Farmworkers’ experiences working during wildfires and impacts on health (Hyland and Gordon, 10/16/24)

This week, in commemoration of the 2017 Tubbs Fire, which destroyed over 5,000 homes in Santa Rosa, we had a really special presentation by two researchers from the Berkeley School of Public Health and Berkeley Law School on the impact of the Ag Pass program and wildfire smoke on Sonoma County farm worker health.  

If you can, please watch their presentation. A recording is available HERE.

It was both fascinating and disturbing to hear two researchers talk about the place we live and practice medicine-- and where thousands of vulnerable farm workers face dangers from our local policies during fire season.

• AB1103: California law that established a "Livestock pass" in 2021, work authorization program, allowing workers back into evacuation zones during natural disasters
• Counties have interpreted this law as permitting them to allow workers into evacuation zones
• Unfortunately, no occupational health analysis (by Cal-OSHA) was done in the passing of this law
• From 2017-2022, such passes were handed out in an Ad-Hoc manner by the Ag Commissioner, often based on personal contacts and phone calls

In 2022, the Sonoma County Board of Supervisors (BOS) passed their own version of the Ag Pass, which allows farmworkers back into an evacuation zones for "critical activities". The SoCo Sheriff decides when Ag Pass is activated.

In 2023, the local law was amended to include "grape harvest" as a "critical activity"

SoCo Ag Pass has three components:

1) Fire safety training (4 hours, no smoke or other exposure training required)

2) Apply through the SoCo Ag Commissioner

3) Go to the SoCo Sheriff's office to obtain the Ag Pass card

(this requires photo identification, address, phone number)

***

We have data from Sonoma County on the health impacts of wildfires on local health: 

• 25% increase in ED visits for respiratory symptoms
• 33% increase in hospitalizations for respiratory illnesses
• 18.7% increase in asthma prescriptions
• Disparities based on race and SES

This project was a collaboration between the Human Rights Center and Berkeley Public Health. Goal to examine health, physical safety, economic security, and data privacy

Law and policy analysis, health survey with overall goals to provide recommendations to Sonoma County and the State of California to improve health and safety of farm workers working in fire evacuation zones. 

Recruited local farm workers and trusted figures

Recruited farm workers: gain understanding of AgPass, their experience working previously in fire conditions (and symptoms), what information they need if they are working in wildfire conditions again, economic concerns related to wildfires.

1000+ workers from all over the county, 60% male, ~41 median age, 13 years on average experience working in agriculture

Experiences working during wildfires:

• 75% reported having worked during wildfire
• 64% received some protective equipment from employer
• many had to reuse
• many given surgical mask (rather than N95)
• 70% reported short term health impacts
• 36% who had health impacts indicated they lingered over time
• Mental health impacts

Barriers to accessing health care

• >50% reported no health insurance
• 39% difficult to get appointment at clinic (hours, days open, etc)

Gaps seen in the Ag Pass program as it relates specifically to health: 1) No consideration of short or long-term health effects to workers when Sheriff activates Ag Pass 2) Lack of criteria when Ag Pass can be activated (e.g. AQI level) 3) No health monitoring during/after wildfire events

Very real tension in this population between health and economic security. At baseline 75% are spending 50-75% of monthly income on rent (recommendation is 33%). If there is fire/flood/extreme heat, and farm workers cannot work and do not get paid, they cannot make their basic needs. Even though people are worried about health impacts of wildfire, even more are worried about financial impacts. 58% continued to work despite feeling sick because they needed income and were worried to lose the job. 

Most farm workers are most worried about paying for rent, groceries, gas, medicine/healthcare

Physical Safety Results

• There is no process to communicate with individuals who are reentering an evacuation zone.
• Currently employers are responsible to ensure workers leave in time
• The sheriff could request the information but no system at the county level to ensure this happens safely for workers. 
• No method for county agencies to communicate directly with pass holders. All communication is via employers.

The research team is holding local forums and events to disseminate these results directly to farm workers, two forums open to the public.

