Tracing the Causes of Death for a Migrant Worker

WASHINGTON -- Elirose Pierre-Louis died last month at age 56 of a heart attack. A Haitian immigrant who labored in this country legally for more than 20 years, she last worked as a tomato picker on Virginia's Eastern Shore, making $6 an hour.

Elirose suffered from high blood pressure and diabetes and couldn't afford the care she needed, according to a health worker who attended to her in her final hours. While a weak heart ultimately killed her, her circumstances likely hastened her death.

As a poor worker living in a remote rural area, she was less likely to have easy access to a health care provider. As a seasonal farmworker who worked long hours and moved on when the crops were picked, her ability to see a doctor for a regular checkup was limited.

According to the National Center for Farmworker Health, agricultural laborers have long been considered to have the worst overall medical status in the country. A 2000 report on the health of California farmworkers, sponsored by the California Endowment, found that "no group of workers in America faces greater barriers in accessing basic health services."

While some of the conditions that jeopardize the health of farmworkers are unique to a rural setting, poor pay, limited health services and substandard housing are common across a wide spectrum of jobs. Today 47 million people in the United States lack health insurance, only around 5 percent of which are farmworkers. In other words, farmworkers are not alone.

According to a new study released this week, 80.4 percent of waiters, 78.8 percent of dishwashers, 76.8 percent of day care providers and 74.7 percent of telemarketers do not have employer-sponsored health insurance or a retirement plan. These and other workers make up 22.1 percent of U.S. workers -- nearly 41 million people who hold "bad jobs," according to the study by the Center for Economic and Policy Research in Washington and the Center for Social Policy at the University of Massachusetts at Boston.

Public assistance programs such as food stamps, Medicaid and the State Children's Health Insurance Program (SCHIP) are crucial. But some of these programs are off-limits to those who make enough money to be above the poverty line, and nearly all public assistance is unavailable to immigrants who are here illegally or have less than five years of legal status. SCHIP, the expansion of which President Bush vetoed last week, also excludes legal immigrant children who have not been here for five years.

One of the few options that poor and moderate-income workers and their families have are community health centers. These facilities often offer extended hours and bilingual social workers. Today, centers serve about 16 million people throughout the United States, according to Dan Hawkins, policy director at the National Association of Community Health Centers.

Congress is seeking to increase community health center funding by at least $200 million. But if President Bush holds firm to his promise of not signing any bill allocating more funds than his administration has requested, the centers may be left high and dry.

That would be particularly ironic considering that Bush has long defended the role of community health centers as crucial to the country's safety net. In fact, he nearly doubled funding as part of a six-year health centers initiative launched during his first year in office. That funding, however, has not kept up with the increased need for affordable basic health care services.

Care for people such as Elirose continues to be scarce. According to Hawkins, only one in four farmworkers has a health center to go to.

So like many others, Elirose had attempted to move up the ladder, so to speak, from farmworker to an employee in an urban area where the opportunity to obtain insurance would supposedly be better.

Last year she began working for a subcontractor responsible for cleaning and maintaining property at a university in Miami. But when Elirose and her fellow janitorial workers tried to unionize in order to secure more benefits than the $6.65 they were making an hour, the university canceled the contract and 100 people lost their jobs, including Elirose.

She then hit the road again and, in order to help relatives back in Haiti, returned to seasonal farm work. This time she didn't make it through the tomato harvest.