Continuity of Care at the Edges of America: Rethinking Health for Migrant and Seasonal Agricultural Workers in the U.S. Midwest.

Abstract

Migrant and seasonal agricultural workers are essential to the food systems of the United States (U.S.), yet they experience some of the most persistent health inequities in the nation. In the U.S. Midwest, particularly Iowa and Nebraska, workers arriving from Mexico and Central America confront structural, linguistic, geographic, and policy barriers that disrupt continuity of care and limit access to preventive services. Despite carrying disproportionate burdens of chronic diseases such as diabetes, hypertension, and musculoskeletal conditions, migrant and seasonal workers face fragmented health systems shaped by immigration status, mobility, lack of insurance, transportation barriers, and fear of institutional discrimination. Drawing on emerging models, including community health workers, mobile agricultural clinics, and cross-border health initiatives, this commentary reflects on how more portable and culturally grounded approaches could improve health outcomes for migrant agricultural populations. The Midwest serves as a critical case for reimagining continuity of care within mobile workforces globally, highlighting the need for health systems capable of moving with people rather than confining care to place. Ensuring consistent access to preventive and chronic disease care for migrant workers is essential for advancing equity, strengthening public health resilience, and honoring the labor of those who help feed the nation.