Preparing for Inclusion of Agricultural Workers in Climate-Related and Other Public Health Emergencies: A Quantitative Content Analysis of County Emergency Preparedness Plans, Eastern North Carolina, 2022-2023

Abstract

Objective

Agricultural workers such as migrant and seasonal farmworkers are a population uniquely vulnerable to the negative effects of climate-related disasters. The primary aim of this study was to assess how counties in eastern North Carolina (NC) incorporated best practices related to agricultural workers in emergency preparedness planning.

Methods

The authors conducted a quantitative content analysis of 47 emergency preparedness plans from 41 eastern NC counties between November 2022 and March 2023. The research team developed a codebook based on recommended best practices from the Centers for Disease Control and Prevention, Farmworker Advocacy Network, Federal Emergency Management Agency, and National Center for Farmworker Health. Best practices included having materials in Spanish language, mapping vulnerable populations, and garnering input from agricultural workers.

Results

Of the 47 plans evaluated, most lacked inclusion of agricultural workers in emergency preparedness planning. Furthermore, plans demonstrated few relevant best practices that address agricultural workers’ specific challenges in preparation for and recovery from climate-related disasters.

Conclusions

Public emergency preparedness plans in eastern NC rarely include mention of recommended best practices related to agricultural workers. Local emergency preparedness officials should consider collaboration with advocacy groups, community health workers, and federal emergency management agencies to build disaster resilience.

Migrant and seasonal agricultural workers (“agricultural workers”) are an often-neglected population in emergency preparedness planning.^{1, 2} The approximately 80 000 migrant and seasonal agricultural workers in North Carolina (NC) play a critical role in the state’s economy.³ They also represent a community particularly vulnerable to the effects of climate-related disasters.^{2, 3} Climate change is contributing to disruptions to the agricultural economy in part by increasing the severity and frequency of hurricanes, extreme heat, and tornadoes.^{1, 4, 5} Extreme weather events like hurricanes Matthew (2015), Florence (2018), and Dorian (2019) exacerbate existing inequalities in environmental health exposures and increase vulnerability for agricultural workers.^{1, 4, 5}

Disasters can have major impacts on agricultural workers as well as the overall agricultural economy. Agricultural workers have reported being uncertain about the future due to destroyed crops, damaged housing, and lack of wages.⁶ Agencies partnering with agricultural workers have reported a lack of emergency plans or protocols that include this population and workers, as a result, have had to improvise on their own in many cases.⁶ Nonetheless, agricultural communities and workers have also shown resilience, forming partnerships to keep each other safe during and after the disasters.⁶

Agricultural workers have unique structural vulnerabilities to climate-related disasters. These vulnerabilities are influenced by factors such as their socioeconomic and immigration status that affect their ability to access social and health services.^{1, 5} A study by Burke and colleagues revealed language, financial constraints, and transportation to be relevant issues for agricultural workers in a climate-related disaster.² Participants in that study viewed preparedness to be important but indicated that they did not know how to prepare for a climate-related disaster or lacked preparedness materials.² Another study by Montz et al. looked at the association between where agricultural workers were located and climate-related disasters within the state.¹ They found that NC counties with a greater density of agricultural workers experienced greater hurricane and tornado exposure.¹

The Centers for Disease Control and Prevention (CDC),^{7, 8} Farmworker Advocacy Network,⁶ Federal Emergency Management Agency (FEMA),⁹ and National Center for Farmworker Health¹⁰ have released best practices for inclusion of groups like agricultural workers in emergency preparedness planning. Their recommendations fall into 2 primary areas: (1) communication and (2) community engagement. For example, recommendations from the CDC include having materials available in languages used locally and a plan for interpretation and translation services in an emergency.⁷ Plans should also include strategies for staying connected with local media outlets that serve vulnerable populations.^6–9 FEMA has recommended that an emergency preparedness plan be made at the local level with support from the national and state levels based on the scale of the disaster.⁹ A coalition or a Community Outreach Information Network (COIN) has been recommended to build connections between communities and emergency preparedness planners prior to an event.^{6, 8–10}

The primary aim of this study was to determine how counties in eastern NC, which is particularly vulnerable to hurricanes and has a high concentration of agricultural workers,⁵ have incorporated best practices concerning communication and community engagement related to agricultural workers in their emergency preparedness plans.

