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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 richand 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/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
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 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.
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
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
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%
(Larson’s 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 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
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 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
27
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
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 2,530247Seasonal 17,151 1,394 1,734
MSFW Pen Rate 20% 12% 65% 1.4%
33
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
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 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
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 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.
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 fundingare 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 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.
48
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