CIRS Blog about Rural California

Agricultural Workers: The Challenge of Assessing Occupational Health Status, 1990-2017

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June 23, 2017

After reflecting on this topic, I realized that the best summary available is the paper which Profs. Marc B. Schenker and Stephen A. McCurdy wrote with Heather E. Riden and myself titled Improving the health of agricultural workers and their families in California: current status and policy recommendations, published by the University of California Global Health Institute in February 2015.

 

Instead, I’ve decided to focus today on how Marc’s leadership and influence broadened the scope of research at the California Institute for Rural Studies (CIRS). In turn, the ultimate impacts of CIRS became greater than any of us could have ever imagined.

 

Prof. Marc Schenker and I met for the first time on June 6, 1990, at a Conference on Health Concerns of Living and Working in Agricultural California, sponsored by UC Cooperative Extension and the School of Public Health, UC Berkeley. CIRS was asked to bring community folks to the conference as panelists to discuss specific topics of current concern, and, as well, contribute an overview presentation about rural California. CIRS arranged for farm worker advocates, leaders from predominantly Mexican-American rural areas, and staff of agencies providing health services for farm workers to participate in the conference.

 

As a few who are here today were aware in 1990, it was risky of Marc to seek to engage me in his new initiative. Some eleven years earlier, I was part of an effort led by California Rural Legal Assistance, inspired by the late Ralph Abascal, to sue the Regents of the University of California for ignoring the needs of a great many rural Californians, most importantly, farmworkers, but also small-scale producers, organic farmers and the rural poor. We were not seeking monetary damages, rather we wanted major changes this public institution’s priorities.

 

Although we prevailed in Alameda County Superior Court, the lawsuit was thrown out by the California State Supreme Court ten years later. But, from the filing of the lawsuit, very quietly, the University of California helped to start or support the Small Farm Center, the Sustainable Agriculture Research and Education Program, and the Student Experimental Farm. Moreover, the controversial Alternatives in Agriculture course, begun in 1977, was added to the formal curriculum of the College of Agriculture.

 

It was in this context that Marc’s invitation was most welcome. Bob Spear had let it be known that one of the purposes of the conference was to scope the possible creation of a Center for Agricultural Health and Safety at UC Davis as part of the newly authorized Agricultural Worker Safety program of the National Institute for Occupational Safety and Health. After the conference, Marc asked CIRS to become a coinvestigator of the new Center and prepare a research proposal as part of his grant proposal for which he was Principal Investigator.

 

Quite frankly, in 1990, I could never have imagined what the relationship with Marc’s initiative would eventually yield. When the first NIOSH grant was awarded to the Western Center for Agricultural Health and Safety, in one of the very first discussions with him, we agreed to collaborate in undertaking a population-based survey of farmworker health that would include a modest physical examination.

 

We approach a farmworker clinic in Parlier, a well-known farmworker community. Joined by a few folks from Marc’s research group, and by Dave Runsten from the CIRS staff, we went to Parlier where Arcadio Viveros, Executive Director of the United Health Centers clinic, and Mayor of Parlier, welcomed us and agreed to cooperate.

I clearly recall one of the first comments Marc made to me about our work.

 

 

 

 “If it isn’t counted, it doesn’t count!

At that time, reliable information about farmworker health was quite limited. In the absence of accurate information, anecdotal reports were sometimes extrapolated to represent all farmworkers, who were mostly invisible.

The willingness of the United Health Centers Clinic to cooperate meant that we could focus on recruiting a representative sample of farmworkers participants.

 

Household-based Health Surveys

  • Conceptually simple: develop a universal sample frame of sleeping quarters, including unconventional dwellings, randomly sample among workers residing in randomly selected dwellings.
  • Suitable methodology for community-based, cross-sectional survey that includes a physical examination provide locally.
  • In early 1990s in Parlier, California, the survey included a modest physical examination at the local United Health Centers Clinic.
  • WCAHS project led by Marc Schenker, Steve McCurdy and collaborators in partnership with CIRS staff, notably Dave Runsten, Ricardo Orenelas and Anna Garcia.

