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Out of the Loop: (In)access to Health Care for Migrant Workers in Canada
Abstract and Figures
Drawing on a survey of nearly 600 migrant farm workers in Ontario, Canada, we investigate the ways in which the liminality of temporary migrants is both conditioning and consequential in terms of health for these migrants. In particular, we demonstrate how the liminality inherent in managed temporary migration programmes creates the conditions for heightened vulnerability, which also have consequences for the health of migrant workers and their access to care. We discuss common barriers to health care access experienced by migrant workers, including employer mediation, language differences, and hours of work.
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... 11,12 The systemic nature of these disadvantages and risks have been conceptualized in ways that foreground the exclusionary framework of TFWP and the precarious conditions MAWs experience. The identification of TFWP as an expression of structural violence 20 is echoed in "relentless border walls" (RBW), 17 liminality, 21 and social quarantining 22 that influences workers' access to various services and protections. Indeed, the differential inclusion of MAWs in migration management regimes 4,23 has been conceptualized as a significant driver of the multiple forms of precarity workers experience through their status as non-citizens, their exclusion from family unity, labour mobility 10,24-26 and settlement services 27,28 their participation in a closed, temporary program, their reliance on circular (and therefore deportable) migratory status, and a limited amount of relevant services that enable adequate health care and protections. ...
... This group, for instance, inhabits a tension both through their inclusion as essential labourers, and their marginality and precarity in relation to nationhood and citizenship. 21,22 These broader dynamics create a greater sense of uncertainty while also restricting and collapsing these individual's social and personal lives in Canada. Workers experience loneliness, isolation, and lack of belonging that is produced by fears of deportation and working conditions 18,[29][30][31][32] that have significant consequences for workers' health. ...
... MAWs' precarity, both because of their temporary or informal status, and also, because of substandard living and working conditions 21,67,68 were identified as significant determinants to the degree that SPs could address workers' needs, and, the accessibility of services. Furthermore, agricultural production in Canada is generally concentrated in rural areas wherein workers are bound to live on employers' properties, at a considerable distance from town centres. ...
Research has long-documented how Canada's temporary foreign worker programs (TFWP) foster workers' precarity through their status as non-citizens and living and working conditions, ultimately, impacting their health. While studies point to limited supports and services for workers, their role in reinforcing or alleviating the precarious conditions that migrant agricultural workers experience remains largely unexplored. This paper draws on interviews with 35 service providers in three migrant-intensive regions in southwestern Ontario, to explore how service providers describe and construct support. We explore the barriers workers face in accessing services, challenges providers experience in supporting workers, and strategies employed to surmount these barriers. We argue that this multiregional analysis is important to illuminate how support shapes and is shaped by the larger structural context, namely common features of Canada's TFWP. A more comprehensive understanding of support moreover, provides direction for sustainable interventions that can promote the health and wellbeing of this population.
... The precariousness of migrant farmworkers' immigration and employment status heightens their risk of poor health outcomes. For example, workers may avoid reporting illness or injury due to fear of not being rehired, or of being medically repatriated (Colindres et al., 2021, Cohen & Caxaj, 2018Hennebry et al., 2016;Orkin et al., 2014;Preibisch & Otero, 2014). Health risks such as exhaustion as well as musculoskeletal injuries and pain are significantly linked to long, intense workdays with few or no breaks (Hennebry et al., 2016;Preibisch & Otero, 2014). ...
... For example, workers may avoid reporting illness or injury due to fear of not being rehired, or of being medically repatriated (Colindres et al., 2021, Cohen & Caxaj, 2018Hennebry et al., 2016;Orkin et al., 2014;Preibisch & Otero, 2014). Health risks such as exhaustion as well as musculoskeletal injuries and pain are significantly linked to long, intense workdays with few or no breaks (Hennebry et al., 2016;Preibisch & Otero, 2014). Mental health concerns including depression and anxiety have also been linked to fear of repatriation, alongside contributing factors such as the loneliness of being apart from children and other family, high levels of stress, and a sense of powerlessness (England et al., 2007;Paciulan & Preibisch, 2013;Pysklywec et al., 2011;Salami et al., 2015). ...
