The Agricultural Worker Health Study

The Agricultural Worker Health Study Case Study No. 5: Salinas Valley A baseline report of The Agricultural Worker Health Initiative Ron Strochlic Nancy Mullenax Mireya Samaniego Xochitl Villaseñor Lillian Salcido Richard Mines June 2003 Research conducted by Sponsored by The California Endowment AWHS Case Study No. 5 – Salinas Valley AWHS Case Study No. 5 – Salinas Valley Table of Contents Summary of Main Findings................................................................. 1 Introduction ......................................................................................... 5 Background ......................................................................................... 6 The Salinas Valley .......................................................................................... 6 Farmworker Demographics........................................................................... 7 Analysis of Key Dimensions .............................................................12 Living Conditions ........................................................................................ 12 Working Conditions .................................................................................... 15 Health Care Delivery System ....................................................................... 24 Service Provider Inventory ..................................................................................... 25 Principal Health Conditions ....................................................................... 43 Barriers to Care ............................................................................................ 56 Facilitators to Care ...................................................................................... 67 Summary of Community Assets and Liabilities.............................. 69 Main Assets .................................................................................................. 69 Main Liabilities ............................................................................................ 70 Menu of Community-based Options ............................................................71 Appendix ............................................................................................ 73 Bibliography .......................................................................................76 AWHS Case Study No. 5 – Salinas Valley AWHS Case Study No. 5 – Salinas Valley Summary of Main Findings Population and Environment The Salinas Valley is known as the “Salad Bowl of the World.” It is at the heart of Monterey County’s $3 billion agricultural industry, which supplies consumers throughout the U.S. and more than fifty nations with one billion pounds of fruits and vegetables. An estimated 68,000 farmworkers comprise the workforce driving this industry. With an estimated 54,000 accompanying family members, Monterey County’s farmworker population is the third highest in California, following Fresno and Kern counties. The vast majority of farmworkers in the region are from Mexico, principally from the highland states of Guanajuato, Michoacan, Jalisco, and Oaxaca. Most have limited education, literacy, and English skills. The majority of farmworkers in the Salinas Valley are married. Many men have left their wives and children behind in Mexico. Some of the men who do live in the valley with their families follow the crops during the winter, leaving their wives and children in the Salinas area. The number of indigenous-language farmworkers in the study region has been growing in recent years. These immigrants are typically more recently arrived, and they present needs and beliefs that are profoundly different from those of Spanish-speaking farmworkers. In particular, most speak little English or Span- ish, come from very impoverished backgrounds, and have little or no experience with formal health care and social service systems. Living and Working Conditions Salinas farmworkers labor under difficult conditions, including long hours stooped over and exposure to heat, cold, pesticides and dangerous machinery. Compensation for agricultural labor in general is low. Farmworkers interviewed in the study reported wages of approximately $7 per hour. Most find only inter- mittent employment, despite the region’s long growing season, resulting in a median income of just $11,000 per year. With the exception of foremen and unionized workers, few farmworkers enjoy health insurance or other benefits, such as vacation or sick days. The cost of housing in the Salinas Valley is high with limited vacancies. Over- crowding among farmworkers is subsequently rife. In addition, many are forced to reside in substandard shelters, including garages, shacks, and sheds that often lack running water and electricity. Health and Social Service System A fairly extensive network of public, nonprofit, and for-profit providers offer cul- turally and linguistically appropriate primary care services for farmworkers. A 1 AWHS Case Study No. 5 – Salinas Valley number of the for-profit providers in the study region that serve farmworkers offer sliding fee scales and payment plans for uninsured patients. Most of the area’s providers offer bilingual services. Clínica de Salud del Valle de Salinas, which operates seven primary clinics in the valley, is the largest provider of primary care services to farmworkers. Other providers include the county’s public clinics and medical center, Mee Memorial Hos- pital and its two outpatient clinics, and Salinas Valley Memorial Health care system, which runs a hospital and a clinic in Salinas. A parallel network of traditional healers provides ethnospecific health care to farmworkers, who see these providers because they feel they are more effective for certain conditions and because their services are generally less expensive than those offered at clinics. Clínica de Salud is the main provider of dental services for farmworkers in the Salinas Valley and the only one that serves people without insurance. The other major provider is the Appolonia Foundation, a nonprofit organization offering dental services to children and pregnant women throughout the valley. Drs. Sanger, Stewart, Chiang, Morris, and Murillo run the only private pediatric dental prac- tice in the Salinas Valley that accepts patients with Medi-Cal. There is a shortage of Spanish-speaking dental workers regionwide. Access to mental health services is much more limited than access to either primary or dental care. Only Monterey County and a limited number of nonprofits offer mental health services to patients who do not have Medi-Cal or private insurance, and many farmworkers rely on priests and pastors for counseling. The shortage of Spanish-speakers is most severe in the mental health field. Existing mental health services are geared towards the seriously and persistently mentally ill, rather than toward those suffering from situational depression, anxiety, and stress, the conditions most frequently identified among farmworkers. Salinas Valley social service providers address a broad range of issues, including youth programming, housing, substance abuse, domestic violence, reproductive health, and HIV/AIDS prevention and treatment. Most offer services in Spanish, and a number of programs specifically target farmworkers. Principal Health Conditions The principal chronic conditions reported by Salinas farmworkers and providers are diabetes—which has risen significantly in recent years, particularly among youth—and upper respiratory disease, hypertension, and obesity. Salinas farmworkers suffer from numerous occupational health problems as well, including musculoskeletal injuries, arthritis, cuts and lacerations, sprains, pesti- cide-related conditions, and injuries from accidents associated with heavy machinery and vehicles. The majority of farmworkers suffer from poor dental health. Screenings of children under age five reveal that two in three have some degree of dental disease and that one in five suffers from severe dental problems. Mental health concerns are common among farmworkers and their family members. Traumatic experiences crossing the border and difficult living and working conditions in the U.S. can lead to stress, anxiety, and feelings of isolation. 2 AWHS Case Study No. 5 – Salinas Valley Substance abuse, domestic violence, gang activity, and high rates of teen pregnancy are some of the consequences of a lack of attention to these situational mental health conditions. Barriers that Impede Access to Care Lack of insurance and inadequate insurance coverage coupled with the high cost of treatment, diagnostic exams, and medications are the principal barriers to care. In addition, private providers often do not accept Medi-Cal insurance, particularly for mental and dental health services, which further limits access to those forms of care. Services in the region, particularly those provided by specialists, are concentrated in the city of Salinas, creating a significant barrier for residents of southern Monterey County, especially for those residing in outlying towns and labor camps that are not served by public transit. Farmworkers often avoid applying for public insurance coverage and other en- titlements because of the complex paperwork and documentation required, re- quirements for periodic reapplication, fears of being apprehended by INS, and misunderstandings about “public charge” laws that can threaten their attempts to become legal residents. Barriers imposed by field work

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