ArticlePDF Available

Precarious patients: health professionals’ perspectives on providing care to Mexican and Jamaican migrants in Canada’s Seasonal Agricultural Worker Program

  • Occupational Health Clinics for Ontario Workers, Hamilton, Ontario, Canada

Abstract and Figures

Introduction: The intersecting vulnerabilities of migrant agricultural workers (MAWs) impact both their health and their access to health care in rural areas, yet rural clinicians' voices are rarely documented. The purpose of this study was to explore health professionals' perspectives on health care for MAWs in sending countries and rural Ontario, Canada. Methods: Qualitative research design occurred over three distinct projects, using a multi-methodological approach including semi-structured interviews in Mexico, Jamaica and rural Ontario (n=43), and session field notes and questionnaires administered to healthcare providers (n=65) during knowledge exchange sessions in rural Ontario. A systematic analysis of these data was done to identify common themes, using NVivo software initially and then Microsoft Excel for application of a framework approach. Results: Structural challenges posed by migrant workers' context included difficulties preventing and managing work-related conditions, employers or supervisors compromising confidentiality, and MAWs' fears of loss of employment and return to countries of origin prior to completing treatments. Structural challenges related to health services included lack of adequate translation/interpretation services and information about insurance coverage and MAWs' work and living situations; scheduling conflicts between clinic hours and MAWs' availability; and difficulties in arranging follow-up tests, treatments and examinations. Intercultural challenges included language/communication barriers; cultural barriers /perceptions; and limited professional knowledge of MAWs' migration and work contexts and MAWs' knowledge of the healthcare system. Transnational challenges arose around continuity of care, MAWs leaving Canada during/prior to receiving care, and dealing with health problems acquired in Canada. A range of responses were suggested, some in place and others requiring additional organization, testing and funding. Conclusion: Funding to strengthen responses to structural and intercultural challenges, including research assessing improved supports to rural health professionals serving MAWs, are needed in rural Canada and rural Mexico and Jamaica, in order to better address the structural and intersecting vulnerabilities and the care needs of this specific population.
Donald C Cole MD, MSc, FRCP(C), Emeritus Professor *
Janet E McLaughlin PhD, Associate Professor
Jenna L Hennebry PhD, Associate Professor
Michelle A Tew RN, BScN, Occupational Health Nurse
*Dr Donald C Cole
Occupational Health Clinic for Ontario Workers, 848 Main St E, Hamilton, ON L8M 1L9, Canada; Dalla Lana School of Public Health,
University of Toronto, Health Sciences Building, 155 College St, Toronto, ON M5T3M7, Canada; and Institute for Work & Health, 481
University Ave Suite 800, Toronto, ON M5G 2E9, Canada
Health Studies, RCE 242, Wilfrid Laurier University, Brantford, Ontario N3T 2Y3, Canada; and International Migration Research Centre,
Balsillie School of International Affairs, Wilfrid Laurier University, 67 Erb Street West, Waterloo, ON, Canada
International Migration Research Centre, Balsillie School of International Affairs - BSIA 243, Wilfrid Laurier University, 67 Erb Street
West, Waterloo, ON, Canada; and Communications Studies, Wilfrid Laurier University, Waterloo, Ontario N2L 3C5, Canada
Occupational Health Clinic for Ontario Workers, 848 Main St E, Hamilton, ON L8M 1L9, Canada
1 December 2019 Volume 19 Issue 4
RECEIVED: 7 February 2019
REVISED: 21 August 2019
ACCEPTED: 5 September 2019
Cole DC, McLaughlin JE, Hennebry JL, Tew MA.Precarious patients: health professionals’ perspectives on providing care to Mexican and
Jamaican migrants in Canada’s Seasonal Agricultural Worker Program. Rural and Remote Health 2019; 19: 5313.
This work is licensed under a Creative Commons Attribution 4.0 International Licence
Rural and Remote Health
James Cook University ISSN 1445-6354
Introduction:The intersecting vulnerabilities of migrant
agricultural workers (MAWs) impact both their health and their
access to health care in rural areas, yet rural clinicians’ voices are
rarely documented. The purpose of this study was to explore
health professionals’ perspectives on health care for MAWs in
sending countries and rural Ontario, Canada.
Methods:Qualitative research design occurred over three distinct
projects, using a multi-methodological approach including semi-
structured interviews in Mexico, Jamaica and rural Ontario (n=43),
and session field notes and questionnaires administered to
healthcare providers (n=65) during knowledge exchange sessions
in rural Ontario. A systematic analysis of these data was done to
identify common themes, using NVivo software initially and then
Microsoft Excel for application of a framework approach.
Results:Structural challenges posed by migrant workers’ context
included difficulties preventing and managing work-related
conditions, employers or supervisors compromising confidentiality,
and MAWs’ fears of loss of employment and return to countries of
origin prior to completing treatments. Structural challenges related
to health services included lack of adequate
translation/interpretation services and information about insurance
coverage and MAWs’ work and living situations; scheduling
conflicts between clinic hours and MAWs’ availability; and
difficulties in arranging follow-up tests, treatments and
examinations. Intercultural challenges included
language/communication barriers; cultural barriers /perceptions;
and limited professional knowledge of MAWs’ migration and work
contexts and MAWs’ knowledge of the healthcare system.
Transnational challenges arose around continuity of care, MAWs
leaving Canada during/prior to receiving care, and dealing with
health problems acquired in Canada. A range of responses were
suggested, some in place and others requiring additional
organization, testing and funding.
Conclusion:Funding to strengthen responses to structural and
intercultural challenges, including research assessing improved
supports to rural health professionals serving MAWs, are needed in
rural Canada and rural Mexico and Jamaica, in order to better
address the structural and intersecting vulnerabilities and the care
needs of this specific population.
agricultural farm workers, Canada, intercultural health, migrant health, occupational health, physician–patient relations, primary care,
rural health and medicine, qualitative methods.
Migrant farm or agricultural workers (MAWs) have formed a critical
part of many rural economies for decades. In 1966, as a response
to agricultural labour supply challenges, the Canadian federal
government developed the Seasonal Agricultural Worker Program
(SAWP), bringing workers initially from the Caribbean and,
beginning in 1974, from Mexico for up to 8months annually. In
2011, the Canadian government instituted a smaller, general
agricultural stream of Canada’s broader Temporary Foreign Worker
Program (TFWP), allowing workers to enter from any country with
contracts of up to 2years, with some additional MAWs through
TFWP’s general streams for low- and high-wage positions . These
workers now include those from Asia, as well as other Latin
American countries. Over 53000 temporary foreign agricultural
worker positions were approved in Canada in 2015, of which nearly
42000 were through the SAWP .
Social determinants of health figure prominently in MAWs’ lives .
Working conditions include physical hazards (egoutdoor physical
labour using farm equipment), environmental factors (such as
extreme heat, inadequate lighting, biting insects), farm chemicals
(such as pesticides and fertilizers), and mechanical hazards (farm
machinery on rough terrain and unsafe transportation), which
heighten their risks of specific occupational injuries and
illnesses . However, unlike citizen farmers and permanent
resident workers, MAWs are precarious workers , under a
managed labour migration program in Canada that renders them
‘permanently temporary’, compounding their vulnerability .
Studies in the Canadian and US contexts have demonstrated that
MAWs are likely to experience a range of health outcomes: injury
and illness from agrochemical and climatic exposures;
musculoskeletal injury from repetitive motion, awkward postures,
and lifting heavy loads; and motor vehicle and machinery
accidents . In addition, MAWs are required to live in
employer-provided housing, which is typically on farms and is
highly variable due to inconsistent application of housing
regulations. Studies of migrant worker housing in Ontario and
British Columbia have demonstrated numerous housing
deficiencies, including insufficient food storage and cooking
facilities, over-crowded and poorly ventilated dormitories lacking
privacy, insufficient cooling and heating systems, and proximity to
pesticides and fertilizers among many other concerns , similar to
those in North Carolina .MAWs lack resources such as
transportation , common among poor people in rural settings.
