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

结构性种族主义被定义为宏观层面的制度、社会力量、制度、意识形态和 相互作用以产生和加强种族/族裔群体之间的不平等的过程。这个 自闭症的机制是“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，他们绝大多数是黑人和/或 拉丁裔，生活在经济隔离的社区，住房条件不达标和拥挤，不安全 或有限的水，使新冠肺炎的预防措施，如手卫生和社交距离 具有挑战性，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 有报酬的，缺乏获得健康信息、预防护理和医疗的机会。这些脆弱性的模式 反映在反黑人种族主义的推动下，历史上将农场工人排除在联邦保护之下的权利之外 组织和其他劳工保护，可追溯到吉姆·克罗时代的劳工做法，以及移民和劳工 MSFW因害怕报复而避免报告疾病或寻求治疗的政策环境 雇主。新冠肺炎只会加剧这些脆弱性；据报道，新冠肺炎的爆发 在美国的农场工人和农业县中，新冠肺炎的发生率高得不成比例。 城市生活垃圾的边际化结构并没有被广泛地从社会责任的角度来考虑。为了更好地保护 保护黑人和/或拉丁裔MSFW的健康，并制定公平的应对不可避免的下一次大流行的措施， 需要进行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。我们的 拟议的工作旨在通过创新的社区驱动、多层次和 多学科方法研究：考察农民工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MSFW随时间的呼吸健康(Aim1)； 描述新冠肺炎政策和监管回应相互作用和 通过社区系统动力学小组影响MSFW的种族健康结果 建模方法(AIM2)；并评估农业移民就业、公共卫生和 住房法律和政策在选定农业州对新冠肺炎疫情的准试验性研究 研究设计(目标3)。这些目标涉及NIH的两个研究重点：1)了解SR对 少数群体健康和健康差距；2)向各级卫生保健和社会政策通报缓解 SR对弱势人群健康的影响。我们建议的研究结果将为设计提供参考 政策和最佳做法，以应对SR影响MSFW的长期机制，优化生活和 提供更好的健康保护和控制未来传染病暴发的工作条件 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.