Methods

This study team used a quantitative content analysis to examine the representation of best practices related to agricultural workers in 47 emergency preparedness plans from 41 counties in eastern NC (Figure 1). This study included both emergency operations plans (n=20) and all hazard plans (n=27).

Figure 1. Map of 41 eastern North Carolina counties included in study.

To develop the coding rubric, the study team first reviewed recommended best practices in emergency preparedness planning for agricultural workers and migrant populations from the CDC, Farmworker Advocacy Network, FEMA, and National Center for Farmworker Health.^6–10 Regarding communication, the coding rubric assessed the presence or absence of materials available in Spanish, interpreters/translators, and communication with relevant ethnic media. Regarding community engagement, the coding rubric assessed the presence or absence of a Community Outreach Information Network and if it included community health workers, community health centers, agricultural workers, farmworker-serving organizations, and Cooperative Extension. The codebook rubric is available as an online supplemental file (Supplemental File 1). The study team included authors with experience in emergency preparedness including a former migrant health outreach program director as well as a former county public health emergency preparedness coordinator. Both reviewed the coding rubric for content.

The study team used only publicly available plans. To identify plans, 2 authors searched government websites and contacted emergency preparedness staff for a copy of or link to plans from November 2022 to March 2023.

To address coding reliability, the team used plans from other areas of NC to calibrate coding until 94% of items were coded the same way by independent coders. In each calibration session, coders discussed how they would code a given plan and why any differences occurred. After each round, the authors made modifications to the rubric for clarity. After establishing reliability, 2 trained coders (the second and third authors) independently reviewed and abstracted the presence or absence of best practices in each plan using an Excel template by text searching the plan for key words related to each best practice. The 2 coders then met with 2 other authors to collectively reconcile each coding discrepancy.

As this research involved the review of public documents, IRB approval was not required.

Results

As shown in Table 1, the best practices assessed in this study were rarely discussed or mentioned in public plans. Furthermore, there tended to be more focus on communication practices than community engagement. Related to communication practices, less than half of the plans included relevant practices as recommended. Of the emergency preparedness plans assessed, 42.6% (20/47) mentioned having materials available in languages other than English and 29.8% (14/47) mentioned materials specifically in Spanish. Related to community engagement, there appeared to be even less congruence with recommend practices. Among the emergency preparedness plans accessed, 68.1% (32/47) of the emergency preparedness plans provided a description of 1 or more vulnerable populations. However, just 8.5% (4/47) of emergency preparedness plans indicated awareness of Spanish-speaking populations within the covered area as part of the description of the population and none indicated awareness of farmworker populations. Lastly, more than half (61.7%, [29/47]) of the emergency preparedness plans mentioned outreach to and input from Cooperative Extension, which is well connected to farmers and farm owners.

Table 1. Coding of recommended practices in emergency preparedness plans,* n = 47, in 41 eastern North Carolina counties, 2022-2023

Note: *Plans are emergency operations plans and hazard mitigation plans.

Discussion

Principal Findings

This study assessed how counties in eastern NC have incorporated recommended best practices related to agricultural workers in their emergency plans. There were major gaps in the preparedness plans related to both communication and community engagement. These gaps may reflect some of the challenges reported by non-governmental organizations in disaster response for agricultural workers.^{6, 10} They also reflect a lack of resources – more often caused by budget constraints and workforce shortages – available for emergency preparedness planning and public health in general.^{1, 6}

