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Immigrant Workers
Jacqueline Agnew, RN, MPH, PhD
Johns Hopkins University
Section A
History of Immigration in the American Labor Force
Immigration to the United States
Image source: Harvard University. Retrieved from http://ocp.hul.harvard.edu/immigration/
4
Early Immigration
Map source: Churchman Genealogy Website. Retrieved from www.churchman.org/Pictures/indmap.gif
5
Arriving in the U.S.
Unidentified artist, creator
Harvard University Art Museums
United States
c. 1903
Photo source: Harvard University. Retrieved from http://ocp.hul.harvard.edu/ww/subject.html
6
Arriving in the U.S.
Photo source: Harvard University. Retrieved from http://pds.lib.harvard.edu/pds/view/3621773?n=9&imagesize=1200&jp2Res=0.25
7
Arriving in the U.S.
„
From Roberts, P. (1912). The
new immigration.
Photo source: Harvard University. Retrieved from http://pds.lib.harvard.edu/pds/view/3621773?n=9&imagesize=1200&jp2Res=0.25
8
Percent Foreign Born in the U.S., by Year
9
Immigration to the U.S.
10
So Why Come Here Now?
„
Economic or political
„
Family
„
Deliberate recruitment
„
Refugee resettlement
„
Opportunities
−
−
Study
Work!
11
Facts from 2007
„
24 Million foreign-born workers in the U.S. labor force
„
Comprise 15.7% of the labor force
„
Accounted for one-half of labor force increase in 2007
„
Men make up 60%
„
Hispanics make up 50% of the foreign-born labor force
„
Asians make up 22% of foreign-born labor force
„
27% are not high school grads
„
31% are college grads (similar to overall labor force)
„
Unemployment rate is less than that of native born
Source: Current population survey.
12
More Facts
„
Region of settlement
− 39% in the West
−
„
30% in the South
Higher proportions than native born in the following sectors:
− 1 of 4 men in natural resources, production, maintenance
−
1 of 3 women in service occupations
13
Concentration of Immigrants across Occupations
14
Concentration of Immigrants across Occupations
15
Concentration of Immigrants across Occupations
16
Distribution of Foreign Born by Region of Birth
Source: Current Population Survey, March 2000, PGP-3
17
Percent Below Poverty Level, by Origin (2000)
Source: Current Population Survey. (2000, March). PGP-3.
18
Forces That Influence Immigration
„
Department of State sets limits on U.S. citizenship
„
U.S. Citizenship and Immigration Services (formerly INS) enforces
„
Department of Labor influences
19
Refugee Resettlement
„
Department of State
− Bureau of Population, Refugees, and Migration
„
From refugee camps to U.S.
„
Volunteer agencies provide the following:
„
−
Housing, furniture, clothing, food, and referrals to employment,
English as a second language (ESL), and other services
Support and assist
−
−
−
Provided housing, help in finding employment, etc.
Must find and hold job
Barriers—language, “culture-shock”
20
Refugees Admitted to U.S. in FY 2004 (Total = 52,868)
21
Visas
„
United States Permanent Resident Card (“green card”)
− Easier if skilled
−
„
Need sponsorship from company
Employment based—priorities
− “Extraordinary ability”—specialty professions, nurses
−
−
−
Skilled and not temporary/seasonal
Temporary or seasonal agricultural
Temporary—other
„
Families
„
“Green card lottery” (approximately 55,000 per year)
22
Benefits for Documented Non-citizens
„
Most cannot receive food stamps
„
Medicaid varies by state
„
Some other programs require five years residence before eligible
23
Workers’ Compensation and Undocumented Workers?
„
A matter of state law:
−
−
„
Six states explicitly include (California, Florida, Nevada, New
York, Texas, and Utah)
Two exclude (Idaho and Wyoming)
Immigration Reform and Control Act of 1986 (“IRCA”) places a duty
on employers to determine their employees’ immigration status and
prohibits their employment if undocumented
24
A Case in Pennsylvania
„
Juan Carlos Astudillo worked as a maintenance helper where he cut
and welded iron and repaired motors and was required to climb
scaffolds and ladders and lift heavy steel beams. In 1994, Astudillo
was hit in the head, neck, and back by a steel beam and was
rendered unconscious at work. Astudillo sustained a concussion, a
mild head injury, and, as a result, over the next few months he
experienced headaches, dizziness, loss of balance, and upper and
lower back pain. He was subsequently terminated from his job, and
he filed for workers’ compensation.
