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Copyright 2009, The Johns Hopkins University and Jacqueline Agnew. All rights reserved. Use of these materials permitted only in accordance with license rights granted. Materials provided “AS IS”; no representations or warranties provided. User assumes all responsibility for use, and all liability related thereto, and must independently review all materials for accuracy and efficacy. May contain materials owned by others. User is responsible for obtaining permissions for use from third parties as needed.
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Jacqueline Agnew, RN, MPH, PhDJohns Hopkins University
Immigrant Workers
History of Immigration in the American Labor Force
Section A
Immigration to the United States
4Image source: Harvard University. Retrieved from http://ocp.hul.harvard.edu/immigration/
Early Immigration
5Map source: Churchman Genealogy Website. Retrieved from www.churchman.org/Pictures/indmap.gif
Arriving in the U.S.
6
Unidentified artist, creator Harvard University Art Museums
United Statesc. 1903
Photo source: Harvard University. Retrieved from http://ocp.hul.harvard.edu/ww/subject.html
Arriving in the U.S.
7Photo source: Harvard University. Retrieved from http://pds.lib.harvard.edu/pds/view/3621773?n=9&imagesize=1200&jp2Res=0.25
Arriving in the U.S.
From Roberts, P. (1912). The new immigration.
8Photo source: Harvard University. Retrieved from http://pds.lib.harvard.edu/pds/view/3621773?n=9&imagesize=1200&jp2Res=0.25
Percent Foreign Born in the U.S., by Year
9
Immigration to the U.S.
10
So Why Come Here Now?
Economic or political
Family
Deliberate recruitment
Refugee resettlement
Opportunities− Study− Work!
11
Facts from 2007
24 Million foreign-born workers in the U.S. labor force
Comprise 15.7% of the labor force
Accounted for one-half of labor force increase in 2007
Men make up 60%
Hispanics make up 50% of the foreign-born labor force
Asians make up 22% of foreign-born labor force
27% are not high school grads
31% are college grads (similar to overall labor force)
Unemployment rate is less than that of native born
12Source: Current population survey.
More Facts
Region of settlement− 39% in the West− 30% in the South
Higher proportions than native born in the following sectors:− 1 of 4 men in natural resources, production, maintenance− 1 of 3 women in service occupations
13
Concentration of Immigrants across Occupations
14
Concentration of Immigrants across Occupations
15
Concentration of Immigrants across Occupations
16
Distribution of Foreign Born by Region of Birth
17Source: Current Population Survey, March 2000, PGP-3
Percent Below Poverty Level, by Origin (2000)
18Source: Current Population Survey. (2000, March). PGP-3.
Forces That Influence Immigration
Department of State sets limits on U.S. citizenship
U.S. Citizenship and Immigration Services (formerly INS) enforces
Department of Labor influences
19
Refugee Resettlement
Department of State− Bureau of Population, Refugees, and Migration
From refugee camps to U.S.
Volunteer agencies provide the following:
− Housing, furniture, clothing, food, and referrals to employment, English as a second language (ESL), and other services
Support and assist− Provided housing, help in finding employment, etc.− Must find and hold job− Barriers—language, “culture-shock”
20
Refugees Admitted to U.S. in FY 2004 (Total = 52,868)
21
Visas
United States Permanent Resident Card (“green card”)− Easier if skilled− Need sponsorship from company
Employment based—priorities− “Extraordinary ability”—specialty professions, nurses− Skilled and not temporary/seasonal− Temporary or seasonal agricultural− Temporary—other
Families
“Green card lottery” (approximately 55,000 per year)
22
Benefits for Documented Non-citizens
Most cannot receive food stamps
Medicaid varies by state
Some other programs require five years residence before eligible
23
Workers’ Compensation and Undocumented Workers?
A matter of state law:
− Six states explicitly include (California, Florida, Nevada, New York, Texas, and Utah)
− Two exclude (Idaho and Wyoming)
Immigration Reform and Control Act of 1986 (“IRCA”) places a duty on employers to determine their employees’ immigration status and prohibits their employment if undocumented
24
A Case in Pennsylvania
Juan Carlos Astudillo worked as a maintenance helper where he cut and welded iron and repaired motors and was required to climb scaffolds and ladders and lift heavy steel beams. In 1994, Astudillowas hit in the head, neck, and back by a steel beam and was rendered unconscious at work. Astudillo sustained a concussion, a mild head injury, and, as a result, over the next few months he experienced headaches, dizziness, loss of balance, and upper andlower back pain. He was subsequently terminated from his job, and he filed for workers’ compensation.