Migrant agricultural workers face various health inequities that have led to preventable illness and death. This paper investigates how material housing conditions have shaped physical and mental health outcomes for temporary foreign workers in Canadian agriculture. We conducted a scoping review of literature on migrant agricultural worker housing in Canada published between 2000–2022, analysing insights on the physical quality of workers’ housing in relation to international frameworks on housing quality. Our review revealed a range of housing-related health risks, including: (1) Sanitation, food security, and water; (2) Thermal safety, electricity, and utilities; (3) Habitability of structure, air quality, and exposure to hazards; (4) Spacing, privacy, and co-worker relations and; (5) Geographic proximity to necessary services and social opportunities. Although housing has been increasingly recognized as a social determinant of health, little research examines how migrant farmworkers’ accommodations shape their health outcomes, particularly in Canada. This scoping review provides timely insights and recommendations to inform research, policy, and public health interventions.
... As a result, they are vulnerable to several health issues, including occupational injury (Mayell 2024;Mayell and McLaughlin 2016;McLaughlin 2009;McLaughlin and Hennebry 2013;McLaughlin et al. 2014;Mysyk et al. 2008;Narushima et al. 2016). In Canada, SAWP workers have a legal right to health care for the duration of their contracts, but they depend on employers to get the health cards needed to access services, and they experience numerous barriers to independently accessing care (Cole et al. 2019;Hennebry et al. 2016;Pysklywec et al. 2011). Notably, many injured and sick workers are repatriated before they can access care or workers' compensation (Basok et al. 2014;Hennebry and Williams 2015;Orkin et al. 2014). ...
A form of indentured labour, Canada’s Seasonal Agricultural Worker Program (SAWP) hires thousands of Jamaican farm workers each year on temporary contracts that bind their employment and immigration status to a single Canadian employer. Hazardous working and living conditions in Canada render SAWP workers vulnerable to poor health outcomes, and injured workers are often repatriated before they can access health care or workers’ compensation. In this context, SAWP workers are typically reluctant to refuse unsafe work, report injuries, or seek health care for fear of losing present or future employment in Canada. This research conceptualizes the SAWP as a necropolitical system of unfree labour wherein Jamaican workers are racialized, dehumanized, and refigured as disposable instruments of labour through mechanisms commensurable with those employed in the plantation slavery system. Drawing on 18 months of ethnographic fieldwork with Jamaican SAWP workers, this paper focuses on the experiences of workers who are physically injured in Canada and explores the challenges they encounter attempting to recover their health and income. To discuss these experiences, I present what I call the triple violence of injury under the SAWP: (1) the pain and debility caused by physical injury; (2) the structural violence that injury both exposes and makes workers vulnerable to; and (3) the necropolitical legacy of slavery and ongoing dehumanization through which Jamaican workers experience their bodies as racialized and vulnerable. In foregrounding the experiences of Jamaican workers, this study addresses the dearth of research on the experiences of migrant farm workers from the Caribbean.
... Specifically, we examine migrant agricultural workers' experiences of employer-provided housing in Canada. Thus far, empirical research on migrant agricultural workers in Canada has only mentioned housing as one of several variables impacting worker health (Hennebry et al., 2016;Preibisch and Otero, 2014). A central focus on housing as a social determinant of health for migrant agricultural workers in Canada bears relevance to other countries that have similarly shifted toward temporary migration programs to satisfy industry demand for workers with weakened bargaining power. ...
... Sixth, our interview guide did not ask questions about how many hours youths' work in agriculture per day or if they experienced wage theft while working in agriculture. While previous research has found that long hours of work is associated with fatigue, work intensity, and pressures to meet and exceed work quotas among Latino migrant farmworkers (Hennebry et al., 2016), there is no information about the effects of long working hours among Latino migrant youth. Furthermore, wage violations and theft are prevalent among Latino migrant farmworkers where almost half (45%) of workers without a H-2 A agricultural visa experienced minimum wage violations (Robinson et al., 2011). ...
Background
There is evidence to suggest that undocumented, unaccompanied migrant youths confront emotional and physical hardships while working in the U.S. agriculture industry. However, little is known about the type of support available to these youths that could protect them from negative developmental outcomes.
Objective
This qualitative research was designed to explore Guatemalan migrant youths’ available support types, expectations of coming to the U.S. for work, and the life lessons learned from being undocumented, unaccompanied minors in the agriculture industry.
Methods
A total of 10 unaccompanied Guatemalan youths (age range 15–17 years, Mage = 16.4 years; 100% male; 100% undocumented) participated in individual semi-structured audio-voice-recorded interviews in the Southeast. Interview responses were transcribed, coded, and analyzed.
