The Health-Care Crisis for Foreign Farmworkers

When migrant farmworkers break bones, fall from ladders while picking cherries or have pesticides drift into their eyes, Javier Robles says they often have two questions.

The first is how to get care. The second is whether they can afford it.

Robles, an outreach worker with KCR Community Resources in Kelowna, is among a group of advocates who say temporary foreign farmworkers in British Columbia routinely struggle to access basic health-care services.

They attribute that to a mix of practical barriers and the high cost of insurance coverage that sometimes forces them to pay out of pocket.

Robles says the result is some workers who are injured on the job either work through the pain or give up their jobs to return home early.

“This happens every year and every season here,” Robles said. “Some workers are trying to stay because sometimes the problem is very bad, and they know they need surgery and followup after, and they know they don’t have money even to get treated back in Mexico.”

In the past two decades, British Columbia’s farms have become increasingly reliant on temporary workers, most of them from Mexico, Guatemala and Jamaica.

In 2022, farmers got permission to hire more than 12,000 on temporary contracts that range in length from a few months to two years.

Those contracts provide vital income to those workers and have been a lifeline for the province’s fruit farms, which say they have struggled to hire other workers at competitive prices.

But the program has also drawn criticism from advocates who believe it gives employers far too much power over workers, who are bound to them through closed work permits and often live on the same farms where they work.

One of the biggest issues is health care.

Dr. Fernanda Novoa, a health researcher at the University of British Columbia Okanagan, began studying health-care access for migrant farmworkers in 2021 as part of a master’s thesis program.

She interviewed 14 workers about their experiences working in British Columbia during the height of the COVID-19 pandemic, when some farms suffered outbreaks.

But COVID-19 is far from the only health problem workers face in Canada. Robles said falls and other workplace injuries are common. So are other routine illnesses. And Novoa said she found workers routinely struggled to access almost all forms of health care.

In many cases, Novoa said, they may not have access to public transportation to get to a clinic and may depend on their employer for a ride.

Language barriers were a consistent problem. Many workers from Mexico and Guatemala do not speak English and rely on outreach workers like Robles as translators.

Many of those support workers are funded by a federal grant that is disbursed by MOSAIC, another non-profit agency in Vancouver. But Novoa said she found many of those aid workers were stretched thin. In some cases, Novoa said, employers were reluctant to let those support workers enter farm property or speak with workers.

“Community-based organizations do this a lot. They try to bridge these gaps and help them,” Novoa said. “But many workers don’t know these exist.”

And even if workers did have access to services, Novoa said, they didn’t always use them. She said some workers she interviewed expressed fears that if they were seen to be injured they might be fired, or their employer may not call them back for the next farming season.

“Their access to housing, to health care and to many other benefits and rights, all of that depends on their employers,” Novoa said. “The employers are kind of the gatekeepers, and at the same time they are the ones who can decide if the workers can hold these jobs.”

Byron Cruz, a longtime advocate for migrant farmworkers and the head of the Sanctuary Health Collective, said those have been persistent problems with the program for more than a decade.

In 2011, Cruz helped establish a mobile health clinic that provides Spanish-language medical services to farmworkers throughout the Fraser Valley, staffed mostly by doctors working on a volunteer basis.

But he said it’s no panacea. “There is no good answer to health care. It is really, really hard,” Cruz said.

Cruz said one of the biggest problems is that workers sometimes have to pay out of pocket for care, due largely to the insurance model used by farmworkers while they are in Canada.

There are two separate programs under which migrant farmworkers can come to British Columbia. The more popular one is the Seasonal Agricultural Worker Program, brokered between the Canadian government and the governments of Mexico and Jamaica, which allows Canadian farmers to hire workers on short, seasonal contracts, usually of just a few months. More than 8,700 workers came to B.C. under that program in 2023, according to the federal government.

Workers in that program, Cruz said, typically are not eligible to enrol in the province’s Medical Services Plan, which is available only to residents who have lived in the province for at least six months.

Instead, they are usually insured under a private health-care plan provided by the Cowan Insurance Group.

But Robles, who frequently serves as a translator and guide for injured or sick workers, said only two clinics in the Central Okanagan accept direct billing through that insurance company.

In other cases, Robles said, workers have to pay out of pocket and then wait for a reimbursement, which usually takes one to two months.

But upfront costs for MRIs or care can be prohibitively high for workers who typically earn close to the minimum wage.

“This happens every year and every season here,” Robles said. Sometimes, he said, workers will try to cobble together the cash until they get the insurance cheque. But in other cases, he said, they return home, where health care is more affordable.

Cruz said his organization has consistently lobbied the provincial government to open up MSP benefits sooner to workers who are in the province for only a short period of time.

“It’s not just affecting agricultural migrant workers but migrants in general,” Cruz said.