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Healthcare Challenges of Global Migrants Farmworker Health


									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

• 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.
Hospitalidad Construcción Manufactura Limpieza Servicios Dómesticos Comercio/Ventas Otras Industrias Total

17 19 19 9 4 7 14 100

Men %
18 28 18 7 1 6 12 100

Women %
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
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


TB Prevalence per 100,000 People

Honduras 45 Nicaragua 42

Guatemala 21 El Salvador 21 Costa Rica 17

Panamá 52



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.

• 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


US-born Mex-born



0% Agriculture Service

N = 1100 Hispanic women, California

Madera, California U.S.



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.


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