Learning Outcomes
By the end of this section, you should be able to:
- 27.4.1 Define the term migrant workers.
- 27.4.2 Discuss the health barriers migrant workers face.
- 27.4.3 Describe the health needs of the migrant worker population.
- 27.4.4 Identify the nurse’s role in caring for migrant workers.
According to the World Health Organization (WHO) (2022), millions of migrants worldwide work dangerous, low-skilled jobs and live and work in substandard conditions. Migrant workers are often mobile, moving frequently to locations that offer work, most often in a seasonal pattern. A migrant farmworker, also commonly called a migratory seasonal agricultural worker (MSAW) or mobile worker, is an individual who is required to be absent from a permanent residence to seek paid employment in agricultural work (Migrant Clinicians Network [MCN], 2023b, para 1). In contrast, immigrants lawfully move to another country to live there permanently.
Globally, migration has evolved and changed. Migrants are now working in industries and communities that never before relied on migrant workers, such as Alaskan salmon fisheries or Wisconsin industrial dairy farms (MCN, 2023c). A few migration patterns have emerged: migrants moving back and forth between their home country and country of migrant work; agricultural workers moving frequently within one country following seasonal changes in work opportunities; and new immigrants searching for opportunity and more stable conditions (MCN, 2023c). In 2020, 281 million people were living outside of their country of birth, and in the United States, over 51 million people were born outside of the country (MCN, 2023c).
An estimated 2.9 million farmworkers reside in the United States, a large majority of whom are immigrants. Sixty-three percent of all U.S. agricultural workers were born in Mexico, and 36 percent lack authorized work status (Farmworker Justice, 2023). Education and literacy are limited among farmworkers, who often have an average formal education ending at ninth grade (Farmworker Justice, 2023). Approximately 15 percent of farmworkers travel long distances to find work, some traveling across the U.S.–Mexico border and some in the United States, especially to Florida, Texas, Arizona, and California. Communities of farmworkers have high levels of poverty as few have benefits such as sick leave, paid vacation, unemployment insurance, or health insurance. Despite this poverty, most farmworkers do not receive federal benefits such as food stamps, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), or Medicaid. Women comprise 34 percent of the agricultural workforce and face additional obstacles such as sexual harassment, fear of reporting sexual harassment, and lack of appropriate health care (Farmworker Justice, 2023; National Center for Farmworker Health [NCFH], 2022).
Health Barriers Experienced by Migrant Workers
Migrants are among the most susceptible and overlooked members of society (WHO, 2022). For many reasons, migrant workers have poorer health outcomes than typical individuals in their host communities (WHO, 2022). They often lack access to health and dental care due to economic instability, lack of health insurance, migratory lifestyle, language barriers, cultural differences, geographic location, and a lack of familiarity with the health care system (MCN, 2023a). Because this population tends to move frequently, they often cannot establish a primary care home or develop relationships with providers and nurses, inhibiting their ability to receive appropriate health screenings, education, and follow-up care. Language and cultural differences are also barriers to overall health and dental care. The complexities of navigating unfamiliar health care facilities, policies, and insurance requirements lead some migrant workers to delay care or avoid the system altogether.
Migrant farmworkers in the United States legally can receive health insurance under the ACA and Medicaid if their annual income is below 138 percent of the federal poverty line. Due to farm labor shortages, the United States created the H-2A guest worker program to bring in temporary agricultural workers. In 2021, the U.S. Department of Labor approved 317,619 H-2A visas (NCFH, 2022). Workers with an H-2A visa can receive health insurance under the ACA, but due to their temporary status, employers are not required to provide them with health insurance, so they may need to pay for it themselves. Co-pays and deductibles often present barriers to low-income migratory workers seeking medical care. In 2021, almost 80 percent of MSAWs were considered low-income, with an income at 200 percent of the federal poverty level, and nearly half had no insurance (NCFH, 2021c). Farmworkers in the United States illegally cannot receive health insurance either privately or through the ACA.
The Migrant Health Act of 1962 authorized primary and supplemental health services to migrant and seasonal farmworkers. Today, 177 federally funded Migrant Health Centers (MHCs) are run by either community-based organizations or by governmental entities such as state and local health departments, serving MSAWs and their families. In 2021, there were nine migrant health–only programs in Maine, Massachusetts, North Carolina, South Carolina, Georgia, Minnesota, Kansas, Iowa, and Montana, providing care irrespective of ability to pay (NCFH, 2021c). Despite the availability of MHCs in some geographic regions, economic instability remains a health barrier due to a lack of transportation and the inability to afford to take a day off from work.
Case Reflection
Stories from the Field
Stories from the Field is a collaboration between the nonprofit Farmworker Justice and photojournalist David Bacon that gives farmworkers and their families a voice to talk about their experiences and the challenges they face.
Read Teresa’s story and Ramona’s story, and then respond to the following questions.
- What health conditions do Teresa and Ramona experience? How are these conditions related to their work?
- In your view, do communities have an ethical duty to do more to protect the rights of these individuals? Why or why not?