Recommendations:

• Recommending consolidating the AgPass application under one department (e.g. under Ag Commissioner) to make process more clear, streamlined, address concerns identified with signing up via the Sheriff's office (considering largely undocumented workforce)
• Support additional research: survey H2A workers inside evacuation zones, specific needs of indigenous language speakers in the county (current offerings only available in Eng/Spanish), understanding air pollutant exposures (increased monitoring), financial literacy needs (long-term planning in changing climate and extreme weather, likelihood this will only get worse)
• Health focused recommendations to SoCo BOS:
• Public Health and Health officials should be included in decisions to activate the Ag Pass, specifically tracking air quality and heat levels inside evacuation zones
• Increased air monitors across the county (hyper-local info needed in rural areas)
  
• Increase collaboration and support with Sonoma County Community Organizations Active in Disaster (COAD), 80 organizations across the county who have infrastructure to provider training and information to farm workers
• $$ support for health and safety training
• PPE to COAD that could be distributed BEFORE fire season in places that are comfortable
• Safety kids: N95, info about wildfire smoke, Cal-OSHA
• Training for employers and how to protect self and 
• Require sufficient stockpile of N95 for workers
• Increase hours of FQHCs across the county, expanded mobile health services, expanded monitoring 
• FQHC collecting farmworker employment
• Health focus recommendations for State of CA
• Update Cal-OSHA smoke standards (AQI >150, PPE needs to be available but not mandatory until AQI >500, no level which is considered unsafe to work)
• Need more monitoring of AQI levels during fire event
• Need requirements employers to communicate AQI levels
• Decrease barriers to reporting concerns to Cal OSHA
• Recommendation for Safety
• Use current active SoCo Alert system, require Ag Pass holders to sign up for these alerts, sign up all farm workers for these alerts
• Develop new alerts: e.g. Ag Pass activated, Deactivated, AQI levels
• Recommendations for economic improvements
• Interconnection of health/economic security
• Comprehensive disaster pay program; create meaningful choice for workers (e.g. hazard pay, disaster insurance, unemployment, paid sick leave)
• Enforcement of retaliation protection so workers don't lose job after choosing not to work for health and safety reasons

It is our duty as family physicians, particularly those of us working in the safety net, to pay attention to local policy and politic and to advocate for safer working conditions for our most vulnerable patients. Please help out where you can!

Weathering the Storms: Climate Change and Graduate Medical Education In The 21st Century (Scott - 8/24/22)

 A recording of the presentation can be found HERE.

Aftermath of the 2017 Wildfires: WHAT-now-CA* Study Results on Needs, Respiratory Health, and Mental Health (Hertz-Picciotto, 11/3/2020)

Great thanks to Dr. Irva Hertz-Picciotto and graduate student in public health, Diego Rivera, from UC Davis' Environmental Health Sciences Core Center for their update this week on the WHAT-now-CA* Study, Aftermath of the 2017 Wildfires. 

Their research team is following a cohort of people who lived through the Northern California fires of 2017 (including Tubbs, Nuns, Atlas, and Redwood Valley fires). They are studying both the short and long-term health impacts of these fires. The study features data from several counties, but the bulk of participants in their cohort are from Sonoma County.

Diego Rivera presented data on physical and mental health needs in 2018 and 2019, and Dr. Hertz-Picciotto presented health impact data, including respiratory and mental health, from year 1 (2018). 

(By Phoenix7777 - Own workData source: VIIRS-AF Active Fire Detections for CONUS - 10/07/2017 through 10/14/2017 0200 MDT)

For many of us who lived through the 2017 fires and the ensuing years of smoke, fire and more evacuations, the study findings are not terribly surprising: greatest reported needs in year 1 (2018) included: clean air, clean up, insurance help, finding housing, and help with refurnishing homes

• greatest reported needs in year 2 (2019) included: mental health, improved health, clean air
• people with underlying pulmonary issues experienced increased respiratory symptoms after fire and smoke exposure; some with no underlying lung disease also had respiratory symptoms
• mental health needs increased after the first year's needs (e.g. housing, clean up, insurance issues) were addressed.

Mental Health Impacts of Fire 

There is a paucity of literature on the impact of wildfires on mental health, but a few studies that have been reported recently from fires in Canada and Australia have found high rates of PTSD in the early months following a fire event, as well as high rates of generalized anxiety and depression.

In the WHAT-now-CA study, adults and children are asked to report rates of agitated behavior, anxiety and stress, depressed moods, difficulty concentrating, loss of appetite, trouble sleeping/nightmares, as well as substance use (including alcohol, smoking, vaping). 

Dr. Hertz-Picciotto's team found high rates of all of the above symptoms in fire survivors, extra high rates of anxiety and stress and trouble sleeping/nightmares in children. They also have found a very strong correspondence between an adult in the home having mental health symptoms and children having these symptoms. Mental health symptoms were more frequent in children ages 12-17 than younger children, also more frequent for those who have experienced multiple evacuations, and those whose home was destroyed. 

I look forward to seeing ongoing data collection from Dr. Hertz-Picciotto--  perhaps if we can have concrete data demonstrating the long-term physical and mental health impacts of these fires on our community, we can actually help to do something about them. . . and eventually heal.

Be safe all, the rains are close.

(*Wildfires and Health-Assessing the Toll in Northern California)