Poor Health, Diet Fate of State Farmworkers

Tom Abate / SF Chronicle 22nov00

A farmworker made his way through the fields adjusting sprinkler heads east of the town of Chualar in the Central Valley. Chronicle photo by Carlos Avila Gonzalez

California fruits and vegetables have fueled a revolution in diet and health, but a new report says the farmworkers who harvest this bounty suffer from worse nutrition, higher cholesterol and more alarming blood pressure statistics than the general population.

The authors billed the report, which was released yesterday, as the first comprehensive study of farmworker health ever done in California.

"It is a tragedy and more than a little ironic that the labor force that is responsible for producing such a great abundance of healthy food in California should themselves be suffering from the effects of poor nutrition," said the executive summary of the 48-page document.

That study was released in Fresno yesterday by the California Endowment and the Institute for Rural Studies.

The Endowment, based in Woodland Hills (Los Angeles County), is a $3.7 billion foundation created in 1996, when the nonprofit HMO Blue Cross transformed itself into the for-profit WellPoint Health Networks. The Endowment sponsored the study by the Institute, a nonprofit group in Davis that studies a range of rural issues.

The study surveyed 971 farmworkers, chosen at random to represent the state's estimated 700,000 agricultural laborers. In addition to asking questions about their ailments, health insurance status, income and other demographic facts, the study took blood samples and performed physical exams to obtain objective data about farmworker health.

Among the key findings in the report, which is posted on the Web at http://www.calendow.org (Executive Summary & Conclusion below)

• Nearly 80 percent of the respondents were overweight, with 28 percent of the men and 37 percent of the women being classified as obese.
• Male farmworkers had higher serum cholesterol levels on average than the general adult population, while male and female farmworkers alike had a higher incidence of high blood pressure, early precursors of heart disease and stroke.
• Respondents, 96 percent of whom were Latino, reported a median income under $10,000. Nearly 70 percent lacked any form of health insurance. And even among the 16.5 percent whose employers did offer a health benefit, only one out of three took advantage. The rest could not afford the co-payments.

"It's a depressing picture, with no easy answers," said David Lighthall, executive director at the Institute for Rural Studies and one of the report's principal authors.

For instance, Lighthall said, two-thirds of the farmworkers were U.S. citizens, green card holders or legal aliens in the process of getting green cards. As a result of their legal status and low income, they are eligible to apply for MediCal, the state's health insurance of last resort.

However, only 7 percent of the farmworkers surveyed took advantage of MediCal, because the rules of the system force them to reapply when they cross county lines, a tough requirement for itinerant workers. "It's almost as if they were trying to prevent people from signing up," Lighthall said.

Bob Krauter, a spokesman for the California Farm Bureau, the main trade association for the state's $26.8 billion agricultural industry, said his members are struggling with higher fuel prices and falling commodity prices, and simply cannot afford more for worker health care.

"You can't assume that if a farmer provides health insurance, that consumers are going to pay more for their produce," he said.

The California Endowment has asked former California Rep. Esteban Torres to bring together a dozen policymakers to recommend ways to address the farmworker health crisis.

"I look forward to working with the task force that is being created to address the issues raised in the study," said Lt. Gov. Cruz Bustamante, the state's senior Latino elected official.

A Report from The California Endowment

Suffering in Silence :
A Report on the Health of California's Agricultural Workers 7 Executive Summary

Executive Summary

This report summarizes the initial findings of a large-scale, statewide, population-based survey of the health status of California's agricultural workers carried out in 1999. The survey was conducted by the California Institute for Rural Studies (CIRS), a private, non-profit research organization based in Davis. The California Agricultural Worker Health Survey (CAWHS) is the first statewide health survey among agricultural workers that has included a comprehensive physical examination, and provides the first-ever baseline health status data for this labor force. The survey was funded by a major grant from The California Endowment.

The (CAWHS) is constructed from a rigorously objective random sample of subjects. Participants were randomly selected from a comprehensive, door-to-door household survey conducted in seven communities. Five communities were randomly selected to represent each of five of the state's six agricultural regions: Arbuckle (Sacramento Valley), Calistoga (North Coast), Cutler (San Joaquin Valley), Gonzales (Central Coast) and Vista (South Coast). The community of Mecca represents the sixth region (Desert). Firebaugh was added to represent the west side of the San Joaquin Valley. Half of the state's agriculture workers are employed in the San Joaquin Valley.

Survey interviewers went to both residences within the towns, as well as thoroughly searched labor camps and informal dwellings found in the agricultural fields surrounding these communities. Some 1,174 randomly selected agricultural workers were asked to participate. Of these, 971 agreed, for a response rate of 83%. Each subject agreed to a one-and-one-half-hour interview at their residence, a comprehensive physical examination at a nearby medical facility, including a full blood chemistry analysis performed by an independent medical laboratory, and a private interview at the clinic that inquired about risk behaviors. Two-thirds of the randomly selected subjects (652) completed all three components of the CAWHS for an overall participation rate of 56%.