25
A Case in Pennsylvania
The employer argued that since the IRCA barred the employment ofillegal aliens, the claimant was not an employee
The Commonwealth Court of Pennsylvania held that undocumented workers were not precluded from receiving workers’ compensation benefits
26
Protecting the Health and Safety of Immigrant Populations in the Workforce
Section B
Concentration of Immigrants across Occupations
28
Injury Risk—Some Findings from Research
Rates are higher for foreign born (more consistent in U.S. studies)
Occupy hazardous jobs, often poor working conditions—construction, agriculture− But even found for retail jobs− Contingent workers at greatest risk
Associated with shorter length of residence in the U.S.
Young migrant workers are at increased risk− Middle school aged: two times as likely as non-migrants− High school aged: four times as likely− Rates probably underestimated
29
Fatal Injury Risk: Data Analysis (1992–2006)
11,300 Hispanics died of work-related injuries (13% of all work-related deaths in the U.S.)
More than two-thirds foreign born—may be underestimate
Death rate consistently 20% higher than for U.S. born
Younger than overall U.S. workforce—35 median vs. 42 for all
95% male
2003–2006 rates greatest in the following sectors− 34% from construction− 10% agriculture− 10% transportation
Projected to increase in numbers
30
Work-Related Injury Deaths of Hispanic Workers
31
Fatal Injury Risk: Data Analysis (1992–2006)
Proposed reasons for high rates− Work in high-risk jobs
But also have higher rates in same jobs− Susceptible to miscommunication− Potential contributors to risk
Cultural, social, economicPerform tasks of higher risk for fear of losing job
Rates may be underestimated if Hispanics undercounted among total workers
32
CDC: In-depth Investigation of 200 Deaths
Characteristics of those killed− Inadequate knowledge and control of safety hazards− Inadequate training and supervision− Exacerbated by different languages and literacy levels
Prevention will require …
− Employers taking additional responsibility to provide safe working environment
− Safety and health agencies providing safety information and assuring compliance with regulations
− Researchers and health communication professionals developing materials that are culturally appropriate and address language and literacy challenges
− Labor unions and community groups can contribute
33
Hotel Workers
916,000 workers in maid/housekeeper occupation
Many not unionized
Low pay (median $8.82/hour; $18,350/year)
Risks− Musculoskeletal injuries—ergonomic hazards− Infectious diseases—handle waste− Chemical exposures—cleaning agents, pesticides
34
Study of Injuries to Hotel Employees
16,000 workers of 35 hotels
− 49% room attendants, stewards/dishwashers, banquet servers and cooks/kitchen workers
Risk factors− Physical demands—load and speed− Pushing carts, making beds, cleaning bathrooms− Demands increase with luxury
King sized bed—113 pound mattress1,000 pounds of linen per day
35
UNITE HERE Local 25 Member, Maria Guzman
“I had to wash a lot of plates and silverware, then bring that heavy stuff to other kitchens. I had to push a cart that was very heavy, everyday. One day I was pushing the cart and it wasn’t working, and it fell down on my leg and hand. I was given light duty, but the department manager pushed me too hard to finish even though I was still recovering from my injury.”
36Photo source: Korean Resource Center. Retrieved from Flickr.com
UNITE HERE Local 26 Member, Lachmin Karaya
Karaya is an American citizen who is an immigrant from Guyana …
“When I worked there I always told the director of housekeeping that we did too many rooms and that we felt pain, but he never did anything. All I remember him doing is telling us to rush and finish by 4:30.”
37
Injury Findings—Differences by Gender
Injury rates for females greater than for males, 5.5% vs. 3.7%
Differences persisted within same jobs− Stewards/dishwashers
Females 10.1% vs. males 5.1%− Cooks
Females 6.1% vs. males 5.1%− Banquet servers
Females 2.6% vs. males 1.8%
38
Injury Findings—Differences by Ethnicity
Race/ethnicity− Nonwhites 4.9% vs. whites 3.0%− Rates higher for nonwhites in three out of four jobs
Housekeepers, cooks, and banquet servers
39
Differences by Gender and Ethnicity
Female Hispanic stewards/dishwashers: 10.0%
Female Hispanic room attendants: 9.5%
Female Asian cooks: 8.9%
Female Hispanic banquet servers: 3.9%
Female Black hotel workers: 3.8%
40
Actions to Improve Health and Safety
Upgrade equipment− Example—lighter-weight carts
Administrative controls− Limit time demands− Light duty options− Allow more work in teams
Training− Including supervisor training
41
Vietnamese Nail Salon Workers
Section C
Vietnamese American Immigrants
1,212,465 Vietnamese in the U.S.
