California farmworkers: Dilemmas in developing interventions for health and medical care concerns

Human Organization, Fall 1998 by Harthorn, Barbara Herr

This article explores possible interventions to address the expressed health and medical care concerns of a pilot sample of Mexicanorigin farmworkers in Santa Barbara County and research-based assessments of health needs of the population. Using a medical and political ecology model that situates the US farmworkers and dependents in this study as an economically peripheral community within the policentric global economy, the article explores the possibilities and problems of melding the aims and methods of scientific intervention research with those of social interventions at the community level and beyond. Health problems addressed include recurrent chemical exposure, the prevalence and treatment of tuberculosis, and maternal and newborn health. Health care problems discussed include issues surrounding access to care, effective treatment, and racism and cultural insensitivity in public health care.

Key words: farmworker health, Mexican immigrants, intervention studies, tuberculosis, chemical exposure, participatory research; US, California

he mission statement of the Society for Applied Anthropology (SfAA 1998) states the shared objective of "making an impact on the quality of life in the world today." This article addresses a particular issue embedded within the ambitious project of "making an impact on the quality of life in the world today," that of designing and implementing intervention studies. The issues explored in this article have emerged from preliminary research on farmworker health in California that demonstrates the problems inherent in pursuing the tandem goals of integrating the aims and protocols of scientific intervention studies on the one hand and intervention in the form of social action on the other. Thus, this article addresses some of the problems surrounding the applied anthropology project of combining the roles of the scholar and activist.

This article uses the results from pilot research on aspects of farmworker health conducted in Santa Barbara County, California from 1995-97 in order to address the issue of how to design and implement effective intervention research on the health problems of farmworkers. The study was designed mainly to determine feasible sampling strategies for a proposed future study and secondarily to explore a limited set of issues concerning Mexican-origin farmworkers' health problems and health care needs. In the study a comprehensive sample of health care and service providers in the area was interviewed in semistructured interviews about the health problems of farmworkers they were treating and about issues associated with delivery of care to farmworkers. A sample of 32 farmworkers drawn from a purposively diverse array of contact points was also interviewed about their own and their dependents' health histories, health concerns, and health care. Ten of the 32 interviewees were drawn from the population of North County public health patients who were undergoing directly observed therapy (DOT) for active TB, which is a critical health problem among migrant workers, and half of these (all who were still locatable) were re-interviewed 9 months later. In 1997-98 the project disseminated preliminary research findings to a farmworker organization in the communities studied in order to enhance the participatory agenda of the research and to continue needs assessment. The analysis in this work has highlighted the inadequacies of care, the institutional and structural conditions that seemed to account for them, and the many unmet needs of the farmworkers studied (Harthorn 1996, 1997; Petersen and Harthorn 1997). Like much anthropological research, the research has not yet being able to offer any instrumental solutions to the many problems identified, but the response by dozens of farmworkers to this outreach has been positive, and enhanced participation has been achieved as a platform for the next study. The issue of how to formulate future intervention research that will have a likelihood of enhancing quality of life for Mexican-origin farmworkers in California is the focus of this article.

Medical anthropologists have much to contribute to a necessary reconsideration of what are taken to be the critical indices of health in populations. This small-scale and preliminary research provides some evidence that concepts of 'health' and `quality of life' are potentially contested in ways that researchers need to take into account to be sensitive and effective, both in scientific and activist terms. These contestations take place on many levels and with many different stakeholder participants, and in this case they encompass care providers in varying positions as well as farmworkers themselves. There is an unmistakable gap between the aims and concerns of funders in the biobehavioral research arena and the interests of those funders who provide for actual provision of service, outreach and care. It is precisely into this gap that future university-based research needs to venture.