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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

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The Southeast: Florida, Georgia, Alabama, Mississippi

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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

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Perspective: Florida vs. Maryland

MSFW Analysis - Florida

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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

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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

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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

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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)

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Income Inequality

There are extreme contrasts between richand poor within small geographic areas.

For example: Palm Beach and Belle Glade Naples and Immokalee

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Population Distribution

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Agricultural Acreage

State

Total Million Acres

Million Acres/Cro

ps

% 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

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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

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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

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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

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Major Agricultural Trends

Growth in the Nursery, Greenhouse and FernIndustry:

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.

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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)

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Population Growth

State Growth 1990-2000

Change1990-2000

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

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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)

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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

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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%.

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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%

(Larson’s and/or BPHC Atlas of State Profiles)

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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)

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MSFW Total Population

MSFW Analysis - Florida

*

Source: Larsons and NCFH

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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

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Florida and Georgia Farmworker Demographic Trends

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.

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

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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 driver’s licenses and fear of deportation Worker’s 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

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Pesticides

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)

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

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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

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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)

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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

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Florida FQHC Locations

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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 2,530247Seasonal 17,151 1,394 1,734

MSFW Pen Rate 20% 12% 65% 1.4%

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Southeast FQHC Provider Breakdown

2002 UDS FL GA AL MS

Total Users501,193 200,819 272,360 285,796

Primary Care Physicians 239 90 120 109

Other Physicians (inc. Psych) 12 3 <1 <2

Nurses 118 48 53 76

Dentists 43 10 18 32

Dental Hygienist 17 3 14 5

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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

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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)

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Is Florida Getting its Share of the Pie?

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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

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A Closer Look at Some Barriers to Care

Florida Workforce Shortages

Physicians Nurses Bi-lingual Psychologists/Psychiatrists Dentists

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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

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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

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A Closer Look at Some Barriers to Care

Barriers to Accessing Specialty Services

High cost of malpractice insurance means specialists aren’t 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

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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

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Recommendation #1

Make It Easier For Specialists To WorkWith 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.

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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

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Recommendation # 3 and #4

Ensure agencies receiving BPHC fundingare coordinating with FQHCs to ensure continuity and avoid “piecemeal, sporadic” care.

Develop a nationally accessible computerized record tracking system.

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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

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Recommendation #6 and #7

Advocate for the right of non-citizens tohold a driver’s 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.

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Contact Information

Erin Kay SologaistoaMigrant Health Coordinator

Florida Association of Community Health Centers433 N. Magnolia Drive

Tallahassee, Florida 32308Phone:(850)942-1822Fax: (850)942-9902

erin@fachc.orgwww.fachc.org