March 15, 2002

Our Daily Bread — Time to Value Farmworkers' Health

By David E. Hayes-Bautista and Robert K. Ross

LOS ANGELES—A suffocating thirst is the first symptom. Baked by temperatures over 110 degrees, the body tries to cool its core by perspiring, drawing moisture for surface evaporation from deep within its tissues. The sensation of thirst grows.

But if the last water was consumed 10 hours ago, just as the body dashed across the international border into the desert remote from prying eyes, if the body becomes disoriented in the featureless landscape, if a group of bodies is abandoned by the "coyote" they paid to see them safely across, the cooling process moves into deficit mode. The body starts to consume itself in a frantic search for water to keep a few vital systems going for just a few hours more. One by one, parts of the organism shut down and die. It is a race against time, until key functions can no longer sustain themselves and the entire body shuts down, permanently and irrevocably.

The next morning, news reports will laconically mention another group of immigrants from Mexico or Central America found dead of dehydration and heat exposure, then move to more interesting matters such as sports championships. In 2000, this happened to 445 people; another 2,454 were rescued at the last minute. Numbers for 2001 should soon be released.

Why are immigrants dying in our deserts? Pushed by 60 years of long-distance labor movements, pulled by constant recruitment and egged on by an erratic economy, many come to tend and harvest California crops and livestock. The lucky ones make it across the desert and move on to our fertile fields, survivors of the first part of the journey.

But there the danger doesn't end. Heavy, whirling machinery that digs, cuts, chops and bales can also mangle hands, feet and arms. A crammed, long commute in an uninspected van in the sleepy hours before dawn can end in a fiery, multiple-fatality accident. Headlines appear for a day, then evaporate.

Compared to their urban Latino kin, farmworkers are far more likely to die of diabetes, unintentional injuries, pneumonia, chronic obstructive pulmonary disease, strokes and heart disease. At home, farmworker families simply live with inferior heating, cooling and sanitation, sometimes in homes or shacks in the path of pesticide drift. Agriculture is the only industry for which U.S. labor laws allow children as young as 12 to work. At least the youngsters born here don't have to risk crossing the desert, but years of toil will take a toll as they mature. When youth or adult workers seek health services, indignities continue. Rural hospitals are closing, few providers are willing to practice in rural California and even fewer communicate in Spanish. Private health insurance is almost non-existent for farmworkers. So physician and dental visits are skipped, and health problems fester for years, erupting into serious conditions after years of faithful service.

Then, the final assault occurs. Agriculture has been exempt from participation in many programs designed to ease a worker's final years, such as Social Security and Medicare. Older farmworkers often find themselves unable to participate in these programs when they need them the most.

From start to finish, farm-workers, quite literally, are just dying to put food on our tables. Meanwhile, agriculture earns a fortune —$21 billion in 2000— for the state. And it brings in those billions while paying wages hovering largely around the poverty level. Hollywood, which we regard as the quintessential California industry and whose workers' lives we follow almost as closely as our own, generated only $14.7 billion, despite paying millions to its stars.

We don't value farmworkers much, but we need them. In the wake of 9/11, concerns about border security have, oddly enough, kept the notion of a new bracero —guest worker—program on the table. So far, proposed programs will increase the U.S. sense of security, but promise very little actual security for the health of these working guests.

After 30 years off the public radar screen, since the days when Cesar Chavez led famous strikes against grape growers, recent events have begun to nudge the farmworker issue slightly onto the edge of public awareness again. Mexico's Vicente Fox administration has recognized that its best, most industrious citizens have been leaving the country for the north, draining off potential talent. Rather than view them as traitors, Fox recognizes them as rational citizens who have made rational choices. He wants to offer more options for staying home, and greater protection for those who travel to this side of the border.

California philanthropy has also stepped up to the plate, organizing roving "think tanks" of various stakeholders, and pledging significant resources for activities in the field. What has emerged is recognition of the need for a permanent gathering of those people — agribusiness, advocacy groups, public officials, health care providers and farmworkers themselves — to keep public attention focused on this issue. Bi-national input will be required so that health services and education will cover both "sending communities" in Mexico, for instance, and receiving communities in California, with benefits transferable between them. More health clinics, rural hospitals, and culturally competent physicians trained in agricultural health will also resolve many of the nagging problems facing all rural California residents, farmworker and grower alike.

Hollywood is entertaining, but at the end of the day it doesn't feed us — we don't sit down to dinner over a plate of celluloid or digital code. California must decide if it wishes to become involved in the health of those who put food on our table, doing more than merely handing out water jugs at the border to save a worker for one more day. We owe nothing less to those who bring us our daily bread.

David E. Hayes-Bautista and Robert K. Ross. Hayes-Bautista is professor of medicine and director of the Center for the Study of Latino Health and Culture, UCLA. Ross is a pediatrician and CEO of The California Endowment.

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