x

Shifts in Demographics: Anticipating, Responding, Meeting New Needs at Community Health Centers

Geopolitical dynamics and demographic shifts in rural communities can often lead to friction in communities, as well as new and unmet health needs for which health centers and their outreach teams need to be ready, nimble, and active. For example, in recent decades, as dairy farms have consolidated and industrialized, farms have had a growing need for labor outside of the farm family, and few in the community are interested in such work. Dairy farms regularly state that labor is their biggest challenge, and immigrants have often filled the need. Over half of dairy workers are now immigrants.1 In many areas, Guatemalan workers are stepping up to take dairy jobs: informally as unauthorized workers, through the H-2A temporary foreign worker program, or formally as year-round authorized workers. Many arrive without experience with dairy farms or handling large livestock, and some speak no English and limited Spanish. “If K’iche’ is not spoken on your dairy, it is just a matter of time before it will,” said an industry news article.2 Training in these highly dangerous environments is essential, but it’s unclear if farms have sufficient trainings that are linguistically and culturally appropriate for their workers. 

Immigration raids at a meatpacking plant in Nebraska in the early 2000s left JBS, the conglomerate that owns the plant, with insufficient numbers of workers willing to take the difficult, dangerous, and low-wage work at the plant, so they hired Somalis, who have legal status as refugees, to replace the Latinx workers.3 Over time, Somalis have begun working in meatpacking plants around the country. Complaints at a Colorado meatpacking plant against working conditions that did not accommodate prayer times eventually led to a $1.5 million settlement in a lawsuit against Cargill.4 Such accommodations slow down production and put undue stress on non-Muslim workers, who struggle to meet the demands of the job with fewer people during prayer time, say the companies and fellow workers, leading to tensions between ethnicities on the plant floor.5 

Many regions, particularly in Florida and the northeast,6 have seen an influx of Haitians, many of whom are authorized to live and work in the US under their Temporary Protected Status (TPS). Haitians began receiving TPS after a 2010 earthquake devastated the small Caribbean nation. Numerous natural disasters, an unstable government, extensive poverty, and widespread violence continued to destabilize the country, leading to expansions and renewal of the program for Haitians under presidents Obama and Biden. Legal challenges prevented former president Trump’s administration from effectively ending TPS.7 The community of Springfield, Ohio, has struggled to accommodate the increase in population, despite their integration into the economy, admitted Ohio governor Mike DeWine, echoing concerns voiced that services like health care were insufficient for the abrupt population rise: “What the companies tell us is that they are very good workers. They're very happy to have them there, and frankly, that's helped the economy. Now, are there problems connected? Well, sure. When you go from a population of 58,000 and add 15,000 people onto that, you're going to have some challenges and some problems.” The community was under the magnifying glass after the unfounded rumors of Haitian immigrants eating pets was repeated in the presidential debates, which increased harassment and led to fear in the Haitian community.   

Health centers can play an important role in anticipating and concretely addressing the many concerns that arise when a new community has begun to grow within the health center patient population. In the case of Haitians, Venezuelans, Ukrainians, Afghanis, and others with refugee or Temporary Protective Status (TPS), groups are often settled together to create the nucleus of a community, noted Deliana Garcia, Director of International Projects and Emerging Issues for Migrant Clinicians Network. Consequently, a health center and its outreach team that is already struggling to care for Spanish-speaking farmworkers may begin to encounter Haitians in a very short timeframe. “Programs need to be nimble enough to recognize changes, and then to shift with those changes,” she concluded. 

In each of these three examples, a change in demographics precipitated a cascade of challenges to the health and well-being of the community: occupational health risks that were amplified by linguistic, religious, and cultural barriers; health care access issues; conflict and tension between segments of communities; and the health impacts of anti-immigrant rhetoric.  

Here are some resources to assist: 

Occupational Health Risks can be reduced when primary care providers understand their patients’ occupations and adjust their differential diagnoses accordingly.  

Health Care Access continues to be a struggle for many migrants and immigrants.  

  • Understand some of the major barriers that migrants face that interrupt their health and limit their access to health care even when they need it on MCN’s Migrant Health Issues page: https://www.migrantclinician.org/explore-migration/migrant-health-issues.html  
  • The SDOH Academy, a collaboration of which MCN is a part, has numerous archived webinars on the role that social determinants of health play on patient access and health. https://sdohacademy.com/  
  • Anti-immigrant rhetoric results in health concerns and may cause immigrants to avoid health care for which they are eligible. MCN’s Words Matter campaign features first-person videos in English and Spanish, five deep-dive blogs on the research about anti-immigrant rhetoric, and a webinar series for clinicians to learn to support their immigrant and migrant patients: https://www.migrantclinician.org/wordsmatter  

Resources

1 National Center for Farmworker Health, Inc. Dairy Workers Fact Sheet 2024. June 2024. Accessed 21 October 2024. https://www.ncfh.org/dairy-workers-fact-sheet.html  

2 Bohnert K. More and More Dairy Workers Speak Another Language: K’iche’. Dairy Herd Management. 15 April 2024. https://www.dairyherd.com/news/labor/more-and-more-dairy-workers-speak-another-language-kiche 

3 Semple K. A Somali Influx Unsettles Latino Meatpackers. New York Times. 15 October 2008. https://www.nytimes.com/2008/10/16/us/16immig.html  

4 Minor N. Cargill, Somali-American Workers Reach $1.5M Settlement Over Discrimination, Terminations. CPR News. 14 September 2018. https://www.cpr.org/2018/09/14/cargill-somali-american-workers-reach-1-5m-settlement-over-discrimination-terminations/ 

5 New York Times (n3). 

6 Kingston S. Why is the Haitian population of Springfield, Ohio, booming? ABC News. 17 September 2024. https://abcnews.go.com/Politics/haitian-population-springfield-ohio/story?id=113731377 

7 Ibid.

Authors

Claire

Seda

Director of Communications

MCN

Category
Health Centers
Occupational Health and Safety
Streamline