25
A Case in Pennsylvania
„
The employer argued that since the IRCA barred the employment of
illegal aliens, the claimant was not an employee
„
The Commonwealth Court of Pennsylvania held that undocumented
workers were not precluded from receiving workers’ compensation
benefits
26
Section B
Protecting the Health and Safety of Immigrant
Populations in the Workforce
Concentration of Immigrants across Occupations
28
Injury Risk—Some Findings from Research
„
Rates are higher for foreign born (more consistent in U.S. studies)
„
Occupy hazardous jobs, often poor working conditions—construction,
agriculture
− But even found for retail jobs
−
Contingent workers at greatest risk
„
Associated with shorter length of residence in the U.S.
„
Young migrant workers are at increased risk
−
−
−
Middle school aged: two times as likely as non-migrants
High school aged: four times as likely
Rates probably underestimated
29
Fatal Injury Risk: Data Analysis (1992–2006)
„
11,300 Hispanics died of work-related injuries (13% of all workrelated deaths in the U.S.)
„
More than two-thirds foreign born—may be underestimate
„
Death rate consistently 20% higher than for U.S. born
„
Younger than overall U.S. workforce—35 median vs. 42 for all
„
95% male
„
2003–2006 rates greatest in the following sectors
„
−
−
−
34% from construction
10% agriculture
10% transportation
Projected to increase in numbers
30
Work-Related Injury Deaths of Hispanic Workers
31
Fatal Injury Risk: Data Analysis (1992–2006)
„
Proposed reasons for high rates
− Work in high-risk jobs
−
−
But also have higher rates in same jobs
Susceptible to miscommunication
X
Potential contributors to risk
X Cultural, social, economic
X
„
Perform tasks of higher risk for fear of losing job
Rates may be underestimated if Hispanics undercounted among total
workers
32
CDC: In-depth Investigation of 200 Deaths
„
Characteristics of those killed
− Inadequate knowledge and control of safety hazards
−
−
„
Inadequate training and supervision
Exacerbated by different languages and literacy levels
Prevention will require …
−
−
−
−
Employers taking additional responsibility to provide safe
working environment
Safety and health agencies providing safety information and
assuring compliance with regulations
Researchers and health communication professionals developing
materials that are culturally appropriate and address language
and literacy challenges
Labor unions and community groups can contribute
33
Hotel Workers
„
916,000 workers in maid/housekeeper occupation
„
Many not unionized
„
Low pay (median $8.82/hour; $18,350/year)
„
Risks
− Musculoskeletal injuries—ergonomic hazards
−
−
Infectious diseases—handle waste
Chemical exposures—cleaning agents, pesticides
34
Study of Injuries to Hotel Employees
„
„
16,000 workers of 35 hotels
−
49% room attendants, stewards/dishwashers, banquet servers
and cooks/kitchen workers
Risk factors
−
−
−
Physical demands—load and speed
Pushing carts, making beds, cleaning bathrooms
Demands increase with luxury
X King sized bed—113 pound mattress
X
1,000 pounds of linen per day
35
UNITE HERE Local 25 Member, Maria Guzman
„
“I had to wash a lot of plates and
silverware, then bring that heavy stuff to
other kitchens. I had to push a cart that
was very heavy, everyday. One day I was
pushing the cart and it wasn’t working, and
it fell down on my leg and hand. I was given
light duty, but the department manager
pushed me too hard to finish even though I
was still recovering from my injury.”
Photo source: Korean Resource Center. Retrieved from Flickr.com
36
UNITE HERE Local 26 Member, Lachmin Karaya
„
Karaya is an American citizen who is an immigrant from Guyana …
„
“When I worked there I always told the director of housekeeping that
we did too many rooms and that we felt pain, but he never did
anything. All I remember him doing is telling us to rush and finish by
4:30.”
