Challenges faced by migrant seasonal agricultural farmworkers for food accessibility in Spain: A qualitative study

Full Te ms & Condi ions o access and use can be ound a h ps://www. and online.com/ac ion/jou nalIn o ma ion?jou nalCode= gph20 Global Public Heal h An In e na ional Jou nal o Resea ch, Policy and P ac ice ISSN: (P in ) (Online) Jou nal homepage: www. and online.com/jou nals/ gph20 Challenges aced by mig an seasonal ag icul u al a mwo ke s o ood accessibili y in Spain: A quali a i e s udy Luis Alejand o Rod íguez-Gue e o, José Tomás Ma eos, I a xe Pé ez- U diales, Ma Jiménez-Lasse o e, Juan Agus ín González & E ica B iones- Vozmediano To ci e his a icle: Luis Alejand o Rod íguez-Gue e o, José Tomás Ma eos, I a xe Pé ez- U diales, Ma Jiménez-Lasse o e, Juan Agus ín González & E ica B iones-Vozmediano (2024) Challenges aced by mig an seasonal ag icul u al a mwo ke s o ood accessibili y in Spain: A quali a i e s udy, Global Public Heal h, 19:1, 2352570, DOI: 10.1080/17441692.2024.2352570 To link o his a icle: h ps://doi.o g/10.1080/17441692.2024.2352570 © 2024 The Au ho (s). Published by In o ma UK Limi ed, ading as Taylo & F ancis G oup Published online: 16 May 2024. Submi you a icle o his jou nal View ela ed a icles View C ossma k da a Challenges aced by mig an seasonal ag icul u al a mwo ke s o ood accessibili y in Spain: A quali a i e s udy Luis Alejand o Rod íguez-Gue e o a,b , José Tomás Ma eos a,b,c , I a xe Pé ez-U diales d , Ma Jiménez-Lasse o e e , Juan Agus ín González ,g and E ica B iones-Vozmediano a,b,c a Heal h Ca e Resea ch G oup (GRECS), Biomedical Resea ch Ins i u e (IRB) Lleida D . Pi a e Founda ion, Lleida, Spain; b Depa men o Nu sing and Physio he apy, Uni e si y o Lleida, Lleida, Spain; c Socie y, Heal h, Educa ion and Cul u e Resea ch G oup (GESEC) o he Uni e is y o Lleida, Lleida, Spain; d Depa men o Nu sing I, Uni e si y o he Basque Coun y (UPV/EHU), Bioc uces Bizkaia Heal h Resea ch Ins i u e, Bizkaia, Spain; e Depa men o Nu sing, Physio he apy, and Medicine, Uni e si y o Alme ía, Alme ía, Spain; Social and Educa ional Analysis G oup (GRASE) o he Uni e is y o Lleida, Lleida, Spain; g Depa men o Educa ion Sciences, Uni e si y o Lleida, Lleida, Spain ABSTRACT Mig an s who wo k seasonally in ag icul u e ace li ing and wo king condi ions ha signi ican ly impac hei heal h. Some o hese condi ions a e ela ed o inadequa e ood access o ood p ese a ion and p epa a ion hygiene. This s udy aimed o explo e how mig an and seasonal ag icul u al a mwo ke s access ood in Spain om he pe spec i e o p o essionals suppo ing his popula ion. We conduc ed a quali a i e s udy in 2021 based on semis uc u ed in e iews wi h 92 social and heal h se ice p o essionals in ol ed in he ca e o seasonal mig an wo ke s in 4 Spanish p o inces. We iden i ied h ee hemes h ough e lec i e hema ic analysis: (1) Access o ood depends on NGOs and ins i u ions, especially a e he COVID-19 pandemic; (2) Rele an cul u al di e ences in die depending on No h A ican o sub- Saha an o igin; (3) Seasonal mig an wo ke s equen ly su e om nu i ional and o he heal h p oblems ela ed o ood secu i y. The p o essionals in e iewed desc ibed he die o seasonal mig an wo ke s as based on ood wi h li le a ie y, insu icien p o ein con en , and obesogenic p oduc s. They also epo ed a gene alized lack o hygiene in ood s o age and p epa a ion. This s udy calls o