They also may lack dominant language communication capacity ,
have different understandings of health and illness, and expect
different healthcare treatment, all of which pose intercultural
competency challenges to providing care .
A substantial literature exists on rural health service provision to
MAWs in the USA . As is the case for other rural residents,
access to health care, particularly specialists, remains an ongoing
challenge for migrant and non-migrant farm workers alike . Yet
MAWs often face particular barriers to health and social services
utilization . In Canada, MAWs are eligible for provincial
health coverage and workers’ compensation systems, and
supplementary insurance benefits (for prescription drugs or
physiotherapy, for example) are usually in contracts. However,
processing delays occur, and health card access is a challenge for
some: nearly 20% of 600 Ontario MAWs in one survey had not
received their cards . The SAWP and other TFWP streams create
structural vulnerabilities and additional barriers to accessing
healthcare systems among MAWs . For example, MAWs may
not take time off work when sick or injured due to fear of loss of
current or future employment or wages. In a survey of
approximately 600MAWs in Ontario, 45% reported working
despite illness or injury for fear of telling their employers, and 55%
worked in these conditions to avoid losing paid hours . Indeed,
under the SAWP, employers can terminate employment and return
workers to their country of origin if MAWs refuse work for any
reason, including for medical reasons .MAWs, their families
and their providers can encounter challenges of transnational
coordination of care across different healthcare systems ,
particularly when MAWs become ill and injured in Canada and are
returned home with their condition not fully investigated,
managed or compensated .
Rural health professionals and health services may have limited
preparation for responding to both the specifics of MAWs’
challenges and their complexity. They may have limited
preparation in evidence-informed management of MAWs for
the determinants of health, the particular health problems, and the
range of structural challenges to care which MAWs present.
However, unlike those serving other migrants, immigrants and
refugees in the US , Canada , and Europe , views of health
professionals providing services to MAWs in Canada have rarely
been documented. Hence, the research reported here asked ‘What
are rural health professionals’ perspectives on health care for
MAWs, both in sending countries and in Canada?’
This research starts from the theoretical underpinnings of
structural vulnerability , which recognizes the social determinants
of health, and the social structures that create systematic barriers
to equitable health care for migrant workers. The researchers
developed a qualitative design to tap the perspectives of
healthcare practitioners responding to migrant workers in rural
Southern Ontario. The critical realist, qualitative research design
drew upon multiple methods to gather data, carried out by the
authors (individually and in collaboration) over a 10-year period
(Fig1). Below the authors comment on various aspects of this
design in reference to key components of the ‘consolidated criteria
for reporting qualitative research’ (COREQ) criteria for qualitative
studies .
Figure1:Timeline for data collection.
Research team
Lead project researchers included two interdisciplinary PhD social
scientists (female), each with more than 15years of qualitative and
community-engaged scholarship with migrant workers in Canada.
Other research team members were an occupational physician
(male) and an occupational health nurse (female), each with
extensive clinical experience with migrant workers, masters’
research training and respect among Ontario clinicians. Three
authors are fluent in Spanish, having worked extensively in Latin
America. Interviews were predominantly carried out by the
research team members, with some Mexican interviews carried out
by a male doctoral research assistant from Mexico. The research
assistant received training in research ethics and interviewing and
was provided an interview protocol and informed consent
information for participants.
Qualitative interviewing was the primary data collection method,
allowing for an emphasis on health providers’ knowledge and
perspectives. In keeping with semi-structured interview
approaches, guides of open-ended questions with potential
probes were developed for each set of interviews. Key questions-
domains were similar, focusing on the challenges and
particularities of providing care for the vulnerable population of
migrant workers, including access to health services and workers’
compensation processes. Questions were added according to
experience-expertise of the interviewee, given their different roles
and national contexts. Interview guides were not formally piloted,
but were iteratively adapted to ensure comprehension and
responsiveness to interviewee concerns and insights. Interviewers
had flexibility in order of questioning and extent of follow-up
probing, but were careful not to frame the latter in a leading
20,35 36 37
Potential interviewees were discussed among research team
members and purposively selected based on role and experience,
with supplementary suggestions emerging from interviewees.
Interviewers approached potential interviewees by phone or email
and arranged the interview in a mutually convenient location,
usually the clinician’s office. Some proposed interviews were
unable to be concretized due to logistical challenges, but no
potential interviewees refused outright. In total, 43interviews were
carried out with healthcare practitioners across the three countries,
with no repeat interviews. During 2006–2009, co-investigator JM
conducted semi-structured interviews in person with doctors,
nurses and other healthcare professionals (n=24) who administer
health examinations as well as provide care to migrant workers
before they leave from and/or return to Mexico and Jamaica, as
well as those who provide care to workers while in Ontario . As
part of investigating transnational aspects of care for MAW in a
second project, additional interviews were carried out in
2010–2012 with primary care practitioners in Mexico and Jamaica
(n=12) and with health professionals in Simcoe, Norfolk county,
Ontario (a top receiving area for MAWs) (n=7) . The interviews in
Canada and Mexico were carried out in person, while the Jamaican
interviews were conducted over the phone. The Canadian
interviews were conducted by a Canadian physician, the Mexican
interviews by a Mexican doctoral student research assistant, and
the Jamaican interviews by one research team member (JM). All
were conducted in private settings, usually the providers’ office,
with no other individuals present. Interviewees in Mexico and
Jamaica were referred to researchers from consular and Ministry
officials and from migrant workers undergoing treatment.
Although interviewees covered a range of genders and years in
practice; only health professional role and province/country have
been used in identifying interviewees to maintain
anonymity.Interview duration was between 30 and 90minutes,
depending upon health professional availability and engagement.
In all interviews, detailed notes were taken, and most interviews
were transcribed verbatim, while some were partially transcribed
for pertinent quotes only.Mexican interviews were conducted and
audio-recorded in Spanish by bilingual researchers, and later
translated into English for analysis.
Initial data analysis of the interviews occurred as interviews were
conducted by the lead social scientist researchers with NVivo v7
(QSR International;
Listening to audio-recordings, reviewing notes and reading
transcriptions enabled a focus on relevant content areas (such as
access to services and emerging themes, and language
challenges). This iterative process informed judgements of
saturation in each wave of interviewing: when no new content
areas or themes emerged, additional interviews were not sought
out. Subsequent coding incorporated the theoretical perspective
on structural vulnerability.
Knowledge exchange sessions
In addition to these interviews, 20 knowledge exchange sessions
were held with health professionals in Southern Ontario
communities at hospitals, medical schools and medical clinics
serving MAWs as part of a third project. These professionals were
recruited through a sampling strategy that identified rural areas
with high proportions of migrant workers in Southern Ontario, as
well as with medical trainees (egmedical students) at surrounding
medical schools. Sessions were held in the Ontario regions of
Brant, Chatham-Kent, Essex, Haldimand-Norfolk, Hamilton,
Middlesex, Niagara, Simcoe, Toronto, and Waterloo. Researchers
contacted healthcare practitioners in these regions directly in order
to seek participants, and referrals to other potential participants
were solicited following a snowball approach. Participants were
actively recruited by email and phone calls, and personal contacts
were made with primary care and rural hospital providers, who
advertised the sessions with staff and colleagues. Sessions were set
at convenient hours and locations, and refreshments were served.
At the beginning of the sessions, informal knowledge testing
questions, prior to the introduction of relevant material, were
designed to obtain a baseline qualitative assessment of
participants’ knowledge of, sentiments about, and experiences
with healthcare and workers’ compensation access for migrant
workers. Presenters took notes, and fielded questions and
concerns expressed, recorded feedback on the presentation format
and content, and developed an understanding of participants. At
the close of each session, self-administered anonymous
questionnaires gauged respondents’ perceptions of barriers to
healthcare services and ways of overcoming them (n=65). The
questionnaire assessed what participants had learned from the
presentation, and obtained their perspective on what ways care or
practices could be modified in response to migrant worker health
issues and challenges accessing health care and compensation.
