From Dowser.org, “Leora Fridman, 23 May 2011.
We often think of agricultural workers as healthy, physically active and surrounded by produce, but obesity and diabetes are at epidemic levels in many farm-worker communities. Researchers at the University of California’s Migration and Health Research Center (MAHRC) are developing a new program to improve agricultural worker health by combining elements from Mexican and U.S. health programs. The program, Sembrando Salud, seeks to increase fruit, vegetable and water consumption, increase activity, and improve mental health in a pilot group of farm workers in California and Jalisco, Mexico. Here Dowser talks with MAHRC co-director Xóchitl Castañeda about how to recognize structural issues and cultural context into a public health program for agricultural workers.
Dowser: How did your background lead you to this issue?
Castañeda: I am a medical anthropologist trained in Guatemala and Mexico, and I did my post-doc at Harvard and UCSF. During my post-doc I started going out into the fields. This dramatically changed my life and made me want to move from pure academia to something that has more impact in the lives of under-served Mexicans. Ten years ago I started the Health Initiative of the Americas (HIA), a Latino health outreach organization through U.C. Berkeley. We thought that we needed a research component to the HIA, so three years ago we launched the Migration and Health Research Center (MAHRC), a joint effort between U.C. Davis and U.C. Berkeley.
What about issue of agricultural worker health particularly captured your attention?
I went to the fields. I realized the horrible conditions that agricultural workers were experiencing in this country, and the irrationality of that. They were producing the wealth and sustenance for our country and at the same time had a lot of health problems including food insecurity, hazardous exposure, and obesity. It’s such an irony to see food insecurity in agricultural workers. Such strange things happen to the people growing our food. They may live in an area where they plant strawberries, and at first they are excited, eating strawberries all time, but after two years of just eating strawberries you don’t want to eat them any more. You want something else, but oftentimes there may not be corn or broccoli around, or it’s very expensive.
What are the roots of this problem, and why does it continue to exist?
The problem of agricultural worker health is a structural problem with a long history. We have had many waves of immigrants in this country and agricultural work is always an entry field for these immigrants because you don’t have to have a lot of high-level skills to get work in it. This is the bottom of the pyramid of work, and has often held a connotation of racism.
Why do you think more attention is being paid to this issue right now?
First, because we have not been able to make comprehensive immigration reform, we are trying to make it in a few different segments. The process of making specific immigration reform for agricultural workers emphasizes how much we need them. Second, many wonderful groups like Farmworker Justice and some of the unions have been strongly advocating to include agricultural workers in federal programs. Third, more research has been conducted on how occupational health and safety issues in agricultural industry are the worst in any industry. Lastly, the advance of global warming brings the issue up more, because the people harvesting our food are most exposed to related heat stress and other environmental issues.
Why did you start MAHRC’s new pilot diabetes and obesity prevention program Sembrando Salud?
Working with this population we started seeing that the people producing healthy food were not themselves healthy, and were themselves developing diabetes and other problems related to bad nutrition. We based Sembrando Salud on two federal models [Mexican and United States] with the goal of changing diet and to changing attitude. Sembrando Salud has five components: eat healthy, measure more, drink water, exercise, and attitude change.
What is most innovative about Sembrando Salud? I know it includes elements like a peer education model in which sessions are led by participant peers. What else distinguishes it from other public health initiatives with immigrant workers?
It doesn’t just approach food intake but includes environmental context and attitude change. In contrast to other programs that place most responsibility on the individual, this approach takes on structural issues by making the curriculum relevant. We’re trying to make this attractive, not just medically-oriented. We are not going to tell an agricultural worker who works in the field ten hours a day to go to the gym – there probably isn’t a gym around. Instead, we’ll suggest they park their car a little further from the field and walk.
What has surprised you most while working on this project?
The way people get involved and appreciate this program. People cooperate a lot and appreciate this program and are extremely motivated to get healthier.
What are the biggest challenges you’ve faced in designing this program and this framework for research?
The project is not traditionally funded by the NIH, so the resources we receive from the private sphere have been very important. We need financial resources to assure that promoters and health workers are able to go into these communities. We need resources for prevention and promotion to actually reduce obesity in this country.
To improve agricultural worker health, what does U.S. society need to learn that it doesn’t currently understand?
We need to act today. If we do not we are condemning new generations to worse and worse health issues. These problems are becoming increasing racialized as more and more of our agricultural work is done by Latinos. If we don’t have this workforce and have it healthy, nobody will be working our fields.
This interview was edited and condensed.