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Shifting Landscapes An Overview of Farmworker Demographics and Health Issues in Florida and the Southeast

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Title: Shifting Landscapes An Overview of Farmworker Demographics and Health Issues in Florida and the Southeast


1
Shifting LandscapesAn Overview of Farmworker
Demographics and Health Issues in Florida and the
Southeast
Erin Kay Sologaistoa, M.S. Southeast Migrant
Health Coordinator Florida Association of
Community Health Centers
2
The Southeast Florida, Georgia, Alabama,
Mississippi
3
Geographic Area and Number of Counties
State Land Area (Sq. Miles) Counties
FL 54K 67
GA 59K 159
AL 52K 67
MS 48K 82
U.S. Census, 2000
4
Perspective Florida vs. Maryland
MSFW Analysis - Florida
5
Population
State Rank Population Non Citizen
FL 4 16,396,515 11
GA 10 8,383,915 4
AL 23 4,464,356 1
MS 31 2,858,029 1
U.S. Census, 2000
6
Ethnic Composition
State Hispanic Black
FL 16.8 14.6
GA 5.3 28.7
AL 1.7 26.0
MS 1.4 36.3
U.S. 12.5 12.3
U.S. Census, 2000
7
Poverty Levels
State Percent of Pop 100 of Poverty Number of People 100 of Poverty
FL 12.5 2,000,000
GA 13.0 1,100,100
AL 16.1 700,000
MS 19.9 600,000
U.S. 11.7 32,900,000
U.S. Census, 2000
8
Ethnic Diversity
  • Mexicans
  • Cubans
  • Guatemalans
  • Central Americans
  • South Americans
  • American Blacks
  • Caribbeans
  • Haitians
  • Puerto Ricans
  • Asians
  • SE has Fastest Growing Hispanic Population
  • FL Haitian Population doubled between 1990-2000
    (182,000)

9
Income Inequality
  • There are extreme contrasts between rich
  • and poor within small geographic areas.
  • For example
  • Palm Beach and Belle Glade
  • Naples and Immokalee

10
Population Distribution
11
Agricultural Acreage
State Total Million Acres Million Acres/Crops Cropland
FL 34.6 3.8 11
GA 37.6 5.3 14
AL 32.5 4.1 13
MS 30.0 5.9 20
U.S, Census of Agriculture, 1997
12
Most Important Commodities (Cash Receipts 2001)
Rank FL GA AL MS
1 Nursery Broilers Broilers Broilers
2 Citrus Cotton Cattle/Calf Cotton
3 Tomatoes Peanuts Eggs Aquaculture
4 Green Peppers Eggs Nursery Cattle/Calf
5 Strawberries Cattle/Calf Cotton Eggs
U.S, Census of Agriculture
13
Rank in 7 Hand Crops from Top 25 Commodities
(cash receipts 2001)  
Rank Vegetable FruitNuts Nursery Tomato Orange Straw Tobacco
1 CA CA CA CA FL CA
2 FL FL FL FL CA FL
3 AZ WA TX OH TX NC
6 GA
8 FL
U.S, Census of Agriculture
14
Florida Agriculture
  • 2nd most important industry generates 6.2
    billion
  • One of the longest growing seasons in U.S.(9 mo.)
  • 3rd (after CA and TX) in hired farm labor
  • 5th in agricultural chemicals
  • 9th largest producer of farm commodities

15
Major Agricultural Trends
  • Growth in the Nursery, Greenhouse and Fern
  • Industry
  • The Southeast and Delta Regions had one of the
    largest increases in hired farm workers between
    2001 and 2002 due to accelerating nursery and
    greenhouse activity (U.S. Census of Agriculture)
  • 9 of the 30 leading congressional districts for
    nursery and greenhouse crops are in Florida one
    is in Georgia
  • This industry is dominated by women.

16
Major Agricultural Trends
  • Rapid Pace of Farm Land Sold For Development
  • Between 2002 and 2003 Florida was one of ten
    states with the largest decreases in farm land,
    losing 100,000 acres (USDA)

17
Population Growth
State Growth 1990-2000 Change 1990-2000 Projection 2015
FL 24.0 3 Million 18,497,000
GA 26.4 1.7 Million 9,200,000
AL 10.1 400 Thousand 4,956,000
MS 10.5 271 Thousand 3,035,000
U.S. 13.1 32.7 Million 325,400,000
18
Florida Growth
  • 650 people move to Florida a day 1 million every
    4 years (U.S. Census)
  • Between 1995 and 2025, population growth in CA,
    FL and TX will account for 45 of the net
    population change in the U.S. (U.S. Dept of
    Commerce, Economic and Statistics Service)