Additionally, open-ended qualitative sections of the questionnaire
gathered further qualitative information on possible
improvements, concerns and questions.
All responses were entered into Excel worksheets by a research
assistant and then checked with hard copy questionnaires by an
author for accuracy and reliability. The 65survey respondents
worked in community health centres (24%), followed by acute care
hospitals (21%), public health units (18%), and family health teams
(8%) (other and unspecified 29%). Of these, the largest proportion
were nurses and nurse practitioners (n=24, 38.1%), physicians
(n=7) and administrators/managers (n=9), with a wide range of
other health providers (n=12) (n missing=13).Most respondents
reported seeing at least some migrant workers, with 42% of
respondents seeing more than 20migrant workers over their
Across primary sources, a framework analysis approach was
used, informed by the literature, clinical experience and earlier
research by the authors. The framework method of analysis is most
suitable for analysis of multiple and disparate sources of interview
data, and provides a well-structuredoverviewof summarised data,
which has guided interpretation of the study’s findings.
Based upon these orientations and the literature cited, data from
each primary source was integrated into a database and then
coded into three high-level nodes related to structural factors,
which emphasized the contexts of the temporary migration
program and the Ontario healthcare system; intercultural factors,
which emphasized the factors related to language and cultural
differences for migrant workers; and transnational factors, which
reflected the experiences and challenges related to providing care
to a group of patients who move transnationally from year to year.
Using the framework approach, interview excerpts were coded into
these three categories and then interpreted and discussed with
specific reference to quotes and phrases employed by
respondents. Findings were then consolidated into four tables
(Supplementary tables S1–S4). Data were triangulated across data
sources in order to strengthen the validity of findings. Co-
consultation across authors, joint narrative writing, and iterative
revisions produced the synthesis.
Ethics approval
Approvals for this research were through research ethics boards at
the University of Toronto (Social Sciences, Humanities and
Education (#18873) and Wilfrid Laurier University (#2865 and
Good workers, poor patients? How structures of international
labour migration programs and healthcare services influence
provision of care
Most rural health professionals deeply admired MAWs:
I think these people work extremely hard; it’s back-breaking
work, it’s repetitive work. They’re up early hours, they’re to bed
late. They never leave the farm, except for Friday evenings and
Sundays, but even still, some of them are working seven days a
week for many, many months. (Ontario physician)
… they’re very easy to deal with, probably because they’re
motivated. They’re motivated to get better. They want to work
– most of them – and they come in here and you know, they’re
genuinely concerned about some issue and you kind of feel
that you’re their only person that they can talk to, so you kind
of feel you’re doing something useful … (Ontario physician)
These health professionals faced a number of challenges providing
care to MAWs (Table1, with more detail in Supplementary tables
S1,S2). Responses to these challenges (Table2) were limited in the
face of the structures of the migration program and health
services. As one Mexican health professional noted for migrants, ‘…
a Mexican is not going to be cared for like a Canadian’.
About half of knowledge exchange session participants
understood that migrant workers were eligible for provincial health
insurance, but only a third understood that migrant workers were
eligible for workers’ compensation, with the remainder responding
‘no’ or ‘unsure.’ Health professionals noted the numerous barriers
that MAWs face accessing care, with one Ontario physician
commenting, ‘they wouldn’t see a doctor unless they’re very sick’.
In rural Ontario, healthcare facilities are often long distances from
farm residences and workers normally lack independent
transportation (Supplementary table S1), only going into town on
Friday evenings or weekends. In some cases, volunteer community
support workers, bilingual co-workers or supervisors facilitate
healthcare access for MAWs. However, most often transportation is
provided by employers, whose involvement in medical
consultations raised concerns about privacy and confidentiality
(Table1), including the use of medical information by consular
officials (whose roles include mediating concerns between SAWP
workers and their employers and arranging repatriation of
workers). For example, when speaking about a health form
requested by a consular official, one doctor explained, ‘I don’t
really even know what that form is for. All I know is, I have to fill it
in.’ MAWs’ concerns about jeopardizing current or future work in
Canada, and fears of their employer or consular officials learning of
their health problems, and ultimately leading to deportation if
unable to work (Tables 1, Supplementary table S1), were noted by
several Ontario rural physicians.
MAWs’ lack of insurance and/or health insurance cards at the
beginning of the season impedes access to healthcare services,
particularly specialists, and may limit investigations and treatment
options (Tables 1, Supplementary table S2). Although a few rural
physicians took on MAWs ‘as quasi-regular patients’, others
argued for formal, continuous rostering of MAWs so that they
could be regularly monitored each season in a primary care
setting. The mismatch between when MAWs could get into town
to see a health professional and most providers’ hours was a
recurrent challenge, often resulting in workers seeking care at
over-burdened rural emergency departments (Table1,
Supplementary table S2). Suggestions included modifying clinic
hours (11, 22% of knowledge exchange participants); for example,
one Simcoe clinic and pharmacy stayed open later on Friday nights
when workers are typically bussed into towns in order to buy
groceries, send money home, etc. Others suggested modifying
locations (9, 18%), including mobile clinics to farms
(Supplementary table S2).
Diagnosis of work-relatedness of diseases, such as asthma, which
often required additional testing and follow-up, was difficult with
MAWs (Supplementary table S2). Among Ontario physicians who
were aware of workers’ entitlements to workers’ compensation,
most indicated that they would offer to complete the required
forms for a clear workplace injury. In more ambiguous cases, they
would be less likely to do so, often because of the preference of
workers, out of fear or pressure from employers, not to file a claim.
Responses (Supplementary table S2) included education on the
first visit, community volunteers who ensured the follow-up, and
involving employers in work modification ‘and if he’s not getting
better ... bring him back’ (Ontario physician).
Table1:Overview of challenges perceived by health professionals serving migrant agricultural workers
Supplementary table S1: Structural challenges posed by
migrant farmworkers’ context and suggested responses
Supplementary table S2:Health services related structural
challenges and suggested responses for improving fit
Worlds apart: intercultural challenges, knowledge gaps and
Communication barriers and knowledge gaps were the most
commonly expressed challenge in knowledge exchange sessions
with Ontario rural health professionals, particularly for English-only
providers (the vast majority) serving Spanish-speaking MAWs
(Table1, Supplementary table S3). Challenges in mutual
comprehension included language and accents for several Ontario
physicians, and comprehension or literacy, including for a Jamaican
physician: ‘Farmworkers are mostly illiterate, do not understand,
even me sometimes. … Education level is a big barrier’. None of
the rural Ontario health professionals had a regular translation
service, so providing access to translators/interpreters
(Supplementary table S3) was a priority for knowledge exchange
participants (15, 31%).Multilingual resources, both printed and
telehealth versions, for MAWs and health professionals were also
mentioned as desirable (Supplementary table S3).
Some health professionals identified ‘cultural issues’ as challenges
(Supplementary table S3). Different interpretations of illness
presentations between MAWs and health providers were noted
(egaround pain and bodily discomfort with mental
distress).MAWs’ different expectations of care and treatment often
reflected common practices in their countries of origin, such as
injections in Mexico .
Providers’ limited knowledge of MAWs’ work/living contexts and
contractual situation posed difficulties in identifying and managing
work-related health problems (Supplementary tables
S1,S2).Mexican health professionals noted the need for training of
primary care providers in occupational health (Supplementary
table S2).Given the burden of musculoskeletal problems, Mexican,
Jamaican, and Ontario providers encouraged training in
‘Ergonomic practices applied consistently including work
modification, stretches, etc. which could help us work towards
injury prevention’ (knowledge exchange participant). Health
officials in Mexico noted that they instituted education sessions,
which include some limited information about workers’ health-
related rights and entitlements, primarily focusing on issues such
as sexual health, nutrition and substance abuse.Many providers,
particularly in sending countries, were unaware of Canadian
workers’ compensation systems.
