Chapter 6 Coalitions of Care for Democratizing Medicine

Coalitions for Healing

The bond between the BPP and the UFW was augmented during key conjunctures in time when new activist strategies were planted. The success of the grape boycott was recognized in 1968 by the New York Senator Robert F. Kennedy, highlighting the workers’ vote for the UFWOC to represent them. Yet, securing concessions from grape growers, even after two years of raising awareness of the grape boycott in the United States and Canada, was less successful. In a turn of strategies toward nonviolence, inspired by Martin Luther King Jr. and Mahatma Gandhi, the UFWOC began connecting with students, artists, and activists as well as nurses and doctors across the state. They sought support from consumers, noting especially the low wages and high-poverty conditions, which included child labor. By 1969, the UFWOC warned the public that eating grapes grown with pesticides could be hazardous to consumers. A flyer highlighted the possible deadly effects of pesticides on plants, animals, and humans (“Warning: Eating Grapes May Be Hazardous to Your Health” 1969) and encouraged consumers to protect themselves from the hidden dangers of grapes sprayed with pesticides.

The national call to consciousness of the farmworkers’ movement and its underlying connection to consumers and their health resonated with the BPP’s leaders. Heeding the call to consciousness, the Panthers boycotted their own iconic Panthers’ drink “bitter dog,” which was a mixture of lemon juice and port wine made from grapes that worker’s harvested (Araiza 2009). Their solidarity with farmworkers gained full momentum when they co-organized a boycott at a local Safeway supermarket. The BPP acknowledged a deep relationship between consumers and the farmworkers’ plight: “Victimized by the same corporate capitalist institutions and structures” (209). During the boycott, they acknowledge how the management of this Safeway store was not only unsupportive of the workers but also firmly refused to endorse the Panthers’ free breakfast program. The Black Panther newspaper editorialized, “We, Black people, join with the Spanish-speaking people in common struggle against a common oppression. We know, far too well, the plight of the landless and the dispossessed” (209). Araiza (2009) describes how community members, children, and the organizers of the UFWOC and the BPP took to the streets to protest the Safeway grocery. They informed incoming shoppers of the store’s culpability in preserving poverty, refusing to support rural and urban children alike. In turn, the boycott organizers provided free rides to shoppers to other community grocery markets that donated to the BPP free breakfast program. The success of their coalition closed the Safeway store in North Oakland.

Another valuable encounter for solidarity arrived with opposition to the emergence of the Center for the Study and Reduction of Violence at the University of California, Los Angeles, campus in 1973. The “violence center” would be dedicated to the biological etiology of violence, specifically exploring “genetic, endocrinal, psychological, neurophysical, epidemiological, and psychosocial research” (Nelson 2013, 161). The center would receive significant research funding from the state governor, Ronald Reagan, who promised to redirect funds from ongoing research projects and to “overhaul” the existing criminal justice system. It drew support from the federal program Law Enforcement Assistance Administration, which directed funds through the local California Council for Criminal Justice (159). The proposal for the violence center advanced the racist ideological underpinnings of the criminal justice system and incarceration policies with biomedicine, overdetermining race as the cause for the rise in violence. The BPP joined forces with the UFWOC, as well as the National Association for the Advancement of Colored People, Mexican American Political Association, National Organization of Women, Committee Opposing Psychiatric Abuse of Prisoners, and the California Prisoners Unions (see also National Association for the Advancement of Colored People, Los Angeles 1965). Together, they formed a strong oppositional force, if only temporarily, to the state’s efforts to racialize crime and violence as biological.

Direct police repression against the BPP interrupted the mutual aid efforts and achievements of the organization. State-sanctioned violence overtook various BPP chapters across the United States. From the FBI’s raids to assassinations of key leaders and members, the BPP was forced to rebuild and reorganize in almost every state. In California, the violence meted out by the government dampened the BPP’s capacity to support the farmworkers’ movement, but it did not terminate the established coalition (Araiza 2009). Cesar Chavez endorsed the Black Panthers’ leader Bobby Seale’s run for mayor in Oakland in 1972. At the same time, the Black Panther newspaper reported on the ongoing farmworker strikes and ballot referendums to their readers. Proposition 22, for instance, would have allowed for existing contracts with growers to be terminated and make any collective bargaining strategy (i.e., elections, strikes, and boycotts) illegal (Araiza 2009; C. Chavez, Henning, and Hartmir 1972). It also would have eliminated farmworkers’ (immigrant and seasonal farmworkers) right to vote in representation elections. The UFWOC and the BPP held on to their alliance even within an increasingly repressive state regime.

