The voices of the millions of farm workers who do the backbreaking work of planting, tending, harvesting and packaging our food have been largely absent from the national health-care debate, drowned out by the cacophony of providers, insurers, businesses, health analysts, academics and lobbyists. Yet the needs of the farm workers are immense, given their historic disenfranchisement. A system that promises universal access must be measured by its ability to provide health care to the most marginalized in our society.

Farm workers, particularly in California's abundant agricultural valleys, lack even basic access to health care. A UCLA study team found that 65% of Latino farm workers are uninsured. This is more than four times the national average. Even fewer of their dependents are insured. The U.S. General Accounting Office reports that existing rural and migrant health clinics are funded for only 15% of the need. Public hospitals, particularly in rural counties, have closed at alarming rates. Even "mainstream" providers shun the rural areas.

Yet farm workers and their families face extraordinary health risks--accidents, pesticide-related illness and on-the-job injuries in addition to respiratory conditions, reproductive health problems, climate-caused illnesses and communicable diseases related to their environment. In California alone, 40 farm workers died and more than 22,000 suffered work-related disabling injuries in 1990. Reproductive hazards associated with exposure to toxic pesticides are particularly alarming, since the agricultural work force is predominantly young and more than one-quarter female.

These health threats, including the long-term cancer dangers of continuous low-level pesticide exposure--in drinking water and blowing dust as well as direct contact in the fields--must be confronted in a national health plan that stresses prevention and early intervention.

The Latino farm worker is also in poorer health overall. Latinos suffer a disproportionately higher incidence of diabetes, high blood pressure, kidney disease and AIDS. Latinos also suffer from an excess incidence of cancers of the stomach, esophagus, pancreas and cervix.

Much of the suffering caused by these diseases could be prevented. With proper treatment, 60% of the blindness caused by diabetes, half of the kidney failure and two-thirds of diabetes-related amputations could have been prevented if appropriate screening and treatment had been available. Unfortunately, access to screening is very limited for the rural Latino population.