It's a classic story: Legions of families leave their native land in search of better lives and jobs. They settle in California's Central Valley to work on the farms. It's hard labor, pay is poor and the community often is hostile to these outsiders who struggle to keep their families unified and healthy.
There are moments of catastrophe and tragedy, but it's mostly a narrative of human perseverance.
John Steinbeck tells this story in his 1939 masterpiece, The Grapes of Wrath. But fast forward a few decades, and you see a very similar picture. For migrant Oklahomans escaping the Dust Bowl, just substitute migrant Mexicans or other nationalities. California has seen a revolving door of immigrants who work its farms. Some 90 percent of farmworkers in the state are foreign-born, mostly from Mexico, according to the U.S. Department of Labor.
“Steinbeck captured the desperate plight of migrant workers,” said Marc Schenker, MD, MPH, professor of medicine and public health at UC Davis.
And while there certainly have been technological advances and improvements in working conditions since the Depression era, Steinbeck's writings and social analysis are relevant today, said Schenker.
For more than 30 years, Schenker has studied farmworkers and their families, focusing on various causes of illness and injury. Those range from lung disease from dust and pesticides to injury and fatalities from extreme, hot weather. At UC Davis, he is founding director of the Center for Occupational and Environmental Health, the Western Center for Agricultural Health and Safety and the Migration and Health Research Center.
From 2010 to 2016, he co-directed with UCLA's Michael Rodriguez, MD, MPH, the UC Global Health Institute Migration and Health Center of Expertise.
Schenker has studied reproductive health issues of Latina immigrants and examined their soaring rates of obesity and diabetes among immigrants. Partly to blame, is unhealthy food that is less costly to immigrants who are poor.
“Being an immigrant – including the stress that goes with being on the move and living on the margin in terms of income – affects their health as much as the work itself,” said Schenker.
For undocumented immigrants, the stress may be even worse because of fears of deportation. And on top of all that, immigrants – documented and not – generally have poor access to health care.
This is not just a California or U.S. problem. “It is a global phenomenon,” said Schenker. “It exists everywhere in the world. In all countries, there are unique patterns of migration, but it's the same story that we see over and over. And that story is of a population that has a very precarious health status.”
“Unfortunately, it's not going away,” he said. “It will only get bigger.”
Whether leaving their native countries to escape natural disasters, political turmoil, violence or simply to pursue a better life, the number of international migrants reached 244 million in 2015, a 41 percent increase compared to 2000, according to data from the United Nations. Europe has the highest number of migrants, some 76 million, followed by Asia with 75 million and North America with 54 million.
Immigrants around the world, as in the U.S., hold the most dangerous jobs, such as farm work, construction and transportation, said Schenker. Many immigrant women do domestic work, and while those jobs may not have increased fatality rates, the chronic health problems rooted in that work is significant, he said.
“If you're an immigrant, you have higher disease and fatality risk than a non-immigrant with the same job,” said Schenker. “Language barriers, training, risk-taking, perceptions about jobs all may play a part. And these are topics that need to be closely examined.”
At research centers across UC, investigators from many disciplines look at broad and multiple factors that affect the health of immigrants.
Social determinants
Studies by UCLA researchers have focused on policies that affect “social determinants of health” – circumstances into which people are born, grow up, live and work and age – and how policies affect immigrants' ability to live healthy lives.
A 2015 report examined policies in all 50 U.S. states, focusing on five areas that influence the health of immigrants and their families: public health and welfare benefits, higher education, labor and employment, driver licensing and government ID card programs and federal Secure Communities program. The latter is the enforcement program requiring local police to share information with federal immigration authorities, and it has contributed to the deportation of an estimated 400,000 undocumented residents, separating families and putting stress on immigrants' finances and health.
California ranked highest of all states in public policies that support health and well-being of undocumented immigrants, while Ohio was the worst, according to the report by Michael Rodriguez, MD, PhD, professor and vice chair of Family Medicine and director of the UCLA Blum Center on Poverty and Health; Steven Wallace, PhD, professor in the UCLA Department of Community Health Sciences and associate director of the Center for Health Policy Research; and graduate student Maria-Elena Young.
“It is frustrating that so many states have policies that ignore or exclude a group of people who work hard and contribute so much to our society,” said Wallace
They hoped that the report – supported partly by the UC Global Health Institute – would set the stage for additional research, advocacy and action to ensure advancement of policies to benefit undocumented immigrants.
But shifts in the U.S. political climate after the 2016 presidential election may hamper research and add strain to immigrants themselves. Proposed immigration policies that are harsh on undocumented immigrants and efforts to repeal and replace the Affordable Care Act already may be negatively affecting the health of immigrants.
A 2016 study by Francisco Pedraza, UC Riverside assistant professor of public policy and political science, found that anti-immigrant policies stigmatize both foreign and US-born Latinos by creating a hostile social environment which affects their experiences of discrimination. These non-health policies can adversely affect their health.
Researchers also are finding that immigrants – documented and undocumented – are avoiding clinics and hospitals because they fear encountering immigration authorities, even though hospitals have been traditionally considered “sensitive locations,” like schools and places of worship, where federal agents usually would not enter.
That fear also hurts the gathering of information and data for immigrant health research. “It's a challenge these days,” said UC Davis' Marc Schenker. “You can't just go into an immigrant community and say ‘I want to ask you these questions.'”
Nancy Burke, PhD, chair of Public Health in the UC Merced School of Social Sciences, Humanities and Arts, studies health disparities and safety net community programs that support immigrants. Staff at clinics and school districts with whom she works make extra effort to reach out, communicate and allay the fears of immigrants. “They are trusted highly by the immigrant community and without their partnership, we wouldn't be able to do our work effectively,” she said.
Good studies that shed light on health issues and potentially influence policies to improve health require evidence-based research, she explained. “We can't gather that evidence without collaborations in the community.”
In a climate in which national support for immigrants may be waning, it is important not only to gather the evidence but also to get research findings into the hands of policymakers who can make a difference, said Burke.
Research and information about immigrant health has to spread widely and quickly, perhaps more of it published online and for more to share and absorb rather than in the traditional scientific journals, she said.
Schenker urged using more venues, including newspaper op-ed pieces to inform the general public about topics and crises in immigrant health. He did his part in May delivering a talk titled. “A Brief History of Global Migration and Worker Health.”
It wasn't at a medical or scientific conference. It was in Monterey, at the annual Steinbeck Festival.