37
Injury Findings—Differences by Gender
„
Injury rates for females greater than for males, 5.5% vs. 3.7%
„
Differences persisted within same jobs
− Stewards/dishwashers
−
Females 10.1% vs. males 5.1%
Cooks
−
Females 6.1% vs. males 5.1%
Banquet servers
X
X
X
Females 2.6% vs. males 1.8%
38
Injury Findings—Differences by Ethnicity
„
Race/ethnicity
− Nonwhites 4.9% vs. whites 3.0%
−
Rates higher for nonwhites in three out of four jobs
X Housekeepers, cooks, and banquet servers
39
Differences by Gender and Ethnicity
„
Female Hispanic stewards/dishwashers: 10.0%
„
Female Hispanic room attendants: 9.5%
„
Female Asian cooks: 8.9%
„
Female Hispanic banquet servers: 3.9%
„
Female Black hotel workers: 3.8%
40
Actions to Improve Health and Safety
„
Upgrade equipment
− Example—lighter-weight carts
„
Administrative controls
„
−
−
−
Limit time demands
Light duty options
Allow more work in teams
Training
−
Including supervisor training
41
Section C
Vietnamese Nail Salon Workers
Vietnamese American Immigrants
„
1,212,465 Vietnamese in the
U.S.
„
38%: < high school diploma; 8%:
none
„
Population centers: California;
Texas; Washington;
Washington, D.C.;
Massachusetts
„
73.8%: services, sales, office,
and production occupations
„
45%: limited English proficiency
„
NAVASA represents communitybased organizations (CBOs)
„
Average income: $15,000 per
year
43
Health Status
„
17.2% of Vietnamese
considered their
health “fair” or
“poor”
„
9.2% API
„
8.9% non-Hispanic
white
44
Productive Days Lost from School or Work
45
Nail Salon Workers
„
Nail salon industry is growing—first in
California, now in the Northeast
„
Heavily dependent on Vietnamese
workers
−
−
−
30% of salons in the U.S. are
owned by Vietnamese; 80% in
the Los Angeles area owned by
Vietnamese
37% of nail technicians in the
U.S. are Vietnamese
24% of the Vietnamese labor
force in in the U.S. are
employed in nail salons
Photo source: AikiDude. Retrieved from Flickr.com
46
Vietnamese Nail Salon Workers
„
Most workers are women between the ages of 20 and 40 years
„
Also must balance home and family duties
„
Language barriers—other employment difficult
„
Limited job skills, education
47
Vietnamese Nail Salon Workers
„
Self-employed, contracted six days (10-hour days are typical)
„
Limited health care access, health or disability insurance, workers
comp
„
No sick or vacation time: no work = no income
„
Licensed according to function—training required
„
Little health and safety information or training
„
Health may not necessarily be highest priority
−
−
Disincentives to exposure control
Long-latency health issues may not be as important as acute
48
Business Concerns
„
Low profit margins and high price competition
„
Few have support from government-funded small business assistance
programs
„
Few have access to financing
„
Reliance on family members and friends for start-up capital
„
Poor access to occupational health and safety resources
49
EPA Nail Salons Project
„
Developed guide
− English and Vietnamese
„
Best practices in salons
„
Focus is on chemical and infectious exposures and controls
for exposure reduction
„
Addresses worker and client protection
50
Recognized Hazards in Nail Salon Industry
„
Methyl methacrylate (MMA)—respiratory irritation, asthma, allergic
dermatitis, reproductive? colon/rectal cancer? (banned in some
states, voluntary recall in others)
„
Methacrylate dust (polymer)
„
Acetone, acetates, phthalates, ethyl ether, formaldehyde, toluene,
benzene, neoprene, fiberglass, etc.
„
Ultraviolet light
„
Infectious agents—fungi, bacteria, viruses
„
Work practices
− Poor ventilation, unlabelled containers
−
−
Eat/drink/smoke in workplace
Varied use of gloves, dust masks
51
Less Attention to …
„
Mental health
„
Work organization issues
„
Work-family issues
„
Ergonomic risk factors
52
Recent Initiative …
„
Forming an organization of stakeholders in business
53
Section D
Informal Work Sector—Day Laborers
Informal Work Sector—Day Laborers
„
Look for work in public places
„
Most immigrants, few skills
„
Hired by day, hour
„
60% seek work > 5 days per week
„
Median wage is $10, annual income rarely exceeds $15,000
55
National Day Labor Survey
„
Conducted in 2005
− 2,660 workers
−
20 states and Washington, D.C.
