Migrant agricultural workers' deaths in Ontario from January 2020 to June 2021: a qualitative descriptive study

Background

Nine migrant agricultural workers died in Ontario, Canada, between January 2020 and June 2021.

Methods

To better understand the factors that contributed to the deaths of these migrant agricultural workers, we used a modified qualitative descriptive approach. A research team of clinical and academic experts reviewed coroner files of the nine deceased workers and undertook an accompanying media scan. A minimum of two reviewers read each file using a standardized data extraction tool.

Results

We identified four domains of risk, each of which encompassed various factors that likely exacerbated the risk of poor health outcomes: (1) recruitment and travel risks; (2) missed steps and substandard conditions of healthcare monitoring, quarantine, and isolation; (3) barriers to accessing healthcare; and (4) missing information and broader issues of concern.

Conclusion

Migrant agricultural workers have been disproportionately harmed by the COVID-19 pandemic. Greater attention to the unique needs of this population is required to avoid further preventable deaths.

Taking a Stand to Remedy the Inadequacies of Action on Health Equity Exposed by COVID-19

As we struggle with the impacts of a global pandemic, there is growing evidence of the inequitable impacts of this crisis. In this commentary, we argue that actions on health equity to date have been insufficient despite significant scholarship to guide both practice and policy. To move from talk to action on health equity, we propose the following five approaches: (1) reversing the erosion of publicly funded health systems; (2) creating broad economic means to support health; (3) moving health action upstream; (4) challenging ageist and/or ableist discourses; and (5) decolonizing approaches and enacting solidarity. Engaging in these actions will help close the gaps and address disparities made more evident during this global pandemic. The COVID-19 pandemic reinforces the need for us to move from discussion to action if we are to achieve health for all. Adopting a health equity lens is a means of both understanding and stimulating action to readdress the root causes of inequities and work toward a fairer, more just society.

Supports for migrant farmworkers: tensions in (in)access and (in)action

Purpose

This study aims to examine the role of support actors in promoting or hindering access to public services/spaces for migrant agricultural workers (MAWs) and to determine the factors that influence adequate support for this population.

Design/methodology/approach

Using a situational analysis methodology, the authors carried out focus groups and interviews with 40 support actors complimented by a community scan (n = 28) with public-facing support persons and a community consultation with migrant farmworkers (MFWs) (n = 235).

Findings

Two major themes were revealed: (In)access and (In)action and Blurred Lines in Service Provision. The first illustrated how support actors could both reinforce or challenge barriers for this population through tensions of “Coping or Pushing Back on Constraints” and “Need to find them first!” Justification or Preparation? Blurred lines in Service Provision encompassed organizational/staff’s behaviors and contradictions that could hinder meaningful support for MFWs revealing two key tensions: “Protection or performance?” and “Contradicting or reconciling priorities? Our findings revealed a support system for MAWs still in its infancy, contending with difficult political and economic conditions.

Social implications

Service providers can use research findings to improve supports for MAWs. For example, addressing conflicts of interests in clinical encounters and identification of farms to inform adequate outreach strategies can contribute to more effective support for MAWs.

Originality/value

This research is novel in its examination of multiple sectors as well as its inclusion of both formal and informal actors involved in supporting MAWs. Our findings have the potential to inform more comprehensive readings of the health and social care resources available to MAWs.

Cultural safety strategies for rural Indigenous palliative care: a scoping review

Background

There is little scholarship on culturally safe approaches to palliative care, especially for rural Indigenous clients. Thus, it is important to articulate how cultural safety can be enacted to support rural Indigenous Peoples and communities at end of life. We sought to identify strategies described in existing literature that have potential to deepen our understanding of culturally safe approaches to palliative care within rural and small-town settings in Canada.

Methods

We searched for peer-reviewed and grey literature about Indigenous palliative care in rural and small-town settings in Canada, United States, New Zealand, and Australia. Medline, CINAHL, and Embase were searched. We thematically analyzed 22 resulting articles to address our interest in culturally safe approaches to palliative care in rural/small-town and on-reserve contexts.

Results

The following themes were extracted from the literature: symbolic or small gestures; anticipating barriers to care; defer to client, family and community; shared decision-Making; active patient and family involvement; respectful, clear, and culturally appropriate communication; community ownership of services; empower cultural identity, knowledge, and traditions; and, policy.

Discussion

Culturally competent practices can improve Indigenous palliative care services; however, they do not result in decolonized care. Strategies include: symbolic or small gestures; anticipating barriers to access; deferring to the client, family, and community members; and, collective decision making and family involvement. Culturally safe approaches contribute to institutional or organizational change and decolonized care. Strategies include: involvement of patient and family in service planning; reflection about individual and systemic racism; community ownership of services and; recognizing distinct Worldviews that shape care.

Conclusions

Culturally safe strategies invite decolonization of care through awareness of colonialism, racism, and discrimination. They invite commitment to building partnerships, power sharing, and decision-making in the delivery of care. Culturally competent activities may catalyze the adoption of a cultural safety framework; however, mislabeling of cultural competency as cultural safety may contribute to organizational inaction and a watering down of the spirit of cultural safety.

Migrant workers’ (non)belonging in rural British Columbia, Canada: storied experiences of Marginal Living

Purpose

The purpose of this paper is to examine the experiences of belonging and wellbeing among temporary migrant agricultural workers (TMAWs) in a rural setting in the interior of British Columbia, Canada.

Design/methodology/approach

A qualitative narrative approach informed by participatory action research principles was employed. In total, 12 migrant workers participated in two to four one-on-one interviews and/or focus group conversations.

Findings

The analysis revealed an over-arching theme of Marginal Living encompassing stories of always on the outside, mechanisms of isolation and exclusion; struggling for the basics, realities of worrying about daily bare necessities; and “nothing but a worker’s,” experiences of being reduced only to one’s labor. These storied experiences each impacted workers’ wellbeing and typically limited their ability to feel a sense of belonging. Yet, workers exerted agency and resilience through storied experiences of “one family and for those who come next.” Their efforts contributed to building a sense of community through mutual support and advocacy.

Originality/value

Very few studies have focused on the day-to-day experiences of this population and its influence on their sense of belonging and wellbeing. This study is also the first to examine this topic within this particular region (the rural BC interior). These findings can provide a starting point for improved program planning to address challenges faced by TMAWs in rural Western Canada. Further, they expand the understanding of concepts such as partial citizenship and structural exclusion as they apply in the day-to-day realities of migrant workers in rural BC.