From Streamline: Hunger Hits Those Who Produce Our Food
By Jillian Hopewell
[Editor’s Note: COVID-19 has exposed the dangerous working conditions, low wages, and lack of worker protection that agricultural workers have endured for decades. In part because of these conditions, agricultural workers have been at a higher risk of COVID-19. These same agricultural workers experience many additional concerning social determinants of health as a result of these conditions, including food insecurity. In this article, reprinted from the spring issue of Streamline, MCN’s Director of Communication and Education, Jillian Hopewell, MPA, looks at hunger, and several programs that seek to address it. Streamline is our in-print quarterly clinical journal. Read the complete issue of Streamline here, where you can also sign up to receive it in the mail.]
There is a profound irony in the fact that many agricultural workers in the United States suffer from food insecurity. Those who plant, cultivate, and harvest the food we all depend on, face economic, social, and logistical challenges that impact their ability to access sufficient food for themselves or their families.
The United States Department of Agriculture (USDA) defines food insecurity as the lack of consistent access to enough food for an active and healthy life.1 Food insecurity does not exist in a vacuum, it is closely linked to a number of overlapping social issues such as inadequate housing, poverty, social isolation, and lack of access to transportation.
While there are no national studies on food insecurity among agricultural workers, regional studies show alarming findings among that population. A 2011 study in Georgia found that 62.83% of migrant agricultural workers surveyed did not have enough food.2 Another study from California revealed that agricultural workers, and especially those who are undocumented, depend on emergency food as their main food source.3 A 2007 study in Fresno County, CA found a 45% prevalence of food insecurity among farmworkers.4 The latest National Agricultural Worker Survey (NAWS) data shows that the average farmworker household incomes ranged from $20,000 to $24,999. According to the NAWS survey, about 30% of agricultural worker families live below the poverty line, almost three times the percentage of the US as a whole.5 The onslaught of the COVID-19 pandemic has noticeably increased food insecurity in low-income communities across the country. In March 2021, Feeding America “projects that 42 million people (1 in 8), including 13 million children (1 in 6), may experience food insecurity in 2021.” Their findings showed that those who were already at risk of food insecurity experienced greater hardship during the pandemic. Prior to the pandemic, food insecurity was more likely to be experienced by Black, Latinx, or Native American individuals. Feeding America says that structural racism and poverty were two major drivers of food insecurity among non-white populations in America. After years of decreasing rates of food insecurity, the economic hardships brought on by the pandemic have elevated food insecurity.6
MCN’s bridge case management program, Health Network (HN), provides a window into some of the challenges facing migrant families. Hannah Lawrence, a MSW candidate working with HN, says that she has seen an increase in the number of HN patients telling her that they do not have access to enough food. HN is currently working with a Haitian family in Florida with twin baby girls. The father contacted HN to say they were completely without food. Alma Colmenero, a Prenatal Coordinator with HN, tells of another family who moved from Texas to Florida. The mother recently gave birth and contacted Colmenero to say that she does not have enough money to pay for food or diapers for her baby. HN staff is working with these families to find local organizations that can provide them with food until they are settled and have work.
There are federal programs that can assist agricultural workers and their families with food and other necessities, but these programs do not go far enough to make a significant dent into food insecurity. Farmworker Justice notes that some agricultural workers are eligible for the Supplemental Nutritional Assistance Program (SNAP); the Women, Infants, and Children (WIC) program; and the National School Breakfast and Lunch programs. While these programs are effective in some communities, agricultural workers face a number of barriers to access these food assistance programs. Given these barriers, local assistance programs are critical to help agricultural workers connect with services that provide them with food and other necessities.7 To better understand the role of local organizations, we offer two case studies of programs that directly confront food insecurity among agricultural worker and their families.
