Beyond the Crops: The Health Impacts of Precarious Employment

Abstract

Agricultural workers feed the world, yet they are exposed to chemicals and pesticides, physically demanding labor, and adverse psychosocial working conditions, many of which are features of precarious employment (PE). PE is a multi-dimensional construct encompassing seven dimensions that characterize workplace conditions marked by material deprivation, job insecurity, limited worker protections, and power imbalances, among others. Most agricultural workers self-identified as Latino and were foreign-born, with nearly half reporting having no legal authorization to work in the United States, suggesting that a large percentage were undocumented. Additionally, a majority have less than a high school education, Spanish is their preferred language, and nearly half have an annual income of $10,000–$30,000 and do not have access to health insurance. These structural factors, along with experiences of PE, contribute to increased exposure to risk factors for adverse health conditions by introducing barriers to access to care, chronic stress, and health-promoting behaviors. To further understand multidimensional PE and its impacts on health outcomes among agricultural workers, we used three approaches. First, we sought to define features of multidimensional PE for agricultural workers in the US within the available literature through a rapid review. We identified 36 studies that included descriptions and findings related to PE dimensions. PE dimensions were reported across all studies, and most studies addressed more than one dimension. The interpersonal relations dimension was included in the majority of studies, followed by material rewards and working time arrangements.Second, conducted focus groups among Washington State agricultural workers in Yakima County and used deductive qualitative content analysis to examine farmworkers' characterization of PE, understand the effects of PE on physical and mental health outcomes, and identify recommendations to improve working conditions. According to our analysis, all seven dimensions of PE were embedded in agricultural work; however, differences in PE experiences varied by employer, type of agricultural work, and unionization status. Participants highlighted more experiences related to material rewards, working time arrangements, employment stability, and interpersonal power relations. Third, we constructed a Standardized Farmwork Precarity Score using Polychoric Principal Component analysis to determine the association between PE and chronic disease outcomes (diabetes, high blood pressure, heart disease), while assessing effect modification by healthcare utilization. Our analysis found an inverse association between PE and chronic disease outcomes, with no effect modification by healthcare utilization. Our exploration of multi-dimensional PE among the agricultural working population is foundational and may inform future studies assessing the impact of PE features on agricultural workers' health. This research and future research on PE are imperative to raise awareness of the highly precarious nature of agricultural work and serve as evidence to advocate for the enforcement and implementation of policies and interventions that protect the health and well-being of farmworkers.