The 2005 American Horse Council census reports that over 383 000 people are employed in the racing industry (American Horse Council 2005) with thousands more working in other equine-related endeavours. A cohort of that workforce, thousands of people who actually take care of the horses, live on or near US racetracks and can be considered members of backstretch communities. (The backstretch is the portion of the racetrack farthest from the grandstand and nearest the stabling area. Backstretch workers maintain the stables and care for the horses, and they usually live on or near the racetrack.) Because the work is associated with assigned racing dates or time-limited ‘meets’, the workers migrate from track to track, some remaining at one or two work sites in the state and others travelling across state lines. In Illinois and most other racing venues, a large proportion of the workers migrate from rural towns and primitive farms in Mexico, Guatemala and Ecuador where economic conditions are very harsh and opportunities are severely limited. The jobs they assume in the racing industry may entail similar agricultural work, e.g. tending livestock, maintaining stables and caring for equipment. It is not uncommon for entire worker communities to emanate from particular towns or regions, indicative of a growing phenomenon called chain migration (Marotta & Garcia 2003).

Bateson (1996) described women’s occupations as ‘enfolded’, and occupations and occupational roles for this population are similarly intertwined. They live in the same environment where they work, where they recreate, where they raise their children and where they worship. Their inclusion in this community is contingent upon their ability to perform a job even as they age. Occupational choices are limited to those that are both culturally acceptable and available in a limited and rather idiosyncratic context. While the lifestyle of backstretch workers might seem unattractive to most, it does afford steady work, marginal housing, education for their children and a semblance of community. Much like the military, the backstretch tends to accommodate a broad spectrum of personalities, behaviours and abilities, making it possible for some who might not succeed in a broader social context to live acceptably.

A large proportion of the workforce, by virtue of low socioeconomic status, limited education, immigration status, race and ethnicity, and access to social resources, is vulnerable to disparities in health and health care (Clancy and Chesley, 2003, Murdock et al., 2003, Health Resources and Services Administration, 2004 and Mokdad et al., 2004). While the scientific literature discretely addresses issues associated with agricultural workers and safety (Purschwitz, 2003 and Frank et al., 2004), migrant worker health (Hansen and Donohoe, 2003 and Villarejo, 2003) and the perils of horse-related activity (Press et al., 1995, Waller et al., 2000 and Abu-Zidan and Rao, 2003), there is little available that addresses the combined impact of these content areas and informs this industry about the unique health needs of its workforce, and none specific to the backstretch population (see also Chapter 4 and Chapter 5).

Unlike typical employers, which sponsor health programmes, racetracks are structured to host trainers and their operations, who, in turn, employ other horsemen. Trainers are required to pay for workers’ compensation coverage but this applies only to work-related injuries, which tend to be under-reported. In most racing jurisdictions, health-related services have been initiated and supported through philanthropy, and these vary widely from racetrack to racetrack. In Illinois, the majority of health-related services are provided through the Racing Industry Charitable Foundation, Inc. (RICF), an endeavour that was seeded by Lucy Reum, a member of the Illinois Racing Board from 1976 to 1977. Peggy Goetsch, current Executive Director, has been working with this population for over 20 years. According to Goetsch, equine migrant and seasonal workers are isolated, with limited access to health resources (Barrett & Clippinger 1997). Services, particularly hospital-based services, for licensed horsemen may be funded through industry benevolent associations but benefits are limited and contingent upon available funds. Some, but not all, racing corporations contribute financial support and facilities for health-related endeavours. Given the nature of the backstretch community, the likelihood of pre-existing health disparities and the risks and exposure related to the work, there is greater need than existing services can address.

Over the past several years, specific research initiatives and funding mechanisms have been directed toward illuminating and eliminating health disparities, e.g. National Institutes of Health, National Center for Minority Health and Health Disparities. The rapidly accumulating literature affirms that health disparities are created or exacerbated by social, economic and behavioural phenomena. Disparities in health and access to quality health care disproportionately affect poor people of colour, poor women and their children, and people with disabilities (Smedley et al 2003). In turn, health status, social resources and overall wellbeing are inextricably related to the pursuit and execution of daily occupations (see also Chapter 4 and Chapter 5).

The workforce in the racing industry is a virtual microcosm mirroring the tensions and challenges inherent in health and health care in broader society. People involved in the industry are diverse and represent a continuum of attributes, resources and vulnerabilities that come to bear on health and quality of life. Partnering with academicians, and specifically occupational scientists and therapists, affords mutually beneficial opportunities to address health issues and improve health within the workforce to the mutual benefit of workers and employers and potentially yielding a more robust industry (see Chapter 1 and Chapter 2). Meeting health-related challenges may be best served by forging partnerships that entail systematic inquiry and analysis, culling wisdom from the health, social and behavioural sciences that yield conceptual models and relevant programmes.

