Dangerous work, unmet health care needs add up to more deaths, negative health outcomes for Texas shrimpers, according to UTHealth Houston research

A dangerous work environment and limited access to health care are related to higher death rates and negative health outcomes among Texas shrimpers in the Gulf of Mexico, according to a new study from UTHealth Houston.

The research, published today in the American Journal of Public Health, shows how under-regulated, dangerous, and physically demanding work performed largely by migrant and refugee workers in the Gulf of Mexico had adverse health impacts, according to the authors.

“We originally were looking at how to prevent slips, trips, and falls and thought we would do some kind of life preserver intervention,” said lead author Shannon Guillot-Wright, PhD, associate professor with the Department of Environmental and Occupational Health Sciences at UTHealth Houston School of Public Health. “But when we started talking to shrimpers, they would tell us about their more basic, pressing needs. We heard stories about cancer, eye infections, diabetes, dental problems, housing and food instability, and the list went on and on. They weren’t interested in hearing that they should wear a lifejacket, they were interested in getting health care.”

The fishing industry has an occupational fatality rate nearly 40 times higher than the national average, according to a report from the Centers for Disease Control and Prevention (CDC). From 2000 to 2019, 201 commercial fishermen died of traumatic injury in the Gulf of Mexico, with vessel disasters and falls overboard accounting for nearly 80% of the fatalities. Shrimp fisheries had 51% of those deaths.

To identify interventions to prevent injury, the researchers conducted a qualitative study among commercial shrimp fishermen in Southeast Texas and the Rio Grande Valley from April 2021 to September 2022. Individual interviews, focus groups, photovoice, and workplace observations allowed researchers to examine behaviors, risks, and everyday interactions.

The research team embraced a participatory approach by placing the participants’ needs, perspectives, and values at the center of research questions and interventions. “If we want to move the needle on workplace injury, it has to start by listening to people instead of thinking we already have all the answers,” Guillot-Wright said.

“What they were telling us made a lot of sense within a hierarchy of needs approach. If we want to reduce injury among shrimpers, we have to make sure their basic needs are met first, like housing, food, and health care access,” Guillot-Wright said. “For example, research shows that self-medication is an issue among commercial fishermen. In our interviews, some of the shrimpers told us they couldn’t afford medicine and used alcohol to cope with injuries, like back pain, which could then increase their risk of falling overboard, or slipping and reinjuring themselves. That’s why we wanted to focus on the root of the problem – health care access.”

Researchers responded by opening a monthly Docside Clinic in Southeast Texas, which has served more than 300 patients since July 2021, through funding from the National Institute for Occupational Safety and Health and the Southwest Center for Agricultural Health, Injury Prevention, and Education at The University of Texas at Tyler. Founded as a one-time event with St. Vincent’s House clinic and other medical partners, it has now been held once a month for nearly three years. Through additional funding, two more clinics are expected to open this year at another Southeast Texas dock and a dock in Louisiana. A grant from the National Institute of Occupational Safety and Health and the U.S. Coast Guard will allow them to add community health workers to the Docside Clinics this summer.

To build trust, the team spent hours sitting at the docks in camp chairs so that people would get to know them. At the Southeast Texas docks, their interpreter, CucHuyen Roberts, who is now a member of the research team, was invaluable.

“She is a Vietnamese refugee herself, and her ability to interpret cultural nuances was incredibly helpful,” Guillot-Wright said.

Research participants were 98% men, 51% Vietnamese, and 49% Latino, and their ages ranged from 19 to 71. Their income averaged from $1,000 to $6,000 per trip, which was typically 30 to 45 days, and approximately 30% experienced unstable housing. In the Rio Grande Valley, participants were mostly Mexican citizens using temporary work visas. In Southeast Texas, most participants were Vietnamese refugees.

Issues fishermen reported included lack of health care coverage, limited time to make appointments between fishing trips, financial and language barriers, and lost, stolen, or incorrect citizenship documentation. Access to health services was generally limited to emergency care. Workers also told researchers that an absence of sick leave benefits led to delaying medical care and working while sick. They also reported housing and food insecurity.

Health care was the most critical issue for the mostly Vietnamese workers in Southeast Texas, while visas were the biggest concern for the Latino workers in the Rio Grande Valley. Rio Grande Valley workers were able to access some medical needs through clinics in Mexico.

Both groups also suffered psychological distress stemming from being away from families and isolated at sea for 30 to 45 days at a time, according to the findings.

To improve the workers’ health outcomes, along with establishing the Docside Clinic, researchers created policy briefs about their fatality rates, health care access, and visa issues. They worked alongside policymakers to bring them the evidence and research needed for change.

“Shrimpers are invisible because of their location on the water,” Guillot-Wright said. “That’s why this new data is so important. We can highlight this worker population and show the connection between policies, like shrimp import prices and how it impacts people’s health. However, it’s not only policies that need to change, but also what we buy as consumers. If something is cheap to buy, there’s a good chance it was made or caught using cheap labor.”

Co-authors for the paper, titled “The Hotel of 10,000 Stars: The impact of social-structural determinants of health among im/migrant shrimpers in the Gulf of Mexico,” were Lacy Davis, MA, from UTHealth Houston School of Public Health; Linh Truong, PA-C, from The University of Texas Medical Branch in Galveston; Heide Castaneda, PhD, MPH, from the Department of Anthropology at the University of South Florida, Tampa; and Anabel Rodriquez, PhD, MPH, from the Department of Environmental and Occupational Health at Texas A&M University.

Funding for the research was largely supported by the Southwest Center for Agricultural Health, Injury Prevention, and Education through a cooperative agreement from the CDC’s National Institute for Occupational Safety and Health (U54-OH007541).