Sherry L. Baron, MD, MPH, Sharon Beard, MS, Letitia K. Davis, ScD, EdM, Linda Delp, PhD, MPH, Linda Forst, MD, MPH, Andrea Kidd-Taylor, PHD, Amy K. Liebman, MPA, MA, Laura Linnan, ScD, Laura Punnett, ScD, and Laura S. Welch, MD
Background: Nearly one of every three workers in the United States is low-income. Low-income populations have a lower life expectancy and greater rates of chronic diseases compared to those with higher incomes. Low- income workers face hazards in their workplaces as well as in their communities. Developing integrated public health programs that address these combined health hazards, especially the interaction of occupational and non-occupational risk factors, can promote greater health equity.
Methods: We apply a social-ecological perspective in considering ways to improve the health of the low-income working population through integrated health protection and health promotion programs initiated in four different settings: the worksite, state and local health departments, community health centers, and community-based organizations.
Results: Examples of successful approaches to developing integrated programs are presented in each of these settings. These examples illustrate several complementary venues for public health programs that consider the complex interplay between work related and non work-related factors, that integrate health protection with health promotion and that are delivered at multiple levels to improve health for low-income workers.
Conclusions: Whether at the workplace or in the community, employers, workers, labor and community advocates, in partnership with public health practitioners, can deliver comprehensive and integrated health protection and health promotion programs. Recommendations for improved research, training, and coordination among health departments, health practitioners, worksites and community organizations are proposed.
- final PDF.pdf (195.08 KB)
Carlos Eduardo Siqueira, MD, ScD, Megan Gaydos, MPH, Celeste Monforton, Dr PH, MPH, Craig Slatin, ScD, MPH, Liz Borkowski, BA, Peter Dooley, MS, CIH, CSP, Amy Liebman, MPA, MA, Erica Rosenberg, JD, Glenn Shor, PhD, MPP, and Matthew Keifer, MD, MPH
Background This article introduces some key labor, economic, and social policies that historically and currently impact occupational health disparities in the United States.
Methods We conducted a broad review of the peer-reviewed and gray literature on the effects of social, economic, and labor policies on occupational health disparities.
Results Many populations such as tipped workers, public employees, immigrant workers, and misclassified workers are not protected by current laws and policies, including worker’s compensation or Occupational Safety and Health Administration enforcement of standards. Local and state initiatives, such as living wage laws and community benefit agreements, as well as multiagency law enforcement contribute to reducing occupational health disparities.
Conclusions There is a need to build coalitions and collaborations to command the resources necessary to identify, and then reduce and eliminate occupational disparities by establishing healthy, safe, and just work for all.
Sara A. Quandt, PhD, Kristen L. Kucera, PhD, Courtney Haynes, MS, Bradley G. Klein, PhD, Ricky Langley, MD, Michael Agnew, PhD, Jeffrey L. Levin, MD, Timothy Howard, PhD, and Maury A. Nussbaum, PhD
Background Workers in the Agriculture, Forestry, and Fisheries (AgFF) sector experience exposures directly related to the work itself, as well as the physical environment in which the work occurs. Health outcomes vary from immediate to delayed, and from acute to chronic.
Methods We reviewed existing literature on the health outcomes of work in the AgFF sector and identified areas where further research is needed to understand the impact of these exposures on immigrant Latino workers in the southeastern US.
Results Outcomes related to specific body systems (e.g., musculoskeletal, respiratory) as well as particular exposure sources (e.g., pesticides, noise) were reviewed. The most extensive evidence exists for agriculture, with a particular focus on chemical exposures. Little research in the southeastern US has examined health outcomes of exposures of immigrant workers in forestry or fisheries.
Conclusion As the AgFF labor force includes a growing number of Latino immigrants, more research is needed to characterize a broad range of exposures and health outcomes experienced by this population, particularly in forestry and fisheries.
- 3 Quandt et al Occupational health outcomes.pdf (183.18 KB)
Arthur L. Frank, MD, PhD, Amy K. Liebman, MPH, MA, Bobbi Ryder, BA, Maria Weir, MAA, MPH, and Thomas A. Arcury, PhD
Background The Agriculture, Forestry, and Fishery (AgFF) Sector workforce in theUS is comprised primarily of Latino immigrants. Health care access for these workersis limited and increases health disparities.