While the origins of radicalizing health care are traceable beyond this valuable coalition, specifically the ideological framing of socialized medicine from physicians Ernesto “Che” Guevara, Frantz Fanon, and Salvador Allende and the revealing of the Tuskegee syphilis experiments (see Nelson 2013), the solidarity crossing racial and spatial geographies provided fertile ground for the resurgence of democratizing health through direct civic participation. Coalitions of care that mobilize a diversity of expertise and skills promote a broader vision of community health, one where community leaders can cocreate public health care that is inclusive but also collaborative and that does not fixate on healing one body part but rather the entire social and environmental structure. Perhaps, more importantly, the coalitions of care can democratize health care by eradicating the racist underpinnings of biomedical and public health research in its teaching and practice.

Services at the NFHG Clinics

The National Farmworkers’ Health Group (NFHG) organized in 1969 offered culturally sensitive and expansive medical care options to union farmworkers. It was possible to offer a variety of services because the NFHG clinics were self-supported, operated and paid for by union members. Primary care included “prenatal and postnatal care, child wellness, periodic screening and health exams, acute illness care, health education, and follow-ups” and care supplied in their preferred language (Chamberlin and Radebaugh 1976, 642). The Delano clinic provided x-rays and had its own prenatal health team. A natural healer or curandera was hired to attend to patients who had musculoskeletal lesions from work. Community services included health education, home screenings, and advocacy for disability claims, connecting the patient to the proper agencies or clinics, and helping the patient navigate the red tape of local hospitals. The combined services allowed for workers to access public health resources that many had paid into through wage deductions but had not previously benefited from.

The NFHG clinics worked with trained medical practitioners who rejected the prevailing racist calculations and cultural assumptions that medical professionals received about nonwhite patients. Instead, the NFHG pamphlets stressed the need for decent living and working conditions: “People are healthy not because of good hospitals or good doctors, or good medicine. Healthy people are a product of a healthy life” (Chamberlin and Radebaugh 1976, 641). Public health for the coalition of care meant having access to safe drinking water, clean air, safe housing, responsible schools, a livable wage, and dignified relationships with medical professionals regardless of race or class. These combined efforts were priorities in the community clinics and were critical to establishing anti-racist politics for developing a more democratic deliverance of health care. Like the People’s Free Medical Clinic, the NFHG posited that health would come from the strengths of each neighborhood. It would require building coalitions to address the social and environmental conditions damaging farmworker health.

By 1971, NFHG clinics opened in Calexico, Delano, Sanger, and Salinas—prime areas that followed “la corrida” or the harvest trail. Member dues allowed clinics to avoid the crippling effects of public defunding projects, which many migrant clinics had experienced (Chamberlin and Radebaugh 1976). Physicians and nurses who volunteered to serve on the steering committees were also on the board of directors negotiating with growers and agribusiness (Chamberlin and Radebaugh 1976). Medical volunteers were recruited from top universities. Marion Moses, for example, volunteered as a nurse at the Delano clinic and, later, left for medical training at the Temple University School of Medicine (Sherman 2020). Moses returned to Delano to provide direct health services at the clinic and on the picket lines during strikes, and she became Cesar Chavez’s family doctor. The efforts of the diverse coalition of care culminated in obtaining handwashing dispensers to remove pesticides at work, brought toilet facilities to the fields, and included the ban of pesticides such as aldrin, endrin, and dieldrin in their contracts with growers four years before the EPA placed a restriction on their use. Dr. Marion Moses and many others helped uncover cancer clusters in the McFarland area outside of Bakersfield in 1983.

