Research Employing Environmental Systems and Occupational Health Policy Analyses to Interrupt the Impact of Structural Racism on Agricultural Workers and Their Respiratory Health (RESPIRAR)

结构性种族主义（SR）被定义为宏观层面的系统，社会力量，机构，意识形态， 这些进程相互作用，产生并加强了种族/族裔群体之间的不平等。的 SR的机制是“看不见的”，因此研究不足，通常不纳入公共卫生 干预措施。例如，美国有250万雇佣的农场工人，绝大多数是黑人和/或 拉丁裔，生活在经济隔离的社区，住房条件不符合标准，拥挤，不安全 或水资源有限，需要采取手部卫生和保持社交距离等COVID-19预防措施 挑战，如果不是不可能的话。此外，移民和季节性农场工人（MSFW）是最低的 这些人没有工资，得不到保健信息、预防保健和医疗。这些脆弱的模式 反映了历史上的排斥，出于反黑人种族主义，农场工人从联邦保护的权利， 组织和其他劳动保护，追溯到吉姆克劳时代的劳动实践，以及移民和劳工 在这种政策环境中，MSFW因害怕报复而避免报告疾病或寻求护理， 雇主COVID-19只会加剧这些脆弱性;据报道，COVID-19的爆发 在美国的农场工人和农业县中，COVID-19的发病率高得不成比例。 通过SR的透镜，没有广泛考虑MSFW的边缘化结构。 黑人和/或拉丁裔MSFW的健康，并设计一个公平的应对不可避免的下一次流行病， 需要开展研究，以了解和消除卫生不平等的结构性和体制性驱动因素。我们 拟议的工作目标是通过一个创新的社区驱动的，多层次的， 多学科方法研究：研究移民劳动力住房政策制度之间的关系， 室内空气质量，接触病毒（例如，SARS-CoV-2）和随时间推移的MSFs呼吸系统健康（Aim 1）; 描述COVID-19政策和监管反应相互作用的结构性途径， 通过一个以社区为基础的系统动力学小组，影响MSFW中的种族化健康结果 模型方法（目标2）;并评估农业移民就业，公共卫生和 在选定的农业州使用准实验性的住房法律和政策， 研究设计（目标3）。这些目标解决了NIH的两个研究重点：1）了解SR对 少数群体的健康和健康差距; 2）为各级保健和社会政策提供信息， SR对弱势群体健康的影响。我们拟议研究的结果将为设计提供信息， 政策和最佳做法，以应对影响MSFW的长期性SR机制，优化生活， 改善工作条件，以更好地保护健康，并控制未来传染病的爆发， 这些看不见的脆弱的工人。

Structural racism (SR) has been defined as the macro level systems, social forces, institutions, ideologies, and processes that interact with one another to generate and reinforce inequities among racial/ethnic groups. The mechanisms of SR are “unseen” and thus understudied and typically not incorporated into public health interventions. For example, 2.5 million hired farmworkers in the U.S., who overwhelmingly are Black and/or Latinx, live in economically segregated communities with substandard and crowded housing conditions, unsafe or limited water that render COVID-19 preventive measures such hand hygiene and social distancing challenging, if not impossible. Additionally, migrant and seasonal farmworkers (MSFWs) are among the lowest paid, lack access to health information, preventive care and medical treatment. These patterns of vulnerability reflect historical exclusion, motivated by anti-Black racism, of farmworkers from federally protected right to organize and other labor protections, labor practices traced to the Jim Crow era, and an immigration and labor policy environment in which MSFWs avoid reporting illness or seeking care for fear of retaliation from employers. COVID-19 has only exacerbated these vulnerabilities; outbreaks of COVID-19 have been reported among farmworkers and agricultural counties in the U.S. have seen disproportionately high rates of COVID-19. Structures of marginalization of MSFWs are not widely considered through the lens of SR. To better protect the health of Black and/or Latinx MSFWs and design an equitable response to the inevitable next pandemic, research is needed to understand and dismantle the structural and institutional drivers of health inequities. Our proposed work aims address this critical need through an innovative community-driven, multilevel and multidisciplinary approach study to: examine the relationships between migrant labor housing policy regimes, indoor air quality, exposure to viruses (e.g., SARS-CoV-2) and respiratory health of MSFWs over time (Aim1); characterize structural pathways through which COVID-19 policy and regulatory responses interact and influence racialized health outcomes among MSFWs through a community-based system dynamics group modeling approach (Aim2); and evaluate the influence of agricultural migrant employment, public health and housing law and policy on COVID-19 epidemics across selected agricultural states using a quasi-experimental study design (Aim 3). These aims address two NIH research priorities:1) understand the impact of SR on minority health and health disparities and 2) inform health care and social policies at all levels on mitigating SR’s impacts on the health of vulnerable populations. Results from our proposed study will inform the design of policies and best practices to counter long-standing mechanisms of SR impacting MSFWs, optimize living and working conditions for better health protections and to control future outbreaks of infectious disease among these invisible and vulnerable workers.