Addressing Work-Related Health Concerns Among Farmworkers

Agriculture is one of the most dangerous occupations in the United States.  In 2007, there were 25.7 work-related deaths for every 100,000 agricultural workers. In comparison, the average death rate was 3.7 in all other industries during the year.[1] Farmworkers face many health risks because of the following factors: 1) their work is very labor-intensive: 2) they are exposed to extreme heat, cold, rain, and direct sunlight due to working throughout all four seasons; 3) they come in direct contact with pesticides and dusts; and 4) they often have to operate heavy machinery.  Along with long work hours, these risk factors can lead to injury, illness, and/or death.  In addition, farmworkers face many barriers to receiving medical care, such as fear of losing their job, risking their immigration status, and the high cost of health care. Consequently, many illnesses and injuries that happen on the job go unreported.  The physically diverse nature of farm work can also make it difficult to accurately identify work-related injuries or illnesses.

Health outreach programs are an important link to health care services for farmworkers and are well- positioned to address farmworker work-related health issues.  This article will introduce the most common work-related health concerns of farmworkers, which include: 1) pesticide exposure, 2) heat illness, 3) skin and respiratory diseases, and 4) musculoskeletal problems (muscles and bones).  It will provide strategies on how outreach can address these health concerns and present additional resources for outreach programs.

Pesticide Exposure [2]
Exposure to pesticides can come from direct spraying or mixing and is absorbed into the human body by breathing it in, contact with skin, or swallowing by accident.  Farmworkers are more often affected by pesticides because of its regular use in farm work.  In addition to exposure through spraying, many farmworkers come into direct contact with pesticides when harvesting produce.  The lack of hand washing facilities, as well as little knowledge about how to protect themselves, can make the effects from pesticide exposure worse and increase the chances of swallowing it by accident.  

Symptoms of pesticide exposure can include stomach pain, nausea, dizziness, vomiting, headache, skin rashes, inflammation, or eye problems.  Pesticide exposure is also connected to a number of delayed illnesses including cancer, birth defects, chronic skin problems, problems sleeping, and abnormalities in the kidney or liver.  However, there is still little information about the chronic health problems caused by exposure to pesticides.

Heat Stress [3]
Farmworkers often labor outdoors in direct sunlight, high humidity, and without enough drinking water.  Coupled with activities that create a lot of body heat and from wearing heavy work clothing, heat illness is one of the most common work-related health concerns for farmworkers.   Heat illness occurs when the body produces more heat than it can handle and it is unable to cool down.   Environmental factors such as high temperatures and humidity, non-stop physical activity, heavy clothing, not drinking enough water, existing health conditions, or a combination of factors can make it more difficult for the body to cool down.  As heat stresses the body, a person becomes confused and unable to focus, making it harder for farmworkers to take actions to protect themselves.  Heat stress can also cause dehydration, electrolyte imbalance (needed to keep body fluids in balance), multi-organ failure, and in worst-case scenarios, death.[1]

Skin and Respiratory Problems [1]
In addition to skin and respiratory problems caused by pesticide exposure, there are many other factors that result in these problems among farmworkers.

Of all the industrial sectors, skin disease affects those who work in agriculture the most.  Many factors specific to farm work such as wet working conditions, a hot and humid environment, exposure to direct sunlight, and contact with pesticides contribute to the high risk of skin disease among farmworkers.  Very few farmworkers are aware of the ways that they can protect themselves, such as using sunscreen, and even fewer are likely to use these ways to protect themselves.

Farmworkers have a high death rate from respiratory illnesses, including asthma, tuberculosis, pneumonia, and influenza.  In particular, workers who are frequently exposed to organic and inorganic dusts, plant and animal particles, and pesticides are at higher risk for respiratory illness.  For example, farmworkers who work in dusty fields or buildings, handle moldy hay, or work around bird droppings are at a high risk.

While adult farmworkers are at risk for many skin and respiratory problems, child workers experience an even greater threat.  According to the Centers for Disease Control (CDC), 42% of all work-related deaths of young workers between 1992 and 2000 were from the agricultural sector.[1]  Since children’s immune systems are still developing and their bodies are still growing, they are more sensitive to skin and respiratory problems, which puts them at a higher risk for major work-related health problems.