Health Needs of Migrant Workers
Hazardous work and living conditions place migrants at risk for adverse health outcomes. In the legal and occupational regulatory systems, a history of agricultural exclusions has resulted in inadequate job protections for farmworkers (MCN, 2023a). The Migrant and Seasonal Agricultural Worker Protection Act (MSPA) of 1983 established employment standards regarding wages, housing, and transportation, among others, but exclusions remain (MCN, 2023a). Health issues occurring more frequently in this population include diabetes, heart disease, arthritis, and TB (MCN, 2023a). Dangerous working conditions often result in musculoskeletal strains, falls, trauma, lacerations, and illnesses related to chemical, pesticide, extreme temperature, and allergen exposures (Figure 27.6) (MCN, 2023b). Workers’ families who travel with them are at increased risk for similar adverse health outcomes. For these reasons, migrant farmworkers have higher morbidity and mortality rates than the majority of the U.S. population (MCN, 2023b).
Maternal child health care among this population is a considerable health need. Of the estimated 2.5 to 3 million migrant and agricultural workers in the United States, more than 25 percent are women, and more than 50 percent are parents. Studies have found that fewer than half of pregnant agricultural workers accessed prenatal care within the first 3 months of pregnancy compared to 76 percent of women who access prenatal care early nationally. Half of the agricultural worker women monitored gained less weight than recommended during their pregnancies, and close to 24 percent had undesirable birth outcomes (NCFH, 2018).
Barriers to oral health include lack of dental insurance, the cost of dental repair, long travel times to receive dental care, and cultural and linguistic barriers. This has both physical and psychosocial effects. Oral disease is very visible, marking individuals as “second-class citizens” and increasing social exclusion (NCFH, 2018c).
Theory in Action
How Building a Community of Care Can Improve Farmworkers’ Health
This short video highlights the Community of Care program in Southeast Arizona as a way to improve farmworkers’ health.
Watch the video, and then respond to the following questions.
- What barriers to accessing health care do the farmworkers experience?
- What is the role of the promotoras de salud described in the video? Why are they effective?
- In your view, will building this “community of care” improve the health outcomes of farmworkers and their families? Why or why not?
Social Determinants of Health Affecting Migrant Workers
Structural factors, including political, commercial, economic, and social factors, directly impact migrant workers’ health and well-being globally. Lack of migrant worker rights and protections negatively affect the health of these individuals and their families. Because employers can pay migrant workers minimal compensation for difficult labor performed under suboptimal conditions, these individuals cannot seek appropriate care for their illnesses or injuries or leave their jobs due to their precarious economic situation.
The health inequities migrant workers experience are a direct result of individual and structural SDOH (Evagora-Campbell et al., 2022). The WHO’s World Report on the Health of Refugees and Migrants reports that migrants’ ill health compared to their host communities is the result of suboptimal individual determinants such as income, education, housing, and access to services, exacerbated by linguistic, cultural, legal, and other barriers (WHO, 2022). According to this report, compared with non-migrant workers, migrant workers are more likely to have occupational-related injuries and less likely to use health services. Limited or restricted access to health services exacerbates these health problems (WHO, 2022). Table 27.5 demonstrates how the SDOH are directly related to migrant workers’ health concerns.
| SDOH | How It Occurs | Negative Outcomes |
|---|---|---|
| Economic insecurity | ||
| Poverty |
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| Neighborhood and Built Environment | ||
| Food insecurity |
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| Substandard housing |
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| Environmental conditions |
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| Educational environment |
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The Nurse’s Role in Caring for Migrant Workers
Migrant health needs are often managed in community settings where community health nurses can make a lasting positive impact. To ensure better health outcomes, nurses need to advocate for the health of migrant workers, who have very little economic or political power. Nurses can help these individuals navigate the complex health system and push for more access and affordable care options. To address transportation barriers, public health nurses can advocate for mobile health units to visit migrant housing centers, a great upstream intervention. School and community nurses have a duty to advocate for the health and welfare of the children in the community. These nurses can advocate for fair labor laws and policies that govern other nonagricultural work, free school breakfasts and lunches, and appropriate health screenings and care.
MSAW clients frequently experience chronic diseases such as hypertension, diabetes, asthma, and eczema, being overweight or obese, and mental health disorders like anxiety and depression (NCFH, 2021c). Community and public health nurses can tailor nursing interventions to address these health issues. For example, education and advocacy efforts can target improving policies, providing healthy food options at little to no cost, and funding accessible telehealth mental health services. Community nurses can work with local businesses, officials, and community food programs to address food insecurity. Nurses can also partner with migrant and seasonal head start programs or farm-to-preschool programs to help provide children with appropriate education, health resources, and food (NCFH, 2021a).
Community health centers (CHC) are a resource for populations with limited access to health care, such as migrant workers. These community-based organizations are classified as CHCs rather than MHCs because they do not receive federal migrant health funding. Community health workers (CHWs) often play a key role in promoting migrant health by facilitating health promotion and disease prevention activities and programs to increase access to services, provide translators, and enhance the cultural competency of health programs (Emery et al., 2022). Community and public health nurses should become familiar with local migrant and community health centers, especially in rural areas, to spread awareness of their services and help migrant workers access and coordinate care. Nurses have a role in primary, secondary, and tertiary prevention for caring for migrant workers (Table 27.6).
| Primary Prevention |
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| Secondary Prevention |
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| Tertiary Prevention |
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Theory in Action
Migrant Clinicians Network
In this video, a community outreach nurse discusses what it is like to care for migrant farmworkers in Maine.
Watch the video, and then respond to the following questions.
- What different roles does Beth Russet, the nurse in the video, play?
- In your view, is this type of health care effective in managing the health needs of migrant workers? Why or why not?
- What alternatives to this type of nurse-led health care for migrants could reach more individuals?