To be clear, it was not that farmworkers did not have access to medical services but rather that budgetary politics and beliefs in biological and cultural differences limited their services. When President John F. Kennedy signed the Migrant Health Act in 1962, he authorized USPHS to disburse grants specifically for migrant workers. This was possible because the farmworkers’ movement helped win concessions in health rights. Specifically, early iterations of the farmworkers’ movement led by a multiracial alliance, during the first decade of the twentieth century, established a national consciousness about the hazardous aspects of factory farming (Almaguer 1984). By 1970, the federally funded Farm Workers Health Services operated thirty-three decentralized migrant clinics in California, covering approximately seventeen counties during the peak harvest season (David Weber 1970). By 1973, shortly after the three-hundred-mile march to Sacramento, rural health clinics funded by the California State Department of Health were forced to share a $100,000 budget. The cut coerced migrant clinics to reduce staff from twenty-eight to four (Bisharat 1975b).

The services that migrant clinics provided did not distinguish between migrant or domestic farmworkers. Migrant clinics offered bilingual and educational services and participated in camp sanitation inspections. Within ten years of operation, however, the clinics only had the capacity to assist 15 percent of the state’s migrant farm working population, leaving most workers to fend for their own health. Migrant health care centers presumed that individuals were responsible for the deterioration of their health (David Weber 1970). They adopted twisted versions of colonial medical models. Clinic staff sought to educate and train farmworkers to make better and healthier individual choices. Sanitation inspections of labor camps reprimanded growers for failing to provide basic infrastructural needs yet ignored the pesticide drifts surrounding labor camps. The growers and contractors did not require workers to exit the fields during aerial or ground pesticide applications. Men, women, children, and elders worked in poisonous and life-threatening conditions. They overwhelmed migrant clinics when they fell sick, but, at the same time, the rural public health model disregarded the consequences of material environmental hazards. It left health interventions almost entirely up to the working poor, with clinics financially strapped by budgetary decisions and unable to address the broader social and environmental conditions. The coalition of care offered a different model.

Because of the odds stacked against them, California farmworkers, both immigrants and citizens, utilized health services sporadically. Farmworkers had the lowest rates of hospital admissions, while also having the highest rates of parasitic infections, circulatory disease, and work-related accidents, all of which required immediate medical attention (Gilbert and O’Rourke 1968). Women working in fields suffered perinatal deaths at greater rates than the state average, or approximately a rate of forty cases per one hundred thousand compared to twenty-one cases per one hundred thousand residents. Although farmworkers comprised only 3 percent of the total population, one informal study found that 20 percent of 222 deaths due to diarrhea were among farm working families (as cited in Gilbert and O’Rourke 1968). The state-sanctioned health care allocated for nonwhite farmworkers was continuously too little and too late.

Community/Migrant Health Clinics

Public health care for migrant and domestic farmworkers has long been underfunded despite the well-documented risks to workers’ health and quality of life. As early as 1932, the federal Committee on the Cost of Medical Care observed that farmworkers had an increased risk of acquiring common diseases related to poverty. President Franklin D. Roosevelt issued a rural relief program through the Farm Security Administration (FSA). Funding was meant to offset the Great Depression’s impacts on “agricultural groups,” which included growers, tenant farmers, and migrant workers (NCFH 2010; Grey 1989, 1994). Through low-interest loans and educational opportunities for bookkeeping and cooperative farming, the FSA helped homestead farmers increase their chances of competing with larger growers and, overall, reduce poverty and disease among workers (Grey 1989, 1994). The philosophy behind the loans was a “trickle down” effect. FSA strategies quickly changed when new studies on the role of bacteria in spreading illness motivated health institutions to redefine disease control as having more to do with individual behaviors than the vexed question of spending money on public health (Nash 2007). Public health institutions contended that controlling unsanitary environments, as opposed to curtailing poverty, would reduce the transmission of illness between people, thus stabilizing the health of poverty-waged workers. With federal funding and a newer, more individual, understanding of disease, the FSA funded the construction of more housing for workers with the unspoken understanding that such developments were primarily reserved for white dust bowl refugees in California (Grey 1989). This period marks an important moment in the history of farmworker health. Health was viewed as distinctly behavioral and biological, distilled from the social well-being and racial discrimination.