Population centers: California; Texas; Washington; Washington, D.C.; Massachusetts
NAVASA represents community-based organizations (CBOs)
Average income: $15,000 per year
38%: < high school diploma; 8%: none
73.8%: services, sales, office, and production occupations
45%: limited English proficiency
43
Health Status
17.2% of Vietnamese considered their health “fair” or “poor”
9.2% API
8.9% non-Hispanic white
44
Productive Days Lost from School or Work
45
Nail Salon Workers
Nail salon industry is growing—first in California, now in the Northeast
Heavily dependent on Vietnamese workers
− 30% of salons in the U.S. are owned by Vietnamese; 80% in the Los Angeles area owned by Vietnamese
− 37% of nail technicians in the U.S. are Vietnamese
− 24% of the Vietnamese labor force in in the U.S. are employed in nail salons
46Photo source: AikiDude. Retrieved from Flickr.com
Vietnamese Nail Salon Workers
Most workers are women between the ages of 20 and 40 years
Also must balance home and family duties
Language barriers—other employment difficult
Limited job skills, education
47
Vietnamese Nail Salon Workers
Self-employed, contracted six days (10-hour days are typical)
Limited health care access, health or disability insurance, workers comp
No sick or vacation time: no work = no income
Licensed according to function—training required
Little health and safety information or training
Health may not necessarily be highest priority− Disincentives to exposure control− Long-latency health issues may not be as important as acute
48
Business Concerns
Low profit margins and high price competition
Few have support from government-funded small business assistance programs
Few have access to financing
Reliance on family members and friends for start-up capital
Poor access to occupational health and safety resources
49
EPA Nail Salons Project
Developed guide− English and Vietnamese
Best practices in salons
Focus is on chemical and infectious exposures and controls for exposure reduction
Addresses worker and client protection
50
Recognized Hazards in Nail Salon Industry
Methyl methacrylate (MMA)—respiratory irritation, asthma, allergic dermatitis, reproductive? colon/rectal cancer? (banned in some states, voluntary recall in others)
Methacrylate dust (polymer)
Acetone, acetates, phthalates, ethyl ether, formaldehyde, toluene, benzene, neoprene, fiberglass, etc.
Ultraviolet light
Infectious agents—fungi, bacteria, viruses
Work practices− Poor ventilation, unlabelled containers− Eat/drink/smoke in workplace− Varied use of gloves, dust masks
51
Less Attention to …
Mental health
Work organization issues
Work-family issues
Ergonomic risk factors
52
Recent Initiative …
Forming an organization of stakeholders in business
53
Informal Work Sector—Day Laborers
Section D
Informal Work Sector—Day Laborers
Look for work in public places
Most immigrants, few skills
Hired by day, hour
60% seek work > 5 days per week
Median wage is $10, annual income rarely exceeds $15,000
55
National Day Labor Survey
Conducted in 2005− 2,660 workers− 20 states and Washington, D.C.
117,600 working or looking for work each day
92% hired by construction or home owners
Often hired to take on most dangerous tasks
56
National Day Labor Survey
In previous two months− Half had their pay denied− 44% denied food, water, or breaks
One in five injured in previous year
60% of those injured lost time from work
50% of injured received treatment
Only 6% were covered by Workers Compensation
57
Hazards to Day Laborers
Exposure to dust, chemicals, emissions
Injury risks− Faulty equipment (scaffolds, tools)− Lack of personal protection equipment− Lack of safety training
58
Country of Origin of Day Laborers
59
Day Labor Worker Centers
Growing response and resource: day labor worker centers
− Community organizations, municipal governments, faith based and others
− Advocated by report− Provide
SpaceOrderSet wage amountsOversight of standards and employer behaviorOften training, classes
60
Growth of Worker Centers
61
National Day Labor Survey Also Stresses the Need for …
Improvement in worker protection
Enforcement of safety regulations
Workforce development strategies
Access to legal services
Realistic immigration reform
62
Study in Chicago
Most hired in construction
37% never used personal protective equipment
Offered tetanus vaccination and blood lead screening at three sites
Blood lead levels− Geometric mean = 3.8 ug/dL− Highest for those from Mexico− Two tested greater than 20 ug/dL− Comparison levels
United States: 1.5 ug/dLMexico: 2.3 ug/dL
63Source: Street corner hazard surveillance and health intervention among Chicago day laborers.
