The United States agricultural industry employs approximately 4.5 million workers nationwide; 1 to 3 million are Migratory and Seasonal Agricultural Workers (MSAWs). Because MSAWs and their families move from one agricultural location to another to continue working, capturing a complete population count can be challenging. MSAWs are a vulnerable population with unique health needs associated with hazardous work environments, limited healthcare access, continuity of care issues, and cultural and language barriers. These risk factors can result in MSAWs having limited access to preventive care, delayed diagnoses, and untreated medical conditions. As a result, MSAWs may have higher rates of chronic health conditions, occupational injuries, and infectious diseases. MSAWs may have higher rates of chronic health conditions, occupational injuries, and infectious diseases.

The good news is that an estimated 977,000 MSAWs and their families have received healthcare from health centers. Many health centers involve Community Health Workers (CHWs) in connecting the community to health services. CHWs, health centers, and health professionals can work together to implement strategic responses to increase healthcare access among MSAWs.

• A Community Health Worker (CHW) is a respected community member who empowers their peers by providing education and connecting them to health and social resources. CHWs build trust with MSAWs through community outreach and by gaining an understanding of their distinct needs as members of the community.

Health centers are community-based organizations that provide comprehensive, culturally competent, and affordable primary care services. They serve as the primary form of healthcare for MSAWs and their families and provide essential services such as medical exams, dental care, mental health services, and health education.

The following examples outline identified barriers and strategic responses focusing on health education, community resources, and advocacy-centered initiatives.

• MSAWs frequently move to follow the harvest season, making it hard for them to get continuous healthcare. MSAWs may live in rural areas with limited healthcare facilities or face other barriers, like transportation or work schedules, making accessing medical care difficult. Connecting MSAWs with resources, such as CHWs, telehealth, health centers, or mobile clinics, can help support better health outcomes.
• Many MSAWs can have different literacy levels, speak different languages, and have diverse cultural backgrounds, which can contribute to miscommunication and misunderstandings with healthcare professionals. Incorporating the practice of cultural sensitivity in clinical settings can help clinicians and enable staff to acknowledge and understand the communication style of MSAWs and their families. Effective cross-cultural communication skills help build trust and reduce communication barriers.
• MSAWs are less likely to have health insurance because of their immigration, low-income status, and lack of benefits. Even when they are eligible for insurance, they may not be aware of their eligibility or may need assistance enrolling for coverage. Promoting health equity among MSAWs can help reduce and address misinformation contributing to underutilizing health-related resources.
• MSAWs may hesitate to seek medical treatment due to concerns about discrimination or fear of possible deportation due to immigration status. It is estimated that roughly half of all agricultural workers in the United States are undocumented. Providing MSAWs with information about their legal rights or work permits like H-2A visas can be helpful. CHWs can help MSAWs connect to organizations that best support their legal needs.

CHWs have many roles when serving MSAWs, including as promotores de salud, care coordinators, navigators, lay health advisors, advocates, and health educators. They help MSAWs navigate the U.S. healthcare system, inform them about available health programs, and identify eligibility criteria. CHWs can provide health education, assist with making appointments and transportation, and improve health literacy through education and interpretation services. They are critical for agricultural workers as they provide direct assistance and serve as a link between MSAWs and inaccessible health and social resources.

It is vital for CHWs to be knowledgeable about emerging health issues and how to implement cultural competency in their day-to-day work. MHP Salud offers various resources to help enhance a CHW’s core skills and competencies and promote the best practices to support cultural competency in healthcare settings.