East Coast Migrant Head Start Program
The East Coast Migrant Head Start Program (ECMHSP) was founded to provide early childhood education and other support services for children and families of migrant and seasonal agricultural workers. Their sites are far ranging, as far north as Pennsylvania and down south to Florida. Currently, they operate nearly fifty sites in ten states. Many of their families migrate during the growing season and ECMHSP provides quality services to their children as they move. Recognizing that nutrition and access to food are critical for growth and development, ECMHSP provides breakfast, lunch, and a snack for enrolled children, and sometimes additional meals if needed. ECMHSP staff, supported by dieticians, work directly with parents to create culturally appropriate menus that also help educate families about good nutrition. Where possible, ECMHSP works with local food banks and other social support organizations to offer nutritional support for families. ECMHSP takes a holistic approach to working with families and tries to meet a wide range of needs. They rely on their intake process to determine which families need additional services such as nutritional support.
When the COVID-19 pandemic hit, ECMHSP staff had to quickly adjust their services. Many of their client families were quarantined, scared, and lost their regular employment as well as services they might otherwise be able to utilize. For the children, ECMHSP was shut down between March and June 2020, after which they were able to open and provide regular education services with COVID-19 protocols in place. Some of the families did not feel comfortable bringing their children to the educational sites, so ECMHSP had to also provide remote services. During this time, families were not able to access school or other community meal distributions due to their work schedules, and grocery store shelves were empty by the time they were able to shop if they had resources to do so. Realizing that many families depended on their nutritional services, ECMHSP utilized their existing partnerships with local food banks and other organizations to put together weekly meal boxes that included food and other items like diapers and wipes. Because the social service landscape is different in each community, the solutions to provide food required a hyper-local focus and leaned heavily on existing local partnerships including food banks, community health centers, and other service organizations.
According to Renée E. AboAmshe, CHES, who served as the Child and Family Health Manager at the Raleigh Administrative Office through March 2021, sometimes the families ECMHSP serves are reluctant to ask for help. She says that it is critical that they find a member of the community who can serve as a conduit to gain the trust of families. She cited a recent example from Alabama where there was an influx of Swahili-speaking migrant workers. Initially the community was hesitant to apply for services, but after ECMHSP connected with an older community member, that person was able to serve as a gatekeeper and helped to bring people in for services. After gaining the community trust, ECMHSP began to work with local organizations to provide culturally relevant nutrition services to children and their families even as they altered their delivery methods because of the pandemic.
Virginia Garcia Community Health Center
Virginia Garcia Community Health Center was founded as a true grassroots organization rooted in the agricultural worker community. In 1975, a young girl named Virginia Garcia was migrating with her parents from Texas to Oregon to work in agriculture. Along the way, Garcia cut her foot and by the time they reached Oregon it had become infected. Without access to adequate health care, Garcia died from what should have been an easily preventable injury. Her death galvanized the local community in Oregon to organize and open a small community health center. Since that time, Virginia Garcia has grown to see over 52,000 patients a year in five primary care sites, six dental sites, four school-based health centers, a women’s clinic and a mobile outreach clinic across two counties in the state.
Virginia Garcia continues to maintain a strong community-based presence and actively partners with other social service agencies in the communities in which it has health center sites. Early on, health center staff realized that access to food was critical to maintain the wellness of their patients. To address hunger, the health center partnered with the Oregon Food Bank. Beginning in 2018, Virginia Garcia and the Oregon Food Bank took their partnership one step further and created Free Food Markets where patients could come and select fresh produce and other food items at locations near or at health center sites. The Oregon Food Bank was also very open to changing the food they offered based on client preferences. For instance, many health center patients wanted more rice, beans, and fresh produce as opposed to canned goods.
Families who might need food assistance are often identified by outreach workers who use the CMS-sponsored Accountable Health Communities Social Determinants of Health (SDOH) screening tool to assess a constellation of needs. Virginia Garcia also employs a warm hand-off method within the clinic where a provider will refer patients to outreach services including food assistance if they identify a need during a clinical encounter.
