The State of Health Care Services for Mobile Poor Populations: History, Current Status, and Future Challenges

Abstract

The State of Health Care Services for Mobile Poor Populations:History, Current Status, and Future Challenges Candace Kugel, FNP, CNM, MS (bio) and Edward L. Zuroweste, MD (bio) A migrant is a person who crosses a prescribed geographic boundary by chance, instinct, or plan and stays away from their normal residence to engage in remunerated activity. The definition of migrant appearing above includes elements from the U.N. Convention on the Rights of Migrants1 and from the American Heritage Dictionary.2 For many in the United States, the term migrant worker conjures an image of an immigrant farm laborer. However, most migrants participate in multiple industries in addition to agriculture, generally low-wage and often high-risk occupations such as construction, poultry and meat processing, and domestic services. In this discussion we are concerned with this broad group of the mobile working poor, some of whom could also be referred to as farmworkers, as people who are homeless, or as undocumented immigrants. The migrant workers of the United States in 2010 are members of diverse populations moving rapidly between sending and receiving locations. The migrant's temporary social and physical environments affect his or her health and well-being.3 The occupations engaged in by migrants, as well as the fundamental factor of mobility itself, combine to create a lifestyle that carries multiple health risks. A review of the history and current status of health care services for United States migrant workers provides a glimpse into the efforts of a few to tend to the unique needs of an otherwise disenfranchised population. History of the Migrant Health Program In an event that is difficult to imagine in our current political climate, President John F. Kennedy signed into law the Migrant Health Act on September 25, 1962, in order to meet one of the "nation's most important health problems and to improve the deplorable health conditions of migrant workers."4 The Migrant Health Act authorized the delivery of primary and supplemental health services to migrant farmworkers and was the beginning of national efforts to improve the health status of the mobile poor. The Migrant Health Program is currently funded under the Consolidated Health [End Page 422] Care Act of 1996 and administered by the Office of Minority and Special Populations (OMSP), Bureau of Primary Health Care (BPHC), in the Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS). There are 156 federally-funded Migrant Health Center (MHC) entities, which in 2008 provided comprehensive primary health care to 834,000 migrant/seasonal farmworkers. Most of these organizations are jointly-funded Migrant and Community Health Centers (M/CHCs). Approximately 18 of the programs are known as voucher programs, a service delivery model that provides health care access to farmworkers in sparsely populated areas through outreach and referral to other health care organizations through the use of payment vouchers that help to pay for office visits. Most M/CHCs are private nonprofit corporations owned and operated by community-based organizations; some are operated by governmental entities such as state and local health departments. Collectively, these M/CHCs operate more than 500 satellite service sites, and constitute a loosely knit network of independent organizations serving migrant and seasonal farmworkers. They range in size from small clinics in frontier and rural areas where farmworkers are in a given location for periods as short as two weeks to large, jointly-funded M/CHCs in high-intensity agricultural areas with tens of thousands of farmworkers served by one organization. Regardless of their setting or farmworker population size, all migrant health grantees are required to provide a standard set of primary care and outreach services. A unique feature of the M/CHC legislation that has made the model particularly responsive and enduring is the mandate that the governing boards of these entities be composed of a 51% majority of consumers of the health center's services. Changing Demographics of the Mobile Poor People are not migrants by choice. We depend on misfortune to build up our force of migratory workers, and when the supply is low because there is not enough misfortune at home, we rely on misfortune abroad to replenish the supply...