Supplementary table S3:Intercultural challenges faced by
healthcare providers and suggested responses
Care across borders: transnational challenges and responses
Both sending-country and Canadian rural providers had difficulty
understanding preventive practices in the other country, for
example sanitation and personal protective equipment when
spraying pesticides in Canada among Mexican providers, and
screening for conditions in Mexico among Canadian providers
(Table1, Supplementary table S4). A Jamaican physician bemoaned
the lack of provision of training in body mechanics. Some Mexican
providers critiqued the exploitation of MAWs, arguing that the ‘era
of exploitation has passed’ and policies (particularly around
providing greater protections and care to migrant workers) should
be changed. They reported raising concerns with their Ministry of
Labour and at binational meetings to correct deficiencies
(Supplementary table S4).
Chronic conditions such as hypertension and diabetes presented
challenges to continuity of care due to differences in medication
names and availability, leading families in Mexico to request
medication for a MAW in Canada from Mexican providers
(Supplementary table S4). Further, MAWs would not always have
sufficient funds to continue treatment started in the other country.
When MAWs had to leave Canada prior to receiving full diagnostic
workups and/or treatment, Ontario providers faced tough
decisions about whether and when to approve a patient as fit to
travel back to their country, and with what consequences
(Supplementary table S4). One Ontario physician refused to
discharge a patient with a newly diagnosed cancer until the
worker, the specialist and the consulate official had laid out a plan
of care and follow-up in the sending country. On the receiving
end, Mexican providers complained ‘… that the migrants come
with a problem from Canada that they are trying to solve here’.
Both occupational conditions and sexually transmitted infections
were mentioned. While clinicians identified the significant
contribution of occupational factors to presenting health
conditions and the need for preventive activities, no pathways for
these were identified at the clinical level. A Jamaican physician was
frustrated by the delays in approval by Canadian workers’
compensation authorities for investigations (egMRIs) and
treatments (egphysiotherapy).Mexican providers described
shifting MAW screening to post-migration, decentralizing the
services, and improving coordination of care with state health
services to better manage MAW health problems. However, they
noted that travel, equipment, medications, and treatments are
often not fully covered by state health services, supplementary
insurance, or workers’ compensation, leaving workers’ families to
pick up the costs if they could (Supplementary table S4).
Supplementary table S4:Transnational challenges faced by
healthcare providers and suggested responses
Health professionals, working in sending countries and Canada,
demonstrated substantial understanding of the complex
challenges involved in providing care to MAWs in rural settings. As
per Fennelly’s work , the importance of ‘listening’ to rural
providers’ experience as reflective insiders, in order to articulate
better the challenges that they face and the opportunities for
improvement, is clear.Much prior work has emphasized the views
of health professionals in high-income countries (egEuropean
providers grappling with competencies for addressing ethnic and
cultural diversity) . Previously, only Holmes interviewed
providers in rural areas of both a sending country (Mexico) and a
receiving country (USA). The present findings echo those of
Holmes on the challenges that rural health providers grapple with
in order to even partially address the social determinants of MAW s
health within rural health services facing their own structural
constraints. Recognizing the potential for feelings of
powerlessness, as voiced by a Mexican physician in this study, is
particularly important given the sometimes overwhelming nature
of structural constraints, with providers feeling ‘caught in the same
web’ .
However, in contrast with Holmes’ work on rural health service
provision to irregular migrants, interviewees in the present study
described potential for joint sending–receiving country governance
mechanisms to address some of the challenges (Table2) .
Suggestions for joint social protection have included ‘agreements
between the Canadian insurers (Ontario) and the home country
social security scheme’ , but few models of social protection
agreements pertain to health , particularly for migrants labelled
low skilled . Such a transnational perspective is increasingly
germane as those with chronic conditions cross borders and
health burdens accrued in one country fall upon another. Babe, I
Hate to Go is a film about one such Jamaican worker diagnosed
with cancer in Canada . Ullman et al also documented different
health burdens among rural Mexicans returning from the USA .
Such added health burdens pose challenges for MAWs and their
providers, particularly in rural areas with limited access to care and
medicines , despite other improvements in health systems . As
Stan noted, the practice and governance task is to negotiate
adequate health care for MAWs in an emerging ‘healthcare
assemblage and citizenship regime in which patients’ movements
across borders are closely interlinked with .… increasingly unequal
access to public healthcare services’ .
Table2:Towards continuity of culturally safe, transnational care for migrant agricultural workers
Although this is the first study in Canada sharing rural health
professionals’ perspectives, it had limited coverage geographically
(only focused on the two largest MAW sending countries and the
Canadian province where the largest numbers of workers are
concentrated: Ontario) and professionally (focused on primary care
versus a full range of specialties). Jamaican provider experience
was inadequately covered with the few providers interviewed and
primarily one sharing key insights. Although the data are
5–13years old, little has changed in laws and programs that might
affect MAWs’ structural vulnerability . Innovative occupational
and primary care services have been developed in some
community sites (storefronts, churches, shopping malls) on Friday
evenings and weekends , but overall health care access and
appropriateness has not substantially changed. Hence, the findings
are still relevant, although substantial scope exists for further
research, particularly transnationally.
A range of opportunities could enhance care for MAWs in rural
Canada and in countries of origin. At the system level, health
service delivery innovations could improve ‘fit’ between people
and providers . In the USA, funded migrant farmworker clinics
exist in major rural agricultural areas and student-run community
43 20
51 52
medical outreach approaches have been used . Nurse-staffed
cluster clinics for common conditions such as diabetes have been
shown to improve MAW satisfaction with care . Communication,
access and follow-up challenges could be better addressed
through budgeting for remote interpretation services and
building on the work of care navigators . Such responses could
be amplified, building upon international examples of innovations
to promote equity in primary health care . At the rural provider
level, training and resources for culturally safe approaches to
health care could be expanded, in partnership with health
professionals from the top MAW sending countries (egMexico and
Jamaica, in the case of Canada). Other strategies include
adaptations of existing guidelines for particular health problems,
such as Kirmayer et al’s work on mental health , implementation
of tailored structural vulnerability assessment tools , social
prescribing initiatives , and sharing of online resources on
conditions and benefits for MAWs specifically . The rewards in
treating MAWs, expressed by interviewees in Holmes’ work and in
this study, are important resources for innovation, although
funding and support to rural health services overall will have to
increase to ensure implementation.
The authors acknowledge participants, research assistants (Aaraon
Diaz, Andres Furet, Eduardo Huesca, Pauline O’Connor, Lisa
Stadelmayer), physician colleagues (Mike Pysklywec, Ted Haines)
and community partner (Industrial Accident Victims Group of
1Employment and Social Development (ESDC). Hire a temporary
foreign agricultural worker. 2018. Available:
/agricultural.html (Accessed November 2018).
2Employment and Social Development (ESDC). Annual labour
market impact assessment statistics 2008-2015. Primary Agriculture
stream. 2017. Available:
annual-statistics/agricultural.html (Accessed November 2018).
3Preibisch K, Hennebry J. Temporary migration, chronic effects:
the health of international migrant workers in Canada. Canadian
Medical Association Journal 2011; 183(9): 1033-1038. PMid:21502343
4McLaughlin J. Trouble in our fields: health and human rights
among Canada's foreign migrant agricultural workers. Doctoral
thesis. Department of Anthropology, University of Toronto, 2009.
/McLaughlin_Janet_E_200911_PhD_thesis.pdf (Accessed November
5Hennebry J, Preibisch K, McLaughlin J. Health across borders -
health status, risks and care among transnational migrant farm
workers in Ontario. Toronto, ON: CERIS Ontario Metropolis Centre,
6McLaughlin J, Hennebry J, Haines T. Paper versus practice:
occupational health and safety protections and realities for
temporary foreign agricultural workers in Ontario. Pistes:
Interdisciplinary Journal of Work and Health 2014; 16(2): 2-17.
