Seasonal agricultural workers come to Vermont to fill the employment gap faced by local farmers. In Vermont, they are mainly from the island of Jamaica. The program hinges on a pattern or event that makes it temporary so, you will find most farmworkers here between April and November each year, for the growing season working in ground crops, apple orchards, or processing facilities. As a Jamaican national with family members and friends who have come as migrant workers and Community Health Worker, I bring a unique and critical perspective about prominent health needs, barriers and the role that culture plays.
A little history on the H-2 program in the US
The H-2 visa program that allows foreigners to temporarily work in US industries with labor shortages started in the 1950s. It now consists of 2 visa types: H2A (agricultural) and H2B (non-agricultural). There are several participating countries. However, since most workers in Vermont are Jamaicans, the focus is placed on that nationality in this context. The program is a significant one that highlights bilateral agreements between the US and Jamaica. Jamaica would provide temporary agricultural labor to fill the increasing need in the US. Business owners must be able to demonstrate a shortage of domestic labor or an absence of willing or qualified US workers for seasonal work.
Farmworkers in Vermont
Over 400 temporary agricultural workers are hidden and underserved throughout the State as a marginalized group of black men coming from a developing country in the Caribbean where resources are scarce. Despite resource scarcity in their home country, many would rather wait to return home to see a doctor especially due to fear and cost. I met two workers who have been coming to Vermont on the farm work program for over 25 years spending more time in Vermont than at home in Jamaica! There are many others serving more than a decade, with newer workers averaging 3-8 years. Many have relayed to me that they have never interacted with the health care system here before. When asked the reasons for this, their responses have fallen in two categories. “I have never seen a doctor in Vermont” or “I don’t really know where to go but one time I needed to go, and my boss took me.” Let’s dive into this further. The lack of access to health care is for a plethora of reasons. They stem from institutional barriers due to their marginalization or personal barriers or often a combination of both.
H2A workers have legal status in the country for the number of months their contracts are for. In that time, they have access to some rights and are ineligible for others. For example, they qualify to get a qualified health insurance plan that they pay a monthly premium to maintain but do not qualify for social security benefits or federal health care programs like Medicaid despite being income eligible.
One very interesting thing that blew my mind was that even after decades of farm labor across the state, many Vermonters are unaware of the existence of Jamaican farmworkers and the role they play in the State’s food system.
Health Needs
Most of the men who come to work on the farms are healthy enough (meaning an ability to work the long hard hours required for the job and the absence of significant impacts of chronic illness). However, we have found hypertension and diabetes to be quite common among Jamaican farmworkers. For those who have been diagnosed and are on medication, they try to bring as much medications as they can with them from Jamaica. Often, they are able to bring 2-3 months’ worth – not enough to last the 6 to 10 months that will be in Vermont. This results in them going many months without medications. The mindset behind this is that they will just have to deal with their health when they return home. Many are fearful of the cost of care and medications should they go to a doctor in Vermont. For those who have tried to access care at a local clinic for ongoing management, they have faced many barriers.
Registration paperwork in some cases is 6-15 pages long. To establish care, especially for a chronic condition, most clinics require previous medical records, which are very challenging to obtain from Jamaica. Even if they find a local clinic that accepts patients without medical records in unique circumstances, many are scheduling establishing care visits months into the future. Additional barriers include lack of access to personal transportation and the reality that missing work means missing out on pay. Clinics are generally not open after work ends in the evenings. Workers are fearful of requesting time off during the workday, and that if health issues are disclosed then they will not be asked to return in future years. This will significantly impact their ability to provide for their families. The cost of both clinic visits and prescriptions are of concern.
This is where Bridges to Health, an initiative within Migrant Health Programs of the University of Vermont Extension, fits in. We have been advocating for equitable health care access for farm workers (and migrant workers in general) across the state for over a decade. This work requires creative problem solving to coordinate health appointments. Whenever possible we support clients in accessing care at a free clinic for the uninsured (where they often offer evening hours) or community health centers that offer a financial assistance program or sliding fee scale. In the case of many Jamaican workers who do not live near a free clinic with evening hours and face the myriad barriers described above, access to a brick-and-mortar site remains out of reach. To counter this, we have been successful in select counties in bringing screenings and consults to the farms on evenings and weekends in collaboration with the UVM Medical Centers Family Medicine Residency Program and volunteers with our program. Using good RX, we are often able to help workers with chronic health issues in accessing low-cost prescriptions.
Farmworker Health from a Cultural Standpoint
Even with the support we can provide, there are key cultural factors that influence how and if a Jamaican worker is open to treatment for health issues. As a nation of 3 million people, the number one cause of death in Jamaicans is hypertension and heart disease (PAHO 2021). Workers are aware of these conditions in society often with a close connection- either in an immediate or extended family member. Yet many are resistant to the use of pharmaceutical drugs as a response to any ailment. Some believe that even if you do take the medication, it usually is a one-off case where once they have completed one dose/bottle/treatment, there is no need to repeat. Many times, they just stop taking the pills because they “feel fine”. I’ve ran into cases where farmworkers who were prescribed medications, when followed up by a provider will disclose that they finished the bottle of pills and threw it out as they don’t believe or even understand the concept of “refills.”
Another side to this is that many are family focused to the point where it is hard for them to prioritize their health. In their eyes, they can’t afford to lose money that their family needs to survive (as many are the sole providers in their households spanning multiple generations). They struggle to see the connection between being in good health and their ability to provide in a sustainable way. Unfortunately, in addition to family history and cultural beliefs and norms, diet plays a role here. It is more complex to address as our diet is at the cornerstone of our culture, ‘wellbeing’ and source of fulfillment.
Conclusion
In short, farmworkers have been coming to Vermont for decades to ‘till the soil’. Regrettably, the nature of the H2A program puts wellbeing on a back burner. For many workers, their health takes second priority to the work and related income that allows them to provide for their families. We know that the strenuousness of the job will only deteriorate their health at a much faster rate. For those with chronic health concerns, my concerns are exorbitant. As a state that is greatly benefited by those who contribute years of backbreaking labor, my hope is that there can be statewide support to ensure that programs like ours can grow and be sustained as an approach to addressing farmworker health. As an individual, you can seek out ways to volunteer and promote funding for our program, centering marginalized migrant community members while contributing to social justice and equity.