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INTERIM REPORT ON THE STATUS OF PROGRAM ACTIVITIES UNDER THE MIGRANT HEALTH ACT, JUNE 1964

BACKGROUND

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In the United States today, about 2 million American citizens, including dependents, are involved in the self-perpetuating conditions of illiteracy, insecurity, and poverty which dominate the life of the domestic migrant farmworker. The migratory work force is composed chiefly of southern Negroes, Americans of Mexican descent, American Indians, and Puerto Ricans.

Domestic migrants move one or more times each year in search of work along three major migration routes—from Florida along the east coast to New England, from Texas to the Rocky Mountain and Central States, and from California north into the Pacific Northwest. They may be away from the place they call home for periods of a few weeks to most of the year.

Their wage rates are low compared with those in industry, and their periods of work are interrupted by travel between jobs and periods when no work is available. Thus, their annual earnings average less than $1,000 per worker.

Although the number of family farms and self-employed farmworkers has declined in recent years, the number of large farms--the chief emplovers of hired farm labor-has increased. Domestic migrants included one-fifth of the Nation's total seasonal hired farm labor force at the 1963 peak. They continue to perform a vital role in modern agriculture for a third of our Nation's counties.

In the past, reports of migrants' health status and services have shown

Repeated serious outbreaks of diarrhea among their children.

Lack of early prenatal care and sometimes none at all for migrant mothers.

Diphtheria epidemics resulting from failure of community immunization programs to reach them.

Numerous unpaid medical and hospital bills for emergency care, some of which simple precautions could have reduced or prevented.

As the 1961 report of the Senate Subcommittee on Migratory Labor pointed out: "The constant interstate movement of migratory farm families prevents them from utilizing public health services generally available to other citizens. Their needs for health services are far from being met even though the conditions under which they live and work are

such that their need for health services is greater than

normal * Much of their disease and disability stems from poverty, filth, and ignorance, afflictions which migrants share with other impoverished people who

Live in poor, overcrowded housing in a substandard setting.

Lack facilities for washing, bathing, and laundry-sometimes even water for family use.

Have little knowledge of good dietary and food handling practices, and no proper place for food storage.

Lack understanding of health needs, or proper health maintenance practices.

Lack funds to pay for care, even if need and suitable ways to cope with it are understood. An added handicap for migrants in maintaining health is their employment far from urban centers where health resources are concentrated.

Some of the rural counties where they are employed lack health resources even for permanent residents.

Others, although well supplied, have health resources so concentrated at a distance from the places where migrants live and work that the travel involved to reach them is as great as the distance across some of the smaller States.

At best, few of their temporary work communities find it possible to expand and adapt their health resources to a large influx of needy newcomers who will soon move on. The community services migrants receive are not planned with their needs in mind, and are not coordinated with the services

they may receive elsewhere. Perhaps greatest of all their handicaps is migrants' frequent need to move in search of farmwork.

They seldom stay in one place long enough to learn the location of physicians or hospitals, the schedules of community clinics, the types of services offered by different local agencies, or proper ways to gain access to services that might be available to them.

Their movement disqualifies them for many types of aid afforded needy local residents. Because they move so often, they are "residents of nowhere."

As strangers wherever they go, they are often viewed with suspicion or outright hostility by local community residents. This magnifies their own fear of the community and makes them even more reluctant to request help for which they might qualify:

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Each spring the migrants move northward, returning in the fall to Florida, Texas,

and the Southwest when no work can be found elsewhere. Source: U.S. Department of Labor, Bureau of Employment Security, 1961.

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The passage of the Migrant Health Act (Public Law 87-692) 1 introduced by Senator Harrison Williams, chairman of the Senate Subcommittee on Migratory Labor, represented a major legislative breakthrough. Signed into law in September 1962, the act provides for financial and technical aid to those public or private nonprofit agencies which develop plans to extend community health services to migrant farm workers and their families. Specifically, the law provides:

Grants by the Public Health Service to pay part of the cost of

(1) family health service clinics;

(2) other types of projects to improve migrants' health conditions or services.

Expanded effort by the Public Health Service to improve migrants' health conditions or services. In administering the law, the Public Health Service encourages the development of community projects which provide migrants personal health care in a setting that enables them to take increasing responsibility for meeting their own health needs. Such a setting requires

Temporary expansion of local services as needed.

Scheduling of services at convenient times, and at places where migrants can reach them easily.

Arranging for necessary transportation for migrants who would otherwise have none available.

Recognizing migrants' low-income status resulting from their limited year-round earning opportunities.

Planning to overcome migrants fear, suspicion, lack of facility in the use of English, lack of understanding of health needs and requirements to maintain good health, and other barriers to the effective use of community health services and

the improvement of personal health practices. The 1962 law authorizes a 3-year program ending on June 30, 1965. The congressional report indicates that "the purpose of the 3-year limitation is to compel an early review of the adequacy of the program

The following guidelines are considered in reviewing migrant health project grant applications:

Substantive merit and potential contribution of the project towards improvement of domestic agricultural migrant workers' health services and conditions.

Estimated number of migrants in the project area, and duration of local crop season.

Evidence of unmet health needs of migrants in the area.

Comprehensiveness of service, with emphasis on sei vice to treat illness and disability and to prevent it to the extent possible.

Degree to which the project plan is adapted to migrants' circumstances and background.

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Extent of planned coordination within the project area, and with other home-base and work areas in the same migrant stream.

Evidence of participation and commitment of resources by appropriate community groups: growers, migrants, physicians, nurses, hospitals, public and voluntary agencies, church groups, and others.

Adequacy of personnel, facilities, and other resources of applicant to carry out project.

Extent to which persons working with the project will be oriented to unique factors in migrant situation.

Proportion of cost assumed by the applicant organization or arranged by the applicant from other State or local sources (not only cash but also contributions of volunteered services, equipment, facilities, etc.).

Evidence that project will continue beyond the period of grant support.

Evidence that project may yield results, or may provide training opportunities, which will be useful to other interested persons and groups.

PROJECT Costs, COVERAGE, AND SPONSORSHIP Requests for project grant assistance have consistently exceeded available funds. An annual appropriation of up to $3 million was authorized for each of the program's 3 fiscal years. Of this amount

In fiscal year 1963, $750,000 was appropriated in midMay, solely for grants. The entire amount was immediately allocated to approved projects. Grants to assist other approved projects had to be delayed until the start of the next fiscal year on July 1.

In fiscal year 1964, $2 million was appropriated. Of this amount, $1,500,000 was for grants and $500,000 for direct operations by the Public Health Service to improve migrants' health conditions or services. A backlog of approved applications will be carried over unfunded to the next fiscal year, starting on July 1.

For fiscal year 1965, the request of the Public Health Service for the full $3 million authorized is now before Congress. Of this amount, $2,500,000 will be for grants, and $500,000 for direct operations will be continued.

New applications are constantly being received, as well as requests for continued support of projects previously granted assistance.

37-354-64---2

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