An ethnographic study of the social context of migrant health in the United States

Abstract

Background: Migrant workers in the United States have extremely poor health. This paper aims to identify ways in which the social context of migrant farm workers affects their health and health care.

Methods and findings: This qualitative study employs participant observation and interviews on farms and in clinics throughout 15 months of migration with a group of indigenous Triqui Mexicans in the western US and Mexico. Study participants include more than 130 farm workers and 30 clinicians. Data are analyzed utilizing grounded theory, accompanied by theories of structural violence, symbolic violence, and the clinical gaze. The study reveals that farm working and housing conditions are organized according to ethnicity and citizenship. This hierarchy determines health disparities, with undocumented indigenous Mexicans having the worst health. Yet, each group is understood to deserve its place in the hierarchy, migrant farm workers often being blamed for their own sicknesses.

Conclusions: Structural racism and anti-immigrant practices determine the poor working conditions, living conditions, and health of migrant workers. Subtle racism serves to reduce awareness of this social context for all involved, including clinicians. The paper concludes with strategies toward improving migrant health in four areas: health disparities research, clinical interactions with migrant laborers, medical education, and policy making.

Figure 1. Summary of Field Work

Figure 2. Map of Migration Route

This map shows the route of migration field research followed by the anthropologist, from the Skagit Valley of Washington state to the central Valley of California, the mountains of Oaxaca, Mexico, the Arizona borderlands, and then back to central California and Washington state. (Illustration: Natalie Davis)

Figure 3. Labor Hierarchy on the Tanaka Farm

Figure 4. Labor Camp on the Tanaka Farm

Each of the Tanaka Farm's labor camp units, called “cabins” by farm executives, is split in half, with each side housing one family.

Figure 5. The Anthropologist with Triqui Migrant Workers in Washington State

The anthropologist with Triqui migrant workers in Washington state.

Figure 6. Teenage Checker Punches the Weight of Berries Brought in by a Picker

A teenage checker punches the weight of berries brought in by a picker.

Figure 7. Triqui People Bent Over Picking Strawberries in Washington State

Triqui laborers picking strawberries on the Tanaka Farm in Washington state.

Figure 8. A Hometown of the Triqui People in Oaxaca State, Mexico

The hometown in the mountains of Oaxaca, Mexico, of many Triqui migrant laborers.

Figure 9. Pesticide Containers Surround Hand-Washing Station and Outhouse

Containers of pesticides surround one of the hand-washing stations and outhouses on the farm.

Figure 10. Conceptual Diagram of Hierarchies on the Farm