What Goes Unnamed: Health Conditions and Concerns Among Colorado's Agricultural Workers

Health can look very different depending on whether a person has ever had the chance to sit down with a doctor. For agricultural workers in Colorado, that chance is often rare, shaped by a lack of insurance, a shortage of nearby providers, and a work schedule that leaves little room for a clinic visit. Agricultural workers have the right to access healthcare providers and other key service providers at their housing, but in May 2025, Governor Polis signed SB25-128 into law, which eliminated their right to access these providers in other locations on employer property. The bill fails to account for a well-documented dynamic that prevents agricultural workers from obtaining important services. KFF Health News reported on a farmworker in the San Luis Valley who suffered a severe allergic reaction in the middle of the night and was too afraid of his foreman to leave worker housing and seek help. For the agricultural workers the Promotora Network serves, access to care can be the difference between a manageable condition and a medical emergency. This week, our analysis of Project Protect’s 2025 HDCGP Preventative Healthcare Survey turned to what respondents told us directly about their health, and what it reveals about which conditions go noticed and which go undiagnosed.

To find out which conditions show up most often, and why so many go undiagnosed in the first place, we can examine the responses to questions that asked respondents to identify any medical conditions or needs affecting their own health and their family’s health. These questions included a multi-select list based on the most common responses to a similar open-ended question in the 2024 Survey. Respondents could select as many conditions as applied to them, write in an “Other” response, or mark that none applied. Among the 595 workers who took the Survey, 371 reported at least one condition or need for themselves, while 316 reported at least one affecting a family member. To understand what shapes whether a condition gets reported at all, these responses were recorded into a simple yes or no, based on whether the respondent named anything beyond “None” or “N/A.” Three factors, H-2A visa status, gender, and current health insurance coverage, were then tested to see whether they were correlated with that outcome.

The first factor examined was H-2A visa status. Among the 571 respondents with a valid answer to the H-2A question, only 40.0 percent of H-2A visa holders reported a medical condition or need, compared to 64.8 percent of workers not on an H-2A visa. This gap is large, and the difference is statistically significant (p=0.000104), meaning it is very unlikely to be due to chance. On its surface, this finding might suggest that H-2A workers face fewer health problems than their peers. The pattern more likely reflects something else entirely. Workers on H-2A visas tend to be younger and present in Colorado for shorter, clearly defined contracts, leaving them less time within the U.S. health system to receive a diagnosis in the first place. A worker who has never had a blood pressure cuff placed on their arm cannot report high blood pressure, whether or not the condition is present. This distinction is worth noting for outreach purposes. It means H-2A workers may need proactive screening built into outreach efforts, since their lower reported rate could reflect limited contact with care instead of lower risk.

Whether a condition gets reported also can depend on something as fundamental as gender. Among the 593 respondents who responded to the gender question, 67.6 percent of women reported a medical condition or need, compared to 59.2 percent of men. This difference reached statistical significance (p=0.0425), meaning the gap between men and women is unlikely to be explained by chance alone. This finding fits within a broader pattern documented in health research more generally: women tend to have more routine contact with the medical system through visits related to reproductive health, and each of those visits creates another opportunity for a condition to be identified and named. The finding does not necessarily mean that men experience fewer health problems. It more likely means that men have fewer chances to find out.

Of the three factors tested, insurance status made the biggest difference, and the results were not what most people would expect. Among the 575 respondents with a valid, unambiguous answer to the insurance question, 72.9 percent of insured respondents reported a medical condition or need, compared to 55.9 percent of uninsured respondents. This difference is highly significant (p=0.000054), and on its surface, it raises an unusual question. Why would carrying health insurance make someone more likely to report having a medical condition?

Insurance itself does not cause a health problem to develop. What insurance does is create more chances for an existing condition to get diagnosed in the first place. A 2025 study using National Health Interview Survey data found that Hispanic and Latino adults report lower rates of high cholesterol than non-Hispanic white adults, despite carrying similar or greater cardiovascular risk, and tied this gap to higher rates of being uninsured, fewer wellness visits, and lower use of prescription medication. The study concluded that the difference most likely reflects underdiagnosis rather than better underlying health. A larger and earlier study of over 16,000 Hispanic and Latino adults reached a similar conclusion, finding that nearly half of participants with high cholesterol did not know they had it, in a population where close to half lacked insurance altogether. Project Protect’s data tell a version of the same story. A person who has never had the chance to sit across from a doctor has no one available to tell them their blood sugar or their blood pressure is elevated. The condition does not disappear simply because it goes unspoken on a survey. It simply continues without any treatment.