encou aging die a y suppo s a egies o educe challenges in ood accessibili y, which would p e en heal h p oblems in his popula ion and b ing hem social jus ice. ARTICLE HISTORY Recei ed 7 Augus 2023 Accep ed 2 May 2024 KEYWORDS Mig an s; ag icul u al wo ke s; ood access; COVID-19; quali a i e esea ch In oduc ion Eu opean coun ies’ ag icul u al sec o s depend on mig an wo ke s, especially du ing speci ic pe iods such as ha es season (Moline o-Ge beau, 2021). Likewise, Spain has his o ically been a coun y des ina ion o ag icul u al wo ke s om ab oad (Ma in, 2016). These wo ke s a e mainly ec ui ed du ing speci ic pe iods o a ew mon hs, which a y om egion o egion and in ol e di e en wo k ac i i ies such as ha es ing and p ocessing ag icul u al p oduc ion (Zimme e © 2024 The Au ho (s). Published by In o ma UK Limi ed, ading as Taylo & F ancis G oup This is an Open Access a icle dis ibu ed unde he e ms o he C ea i e Commons A ibu ion-NonComme cial License (h p://c ea i ecommons. o g/licenses/by-nc/4.0/), which pe mi s un es ic ed non-comme cial use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly ci ed. The e ms on which his a icle has been published allow he pos ing o he Accep ed Manusc ip in a eposi o y by he au ho (s) o wi h hei consen . CONTACT Jose Tomás Ma eos [email p o ec ed] GLOBAL PUBLIC HEALTH 2024, VOL. 19, NO. 1, 2352570 h ps://doi.o g/10.1080/17441692.2024.2352570 e al., 2020). Mig an and seasonal ag icul u al a mwo ke s (MSAFW’s) in Spain a e mainly people om he Magh eb, sub-Saha an A ica, Eas e n Eu ope, and, o a lesse ex en , La in Ame ica (González, 2018; Ma in, 2016). In 2018, a ound 150,000 and 276,000 empo a y wo ke s we e hi ed in Spain o ag icul u al wo k (Augè e-G anie , 2021). O en, MSAFW’s ace p eca ious li ing and wo king condi ions caused by ins abili y in employ- men , in some cases i egula , which implies geog aphic mobili y and less gua an ee o hei igh s (F ies-Te sch e al., 2021; T ianda yllidou & Ba olini, 2020). These poo e condi ions en ail a highe isk o poo e heal h and less access o he heal h and social p o ec ion sys em (U ego- Pa a e al., 2022). This si ua ion also en ails a high isk o su e ing challenges o access nu i ion- ally adequa e ood due o poo e access o ood and mo e signi ican di icul ies in ood p epa a ion and p ese a ion (Kiehne & Mendoza, 2015). Food secu i y depends undamen ally on ou aspec s: a ailabili y, access, u iliza ion, and s ab- ili y (FAO, 2009). In his s udy, we will ocus on access o ood, unde s ood as he household’s o indi idual’s abili y o ob ain a ailable ood (B iones e al., 2018). While malnu i ion is no solely de e mined by his aspec , i can lead o an inc eased isk o ood- ela ed p oblems (Pins up- Ande sen, 2009). In his sense, ood access p oblems a e also included when his access leads o ul- ne abili y o ma ginaliza ion, such as h ough dona ions, cha i ies, ood banks, o he (Ande son, 1990; Radime e al., 1992). Among MSAFW’s, he p e alence o ood insecu i y is es ima ed a 87% (Al-Bazz e al., 2022; Kiehne & Mendoza, 2015). The e a e ba ie s o accessing ood, such as emo eness om supe ma - ke s and g oce y shops, a lack o means and ime o do he shopping, and a lack o access o a o d- able, su icien , a ied, and heal hy ood (Meie o o & Som Cas ellano, 2020; Summe s e al., 2015). As a esul , hey could ha e poo die a y beha iou s, including i egula in ake pa e ns, low