Methods This article addresses health care access for immigrant workers in the AgFF Sector, and the workforce providing care to these workers.
Contents Immigrant workers bear a disproportionate burden of poverty and ill health and additionally face significant occupational hazards. AgFF laborers largely are uninsured, ineligible for benefits, and unable to afford health services. The new Affordable Care Act will likely not benefit such individuals. Community and Migrant Health Centers (C/MHCs) are the frontline of health care access for immigrant AgFF workers.C/MHCs offer discounted health services that are tailored to meet the special needs of their underserved clientele. C/MHCs struggle, however, with a shortage of primary care providers and staff prepared to treat occupational illness and injury among AgFF workers. A number of programs across the US aim to increase the number of primary care physicians and care givers trained in occupational health at C/MHCs. While such programs are beneficial, substantial action is needed at the national level to strengthen and expand the C/MHC system and to establish widely Medical Home models and Accountable Care Organizations. System-wide policy changes alone have the potential to reduce and eliminate the rampant health disparities experienced by the immigrant workers who sustain the vital Agricultural, Forestry, and Fishery sector in the US. Am. J. Ind. Med.
By Amy K. Liebman, MPA, MA, Melinda F. Wiggins, MTS, Clermont Fraser, JD, Jeffrey Levin, MD, MSPH, Jill Sidebottom, PhD, and Thomas A. Arcury, PhD
Background Immigrant workers make up an important portion of the hired workforce inthe Agricultural, Forestry and Fishing (AgFF) sector, one of the most hazardous industrysectors in the US. Despite the inherent dangers associated with this sector, workerprotection is limited.
Methods This article describes the current occupational health and safety policies andregulatory standards in theAgFF sector and underscores the regulatory exceptions and limitationsin worker protections. Immigration policies and their effects on worker health and safety arealso discussed. Emphasis is placed on policies and practices in the Southeastern US.
Results Worker protection in the AgFF sector is limited. Regulatory protections are generallyweaker than other industrial sectors and enforcement of existing regulations is woefullyinadequate. The vulnerability of the AgFF workforce is magnified by worker immigrationstatus. Agricultural workers in particular are affected by a long history of “exceptionalism”under the law as many regulatory protections specifically exclude this workforce.
Conclusions A vulnerable workforce and high-hazard industries require regulatoryprotections that, at a minimum, are provided to workers in other industries. A systematicpolicy approach to strengthen occupational safety and health in the AgFF sector mustaddress both immigration policy and worker protection regulations.
- 5 Liebman et al Occupational health policy.pdf (123.07 KB)
CDC’s US-Mexico Unit (USMU) works to prevent the spread of infectious disease across borders and improve and promote the health of travelers, migrants, and other mobile border and binational populations. USMU’s main activities include collaborating on the US-Mexico Binational Technical Working Group, overseeing the operation of the Binational Border Infectious Disease Surveillance Program (BIDS), migrant health and binational tuberculosis programs, and international regulatory responsibilities. Their website on US-Mexico health provides a brief overview of the public health issues unique to the border region, our key partners, the guidelines for cooperation, and a resources page complete with health education/communication resources and publications.
To learn more, please visit http://www.cdc.gov/USMexicoHealth/index.html and check back for updates and a Spanish mirror site which should launch this summer.
The West Virginia Rural Health Research Center (WVRHRC) pursues a multi-disciplinary research effort directed to improve environmental health for rural populations. Collaborators from public health, geographic information systems, nursing, pharmacy, environmental science, health policy and other disciplines work together to conduct policy-relevant research to achieve this goal.
This study, conducted by the West Virginia Rural Health Research Center, identified the availability and characteristics of agricultural medicine training opportunities for health care professionals. Agricultural workers and their families face numerous threats to health and safety, and yet there is limited information on health care expertise in place to recognize and prevent threats, and to diagnosis and treat agriculturally-related injury and illness.
- WVRHRC Ag Health Training Policy Brief.pdf (437.33 KB)
- WVRHRC Ag Health Training Final Report.pdf (477.87 KB)
Good article on cultural humility--basically the groundbreaking one used to propose the term
Journal of Health Care for the Poor and Underserved; May 1998; 9, 2; Research Library
Melanie Tervalon; Jann Murray-Garcia
Objectives. We assessed implicit and explicit bias against both Latinos and
This article from the American Journal of Public Health is on implicit bias.
