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Jacqueline Agnew, RN, MPH, PhDJohns Hopkins University

Immigrant Workers

History of Immigration in the American Labor Force

Section A

Immigration to the United States

4Image source: Harvard University. Retrieved from http://ocp.hul.harvard.edu/immigration/

Early Immigration

5Map source: Churchman Genealogy Website. Retrieved from www.churchman.org/Pictures/indmap.gif

Arriving in the U.S.

6

Unidentified artist, creator Harvard University Art Museums

United Statesc. 1903

Photo source: Harvard University. Retrieved from http://ocp.hul.harvard.edu/ww/subject.html

Arriving in the U.S.

7Photo source: Harvard University. Retrieved from http://pds.lib.harvard.edu/pds/view/3621773?n=9&imagesize=1200&jp2Res=0.25

Arriving in the U.S.

From Roberts, P. (1912). The new immigration.

8Photo source: Harvard University. Retrieved from http://pds.lib.harvard.edu/pds/view/3621773?n=9&imagesize=1200&jp2Res=0.25

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

12Source: Current population survey.

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

17Source: Current Population Survey, March 2000, PGP-3

Percent Below Poverty Level, by Origin (2000)

18Source: Current Population Survey. (2000, March). PGP-3.

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, Astudillowas 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 andlower 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 ofillegal 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

Protecting the Health and Safety of Immigrant Populations in the Workforce

Section B

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 work-related 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− Potential contributors to risk

Cultural, social, economicPerform 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

King sized bed—113 pound mattress1,000 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.”

36Photo source: Korean Resource Center. Retrieved from Flickr.com

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

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

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

Vietnamese Nail Salon Workers

Section C

Vietnamese American Immigrants

1,212,465 Vietnamese in the U.S.

Population centers: California; Texas; Washington; Washington, D.C.; Massachusetts

NAVASA represents community-based organizations (CBOs)

Average income: $15,000 per year

38%: < high school diploma; 8%: none

73.8%: services, sales, office, and production occupations

45%: limited English proficiency

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

46Photo source: AikiDude. Retrieved from Flickr.com

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

Informal Work Sector—Day Laborers

Section D

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

SpaceOrderSet wage amountsOversight of standards and employer behaviorOften 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

United States: 1.5 ug/dLMexico: 2.3 ug/dL

63Source: Street corner hazard surveillance and health intervention among Chicago day laborers.

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

Migrant Farm Workers

Section E

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

75Source: Hiott et al. (2008).

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/

Legislative and policy workDirect work—U.S.-Mexico border

Collaborate with community-based organizations (CBOs) and clinicsHealth promotion programsChildren’s healthHIV/AIDS prevention

See list in Arcury and Quandt article

80

Training and Advocacy

Section F

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

84Source: O’Connor, T., et al. (2005, March 1). J Occup Environ Med, 47, 3, 272–277.

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