they have or lack health insurance. health insurance.

Many times language is an issue.Many times language is an issue. Other times educational level is the issues Other times educational level is the issues

issue as many MSFW’s cannot read.issue as many MSFW’s cannot read.

Obstacle: Lack of Understanding of Obstacle: Lack of Understanding of Health Problems and Risks Health Problems and Risks

MSFW’s many times do not know MSFW’s many times do not know medical problems they have and what medical problems they have and what risks they are taking on the jobrisks they are taking on the job

Many do not understand the dangers of Many do not understand the dangers of pesticides, or the needs of vaccinations. pesticides, or the needs of vaccinations.

Obstacle: Lack of Understanding of Obstacle: Lack of Understanding of the U.S. Health Care System the U.S. Health Care System

Many simply cannot navigate the process of Many simply cannot navigate the process of how our health care system works (even if how our health care system works (even if they have health insurance) they have health insurance)

Many do not pursue care, even if it is an Many do not pursue care, even if it is an emergency as they do not know laws exist in emergency as they do not know laws exist in this country that emergency rooms must this country that emergency rooms must follow to assure all emergencies are seen.follow to assure all emergencies are seen.

Obstacle: Cultural and Linguistic Obstacle: Cultural and Linguistic Differences with Providers of CareDifferences with Providers of Care

Many MSFW’s cannot communicate Many MSFW’s cannot communicate effectively with their clinicians as they do effectively with their clinicians as they do not speak English, sometimes missing not speak English, sometimes missing important aspects of their desired treatment. important aspects of their desired treatment.

Also, cultural aspects in regards to modesty, Also, cultural aspects in regards to modesty, family values and expectations are family values and expectations are sometimes taken for granted by clinicians as sometimes taken for granted by clinicians as they seek to heal the patient.they seek to heal the patient.

Obstacle: Fear or Mistrust of the Obstacle: Fear or Mistrust of the Health Care Establishment or Health Care Establishment or

Governmental AssistanceGovernmental Assistance

Overall, MSFW's still associate health Overall, MSFW's still associate health care agencies as agencies lead by care agencies as agencies lead by governmental agencies and are of course governmental agencies and are of course afraid to go to a clinic or hospital and afraid to go to a clinic or hospital and compromise themselves with their compromise themselves with their undocumented status.undocumented status.

What would Steinbeck say??What would Steinbeck say??