There are numerous barriers to recognizing and treating work-related health problems at the primary care level. One of the underlying reasons that addressing work-related health is a challenge is the limited occupational health training front line providers receive. Institutional challenges can also prevent clinicians from adequately addressing work-related health problems. For migrant farmworkers and other vulnerable populations working in hazardous occupations such as construction, an occupational injury or exposure is often the reason for a first point of contact with the health care system, underscoring the need to consistently address work-related health concerns at the primary care level. Since its inception, MCN has worked to eliminate health disparities among migrant and seasonal farmworkers. In particular, MCN focuses on occupational health disparities because many migrants are at higher risk for injuries and other health problems due to their work. MCN assists frontline providers to integrate occupational and environmental health practices into primary care to strengthen the quality of care and meet the unique healthcare needs of the migrant population. MCN recognizes that migrant clinicians, like the majority of primary healthcare providers, generally do not consider work-related health when consulting their patients, despite the fact that they are serving migrants employed in high risk occupations. Given the competing demands and severe time constraints in a primary care setting, healthcare providers struggle with ways to incorporate occupational medicine practices into their day to day efforts. Environmental and Occupational Illness and Injury
Occupational injuries and illnesses are one of the most prevalent patient care issues for clinicians working with migrant workers. Migrant patients are a unique segment of the U.S. workforce and factors such as lack of training, poor safety precautions, over representation in dangerous industries, language barriers, piece-rate pay, undocumented worker status, and geographical and cultural isolation can put these workers at increased risk for work related injuries and illnesses. Health disparities in this population are starkly demonstrated by excess mortality and injury at work. Fatal occupational injuries among farmworkers occur at five times the rate for all workers in the U.S (USDOL, 1998).
Trapé-Cardoso and colleagues described migrant workers seeking medical care at Migrant/ Community Health Centers in Connecticut. Of the 331 workers seen during medical clinic visits, 41 percent reported a work-related injury or illness. Thirty-nine percent were musculoskeletal disorders (sprains/strains, tenosynovitis, and muscle spasm), 22 percent allergies, irritation, or rhinitis, and 22 percent dermatitis (2003). The New York Center for Agricultural Medicine and Health examined over 5,000 medical charts from 12 Migrant/Community Community Health Centers and found that approximately 20 percent of visits by migrants were for obvious occupational injuries. The rate of occupational injury was as high as 50 percent for migrant men in certain clinics. Moreover, 90 percent of farmworkers with documented occupational injuries chose not to file a claim for their work-related injuries(Sorensen, 2004; NYCAMH, 1997-1999). Twenty-four percent of California agricultural workers surveyed by the NAWS reported suffering from at least one musculoskeletal injury during the previous year (Aguirre International, 2005). In a recent study in North Carolina, it was found that 45 percent of occupational heat-related deaths were in farmworkers (Mirabelli and Richardson, 2005).
Pesticides and other chemical exposures are a significant environmental hazard for farmworkers and their families. The absence of a national system for reporting pesticide poisonings makes it difficult to estimate the number of pesticide poisoning incidents in workers nationwide and estimates differ widely (Blondell, 1997; Calvert, 2004). There are a number of studies, however, that document the existence of pesticide exposures among farmworkers and their families (Arcury et. al., 2005; Arcury and Quandt, 2003; Curl, et. al., 2003, Calvert, 2004; CDC, 1997; Coronado et al., 2004).