con- sump ion o nu i ious oods, and a lack o ime o meal p epa a ion (Benazizi e al., 2018; Rod í- guez, 2019; Sliwa e al., 2015). Because o he di icul y o accessing his popula ion, o he bes o ou knowledge, ew s udies ha e desc ibed access o ood and i s implica ions o he heal h o MSAFW’s in Spain. One way o app oaching he eali y o MSAFW’s is h ough he p o essionals who wo k in he p o ec ion and suppo sys em o mig an s in public ins i u ions o NGOs (Cáno as e al., 2022; Mozo e al., 2022). The lack o knowledge ela ed o ood accessibili y ha is expe ienced among he mig an popu- la ion, in gene al, and among MSAFW’s, inc eases he in isibili y o he ulne abili y o hese g oups and hinde s he e ec i e gua an ee o he igh s o heal h and an adequa e s anda d o li ing (Co ado & Palumbo, 2022). The e o e, his s udy aimed o explo e how MSAFW’s access ood in Spain om he pe spec i e o p o essionals suppo ing his popula ion. Ma e ial & Me hods S udy design and se ing This quali a i e, explo a o y and desc ip i e s udy is pa o he i s phase o a b oade p ojec (ANO- NIMIZED), ocused on assessing he in luence o job insecu i y and social exclusion on he heal h o mig an women and men wo king in he ag icul u al sec o in Spain. Du ing 2021, semis uc u ed in e iews we e ca ied ou in ou p o inces o Spain wi h di e en ypes o ag icul u al p oduc ion (seasonal campaigns: Ca alonia and La Rioja/in ensi e ag icul u e: Andalusia and Mu cia). Ag icul- u al seasons in he no h (Lleida and La Rioja) las a ew mon hs and a e open-ai , ex ensi e, and ocused on exploi ing a educed ange o p oduc s. In con as , he campaigns in he sou h (Mu cia and Alme ia) end o las se e al mon hs, be in ensi e, unde plas ic o o cha ds, and p oduce a wide ange o p oduc s (Ma ínez Fe nández, 2020; Moline o-Ge beau & Muñoz-Rico, 2022; So uco- Pa ada, 2021). In all o hem, he e a e many ag icul u al wo k ac i i ies: ha es ing, p uning, picking, p ocessing, and packaging (González e al., 2021). Seasonal wo k is mainly ca ied ou in he ield o ha es ing, p ocessing, and opping ui and ege ables, in ag icul u al s a ions o ha es ing, on 2 L. A. RODRÍGUEZ-GUERRERO ET AL. a ms o ineya ds, o in nu se ies. The e is also a signi ican g oup dedica ed o wo king in sheds o wa ehouses o he packaging and s o age o p oduce and s o age o p oduce (Gadea e al., 2016). Pa icipan s Pa icipan s we e heal h and social ca e p o essionals wo king in public ins i u ions and NGOs in ol ed in he suppo o MSAFW’s. Pa icipa ing NGOs we e na ional and local o ganiza ions c ea ed o imp o e li ing condi ions in a eas such as heal h, educa ion, housing, public se ices, anspo , and employmen , among o he aspec s (Delgado, 2010). Rec ui men was ca ied ou by pu posi e sampling by iden i ying key in o man s in he ou selec ed egions and hen by using he snowballing echnique. A o al o 92 pa icipan s (55 women, 37 men) in ol ed in he ca e and suppo o e ed o MSAFW’s we e ec ui ed, including p o essionals om Heal h ca e: physicians, nu ses, psychologis s (n = 23), social se ices (n = 3), NGOs and cul u al media o s (n = 43), wo ke unions (n = 17) and Go e nmen al ins i u ions (n = 6) in ou Spanish egions: Andalusia (n = 31), Ca alonia (n = 24), La Rioja (n = 20) and Mu cia (n = 17)[ Table 1]. We chose semis uc u ed in e iews as he da a collec ion echnique o ob ain deep in o ma ion om each in o man ega ding se e al opics included in he in