A Migrant farmworker is an individual that works at local farms and is required
to be absent from his/her permanent residence to perform different tasks
for pay in the agricultural sector. They may also be referred as “migratory
agricultural workers” or “mobile workers.” Seasonal farmworkers are
those employed for short periods, but do not necessarily need to move from
their permanent residency to seek work in farms and could have other
types of employment. Some estimations contemplate up to 2.43 million
farmworkers in the United States, including migrant, seasonal, year-round,
permanent, and international guest workers (2017 Census of Agriculture).
The contributions of farmworkers to the United States and Michigan’s economies
are vast and extremely important, they work hard producing the food that
we consume, pay taxes, contribute to the local economy through purchase of
durable products as well as accessing local services for individual and/or family
sustainability and recreation, share their culture at local events. It is estimated
that migrant workers in Michigan
generate over $2.3 billion in
farm revenues that benefit
Michigan’s economy As of 2020, there were roughly 49,000 Migrant and Seasonal
Farmworkers working in Michigan’s agricultural sector (Food
and Agriculture Task Force, 2021), 18 of the 83 Michigan counties
house over 1,000 farmworkers, their families, and more than
12,000 farmworkers and their families located in Oceana and Van
Buren counties. The State ranks tenth in the nation for migrant
and seasonal farmworkers registered for employment (source?).
Figure 1 shows a map of Michigan, which includes a concentration
(concentrated) number that describes the number of migrant
and seasonal farmworkers; these numbers include family
members that accompany the farmworkers to different counties.
Farmworkers in Michigan directly participate in the
cultivation of more than 162 commercial crops, making the
state one of the most agriculturally diverse in the nation.
Farmworkers labor in planting, cultivating, harvesting, and
packaging of 41 labor-intensive crops. They become essential
to the farming industry, due to their strong work ethic and
dedication working under very harsh/difficult conditions.
A report from Campbell County Health (2017) citing data from
the Center for Disease Control (CDC) asserts that preventive
health care is necessary and important because it improves
health outcomes. According to this report “Estimates show
that over 100,000 deaths could be prevented annually just by increasing access to primary care physicians.” Studies that
describe the benefits of primary care discuss the lower overall
cost of providing health care when preventive care is in place.
Most farmworkers do not have access to preventive healthcare
due to lack of funds for medical appointments, cannot visit
medical facilities due to lack of transportation, the type of work
they perform based on long workdays, or because they think
it is not necessary. For farmworkers seeking health care often
translates into loss of income, due to the type of work they do
with low hourly salaries or under contract based on piece rate.
Tables 1 and 2 are based on a recent health survey conducted
in Ottawa county. It illustrates the stark differences in access to
health and preventive care for farmworkers compared to the
county’s general population.
The two tables show results of a survey taken in Ottawa county,
we expect that these results would be comparable to data obtained
from other counties related to health care access for migrant
and seasonal farmworkers. Preventive health care does not only
benefit farmworkers, but also to farmers, and state budgets. For
farmers, it means a healthy workforce that is able to work every
day completing their work assignments to their fullest ability. It
also means a more secure and predictable workforce that will
be able to return to the same farms every year as a reliable and
experienced (healthy) worker. The return of farmworkers to the
same farm will improve work efficiency and enhance profitability. The benefits to the state government are primarily financial. A
well planned preventive health system could reduce the visits to
Emergency rooms of uninsured farmworkers who are unable to pay the high costs of these visits while decreasing reliance on state
budgets for these costs. Many studies that describe the benefits
of primary care point to the lower overall cost of providing
health care to a population (Hostetler, et. Al., 2020, Smith, Y.,
2019, and Writing, 2017). This cycle continues and could get
worse if follow-ups to the emergency room visits are scheduled,
thus avoiding return trips to an ER which are more costly.
Migrant and farmworkers are at a higher risk of
experiencing health disparities for many reasons. As noted by
Sanne, et al. (2004):
“In older studies it has been shown that farmworkers have
better health than their peers in other professions. Recently
this has begun to change, and now farmworkers are at higher
risk to face health concerns associated with their occupations.