„
117,600 working or looking for work each day
„
92% hired by construction or home owners
„
Often hired to take on most dangerous tasks
56
National Day Labor Survey
„
In previous two months
− Half had their pay denied
−
44% denied food, water, or breaks
„
One in five injured in previous year
„
60% of those injured lost time from work
„
50% of injured received treatment
„
Only 6% were covered by Workers Compensation
57
Hazards to Day Laborers
„
Exposure to dust, chemicals, emissions
„
Injury risks
− Faulty equipment (scaffolds, tools)
−
−
Lack of personal protection equipment
Lack of safety training
58
Country of Origin of Day Laborers
59
Day Labor Worker Centers
„
Growing response and resource: day labor worker centers
−
−
−
Community organizations, municipal governments, faith based
and others
Advocated by report
Provide
X Space
X
X
X
X
Order
Set wage amounts
Oversight of standards and employer behavior
Often training, classes
60
Growth of Worker Centers
61
National Day Labor Survey Also Stresses the Need for …
„
Improvement in worker protection
„
Enforcement of safety regulations
„
Workforce development strategies
„
Access to legal services
„
Realistic immigration reform
62
Study in Chicago
„
Most hired in construction
„
37% never used personal protective equipment
„
Offered tetanus vaccination and blood lead screening at three sites
„
Blood lead levels
− Geometric mean = 3.8 ug/dL
−
−
−
Highest for those from Mexico
Two tested greater than 20 ug/dL
Comparison levels
X United States: 1.5 ug/dL
X
Mexico: 2.3 ug/dL
Source: Street corner hazard surveillance and health intervention among Chicago day laborers.
63
Results of Blood Lead Testing in Chicago Day Laborers
64
Chicago Study Conclusions
„
Hiring sites and worker centers promising for
− Primary care
−
−
−
Screening
Worker training on health and safety
Equipment demonstrations
65
Section E
Migrant Farm Workers
A Migrant Farm Worker Is One Whose …
„
Principal employment is in agriculture on a seasonal basis and, for
purposes of employment, establishes a temporary home
67
Migrant Farm Workers
„
Approximately 200 million migrant workers worldwide
„
Estimated 1.6 million in the U.S. (1990)
„
In the U.S., 84% are Hispanic
„
75% are from Mexico
„
Three main streams: West Coast, Midwest, East Coast
−
North-south routes: “follow-the-crop”
68
Characteristics
„
Hard to reach
„
Many undocumented
„
Live in camps without established addresses
„
Often unaccompanied by spouse or children
„
Isolation
„
Discrimination
„
Hazardous working conditions
„
Low pay and uninsured
69
Substandard Housing
„
Study of North Carolina farm worker homes
„
Crowded—in 70%, more than one person per room
„
Unsafe locations—located adjacent to fields
„
Structural problems—18% had leaky roofs
„
Lacking facilities—27% without oven
„
Most did not meet U.S. Department of Housing and Urban
Development minimum criteria
70
Hazards
„
Acute and chronic poisoning
− Pesticides, other chemicals
−
−
„
„
Plants
Asthma
Dermal diseases
−
−
−
Pesticides, other chemicals
Plants: allergies
Ultraviolet light
Injuries
−
−
Mechanical
Motor vehicle
71
Green Tobacco Sickness
„
Nicotine absorbed through the skin
„
24% of tobacco workers
„
Nausea, dizziness, GI symptoms
„
Associated with wet tobacco
− Harvest during the morning (dew)
„
Gloves, rain suit—protective
− Must prevent against heat injuries
72
Eyes at Particular Risk
„
Eye injuries
− Dust, allergens, trauma
„
May not have adequate eye care
−
−
Vision deficits
Need for eye protection and glasses
73
Heat-Related Injuries
„
Rate of crop worker death from heat stroke is twenty times that of
all workers in the U.S.
