Migrant and seasonal farmworkers represent a large, global population with the double hazard of occupational health hazards of farming superimposed on a foundation of poverty and migrancy, with its associated health and safety problems. In the United States, for example, there are as many as 5 million migrant and seasonal farmworkers, although precise numbers are not known. As the total farm population has decreased in the United States, the proportion of hired farmworkers has increased. Globally, workers migrate in every region of the world for work, with movement generally from poorer to wealthier countries. In general, migrants are given more hazardous and difficult jobs and have increased rates of illness and injury. Poverty and lack of adequate legal protection exacerbate the risks of occupational and non-occupational disease.
Studies of hazardous exposures and health problems in this population have been limited because of the general paucity of occupational health studies in agriculture and the specific difficulties in studying farmworkers, due to their migratory residence patterns, language and cultural barriers, and limited economic and political resources.
Migrant and seasonal agricultural workers in the United States are predominantly young, Hispanic males, although farmworkers also include whites, blacks, Southeast Asians and other ethnic groups. Almost two-thirds are foreign born; most have low levels of education and do not speak or read English. Poverty is a hallmark of agricultural workers, with over half having family incomes below the poverty level. Substandard working conditions prevail, salaries are low and there are few benefits. For example, less than one-fourth have health insurance. Seasonal and migrant agricultural workers in the United States work about half the year on the farm. Most work is in labour-intensive crops such as harvesting of fruits, nuts or vegetables.
The general health status of agricultural workers directly derives from their working conditions and low income. Deficiencies exist in nutrition, housing, sanitation, education and access to medical care. Crowded living conditions and inadequate nutrition may also contribute to the increased risks of acute, infectious illnesses. Farmworkers see a physician less often than non-farmworking populations, and their visits are overwhelmingly for treatment of acute illnesses and injuries. Preventive care is deficient in farmworker populations, and surveys of farmworker communities find a high prevalence of individuals with medical problems requiring attention. Preventive services such as vision and dental care are seriously deficient, and other preventive services such as immunizations are below the population averages. Anaemia is common, probably reflecting poor nutritional status.
The poverty and other barriers for migrant and seasonal farmworkers generally result in substandard living and working conditions. Many workers still lack access to basic sanitary facilities at the worksite. Living conditions vary from adequate government-maintained housing to substandard shacks and camps used while work exists in a particular area. Poor sanitation and crowding may be particular problems, increasing the risks of infectious diseases in the population. These problems are exacerbated among workers who migrate to follow agricultural work, reducing community resources and interactions at each living site.
Various studies have shown a greater burden of infectious diseases on morbidity and mortality in this population. Parasitic diseases are significantly increased among migrant workers. Increased deaths have been found for tuberculosis, as well as many other chronic diseases such as those of the cardiovascular, respiratory and urinary tracts. The greatest increase in mortality rates is for traumatic injuries, similar to the increase seen for this cause among farmers.
The health status of children of farmworkers is of particular concern. In addition to the stresses of poverty, poor nutrition and poor living conditions, the relative deficiency of preventive health services has a particularly serious impact on children. They also are exposed to the hazards of farming at a young age, both by living in the farming environment and by doing agricultural work. Children under 5 years of age are most at risk of unintentional injury from agricultural hazards such as machinery and farm animals. Above 10 years of age, many children begin working, particularly at times of acute labour need such as during harvesting. Working children may not have the necessary physical strength and coordination for farm labour, nor do they have adequate judgement for many situations. Exposure to agrochemicals is a particular problem, since children may not be aware of recent field application or be able to read warnings on chemical containers.
Farmworkers are at increased risk of pesticide illness during work in the fields. Exposures most commonly occur from direct contact with the spray of application equipment, from prolonged contact with recently sprayed foliage or from drift of pesticide applied by aircraft or other spray equipment. Re-entry intervals exist in some countries to prevent foliar contact while the pesticide on foliage is still toxic, but many places have no re-entry intervals, or they may not be obeyed to hasten the harvest. Mass poisonings from pesticide exposure continue to occur among agricultural workers.
The greatest workplace hazard to farmworkers is from sprains, strains and traumatic injuries. The risk of these outcomes is increased by the repetitive nature of much labour-intensive agricultural work, which often involves workers bending or stooping to reach crops. Some harvesting tasks may require the worker to carry heavy bags full of the harvested commodity, often while balancing on a ladder. There is substantial risk of traumatic injuries and musculoskeletal strains in this situation.
In the United States, one of the most serious causes of fatal injuries to farmworkers is motor vehicle accidents. These often occur when farmworkers are driving or being driven to or from the fields very early or late in the day on unsafe rural roads. Collisions may also occur with slow-moving farm equipment.
Dust and chemical exposures result in an increased risk of respiratory symptoms and disease in farmworkers. The specific hazard will vary with the local conditions and commodities. For example, in dry-climate farming, inorganic dust exposure may result in chronic bronchitis and dust-borne diseases of the lung.
Skin disease is the most common work-related health problem among agricultural workers. There are numerous causes of skin disease in this population, including trauma from using hand equipment such as clippers, irritants and allergens in agrochemicals, allergenic plant and animal materials (including poison ivy and poison oak), nettles and other irritant plants, skin infections caused or exacerbated by heat or prolonged water contact, and sun exposure (which can cause skin cancer).
Many other chronic diseases may be more common among migrant and seasonal farmworkers, but data on actual risks are limited. These include cancer; adverse reproductive outcomes, including miscarriage, infertility and birth defects; and chronic neurologic disorders. All of these outcomes have been observed in other farming populations, or those with high-level exposure to various agricultural toxins, but little is known about actual risk in farmworkers.