Some reasoning for this change includes rationalization,
mechanization, social isolation, and financial strain.” The study considers that the current heavy use of machineries by
the agricultural sector is one of the key elements for the increased
health disparities between farmworkers and their peers working
in other industries. Inadequate training and familiarity with new
technologies increases the likelihood of injuries. The low wages
that farmworkers receive force them to make choices between
paying for health care services, familial subsistence, as well
as remittances to support extended families in other states or
abroad. For this reason, access to preventive health care becomes
a low priority – which exacerbates chronic health issues (i.e.,
untreated high blood pressure can impact carpological issues that
if undetected and untreated, can become life-threatening or fatal).
Social isolation has emerged as another important
preventive care issue. Due to the type of work farmworkers
perform, the farms’ location in which they work, the lack of
transportation, cultural problems such as language barriers
and the lack of trust in the public health system, make it
difficult for farmworkers to obtain preventive care.
There are also many other barriers that farmworkers face to
receive preventive health care, these include but not limited to:
the prevailing high cost of healthcare, shortage of healthcare
services especially not enough doctors and nurses working in
the rural areas, lack of culturally and linguistically appropriate
services, lack of information about healthcare coverage options,
unclear and confusing eligibility requirements, inability to get
sick leave, concern of losing paid work time, and social exclusion.
The health care gap for undocumented farmworkers is even
larger, since they cannot apply for any government health
sponsored program, Farmworkers fear that their immigration
status will affect the eligibility and program access. Another major constraint that farmworkers encounter in
accessing quality healthcare is their frequent relocation. Because
they travel each cropping season from state to state to sustain
their work and income, the cohesiveness between providers and
sharing of medical information presents additional and unique
challenges. Diabetes, cancer, and HIV are the most commonly
identified health issues that farmworkers experience that
require ongoing care to manage more serious health impacts. TO ADDRESS HEALTH DISPARITIES
There are only a few things farmers, migrant workers, and
health promoters (volunteers) can do to help address these health
disparities. They need to work closely with local health providers
promoting the access of farmworkers to preventive care,
facilitating the elimination of cultural barriers, and increasing
health professionals that are fluent Spanish speakers who can
effectively communicate with patients. Farm owners should
facilitate free and flexible transportation of farmworkers to health
facilities. Medical transportation covered through Medicaid is
only for those farmworkers who qualify for Medicaid support.
Migrant outreach staff can facilitate increased accessibility and
information sharing through their efforts. Asking farmworkers,
for example, can result in simple modifications of existing efforts
to increase accessibility and facilitate access to local health
care facilities. At the same time, migrant outreach provides
regular updates about policies and the type of services that
are local and used by other farm laborers. Health promoters
can also gather information from farms about their pressing
health needs, which in turn can be shared with medical
providers to identify those agencies willing to offer services.
This type of reciprocal information sharing can ensure
Additionally, advocating for more comprehensive health
insurance from employers and the State’s Medicaid program
could significantly facilitate the access of migrant and
seasonal farmworkers to seek preventive and regular
medical services. Currently, undocumented and immigrant
workers are excluded from full Medicaid coverage. While
there are private health insurance options, the financial
requirements render them inaccessible for most migrant
farmworkers. At this time, a permanent advocacy program is
needed for the expansion of comprehensive health services
under the Emergency Services Only Medicaid Program.
Other challenges could exist among health care practitioners.
It is not uncommon for emergency room physicians or urgent
care practitioners to recommend follow-up treatments.
However, not all migrant farmworkers that need to access urgent or emergency services have the financial resources
or accessible follow-up options to address health concerns.
Without federal/state support, farmworkers would not be able
to access needed follow-up care to ensure their recovery.
As an example, in an interview with a female migrant program
worker, we learned that she worked hard to get authorization
for a follow-up specialist for an injured farmworker. Despite a
broken arm and chipped elbow, he decided to continue working
to ensure needed income that was needed to support his family.
This is an example of how farmworkers need to work around
their health needs. This worker feared that if he stopped working
he would be fired or not allowed to come back in subsequent
years. The migrant outreach worker understood that in order
to support this injured laborer, she needed to contact several
health professionals to) find someone who could visit the
laborer at their worksite rather than to require them to miss
valuable working hours. An outcome of this experience was
that the migrant outreach worker felt empowered to prioritize
and establish networks to provide healthcare services.
