This story was originally published by the Sonoma County Department of Health Services.

Agriculture is an essential component of the economy in Sonoma County. A healthy agricultural workforce is critical to maintaining our local economy, yet agriculture has been recognized as one of the most demanding and high-risk industries. Compared to the general population, farmworkers experience higher rates of unintentional fatal and occupational injuries and a higher prevalence of chronic diseases. Previous research also indicates many farmworkers lack high-quality, affordable housing options and that housing affects many aspects of health. With the goal of gathering information on the health and well-being of local farmworkers, the Sonoma County Farmworker Health Survey (FHS) was developed. The County of Sonoma Department of Health Services, in partnership with California Human Development, surveyed 293 farmworkers between September 2013 and January 2014. This was the first assessment of farmworkers in Sonoma County and the most recent health-specific survey of farmworkers in California, making these results the most updated information available. Below, the five key findings from the FHS are presented.The report is available on the Department of Health Services' website. 

This report is a call to action for all of Sonoma County, to better address the needs of our struggling neighbors and their children. No matter your role in the county, when you read these findings you can’t help but feel that we can do better here.

- Chris Vanden Heuvel, Superintendent, Healdsburg Unified School District

Nine out of ten farmworkers (88%) reported that Sonoma County was their permanent residence, and most (71%) farmworkers were living with their families. These data suggest that Sonoma County farmworkers are part of our community, they work and raise their families here. 

The average Sonoma County farmworker family earned $20,000 each year, and these families were estimated to spend between 30% and 54% of their family's annual income on housing. According to the US Department of Housing and Urban Development, housing should account for no more than 30% of a family’s income, suggesting that Sonoma County farmworkers and their families lacked access to affordable housing.  The rental market is getting worse here in Sonoma County, as the average apartment rent rose to $1,521 in 2014, a jump of 13.3% from the prior year. The rate of Sonoma County’s increase was the greatest of 23 metropolitan areas in the state. This lack of affordable housing is worrying because housing is the single largest expenditure for most households, and high housing prices leave low-income families with little funds to go towards food, medical care, and other basic necessities that support well-being. This means that the cost of housing has the potential to dramatically affect all domains of life subject to budget constraints - including health. 

“Rents are very expensive. We wanted to rent a two-bedroom apartment, but we had to rent one of the rooms to a nephew, he’s family, to help him. And my daughter didn’t want to, I have a 13-year old daughter, she wants her own room. She wants somewhere to live and space to put her things, but I tell her we can’t do it, mami. We have to be in the same room because the rents are so expensive." - FlorUp to two-thirds of farmworkers surveyed in FHS lived in overcrowded dwellings in Sonoma County, and farmworkers who lived with their families experienced the highest crowding. This alarming because studies find that crowding has negative effects on mental health, ability to cope with stress, interactions between children and parents, social relationships, and sleep of children. 

Nine out of ten (92%) farmworker families did not earn enough to meet their family’s basic needs in Sonoma County. Additionally, farmworkers that were living with their families earned about one-third of the income of Sonoma County family households overall in 2012. These data highlight that farmworker families were earning very low incomes, much lower than the typical Sonoma County household. And each month this poverty forced farmworker families to choose between basic necessities. Rent? Food? Healthcare?

Health insurance coverage among surveyed Sonoma County farmworkers (30%) was more than two-times lower than Sonoma County adults overall (86%). This lack of insurance was important because farmworkers reported "cost" or "lack of health insurance" as the primary barrier to accessing needed healthcare in Sonoma County.Health insurance has been shown to improve access to healthcare and health outcomes in the U.S. Research has also shown that the uninsured are more likely to forgo needed medical care than insured individuals, and uninsured U.S. citizens are more likely to visit the emergency room or be admitted to the hospital for preventable illnesses. The uninsured and underinsured has changed dramatically since the Patient Protection and Affordable Care Act (PPACA) was passed in 2010; however, health insurance options for undocumented immigrants will remain largely unchanged as undocumented immigrants who cannot enroll in Medicaid or Medicare and are not eligible for tax credits or subsidies.  

“The other day, my grandson told me that he felt really bad, that he had a stomach ache. I asked him if he needed to go to the doctor and he told me yes, and I said let’s go. I took him to the clinic and they told me to take him to the emergency room and I did…it’s so expensive. He had to pay $500 just to enter and leave. The visit was only 15 minutes." - Maria Teresa

Surveyed farmworkers had more than a three-fold higher prevalence of Poor or Fair health in general when compared to Sonoma County adults overall. This result indicates dramatic health disparities among farmworkers. This disparity is particularly concerning because most farmworkers lacked health insurance, which decreases the likelihood that farmworkers were able to access medical care.  Additionally, farmworkers had a three-fold higher prevalence of diabetes when compared to Sonoma County adults overall. Access to medical care, medications, and diabetes self-management education are critical to the care of diabetes. Given that farmworkers had a higher prevalence of diabetes, most farmworkers were uninsured, and nearly all farmworkers were low-income, the Sonoma County farmworker population should be prioritized for further diabetes research and prevention efforts. 

Our County has set its mission to invest in beautiful, thriving, sustainable communities for all, where all families have access to the same opportunities to meet their full potential and live long and healthy lives. This commitment to community well-being reflects both our agricultural heritage and the recognition that it will take broad cross sector partnerships to address these disparities.  

When we tackle social inequity by developing interventions "Upstream" we cannot forget to invest in the adult men and women who do some of the hardest and most important work in our region. Farmworkers, day laborers, and domestic workers are mothers and fathers, they plant and grow the wealth of other people, and they take care of what is most precious to us: our homes, and our families. We need to more appropriately value their labor and their contributions as fully integrated members of our community.

- Maureen Purtill, Ph.D., Director, Centro Laboral de Graton

Portrait of Sonoma County Agenda for Action

These data highlight a specific population living with the inequities explored in A Portrait of Sonoma County, commissioned by the Department of Health Services and supported by the Board of Supervisors. The report examines disparities in health, education, and income by neighborhood, ethnicity, and gender.The data highlighted in this story fall within two areas outlined in the Agenda for Action:Mend the holes in the safety net for undocumented immigrantsTake a two-pronged approach to raising earnings: boost education and improve pay

Policies Underway to Reduce Disparities Outlined in FHS 

The County of Sonoma supports health in all policies to alleviate disparities and inequities in our community. The County is advocating for aggressive changes at the federal and state levels to promote more funding for affordable housing, childcare and access to healthcare. Additionally, the County supports an Earned Income Tax Credit (EITC) at the state level to provide more funding for vulnerable populations.  The County is also working with our community partners on strengthening healthy housing options and policies in our County. The County supports efforts to implement meaningful reforms on the policy of housing insecurity to achieve better outcomes for working class families, including farmworkers.  Our County values the need to support greater access to health insurance as a means to improve the wellbeing of our County. Unfortunately, a lack of access to quality healthcare results in poor health, preventable hospitalizations, and premature death. The Board is supporting legislation to provide health insurance coverage to undocumented immigrants, especially children. Lastly, the Board supports the development of a long-term solution that will provide healthcare coverage for all residents of California. 

Acknowledgements

Most importantly, we would like to thank the farmworkers that participated in this survey for sharing their experiences and stories.Thank you also to California Human Development and the many other partners of this project.The Sonoma County Farmworker Health Survey was supported by the Community Transformation Grant, Cooperative Agreement 1H75DP004611-01, from the Centers for Disease Control and Prevention.  The contents of this report are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.