Because race was contentiously viewed as biological and contagious, sanitation improvements in nonwhite labor camps and shantytowns were proposed only as a means for salvaging the surrounding rural white communities (Williams 1939). In many cases, however, the growers influenced such propositions by writing letters to the Department of Public Health claiming that “these ‘hoboes’ or ‘these Mexicans’ or ‘these foreigners’” would not accept improved standards of living “if they had a chance” (R. Miller 1921, 700). The rural Mexican American shantytowns and farm labor camps were overwhelmingly unchanged. By 1974, 488 farm labor camps failed to meet the state’s housing, safety, and sanitation standards (Bisharat 1975a). During this early period of public concern for the health of farmworkers, racism and anti-immigrant politics influenced how health institutions implemented services. They slowed down the infrastructural development that would have otherwise improved rural residents’ health.

Outdoor workers’ health was a national problem due to the living and working conditions and scant resources in rural communities. White growers with small landholdings faced the problem of accessible health care in ways similar to nonwhite domestic and immigrant farmworkers. An investigation into why white farmers were unable to repay their FSA loans revealed that 50 percent of unpaid loans were “directly traceable to ‘bad health’” (Williams 1939). White small farm landholders spent most of their revenue paying for expensive medical bills rather than covering the costs of loans. In their attempt to improve loan collections in California, the state and private health institutions created the Agricultural Worker’s Health and Medical Association (AWHMA), a nonprofit government corporation to serve farmers and workers alike (Williams 1939; Schaupp 1944). The AWHMA provided a membership identification card to farmers and migrant laborers who participated in the program for clinical health services, regardless of citizenship. Medical or hospital professionals billed AWHMA for health costs. In theory, billing the AWHMA would have addressed the need for access to affordable health care and would have increased workers’ and farmers’ chances of surviving a treatable disease. But the goals and objectives of this system of health care were fractured by labor and immigration politics. Under Amendments to Public Law 45 (the Bracero Program), all agricultural workers who did not receive employment through a government agency funded by the agreement were excluded from receiving medical care (“Farm Security Administration Reports and Miscellaneous Documents, 1942–1943” 1943; NCFH 2010). Domestic and immigrant outdoor workers who had leveraged their personal connections to secure employment on a farm were no longer qualified to receive health services by 1944.

When Congress revised Public Law 45 two years after its enactment, they turned over all farm labor health operations to the private growers. They ended the free clinic program for rural domestic and immigrant farmworkers (David Weber 1970). Under this model, the health of the domestic outdoor worker in the United States was contingent upon the generosity of growers or their ability to pay the high price of hospitals. At the same time, they were at the mercy of health service providers that felt entitled to segregate nonwhite people and presumed the right to restrict services to anyone they pleased. Healing from an illness or a disease came with added humiliation and prolonged suffering, as growers mostly did not provide these ­services.

The Pursuit of Health Justice

The foregoing failure of public health care for domestic and immigrant farmworkers was an additional incentive for the labor movement to pursue a more democratic alternative model of care. The National Farmworker Health Group clinics focused on alleviating the collective and cumulative injuries to people’s health, which included poverty wages, deplorable housing, the threat of deportation, racial discrimination, pesticide exposure, cancer clusters, and being turned away from hospitals. NFHG clinics envisioned health as a collective resource in need of a commitment shaped through coalitions of activists, scientists, doctors, nurses, and workers. Union members and health professionals actively co-negotiated with growers for the elimination of toxic hazards and the oppressive and unsafe conditions, a practice that some regulators such as the EPA soon followed.

The first National Farmworker Health Group was housed at Forty Acres, the headquarters of the UFW union on a parcel of land outside the city of Delano. The building is a hand-built adobe brick casita with a long-attached drive-up porch. That porch served as a gas station for farmworkers to fuel up at a time when white gas station owners conspired with growers to refuse service to Mexican farmworkers protesting over dangerous labor conditions. The plot of land was also the site for the Agbayani Village at the north entrance, which was built to house elderly Filipino men who migrated to California in the 1920s and 1930s but were evicted from the labor camps when they no longer were of working age. This land hosted parallel institutions that offered access to levels of housing and health care that the established authorities refused to provide.

