|
|
 |
|
|
National
Advisory Council on Migrant Health (NACMH) Recommendations
- 2009
The Honorable Acting
Secretary Charles Johnson
Department of Health and
Human Services
200 Independence Avenue, S.W.
Washington, DC 20201
Dear Acting Secretary Johnson:
Since our last communication
with your office, the Secretary of Health and Human Services’ National Advisory
Council on Migrant Health (Council) has held two very exciting meetings to
discuss the health needs of migrant and seasonal agricultural workers in the United States . During the first of these two meetings, which
was held in November 2008, the Council had the privilege of hearing testimonies
from frontline health care workers—including administrators, clinicians,
outreach professionals, and Promotoras
(lay health workers). Our second
meeting, held recently in February 2009, built upon the issues identified from
the testimonies and then advanced discussion by identifying th ose health and health-related issues that are seen
by the Council as m ost critical to
the future of migrant/seasonal farmworkers’ (MSFWs) health over the coming
decade. These discussions yielded
overlap between meetings, as well as with issues raised in the past; they also
led to new issues which we believe are critical to the Health Resource and
Services Administration’s (HRSA) central role of assuring access to care for
farmworkers and their families.
Below we make
recommendations, for your consideration, based upon four key discussion topics
that either recurred frequently acr oss
Council members (and therefore geographic regions of the U.S. ) and/or were affirmed by testimonies
heard. Moreover, we highlight, for your
attention, the Council’s expectation that steps taken to address these four
items regarding MSFWs and their families in the U.S. will result in:
- improved health
services access,
- improved quality
of health services delivered, and
- improved
demographic knowledge.
Underlying each of these
recommendations is recognition that the health and services needs, as well as
the vulnerability of migratory and seasonal agricultural workers, are unique
among U.S. populations. This unique vulnerability
results from their heightened intra- and international mobility, physical
demand of their work, social and geographic isolation, provider-patient
language barriers, and high rates of financial impoverishment.
Therefore, the Council
recommends the following areas for your consideration:
- Improve the availability of services delivered in
the Migrant Health Programs to a larger proportion of the population of
migrant and seasonal farmworkers. Improved access to health care services is the
key goal of this recommendation. The Council identified the following two specific actions that it
believes are the next steps towards achieving this goal:
- Require that
all Migrant Health Programs provide comprehensive, family centered Dental Health
Care Services. This is an area in which farmworkers experience their
greatest access barriers and unmet health needs; it is also brought up as one
of the main causes of infirmity and/or death among MSFWs and their families, in
particular children. We believe this
will improve the availability of effective and successful health services to
MSFWs and their families.
- For Migrant Health Programs seeking to expand their medical capacity,
reduce the minimum expected increase of farmworkers to be served upon expansion
to ‘500 or 10% whichever is less’, rather than the current increase of
1000. This reduction in the expected numbers of farmworkers
to be served as a result of a program expansion will allow Migrant Health
Programs greater flexibility to meet and be responsive to short-term changes in
population dynamics that result from such characteristics as shifts in their
migration pattern. This will also allow
Migrant Health Program grantees to meet the application eligibility
standards.
- Expand multidisciplinary provider participation
in the National Health Service Corps (NHSC). The Council recognizes the need to
increase the quantity of providers—and recommends developing and expanding
programs designed to attract and to train students early in both
pre-medical and medical training programs, nursing programs, dental
programs, school of psychiatry programs as well as the quality of
providers—by ensuring cultural competence and relevance among th
ose health care professionals recruited. These courses of action will ensure the
availability of a disciplinary diverse and culturally competent health
care workforce to serve MSFWs and their families.
- Stimulate and systematize the use of information
technology within and among Migrant Health Programs locally, regionally,
and nationally. Provider-patient language barriers and heightened
intra- and international mobility among farmworkers places them at
heightened risk of l
oss of
continuity of health care, l oss
of public health insurance benefits, and missed opportunities to prevent
long-term sequelae of acute conditions. For example, greater use of information technology can reduce
barriers currently encountered as a result of lack of portability of
medical records and insurance benefits, and can increase the availability
of health care that is seamless, uninterrupted, and appropriate when
farmworkers travel acr oss state
and international borders. It is
further recommended that the technology used worldwide for information
exchange within the banking system be investigated and replicated in terms
of utilization for accessibility and exchange of medical information.
- Create and fund a Center for the Study of Migrant
Health. The Council recognizes
both the long-standing lack of scientifically-based information about
farmworkers’ health status and barriers to care. In addition, the Council acknowledges
the need to better characterize and account for health outcomes of MSFWs
and their families—such as patient satisfaction, and health-related
population characteristics, i.e., migration patterns and changing
demographic trends. Key demographic
trends discussed include shifting migration patterns and greater
linguistic variation among workers and their families—including the
increased encounter of speakers of indigenous languages. The Council recognizes the potential
for such a center to add to the empirical knowledge base, as well as to
make use of existing databases that include farmworkers in order to inform
decision making by policy and program developers. Moreover, such a center could develop,
nurture, and sustain a network of new and seasoned scientists interested
in the health needs of migratory and seasonal farmworkers while connecting
them to the network of direct service providers for this population.
These recommendations are
humbly submitted on behalf of your National Advisory Council on Migrant
Health. We appreciate and thank you for
your consideration of these recommendations.
Sincerely,
Rogelio Fernandez, M.D. Rosita Castillo-Zavala
Chair,
National Advisory Council on Vice Chair, National
Advisory
Migrant
Health Council
on Migrant Health
cc: Dr. Elizabeth M. Duke
Mr. James Macrae
Capt. Henry Lopez
Dr. Marcia
Gomez
|