Musculoskeletal Problems
Musculoskeletal pain affects the muscles, ligaments and tendons, and the bones.  The source of this type of pain is varied, but can be caused by trauma from falls, fractures, or sprains.  Repetitive movements, overuse of the body, and postural strain can also lead to musculoskeletal pains.  Due to the nature of farm work, fractures and sprains that are caused by falls from ladders or equipment are common. Farm work often requires workers to continuously repeat actions, carry heavy bushels of produce and lift them above their heads to empty into trucks, and spend hours bent over or uncomfortably positioned to complete their work.  Symptoms of musculoskeletal pain can include achiness throughout the entire body, muscle soreness or the feeling of pulling a muscle, and muscle twitches and burns.  Other common symptoms include fatigue; stiffness; and pain in the neck, lower back, shoulders, and arms.[4][2]

 

What Your Outreach Program Can Do
As the link between providers, the community, and farmworkers, outreach programs are well-positioned to address farmworker work-related health issues. The following are a few strategies:

 

Educate and Support Employers or Crew Chiefs

• Educate employers or crew chiefs about Occupational Health and Safety Administration (OSHA) agricultural standards for access to fresh drinking water and hand washing and toilet facilities. Explain that healthy workers ensure that their operations run well.  
• Provide education about the various types of work-related health issues that farmworkers face and help employers and crew chiefs develop a plan to address these issues. For example, outreach workers can work with employers and crew chiefs to prevent heat illness by creating a plan to slowly acclimate farmworkers to hot and humid working conditions. 
• Work with employers or crew chiefs to provide linguistically- and culturally- responsive safety trainings to their workers. Help create pesticide warnings and cautionary signs on machines that farmworkers can understand.

 

Involve Clinical Staff

• Collaborate with clinic staff to identify and learn more about work-related health issues that are specific to farmworkers in your area. Outreach programs have direct knowledge about farmworker communities and the type of conditions in which they work 
• Share personal stories about farmworker health problems with clinic staff to help identify the most common issues affecting the community. Clinic staff can share knowledge about specific symptoms with outreach staff to help them accurately identify health issues during outreach.  
• Organize preventative health screenings for work-related health issues at farmworker camps with clinic staff. 

 

Empower Farmworkers through Health Education and Advocacy

• Provide health education on work-related hazards at farmworker camps and community spaces. Be creative by using images and props to show ways that they can protect themselves.
• Work with farmworkers to report dangerous working conditions. Ensure that incidents are reported with the consent of the farmworker.

 

Create Community Awareness and Support

• Address farmworker health needs by creating community-wide understanding of farmworker issues. Farmworkers, employers, providers, and community leaders all play important roles in addressing these issues. Create community awareness through education, working with the local press and ethnic media, and collaborating with potential community partners.  
• Work with the local community to donate supplies that can be used by farmworkers to prevent occupational health issues. For example, run a drive to collect used or new hats, sunscreen lotion, and sunglasses that can be used to help farmworkers stay safe while they work.  

Outreach programs are the main link between farmworkers, health care services, and the larger community. Since outreach workers have built relationships with farmworkers, they have a special understanding of the work-related health needs of these communities and can help to find solutions in partnership with the groups they serve.  Outreach programs are important in addressing the work-related health needs of farmworkers and in promoting a safer and healthier work environment.  

 

Resources
Increasing outreach worker knowledge around these work-related issues will improve their capacity to address the health needs of farmworkers. The following resources provide information on additional farmworker work-related health concerns, tools for health education, and information on ways outreach programs can advocate for farmworkers’ safety and rights.

• Outreach Connection Articles: Read more about environmental toxin exposure to children. See articles under the topic “Environmental Toxins/Children”.
  http://web.outreach-partners.org/resources/outreachconnection

 

• Health Education Recipes and Tools: Use HOP’s Health Education Recipes on heat stress and pesticide exposure to educate farmworkers. See recipes under the topics “Heat Stress Recipes” and “Pesticide Exposure Recipes”.
  http://web.outreach-partners.org/resources/outreachconnection

 

• Innovative Outreach Practices: Explore Innovated Outreach Practices that address Occupational Health from other outreach programs. Select the topic “Occupational Health” from the drop-down menu to read about the programs.
  http://web.outreach-partners.org/resources/iop

 

• Safe and Healthy Children’s Curriculum: HOP offers a Training-of-trainers (TOT) curriculum on environmental health safety for migrant and seasonal farmworker children. Contact HOP to learn more about the project.
  http://web.outreach-partners.org/resources/SHCI

 

• Migrant Clinicians Network (MCN): MCN offers a number of research articles and tools on occupational and environmental health.
  Articles: http://www.migrantclinician.org/mcn/clinical-education/environmental-and-occupational-health/index.html
  Tools: http://www.migrantclinician.org/tools-and-resources/toolbox_intro.html
• Farmworkers Justice: Visit the Farmworker Justice website to learn more about farmworker workplace safety and protections. 
  Workplace Safety: http://www.fwjustice.org/workplace-safety
  Guide to State Workers’ Compensation for farmworkers: http://www.fwjustice.org/workplace-safety/workers-comp/guide-to-state-workers-compensation-for-farmworkers

 

• Centers for Disease Control (CDC) National Institute for Occupational Safety and Health (NIOSH): Visit the CDC NIOSH agricultural webpage for a list of resources and research on agricultural occupational safety and health.
  http://www.cdc.gov/niosh/topics/agriculture/