February 23, 2019
Central California Lettuce Harvest
Expert Q&A

Migrant Farm Workers: Their Health Is Our Health

by Peter Jaret  

For 18 months, UC Berkeley faculty member, physician, and anthropologist Seth M. Holmes, MD, PhD, lived and worked side-by-side with migrant farm laborers, moving from the Pacific Northwest south into Mexico. Here he describes his firsthand experiences, and why he believes our health and well-being depend on fair treatment of the people who grow much of the food we eat.

Why is immigrant health—including that of migrant farm workers—something that should matter to all of us?

These are the people who do a lot of the work that allows this society to thrive. They plant and harvest the foods that are essential to a healthy diet. They are the people who work in restaurants where we dine and in construction trades that maintain the infrastructure we depend on. In many ways, the standard of living we enjoy is the result of their contributions. As an anthropologist and physician, I wanted to understand more about the lives and health of immigrants, and particularly migrant farm workers, because I had become increasingly aware of the contribution immigrant workers make to the health of our society.

Why did you decide to live and work among migrant farm workers?

As an anthropologist, I use a research method known as participant observation. In order to understand fully what the lives of migrant farm workers are like, I needed to base my research on a mix of observations, my own experiences, interviews, and recorded conversations. I couldn’t get the same full understanding from only interviews or surveys. For my participant observation, I lived in farm labor camps, harvested berries and pruned vineyards, and migrated between states as the seasons changed. I also went to the home villages of migrant workers in Mexico and visited their family members. I took the trek with migrant workers from Mexico across the border into the U.S. in order to understand all the aspects of their lives as well as I could. In an attempt to understand the perspectives and roles of many people involved in transnational farm labor and health, I conducted field research with people along what anthropologist Laura Nader has called a “vertical slice.” I observed and interviewed supervisors and farm owners, migrant health doctors and nurses, border control agents, and border vigilantes. I wanted to understand all of their perspectives and experiences.

What did you discover?

I learned that our food system is built on a hierarchy based largely on ethnicity and citizenship. Depending on your ethnicity and citizenship, you have a very different position within our food system. The people who do the most dangerous work, both in terms of safety and health, are most often indigenous Mexican farm workers who cross the border to come and plant and harvest here. They suffer the most health-related problems from their work, have the highest fatality rates, and have the least protection and the least access to health care.

Where do migrant workers go if they need care?

There are some federally funded clinics that have staff bilingual in Spanish and English and serve migrant workers. But often they aren’t near where people are working, and some are only open during normal business hours, so they aren’t very practical for someone working in the fields. In most states, farm workers are not covered by Workers’ Compensation, which for most other workers includes health care if they are injured on the job. So when they become sick or are injured, they have no coverage and very few options for treatment. Even when clinics are available, migrant workers often encounter a system that doesn’t address their needs.

What are the obstacles?

One involves language. Some farm workers are indigenous people from Latin America for whom Spanish isn’t necessarily their first language. So even in bilingual clinics, communication may be difficult.

But there are other, more entrenched obstacles. In medicine, we tend to think that health is either a matter of biology—a genetic predisposition to heart disease, for example—or behavior, eating a poor diet or not getting exercise, for instance. We’re not trained very well to understand the ways in which social, political, and economic factors lead to health problems, even though a lot of research shows that the primary causes of most health problems are social, political, and economic.

Let me give you an example from my research. One farm worker who lived near me in a farm labor camp went into a clinic with extreme knee pain from working seven days a week in the fields, bent over, picking strawberries, which requires pivoting back and forth. He worked seven days a week because he couldn’t afford not to, and because in most states there are no laws to protect farm workers and require days off or breaks during the day. There were clear political, economic, and social reasons why he had knee pain. But when he talked with a physician, she told him that he was bending the wrong way. The physician may have been well-intentioned, but she didn’t understand that there’s only one way to bend over if you are a farm worker and want to keep your job. The physician was out of sync with the reality of the farm worker’s life such that it made mutual understanding between them very unlikely. The farm worker said to me later, “Los médicos no saben nada.“ The doctors don’t know anything.

How can the healthcare system bridge such a gap?

Some of us—a mix of physicians, nurses, and social scientists across the country—are pushing for a new way to educate professionals. We’re arguing that in order for physicians and nurses to understand and respond appropriately to the reality of their patients, they need to be trained to see and analyze the structural social, political, and economic issues that their patients experience. Many of us are calling this necessary framework “structural competency.” Otherwise we’ll do the same thing that happened to this migrant farmer worker, and blame the patient’s behavior instead of trying to work with him to improve the situation.

Given the current political climate, do you ever feel disheartened?

I’ve seen some recent changes that are heartening. Last year, the United Farm Workers and other groups fought successfully for a law that offers farm workers overtime pay in California, for the first time in history. In Washington State, Familias Unidas worked to change regulations last year so that farm workers who are paid per pound for the produce they harvest are given meal and rest breaks. But at the same time, we’re at a moment in history in our country when anti-immigrant prejudice and institutional and structural racism and violence have become more acceptable. Many of the farm workers I know have been scared enough that, since the inauguration, there have been times when they have been afraid to leave their homes. The kids won’t go to school. The farm workers won’t leave home to go to work. That hurts these struggling families in many ways. And it also means that the farms where they work have an extremely difficult time harvesting the food we eat. Despite some politicians claiming that migrants are taking jobs from Americans, I have never seen a white American trying to get a farm work job. When migrant farm workers are scared away from the vital work they do, this hurts all of us as the fruit and vegetables we depend on for our health are not harvested.

What can those of us who are concerned do to make a difference?

Three things come to mind immediately. You can choose to buy produce from farms that treat workers well. You can go to the United Farm Workers site to find farms that have contracts with the UFW for wine, berries, mushrooms, and much more. There’s a new program called the Equitable Food Initiative (EFI), which labels produce from farms where farm workers are part of the decision-making process for work conditions. Costco recently joined the program. And you can ask about the treatment of farm workers when you shop at your local farmers’ market or grocery store to signal that this is important to you.

As members of families and communities, you can challenge negative and unfair stereotypes about migrant workers. The fact is, these are people who contribute far more to our society and economy than they receive in return. They deserve our deep respect and support.

The third thing you can do, as citizens and voters, is vote for politicians who support immigrants and farm workers and speak out against anti-immigrant and anti-worker measures. When there is a political move to undo important protections, such as we’re seeing now with the Deferred Action for Childhood Arrivals, or DACA, you can call your representatives and demand that they protect structurally vulnerable people, the people we all depend on for our food, for our own health and well-being.

This opinion does not necessarily reflect the views of the UC Berkeley School of Public Health or of the Editorial Board at BerkeleyWellness.com.

Also see Dispelling a Myth About Immigrants’ Health.