„
Most among foreign born
„
Risk factors
„
−
−
−
Environment
Protective clothing, extra clothing
Poor recognition of signs
Heat injuries often omitted from training
74
Mental Health Issues
„
Identified by migrant community as a concern
„
In one study
− 40% greater than cutoff score for depression survey
−
−
„
18% above threshold for anxiety
38% potential alcohol dependence
Anxiety and depression are associated with …
−
−
Social isolation (e.g., away from friends and family, difficult to
meet people) strongest effect on anxiety
Working conditions (e.g., enough water, exploitation,
discrimination) strongest effect on depression
Source: Hiott et al. (2008).
75
Other Health Problems
„
Oral health
„
Blood-borne illnesses
„
Infectious diseases, e.g., tuberculosis
„
Chronic diseases
− Diabetes
−
−
Cardiovascular
Overweight
76
Children’s Issues
„
Many accompany parents (300,000 in Northern
Mexico)
„
Many work in fields—long hours
„
May not attend school or may attend for few hours
„
At risk for dangerous exposures
−
−
−
Pesticides
Mechanical equipment
Sometimes operate vehicles or machinery
77
Barriers to Care
„
Education and language—dialects
„
Logistics—availability, transportation, financial, can’t miss work,
follow-up
„
Family roles and priorities
„
Acceptance of care givers
„
Health beliefs—other diagnoses and remedies
„
Faith and spiritual practices
78
Some Approaches
„
Some conditions can be improved—access to water, improved field
sanitation
„
Telephone access to reach families
„
Community activities—faith groups, sports teams (concept of
“coherent communities”)
„
Clinics and outreach programs
„
−
−
Health Resources and Services Administration (HRSA)
State and local
Screening when seen for health care
79
Advocacy/Resources
„
One example: HRSA funding
„
Farmworker Justice, Inc.
− http://www.fwjustice.org/
X
X
X
X
X
X
„
Legislative and policy work
Direct work—U.S.-Mexico border
Collaborate with community-based organizations (CBOs)
and clinics
Health promotion programs
Children’s health
HIV/AIDS prevention
See list in Arcury and Quandt article
80
Section F
Training and Advocacy
Modes of Communication
„
Web sites
„
Training materials
„
“Classroom” training
82
Training Issues
„
„
Efforts vary widely
−
72% for Latino construction workers, but median time of only 1
hour
Lack of training itself is not a predictor of injury
83
Example from One Sector: Construction
„
Latino immigrant youths in construction under 21 years
− Range of hazardous tasks, some while under 18 years old
„
Training—reported by 68%
„
−
−
−
Median training time of 1 hour
24% receive written materials
Fewer English skills = less training
Need increased bilingual training and medical care
Source: O’Connor, T., et al. (2005, March 1). J Occup Environ Med, 47, 3, 272–277.
84
Language Barriers
„
Awareness and attention to language differences increasing
„
More training aids, especially in Spanish
„
More organizations with Spanish Web sites
„
„
−
OSHA and NIOSH are examples
Some are designing training programs in other languages
−
eLCOSH—Creole, French, German, Italian, Portuguese, Polish,
Vietnamese
Need accessibility to additional languages
85
eLCOSH
86
eLCOSH
87
eLCOSH
88
Production of Culturally Competent Materials
89
Production of Culturally Competent Materials
„
State training program
90
OSHA Hazard Communication Standard
„
Instructions for inspections
−
“If the employees receive job instructions in a language other
than English, then training and information to be conveyed
under the [hazard communication standard] will also need to be
conducted in a foreign language”
91
Health Care Provider Actions
„
Cultural competence—training and awareness of issues, language
skills
„
Diversity within professional community
„
Involvement of immigrants in own care and design of health
programs
„
Advocate and provide education on occupational health problems in
settings where immigrant care is provided
92
Recap
„
We have looked at four at-risk worker groups among immigrant
population
„
Share common issues—health risks in the workplace, psychosocial
threats to well being, barriers to care
„
Means of interventions—elements of programs, training approaches
„
Long way to go!
93