title: An ethnographic study of the social context of migrant health in the United States.
abstract: BACKGROUND
  Migrant workers in the United States have extremely poor health. This paper aims to identify ways in which the social context of migrant farm workers affects their health and health care.
  
  
  RESULTS
  This qualitative study employs participant observation and interviews on farms and in clinics throughout 15 months of migration with a group of indigenous Triqui Mexicans in the western US and Mexico. Study participants include more than 130 farm workers and 30 clinicians. Data are analyzed utilizing grounded theory, accompanied by theories of structural violence, symbolic violence, and the clinical gaze. The study reveals that farm working and housing conditions are organized according to ethnicity and citizenship. This hierarchy determines health disparities, with undocumented indigenous Mexicans having the worst health. Yet, each group is understood to deserve its place in the hierarchy, migrant farm workers often being blamed for their own sicknesses.
  
  
  CONCLUSIONS
  Structural racism and anti-immigrant practices determine the poor working conditions, living conditions, and health of migrant workers. Subtle racism serves to reduce awareness of this social context for all involved, including clinicians. The paper concludes with strategies toward improving migrant health in four areas: health disparities research, clinical interactions with migrant laborers, medical education, and policy making.
authors.affiliation: University of Birmingham, United Kingdom. seth.holmes@ucsf.edu
authors.forename: Seth M
authors.initials: SM
authors.lastname: Holmes
mesh_terms: D000383:Agriculture; D000884:Anthropology, Cultural; D018771:Arthralgia / Q000453:epidemiology; D001294:Attitude to Health; D003695:Delivery of Health Care; D006262:Health; D006608:Hierarchy, Social; D006801:Humans; D008800:Mexico / Q000208:ethnology; D009784:Occupational Diseases / Q000453:epidemiology; D011287:Prejudice; D015995:Prevalence; D011602:Psychophysiologic Disorders / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology; D014171:Transients and Migrants; D014481:United States; D014754:Violence; D000078329:Workforce; D014947:Wounds and Injuries / Q000453:epidemiology