Érica Chavez Santos, a public health researcher and Ph.D. student in Health Systems and Population Health at the University of Washington (UW), recently spoke with the Bridges Center about her research interests, approach, and ongoing study on how labor and social determinant-related policies impact agricultural workers. The conversation covered a range of topics including the importance and value of centering workers and communities in research and the importance of considering how labor and social policies affect workers, especially those at the intersection of racism and/or xenophobia.

Érica’s work often addresses Latinx health disparities and examines the occupational risk of agricultural and low-wage workers. This is a topic that’s personal to Érica, as her parents were farm workers and she also worked in the orchards when she was younger. Her recent research includes supporting the Heat Education and Awareness Tools (HEAT) study - which focused on preventing heat-related illnesses in agricultural workers and working with the Department of Labor and Industries Safety & Health Assessment for Research and Prevention (SHARP) study to identify injury risk factors among janitors.

Érica received a Washington State Labor Research Grant (WSLRG) through the Harry Bridges Center for Labor Studies for the 2022-2023 academic year for her proposal "Examining the association of labor and social determinant related policies on workplace safety and chronic health indicators among agricultural workers” and received the LERA-Bassett Scholarship in Labor Relations from the Bridges Center in 2019.

An excerpt of the conversation is below, and you can watch the full conversationhere

Bridges Center: What drew you to occupational health? What continues to excite you about your research and work with communities?

I never really saw myself as an occupational health researcher. I wasn’t exposed to many career paths or disciplines in Pateros, where I grew up, I didn’t even know what public health or research was at the time. I was always very passionate about the health of communities. As I experienced life in an agricultural worker family, I had a lot of realizations about how physically taxing the work is, the language barriers families experience, the inability to qualify for Medicaid and/or being unable to pay for health services, and even taking time off to see the doctor, low number of doctors working in rural areas, low wages, harsh work environment, all these things that put agricultural workers at greater risk for adverse health. It became something that I really cared about, and I never lost the passion to work with communities like my own, low-income communities and Black, Indigenous, and communities of color, Latinx communities.

I worked at a community health center after college and that’s where I really solidified my passion for public health and where I decided I wanted to work on changing systems and policies to shift the environment that people live and work in. I also am very idealistic, and I like to think that all of this work will lead to systemic change. That it can be an incremental change in how people view and understand public health problems and ultimately can lead to creating more equitable and inclusive policies.

I never lost the passion to work with communities like my own, low-income communities and Black, Indigenous, and communities of color...

Bridges Center: What is community-based participatory research?  What does it mean to you, and how would you say it differs from research not using this approach?

Community-based participatory research methods involve community members equitably in the research as equal partners.  The values and core of CBPR principles in research are to ensure that community members are equitably involved as equal partners and begin with a research topic that is important to the community and together, can build capacity and each other’s knowledge and skills, to create healthier communities and reduce health disparities.

I think in using CBPR, you’re also sort of questioning who has historically been excluded and therefore who is and isn’t represented, the questions asked, how results are interpreted, and how colonization and history of racism affect the knowledge base we have of current literature. When you don’t engage the communities most impacted, it’s difficult to know if you’re missing something or not understanding the context or the experiences of people. You don’t even really know how your work can impact people, but bringing these practices, can really strengthen your research in my opinion and is so necessary as we try to dismantle racist systems. But this is really hard to do, it’s so embedded in our history and even how academic environments work.

CBPR to me means, coming in with openness in your research and a willingness to be reflective and learn alongside the people you’re working with, checking in with the community, and seeing how the work can build off existing efforts. Many times, communities are already doing amazing work and so it’s not about you coming in to do your own thing, but really prioritizing what’s important to people.

Bridges Center: Were there findings from the HEAT study that surprised you? If so, what were they?

One of the findings that surprised me the most was in the weekly symptoms analysis. We looked at whether more symptoms reported were associated with more heat strain. We expected the association to be that those with higher heat strain would be reporting the most symptoms. However, we didn’t find a clear relationship.

I think the demographics of workers affect not only worker familiarity with heat-related illness (HRI) symptoms but the likelihood and level of comfort of reporting HRI symptoms. An example is workers that have more experience working in agriculture, who also happen to be older, may not be physically straining themselves because they’re used to the work and acclimatized to the work conditions. Whereas another demographic group in the study was H-2A workers, who are workers contracted from other countries. H-2A workers in the study tended to be younger and because they may be new to work, don’t necessarily recognize symptoms as well, and on top of that, many workers are expected to perform at a certain level to be brought back again next year to work, there’s an added pressure. This is where we need to consider the social-political context in the US. H-2A workers are a group in the US that can be vulnerable in that their employment and their visas are tied to a specific employer, so there’s added risk if they report symptoms at their workplaces.