7Molineri A, Signorini ML, Tarabla HD. Risk factors for work-
related injury among farm workers: a 1-year study. Rural and
Remote Health 2015; 15: 2996. Available:
/journal/article/2996 (Accessed October 2019).
8Benach J, Muntaner C. Precarious employment and health:
developing a research agenda. Journal of Epidemiology &
Community Health 2007; 61(4): 276-277.
/jech.2005.045237 PMid:17372284
9Lewchuk W, Clarke M, deWolff A. Working without commitments:
precarious employment and health. Work, Employment and Society
2008; 22(3): 387-406.
10 Hennebry JL. Permanently temporary: agricultural migrant
workers and their integration in Canada. IRPP study no. 26. 2012.
/IRPP-Study-no26.pdf (Accessed 24 October 2019).
11 Hansen E, Donohoe M. Health issues of migrant and seasonal
farmworkers. Journal of Health Care for the Poor and Underserved
2003; 12(2): 153-164.
12 Arcury TA, Quandt SA. Delivery of health services to migrant
and seasonal farm workers. Annual Review of Public Health 2007;
28: 345-363.
/annurev.publhealth.27.021405.102106 PMid:17291182
13 McLaughlin J, Hennebry JL. Backgrounder on health and safety
for migrant farmworkers. IMRC Policy Points 2010; Issue I,
December: 1-7.
14 Keim-Malpass J, Spears Johnson CR, Quandt SA, Arcury TA.
Perceptions of housing conditions among migrant farmworkers
and their families: implications for health, safety and social policy.
Rural and Remote Health 2015; 15: 3076. Available: (Accessed October
15 McLaughlin J, Hennebry J, Cole D, Williams G. The migrant
farmworker health journey: stages and strategies. IMRC Policy
Points 2014; 6: 1-14.
16 Kim-Godwin YS, Alexander JW, Felton G, Mackey MC, Kasakoff
A. Prerequisites to providing culturally competent care to Mexican
migrant farmworkers: a Delphi study. Journal of Cultural Diversity
2006; 13(1): 27-33.
17 White-Means S. Health characteristics and utilization of public
sector health facilities among migrant agricultural workers in
Orange County, New York. Journal of Health & Social Policy 1992;
4(1): 57-75.
18 Dean AL. Caring for the Mexican-American migrant farmworker.
Journal of the American Academy of Physician Assistants 1998;
11(2): 41.
19 Bechtel GA, Davidhizar R, Spurlock W. Migrant farm workers
and their families: cultural patterns and delivery of services in the
United States. International Journal of Nursing Practice 2000; 6(6):
20 Holmes S. The clinical gaze in the practice of migrant health:
Mexican migrants in the United States. Social Science & Medicine
2012; 74: 873-881.
/j.socscimed.2011.06.067 PMid:21992736
21 Kulig JC, Williams AM (Eds). Health in rural Canada. Vanc ouve r,
BC: UBC Press, 2011.
22 Sibley LM, Weiner JP. An evaluation of access to health care
services along the rural-urban continuum in Canada. BMC Health
Services Research 2011; 11: 20.
/1472-6963-11-20 PMid:21281470
23 Newfoundland and Labrador Medical Association. Fact sheet -
rural health care. Available:
/document_39.pdf (Accessed May 2018).
24 Basok T. Human rights and citizenship: the case of Mexican
migrants in Canada. Working paper No.72. San Diego, CA: Center
for Comparative Immigration Studies, 2003.
25 Pysklywec M, McLaughlin J, Tew M, Haines T. Doctors within
borders: meeting the health care needs of migrant farm workers in
Canada. Canadian Medical Association Journal 2011; 183(9):
1039-1042. PMid:21502349
26 Schmalzried HD, Fallon Jr LF. Reducing barriers associated with
delivering health care services to migratory agricultural workers.
Rural and Remote Health 2012; 12(2088): 1-10. Available: (Accessed October
27 Hennebry J, McLaughlin J, Preibisch K. 'Out of the loop':
(In)access to health care for migrant workers in Canada. Journal of
International Migration and Integration 2016; 17(2): 521-538.
28 Hennebry J, McLaughlin J. The exception that proves the rule:
structural vulnerability, health risks and consequences for
temporary migrant farmworkers in Canada. In: C Hughes, P Lenard
(Eds). Legislated inequality: Canada's Temporary Migrant Worker
Program. McGill-Queen's University Press, 2012; 117-138.
29 Orkin AM, Lay M, McLaughlin J, Schwandt M, Cole D. Medical
repatriation of migrant farm workers in Ontario: a descriptive
analysis. Canadian Medical Association Journal OPEN 2014; 2(3):
30 Hennebry JL, Williams G. Making vulnerability visible: medical
repatriation and Canada's migrant agricultural workers. Canadian
Medical Association Journal 2015; 187(6): 391-392.
/10.1503/cmaj.141189 PMid:25561629
31 Chilingerian JA, Savage GT. The emerging field of international
health care management: an introduction. In: GT Savage , JA
Chilingerian, M Powell, Q Xiao (Eds). International Health Care
Management (Advances in Health Care Management, Volume 5).
Bingley, United Kingdom: Emerald Group Publishing Limited, 2005;
32 Villa-Torres L, Gonzalez-Vazquez T, Fleming PJ et al.
Transnationalism and health: A systematic literature review on the
use of transnationalism in the study of the health practices and
behaviors of migrants. Social Science & Medicine 2017; 183: 70-79. PMid:28463722
33 Frank AL, Liebman AK, Ryder B, Weir M, Arcury TA. Health care
access and health care workforce for immigrant workers in the
agriculture, forestry, and fisheries sector in the Southeastern US.
American Journal of Industrial Medicine 2013; 56: 960-974. PMid:23532981
34 Donham KJ, Thelin A. Agricultural medicine: rural occupational
and environmental health, safety, and prevention. Hoboken, NJ:
John Wiley & Sons, 2016.
35 Fennelly K. Listening to the experts: provider recommendations
on the health needs of immigrants and refugees. Journal of
Cultural Diversity 2006; 13(4): 190-201.
36 Rosenberg E, Kirmayer L J, Xenocostas S, Dominice Dao M,
Loignon C. GPs' strategies in intercultural clinical encounters.
Family Practice 2007; 24: 145-151.
/cmm004 PMid:17283216
37 Priebe S, Sandhu S, Dias S, et al. Good practice in health care
for migrants: views and experiences of care professionals in 16
European countries. BMC Public Health 2011; 11: 187. PMid:21439059
38 Bourgois P, Holmes SM, Sue K, Quesada J. Structural
vulnerability: operationalizing the concept to address health
disparities in clinical care. Academic Medicine 2017; 92: 299-307. PMid:27415443
39 Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting
qualitative research (COREQ): a 32-item checklist for interviews and
focus groups. International Journal for Quality in Health Care 2007;
19(6): 349-357.
40 Hennebry J, McLaughlin J. Responding to temporary migration
in Ontario's agricultural workplaces. Final research report
submitted to the WSIB Research Advisory Council. Waterloo, ON:
International Migration Research Centre, 2012.
41 Ritchie J, Spencer L. Qualitative data analysis for applied policy
research. In: A Bryman, RG Burgess (Eds). Analyzing qualitative
data. London & New York: Routledge, 1994; 172-194.
42 Pope C, Ziebland S, Mays N. Qualitative research in health care:
analysing qualitative data. British Medical Journal 2000; 320:
43 Hordijk R, Hendrickx K, Lanting K, MacFarlane A, Muntinga M,
Suurmond J. Defining a framework for medical teachers'
competencies to teach ethnic and cultural diversity: results of a
European Delphi study. Medical Teacher 2019; 41(1): 68-74. PMid:29490534
44 Robillard C, McLaughlin J, Cole DC, Vasilevska B, Gendron R.
Caught in the same webs - service providers' insights on gender-
based and structural violence among female temporary foreign
workers in Canada. Journal of International Migration and
Integration 2018; 19(3): 583-606.