Results
Thematic analysis yielded three primary interconnected themes: (1) “Coping and managing sadness by reaching out to others,” (2) “I have a dream but then, reality hits,” and (3) “Life lessons for future migrants.”
Conclusion
Findings suggest that despite their vulnerable social position, Guatemalan migrant youth in U.S. agriculture displayed an optimistic attitude, exercised persistence, and developed resourcefulness. Besides these competencies, youth possessed social networks with left-behind families, developed and leveraged new social ties to “manage sadness,” and built a tight-knit community away from their countries of origin.
... Likewise, participants must assess services available both in terms of accessibility and in terms of the real and perceived risk it poses should their access to such support be known to their employer. Such common reports speak to the need to explore safe and confidential pathways for legal and healthcare support for his population (Hennebry et al., 2016;Mayell & McLaughlin, 2016). The need for unmediated access to services and support for this population has been well documented (Caxaj & Cohen, 2023;Caxaj et al., 2020;George & Borrelli, 2023). ...
Canada has intensified its reliance on temporary foreign workers, including migrant agricultural workers (MAWs) who have contributed to its agriculture sector, rural economies, and food security for decades. These workers live and work in rural communities across Canada for up to two years. Thousands of MAWs engage in recurring cyclical migration, often returning to the same rural communities in Canada for decades, while others are undocumented. Yet MAWs do not have access to the supports and services provided for immigrant newcomers and pathways for permanent residence. The exclusion of these workers from such entitlements, including labour mobility, reinforces their precarity, inhibits their sense of belonging, and reflects the stratification built into Canada’s migration regime. This article draws on interviews with 98 MAWs in three migrant‐intensive regions in southwestern Ontario to examine how workers construct and describe support in relation to co‐workers, employers, residents, and community organizations. Drawing on conceptualizations of support as an important vehicle for social connection and inclusion that comprises social and citizenship belonging, we document how the strategies MAWs employ to forge connections are enabled or undermined by Canada’s Temporary Foreign Worker Program, community dynamics, and the broader forces of racialization, gender, and exclusion. This article contributes to the limited scholarship on the support landscape for MAWs, whose experiences foreground the contested nature of belonging and inclusion among migrant populations across smaller cities and rural areas.
... Being 'neither here nor there', they fall out of place-bounded structures, resources, and benefits. As Hennebry et al. (2016) point out regarding transnational temporary migration programmes in Canada, liminality 'is produced through a confluence of structural factors which keep these individuals in a permanently temporary limbo ' (p. 523). ...
Spain's berry industry relies on the agricultural labour of both local and seasonal migrant workers. A significant part of this migrant workforce comprises Moroccan mothers who leave their children with relatives in order to perform this wage labour. The bilateral recruitment regime favours the employment of Moroccan women with children for this labour to ensure that workers return home at the end of the harvesting season. Drawing on multi‐site ethnographic research in Spain and Morocco, this study revealed the effects of this bilateral labour regime on the intimate lives of migrant workers. We argue that the geopolitical prescriptions of this labour migration regime, along with the working and living conditions of migrant workers in Huelva, result in experiences of intimate liminality. We examined these experiences by exploring: (1) how the role of female workers as mothers becomes liminal as transnational labour agreements marginalise and outsource care obligations, (2) how governmental neglect of migrant workers' occupational health exposes them to reproductive health risks and (3) how this neglect places them in a liminal space in terms of access to healthcare, and (4) how, despite their liminality, migrant workers contest precarious conditions through everyday solidarity practices. We advance a feminist approach to liminality, emphasising the importance of an embodied, intersectional, and multiscalar perspective.
... lack of awareness of services, stigma) and to accessing the existing services (e.g. language differences, lack of culturally appropriate services) [14,15]. In light of the COVID-19 pandemic, there is thus an even higher need for psychosocial interventions for IMWs targeting the most notable symptoms of psychological distress, such as anxiety, depression, and posttraumatic stress disorder (PTSD) [16,17]. ...
Background
The COVID-19 pandemic has negatively affected the mental health of international migrant workers (IMWs). IMWs experience multiple barriers to accessing mental health care. Two scalable interventions developed by the World Health Organization (WHO) were adapted to address some of these barriers: Doing What Matters in times of stress (DWM), a guided self-help web application, and Problem Management Plus (PM +), a brief facilitator-led program to enhance coping skills. This study examines whether DWM and PM + remotely delivered as a stepped-care programme (DWM/PM +) is effective and cost-effective in reducing psychological distress, among Polish migrant workers with psychological distress living in the Netherlands.
