This spring I had the honor of being elected into the Oregon Academy of Family Physicians.
As I took my oath I could not help but think about the steep and significant climb it had been for me, a first-generation Mexican-American woman, to become a physician and to join the board of Oregon's largest physician's academy. But with that pride also came a deep sense of obligation to be a voice for the most vulnerable that I care for, that is farmworkers and their families.
An estimated 2.4 million farmworkers labor on our nation's farms and ranches. Farmworkers experience a wide range of social conditions that impact their health. Hazardous working conditions, crowded and substandard housing, and cultural and language barriers all contribute to poor health. Furthermore, the vast majority of farmworkers do not get overtime pay, sick leave or health insurance. They are often excluded from workplace safety standards. Many do not qualify for public benefits such as unemployment and food assistance programs. This lack of protections magnified existing health disparities and left families with no financial cushion in the midst of the current health crisis. Financial stress can trigger anxiety disorders, depression, and substance abuse. Poor health then becomes part of a vicious cycle that cripples opportunities for education, employment and social mobility.
These exclusions for farmworkers illustrate a history of systemic racism and are the product of years of discriminatory policies and practices. In 1938 the Fair Labor Standards Acts, which granted overtime pay and other worker protections, excluded farmworkers. And today, the Affordable Care Act excludes a large portion of our nation's farmworkers, as much of the workforce remains without legal work status, despite a pandemic that has laid bare the essential contributions of farmworkers to our nation's food supply.
Expanding employer and public benefits to include farmworkers will put farmworkers and their families on a path to better health; care for chronic health conditions would be less likely to be delayed, medications would be more affordable, and treatment plans would be easier to follow through. If faced with a health crisis or job loss, like that experienced by many families during the COVID-19 pandemic, farmworkers would have a safety net, mitigating financial hardship for families already living in poverty.
In Oregon, two bills in the past legislative session would have begun to offer farmworkers and their families a safer working and living environment. House Bill 3352, also known as Cover All People, was signed into law July 19 and provides all Oregonians with health care, regardless of their immigration status. Another bill, HB 2358, would have prohibited employers from requiring farmworkers to work overtime without pay. Unfortunately, this bill did not pass.
Farmworker advocates have also been fighting for safer working and living conditions and in April of this year, Oregon OSHA implemented a permanent rule around employer provided farmworker housing.
In my medical training, I learned the narrative that poor health was mostly the product of genetics and lifestyle choices. But after more than 10 years in practice I see that social conditions, shaped by policies and practices rooted in systemic and structural racism, make the biggest impact in the health of my patients.
As I begin this new stage in my professional journey, I remain committed to continue providing high quality care to farmworkers and vulnerable populations through my work at Virginia Garcia Memorial Health Center, but I also commit to bringing a different narrative forward, one that illustrates how social and economic inequities shape the health of the patients that I care for.
For me personally, I strive for more than just an awareness, but to also be a fierce advocate for policies such as overtime pay, health care for all, better working protections and safer living conditions because if my duty as a physician is to protect the health and well-being of my patients, then I must strive to take on the larger social forces that undermine their health.
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