Structural racism (SR) has been defined as the macro level systems, social forces, institutions, ideologies, and
processes that interact with one another to generate and reinforce inequities among racial/ethnic groups. The
mechanisms of SR are “unseen” and thus understudied and typically not incorporated into public health
interventions. For example, 2.5 million hired farmworkers in the U.S., who overwhelmingly are Black and/or
Latinx, live in economically segregated communities with substandard and crowded housing conditions, unsafe
or limited water that render COVID-19 preventive measures such hand hygiene and social distancing
challenging, if not impossible. Additionally, migrant and seasonal farmworkers (MSFWs) are among the lowest
paid, lack access to health information, preventive care and medical treatment. These patterns of vulnerability
reflect historical exclusion, motivated by anti-Black racism, of farmworkers from federally protected right to
organize and other labor protections, labor practices traced to the Jim Crow era, and an immigration and labor
policy environment in which MSFWs avoid reporting illness or seeking care for fear of retaliation from
employers. COVID-19 has only exacerbated these vulnerabilities; outbreaks of COVID-19 have been reported
among farmworkers and agricultural counties in the U.S. have seen disproportionately high rates of COVID-19.
Structures of marginalization of MSFWs are not widely considered through the lens of SR. To better protect the
health of Black and/or Latinx MSFWs and design an equitable response to the inevitable next pandemic,
research is needed to understand and dismantle the structural and institutional drivers of health inequities. Our
proposed work aims address this critical need through an innovative community-driven, multilevel and
multidisciplinary approach study to: examine the relationships between migrant labor housing policy regimes,
indoor air quality, exposure to viruses (e.g., SARS-CoV-2) and respiratory health of MSFWs over time (Aim1);
characterize structural pathways through which COVID-19 policy and regulatory responses interact and
influence racialized health outcomes among MSFWs through a community-based system dynamics group
modeling approach (Aim2); and evaluate the influence of agricultural migrant employment, public health and
housing law and policy on COVID-19 epidemics across selected agricultural states using a quasi-experimental
study design (Aim 3). These aims address two NIH research priorities:1) understand the impact of SR on
minority health and health disparities and 2) inform health care and social policies at all levels on mitigating
SR’s impacts on the health of vulnerable populations. Results from our proposed study will inform the design of
policies and best practices to counter long-standing mechanisms of SR impacting MSFWs, optimize living and
working conditions for better health protections and to control future outbreaks of infectious disease among
these invisible and vulnerable workers.
