Healthcare Challenges of Global Migrants: Farmworker Health Marc Schenker M.D., M.P.H. •••••• Beyond Borders: 16th Annual GHEC Conf. February 17, 2007 •••••• • Professor and Chair, Dept. Public Health Sciences, University of California at Davis Outline • Immigration and work – Agricultural work and immigration • General health of agricultural workers • Immigration and “Hispanic epidemiologic paradox” • Acculturation and health • Health care implications Mexican-born US Population by Occupation, 1994 and 2004 . Source: CONAPO estimation based on the US Census Bureau, Current Population Survey (CPS), March, 1994 and 2004. Percentage of Total US Labor Force Composed of Mexicans by Occupation, 1994 and 2004 Fuente: estimaciones de CONAPO con base en Bureau of Census, Current Population Survey (CPS), March 1994 and 2004. Employment by Gender in the Labor Market in U.S. Industry Agricultura Hospitalidad Construcción Manufactura Limpieza Servicios Dómesticos Comercio/Ventas Otras Industrias Total Total 11 17 19 19 9 4 7 14 100 Men % 11 18 28 18 7 1 6 12 100 Women % 11 16 2 21 13 10 11 17 100 Agriculture has been a traditional first occupation for immigrants in California, and remains an entry job today European immigrants, 1900’s Hispanic immigrant farmworkers, today Dust bowl migrants, 1930’s General Health Status of California Farmworkers The CaliforniaCalifornia Agricultural Workers Health Study Agricultural Workers Health Study (CAWHS) Family Income and Assets, CAWHS Households, 1999, N = 959 Characteristic Total family income (median) Per capita income (average) Home owner No U.S. assets CAWHS (1998) Census, CA (1999) $12,500 - $14,999 $53,025 $3,690 - $4,420 23% 68% $22,711 57% n.a. Housing Conditions, CAWHS, 1999, N = 940 Characteristic Dwelling shared (2 or more households) No telephone service Lacking complete plumbing Persons per dwelling Non-standard dwelling CAWHS (1999) 42% 20% 4.4% 4.33 30% Census, CA (2000) 7.6% 1.5% 0.7% 2.87 n.a. The Range of Farmworker Housing, California High Blood Pressure, Males Anemia, Females Dental Outcomes, Male & Female Occupational Health Outcomes of Hired Farmworkers Occupational Health Problems Among Agricultural Workers “A textbook of occupational disease” • • • • • • • • • • • Injuries; acute and cumulative Respiratory disease Dermatologic disease Infectious disease Heat stress Cancer Adverse reproductive outcomes Mental illness Pesticide illness (acute, chronic) Neurologic disease Etc. Tuberculosis among Agricultural Workers • (+) PPD was twice as common among Mexican-born than US-born California farmworkers, independent of age and smoking (McCurdy, 1997). • A North Carolina study found (+) PPD in 33% of Hispanic farmworkers, and active TB in 0.47% (Ciesielski, 1991). • Migrant day labor farmworkers (solo males) may have (+) PPD prevalence of 37 - 48%. • Drug resistant TB is 2-6x more common among immigrant farmworkers born outside the U.S. Pulmonary Tuberculosis 5 . TB Prevalence per 100,000 People 15 Honduras 45 Nicaragua 42 Guatemala 21 El Salvador 21 Costa Rica 17 Panamá 52 Source: MMWR-CDC, DGE-SALUD Immigration, Acculturation and Health The Hispanic Reproductive Paradox • Many health behaviors and health outcomes worsen after immigration to the U.S. despite increased income and access to health care. • Latinas have a higher risk profile, yet fewer preterm, low birthweight births (PTLBW ) in Mexico • Birth outcomes worsen the longer immigrants reside in the US, despite access to better medical care and social services Two Hypotheses for Paradox • Immigrant women are a healthy subsection of the population of origin, and therefore, have better than expected birth outcomes, i.e. Healthy Immigrant Hypothesis • Behavioral practices from country of origin protect immigrant women in the U.S. from risks associated with disadvantaged SES once in the U.S. This “protection” decreases with acculturation. Acculturation • Change experienced by members of immigrant groups as they adopt the culture (i.e. language, norms, values) of the dominant group in the host society • During the acculturation process Hispanics, and other immigrants, undergo a variety of behavioral, cultural, and occupational changes that may be related to their health Kasirye, Eth Dis, 2005 Occupation in Past Year by Place of Birth 80% 60% US-born Mex-born 40% 20% 0% Agriculture Service N = 1100 Hispanic women, California Madera, California U.S. Madera Chavinda Chavinda, Michoacan Mexico Binational Comparisons by Acculturation Status 60 50 40 30 20 10 0 Ever smoked Drink alcohol > 1 sex partner Asthma Chavinda Madera (low) Madera (Med/high) What is the Underlying Cause for Acculturation-Associated Behavioral Changes? • • • • • Increased income Increased opportunity (access) Peer group pressure Loss of family influence Stress • Targeted advertising campaigns Health Care Implications for Immigrant Farmworkers • Overall health status of immigrants, especially agricultural workers in U.S. is poorer than comparable non-farmworker, non-immigrant populations • Factors affecting farmworker health include: – Low socio-economic status, lack of access to care – Disease patterns in sending countries – Specific occupational hazards of agricultural work – Environmental exposures Health Care Implications for Immigrant Farmworkers - 2 • Several adverse health behaviors increase among Hispanics after immigrating to the U.S., and are associated with acculturation. Some of these changes are greater among women immigrants – Cigarette smoking, Alcohol intake, High risk sexual behaviors, Drug use • Understanding the causes of behavioral changes that are associated with acculturation is critical to reversing the current and future adverse health effects of these changes. • Preventive public health efforts should be targeted to those groups at high risk for adopting adverse health behaviors. Health Care Implications for Immigrant Farmworkers - 3 • Injury rates are higher for immigrant workers, and require particular attention and targeted enforcement of safety standards. • Risk profiles may be different for men and women, and require culturally sensitive, targeted efforts. • Public health efforts must be blind to immigration status, and directed to diseases that are increased in immigrants (e.g. tuberculosis) that can result in disease transmission after immigration. Gracias!