Tooth pain and dental care was the most commonly reported individual needs and most commonly reported family need, named by 114 respondents for themselves and by 115 respondents for a family member, well ahead of every other condition listed. This pattern extends well beyond Project Protect’s survey sample. The National Center for Farmworker Health has documented that agricultural workers consistently experience worse oral health outcomes than the general population, a gap driven mainly by limited access rather than limited awareness, shaped by low Medicaid reimbursement rates for dental providers and a shortage of dentists willing to practice in rural areas. A study of Latino farmworkers in North Carolina found that over half of participants reported cavities and a third reported missing teeth, while only about one in five had received dental care in the United States within the past year, with most care received back in a worker’s home country instead. Dental coverage tends to fall outside emergency safety-net programs entirely, which means it is often the first need set aside when time and money run short, even as the underlying pain continues to build.

Just beneath dental care, four of the next six spots on both lists belong to a closely related group of conditions: hypertension, high cholesterol, diabetes, and pre-diabetes. A 2022 study of Latino farmworkers across three California cohorts found high blood pressure in over 40 percent of participants and elevated cholesterol in roughly a quarter, and noted that because only about half of farmworkers make use of any form of U.S. health care, self-reported rates likely understate the true share of undiagnosed cases considerably. A separate study of agricultural workers in Oregon documented a similar pattern among more than 3,000 vineyard and winery workers. This undercount problem mirrors the insurance finding discussed earlier in this post. The workers with the least connection to ongoing care are likely the ones carrying the greatest hidden burden of chronic disease.

Chronic pain and mental health were the seventh and eighth most commonly reported conditions among both groups. Chronic pain was more common among self-reports, likely reflecting the physical demands of agricultural labor on the worker directly, while mental health draws slightly more mentions related to family members than for respondents themselves, a pattern that outside research helps explain. A 2022 report on farmworker mental health found that nearly half of farmworkers experiencing anxiety or depression never received a formal diagnosis from a provider, and described a persistent stigma surrounding mental health treatment within Latino communities. That stigma may make a worker more willing to name a concern in a loved one than to name the same concern in themselves.

Having a condition and worrying about it turned out to be two different things. Questions 11 and 14 of the Survey asked about the concerns driving these needs, rather than the conditions themselves, and the responses reinforce the pattern described above. The most common concern for both individuals and families was the high cost of health care in the United States, named by 372 respondents for themselves and 273 for their families, followed closely by a lack of health insurance (268 self, 180 family) and fear of becoming seriously ill without a safety net in place (191 self, 110 family). Managing a long-term medical condition ranked lower on both lists than the prevalence of chronic disease in this data would suggest, which may reflect that an existing diagnosis becomes a fact of daily life over time, while the cost of care and the absence of coverage remain the ongoing sources of worry. These worries are a rational response to a system in which a dental problem or a blood pressure reading can quickly become a bill no one can afford to pay.

Project Protect’s 2025 HDCGP Preventative Healthcare Survey shows that Colorado’s agricultural workers and their families carry a health burden centered on the same handful of conditions, regardless of whether the worker holds an H-2A visa, regardless of gender, and regardless of insurance status. The underlying need stays the same across every group. What changes is the likelihood that the need ever gets named. This data suggests that access on its own will not close the gap it was designed to address. The deeper problem is that insurance status and visa status shape whether a condition ever becomes a diagnosis in the first place. That question is just as important as whether a worker can physically reach a provider. A worker who has the right to a visit from a community health worker still needs that visit to lead somewhere, toward a diagnosis, a referral, or a way to cover dental care that most emergency programs leave out entirely. Policies that expand physical access to care should be paired with targeted outreach toward uninsured and H-2A workers, who this Survey suggests carry the largest hidden burden of undiagnosed chronic disease. The Promotora Network’s community health worker model, built around meeting people where they are, in a language and setting they already trust, is the kind of infrastructure that can turn a legal right to access into an actual diagnosis, and from there, into treatment.