45 Brem M. Migrant workers in Canada: a review of the Canadian
Seasonal Agricultural Workers Program. 2006. Available:
(Accessed July 2018).
46 McLaughlin J. Migration and health: implications for
development. The Canadian Foundation for the Americas (FOCAL)
Labour Mobility and Development Project, policy paper 2. 2009.
/pdf/MigrantHealthMcLaughlin2009.pdf (Accessed 28 October
47 Hennebry J. Falling through the cracks? Migrant workers and
the global social protection floor. Global Social Policy 2014; 14(3):
48 Brieger K. A dietician's perspective on diabetes among migrant
farmworkers. Journal of Health Care for the Poor & Underserved
2006; 17(3): 469-476.
49 CBC/Radio Canada. Babe, I hate to go. 2018. Available: (Accessed
23 October 2019).
50 Ullmann SH, Goldman N, Massey DS. Healthier before they
migrate, less healthy when they return? The health of returned
migrants in Mexico. Social Science and Medicine 2011; 73: 421-428. PMid:21729820
51 Bourne PA. Socio-demographic determinants of health care-
seeking behaviour, self-reported illness, and self-evaluated health
status in Jamaica. International Journal of Collaborative Research on
Internal Medicine & Public Health 2009; 1(4): 101-130.
52 Gómez-Dantés O, Sesma S, Becerril VM, Knaul FM, Arreola H,
Frenk J. The health system of Mexico. Salud Publica Mexicana 2011;
53(Suppl 2): S220-S232.
53 Stan S. Transnational healthcare practices of Romanian migrants
in Ireland: inequalities of access and the privatisation of healthcare
services in Europe. Social Science & Medicine 2015; 124: 346-355. PMid:24797693
54 Faraday F. Canada's choice: decent work or entrenched
exploitation for Canada's migrant workers? 2016. Available:
/Canadas-Choice-2.pdf (Accessed August 2019).
55 Occupational Health Clinics for Ontario Workers. Migrant Farm
Worker Health Program. Available:
/migrant-farm-worker-program.html (Accessed 6 November 2019).
56 McLaughlin J, Tew M. Migrant farm worker health care: unique
strategies for a unique population. In: AN Arya, T Piggott (Eds).
Under-served:health determinants of indigenous, inner-city, and
migrant populations in Canada. Toronto, ON: Scholars' Press, 2018;
57 Lawrence J. Kearns R. Exploring the 'fit' between people and
providers: refugee health needs and health care services in Mt
Roskill, Auckland, New Zealand. Health and Social Care in the
Community 2005; 13(5): 451-461.
/j.1365-2524.2005.00572.x PMid:16048533
58 Heravi M, Bertram JEA. A novel resource model for
underprivileged health support: community medical outreach.
Rural and Remote Health 2007; 7: 668. Available: (Accessed October 2019).
59 Heuer LJ, Hess C, Batson A. Cluster clinics for migrant Hispanic
farmworkers with diabetes: perceptions, successes, and challenges.
Rural and Remote Health 2006; 6: 469. Available: (Accessed October 2019).
60 Access Alliance. The Remote Interpretation Network. Available:
i-o-network-remote-interpretation-ontario (Accessed February
61 Natale-Pereira A, Enard KR, Nevarez L, Jones LA. The role of
patient navigators in eliminating health disparities. Cancer 2011;
117(15Suppl): S3543-S3552.
62 Richard L, Furler J, Densley K, Haggerty J, Russell G, Levesque
J-F, et al. Equity of access to primary healthcare for vulnerable
populations:the IMPACT international online survey of innovations.
International Journal for Equity in Health 2016; 15: 64. PMid:27068028
63 Vogel L. Is your hospital culturally safe? Canadian Medical
Association Journal 2015; 187(1): E13.
/cmaj.109-4953 PMid:25452319
64 Kirmayer LJ, Narasiah L, Munoz M, Rashid M, Ryder AG, Guzder
J, et al. Common mental health problems in immigrants and
refugees: general approach in primary care. Canadian Medical
Association Journal 2011; 183(12): E959-E967.
/10.1503/cmaj.090292 PMid:20603342
65 Kilgarriff-Foster A, O'Cathain A. Exploring the components and
impact of social prescribing. Journal of Public Mental Health 2015;
14(3): 127-134.
66 McLaughlin J, Hennebry J. Connect Consider Change - a guide
for health care providers. 2012. Available: (Accessed July 2018).
This PDF has been produced for your convenience. Always refer to the live site for the
Version of Record.
... Several structural factors exacerbate the risk of workplace abuse in the SAWP (Bhuyan et al., 2018;Robillard et al., 2018). First, the SAWP allows employers to dismiss and deport migrant workers without sufficient avenues for workers to appeal this process (Cole et al., 2019;Cortina-Castro & Kobayashi, 2020;Strauss & McGrath, 2017). Since SAWP workers are assigned temporary work visas linked to specific employers, workplace dismissal can jeopardize the immigration status of migrant labourers (Binford, 2019;Edmiston, 2020;Preibisch, 2004;Strauss & McGrath, 2017). ...
... Thirdly, government regulation of the SAWP is inadequate and demonstratively biased towards employers (Caxaj & Cohen, 2019;Cole et al., 2019;). Through complaint-driven systems, government regulatory bodies require migrant workers to identify and report workplace violations committed by their employers (Caxaj & Cohen, 2019;Edmiston, 2020;Strauss & McGrath, 2019). ...
... Current research has identified that language barriers often compound the pre-existing structural harms of the SAWP, which highlights the importance of interpretation services (Basok, 2009;Caxaj & Cohen, 2019;Cole et al., 2019;Mysyk et al., 2009). In the context of the SAWP, the inaccessibility of government-provided interpretation services, and the associated cost of private interpretation, have prompted pro-worker groups to rely on the support of uncertified interpreters (Cole et al., 2019;Mysyk et al., 2009). ...
Full-text available
Uncertified interpreters enable migrant agricultural workers in Canada’s Seasonal Agricultural Worker Program to access key resources and connect with community. Through providing a range of services, including support work and advocacy, interpreters assist migrant workers at risk of exploitation and injury in Canada. This article explores how uncertified interpreters navigate the power dynamics between migrant workers, interpreters, and other actors. Moreover, this article investigates how uncertified interpreters perceive their role and the ethical values that guide their communicative methods. This study’s research findings show that interpreters may adopt a pro-worker role perception as they gain knowledge of the disempowerment experienced by migrant workers. Arising from this role perception, interpreters may also adopt pro-worker ethical values that renounce interpreter neutrality in favour of accessibility and an explanatory communication style. Ultimately, this article contends that uncertified interpreters may reject some traditional interpretation guidelines to adopt a role perception, ethical framework, and communicative style perceived to be more well-suited to supporting migrant farm workers in British Columbia.
... Seasonal agricultural workers migrate to North America and Europe from developing and underdeveloped countries in the regions of South America, Caribbean, Africa, Eastern Europe and Asia with little or no prior training to gain knowledge about occupational health and safety guidelines and issues in the host country. Most of the seasonal agricultural workers to Canada and United States are from 11 Caribbean countries and Mexico [1]. There is abundance of research-based evidence merging from Europe, North America and Oceania confirming agricultural workers, in general, and foreign seasonal farm workers more specifically, as experiencing high occupational health associated health risks and injuries [2]. ...
... The term "foreign seasonal farm worker" refers to those temporary workers, who come under "work visa" to work in the farms, vegetation, animal husbandry, meat, or fish production facilities [1]. These foreign seasonal farm workers (FSFW) often get attracted to concentrations of agricultural facilities, where workers are paid minimal wages, work has to be carried out under hazardous conditions and workers are required to work long hours [2]. ...
