For 18 months, UC Berkeley faculty member, physician, and anthropologist Seth M. Holmes, MD, PhD, lived and worked side-by-side with migrant farm laborers, moving from the Pacific Northwest south into Mexico. Here he describes his firsthand experiences, and why he believes our health and well-being depend on fair treatment of the people who grow much of the food we eat.

Why is immigrant health—including that of migrant farm workers—something that should matter to all of us?

These are the people who do a lot of the work that allows this society to thrive. They plant and harvest the foods that are essential to a healthy diet. They are the people who work in restaurants where we dine and in construction trades that maintain the infrastructure we depend on. In many ways, the standard of living we enjoy is the result of their contributions. As an anthropologist and physician, I wanted to understand more about the lives and health of immigrants, and particularly migrant farm workers, because I had become increasingly aware of the contribution immigrant workers make to the health of our society.

Why did you decide to live and work among migrant farm workers?

As an anthropologist, I use a research method known as participant observation. In order to understand fully what the lives of migrant farm workers are like, I needed to base my research on a mix of observations, my own experiences, interviews, and recorded conversations. I couldn’t get the same full understanding from only interviews or surveys. For my participant observation, I lived in farm labor camps, harvested berries and pruned vineyards, and migrated between states as the seasons changed. I also went to the home villages of migrant workers in Mexico and visited their family members. I took the trek with migrant workers from Mexico across the border into the U.S. in order to understand all the aspects of their lives as well as I could. In an attempt to understand the perspectives and roles of many people involved in transnational farm labor and health, I conducted field research with people along what anthropologist Laura Nader has called a “vertical slice.” I observed and interviewed supervisors and farm owners, migrant health doctors and nurses, border control agents, and border vigilantes. I wanted to understand all of their perspectives and experiences.

What did you discover?

I learned that our food system is built on a hierarchy based largely on ethnicity and citizenship. Depending on your ethnicity and citizenship, you have a very different position within our food system. The people who do the most dangerous work, both in terms of safety and health, are most often indigenous Mexican farm workers who cross the border to come and plant and harvest here. They suffer the most health-related problems from their work, have the highest fatality rates, and have the least protection and the least access to health care.

Where do migrant workers go if they need care?

There are some federally funded clinics that have staff bilingual in Spanish and English and serve migrant workers. But often they aren’t near where people are working, and some are only open during normal business hours, so they aren’t very practical for someone working in the fields. In most states, farm workers are not covered by Workers’ Compensation, which for most other workers includes health care if they are injured on the job. So when they become sick or are injured, they have no coverage and very few options for treatment. Even when clinics are available, migrant workers often encounter a system that doesn’t address their needs.

What are the obstacles?

One involves language. Some farm workers are indigenous people from Latin America for whom Spanish isn’t necessarily their first language. So even in bilingual clinics, communication may be difficult.

But there are other, more entrenched obstacles. In medicine, we tend to think that health is either a matter of biology—a genetic predisposition to heart disease, for example—or behavior, eating a poor diet or not getting exercise, for instance. We’re not trained very well to understand the ways in which social, political, and economic factors lead to health problems, even though a lot of research shows that the primary causes of most health problems are social, political, and economic.

Let me give you an example from my research. One farm worker who lived near me in a farm labor camp went into a clinic with extreme knee pain from working seven days a week in the fields, bent over, picking strawberries, which requires pivoting back and forth. He worked seven days a week because he couldn’t afford not to, and because in most states there are no laws to protect farm workers and require days off or breaks during the day. There were clear political, economic, and social reasons why he had knee pain. But when he talked with a physician, she told him that he was bending the wrong way. The physician may have been well-intentioned, but she didn’t understand that there’s only one way to bend over if you are a farm worker and want to keep your job. The physician was out of sync with the reality of the farm worker’s life such that it made mutual understanding between them very unlikely. The farm worker said to me later, “Los médicos no saben nada.“ The doctors don’t know anything.