Madeline Sage, UNC School of Medicine 2nd-year medical student and 2025-26 NC Schweitzer Fellow, pens op-ed about how occupational health is one of the most overlooked determinants of health.
Madeline Sage, UNC School of Medicine 2nd-year medical student and 2025-26 NC Schweitzer Fellow, pens op-ed about how occupational health is one of the most overlooked determinants of health. In this article, she addresses the realities of agricultural work, health outcomes and the barriers North Carolina farmworkers experience when trying to access healthcare.
In medical school, we learn to take detailed histories, documenting symptoms, past illnesses, family history, and a review of systems. But we routinely overlook a question that can be just as important as any of these: “What do you do for work?”
Occupational health is one of the most overlooked determinants of health. For millions of workers, particularly those in agricultural and other manual labor industries, job conditions, not genetics, pose the greatest risks. When clinicians fail to ask about how work affects health, we lose the full picture of our patients’ lives. Without that context, we miss opportunities to adapt treatment to their circumstances and to provide care that meets their individual needs.
Nowhere is this more apparent than among the migrant farmworkers who drive North Carolina’s agricultural economy. These workers harvest the food that fills our grocery stores, yet face some of the harshest exposures of any labor group in the country. Many spend ten to twelve hours a day in direct sunlight with little access to shade or protective clothing. They regularly handle or work near pesticides that can cause acute skin, respiratory, and neurologic symptoms. They labor in extreme heat that can trigger dehydration, heat illness, and dangerous fluctuations in blood glucose for those living with diabetes. Over time, these conditions contribute to higher burdens of chronic disease, including diabetes, hypertension, kidney disease, skin damage, musculoskeletal injuries, and significant mental health concerns.
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