The Geography of Farmworker Health: A Mixed-Method Exploratory Analysis of Chronic Disease
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Known by some as the ‘invisible’ people because of their precarious work and low social status, migratory and seasonal farmworkers (MSFW) are a critical and underappreciated component to the agriculture industry in the United States. Despite advances in knowledge of about the health needs of this population, identifying geographic regions of high-risk remains a challenging task for community health workers and farmworker advocacy organizations. Guided by the farmworker ecosocial model of health, this dissertation for the first time investigated the geography of farmworker health in California, Colorado, and Michigan. This study utilized two quantitative techniques. The first, spatial scan statistics, were used to measure geographic variations in farmworker disease clusters, while the second technique featured the delineation of healthcare service areas. Qualitative techniques featured interviews with key informants and farmworkers based on the theoretical foundation of social epidemiology. In the study areas, this dissertation found 209 total disease clusters (< 0.02) encompassing 259 zip codes, and 2,732 farmworkers (7% of total population) living greater than 30-minutes from community and migrant health centers (C/MHC). Patient encounters at all C/MHC’s were predominantly for diabetes and evenly distributed; however, farmworkers treated for chronic disease risk factors had the highest percentage of total encounters when comparing individual clinics. Additionally, 32 interviews conducted at C/MHC’s revealed that contextual-level barriers to healthcare are numerous in all study areas and include lack of transportation, poverty, inadequate housing, cultural practices, low educational attainment, and healthcare literacy. Farmworkers were on average young (33.9), and likely to practice circular-migration in Colorado and Michigan, while their counterparts in California resided in the area year-round. By better understanding, the health of farmworkers from multiple contextual and methodological perspectives, appropriate outreach, research, and policy strategies for migratory and seasonal farmworkers can be developed to best serve the unique geographic challenges highlighted in this dissertation.