The main feature of the CAWHS sample (971 persons) is that it is mostly comprised of young, married, Mexican men who have little formal education and who earn very low annual incomes. Overall, the sample median age is 34, about 92% are foreign-born, 59% are married, 63% have attained six or fewer years of formal education, only half say they can read Spanish well, and the median reported total annual earnings from all sources is between $7,500 and $9,999. About 96% say they are Mexican, Hispanic or Latino, and 8% overall are of indigenous origin (indios). Physical examination and blood chemistry data have been reviewed and analyzed for the 652 persons who completed all components of the survey, the "PE sample." The main findings are:

• Nearly one in five male subjects (18%) had at least two of three risk factors for chronic disease: high serum cholesterol, high blood pressure or obesity..8
• For all three age cohorts (20-34, 35-44, 45-54), a significantly larger fraction of male subjects had high serum cholesterol as compared with the U.S. adult population.
• Both male and female subjects in the CAWHS sample show substantially greater incidence of high blood pressure as compared with the incidence of hypertension among all U.S. adults.
• 81% of male subjects and 76% of female subjects had unhealthful weight, as measured by the Body Mass Index (BMI). Overall, 28% of men and 37% of women were obese. In both aspects, the PE sample compares unfavorably with all U.S. adults and with findings from the Hispanic Health and Nutrition Examination Survey.
• For both male and female subjects, a significantly greater fraction of persons in the PE sample, show evidence that they are likely to suffer from iron deficiency anemia than is the case for U.S. adults. For males, in both age cohorts, it is about four times greater in the PE sample than among comparable groups of U.S. men.
• Clinically determined dental outcomes were startling. More than one-third of male subjects had at least one decayed tooth. And nearly four out of ten of female subjects had at least one broken or missing tooth. Subjects in the CAWHS sample (971 subjects) were asked to report on utilization of and access to health care services. The findings contrast sharply with comparable data for U.S. adults:
• Nearly 70% of all persons in the sample lacked any form of health insurance, and only 7% were covered by any of the various government-funded programs intended to serve low-income persons.
• Just 16.5% said their employer offered health insurance, but nearly one-third of these same workers did not participate in the insurance plan that was offered, most often because they said they could not afford either the cost of premiums or because they could not afford the co-payments for treatment.
• When asked to describe their most recent visit to a doctor or clinic, a plurality of male subjects (32%) said they had never been to a doctor or clinic in their lives. But a plurality of women had a medical visit within the previous five months.
• Half of all male subjects and two-fifths of female subjects said they had never been to a dentist. The extremely low access to dental health services is reflected in the high proportion of adverse dental health outcomes found in the PE sample.
• More than two-thirds of subjects reported never having had an eye care visit.
• Some 18.5% of CAWHS subjects reported having a workplace injury at some point in their farm work career that was compensated by a payment to them under the California Workers Compensation Insurance System. But just one-third of all CAWHS subjects thought that their employer had such coverage, despite the fact that California law required such coverage..??Only 57% said they had received pesticide safety training, but more than 82% reported that their employer provided toilets, wash water and clean drinking water.

The report concludes that the risks for chronic disease, such as heart disease, stroke, gall bladder disease and diabetes, are startlingly high for a group that is mostly comprised of young men who would normally be in the peak of physical condition. Hired farm work is often very strenuous, and surely qualifies as regular exercise.

Unhealthful diet is likely to be a major contributor to the conditions noted above. It is a tragedy and more than a little ironic that the labor force that is responsible for producing such a great abundance of healthy food in California should themselves be suffering from the effects of poor nutrition.

Conclusion

The findings of this study demonstrate that we, as Californians, need to reevaluate how to address the unmet health and health care needs of agricultural workers. Attention is urgently needed to address the access to health care problems found in this survey. The lack of health insurance, the inability of existing programs to meet the needs of this population, and the infrequency of health care visits demonstrates a breakdown of this nation's health care system for hired farm workers. These findings point to the need for vigorous efforts to address the lack of

health insurance coverage issues, and the shortage of culturally compatible health care providers and facilities in rural areas. The lack of dental care in particular, has been shown to be a serious concern; that many hired farm workers are working every day with dental pain, numbed only by herbal medications, is unacceptable. As the authors of this report we applaud The California Endowment for its creation of a high-profile task force to formulate recommendations for the foundation and policy makers to address these serious issues. It is our sincere desire that the findings of this report will serve as motivation for other public and private interests to respond accordingly with effective strategies to relieve the suffering of those who provide us with our daily food.