Our findings suggest that current plans do not address specific communication challenges faced by agricultural workers during a climate-related disaster. This is in line with some of the challenges identified by the Farmworker Advocacy Network in the aftermath of Hurricane Florence (2018) including the lack of protocols and training available to members of the Farmworker Advocacy Network.⁶ Advocates of the organization emphasized the importance of contacting agricultural workers before the hurricane using social media and WhatsApp in Spanish, having phone operators who speak Spanish, and transportation assistance for agricultural workers who need to move to available shelters.⁶ It is important to not just recognize the vulnerabilities of agricultural workers during a climate-related disaster but to include actionable steps before, during, and after a disaster in emergency preparedness plans.^{1, 2, 6} These steps could include providing welcome packets to agricultural workers upon arriving for the agricultural season or during education or health outreach. Additionally, counties can train and recruit bilingual volunteers as part of their preparedness infrastructure. Lastly, communication channels such as social media, radio stations, and WhatsApp offer a means of reaching agricultural workers.⁶ Having a plan that addresses language barriers, accessibility of culturally-competent materials, and other communication needs is essential for local communities in building climate resiliency and in ensuring the safety of agricultural workers.

The importance of community engagement in emergency preparedness planning is well established as community involvement can contribute to the design of interventions that are specific to the issues faced by the vulnerable population.^6–10 While the plans included in this study did not document much engagement with agricultural workers, more than half did report engagement with Cooperative Extension. County and state Extension programs are a valuable resource; however, their outreach to agricultural workers, specifically migrant and seasonal farmworkers, has historically been more limited in NC than the reach of community health workers. Indeed, it was a surprise to find little discussion in the plans of the community health worker outreach teams that serve agricultural workers at migrant health centers and sites supported by the NC Farmworker Health Program.³ Furthermore, there are other organizations that could be included in planning like the Farmworker Advocacy Network, Association of Mexicans in North Carolina, and the Hispanic Federation that represent agricultural workers’ interests and could inform transportation services, evacuation drills, and emergency preparedness education.^{3, 6} There is a need for more involvement of agricultural workers and organizations that work directly with agricultural workers across all measures of communication and community engagement. We recommend planners review best practices from the CDC, Farmworker Advocacy Network, FEMA, and National Center for Farmworker Health.^6–10 Specific examples of recommended practices that counties can implement during and after a climate-related disaster include partnering with local FEMA agents as soon as possible, promoting shelter lists and evacuation routes on social media, and educating local law enforcement on the location of agricultural worker housing.^{6, 9}

Strengths and Limitations

This research has important strengths including the identification of 47 plans from 41 counties in a region with substantial vulnerability to climate-related disasters, use of 2 independent coders, and a coding scheme based on expert input and best practices from both government and non-governmental organizations. However, there are also limitations. Investigators used public plans; thus, internal planning documents and operating procedures are not included in this study. Internal documents may have more detail, and future research should consider interviewing emergency preparedness coordinators to understand how vulnerable populations are incorporated in internal plans or informal practices. Plans are limited to a single geographic region in a single state and are not generalizable to other states or regions. Planning may also be unique to NC’s specific state-level public health resources and infrastructure. However, our findings should be of concern to areas of the country with large agricultural worker populations. For example, western NC, which is not generally thought of as vulnerable to hurricanes, faced severe flooding from Hurricane Helene in 2024. Planners outside of coastal areas should consider how agricultural workers and other vulnerable groups are included in planning. There is some variability in agriculture and the agricultural workforce across the region included in this study, so the need for inclusion is not uniform across all 41 counties. However, there are agricultural workers and farms across the entire eastern NC region. Furthermore, while a substantial amount of agricultural workers in eastern NC are minoritized – predominantly Latine – there are other migrant populations who may not be agricultural workers but may face similar challenges during a climate-related disaster.^{2, 3} Finally, this study likely does not present an exhaustive list of all considerations relevant for agricultural workers in our analysis. Future research should address a larger geographic area and qualitatively interview planners to assess barriers to inclusion of best practices and to learn from experiences with prior disaster response.

Conclusions

Agricultural workers are a population uniquely vulnerable to the negative effects of climate-related disasters. This study showed that counties in eastern NC have gaps related to inclusion of agricultural workers in their emergency preparedness planning. Further research studies are needed to understand differences in planning and implementation strategies, including internal or confidential plans or practices not documented in plans. Federal agencies and advocates should consider strategies for improving implementation of best practices related to agricultural workers, and county planners should consider engaging with organizations that work closely with agricultural worker communities.