Guest post by E. Roberta (“Bobbi”) Ryder, President and Chief Executive Officer, National Center for Farmworker Health
Migrant and Community Health Centers Serving Migratory and Seasonal Agricultural Workers in 2013 and Beyond
In 1962, Congress passed into law the Migrant Health Act. In 2012, we celebrated the 50th anniversary of this monumental piece of legislation that launched the provision of primary care services through private, nonprofit community-based organizations, a sea change which set the stage for the Community Health Center Act in 1967, and the Health Center Program as we know it today. This was truly an example of disruptive innovation.
Back in 1962, communities were not equipped to serve large numbers of migratory agricultural workers who were there only briefly to work, or touch home base before beginning the circuit again. Health departments played a pivotal role in the promulgation of the legislation and the implementation of the program. Out of obvious necessity for access to care for this vulnerable population has arisen a wealth of program services across our nation, for special populations like agricultural workers, homeless individuals and families, and underserved people living in rural and urban areas, served in schools, public housing developments, mobile units, and full-service community health centers. I like to say that the Migrant Health Act was the pilot for demonstrating how to provide the right care to those in need, in the manner best suited to their unique need.
It is ironic that as we move forward with the implementation of the Affordable Care Act (ACA), which is the most significant reform in health care since 1962, many agricultural workers are being left out of the benefits, but still held responsible for the penalties of not having insurance. Either because of migration, multiple employers, immigration status, day labor status or income status, agricultural workers will be among the residual uninsurable in this nation who will still be kept outside of the mainstream population. It seems to me that the necessity that prevailed in 1962 still exists; we have a key segment of the workforce that our nation depends on for production of affordable commodities, which is still seen as ‘outsiders’. So while I understand the sense that we as a nation do not want to spend tax dollars on a population that is seen as ‘not our responsibility’ because of perceptions that they are all ‘illegal immigrants’, the fact that remains is that we, as consumers, depend upon them for their contributions to our food chain, and they are very clearly employed or they would not be called ‘agricultural workers’ or ‘farmworkers’, regardless of their immigration status.
A reporter once asked me: “If we as a nation do not care about farmworkers out of a sense of ‘noblesse oblige’, how can we motivate the public to care about them?” My reply today would be that if we do not include them in the principles and benefits of health reform in 2014, we will probably pay an even higher price in the decades to come, scrambling to patch together a ‘fix’ that will treat them like second class members of our communities and our society. If health care reform is all about containing costs and improving health outcomes, why would we omit the hands that harvest our table food from reform? What better time than now, to recognize their contributions to the economic infrastructure of our nation, to the health and well-being of the communities where they live and work and their role as human members of our society?
Migrant and Community Health Centers are, and must remain, the primary points of access to care for this population that gives so much and asks for so little in return. As we celebrate Farmworker Health Day on August 15, 2013, during National Health Center Week, let us be bold in our embrace of this population to which we owe so much, and continue to seek ways to integrate them into our care and our communities with the respect and dignity that they deserve. Please join us at NCFH and NACHC in reaching out to this population and making every effort to educate the general public on the reality of their lives and their contributions.
–E. Roberta (“Bobbi”) Ryder