e iew guide. We conduc ed 86 in e iews (indi idual n = 80 o in pai s n = 6) in pe son o by Zoom un il he in o ma ion sa - u a ion. This esul ed in no new in o ma ion being ob ained. A single in e iew sc ip wi h open-ended ques ions was designed by he p ojec ’s esea ch eam in acco dance wi h he p ojec ’s objec i es and p e ious li e a u e. I con ained i e sec ions: ca e and suppo o MSAFW’s p o ided by he se ice, mig a o y ajec o y, MSAFW’s li ing con- di ions, MSAFW’s heal h and impac o he COVID-19 pandemic. The in e iews we e conduc ed om Janua y o Oc obe 2021. The du a ion o he in e iews las ed on a e age 60 minu es (be ween 30 and 90 minu es). The eam o in e iewe s we e membe s o he men ioned esea ch p ojec . The in e iews we e conduc ed bo h online and in-pe son in he a o emen ioned egions. They we e audio- eco ded elec onically and hen ansc ibed e ba im. Analysis The ansc ip s we e impo ed in o he ATLAS. i web so wa e (online e sion 9) (ATLAS. i Scien- i ic So wa e De elopmen GmbH, 2022), which was used o o ganize and code he in o ma ion du ing he analysis. We conduc ed a e lec i e hema ic analysis (B aun & Cla ke, 2022). In he i s s ep, he esea che s elabo a ed a code ee based on he in e iew sc ip o iden i y he key concep s in he ansc ip s, assigning a code wi h a simila meaning o each sen ence o pa ag aph. In he second s ep, hey labelled he pa ag aphs ela ed o he s udy’s objec i es wi h open codes summa ising he meaning o each sen ence. Finally, ollowing a cons an compa ison p ocess, he esul ing lis o open codes was g ouped unde g oups o codes acco ding o hei simila i y, esul ing in he sub hemes and hemes shown in he esul s sec ion. The au ho s me se e al imes o discuss he inal hemes and he s uc u e o he esul s. Table 1. S udy pa icipan s acco ding o he sec o and egion (N = 92). Region Sex Sec o Female Male Heal h ca e Social se ices NGOs Media ion Wo ke unions Go e nmen al ins i u ions Andalusia 25 6 9 1 17 4 0 0 Ca alonia 10 14 9 0 7 4 2 3 La Rioja 13 7 3 2 5 0 6 2 Mu cia 7 10 2 0 6 0 9 1 To al pa icipan s N = 92 55 37 23 3 35 8 17 6 GLOBAL PUBLIC HEALTH 3 The igou o he analysis was ensu ed h ough a combina ion o s a egies, including he e ogen- ei y o pa icipan p o iles, egions o o igin and esea che pe spec i es, as well as by accompany- ing he esul s wi h meaning ul exce p s ( e ba im quo a ions) om he in e iews. E hical conside a ions The s udy was conduc ed aking in o accoun all e hical conside a ions o he Decla a ion o Hel- sinki. P io o da a collec ion, app o al was ob ained om he Heal hca e E hics Commi ee o he A nau o Vilano a Hospi al in Lleida in 2021 [CEIC– 2459].. Responden s ag eed o pa ici- pa e olun a ily and signed an in o med consen documen gua an eeing con iden iali y o he da a. Du ing da a collec ion and ansc ip ion, an iden i ica ion numbe was assigned o each pa icipan in o de o p ese e hei anonymi y. Consolida ed C i e ia o Repo ing Quali a i e Resea ch (COREQ) c i e ia we e ollowed (Tong e al., 2007). Resul s The esul s ha e been s uc u ed in o h ee eme ging hemes (1) Suppo and ood dis ibu ion by ins i u ions and NGOs; (2) Nu i ion cha ac e is ics o MSAFW’s; and (3) Nu i ion- ela ed heal h p oblems o MSAFW’s, wi h hei co esponding sub hemes. Suppo and ood dis ibu ion by ins i u ions and NGOs Seeking suppo and accessing ood- ela ed esou ces The pa icipa ing p o essionals desc ibed ha MSAFW’s ace si