Despite the gains of the NFHG clinics in the 1970s, immigration policies made workers vulnerable to precarious work conditions. The California legislature introduced twenty-one pieces of legislation that would reduce or eliminate the rights of undocumented immigrants; among them were strict policies at work and cutting public funding for social services by 1993 (Garcia 1995). The Immigration Reform and Control Act (IRCA) of 1986 penalized employers who hired undocumented workers, though it did provide amnesty to over a million long-term immigrant residents. Its persecution of unlawful employers punished recent immigrants by removing labor protections and increasing the need for covert hiring practices. The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 disqualified undocumented immigrants from obtaining social safety benefits. The highest numbers of recipients of the program were in rural communities and among U.S.-born children whose parents were undocumented (PPIC 2003). These changes generated poverty where immigrants lived and worked as seasonal and, sometimes, migrant workers. Additionally, Congress placed restrictions on undocumented immigrants’ use of health insurance, stipulating that they would qualify for Emergency Medi-Cal only to stabilize their health (Rural Migration News 1995). The federal government placed block grants (the allocation of a set amount of federal money to fund state programs) on Medicaid and opened bids for contracts for private physicians. Community and Migrant Health Clinics (C/MHC) had to compete for funding with private physicians, straining the quality of care that they provided to the almost 20 percent of the population who lacked medical insurance (Henderson and Markus 1996).

The C/MHCs absorbed a greater number of patients who were rejected by private physicians because of their high risk of illness, which meant that C/MHCs would cover the higher costs of health care procedures that federal grants were unlikely to reimburse. The new restrictions were a direct blow to the farm working population. The uninsured would increasingly depend on C/MHCs for health services, but these organizations were now less capable of providing care. Outraged by the disproportionate impact on immigrant health, organizations that served farmworkers protested futilely on the steps of the capitol in Washington, DC (Rural Migration News 1995). The unavailing results forced immigrant farmworkers to substitute limited medical care and social welfare for alternative measures, leaving many dangerously waiting to qualify for Emergency Medi-Cal state insurance when they became ill.

The wave of anti-immigrant policies and the rise of social control and surveillance deterred farmworkers even more from seeking medical services. Proposition 187 passed by California voters in 1994 established the cooperation of law enforcement authorities and the Immigration and Naturalization Service to identify, stop, and arrest anyone who was suspected of violating the federal immigration laws (Garcia 1995). The law further sought to exclude the undocumented children and citizen children of undocumented parents from participating in primary and secondary education, making the school to prison nexus more deadly than before. Social service providers would be required to decline serving anyone determined to be—or suspected of being—undocumented. Nonemergency health services, such as rural clinics, were authorized to use this same provision. The proposition operated with the underlying racial logic not only to target and criminalize Mexican and Central Americans but also to authorize all institutions to become reporters of “illegality” (De Genova 2002). Despite many of its provisions being ruled unconstitutional in the courts, the core premises of Proposition 187 were absorbed by subsequent federal and state laws. Everyday life for immigrants became saturated with the risk of deportability, a form of structural and symbolic violence against them that could lead to real physical injuries. The parade of conservative policies to separate the authorized from the unauthorized was a multiscale effort both to sift “illegals” into categories, for example, as the less deserving poor, and to compel them to be more willing to accept low-paying, informal, and temporary jobs (see Quesada et al. 2011). Anti-immigration policies reaffirmed white sovereignty and its attendant moral entitlements of citizenship and privileged access to social resources, employment, and health care.

The coalition between the UFWOC and the BPP sheds light on the perils of present-day health care models, which are tailored for rather than by the people. Looking back at the gains of the BPP’s and the UFWOC’s community clinics, it is clear that our current medical and public health care systems are still struggling to remedy a century of racialized medicine and silence on anti-immigrant politics. The labor and party organizations of the 1960s and 1970s both evidence a potential model for the future. They walked the imperfect but powerful path of building coalitions of care that promoted and protected the socioecology of community and its health at a time when biomedical sciences and health services were weaponized against vulnerable groups of people. Building community access to healthy communities and adequate medicine highlight a familiar struggle that participants in this book describe in earlier chapters. But unlike differential access because of racial and class identities, citizenship and even township differences are used against community health. There is no universal access to health care. At the same time, testing and treating farmworkers and people who are incarcerated and vulnerable to valley fever remain exclusively in the hands of medical experts. Where are the coalitions of today?