In the 19th and early 20th centuries, an industrial medicine physician named Alice Hamilton raised public consciousness about worker health and safety through her practice of “shoe leather epidemiology”—going into dark and dusty factories to interview laborers and evaluate their working conditions. Hamilton’s investigations of worker exposures to lead, mercury, and other toxic materials were instrumental in the development of safer working conditions. To this day, her legacy continues to inspire many researchers within the field of Occupational Medicine.  

Clinical Professor of Pulmonary, Critical Care and Occupational Medicine, Claudia Corwin, MD, MPH, has been inspired by Hamilton’s work, which aligns with her own passion for pursuing structural changes that improve the lives of workers who fall through the health safety net. Recently, the Central States Occupational and Environmental Medicine Association (CSOEMA) has recognized Corwin with the Alice Hamilton Award for her work in the field.  

Corwin was presented with the award during the CSOEMA Spring Seminar held March 12–14 in Naperville Lisle, Illinois. She was also invited to present some of her on-the-ground programmatic work and research centered on migrant and seasonal farmworkers and with service workers in health care.  

Migrant and seasonal farmworkers 
Corwin’s work with migrant and seasonal farmworkers evolved when she began volunteering with Proteus, a federally qualified health center that provides mobile health care to migrant and seasonal farmworkers. Proteus’ services were the primary response for farmworkers during the pandemic, and Corwin helped the agency develop mitigation and response processes. Corwin said Proteus was well-suited to this work as it is a trusted entity among immigrant workers and farm employers alike.  

Over several years, Corwin developed her own trusting relationship with Proteus—a partnership that has allowed her to do her work, which often takes place in “safe spaces” on farm properties, such as laundry rooms or outside worker dining halls. She describes trust as a crucial foundation for any community-based or community-engaged work. 

Through her partnership with Proteus, Corwin has spearheaded a variety of projects to test models that address health and safety conditions faced by migrant and seasonal farmworkers. Many of the risks these workers faced during the pandemic arose from the very nature of their work—group transport, employer-owned communal housing, and little practical ability to distance or isolate. 

In one project, a large family farm collaborated with Proteus along with Corwin and her colleagues to mitigate Covid infection rates among their workers. The process involved cohorting workers who traveled to the Iowa farm from Mexico and Texas on employer-operated buses. This cohorting process followed CDC guidelines for quarantine and isolation and resulted in a 3.5% infection rate compared to a 12.7% rate in another group of the farm’s workers during a different season. 

Trust between partners is what makes these types of “public health in practice” innovations possible, Corwin says. In this project, “trust enabled the employer, the workers, the health provider, and academicians to work together and achieve a meaningful outcome.” Corwin says academic researchers are just one piece of the puzzle. The community and community partners are invaluable in informing the approaches that academicians use to better understand and improve health outcomes for the populations they study.  

“A lot of times when I speak about this (research), I feel like it can sound very ivory tower,” Corwin said. “But the fact is that without data, we can’t create policies, and without new policies we can’t address health inequities”  

Low-wage healthcare workers 
While working in the Occupational Health Clinic, Corwin began to realize that many of UI Health Care’s lowest wage workers, such as environmental and food service workers, were not accessing their excellent health benefits and receiving primary care. Understanding that having health insurance was just the tip of the iceberg with respect to care access, Corwin and her colleague, Associate Professor in General Internal Medicine Kimberly Dukes, PhD, developed a pilot study funded by the College of Public Health, Heartland Center. The pair aimed to learn what low-wage healthcare workers know about their health insurance and the UI Health Care system, and to understand the challenges they encounter in using their benefits and accessing health care.  

Through worker surveys, Corwin says, the team learned that “having health insurance does not equate with equity or with access.”  

“There are so many factors—all related to social determinants of health,” she said. “So, this assumption that providing health benefits is all we need to do to get people health care and equity is a fallacy.” 

A few of the factors Corwin and her team identified through surveys were language barriers, schedule conflicts, lack of transportation to and from clinics, and ability to afford co-pays and deductibles.  

Corwin also found that the healthcare system itself creates confusion around care navigation. Many workers were uncertain about what health conditions each level of care addresses—when QuickCare, Urgent Care, or the ER is appropriate. Limited awareness of preventive care benefits reflected the same dynamic.  

The team found that limited knowledge of the system as a whole, paired with broader concerns about the cost of treatment, can lead members of this population to delay care or avoid care altogether. This can lead to more advanced disease progression and emergency room visits, costing everyone, from the worker to the institution, more in the long run. 

Corwin’s work didn’t conclude with the survey and knowledge assessment. Her pilot study also incorporated a coaching intervention to engage workers in peer-to-peer education about UI Health Care and to provide employees with resources to learn about benefits.  

As a member of a THRIVE at Carver cohort, Corwin also presented an expanded version of her funded pilot to make a case for improving primary care access and worker awareness of health benefits. She holds that these improvements could better sustain an essential University of Iowa workforce and reduce sick days and turnover. Corwin is hopeful that she can help encourage institutional infrastructure to sustain this workforce while reducing health disparities among UI employees.   

Acknowledgements
Corwin expresses deep gratitude to the Environmental Services Department, UI Human Resources, Carver College of Medicine, and the College of Public Health, Heartland Center for their “tremendous support.” She shared that her work would not be possible without their contributions and the contributions of her colleagues: Dukes and Clinical Associate Professor of Emergency Medicine Michael Miller, MD.  She also expresses her sincere appreciation of Proteus leadership and staff for all they do on behalf of farmworkers in Iowa. 

Finally, what remains most salient to Corwin, beyond the research, is the resilience of the workers themselves. She acknowledges their generosity of participation and all they have taught her over time. She notes, “Any discussion of this work would be imbalanced without recognizing all that they do and all the strengths they possess.”   

In fact, throughout every survey, interview, and conversation, Corwin has found that the workers inspire her much as Alice Hamilton’s legacy.