19
Florida Stressors
  • High degree of ethnic diversity
  • High growth rate demands increases in
    infrastructure and services
  • Low property taxes
  • No personal income tax
  • Many homestead exemptions
  • Large number of retirees
  • Lack of resources for needed services
  • Low level of public investment in services

20
Florida Rural Health Challenges
  • 982,544 medically underserved in 67 geographic
    regions
  • 13 entire counties MUP
  • 14 counties lack even one pediatrician
  • 33 counties lack even one OB/GYN
  • Highest of elderly at 18.5 vs. the national
    average of 12.8.

21
Farmworker Demographics
State Total Migrant Seasonal Migrant
FL 286 K 165 K 121 K 57
GA 94 K 28 K 65 K 30
AL 6.5 K 4 K 2.5 K 61
MS 18 K 4.5 K 14 K 25
(Larsons and/or BPHC Atlas of State Profiles)
22
Florida Farmworkers
  • 82 Male
  • 86 Hispanic
  • 9 Black Non Hispanic
  • Mean Age of 30
  • 39 Married with Children
  • 43 Single without Children

(University of Florida Dept of Anthropology/
Florida Department of Community Affairs 2002)
23
MSFW Total Population
MSFW Analysis - Florida

Source Larsons and NCFH
24
Florida Farmworkers According to NAWS
  • 66 poverty
  • 42 consider Florida their permanent residence
  • 32 consider Mexico their permanent residence
  • Settled farmworkers spend an average of 11.5
    months a year in Florida
  • Migrants spend an average of 6.3 months in
    Florida
  • 81 are uninsured
  • 6 have employer provided insurance

25
Florida and Georgia Farmworker Demographic
Trends
  • Increasing numbers of educated Latin Americans
    who were not farmers in their countries
  • Increasing numbers leaving farm work in a
    decreasing amount of time
  • Decreasing numbers of migrant labor camps leading
    to increasing housing shortages
  • Increasing numbers of 13-16 year old males (30
    more in the past 3 years according to the Florida
    Farmworker Association)
  • Increasing numbers of indigenous speakers from
    Southern Mexico and Central America
  • Increasing numbers of South Americans
  • Increasing numbers of Farmworkers in N. FL/ S.
    GA.

26
Florida Farmworker Issues
  • Increasing unemployment and under employment
  • Lack of housing
  • Highest number of labor contractors leading to
    abuse and lack of grower accountability
  • Lack of drivers licenses and fear of deportation
  • Workers Comp reform allowing insurance companies
    to contest every claim has caused fewer MSFW to
    file (80 million five years ago to 25 million
    today)
  • Barrier to higher education caused by social
    security number requirement

27
Pesticides
  • Lax laws requiring growers to inform workers
    about pesticide risks and safety measures
  • Lax enforcement of existing laws
  • Conflict of interest created because the Dept. of
    Agriculture enforces laws created by Agriculture
    committees run by agricultural interests
  • Lack of knowledge about Florida specific
    pesticides especially for ornamentals (organo
    phosphates)
  • Treated strictly as an agricultural issue with
    little involvement by the DOH
  • Lack of buffer zones between fields and living
    quarters, schools and communities (Methyl
    bromide)

28
Florida and Georgia Frequent Diagnosis
  • Diabetes
  • Hypertension
  • Heat Stroke
  • Farm Injuries (104 fatalities in Florida)
  • Vehicle Accidents
  • Muscle Strain
  • Dermatitis
  • Repetitive Motion Injuries
  • Eye Injuries
  • Green Tobacco Sickness

29
Florida Farmworker Health Issues and Trends
  • HIV in young, male population
  • Lack of early access to prenatal care
  • Teen Pregnancy
  • Lack of Mental Health Services
  • Lack of Dental Services
  • Domestic Violence
  • Growing number of free clinics (Gaps)

30
Community and Migrant Health Centers in the
Southeast
State Total CHC MHC MHC/CHC
FL 153 79 0 74
GA 85 68 13 4
AL 91 82 1 9
MS 100 100 0 0

31
Florida FQHC Locations
32
Southeast FQHC Users
2002 UDS FL GA AL MS
Total Users 501,193 200,819 272,360 285,796
100 poverty 64 57 57 60
Uninsured 54.9 45 44 45
Regular Medicaid 24.4 25 32 33
Non White 65 72 64 67
BSIAL 29 11 4 1
Migrants 40,005 9,777 2,530 247
Seasonal 17,151 1,394 1,734 247
MSFW Pen Rate 20 12 65 1.4