With an unknown number of migrant workers in Parlier at the time of the raisin and tree fruit harvests, some of whom lived in sheds or other structures in the back yards of settled residents, we needed a strategy to insure every worker had a known chance to participate.

This is how we did it.

 

parlier map view

 

The illustration here is an example of Parlier’s back houses, found by walking the streets and alleys.

 

Adjacent backhouses Parlier

 

All dwellings were enumerated, both the front houses as well as any suspected dwelling where workers might be living, including garages and vehicles. After some fits and re-starts, mostly by CIRS staff, 150 randomly selected farmworkers participated. CIRS published a monograph later describing the experience under the title Finding Invisible Farm Workers. The Parlier Survey.

 

 

Later, in 1998, Prof. Steve McCurdy and CIRS gained the support of The California Endowment for a much larger survey, this time statewide, with a comprehensive physical examination. The California Agricultural Workers Health Survey (CAWHS) was headed by Profs. Bonnie Bade and Stephen McCurdy, Drs. Rick Mines and Steve Samuels, Ann Souter and myself with CIRS staffer Daniel Williams and, later, the late Dr. David Lighthall. 

 

California Agricultural Workers Health Survey (CAWHS, 1999)

  • Main Survey Instrument. In Dwelling, 1 ½ to 2 hours, administered face-to-face by qualified interviewer
  • Physical Examination. At “Clinic”, 20 to 30 minutes, Medical Staff, By Appointment, Transportation Provided
  • Risk Behavior Instrument. At “Clinic” after PE, 20 to 30 minutes, face-to-face by qualified interviewer in a private room
  • Participants received report of PE findings from a medical professional, referrals (if needed) and $30 cash in respect for their time

 

Five communities were randomly selected, each one representing one of five of the state’s six agricultural regions. For the sixth region, we purposefully selected another, and a seventh was added on the west-side of the San Joaquin Valley.

 

CAWHS communities

CAWHS finding included surprises, such as an unexpected prevalence of chronic health conditions, ranging from obesity to pre-diabetes conditions and poor dentition. Access to health care services was shocking: three-quarters of workers lacked health insurance. Housing conditions for many workers were terrible.

 

 

CAWHS, 1999, Findings

  • Unexpected prevalence of chronic disease: obesity, pre-diabetes risk factors, high serum cholesterol, poor dentition.
  • Lack of access to health care: three-quarters of workers lacked any form of health insurance
  • While many male workers had never visited a U.S. health care provider, most female workers reported a recent visit.
  • 11% of “dwellings” unrecognized by the USPS and assessor; 41% of male workers shared living quarters with unrelated persons.
  • Unlike employment-based surveys of employed persons, some CAWHS participants had been injured at work and were unable to work at the time of the survey.

 

 

CIRS persuaded The California Endowment to provide $50 million in new funding for improving farmworker access to health care, as well as $30 of new funding to improve farmworker housing. Marc realized the significance of the findings: a young population of workers presenting obesity, increased risk of diabetes, and other indicators of poor health status, such as poor dentition.

 

Some years later, reflecting his commitment to public health, Marc joined with a major California grower-packer-shipper to develop a hands-on obesity prevention intervention at the company’s own health clinic. With Xochitl Castaneda, he created a Spanish-language program at the clinic.

 

Marc recognized that a prospective cohort study among a representative sample of farmworkers could inform efforts to address adverse health conditions found in the CAWHS. He initiated the MICASA prospective cohort research program in Mendota which also brought an oral health program to town.

 

 

WCAHS Prospective Cohort Health Study (MICASA), Mendota, California

  • Enumerate all dwellings; random selection of dwellings; recruit participation by settled families, with a member employed in agriculture.
  • Identify health risk factors at work and at home, as well as personal risk behaviors.
  • MICAS engaged Prof. Jane Weintraub, UCSF Oral Health Disparities Program, to promote healthy dental care among all residents of Mendota.
  • Currently studying risk behaviors in high-heat environments.

 

Marc’s hands-on initiatives in the community as part of a research agenda is in the best tradition of public health practice.

I want to turn briefly to one of the important achievements of the NIOSH Agricultural Safety Initiative, namely the development of safety interventions which were based on reliably accurate information on the work experience of agricultural workers.