... Among pregnant workers, increased incidences of pesticide and weedicide chemicals and veterinary pharmaceutical exposures had resulted in reproductive health concerns and miscarriages [7]. Studies in Canada and US among FSFWs have identified agrochemicals and heat exposure related illnesses, musculoskeletal injuries from repetitive motions, ubiquitous posture, resulting from manually lifting heavy loads, in addition to motor vehicle and machinery injuries [1]. Migrant farmers live in poor housing conditions in the host country and the researchers in Canada and US have noted unhealthy living and working environments, with the presence of mold, pesticide, weedicide residues, infested with disease carrying pests, rodents, mice and cockroaches in occupational and residential settings. ...
Full-text available
Health and safety standards are paramount to all agricultural workers and more so to the foreign seasonal farm workers. European, North American and Oceanic agricultural sector heavily depends on the foreign workers migrating temporarily to carryout seasonal agricultural work that are not attractive to local citizens. The aim of this chapter is to critically analyze existing workplace health and safety measures, policies and practices of Foreign agricultural workers with a secondary focus on Canadian public health standards that applies to COVID-19 pandemic control and beyond. During the pandemic, many countries opened international labour migration as a measure of economic recovery. Recent news media reported two Caribbean workers in the Canadian Agricultural sector, had died of COVID-19 complications. The basis of this chapter is the research based evidence that the author carried out on occupational health and safety standards of the population of foreign seasonal farm workers using a multi-method data collection: a scoping review of existing standards, policies and practices and personal interviews with seasonal agricultural workers and their employers. This chapter provides a critical analysis of data from multiple sources and from multiple jurisdictions to uncover gaps and malpractices of existing occupational health and safety practice standards for illness and injury prevention of foreign seasonal farm workers.
... Likewise, employers or supervisors may encourage or enforce this behavior if it is viewed as posing a threat or delay in farm operations [48,55,56]. Furthermore, when workers seek medical care, they often continue to rely on employers or supervisors for spoken language interpretation, which poses challenges for full disclosure and adequate follow-up in care for both workers and healthcare providers [37,57]. For instance, employers may discourage workers from reporting workplace injuries, or censor workers' concerns to a physician [51,54]. ...
Full-text available
Background Nine migrant agricultural workers died in Ontario, Canada, between January 2020 and June 2021. Methods To better understand the factors that contributed to the deaths of these migrant agricultural workers, we used a modified qualitative descriptive approach. A research team of clinical and academic experts reviewed coroner files of the nine deceased workers and undertook an accompanying media scan. A minimum of two reviewers read each file using a standardized data extraction tool. Results We identified four domains of risk, each of which encompassed various factors that likely exacerbated the risk of poor health outcomes: (1) recruitment and travel risks; (2) missed steps and substandard conditions of healthcare monitoring, quarantine, and isolation; (3) barriers to accessing healthcare; and (4) missing information and broader issues of concern. Conclusion Migrant agricultural workers have been disproportionately harmed by the COVID-19 pandemic. Greater attention to the unique needs of this population is required to avoid further preventable deaths.
... For example, migrants living in overcrowded bunkhouses at farm sites in Nova Scotia reported having to sacrifice sleep in order to access their shared kitchen and washroom (Horgan & Liinamaa, 2012). Poor living conditions are fertile grounds for the spread of microbial disease, existing health conditions, including musculoskeletal injuries and pain, as well as respiratory, gastrointestinal, ocular, dermatological, psychological, sexual, and reproductive conditions (Chatta et al., 2017;Cole et al., 2019;Elbadri, 2020;Orkin et al., 2014;Pysklywec et al., 2011;Weerasinghe, 2020). ...
Technical Report
Full-text available
"Safe at Work, Unsafe at Home: COVID-19 and Temporary Foreign Workers in Prince Edward Island" is the first report in a series of research projects by the Migrant Workers in the Canadian Maritimes partnership. Using desk research and 15 interviews with migrant workers to explore how COVID-19 has affected their health and safety, "Safe at Work, Unsafe at Home" reveals: Housing and workplace violations; unscrupulous staffing practices; overcrowded and inadequate housing conditions; lack of health coverage and medical insurance; and increased surveillance related to COVID-19 and decreased personal freedoms.
... These vulnerabilities include a lack of personal protective equipment crowded living conditions, lack of paid sick time, and the temporary and conditional nature of migrant worker programs that discourage help-seeking because of significant pressure to be the 'ideal worker' [8,16]. Health barriers and challenges faced by migrant agricultural workers, although exacerbated by COVID-19, are long-standing and multi-faceted [8,[17][18][19]. Yet very few quantitative studies exploring the prevalence of these issues have been undertaken. ...
Full-text available
In this paper, we provide descriptive data that characterize the health, safety, and social care environment of migrant agricultural workers in British Columbia, Canada. Through the administration of surveys (n = 179), we gathered information in three domains: (1) living and working conditions; (2) barriers to rights, health, safety and advocacy/reporting; (3) accessibility of services. Our study confirms what predominantly qualitative studies and Ontario-based survey data indicate in terms of health, legal, and social barriers to care and protection for this population. Our findings also highlight the prevalence of communication barriers and the limited degree of confidence in government authorities and contact with support organizations this population faces. Notably, survey respondents expressed a strong intention to report concerns/issues to authorities while simultaneously reporting that they lacked the knowledge to initiate such complaints. These findings call into question government responses that task the agricultural industry with addressing access and service gaps that may be more effectively addressed by government agencies and service providers. In order to improve supports and protections for migrant agricultural workers, policies and practices should be implemented that: (1) empower workers to independently access health, social, and legal protections and limit workers’ dependence on their employers when help-seeking; (2) provide avenues for increased proactive inspections, anonymous reporting, alternative housing/employment and meaningful 2-way communication with regulators so that the burden of reporting is lessened for this workforce; (3) systematically address breaches in privacy, translation, and adequate workplace injury assessments in the healthcare system. Ultimately, the COVID-19 context has put into sharper focus the complex gaps in health, social and legal services and protections for migrant agricultural workers. The close chronology of our data collection with this event can help us understand the factors that have resulted in so much tragedy among this workforce.
... Such limitations translate into a greater risk for poverty, nutritional deficiencies, and diseases [13]. These conditions are similar to situations in other parts of the world for this type of worker [14]. ...
Full-text available
Objective: To describe the experience and prevalence of dental caries in schoolchildren aged 6-12 years belonging to agricultural manual worker households. Material and methods: A comparative cross-sectional study was conducted in two groups of schoolchildren: One considered "children of agricultural worker migrant parents" (n = 157) and the other "children of agricultural worker non-migrant parents" (n = 164). Epidemiological indices for dental caries were calculated for primary (dmft) and permanent (DMFT) dentitions, and compared in terms of age, sex, and the Simplified Oral Hygiene Index (SOHI). Two binary logistic regression models for caries prevalence in primary and permanent dentitions were generated in Stata. Results: For primary dentition, we observed the following dmft index: Non-migrants = 1.73 ± 2.18 vs. migrants = 1.68 ± 2.14. Additionally, we recorded the following caries prevalence: Non-migrants = 59.1% vs. migrants = 51.3%. For permanent dentition, we observed the following DMFT index: Non-migrants = 0.32 ± 0.81 vs. migrants = 0.29 ± 0.95. Further, we recorded the following caries prevalence: Non-migrants = 17.6% vs. migrants = 12.8%. No differences were observed for either dentition (p > 0.05) in caries indices and their components or in caries prevalence. When both caries indices (dmft and DMFT) were combined, the non-migrant group had a higher level of caries experience than the migrant group (p < 0.05). No relationship (p > 0.05) with migrant status was observed in either multivariate models of caries prevalence. However, age did exhibit an association (p < 0.05) with caries. Only the plaque component of SOHI was associated (p < 0.05) with caries in permanent dentition. Conclusions: Although over half of school children from agricultural manual worker households had caries in either or both dentitions and a considerable proportion were untreated lesions, the prevalence levels were somewhat lower than other reports from Mexico in similar age groups. No statistically significant differences were found in caries experience or prevalence in either dentition between non-migrant and migrant groups.