COPING WITH HEALTH ISSUES
There are many reasons that explain the difficulty that
farmworkers face dealing with health disparities. Many United
States citizens deal with these disparities by simply going to a
doctor, but for farmworkers the most obvious option is not always
a plausible option. For some farmworkers a form of dealing with
these disparities, especially those dealing with unaddressed
aches and pains, is through excessive drinking. It is not unusual
to find one or more trash cans overflowing with empty alcohol
containers. Drinking is a coping mechanism, it is not recognized
by workers, but can be observed by program workers, volunteers,
and others that may visit farmworkers’ camps. Many farmworkers
need to utilize mental health care services, but given the type of
work they perform, the lack of transportation, time constraints,
and the financial burden they create, these care services do not
offer easy access for these workers. This is why farmworkers
are unlikely to participate in mental care health services.
Great Lakes Bay Health Centers, a nonprofit organization,
provides health care to individuals and communities, especially
those who are underserved, uninsured or underinsured.
This organization has mobile clinics, both medical and
dental, that travel to different camps across the state, where
farmworkers temporarily live, to provide access to basic health
care. A distinguishing characteristic of this organization is
that they go where the patient is instead of waiting for the
patient to come to them in an effort to close the health gap.
A migrant health program worker who works for this
organization considers transportation from camps to health
centers as a major barrier for accessible care. Since there are
a large number of people (farmworkers and their families)
living at camps, and since the available transportation only
comes from buses or larger vehicles, accessibility and the
use of shared vehicles can have unintended consequences for community and family members. This migrant health
worker wishes more health facilities would introduce outreach
efforts within migrant communities to increase health access.
This would have the added benefit of providing ongoing
treatment visits to address ongoing illnesses or diseases.
The State of Michigan’s agricultural sector is one of the largest
and more diversified in the country, it practices and relies on
the hard work of migrant and seasonal farmworkers. In the
previous years the composition of this workforce has been
shifting from families to individualized workers. Nevertheless,
the new composition of the workforce for health care is still
relevant. Increased options for preventive and continued health
are available through federal and state sponsored programs
(i.e., ACA, extended Medicaid, etc), non-profit organizations, and
private insurances, which combined with better transportation
options would increase the utilization of preventive care services.
A more consistent use of preventive care services could decrease
emergency room visits, which are not cost-effective and strain
the provision of other needed services to farm laborers and the
community at large.
Farmworkers are highly interested in the different health
care options for them and their families. At outreach events
held during peak season at several camps, farmworkers
expressed their health concerns and their reasonings for not
seeking health services. To avoid duplications in the provision
of health services to farmworkers, it will be necessary to
form an interagency team to plan, coordinate, and offer the
necessary health services to farmworkers and their families.
Finally, the need for accessible, affordable, and quality
health services is continually challenged and evolving. ⏹
Clarke, Karen, 2017, Campbell County Health, “Preventive Care Saves
lives,” Campbell County Health, https://www.cchwyo.org/news/2017/
Census of Agriculture, 2017, https://www.nass.usda.gov/AgCensus
Lada, Sophia, 2021, Farmworkers need more off-site housing, Michigan Task
Force says. cites a report from Migrant Labor Housing Advisory Board,
Great Lakes Echo. https://greatlakesecho.org/2021/03/15/farmworkersneed-
Sanne, B., Mykletun, A., Moen, B.E., Dahl, A.A., and Tell, G.S., 2004,
Farmers are at risk for anxiety and depression: the Hordaland Health Study,
Journal of Occupational Medicine, Vol. 54, No. 2. (pp. 92-100).
Smith, Yolanda, 2019, Benefits of Primary Health Care, News Medical Life
Sciences, Benefits of Primary Health Care (news-medical.net)
Writing, Alexis, 2017, Advantages and Disadvantages of Primary
Health Care, Healthfully, Advantages & Disadvantages
of Primary Health Care (healthfully.com)