 

The Census of Fatal Occupational Injuries, begun in 1992, is now regarded as a reliable source of information concerning acute fatal injuries in agriculture. The latest report for California is for 2015.

 

 

Occupational Fatalities, California, 2015
Source: Cal-DIR, CFOI, 2015; BLS, QCEW

Industry category (NAICS) Hired workers Self-employed workers
Crop production (111) 16 3
Animal production (112) 4 0
Farm labor contractors and crew leaders (115115) 23 0
Total occupational fatalities 43 3
Annual average employment (FTE) 377,808 n.a.
Rate per 100,000 FTE 11.4 n.a.

 

 

Regrettably, we don’t yet have a reliably accurate source of information about non-fatal occupational injuries and illnesses in agriculture. Congress forbids OSHA and NIOSH from systematically collecting information from farms with fewer than 11 workers. Most U.S. farms with hired workers have fewer than 11 employees.

 

 

Survey of Occupational Injuries & Illnesses
Cal-DIR, 2015
Footnote 5. “Excludes farms with fewer than 11 employees.”

This is a consequence of the “small farm” exclusion of OSHA.

 

As many of you know, the Fair Labor Standards Act of 1938, which established a minimum wage, the 40-hour work week, overtime pay and child labor standards, excluded agricultural and domestic workers. As Ira Katznelson history of Congressional deliberations of FLSA, titled Fear Itself, demonstrates, this exclusion was by the Jim Crow Congress of that time which sought to keep black workers from enjoying the same rights as white workers. Agricultural exceptionalism policy dates from that time. Our future task it turn that around.  

 

I want to conclude my comments today with a heartfelt “Thank you!” to Marc for his many contributions and for launching CIRS in a new direction which I could never have anticipated.

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Don Villarejo became active in civic affairs in 1955, successively participating in the student, civil rights and peace movements. In 1960, he was a founding editor of New University Thought, one of the first publications of the New Left, serving as Chair of the Board of Editors until 1965. In 1967-68, he participated in the preparation of protests at the 1968 National Democratic Party Convention in Chicago.

After several years of involvement in the Los Angeles peace movement, including founding the Indochina Work Group (dedicated to ending U.S. military intervention in Vietnam), he joined the eight-member National Standing Committee of the Indochina Peace Campaign in 1972, representing the Pacific Region, a position he held until the conclusion of the U.S. involvement in 1975.

He served as volunteer with the farmworkers movement in 1976 and, after the conclusion of this work, founded the California Institute for Rural Studies (CIRS) in 1977, serving as Executive Director until his retirement from that position in 1999. CIRS is a private, non-profit research and education organization dedicated to helping create a rural California that is socially just, economically viable and ecologically balanced.

His professional career has been multi-disciplinary, starting with a Ph.D. in Physics from the University of Chicago in 1967. He joined the faculty of the Physics Department at the University of California, Los Angeles, in 1968, serving until 1975, and then taught at the University of California, Davis, for several years until switching careers subsequent to the founding of CIRS. Dr. Villarejo's experience as a research physicist, particularly analytical and quantitative skills, proved to be invaluable preparation for his subsequent career as a researcher interested in agricultural economies and rural societies. http://www.donvillarejo.com/index.html

Dr. Villarejo has served as a consultant for numerous public and private agencies, including the California Agricultural Labor Relations Board, California State Assembly (Office of Research), California Department of Industrial Relations, U.S. Department of Labor, Bureau of Reclamation, National Institute for Occupational Safety and Health, California Rural Legal Assistance, International Brotherhood of Teamsters (Locals 601 and 890), and Migrant Legal Action Program, among others.

He has received a number of awards in recognition of his service, most recently the 2000 National Service Award of the Office of Migrant Health (U.S. Department of Health & Human Services) for "Exemplary commitment, dedication and service to the nation's migrant farm workers."

Dr. Villarejo's publication, Suffering in Silence (November 2000), was cited by The California Endowment as the primary motivating factor in its recently announced $50 million commitment in new grants to provide health services for hired farm workers in California.

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