Politics in the development of a migrant health center. A pilgrim's progress from idealism to pragmatism

Migrant and Seasonal Farmworkers in the United States: A Review of Health Hazards, Status, and Policy

Although the occupation and associated living conditions of migrant and seasonal agricultural workers in the U.S. pose exceptional health hazards to the workers and their dependents, relatively few occupational health professionals have been involved with this group. This article examines the basis for this neglect and proposes a definition of the population that should be considered in farmworker health policy. It then reviews existing evidence regarding hazards of four major occupational exposures — pesticides, the sun, injuries, and poor field sanitation — and policies that have been developed to address these hazards. The extremely negative health consequences of farmworker living conditions, which are indirect occupational hazards, are also summarized. Numerous policy, planning, and research recommendations are made. Adequate solutions for this impoverished and powerless group, however, will require significant sociopolitical advances, such as are developing with unionization and other forms of political organization.

The prevalence of intestinal parasites in Puerto Rican farm workers in western Massachusetts

A parasitic surveillance of farm workers of Puerto Rican background and their children revealed a high prevalence rate (35.5%) of parasites in this population. This high prevalence rate, however, was expected in view of the fact that other researchers have found a high degree of parasitosis in Puerto Rican populations residing on the US mainland. However, the prevalence rate was almost double that reported by Winsberg, et al, for the urban population, thus suggesting a higher degree of exposure to the migrant worker than to his counterpart living in the cities. Two cases of hookworm infections were detected in children born in the United States who had never traveled outside the area, thus confirming that there is ample opportunity for the transmission of pathogenic parasites on farms, and also suggesting that migrant workers must live under poor sanitary conditions.

The impact of a pediatric practice on hospital admissions in a rural area

The establishment of a two-man pediatric practice in a rural area of New Mexico was followed by a decrease in hospital admissions of children and an increase in average length of stay. While other factors may have been involved, The reliance of the study region's children on pediatricians rather than family physicians for primary care may have contributed to the decline in hospitalization. Further research on the relationship between source of care and hospital utilization is needed.

Models of health and wholeness

A church-clinic model of the neighborhood health center, developed initially in a low-income area, has now been established over the past three years in middle- and upper-income areas. The church-clinics, called Wholistic Health Centers, are primary care medical clinics located in church buildings that utilize an interdisciplinary team in the planning for patient treatment and health education. The project integrates primary medical care with pastoral counseling services. Evaluation of the two clinics in middle-to-upper-income areas indicates that the patients are middle to upper class, well educated, and are not medically disenfranchised; their presenting problems are only slightly more often medical (58%) than psychosocial (42%).

Recent rural health research

Recent rural health research may be examined in two ways: needs and solutions. A definition of needs requires an evaluation of the social factors that affect the expectations and the behavior of both the provider and the consumer. Three types of solutions should be considered: the appropriate utilization of manpower, including the efforts to influence physician location and specialty distribution, new health practitioners, and team approaches; the new technology for transportation and communication; and the organization of new delivery systems. Two areas of rural health research that need more attention are program evaluation and financial planning.