Why Farmworker Health Requires More Than Medical Care: Lessons from RESPIRAR

What determines whether a farmworker can get medical care, recover from illness, or live in conditions that protect their health? Through RESPIRAR, we are examining these questions alongside farmworkers—and asking why harmful conditions persist despite laws and regulations intended to protect them.

Over the last three to four years, CATA has collaborated with the University of Maryland and the University of Michigan to investigate farmworkers’ respiratory health and living and working conditions in Maryland. The project combines health and housing research with conversations involving workers and others connected to their lives. This approach helps us understand both the conditions workers face and the systems that sustain them.

What the data tells us

During two agricultural seasons, our teams visited farmworkers weekly at sites across Maryland’s Eastern Shore. We conducted surveys and interviews, collected nasal swabs to test for common respiratory infections, and gathered housing information.

The first analysis of baseline surveys from 135 workers is now published in Frontiers in Public Health: “Fields of inequity: initial insights into structural disparities among migrant farmworkers in Maryland.”

The report documents substantial wage differences: 93% of H-2A workers reported earning at least $15 hourly, compared with 25% of Temporary Protected Status beneficiaries. Our study found that H-2A visa status was strongly associated with higher pay in comparison with U.S. permanent residents and TPS holders. These discrepancies between wages paid to H-2A and other workers, underscore the need to address the wage gap among farmworkers but also raises questions of whether the AEWR is truly protecting U.S.-based workers or is actually suppressing wages for all hired agricultural labor. 

Despite the purported purpose of the H2A program to provide labor for short term labor needs of farm employers, many of our H2A program participants have been returning to work in Maryland, often for the same employer.  64% of our participants have performed agricultural work in the U.S. for 8 years or more.

Housing findings show how employment shapes life beyond the workplace. Approximately 96% lived in employer-controlled housing. Researchers observed overcrowding, mold, damaged structures, and inadequate facilities. They argue that floor-space requirements alone are insufficient to protect respiratory health; ventilation also matters. Missing laundry facilities can undermine workers’ ability to follow pesticide safety practices. 

Additionally, 80% of workers rely on their employers for transportation - not only to and from the worksite, but to be able to buy groceries, do errands, access medical care and more.  This dependence on employers  can play out in different ways - positive or negative depending on the relationship with the employer.

Only 67% reported drinking water access at work. Among participants reporting downtime from illness or injury, 62% received no pay.

Listening to workers explain the systems

This past summer, RESPIRAR shifted toward workshops exploring how workers navigate health decisions. We have held discussions with four groups representing different experiences, including men, women, H-2A workers, undocumented workers, and citizens. A workshop with Haitian TPS holders remains an important missing perspective. These discussions are a separate phase from the published baseline analysis.

Across workshops, personal networks emerged as essential sources of transportation, interpretation, and help accessing care. Some groups also described employer assistance, highlighting difficulties for newer workers without those connections or support.

Economic pressure came up in every workshop. Workers weigh healthcare needs against supporting family and paying bills. For those without insurance, anticipated medical costs can influence decisions as much as actual costs.

From research to action

RESPIRAR is already creating opportunities to address the conditions documented in this research. Over the past several months, CATA has held conversations with the Maryland Department of Labor about farmworker housing. A Maryland state delegate has also expressed interest in exploring how regulatory and legislative changes could improve conditions.

This fall, additional workshops will bring in farmworker service providers, advocates, and, we hope, government officials responsible for implementing worker protections. We plan to bring together findings from these conversations and share them in the new year.

CATA will use what we learn to press for concrete improvements in farmworkers’ working and living conditions. Workers’ experiences, supported by research, can help regulators and legislators identify where protections fall short and what needs to change.