(Public Health Service Act, Section 340) programs. The last portion of this paper proposes a series of indicators of barriers to access for these groups and a set of special studies that would provide data on access for these populations that are otherwise lacking today.
The homeless and the migrant farmworker population share a distinctive characteristic in our society: they survive without a permanent home address, a fixed locality where mail can be sent, phones can be installed, and the census bureau can locate them. For example, the National Health Interview Surveys and many studies on access, including the Robert Wood Johnson Foundation (1986) survey on access, rely on telephone contacts to enter respondents into the studies. Such surveys in specific geographic areas frequently also rely on the telephone (e.g., Hubbell et al., 1991). Other surveys use lists of randomly generated household addresses. Because of the lack of a fixed address and the related lack of telephone service, migrant and seasonal farmworkers and the homeless are often excluded from these types of studies. The National Health Interview Survey (NHIS) requires that at least one household member in a respondent household be an English speaker. Because many migrant and seasonal farmworkers are Hispanic or members of recently arrived, non-English-speaking immigrant groups, they may be excluded from the NHIS and other surveys requiring English. Tragically, migrants and the homeless share more than the lack of a fixed address: members of both groups live in extreme poverty, have less than the national average level of education, and have a greater burden of illness, higher rates of infant mortality, and shorter life expectancies than Americans as a whole (National Migrant Resource Program, 1990; Wright and Weber, 1987).
Migrant farmworkers and their families, the single adult living on the street, and homeless families in shelters periodically become "visible." For brief periods, the news media and policymakers focus on the problems of homelessness or the plight of migrants. These news stories include references to the poor health indices of both groups. Despite individual studies and some targeted surveys, however, few systematic national efforts have been made to monitor the health status of members of either group and their access to quality health care. Interestingly, far more is known about the health status and illness patterns of the homeless than about the comparable status of migrants, even though homelessness is only a decade-old phenomenon in its most recent manifestation and migrant farmworkers have been an essential component of agribusiness for more than half a century. Several possible explanations can be postulated. The creation of a class of people known as the homeless was an inadvertent offshoot of other social policies and programmatic decisions. The homeless are highly visible in the nation's cities and media centers, which are also the epicenters of medical and health services research. During the 1980s, as the number of