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.

Preventive Healthcare

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.

Health Disparities

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.

Conclusion

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 healthcare 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. 

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