Designed for Disparity: The Structural Origins of Migrant Farmworker Health Inequities in Maryland, 1900‒1950

The COVID-19 pandemic has renewed attention to farmworker health disparities, prompting scholars to examine the structural determinants of agricultural worker health. Through analysis of archival materials, government documents, and period newspapers, we trace the evolution and institutionalization of migrant farm labor on Maryland's Eastern Shore from 1900 to 1950. We identify four key periods of transformation: the postemancipation agricultural adjustment (1900-1915), the rise of seasonal commodity agriculture (1915-1930), the response to mass displacement (1930-1940), and wartime labor management (1940-1950). At each stage, we demonstrate how agricultural industry interests deliberately cultivated conditions of racial stratification, worker precarity, and social isolation to establish and maintain the migrant labor system. Although contemporary public health frameworks often treat these conditions as independent social determinants of health, this history reveals them as essential, deliberately produced features of the migrant labor system itself. Understanding this historical context is crucial for public health practitioners working to address persistent health disparities in agricultural work, particularly as the COVID-19 pandemic has heightened attention to farmworker vulnerability. (Am J Public Health. 2026;116(5):657-664. https://doi.org/10.2105/AJPH.2025.308362).