33
Southeast FQHC Provider Breakdown
2002 UDS FL GA AL MS
Total Users 501,193 200,819 272,360 285,796
Primary Care Physicians 239 90 120 109
Other Physicians (inc. Psych) 12 3 lt1 lt2
Nurses 118 48 53 76
Dentists 43 10 18 32
Dental Hygienist 17 3 14 5
34
MHC/CHC Grantee Delivery Areas MSFW Population
Data sources MSFW Enumeration Profiles Study
FL, Larson, 9/2000 BPHC web site, 5/2003, and
FACHC update, 5/2003 NCFH
35
Florida Intended Expansions Through 2007
  • 28 sites
  • 118 providers
  • 146,450 patients
  • 12,000 MSFW
  • 10 EMC
  • 5 behavioral health sites
  • 11 dental sites
  • (Florida State Strategic Plan)

36
Is Florida Getting its Share of the Pie?
37
Barriers to Care
  • Lack of
  • Accurate data on farmworkers
  • Access to specialty services
  • Comprehensive language access strategy
  • Transportation
  • Workforce Shortages
  • State and County boundaries
  • High cost of pharmaceuticals for those 100 of
    poverty
  • Penalties for non participation in collaboratives
    where none exist
  • Need for clinicians to inquire about type of work
    performed by MSFW

38
A Closer Look at Some Barriers to Care
  • Florida Workforce Shortages
  • Physicians
  • Nurses
  • Bi-lingual Psychologists/Psychiatrists
  • Dentists

39
A Closer Look at Some Barriers to Care
  • Workforce Shortages
  • 31rst in number of RNs per 100,000
  • Will need 34,000 additional nurses by 2006 (
    HRSA)
  • Imports 90 of its new physicians each year
  • 50 received their education in other countries
  • Third in percentage of practicing physicians
    educated in other countries

40
A Closer Look at Some Barriers to Care
  • Lack of Access to Specialty Services such as
  • Radiology
  • Specialized Blood work,
  • Cat scans
  • Surgical specialties
  • ENT

41
A Closer Look at Some Barriers to Care
  • Barriers to Accessing Specialty Services
  • High cost of malpractice insurance means
    specialists arent willing to take the risk,
    especially with patients that have a low rate of
    compliance
  • Many specialists require patients to present a
    Social Security card

42
A Closer Look at Some Barriers to Care
  • Transportation
  • Not viewed as cost effective Liability
    insurance 9000 per Van
  • Transportation to specialists is particularly
    difficult
  • Language Access
  • No comprehensive strategy for addressing language
    access

43
Recommendation 1
  • Make It Easier For Specialists To Work
  • With FQHCs
  • Increase the number of specialists that can
    participate in Medicaid
  • Afford liability immunity (FTCA coverage) to
    specialty and secondary care providers who
    provide services to the uninsured
  • Encourage states to increase Medicaid payments
    for specialty care, acknowledging that Medicaid
    patients are sicker and the potential problems
    are greater.

44
Recommendation 2
  • Increase Funding For
  • Pharmaceuticals
  • Dental
  • Chronic diseases such as diabetes, hypertension
    and cancer
  • Capital Outlay
  • Loan forgiveness for FQHC practitioners,
    including bi-lingual mental health professionals

45
Recommendation 3 and 4
  • Ensure agencies receiving BPHC funding
  • are coordinating with FQHCs to ensure continuity
    and avoid piecemeal, sporadic care.
  • Develop a nationally accessible computerized
    record tracking system.

46
Recommendations 5
  • Research
  • The changing needs of settled farmworkers moving
    into new industries such as construction and
    landscaping
  • Pesticides in Florida, especially in the
    greenhouse and nursery industries
  • Adolescent health including teenage pregnancy,
    HIV and STDs

47
Recommendation 6 and 7
  • Advocate for the right of non-citizens to
  • hold a drivers license
  • Encourage the recruitment of
  • farmworkers into the health care field.
  • Work with the Department of Education to
    eliminate barriers to secondary and post
    secondary education, such as the Social Security
    number requirement.

48
Contact Information
  • Erin Kay Sologaistoa
  • Migrant Health Coordinator
  • Florida Association of Community Health Centers
  • 433 N. Magnolia Drive
  • Tallahassee, Florida 32308
  • Phone(850)942-1822
  • Fax (850)942-9902
  • erin_at_fachc.org
  • www.fachc.org
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