PERSPECTIVE ON HEALTH CARE : It’s Indecent to Ignore Those Who Feed Us : Any universal plan must include farm workers, who suffer high rates of illness and injury and have poor access to care.
The voices of the millions of farm workers who do the backbreaking work of planting, tending, harvesting and packaging our food have been largely absent from the national health-care debate, drowned out by the cacophony of providers, insurers, businesses, health analysts, academics and lobbyists. Yet the needs of the farm workers are immense, given their historic disenfranchisement. A system that promises universal access must be measured by its ability to provide health care to the most marginalized in our society.
Farm workers, particularly in California’s abundant agricultural valleys, lack even basic access to health care. A UCLA study team found that 65% of Latino farm workers are uninsured. This is more than four times the national average. Even fewer of their dependents are insured. The U.S. General Accounting Office reports that existing rural and migrant health clinics are funded for only 15% of the need. Public hospitals, particularly in rural counties, have closed at alarming rates. Even “mainstream” providers shun the rural areas.
Yet farm workers and their families face extraordinary health risks--accidents, pesticide-related illness and on-the-job injuries in addition to respiratory conditions, reproductive health problems, climate-caused illnesses and communicable diseases related to their environment. In California alone, 40 farm workers died and more than 22,000 suffered work-related disabling injuries in 1990. Reproductive hazards associated with exposure to toxic pesticides are particularly alarming, since the agricultural work force is predominantly young and more than one-quarter female.
These health threats, including the long-term cancer dangers of continuous low-level pesticide exposure--in drinking water and blowing dust as well as direct contact in the fields--must be confronted in a national health plan that stresses prevention and early intervention.
The Latino farm worker is also in poorer health overall. Latinos suffer a disproportionately higher incidence of diabetes, high blood pressure, kidney disease and AIDS. Latinos also suffer from an excess incidence of cancers of the stomach, esophagus, pancreas and cervix.
Much of the suffering caused by these diseases could be prevented. With proper treatment, 60% of the blindness caused by diabetes, half of the kidney failure and two-thirds of diabetes-related amputations could have been prevented if appropriate screening and treatment had been available. Unfortunately, access to screening is very limited for the rural Latino population.
Farm workers face a number of additional health risks peculiar to rural communities. Farm-labor housing is abysmal. Many homes lack septic tanks or running water. Lead paint in what poor housing is available is a particular risk for children. Toxic-waste facilities are often sited in rural areas. And low-income and minority rural residents suffer disproportionately from water and air pollution caused by the excessive use of agricultural chemicals.
The most shocking of all the health problems is that the families who toil in our abundant fields go hungry. A 1990 study found that more than a third of the farm-worker families surveyed in four Central Valley counties faced severe hunger. They skimp on food, skip meals and run out of food money on a regular basis.
So, how are the health-care ideas coming out of Washington addressing the issues of the rural and agricultural heartland? They’re not.
“Managed competition” will not work in sparsely populated areas, since it requires large numbers of providers and participants to be cost-effective. Nor will employer-based or -financed insurance, since farm work is often seasonal, periodic, part-time and involves working for a number of different employers in a year. Given agribusiness’ creative use of deceptive practices, such as the hiring of farm-labor contractors or calling farm workers “independent contractors” to avoid employer responsibilities, the task of ensuring health coverage will be even more daunting. Witness Washington state’s Health Reform Act, which, at the growers’ behest, specifically excludes farm workers.
And where in the national health plan is a requirement that services be culturally and linguistically appropriate? Many farm-worker families speak Spanish as their first or only language. There also are large numbers of recent Latino immigrants-- indigenas-- for whom even Spanish is a second language. Not to mention the Asian immigrants working in rural areas.
The best plan is one with universal access without employer linkages. And it must include more than care for disease; well-baby care and child nutrition, plus preventive and screening programs geared to the special needs of agricultural and rural areas, also are essential. Access, especially to these basics, probably will require a system of mobile outreach facilities.
Any phase-in of coverage must include the most needy and marginalized populations in the first instance. To meet the needs of farm workers, the national health planners must give priority to what will work for the isolated rural agricultural communities that feed us.
