HLTH 4073 Module 4 Access to Care Analysis Example

Forty-Five Miles, Weekday Hours and a Letter in English: Access to Care for Seasonal Farmworkers in a Rural County, Through Five Dimensions of Access

Student Name

American College of Education

HLTH4073: Fundamentals of Public Health

Module 4 Assignment

Instructor Name

October 26, 2026

The Population

The composite farming county examined in earlier modules draws about 2,100 seasonal and migrant farmworkers at the peak of its growing season, from May through October, for vegetable harvesting, detasseling and work in two packing sheds. Most are Latino, most speak Spanish as their first language, and a growing number speak an Indigenous language from southern Mexico, such as Mixteco, with Spanish as a second language. Some live in the county year round; others follow the harvest from state to state. Many live in employer-provided housing or rent older farmhouses, the same homes that the earlier modules found most likely to draw from shallow wells with high nitrate.

Arcury and Quandt (2007), in a review of health services for farmworkers, describe them as low-paid and often uninsured workers in an extremely hazardous industry who provide an essential service to the country, and they identify cultural, structural, legal, financial and geographic barriers to their use of care. They note needs in occupational health, mental health, oral health and chronic disease. This paper examines how those barriers operate in this county.

A Framework for Access

Access to care is more than the presence of a clinic. Levesque et al. (2013) treat access as a chain of chances, running from noticing a health need through finding, reaching and using services to having the need actually met. On the service side, their framework asks whether care can be found, whether it is culturally and socially acceptable, whether it is available at usable times and places, whether it can be paid for, and whether it fits the need. On the population side, it looks at people's capacity to recognize that something is wrong, to go looking for help, to get to it, to cover its cost and to take part in treatment once they arrive. Access happens where the two sides meet. The framework suits this population because farmworkers' barriers fall on both sides: services are hard to find and reach, and workers' circumstances limit their ability to use them.

Approachability and the Ability to Perceive

Services must be known before they can be used. The county's federally qualified health center charges uninsured patients by income on a sliding scale, but its outreach consists of English-language flyers at the library and a website. Few farmworkers know it exists or that it serves people regardless of insurance or immigration status. The nearest clinic funded specifically to serve migrant and seasonal agricultural workers under the federal health center program is 45 miles away (Health Centers, 2018). Workers new to the area, arriving for a single season, have no one to tell them where to go until a problem becomes urgent.

Acceptability and the Ability to Seek

Even known services may not feel acceptable. The health center has two bilingual medical assistants but no interpreter for Indigenous languages, so a Mixteco-speaking worker may have to discuss symptoms through a coworker. Fear shapes decisions as well: workers without legal status may avoid any office that asks for identification or seems connected to government, and some worry that illness will cost them their job. Arcury and Quandt describe cultural and legal barriers of exactly this kind. A clinic can be open, free and nearby and still be out of reach if a worker believes that walking in carries a risk.

Availability, Accommodation and the Ability to Reach

The health center keeps weekday business hours only, closing at five, the same hours farmworkers are in the fields, often six or seven days a week during harvest. Many do not have a car, and the county has no public transit outside its one town. A visit can therefore cost a full day of work and a paid ride. Workers with chronic conditions such as diabetes or high blood pressure face the hardest time, since they need repeated visits that the schedule and distance make nearly impossible during the season.

Affordability and the Ability to Pay

Most of the county's farmworkers are uninsured. The sliding fee scale makes a visit affordable in principle, but the true cost includes lost wages and transportation, which are not discounted. Prescriptions and dental care add further costs. For a worker paid by the piece, a half day at the clinic may cost more in lost earnings than the visit itself, which is why many workers wait until a condition becomes an emergency and then use the hospital emergency department an hour away.

Appropriateness and the Ability to Engage

Care must also fit the population's needs. Farmworkers face pesticide exposure, heat illness, musculoskeletal injury and eye injuries, yet clinicians in the county rarely ask about occupation or exposures. Migrant workers who move every few months lose continuity; a diabetes plan started in one state is rarely continued in the next, and records do not follow them. Housing adds an environmental dimension: families in older farmhouses may be drinking well water that no one has tested, and a clinic visit is a chance to ask.

Needs the Clinic Rarely Sees

Some needs never reach a clinic at all. Arcury and Quandt list mental health and oral health among farmworkers' unmet needs, and both are visible in this county. Workers who migrate alone spend months away from family in crowded housing, and the long hours, debt and uncertainty of seasonal work can bring anxiety and depression that no one asks about. The health center has one behavioral health counselor, who does not speak Spanish, and there are no evening appointments. Dental pain is common and usually untreated until a tooth must be pulled, because the county has no dentist who takes uninsured patients on a sliding scale. Children in farmworker families face their own gaps: families who move mid-season may miss well-child visits and vaccinations, and school-based services end when the family leaves. These needs are hardest to see precisely because the people who carry them do not show up in the clinic's records, which is why a population view, rather than a count of patients seen, is needed to judge access.

Improving Access

The analysis points to five changes, one for each dimension. For approachability, the health department and the health center should recruit two promotores de salud, trusted community health workers from the farmworker community, to visit housing sites weekly in the season. For acceptability, the center should contract a telephone interpreter service that covers Indigenous languages and state publicly, in Spanish, that it does not ask about immigration status. For availability, it should partner with the migrant health center 45 miles away to run an evening mobile clinic at the two largest housing sites twice a week from June through September. For affordability, the mobile clinic should dispense common medicines on site under the sliding fee scale. For appropriateness, clinicians should add occupational and water-source questions to every farmworker visit and give migrant patients a portable summary of their conditions and medicines. Success should be measured by visits per worker during the season, the share of workers with a chronic condition seen at least twice, and emergency department visits by farmworkers for conditions that could have been treated earlier.

References

Arcury, T. A., & Quandt, S. A. (2007). Delivery of health services to migrant and seasonal farmworkers. Annual Review of Public Health, 28, 345-363. https://doi.org/10.1146/annurev.publhealth.27.021405.102106

Health Centers, 42 U.S.C. § 254b (2018).

Levesque, J.-F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: Conceptualising access at the interface of health systems and populations. International Journal for Equity in Health, 12, Article 18. https://doi.org/10.1186/1475-9276-12-18