Authors: Irene V. Blair, PhD, Edward P. Havranek, MD, David W. Price, MD, Rebecca Hanratty, MD, Diane L. Fairclough, DrPH, Tillman Farley, MD, Holen K. Hirsh, PhD, and John F. Steiner, MD, MPH
Objectives. We assessed implicit and explicit bias against both Latinos and African Americans among experienced primary care providers (PCPs) and community members (CMs) in the same geographic area.
Methods. Two hundred ten PCPs and 190 CMs from 3 health care organizationsin the Denver, Colorado, metropolitan area completed Implicit Association Tests and self-report measures of implicit and explicit bias, respectively.
Results. With a 60% participation rate, the PCPs demonstrated substantial implicit bias against both Latinos and African Americans, but this was no different from CMs. Explicit bias was largely absent in both groups. Adjustment for background characteristics showed the PCPs had slightly weaker ethnic/racial bias than CMs.
Conclusions. This research provided the first evidence of implicit bias against Latinos in health care, as well as confirming previous findings of implicit bias against African Americans. Lack of substantive differences in bias between the experienced PCPs and CMs suggested a wider societal problem. At the same time, the wide range of implicit bias suggested that bias in health care is neither uniform nor inevitable, and important lessons might be learned from providers who do not exhibit bias.
(Am J Public Health. 2013;103:92–98. doi:10.2105/AJPH.2012.300812)
- AJPH 2012Bias.pdf (528.21 KB)
This web site houses a collection of information, contacts and resources to assist health practitioners in providing care to migrant farm workers. Although the primary intended audience is health care providers in Ontario, much of the information may be useful to other parties.
This website contains information on the 156 health centers that get federal funds to provide primary care to migrant and seasonal farmworkers regardless of immigration status. Most are part of community health centers that also receive additional federal funding to serve all low-income people. They offer services on a sliding fee scale.
A preliminary total of fatal work injuries recorded in the United States. According to results from the
Census of Fatal Occupational Injuries (CFOI) program conducted by the U.S. Bureau of Labor
Statistics.
At Workers' Comp Hub we provide basic information for workers with job-related injuries and illnesses. We also share resources to advance pro-worker advocacy and action.
The Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) provides for federal regulation of pesticide distribution, sale, and use. All pesticides distributed or sold in the United States must be registered (licensed) by EPA. Before EPA may register a pesticide under FIFRA, the applicant must show, among other things, that using the pesticide according to specifications "will not generally cause unreasonable adverse effects on the environment.''
Haz-Map® is an occupational health database designed for health and safety professionals and for consumers seeking information about the adverse effects of workplace exposures to chemical and biological agents. The main links in Haz-Map are between chemicals and occupational diseases. These links have been established using current scientific evidence.
Children encounter pesticides daily and have unique susceptibilities to their potential toxicity. Acute poisoning risks are clear, and understanding of chronic health implications from both acute and chronic exposure are emerging. Epidemiologic evidence demonstrates associations between early life exposure to pesticides and pediatric cancers, decreased cognitive function, and behavioral problems.
In this policy statement, the American Association of Pediatrics outlines the symptoms and suggested course of treatment for acute exposure pesticides belonging to the eight most predominant classes of pesticides. The policy statement also makes recommendations for both pediatricians and government to take measures to improve pesticide safety.
© AAP - 2012; This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors.
- PestExposureChild_Policy_AAP.pdf (523.63 KB)
The California Healthcare News regularly posts jobs around the state. Check back frequently for updated information.
Barbara C. Lee PhD, Susan S. Gallagher MPH, Amy K. Liebman MPA, MA, Mary E. Miller RN, MN & Barbara Marlenga PhD (2012)Journal of Agromedicine, 17:2, 88-93ABSTRACT. In 1996 the US launched a National Childhood Agricultural Injury Prevention Initiative, guided by an action plan generated by a 42-member multidisciplinary committee. A major update to the plan was released following the 2001 Summit on Childhood Agricultural Injury Prevention. From the year 2010 through 2011 a comprehensive assessment of progress to date was conducted followed by the drafting, review and finalizing of a new action plan—“The 2012 Blueprint for Protecting Children in Agriculture.” This paper briefly describes the purpose and process for generating the new action plan then provides a listing of the 7 goals and 26 strategies within the plan. These goals and strategies account for trends in childhood agricultural injuries, changes in agricultural production and the demographics of its workforce, effectiveness of interventions, and the increasing use of social media, marketing and social networking. Primary funding for this project was provided by the National Institute for Occupational Safety and Health (NIOSH), which continues to serve as the lead federal agency for the national initiative.