In March 2020, as the scope of the pandemic became apparent, Virginia Garcia and the Oregon Food Bank realized they could not hold in-person free food markets and scrambled to find another way to get food to families in need. At some sites, the partners switched to holding drive-through markets with pre-packaged boxes of food. At other sites, they worked with other local organizations such as Centro Cultural in Cornelius to have outreach workers deliver food boxes to families. Like the free food market, the food boxes are customized with culturally appropriate food items. Kendra Powell, LCSW, Primary Care Social Worker Supervisor and Roxanna Pascual, Regional Operations Manager from Virginia Garcia say that the Oregon Food Bank has been very open to changing the type of food they provide based on cultural and dietary preferences.
At their five sites, Virginia Garcia outreach workers have been particularly diligent about getting food boxes to patients who have tested COVID-19 positive and are required to isolate at home. Powell and Pascual estimate that in the Yamhill County area alone as of March 2021, Virginia Garcia is delivering 50-70 food boxes a week. They say that this represents a significant increase over a year ago. The increased need is also evidenced by the fact that in past years families would often only need one food box a month. Once COVID-19 hit, many of the same families needed a food box every week. Powell and Pascual say that the pandemic exploded the need for social support as families lost work or were forced to isolate or quarantine.
Where do we go from here?
Local support services will continue to be a critical component to address food insecurity among agricultural workers, in part because they better understand the cultural and dietary needs of their clients. They are also better at finding community gatekeepers to increase trust in the services provided. Additionally, local organizations understand how to reach hard-to-find people and communities. At the same time, it is critical to continue to advocate for state and federal policies that address the root causes of hunger in all low-income populations. Ensuring a living wage for agricultural workers would go a long way towards addressing food insecurity, but there are other issues to consider including transportation and access to healthy food. The COVID-19 pandemic has exposed fissures in our social fabric and shone a light on pre-existing inequities. The pandemic has also shown how essential agricultural workers are to the systems that allows us all to have access to food. In this moment, it is critical to advocate for a world in which agricultural workers and their families have consistent access to enough food to support active and healthy lives.
1 Definitions of Food Security. USDA Economic Research Service. Accessed 13 March 2021. Available at: https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/definitions-of-food-security.aspx#:~:text=Food%20insecurity%E2%80%94the%20condition%20assessed,may%20result%20from%20food%20insecurity
2 Hill BG, Moloney AG, Mize T, Himelick T, Guest JL. Prevalence and predictors of food insecurity in migrant farmworkers in Georgia. Am J Public Health. 2011;101(5):831-833. DOI:10.2105/AJPH.2010.199703
3 Minkoff-Zern L-A. Hunger amidst plenty: farmworker food insecurity and coping strategies in California. Local Environment. 2014;19(2):204-219. DOI:10.1080/13549839.2012.729568
4 Wirth C, Strochlic R, Getz C. Hunger in the fields: Food insecurity among farmworkers in Fresno county. California Institute for Rural Studies. November 2007. Available at: https://www.researchgate.net/profile/Ron-Strochlic/publication/255532448_Hunger_in_the_fields_Food_insecurity_among_farmworkers_in_Fresno_county/links/55aff9a808aeb92399171912/Hunger-in-the-fields-Food-insecurity-among-farmworkers-in-Fresno-county.pdf
5 United States Department of Labor. Findings from the National Agricultural Workers Survey, 2013-14. Research Report No. 12 (published 2016) at iii, 37-38. The survey asked farmworkers to report their income from the year before. We therefore compare the NAWS results to data in other surveys from 2012. Available at: https://www.dol.gov/agencies/eta/national-agricultural-workers-survey/research
6 Feeding America. The impact of the coronavirus on food insecurity in 2020 and 2021. March 2021. Available at: https://www.feedingamerica.org/sites/default/files/2021-03/National%20Projections%20Brief_3.9.2021_0.pdf
7 Farmworker Justice, Hunger amidst plenty: Food assistance in farmworker communities. Blog post. Available at: https://www.farmworkerjustice.org/blog-post/hunger-amidst-plenty-food-assistance-in-farmworker-communities/
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