Canada’s ‘Syndemic’: Migrant Workers are Essential—And So is Their Health

Much of the Canadian public is blissfully unaware that the fresh-cut fruits and vegetables sitting in their fridges were picked by migrant agricultural workers—one of Canada’s most invisible and underrepresented groups.

As vaccines roll out across the country, many Canadians are starting to feel like the 16-month-long pandemic might be nearing its end. However, to the most vulnerable and most underrepresented groups in Canada—like migrant workers, refugees, and racialized and marginalized communities—the crisis is far from over and, in fact, has morphed into a ‘syndemic.’

It is essential to recognize the disproportionate challenges that many communities face due to their race, age, location, or access to resources and, in so doing, address the inequalities in Canada’s pandemic response.

What is a ‘syndemic’?

Medical anthropologist Merrill Singer coined the term “syndemic” and defined it as “the aggregation of two or more diseases or other health conditions in a population in which there is some level of deleterious biological or behaviour interface that exacerbates the negative health effects of any or all of the diseases involved.”

In other words, a syndemic occurs when two or more diseases and health conditions coexist and interact “synergistically.” A syndemic can involve the interaction of diseases and health conditions of all types: infections, chronic non-communicable diseases, mental health challenges, and malnutrition.

Syndemics are likely to occur in environments of health inequality. For instance, poverty, stigmatization, structural violence, and stress can jeopardize a person’s immune function, and worsen their health outcomes.

In the case of the COVID-19 pandemic, the primary diseases and health conditions co-interacting within the population include the SARS-CoV-2 virus, chronic non-communicable diseases (diabetes, respiratory disease, etc.), and deteriorating mental health. When marginalized and racialized groups such as migrant workers and refugees experience these health conditions in environments of health inequality and social and economic disparity, this can further exacerbate the effects of each health condition and disease.

COVID-19 is therefore not only a pandemic but a syndemic, in which preexisting health conditions, socioeconomic disparities, and health inequalities among vulnerable populations—guided by factors of systemic racism and failure from political leadership—cause an imbalanced distribution of infection risk.

Canada’s reliance on migrant farm workers

With the 2021 agricultural season approaching, Canada is set to welcome a wave of migrant farm workers (MFWs) to the country, helping to contribute to the $68.8 billion agriculture and food sector. In 2017, Canada employed over 550,000 temporary foreign workers, accounting for 2.9% of all employment in Canada. Foreign workers in Canada are particularly essential in the agriculture, forestry, hunting, and fishing sectors, accounting for 15.5% of total employment in those industries.

Migrant workers matter, and it is imperative that the federal government acknowledge the precarious situation migrant workers find themselves in thanks to the COVID-19 crisis. Only then can the government’s policy gaps be addressed.

The idea of migration and the movement of people across borders and lands is daunting, and the migratory process can cause widespread vulnerability and uncertainty.

MFWs can enter Canada through the Seasonal Agricultural Worker Program (SAWP), which works under bilateral agreements between Canada and Mexico, as well as between Canada and Caribbean countries, to provide seasonal employment in the agriculture sector. Under SAWP, workers stay in Canada for eight months and contribute to the planting and harvesting seasons. MFWs who apply through SAWP earn minimum wage, and they hold a “closed work permit,” which ties workers to one employer and does not provide permanent residency pathways.

The idea of migration and the movement of people across borders and lands is daunting, and the migratory process can cause widespread vulnerability and uncertainty. Many migrants leave their home countries because of economic uncertainty, political repression, violence, climate-related challenges, and war. At every stage of the migration process, factors like gender and socioeconomic status exacerbate the challenges that migrants endure.

Moreover, their migrant status puts them in an “ambiguous and often hostile relationship to the state, and its institutions, including health services.”

The precarious life of a migrant farm worker

During the first wave of the pandemic, 12% of MFWs contracted COVID-19 in Ontario and three male MFWs died. Unfortunately, this is unsurprising: COVID-19 infection rates are ten times higher among MFWs than the rest of the population. 

In Canada, MFWs are in a precarious situation thanks to their temporary status, lack of access to healthcare, and exposure to dangerous working environments—all the more evidence that MFWs are in the throes of a syndemic.

The workplace health and safety risks for migrant workers highlight the deep inequalities that migrants face, ranging from isolation to overcrowded living conditions to dirty sanitation facilities. As a result, the working conditions and living environment for migrant workers are linked to numerous physical and mental health challenges, which make it hard for MFWs to protect themselves and, overall, increases the risk of contracting COVID-19.

MFWs endure physically demanding work over long hours. Many of the workers lack access to personal protective equipment, which exposes them to pesticides and dangerous chemicals. Over time, the constant stress, coupled with the adverse physical and mental health conditions, results in migrant workers accumulating a “physiological toll that can include musculoskeletal disorders, severe chronic pain, cardiovascular disease, diabetes, kidney failure, stroke, and mental health conditions.”

Many migrant workers are less likely to report injuries and health concerns because they fear losing their jobs and being sent home based on “medical deportation.”

In addition, MFWs’ temporary status adds to their uncertainty, stress, trauma, and economic hardship. This temporary status places MFWs in a problematic situation of choosing between access to healthcare and workers’ compensation or potentially losing employment from refusing work in unsafe environments.

Also, many migrant workers are less likely to report injuries and health concerns because they fear losing their job and being sent home based on “medical deportation.” This shows that the health inequalities and socioeconomic disparities further worsen migrant workers’ health by making them more vulnerable to COVID-19.

It is important to note that before the pandemic, migrant workers already faced threats to their physical and mental health; the COVID-19 crisis has only magnified the precariousness of their situation.

Recommendations for the future

With the 2021 agricultural season approaching—and as the public awaits fresh fruits and vegetables—the government has to ensure that they prioritize the health of MFWs.

Governments, policymakers, and professionals need to adopt ‘syndemic thinking’ as a tool to highlight the role of power in determining the outcomes for marginalized, economically disadvantaged, and racialized communities to access healthcare services. In addition, using a ‘syndemic approach’ to health-response measures allows for a better understanding of how inequities and injustices contribute to “disease clustering,” specifically how diseases and health conditions interact with vulnerable populations to increase their “disease burden”.

To effectively prepare for future emergency health preparedness plans, governments, public health officials and policymakers should first address the institutional structures and pre-conditions that cause specific groups to be more vulnerable than others. This is a crucial step if Canada wants to better understand health interactions and improve clinical care while ensuring disease prevention.

It is also essential that the public listen, learn from and engage with migrant-led advocacy organizations to confront the inequalities in Canada’s immigration structures.


Anjali Shanmugam holds an MA in International Public Policy from the Balsillie School of International Affairs. Her research interests include migrant rights, transnationalism, gender justice, health rights and water governance.

Photo Credit: Wikimedia Commons.

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