Fields of inequity: initial insights into structural disparities among migrant farmworkers in Maryland.

Background: Despite well documented health vulnerabilities of migrant and seasonal farmworkers (MSFWs), few public health studies have comprehensively evaluated these population health differences through the lens of social causal structures. In this article we describe a community-based participatory and interdisciplinary research partnership, RESPIRAR, a community-based and interdisciplinary research collaboration that seeks to understand the social, structural and institutional drivers of respiratory health and housing conditions of migrant and seasonal farmworkers (MSFWs) in the Mid-Atlantic States and we report on structured disparities among MSFWs in Maryland participating in our study. Few data exist on the demographics, health and housing conditions of MSFs currently employed in Maryland. Methods: All elements of RESPIRAR were co-designed by the partnership including the development of the baseline survey. Participant recruitment and data collection were carried out by teams consisting of staff from the university collaborators and CATA, a farmworker organization with over 40 years of experience supporting farmworkers and low-wage immigrant workers in the Mid-Atlantic region. 135 MSFWs on Maryland's Eastern Shore completed baseline surveys on their demographic characteristics, housing and working conditions, and health status during the 2023 and 2024 agricultural seasons. In addition to generating summary statistics, we examined differences in wages and housing type by farmworker demographics, work authorization status and work tasks. Results: MSFWs held a variety of work authorization statuses (77.8% H-2A and 15% EAD under TPS), reported Spanish (84.3%) and Haitian Creole (15.7%) as primary languages, and 47% reported long tenure in agricultural work. Participants lived in various overcrowded housing types including detached/single family homes, motels, barrack/labor camps and mobile homes. Hypertension was the most common chronic health condition reported by participants but not everyone had access to needed medications. We found disparities in wages by gender, education, and nationality (e.g., male, H-2A and Mexican workers were significantly more likely to earn ≥$15/h.). Conclusion: Given the lack of systematically collected data on Maryland's present-day MSFWs, our data provide critical insights for local farmworker advocacy, social service and health care organizations, and governmental agencies responsible for the health and wellbeing of MSFWs. Impoverished working and living conditions of MSFWs are constant features, structured by design of the United States agriculture labor system. To find lasting solutions, we can no longer treat these features as independent factors. We must apply a systems lens to examine how the structures of law, policy, practices and norms give rise to the lived experiences of MSFWs. Our baseline results provide grounding into the current lived experiences of MSFWs in Maryland and aspects of labor, immigration, agriculture and public health systems that we will interrogate further through community-based system dynamics and group model building workshops co-facilitated with CATA.