Results of Blood Lead Testing in Chicago Day Laborers
64
Chicago Study Conclusions
Hiring sites and worker centers promising for− Primary care− Screening − Worker training on health and safety− Equipment demonstrations
65
Migrant Farm Workers
Section E
A Migrant Farm Worker Is One Whose …
Principal employment is in agriculture on a seasonal basis and, for purposes of employment, establishes a temporary home
67
Migrant Farm Workers
Approximately 200 million migrant workers worldwide
Estimated 1.6 million in the U.S. (1990)
In the U.S., 84% are Hispanic
75% are from Mexico
Three main streams: West Coast, Midwest, East Coast− North-south routes: “follow-the-crop”
68
Characteristics
Hard to reach
Many undocumented
Live in camps without established addresses
Often unaccompanied by spouse or children
Isolation
Discrimination
Hazardous working conditions
Low pay and uninsured
69
Substandard Housing
Study of North Carolina farm worker homes
Crowded—in 70%, more than one person per room
Unsafe locations—located adjacent to fields
Structural problems—18% had leaky roofs
Lacking facilities—27% without oven
Most did not meet U.S. Department of Housing and Urban Development minimum criteria
70
Hazards
Acute and chronic poisoning− Pesticides, other chemicals− Plants− Asthma
Dermal diseases− Pesticides, other chemicals− Plants: allergies− Ultraviolet light
Injuries− Mechanical− Motor vehicle
71
Green Tobacco Sickness
Nicotine absorbed through the skin
24% of tobacco workers
Nausea, dizziness, GI symptoms
Associated with wet tobacco− Harvest during the morning (dew)
Gloves, rain suit—protective− Must prevent against heat injuries
72
Eyes at Particular Risk
Eye injuries− Dust, allergens, trauma
May not have adequate eye care− Vision deficits− Need for eye protection and glasses
73
Heat-Related Injuries
Rate of crop worker death from heat stroke is twenty times that of all workers in the U.S.
Most among foreign born
Risk factors− Environment− Protective clothing, extra clothing− Poor recognition of signs
Heat injuries often omitted from training
74
Mental Health Issues
Identified by migrant community as a concern
In one study− 40% greater than cutoff score for depression survey− 18% above threshold for anxiety− 38% potential alcohol dependence
Anxiety and depression are associated with …
− Social isolation (e.g., away from friends and family, difficult to meet people) strongest effect on anxiety
− Working conditions (e.g., enough water, exploitation, discrimination) strongest effect on depression
75Source: Hiott et al. (2008).
Other Health Problems
Oral health
Blood-borne illnesses
Infectious diseases, e.g., tuberculosis
Chronic diseases− Diabetes− Cardiovascular− Overweight
76
Children’s Issues
Many accompany parents (300,000 in Northern Mexico)
Many work in fields—long hours
May not attend school or may attend for few hours
At risk for dangerous exposures− Pesticides− Mechanical equipment− Sometimes operate vehicles or machinery
77
Barriers to Care
Education and language—dialects
Logistics—availability, transportation, financial, can’t miss work, follow-up
Family roles and priorities
Acceptance of care givers
Health beliefs—other diagnoses and remedies
Faith and spiritual practices
78
Some Approaches
Some conditions can be improved—access to water, improved field sanitation
Telephone access to reach families
Community activities—faith groups, sports teams (concept of “coherent communities”)
Clinics and outreach programs− Health Resources and Services Administration (HRSA)− State and local
Screening when seen for health care
79
Advocacy/Resources
One example: HRSA funding
Farmworker Justice, Inc.− http://www.fwjustice.org/
Legislative and policy workDirect work—U.S.-Mexico border
Collaborate with community-based organizations (CBOs) and clinicsHealth promotion programsChildren’s healthHIV/AIDS prevention
See list in Arcury and Quandt article
80
Training and Advocacy
Section F
Modes of Communication
Web sites
Training materials
“Classroom” training
82
Training Issues
Efforts vary widely
− 72% for Latino construction workers, but median time of only 1 hour
Lack of training itself is not a predictor of injury
83
Example from One Sector: Construction
Latino immigrant youths in construction under 21 years− Range of hazardous tasks, some while under 18 years old
Training—reported by 68%− Median training time of 1 hour− 24% receive written materials− Fewer English skills = less training
Need increased bilingual training and medical care
84Source: O’Connor, T., et al. (2005, March 1). J Occup Environ Med, 47, 3, 272–277.
Language Barriers
Awareness and attention to language differences increasing
More training aids, especially in Spanish
More organizations with Spanish Web sites− OSHA and NIOSH are examples
Some are designing training programs in other languages
− eLCOSH—Creole, French, German, Italian, Portuguese, Polish, Vietnamese
Need accessibility to additional languages
85
eLCOSH
86
eLCOSH
87
eLCOSH
88
Production of Culturally Competent Materials
89
Production of Culturally Competent Materials
State training program
90
OSHA Hazard Communication Standard
Instructions for inspections
− “If the employees receive job instructions in a language other than English, then training and information to be conveyed under the [hazard communication standard] will also need to be conducted in a foreign language”
91
Health Care Provider Actions
Cultural competence—training and awareness of issues, language skills
Diversity within professional community
Involvement of immigrants in own care and design of health programs
Advocate and provide education on occupational health problems in settings where immigrant care is provided
92
Recap
We have looked at four at-risk worker groups among immigrant population
Share common issues—health risks in the workplace, psychosocial threats to well being, barriers to care
Means of interventions—elements of programs, training approaches
Long way to go!
93