Methods
The stepped-care DWM/PM + intervention will be tested in a two-arm, parallel-group, randomized controlled trial (RCT) among adult Polish migrant workers with self-reported psychological distress (Kessler Psychological Distress Scale; K10 > 15.9). Participants (n = 212) will be randomized into either the intervention group that receives DWM/PM + with psychological first aid (PFA) and care-as-usual (enhanced care-as-usual or eCAU), or into the control group that receives PFA and eCAU-only (1:1 allocation ratio). Baseline, 1-week post-DWM (week 7), 1-week post-PM + (week 13), and follow-up (week 21) self-reported assessments will be conducted. The primary outcome is psychological distress, assessed with the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS). Secondary outcomes are self-reported symptoms of depression, anxiety, posttraumatic stress disorder (PTSD), resilience, quality of life, and cost-effectiveness. In a process evaluation, stakeholders’ views on barriers and facilitators to the implementation of DWM/PM + will be evaluated.
Discussion
To our knowledge, this is one of the first RCTs that combines two scalable, psychosocial WHO interventions into a stepped-care programme for migrant populations. If proven to be effective, this may bridge the mental health treatment gap IMWs experience.
Trial registration
Dutch trial register NL9630, 20/07/2021, https://www.onderzoekmetmensen.nl/en/trial/27052
Canada’s robust universal, single-payer healthcare system has long made socio-economic rights (SER) advocates in the United States envious of our neighbors to the north. Fundamental human rights tenants echo in the Canadian Charter of Rights and Freedoms, including non-discrimination and individual freedom, yet the “right to health” has not been constitutionalized at the moment this essay was written.1 While Canada has a strong track record of signing international human rights conventions and guaranteeing the right to health for permanent citizens, there remains a gap in the health rights of migrant workers, even in regular situations or formalized citizenship pathways. Ever-changing legal qualifications for permanent residency and arbitrary three-month waiting periods for healthcare coverage to come into effect make securing the right to health for even the most highly desirable workers—namely, healthcare workers in private households—a thorny task. The motto for Canada’s paradoxical commitment to the socio-economic rights of migrant workers might be, as Toronto doctors Ritika Goel and Michaela Beder aptly articulate in the title of their medical journal op-ed, “Welcome to Canada...but don’t get sick.”
Growing numbers of migrant workers worldwide face human rights violations, exploitation and mistreatment, and lack broader social protections granted to permanent residents in countries where they work. Protecting migrant labour was an objective at the founding of the International Labour Organization (ILO), documented within the Declaration of Philadelphia in 1944. Yet, more than 60 years on, despite numerous United Nations (UN) conventions, declarations and frameworks aimed at protecting their rights, migrant workers remain marginalized. In the context of globalizing labour markets and economic crises, migrant workers are a particularly vulnerable group. This article will discuss the extent to which the Global Social Protection Floor Initiative (SPF) has addressed this group, and will assess how well existing international, bilateral and national frameworks for social protection extend to migrant workers.
Fresh Fruit, Broken Bodies provides an intimate examination of the everyday lives and suffering of Mexican migrants in our contemporary food system. An anthropologist and MD in the mold of Paul Farmer and Didier Fassin, Holmes shows how market forces, anti-immigrant sentiment, and racism undermine health and health care. Holmes's material is visceral and powerful. He trekked with his companions illegally through the desert into Arizona and was jailed with them before they were deported. He lived with indigenous families in the mountains of Oaxaca and in farm labor camps in the U.S., planted and harvested corn, picked strawberries, and accompanied sick workers to clinics and hospitals. This "embodied anthropology" deepens our theoretical understanding of the ways in which social inequalities and suffering come to be perceived as normal and natural in society and in health care.
This interdisciplinary volume offers a multifaceted picture of precarious employment and the ways in which its principal features are reinforced or challenged by laws, policies, and labour market institutions, including trade unions and community organizations. Contributors develop more fully the concept of precarious employment and critique outmoded notions of standard and nonstandard employment. The product of a five-year Community-University Research Alliance, the volume aims to foster new social, statistical, legal, political, and economic understandings of precarious employment and to advance strategies for improving the quality and conditions of work and health.