The oldest of all laws that have come to comprise the modern health centers program, The Migrant Health Act, signed in to law by President John F. Kennedy in 1962, authorized the development and support of clinical health care services for migrant farmworkers and their families. Today the program is part of the same Public Health Service Act statute that authorizes the establishment and operation of health centers, providing grants to support health care for migrant and seasonal farmworker families. The United States Department of Health and Human Services, Health Resources and Services Administration (HRSA), had awarded funds to 169 grantees (2013) ,most of which are jointly funded as Community and Migrant Health Centers. Migrant health centers serve approximately 25% of all migrant farm workers in the United States, providing care to over 800,000 migrant and seasonal farmworkers and their families.
Migrant farm workers, defined as seasonal agricultural employees who take up temporary residence during their employment, are the backbone of the nation’s agricultural workforce, comprising over 40% of the nation’s estimated 3 to 5 million agricultural workers. This highly mobile, physically taxing and incredibly important work is poorly compensated, making farmworkers among the most economically disadvantaged populations in the country. Few farmworkers have health insurance, and while farmworkers typically would qualify for Medicaid on the basis of income, the complexity of applying for Medicaid, coupled with a transitory existence, greatly limits the program’s reach, making health center services particularly important.
Migrant farmworkers endure substandard housing and sanitation conditions, as well as poor working conditions and unique occupational health hazards, including exposure to weather, pesticides, and dangerous equipment. These factors increase the vulnerability of farmworkers to illness and injury; the health status of farmworkers has been compared with that of populations in developing nations. Poverty, lack of health insurance, language barriers, long work hours, and distance from medical services compound the problem problems of poor health status and high incidence of chronic and episodic health conditions. Since most farmworkers lack paid sick leave or job protection, most cannot afford to miss work in order to receive medical care, and many postpone seeking health care services unless or until they face an emergency.
Working from both fixed and mobile sites, migrant health centers provide accessible health care aimed at addressing the complex needs of the farmworker population. The centers offer primary and preventive care, as well as dental care, behavioral health and pharmacy services. To address the complex access barriers that confront migrant farmworkers, health centers provide culturally and linguistically appropriate care and offer outreach, education, extended hours, and transportation and support services. The centers also coordinate care for farmworkers whose location changes as their employment shifts.
