Who is at Risk Amid the H5N1 Influenza Outbreak? Characteristics and Health Coverage of Animal Production Workers

There is an ongoing multi-state outbreak of H5N1 influenza virus in dairy cattle and other animals in the U.S., the first time this virus is known to have infected cows. So far, only one human case of H5N1 has been associated with the U.S. cattle outbreak, an eye infection in a worker at a dairy farm in Texas. However, there is increasing concern that farmworkers are being exposed to the virus and additional human infections may be occurring. Moreover, repeated exposures between infected animals and humans could result in the virus becoming more transmissible in humans, even potentially sparking a new influenza pandemic.

Dairy farm workers are the population most directly exposed to H5N1 infected cattle, and therefore the people at highest risk of further infections. They also face other occupational health risks such as injury and musculoskeletal injuries. However, reports suggest there are multiple challenges to providing testing and other health services to this population including lack of health coverage, language barriers, and fears or concerns about engaging with health officials.

In general, there is limited information available about the number of dairy farm workers and the working conditions, demographics and insurance status of those workers, especially at the state level. Estimates suggest that as of 2018, there were roughly 130,000 employees on U.S. dairy farms, a subset of whom come into direct contact with cattle and would be at risk for exposure. Previous studies indicate dairy farm workers typically receive poor health and safety training and often lack personal protective equipment. A USDA study found that, in 2015, over 40% of dairy farmer household members were uninsured, the highest rate among farm households nationwide, and a 2014 survey conducted for the National Milk Producers Federation estimated that immigrant workers make up over half of the dairy labor force. A 2020 survey of dairy farms nationwide found over half of farms report having employees who have a first language other than English. However, these surveys may not be representative of dairy farms and farmworkers nationwide. For example, compared to dairy farms nationwide, dairy farm respondents to the 2020 survey were disproportionately in the Northeast and had larger herd sizes, which is associated with greater likelihood of hiring non-family labor and may affect the reported characteristics of workers.

To provide more information about workers at potential risk for the H5N1 influenza outbreak we analyze demographic characteristics, income, and health coverage for “animal production and aquaculture” workers in the U.S. and in states experiencing outbreaks using data from the 2022 American Community Survey (see Methods below). “Animal production and aquaculture workers” include workers who are “primarily engaged in keeping, grazing, breeding, or feeding animals.” This category includes dairy farm workers as well as other animal production workers but is the most specific category with data available to examine these workers’ characteristics. Data do not allow for estimates of what share of these workers are dairy farm workers. We compare the characteristics of workers in the animal production worker category with all workers in the U.S., and within affected states. However, of the nine states with reported dairy cattle infections as of May 14, 2024, two (Idaho and New Mexico) are not included in the state-level analysis due to insufficient sample sizes.

Findings

Animal production workers are more likely than workers overall to be Hispanic and noncitizen immigrants as well as to be uninsured, have lower household incomes (less than $40,000 per year), and have limited English proficiency (LEP) (Figure 1). Overall, about one in five animal production workers is Hispanic, slightly higher than the share of U.S. workers overall (22% vs. 19%). Animal production workers also include a higher share of noncitizen immigrants compared to workers overall (13% vs 8%). One in five (20%) animal production workers are uninsured, about twice the share of workers overall (9%), which may, in part, reflect that they have lower incomes (18% vs. 12%). They also are more likely to have limited English proficiency (16% vs. 9%).

These differences often hold true in states that have been affected by outbreaks, although there is variation among the states, and small survey sample sizes limit the ability to identify statistically significant differences in some cases. In most of the affected states for which sufficient data are available, uninsured rates are higher among animal production workers than workers overall in a statistically significant way. For example, in Texas, 31% of animal production workers are uninsured compared to 19% of workers overall, and, in Ohio, 29% of animal production workers are uninsured compared to 7% of Ohio workers. Similarly, in four of the states (Kansas, Michigan, North Carolina, and Texas), animal production workers include a higher share of workers with LEP compared to workers overall. The share of animal production workers who are noncitizen immigrants is higher than workers overall in three of the states (Kansas, Michigan, and Texas). In some cases, differences between animal production workers and total workers within states may not be statistically significant due to smaller sample sizes, which limits the power to detect significant differences.

Across the affected states, there is variation in the characteristics of animal production workers largely reflecting overall demographic differences across states. For example, less than one in ten animal production workers in Ohio (4%) and South Dakota (8%) is Hispanic compared to nearly four in ten of their counterparts in Texas (37%), and the share who are noncitizen immigrants ranges from 5% in Ohio to 21% in Texas. The share of animal production workers who are uninsured ranges from 13% in Michigan and South Dakota to over one in four North Carolina (27%), Ohio (29%), and Texas (31%), and the share with LEP ranges from 6% in South Dakota to 19% in Texas.

Potential Future Actions

The federal government has recently announced several steps to try to address some of the potential health threats from the H5N1 outbreak. For example, on May 6, CDC announced an effort to provide personal protective equipment for affected workers, and on May 10, 2024, the USDA and CDC announced a package of incentives to support more testing and prevention at dairy farms in affected areas.

Efforts to address exposure and health threats posed by H5N1 could be complicated by challenges dairy farmworkers may face accessing health care and other services given that animal production workers are disproportionately likely to be noncitizen immigrants, uninsured, and have LEP. These challenges could be mitigated by providing information and resources to dairy farmworkers in linguistically accessible formats and utilizing trusted messengers who can help mitigate potential immigration-related fears, such as community health centers and community-based organizations. Providing these resources at no cost, including for people without health coverage, also could facilitate access.

The data further emphasize the potential value of tailored outreach approaches in each state to reflect varying demographics and needs across affected states as well as variation in state policies, which may impact workers’ overall access to health care and levels of immigration-related fears. For example, Colorado provides Marketplace coverage with premium subsidies to income-eligible people regardless of immigration status, while in the other affected states, undocumented immigrants are ineligible for federally funded or state coverage options. Two of the affected states (Texas and Kansas) have not implemented the ACA Medicaid expansion, resulting in more limited coverage options for low-income adults overall. In 2023, Texas passed legislation that would allow state and local police to question and arrest anyone they believe entered Texas through Mexico without authorization. While enforcement of the law is on hold pending court rulings, it likely contributes to increased uncertainty and fear among immigrants about interacting with officials.