¶ … Public Health and Community Nursing Issue The exploitation of farm workers in California during the Great Depression was so heart-rending and outrageous that two powerful works of literature came out in the same year to expose it. John Steinbeck, in his novel, "The Grapes of Wrath," and Carey McWilliams, in his book, "Factories in the Field," both published in 1939, graphically revealed the inhuman working conditions of migrants who were prey to corporate greed and cruelty. Just last August, Occidental College Professor of Politics Peter Dreier, came out with a follow-up on the persistently inhuman conditions of these workers, published in the Huffington Post. He revealed how more than 400,000 farm workers, migrant and seasonal ones in particular, in more than 35,000 farms in California labor in conditions of extreme heat and conditions for 8- 12 continuous hours every day without water, shade or provision for health care. In the process, a number of them have succumbed to various illness and even death. These farm laborers comprise 90% of the labor force, which fuels the multibillion-dollar agricultural industry. Theirs are the hands that reap the entire line of agricultural produce, including grapes, strawberries, lettuce and tomatoes. Heat regulation laws exist but the lack of water and shade continues to threaten their survival. Heat regulations have not contained the successive injuries, illnesses and fatalities for lack of resources in the enforcement of heat standards.

These tragedies prompted the United Farm Workers unions to sponsor two bills to urgently address the situation. The Humane Treatment for Farm Workers Act or AB 2676 would penalize farm owners for maltreatment of farm workers and the Farm Worker Safety Act or AB 2346 would compel farm owners to provide shade and drinking water to the farm workers. But powerful business and political allies of farm owners ably oppose these bills. They decry the bills as not fit for implementation and for the crippling fines they propose to impose for violations. Each passing day, each ticking of the clock can be severely injurious or fatal to these exploited farm workers.

The Two Sides

The health and lives of 3-5 million migrant and seasonal farm workers in the United States have been exposed to occupational hazards, poverty, substandard living conditions, migrancy, language and cultural barriers, and inadequate health care access. Many of them have contracted infectious diseases, illnesses from exposure to chemicals and pesticides, trauma, reproductive health, dental diseases, cancer, and mental disorders. They have also been exposed to agricultural injuries, the risk being higher among women on piece-rate wages. In general, they confront high level and frequency of strain and sprain injuries. These migrant farm workers are mostly young men who are able to make minimal use of available clinical services. Skin conditions are common among them but medical services are not. And they are also exposed to mental health risks on account of cultural adjustment problems. The provision for their care is far from adequate.

The other side contends that efforts have been exerted to meet the demand and address the problem. The paradigm of a "Health Promoter" has been put in place as a potential solution to the need for cost-effective managed health care, especially for migrant workers, and to provide for necessary public health measures. The paradigm is a Third-World health care concept in the First World. It is for bring medical attention to all undocumented peoples throughout the country. In addition, migrant farm workers who enter the United States for work opportunities must also realize that they and their children will also confront unwanted opportunities of injury, sickness or death from exposure to household toxics they may not be aware of or cannot comprehend or avoid because of language barriers. The Community Outreach and Education Program at the University of California, Davis, Center for Environmental Health Sciences intends to provide training to migrant families in Northern California for skills formation in protecting themselves and their children from accidental poisonings.

Chosen Side

This is the first side, which reveals the severe and chronic survival and health conditions of migrant and seasonal...

The justification of the second side about the Health Promoter paradigm and the outreach and education program for migrant families is insufficient as the provisions are far from adequate.
Evidence for Conclusion

In their study, Hansen & Donohoe (2003) found that migrant and seasonal farm workers constitute a sorely underserved population, which is subjected to multifarious socioeconomic conditions and health care shortage. The occupational hazards inherent to their work, poverty, substandard living conditions, migrancy, and cultural and language barriers contribute to their health problems and serve as barriers to health care. The study identified their specific health challenges as including infectious diseases, chemical and pesticide-related illnesses, dermatitis, heat-related illnesses, respiratory conditions, musculoskeletal disorders, traumatic injuries, reproductive and child health problems, dental caries, cancer, mental illness and disorders, and inadequate access to health care (Hansen & Donohe).

A longitudinal study conducted on Hispanic migrant workers in 6 Northern California Migrant Family Housing Centers during the 1997 harvest reflected the risk of agricultural injury (McCurdy et al., 2003). The risk of injury was especially high among women paid on piece-rate basis. These injuries were mostly sprains and strains at 31% and lacerations at 12%. A sample of 1,201 adult farm workers was surveyed at 85.2% (McCurdy et al.).

Migrant and seasonal farm workers were also afflicted with skin diseases as another common occupational illness (Feldman et al., 2009). Another study, based on the Health Behavior Model, sought to assess their health care use for their skin diseases. It examined 304 migrant and seasonal Latino farm workers in North Carolina. They reported that they had only 34 health care visits during the entire agricultural season and not one was for their skin disease. They had to resort to self-treatment, consisting of non-prescription preparations at 63%, prescription products at 9%, and home remedies at 6%. The researchers concluded that migrant farm workers, who were mostly male, used formal health care services infrequently for their highly prevalent skin disease. Clinic-based samples could not generalize the types and prevalence of the disease and injuries for this population as these are vastly different from the prevalence of health problems in the overall farm worker population. Clinic visits significantly veil the true prevalence of health problems among them, particularly the frequency of skin disease and injury (Feldman et al.).

Another study examined the prevalence and risk factors of 12 psychiatric disorders among Mexican migrant farm workers in Fresno County in California (Alderete et al., 2000). It engaged 1,001 respondents, aged 18-59, using a modified version of the Composite International Diagnostic Interview, which tested the effects of socio-demographic and acculturation factors on lifetime psychiatric disorders. Findings showed that men had a 26.7% probability of developing psychiatric disorders, women 16.8%, Indians 26%, and non-Indians 20.1%. These psychiatric disorders were affective disorders at 5.7%, anxiety disorders at 12.5%, substance abuse or dependence at 8.7%, and antisocial personality at 0.2%. The lifetime disorders were lower among Mexican-American migrants and the U.S. population as a whole. They were also higher with high acculturation and primary U.S. residence. These results showed the risks created by cultural adjustment problems and deterioration of mental health (Alderete et al.).

Evidence for Argument to Contradicting Side

The Health Promoters Program is a comprehensive education and prevention model designed to address migrant farm workers' needs and their medical and ethical concerns, originally for those in southern New Jersey (Clark et al., 2009). Being framed from an established program in the Third World, it has shown to increase medical care in pilot areas and saved many lives as a consequence. With a continuous increase in undocumented populations and the corollary increase in health care cost, this new initiative can become a paradigm in all hospitals. It will continue to address health disparities…