Pesticides Pesticides are essential tools in the production of the world’s food supply, in the protection of structures, in the prevention of illness transmission and in the control of vectorborne diseases. As a group, however, pesticides contain some of the most toxic chemical products produced by modern chemistry. They are also unique among toxic environmental contaminants found in our environment for, like no other chemicals except war gases, pesticides are purposefully released into our environment with the intention of doing harm to living beings. In 1990, the date of the last attempted world estimate, the World Health Organization estimated there are 3 million poisonings and 200,000 deaths from pesticide exposure per year in the world and that this reflects only a fraction of the real problem. Learn more... Lead Lead poisoning is a preventable disease. It causes behavioral and learning disorders in children. Migrant populations face unique dimensions of exposure that increase their risk of lead poisoning such as occupational exposures, neonatal exposures, cultural practices (folk remedies, food preparation, etc), migration and substandard housing environments. Learn more... Heat Stress Heat Stress is a preventable illness brought on by prolonged overexposure to heat and the sun. Please visit our Heat Stress patient education materials for more information about this sometimes fatal condition. Water & Sanitation Despite advances in water supply and treatment, many farmworkers remain vulnerable to contaminated water supplies. Most of the water sources used to provide water to farmworkers in the fields or in the camps are private wells. This is of particular concern in agricultural areas where rain and irrigation water can carry pesticides, fertilizers and human and animals wastes through the soil and into the underlying aquifer. Farmworkers may or may not be exposed to contaminated water via poorly maintained wells. Facilities for hand washing and properly maintained excreta disposal systems may or may be available to farmworkers. Knowing that enteric infection may be an issue for farmworkers has several implications for clinicians, outreach workers, and health educators. Learn more... Migrant Children in Agriculture
The children of farmworkers are no less vulnerable to occupational and environmental risks. All children residing on or near farms as well as those working in agriculture face risks from injury and exposure both in their homes and at the worksite. While some farmworker parents report regular access to healthcare for their children, many lack continuity with regular providers and do not receive preventive care on standard schedules due to multiple access barriers.
According to a recent study, children ages 14 to 17 make up 5.5 percent of the hired crop farmworker labor force (Kandel, 2008). Many of these children are emancipated minors, who often work and reside in a different country or state than their parents; most farmworker children begin working on farms at 10 years old (Kandel, 2008). Children working in agriculture sustain high numbers of injuries and fatalities; agriculture accounted for 41 percent of fatal work injuries to youth from 1998 to 2002 (Windau and Meyer, 2005). For workers under the age of 16, agricultural production accounted for nearly 60% of deaths in this age group, with 79% of all work-related deaths for youths ages 10 or younger occurring in agriculture (Hard and Myers, 2006).
Young worker deaths in agriculture occur more frequently than in all other industries combined (Blueprint for Protecting Children in Agriculture, 2012). Despite the risky nature of agriculture, children who work in agriculture have been historically under protected compared to children employed in other industries. Child labor laws do not protect children working in agriculture in the same way that children working in other industries are protected. For example, in agriculture, children who are 12 years old and older can work unlimited hours on a farm as long as they have parent permission (Blueprint for Protecting Children in Agriculture, 2012).
When farmworker parents do not have accessible and affordable childcare, they are more likely to bring their children to work with them. One study shows that 7 percent of farmworker parents being preschool age children to work (Salazar et al, 2004). While these children are not part of the agricultural work force, they are still at risk for some of the same work-related dangers that their parents face. In fact, among the more than 1,800 injuries to children on farms in 2012, 75% of these injuries occurred to children who were not working (Blueprint for Protecting Children in Agriculture, 2012). MCN is dedicated to serving the needs of both working and nonworking children on farms, so that we can reduce injuries and improve health outcomes for all youth.
Links to EOH Resources
For further resources,
The New York Center for Agricultural Medicine and Health has created a website linking clinicians and healthcare providers to information and resources to treat and manage farmworker patients. The site includes clinical and diagnostic tools, patient education materials, links to demographic data and citations for regional research on farmworker health and safety.
Farmworker Clinical Care Resource for Occupational Health For more information on MCN's response to environmental and occupational challenges in primary care, visit MCN's Environmental and Occupational Health Initiative webpage.
For questions about MCN's Environmental and Occupational Health Initiative, please contact
**MCN’s EOH efforts are largely supported through cooperative agreements with the US Environmental Protection Agency as part of their National Strategies for Health Care Providers: Pesticide Initiative. The conclusions and opinions expressed herein are those of MCN and do not necessarily reflect the positions and policies of the U.S. EPA.