- JAMmanus_Protecting Children_Apr2012.pdf (181.64 KB)
American Journal of Public Health. October 2012, Vol 102, No. 10
Werner E. Bischoff, MD, PhD, Maria Weir, MAA, MPH, Phillip Summers, MPH, Haiying Chen, MD, PhD, Sara A. Quandt, PhD,
Amy K. Liebman, MPA, MA, and Thomas A. Arcury, PhD
Objectives. The purpose of this study was to assess water quality in migrant farmworker camps in North Carolina and determine associations of water quality with migrant farmworker housing characteristics. Methods. We collected data from 181 farmworker camps in eastern North Carolina during the 2010 agricultural season. Water samples were tested using the Total Coliform Rule (TCR) and housing characteristics were assessed using North Carolina Department of Labor standards. Results. A total of 61 (34%) of 181 camps failed the TCR. Total coliform bacteria were found in all 61 camps, with Escherichia coli also being detected in 2. Water quality was not associated with farmworker housing characteristics or with access to registered public water supplies. Multiple official violations of water quality standards had been reported for the registered public water supplies. Conclusions. Water supplied to farmworker camps often does not comply with current standards and poses a great risk to the physical health of farmworkers and surrounding communities. Expansion of water monitoring to more camps and changes to the regulations such as testing during occupancy and stronger enforcement are needed to secure water safety. (Am J Public Health. 2012;102: e49–e54. doi:10.2105/AJPH.2012.300738)
- Bischoff_etal_WaterQuality_AJPH_2012_0.pdf (495.42 KB)
Cancer statistics for Hispanics/Latinos, 2012 by Rebecca Siegel MPH, Deepa Naishadham MA, MS, Ahmedin Jemal DVM, PhD
Article first published online: 17 SEP 2012
Abstract
Hispanics/Latinos are the largest and fastest growing major demographic group in the United States, accounting for 16.3% (50.5 million/310 million) of the US population in 2010. In this article, the American Cancer Society updates a previous report on cancer statistics for Hispanics using incidence data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data from the National Center for Health Statistics. In 2012, an estimated 112,800 new cases of cancer will be diagnosed and 33,200 cancer deaths will occur among Hispanics. In 2009, the most recent year for which actual data are available, cancer surpassed heart disease as the leading cause of death among Hispanics. Among US Hispanics during the past 10 years of available data (2000-2009), cancer incidence rates declined by 1.7% per year among men and 0.3% per year among women, while cancer death rates declined by 2.3% per year in men and 1.4% per year in women. Hispanics have lower incidence and death rates than non-Hispanic whites for all cancers combined and for the 4 most common cancers (breast, prostate, lung and bronchus, and colorectum). However, Hispanics have higher incidence and mortality rates for cancers of the stomach, liver, uterine cervix, and gallbladder, reflecting greater exposure to cancer-causing infectious agents, lower rates of screening for cervical cancer, differences in lifestyle and dietary patterns, and possibly genetic factors. Strategies for reducing cancer risk among Hispanics include increasing utilization of screening and available vaccines, as well as implementing effective interventions to reduce obesity, alcohol consumption, and tobacco use. CA Cancer J Clin 2012;. © 2012 American Cancer Society.
New research out of Cornell University's College of Human Ecology found that low-income children of immigrants have much poorer health than low-income children of citizens, as reported in a special section of the journal Child Development.
Robert Wood Johnson Foundation
http://www.farmworkercliniciansmanual.com
This comprehensive manual was developed by the New York Center for Agricultural Medicine and Health and the Migrant Clinicians Network for the diagnosis and treatment of occupational injuries in migrant and seasonal farmworkers. The information in the manual does focus on agricultural occupations in the Northeast.
¡Cuídate! is an educational resource on the prevention of musculoskeletal injuries at work. This comic is in Spanish, English and Haitian Creole.
- injury prevention ENGLISH 2019.pdf (19.34 MB)
- injury prevention SPANISH 2019.pdf (11.9 MB)
- injury prevention WEB CREOLE AUG 14 2019.pdf (12.77 MB)