From the federal docket on Preventive Controls for Fresh Produce comes this comment on farm labor and hygiene.

Bob Gravani,
Cornell University

Author and Presenter, Farm Worker Health and Hygiene
February 19, 2010
Rochester, NY

One of the issues that we address with farm worker health and hygiene is that we need to think about how we would do our jobs without hired farm labor, and clearly over the years, we've had a great dependence on farm labor to help us get the job done. Most of you recognize that it's physically demanding, it's a tough job. So let's take a look at some of the background and the demographics of who this broad audience of hired farm workers is.

First of all, there's over a million hired farm workers employed in the U.S., and most of those work on crop farms, basically, some work on live stock, but most work on crop farms. If you think about it, they make up about 1/3 of all farm labor; the other 2/3 comes from self-employed farmers and growers, and their unpaid family members who provide assistance on the farm. So clearly, this group has decreased over time, and you can think about the reasons why they decreased:

 No. 1 is greater mechanization, greater productivity, certainly a consolidation of farmland and farms; so we rely on farm workers a great deal, but the numbers have declined over the years, and if you go to the website, you'll see a very nice graph that Bill Campbell from the USDA's Economic Research Service has put together to show the difference between hired farm labor, and growers and their family members and how that has decreased.

Who are the farm workers that are out there? I'm going to spend a few moments in my next two slides teasing out who this group is, so I'll just provide some very basic information now: Farm workers are usually young, this is a young person's job, because of the physically demanding nature of it; they're usually less educated; they're usually white; they're usually Hispanic; they're usually male; they're usually married; and they're more like to be foreign-born.

Now when you think about the health status of farm workers, the issue here is that while the research is increasing on the health status of this group of people, we still don't have a lot of good understanding about the actual health status of this group; but think about it, they're economic status, their lack of health insurance, as well as cultural and language barriers are really access issues to proper health care.

 When these people are sick or injured, they will go to an emergency room, a hospital emergency room, or to local clinics to get attention, but only as a last resort; this is expensive, so people in this demographic don't really seek out health care unless it's absolutely necessary.

So let's take a look at who they are. I mentioned that they're predominantly make, about 81% of farm workers in the U.S. are male; about 72% of them, almost 3/4 are less than 44 years of age, and the median age for farm workers across the country, and this comes from Economic Research Service USDA data, based on farm worker population studies, etc., the median age of farm workers is about 34; so clearly, if anybody has spent a lot of time on farms here, and in the West and Southwest, you recognize that this is a young person's occupation.

Talk about less educated - 30% of them have less than a 9th grade education, and 51% of this whole group have not graduated from high school, so clearly a very undereducated portion of our population. Fifty-three, 53% of them are married, and most of them, about 43% of them are of Hispanic ethnicity. Now here's a telling factor that came out of this very nice paper that appeared in 2008 by Bill Campbell, again of Economic Research Service, about 5.5% of this farm worker hired labor force is made up of children under the age of 18.

So think about this entire demographic. Now when we look at farm workers, one of the things we think about is farm workers - migrant workers. Well actually, that's a pretty large misconception, because as this next slide shows, and again according to this really good report on farm worker profiles in the U.S., migrant workers, that is people who move seasonally from place to place based on the crop, etc., make up only about 12% of all of the crop farm workers in the United States.

Most of our farm workers are settled farm workers; that is, they may  have had temporary jobs at your farms, and then they turned out to be a good fit, you liked them, they liked you, and they settled. Now what's the reason for the settling. Certainly the reason for the settling has been clearly a more seasonal operations, your ability to get jobs off of the farm in other sectors of the economy, as well as a tightening of border rules, for those people who are moving back and forth across borders.

There's a number of people called shuttler workers, and basically they make up roughly 20% of hired farm crop workers, and basically this group moves from their homes, either in the U.S. or in other countries, to their place of employment; and those of you who have been to Yuma recognize that there are folks who live in Mexico who actually travel across the border and work on U.S. farms and go back at the end of the day; those are called shuttler workers, making up about 20% of the farm labor.

The newcomers are really people who have been in the United States for about a year, and based on all the demographic studies that have been done, they haven't really been able to categorize those folks into one of these other three groups, so they put them sort of in the newcomer group, and they're still getting settled to be anywhere in that nexus right at the moment.

So okay, we know that farm workers have intimate contact with the fruits and vegetables that they harvest, sort of pack, and therein, lies the issue. If you look at the data from FDA and you look at farm investigations based on outbreaks that have occurred, what do we see; and I didn't put this graphic in, but clearly we see that farm workers are certainly part of the issue related to food borne illnesses; infected workers, as you know, can be asymptomatic, and certainly have intimate contact with the fruits and vegetables that they're involved with.

Now if you look at some of the outbreaks, and when you go to the issue brief on the website, you'll see a number of those outbreaks that have been linked back, in some cases totally, and in some cases partially, to farm workers; and if you think about pathogens like shigella, gora-virus, and Hepatitis-A, and others, the reservoir through those are infected humans; and clearly, there's a direct linkage between fecal oral contamination and their contact with fresh fruits and vegetables that are going into a package and being sold to consumers.

