Social Determinants of Health of Migrant Farmworkers in Canada: A Literature Review

Transcription

1 Social Determinants of Health of Migrant Farmworkers in Canada: A Literature Review Willem van Heiningen, MD, McMaster University, Janet McLaughlin, PhD, Wilfrid Laurier University, Donald Cole, MD, University of Toronto, Beth Jackson, PhD, Public Health Agency of Canada Acknowledgements: An earlier version of this literature review (J. McLaughlin, Background Document on the Social Determinants of Health Among Migrant Farm Workers in Canada, PHAC, 2009) was funded by the Public Health Agency of Canada (PHAC).

2 Methods Multi-database thematic literature review on SDH among adult migrant farmworkers (MFWs) in the US and Canada Databases: Medline, Embase, CAB Global Health, CINAHL, and Sociological Abstracts from 1990 to unique peer reviewed articles retrieved 156 articles identified as having SDH relevance

3 Excluded Articles Reason for Exclusion Count population (not MFWs) 323 geography (not Canada/US) 262 no health focus 101 intervention (rather than SDH) 73 focus on children MFWs 57 focus on health outcomes, not SD 44 focus on research methods 31 focus on health beliefs/behaviours 30 historical (prior to 1990s) 12 study type (not original studies) 11 exposure assessment 4 Total 948 Note: only primary reason for exclusion included; in table some articles had multiple categories of exclusion.

4 Summary of Main Findings SDH Relevant Articles health services 56 working conditions 44 gender 21 culture and race 16 living conditions 15 policy 14 education and literacy 12 income and social status 12 social support 11 Relevant Working Conditions Articles pesticides 22 OHS training and provisions 12 general working conditions 12 workplace risks 8 ergonomic risks 2 Some articles multiple. Other themes identified included language, legal status, transportation, religion, discrimination.

5 Overview of Literature Majority of articles retrieved dealt with MFWs in the US useful comparative context, but most MFWs there are working without legal status Additionally sought out health focused studies of MFWs in Canada: McLaughlin (2009) (Ontario); Hennebry (2010) (Ontario); Otero and Preibisch (2009) (British Columbia)

6 MFW Programs in Canada Seasonal Agricultural Workers Program (SAWP) (managed migration program since 1966; workers come up to 8 months) Temporary Foreign Worker Program (TFWP) Low-Skilled Program (Open to agriculture since 2002; workers come up to 24 months) Approx 30,000 MFWs across Canada Majority: Ontario, Quebec, BC, Alberta

7 Demographics Canadian MFW Population Average age: years (SAWP) 97% male (SAWP) SAWP: Mexico, Commonwealth Caribbean countries TFWP: Any source country, e.g., Guatemala, El Salvador, Thailand, Philippines

8 Health Services Barriers Include: Inconsistent access to health insurance Isolation and lack of transportation Workers fear reporting health concerns Lack of interpreters Lack of rural doctors and occupational specialists Limited understanding of rights/entitlements Continuity of care and communication among mobile populations

9 Employment and working conditions High demand and low control Risks of farm work (exposure to agrochemicals, machines, soil, awkward and repetitive ergonomic positions, plants, climatic extremes, dangerous transportation, etc.) Poor and inconsistent occupational health and safety (OHS) protections and training Precarious nature of contracts no job security or protections; workers fear losing contracts and right to be in Canada

10 Culture, Race and Gender MFWs come from racialized groups and sometimes experience discrimination Indigenous workers (e.g. Maya of Guatemala) face additional language barriers and discrimination Women face harassment and pressure for sexual relationships, reproductive health concerns, intense competition for fewer jobs, and heightened emotional strain

11 Living Conditions Over-crowded, inconsistent conditions Little control over conditions; MFWs do not feel empowered to make complaints Potential health implications: poor sleep habits, susceptibility to infectious disease, compromised food and water safety, stress

12 Income / Social Status Low, seasonal incomes with numerous deductions Exclusion from some benefits (e.g. regular EI); lack of transnational social security/health insurance Potential health implications: e.g., nutritious food access, safe transportation

13 Policy Lack of coherent, focused, standardized policy on migrant worker health, OHS, health care, and other SDH issues Inconsistent and/or insufficient targeted initiatives and patchwork of interventions, mainly from non-government groups

14 Education, literacy and language Generally poor levels of education and literacy Difficulty understanding and applying health and safety instructions Poor health literacy Lack of language training opportunities Communication challenges with employers, community members, and health care providers

15 Social Support Isolation and lack of services and community integration in rural areas Dislocation from families and traditional support networks Restrictive nature of living conditions and long work hours sometimes limit personal relationships Potential health implications: mental and emotional health, lack of coping mechanisms

16 Conclusions Although the Canadian evidence is still limited, initial indications suggest that MFWs face numerous SDH issues in both the US and Canada Specifically targeted research as well as expanded program and modified policy interventions are needed to address these issues