Holmes Seth M
University of Birmingham, United Kingdom.
PLoS Med. 2006 Oct;3(10):e448. doi: 10.1371/journal.pmed.0030448.
Migrant workers in the United States have extremely poor health. This paper aims to identify ways in which the social context of migrant farm workers affects their health and health care.
This qualitative study employs participant observation and interviews on farms and in clinics throughout 15 months of migration with a group of indigenous Triqui Mexicans in the western US and Mexico. Study participants include more than 130 farm workers and 30 clinicians. Data are analyzed utilizing grounded theory, accompanied by theories of structural violence, symbolic violence, and the clinical gaze. The study reveals that farm working and housing conditions are organized according to ethnicity and citizenship. This hierarchy determines health disparities, with undocumented indigenous Mexicans having the worst health. Yet, each group is understood to deserve its place in the hierarchy, migrant farm workers often being blamed for their own sicknesses.
Structural racism and anti-immigrant practices determine the poor working conditions, living conditions, and health of migrant workers. Subtle racism serves to reduce awareness of this social context for all involved, including clinicians. The paper concludes with strategies toward improving migrant health in four areas: health disparities research, clinical interactions with migrant laborers, medical education, and policy making.
美国的农民工健康状况极差。本文旨在确定农民工的社会环境影响其健康和医疗保健的方式。
这项定性研究在美国西部和墨西哥对一群本土特里基族墨西哥人进行了为期15个月的移民期间，在农场和诊所开展了参与观察和访谈。研究参与者包括130多名农场工人和30名临床医生。利用扎根理论对数据进行分析，并结合结构暴力、象征暴力和临床凝视理论。研究表明，农场工作和居住条件是根据种族和公民身份来安排的。这种等级制度决定了健康差异，无证的墨西哥本土人健康状况最差。然而，每个群体都被认为在等级制度中有其应有的位置，农民工经常因其自身疾病而受到指责。
结构性种族主义和反移民做法决定了农民工恶劣的工作条件、生活条件和健康状况。微妙的种族主义使包括临床医生在内的所有相关人员对这种社会环境的认识降低。本文最后提出了在四个领域改善农民工健康的策略：健康差异研究、与农民工的临床互动、医学教育和政策制定。