... The teams realized that the relationship between work and community health problems was unknown to the communities' health care staff. This so-called "blind spot" in occupational health [51,52] of health care providers is well known globally [24,25,41,49,[51][52][53][54]. Likewise, local authorities were unaware of the association between work and health. ...
Full-text available
Integrating basic occupational health services into primary care is encouraged by the Pan American Health Organization. However, concrete initiatives are still scarce. We aimed to develop a training program focusing on prevention of occupational risks for primary healthcare professionals. This train-the-trainer program was piloted at four universities in Chile and Peru. Occupational health or primary healthcare lecturers formed a team with representative(s) of one rural primary healthcare center connected to their university (Nparticipants = 15). Training started with a workshop on participatory diagnosis of working conditions. Once teams had conducted the participatory diagnosis in the rural communities, they designed in a second course an active teaching intervention. The intervention was targeted at the main occupational health problem of the community. After implementation of the intervention, teams evaluated the program. Evaluation results were very positive with an overall score of 9.7 out of 10. Teams reported that the methodology enabled them to visualize hazardous working conditions. They also stated that the training improved their abilities for problem analysis and preventive actions. Aspects like time constraints and difficult geographical access were mentioned as challenges. In summary, addressing occupational health in primary care through targeted training modules is feasible, but long-term health outcomes need to be evaluated.
Technical Report
Full-text available
This project was funded by the Ontario Ministry of Agriculture, Food and Rural Affairs (OMAFRA), and took place from May 2021 to March 2022.. The main goal of the project was to create an inventory of available mental health and psychosocial wellbeing supports and services available to Latinx and Caribbean International Agricultural Workers (IAWs) in Ontario. The report includes literature review and interviews with workers and key stakeholders. It is available at OHCOW's webpage <>
Full-text available
Background: Medical students need to be trained in delivering diversity-responsive health care but unknown is what competencies teachers need. The aim of this study was to devise a framework of competencies for diversity teaching. Methods: An open-ended questionnaire about essential diversity teaching competencies was sent to a panel. This resulted in a list of 74 teaching competencies, which was sent in a second round to the panel for rating. The final framework of competencies was approved by the panel. Results: Thirty-four experts participated. The final framework consisted of 10 competencies that were seen as essential for all medical teachers: (1) ability to critically reflect on own values and beliefs; (2) ability to communicate about individuals in a nondiscriminatory, nonstereotyping way; (3) empathy for patients regardless of ethnicity, race or nationality; (4) awareness of intersectionality; (5) awareness of own ethnic and cultural background; (6) knowledge of ethnic and social determinants of physical and mental health of migrants; (7) ability to reflect with students on the social or cultural context of the patient relevant to the medical encounter; (8) awareness that teachers are role models in the way they talk about patients from different ethnic, cultural and social backgrounds; (9) empathy for students of diverse ethnic, cultural and social background; (10) ability to engage, motivate and let all students participate. Conclusions: This framework of teaching competencies can be used in faculty development programs to adequately train all medical teachers.
Full-text available
The authors propose reinvigorating and extending the traditional social history beyond its narrow range of risk behaviors to enable clinicians to address negative health outcomes imposed by social determinants of health. In this Perspective, they outline a novel, practical medical vulnerability assessment questionnaire that operationalizes for clinical practice the social science concept of "structural vulnerability." A structural vulnerability assessment tool designed to highlight the pathways through which specific local hierarchies and broader sets of power relationships exacerbate individual patients' health problems is presented to help clinicians identify patients likely to benefit from additional multidisciplinary health and social services. To illustrate how the tool could be implemented in time- and resource-limited settings (e.g., emergency department), the authors contrast two cases of structurally vulnerable patients with differing outcomes. Operationalizing structural vulnerability in clinical practice and introducing it in medical education can help health care practitioners think more clearly, critically, and practically about the ways social structures make people sick. Use of the assessment tool could promote "structural competency," a potential new medical education priority, to improve understanding of how social conditions and practical logistics undermine the capacities of patients to access health care, adhere to treatment, and modify lifestyles successfully. Adoption of a structural vulnerability framework in health care could also justify the mobilization of resources inside and outside clinical settings to improve a patient's immediate access to care and long-term health outcomes. Ultimately, the concept may orient health care providers toward policy leadership to reduce health disparities and foster health equity.
Full-text available
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.
Full-text available
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.
Full-text available
Background: Approximately 40 000 migrant farm workers are employed annually in Canada through temporary foreign worker programs. Workers experiencing health conditions that prevent ongoing work are normally repatriated to their home country, which raises concerns about human rights and health equity. In this study, we present data on the reasons for medical repatriation of migrant farm workers in Ontario. Methods: In this retrospective descriptive study, we examined medical repatriation data from Foreign Agricultural Resource Management Services, a non-profit corporation managing the contracts of more than 15 000 migrant farm workers in Ontario annually. We extracted repatriation and demographic data for workers from 2001-2011. Physician volunteers used a validated system to code the reported reasons for medical repatriation. We conducted descriptive analyses of the dominant reasons for repatriation and rates of repatriation. Results: During 2001-2011, 787 repatriations occurred among 170 315 migrant farm workers arriving in Ontario (4.62 repatriations per 1000 workers). More than two-thirds of repatriated workers were aged 30-49 years. Migrant farm workers were most frequently repatriated for medical or surgical reasons (41.3%) and external injuries including poisoning (25.5%). Interpretation: This study provides quantitative health data related to a unique and vulnerable occupational group. Our findings reinforce existing knowledge regarding occupational hazards and health conditions among migrant farm workers. Medical repatriation of migrant farm workers merits further examination as a global health equity concern.
Purpose – Social prescribing are short-term intermediary services that facilitate patients with psychosocial needs to engage in non-clinical support. However, little is known about the components and potential impact of social prescribing. The paper aims to discuss this issue. Design/methodology/approach – A review was conducted to explore the evidence based on social prescribing including mapping its key components and potential impact. Database, internet and hand searching was utilised to identify relevant studies. Data extraction and narrative analysis was undertaken to explore the issues. Findings – In total, 24 studies met the inclusion criteria. The studies were diverse in their methodologies and the services evaluated. Stakeholders such as general practitioners and patients perceived that social prescribing increased patients’ mental well-being and decreased health service use. However, the quantitative evidence supporting this was limited. The only randomised-controlled trial showed a decrease in symptoms and increase in functional well-being at four months. The other non-controlled designs had large drop-out rates limiting their value in determining effectiveness. Research limitations/implications – Further research is needed on the effectiveness and cost-effectiveness of social prescribing using robust evaluative designs. Originality/value – This is the first review of generic social prescribing services focusing on the general evidence base.
It’s been almost six years since Brian Sinclair wheeled himself into the emergency room at Winnipeg’s Health Sciences Centre seeking treatment for a blocked catheter. Thirty-four hours later staff checked on the Aboriginal amputee. Some had assumed Sinclair was just drunk or homeless. By that time, he was dead. The final report of the inquest into Sinclair’s death is expected soon. But presenters at Canada’s first Indigenous Health Conference were dismayed that it will focus exclusively on patient flow. “There was a level of profiling and stereotyping that had to happen in order for a physically disabled man to languish and die in full public view and surrounded by health professionals,” said Vanessa Ambtman-Smith, Aboriginal health lead for Ontario’s South West Local Health Integration Network (LHIN). “We won’t have an opportunity to further pursue some of that underlying racism.” Too often in health care the r-word “gets couched in terms of stereotypes, bias, discrimination and health inequities,” she said. “This is what it looks like when the system is failing; this is an example of an environment that is not culturally safe.”