Bridges Center: can you tell us about your current research - for which you were awarded a Washington State Labor Research Grant (WSLRG) for?

My research will investigate the association of labor and social determinant-related policies with agricultural workers’ health by looking critically at policies that expand and/or exclude agricultural workers at the state level. Using mixed and community-based participatory research methods, state-level policies will be compiled to develop a labor policy equity index and used to examine its association with agricultural worker health indicators. This research aims to address the gap in knowledge about the impact of labor policies in agricultural workers’ health.

The proposed aims are to 1.) Use qualitative methods to understand the labor (e.g., minimum wage, sick leave, etc.) and social determinant related (e.g., housing, immigration, etc.) policies that are most relevant to agricultural workers and how these policies are experienced in their work and community environments, 2.) develop a state-level labor policy equity index (LPEI) that centers the most important policies for agricultural workers and 3.) assess the association of the LPEI with the workplace, chronic condition health, and mental health indicators, and barriers to health care services using the National Agricultural Worker Survey data.

For Aim 1, interviews with agricultural workers and key informants will determine the policies that are most important and therefore the policies that will be included in the development of the LPEI. For Aim 2, the policies we include in the index will be compiled using a combination of consulting with the Agricultural Community Advisory Board (ACAB) and interview results from aim 1. All state-level labor policies will be systematically coded using public records, state legislative websites, and worker advocate organizational web pages. For Aim 3, multilevel models will be used to assess the association between LPEI state scores and the following agricultural worker health indicators: 1) workplace environment, 2) chronic health conditions, 3) mental health, and 4) health care barriers using the National Agricultural Workers Survey data.

The study results will help researchers and labor policymakers make evidence-based and strategic changes to labor and social policies and their enforcement by understanding these policies’ role in agricultural workers’ health. Results of such policy changes across US states can provide agricultural workers access to benefits and resources to reduce exposure to occupational health risks and enhance overall well-being. Additionally, this labor policy equity index can be a tool for labor justice organizations and legislators across the US, as well as, be used to understand the role policies play in other occupations.

Bridges Center:What advice do you have for researchers who are hoping to center and include the voices of the communities, including workers, in their work?

I think it’s really important to be intentional about including worker voices. I don’t know if you can adequately do a lot of this work without including the people that are most impacted. I think it’s helpful to look at community-based participatory research along a spectrum and we always want to aim to have the most equitable environment and practices to center and include communities, but sometimes we’re limited. Sometimes you’ll end up with challenges in doing participatory research depending on the context, whether you’re in a government organization or academic institution, wherever you may be, there may be challenges. But I think it’s about finding creative ways to include communities and maybe you won’t end up exactly where you want but holding yourself accountable to striving to do what you can. These little changes can sometimes be disheartening because it’s not exactly where I’d/we’d want to be but there’s also power in making changes towards where we want to be.

I think it’s really important to be intentional about including worker voices. I don’t know if you can adequately do a lot of this work without including the people that are most impacted.

Another important thing to keep in mind is to truly understand why you are trying to center and include the voices of communities and workers in your research. I know there are a lot of conversations on health equity and justice, but what does it truly mean for the specific group you’re working with? I don’t think we need to know everything but take time to dive in and familiarize yourself with the community you’re working with to understand who has been historically excluded, who is missing from the table that we haven’t been able to reach, and why, what are policies and practices that have impacted some of the disparities we see today? Taking the time to do this allows 1.) to ensure you’re going to do some of the work to inform yourself and you’re not asking communities to teach you, and 2.) the more you understand the context, how things ended up the way we’re observing them, then you’ll understand why it’s all the more important to include the voices of communities because you’ll more deeply understand the injustices that happen and the ways they affect real people.

Think about how the work you do can/will benefit the communities you’re working with. If you don’t know, ask, and have that conversation. You don’t have to over-commit to a deliverable that you can’t produce, but I also don’t think that the work produced should be limited to a published article that most people won’t have access to. It can be things like ensuring when you publish the work that it’s in an open access journal, creating a short report so communities are aware of the findings from the research, doing radio programs, podcasts, or anything that will make knowledge more accessible. Maybe communities will have questions about resources in the region and you can help make that connection by providing an info sheet or using your network to connect people.