The corporate entity that owns each racetrack facility hosts the racing stables, establishes the races and entries, and oversees the racetrack operations, including betting. State Racing Boards regulate the industry and issue licences to an array of horsemen. (In Illinois alone, the Racing Board customarily issues thousands of licences annually to horsemen, including owners, trainers, assistant trainers, jockeys, apprentice jockeys, exercise riders, pony riders, harness drivers, prospective harness drivers, stable foremen, grooms, hotwalkers and an array of service providers from veterinarians to feed salesmen (State of Illinois Legislature, 1975 and Illinois Racing Board, 2005)). Owners of racehorses provide the capital that acquires and maintains the horses and their entourages. Trainers oversee the horses and the workers of the racing stable that they own or operate. The racetrack labour force is organized hierarchically and trainers generally have the most status and resources at their disposal. There are, however, many trainers whose small operations do not allow them luxuries such as health insurance.

In contrast to the owners and large-scale trainers, those who assume roles at the lower end of the hierarchy represent a good deal more diversity in terms of race, ethnicity and sex. Precise demographic data are unavailable and methodological challenges are similar to those encountered in collecting data for the US census. Although licences are required in each state, authenticity of documentation is sometimes questionable, impacting access to health-related services. Historically present in the racetrack environment, a small proportion of the backstretch population is African American. Over the years, women have become increasingly present, especially in the lower rungs of the labour hierarchy. More recently on the scene are Muslim men who are employed by racing stables owned by wealthy Middle Easterners. Today at least 50% of the people working and living on the backside of US tracks are Latino/Latina (more than 90% in Illinois) and a large number of them are new immigrants (P. Goetsch, personal communication, 2004). In Illinois in 2006, backstretch workers comprised 68.7% of the licensed horsemen who actually had responsibility for training and caring for the horses.

Caring for horses requires a 365-days-a-year commitment and the workers on the backside maintain the stable environment, the horses and the equipment. By dawn, stables are bustling with activity. Horses are fed and readied for their workouts, and exercise riders appear to condition them for their races. Between the hours of 5 am and 11 am, horses (upward of 2000 on major tracks) are fed, groomed and exercised. The work is physical and similar to that in other agricultural environments except that racehorses are sensitive, high-maintenance athletes. Not only must the animals’ basic needs be met but they must also be carefully observed and tended. Grooms function much like athletic trainers, wrapping, rubbing, applying poultices or liniment and otherwise ministering to the elite equine athletes (Figure 18.1 and Fig. 18.2). After morning workouts, preparations are made for those entered in the afternoon’s races. Consequently, days are long, and time off during a racing meet is rare.

The racetrack image more familiar to patrons invokes the pageantry of the bugler’s call, the colourful silks worn by the jockeys and the parade to post. Most patrons are unaware of the array of people and hours of training devoted to the animals at the starting line. Those who live and work on the backside leave the track infrequently and any special needs, including health care, must fit into the ebb and flow of the racetrack routine. Since wages associated with these jobs are very low, many backstretch workers live meagrely, especially those who are supporting families. Most live in dormitories built to the prevailing standards for migrant and seasonal housing at the time of construction. When migrant housing is not available on the racetracks, workers tend to live in the immediate surrounding community. Given the expendable income of the workers, housing options are quite limited. Since the characteristics of the workforce have shifted to include couples and sometimes families, housing has been a source of increasing concern and controversy (Rozek 2004). Children are not allowed on the backside of the majority of racetracks but they are permitted in some of the venues in Illinois. High-spirited racehorses and impulsive young children sharing the same environment pose additional health and safety risks and housing challenges. Criddle (2001) reported that children who are bystanders are at risk of serious injury by livestock and horses when these incidents occur.

Risks and exposures relative to the work on the backside are similar to those encountered in other agricultural endeavours. A rural lifestyle entails strenuous, physical work and depends upon the physical abilities and determination of rural, agricultural workers, typically farmers. The racetrack, like the ‘family farm’, encompasses the workplace, the home and the playground for the workforce. Over the last 20 years, Department of Labor statistics indicate that farming has risen from the third most hazardous occupation in the US to the most hazardous (Petrea, 2003 and US Bureau of Labor Statistics, 2003). The second highest number of fatalities of any industry was associated with farming in 2003, including an additional 110 000 disabling injuries in that same year (National Safety Council 2004). Older workers, predominantly Hispanic migrant workers, and women are changing the nature of the workforce. These workers, with associated occupational risks for chronic health problems, work-related injuries and occupational exposures permeate traditional and non-traditional environments in agribusiness. In 1996, the National Institute for Occupational Safety and Health (NIOSH) defined such workers as populations of risk in agricultural settings, and they are among the research priorities set by NIOSH (National Institute for Occupational Safety and Health 1996). Backstretch workers share many of the same attributes and challenges and are thus likely to experience comparable problems and health disparities (Culp & Umbarger 2004).