Incorporating Structural Racism, Employment Discrimination, and Economic Inequities in the Social Determinants of Health Framework to Understand Agricultural Worker Health Inequities

In 2010, the federal government and several state governments began using the social determinants of health (SDOH) framework to highlight contributing factors of health inequities and, in 2022, recognized that structural racism was associated with health inequities. Yet, efforts to eliminate health inequities have disproportionately focused on individualized solutions instead of addressing structural racism. Many racial/ethnic-minority workers have been segregated to low-wage occupations that lack access to paid sick leave, such as agricultural work, which has been associated with health inequities. Research shows these inequities are attributable to structural racism enforced through laws that structure the employment system to disadvantage agricultural workers, who are disproportionately racial/ethnic-minority individuals, which will not be addressed with individualized solutions. In this article, we explain why the current SDOH framework and efforts to eliminate health inequities are inadequate, discuss Yearby's revised SDOH framework that includes structural racism as one of the root causes of health inequities, and illustrate how Yearby's revised SDOH framework better captures the impact of structural racism, which is associated with health inequities for agricultural workers.