So clearly, we have to break that fecal oral route of transmission, and that's important; and I'm not going to bore you with the details of all these outbreaks of all the organisms, but recognize that all these organisms present a variety of salmonella species, e-coli 0157, cryptosporidium, cyclospora, etc., have all been implicated in produce-associated outbreaks. What are some of the factors that contribute to these outbreaks related to hired farm workers?

Lack of an adequate water supply, and we've talked a lot about that this morning in the two sessions, mostly from an irrigation and crop protectant point of view; but clearly, when we think about an adequate water supply for hand-washing, for drinking, etc., that's important.

Limited hygiene education, and I think many of you have heard this before, but when we did a survey, I did a survey in 2002 of New York State growers, we asked people whether they did hygiene training, and most people said no, 57% said we didn't do it; why didn't we do it, because it really wasn't needed. Well, when we asked the workers in an oral administered survey, about 680 of them, they said, "We'd love to have more information about hygiene training."

So clearly, there's a bit of a disconnect there, and I think now, we're seeing a lot more hygiene education training. Poor or no toilet facilities -- clearly if you don't provide opportunities to use field toilets and to wash hands afterwards, that fecal oral routed contamination is going to become a key issue in the transmission of these organisms.

Bare hand contact with produce -- when you think about this, many times it's farm workers who touch that product, the last person, just before we consumer it. So, are they food handlers? A lot of folks, including us, would say yes.

It's very important that we require our food handlers throughout the system, whether they be in processing or in retailing or in food service, to pay attention to personal hygiene, we really obviously need to do this the same way with our farm workers. Lack of food contact surface sanitation -- when we first began gaps training in 1998, 1999, we weren't thinking about surface contamination and the ability of workers to contaminate some of those surfaces, and certainly there have been a number of outbreaks where children in the fields, because lack of child care for workers, became an influence; changing a poopy diaper, and then going back and picking crops, is not exactly breaking fecal oral route of transmission very well.

So, do your audit checklists include worker hygiene, I think the answer is clearly yes, and I think this has changed a great deal from our 2002 survey. Today, most audit checklists, and I can't think of any that don't include good agricultural practices, worker health and hygiene issues; and again, of the 450 growers we surveyed in 2002, 57% had no worker training for hand hygiene or hand washing.

Clearly, growers must conduct and document worker training programs, as you all know, or risk losing points on the Gaps Audits. The training programs, and again, many growers said, "Look, I'm not in the hygiene business, I'm in the fruit and vegetable business, and that's what I do best", but p.s., hygiene is part of the fruit and vegetable business, and an important part if you want to reduce the risks from the worker contact with products. Worker health and hygiene is clearly important, and needs to be transmitted to workers in their native language by someone who is a cultural agent, someone who speaks their language who they respect and understand, lots of research on that.

Personal cleanliness, the whole issue of, Jim Gorney told me before I got up here, just tell them, "Wash your hands, get your workers to wash their hands, and we'll be reducing that risk substantially", and that's true; wash early and often, do it properly, and I don't have time to talk about all the details here, but a 20-second wash seems like an eternity, but it's important.

Water, good portable water for hand-washing, as well as for personal consumption; women more important than men, because of the hydration issues, because of the dehydration issues that are important there. Jewelry and personal adornments make up what we call physical hazards -- they fall in a product, somebody breaks a tooth, or swallows it, lacerates their mouth or whatever, that's an issue; more of a concern on the processing of the equation, but nevertheless an important issue. Proper toilet use -- where do you put the toilet paper when you use a field toilet, you put it in the toilet, a lot of ethnic groups don't do that because of their cultural nature and the plumbing system in their countries.

We mentioned hand-washing. Glove use, both disposable glove use and re-usable glove use, making sure that's done properly. Certainly first-aid for issues related to cuts, abrasions, other injuries, as well as bodily fluid contact, food contact surfaces, and also product. Does your operation have a worker training program that includes health and hygiene?

Clearly, the conclusions are that farm workers do play a key role in safety of fresh fruits and vegetables; and clearly, training programs have to be practical, useful, meaningful, and aimed at an appropriate education level -- keep it simple, address the issues, have someone knowledgeable do it. Top management -- all of you in your respective operations really set the tone, and someone in our water group this morning said, "You know, there's a difference after we've been Gap Certified, it raised the bar, it raised the awareness level for all of the people in our operation." They get it now, and that culture of food safety is really important as we move forward. It sounds hokey, but it's really true. It works in all sectors of the food system, from farms to processors to retailers and food service operations.

You've got to implement really good quality programs, they've got to be done in a meaningful way, and we've got to clearly enforce the rules that are out there. If we don't enforce them, then everything goes to heck in a hand basket. So clearly, our points of discussion this afternoon are -- are there scientific issues that we did not address that you think are key to improving worker health and hygiene? What are they? We really need to know what they are? Are there important regional considerations?

Do we do things differently in the Northeast on small farms versus large farms in other parts of the country? We need to think about that, and do the suggestions for improving worker-related food borne illnesses makes sense to you. What other issues should we be thinking about when it comes to worker health and hygiene? And again this seems very simplistic, but it's like all the other issues we've talked about, it's much more complex than just a very simple fix. But I think we can address it today, and with your help and expertise, I think we can get to the next level. Thanks very much.