ua ions o economic p eca ious- ness. Al hough, in some cases, MSAFW’s eso o collabo a ion o begging s a egies, dona ions om ins i u ions and NGOs a e hei p ima y sou ce o accessing ood. P o essionals highligh ed ha MSAFW’s main demands o suppo a he ins i u ions a e ood and housing cos s. Pa ici- pan s iden i ied ba ie s o accessing ood esou ces, such as knowing whe e ood esou ces a e p o- ided, ime cons ain s, and he size o he ci y o go o such places. Fo example, i hey come ou side o egula hou s, I won’ eed hem, and some imes someone will come one and a hal hou s la e. The e’s a schedule he e and you ha e o s ick o i . (E50, Social wo ke , NGO, La Rioja) The pa icipa ing p o essionals indica ed ha hey also assis ed homeless MSAFW’s by suppo - ing hem in ob aining ood, housing, and economic esou ces. Some NGOs ha e speci ic p og ams o help people expe iencing homelessness, no speci ic o MSAFW’s, and p o essionals epo ed ha hey se e many o hem. In o he cases, p o essionals di ec ly ga e ood o homeless MSAFW’s when hey assis ed hem wi h o he adminis a i e o heal h- ela ed issues. Some imes you’ll bump in o a guy and he’ll ask i you can please lend him 50 cen s. I he hasn’ ea en o wo days o one day, well, you eally eel like you ha e o buy him a sandwich. (E32, Media o , Media ion, Ca alonia) To dis ibu e ood and essen ial p oduc s, local councils and public ins i u ions diagnose basic needs, e e o he co esponding ci cui s, p omo e p ope con ac s, and dis ibu e ood and hygiene p oduc s wi h NGOs. I can be done egula ly in acili ies o by anspo ing he ood o he MSAFW’s loca ions. Usually, he ood packs include h ee meals daily (b eak as , lunch, and dinne ), o example, including a lunch box wi h a sandwich hey b ing o wo k, depending on he a ailable budge . The e’s a municipal meal se ice. They ha e wo e sions. One does ho meals, whe e hey se e lunch and dinne , and his ope a es e e y day o he yea , and we can e e hem he e om he echnical depa men . And hen he o he one is a lowe -demand se ice, whe e hey gi e ou sandwiches o people who don’ sign 4 L. A. RODRÍGUEZ-GUERRERO ET AL. up o he lunch se ice o a en’ signed up o a jobseeke s plan, bu ha sandwich se ice somehow gua an- ees ha hey ge a leas one meal a day e en i i ’s some hing empo a y. (E52, Social wo ke , Ci y Hall, Ca alonia) The in e iewed p o essionals explained ha ood dis ibu ion can also be o e ed h ough ou- che s o inancial alloca ion. We need o mo e owa ds ha ing hem buy hei own [ ood], we need o help wi h di ec ans e s, and one e y in e es ing measu e ha is wo king in Ba celona, bu hasn’ been b ough in he e ye , is ca ds. (E14, Social wo ke , Union, Ca alonia) And he o he aid ha ’s inc eased he mos is he money we gi e ou . I ’s a di ec cash ans e o hem o buy ood. This is wha ’s inc eased he mos as a esul o he pandemic. Wha hey call ‘ inancial dona ions’ i ’s jus hey b ing you hei ouche s and you gi e hem he money … (E15, NGO, Ca alonia) In addi ion, he in e iewees explained ha o dis ibu e ood, he NGOs conside hei speci ic needs, such as hei age, he loca ion o he MSAFW’s homes and household appliances, and hei employmen si ua ion. Fo ins ance, i hey don’ ha e wo k, we gi e hem ood and a bi … They’ll ha e o manage hei shopping a bi , bu also conside ing whe he hey ha e a idge o no . (E64, Nu se, Heal hca e, Andalusia) Collabo a i e wo k o di e en NGOs and an ex ensi e olun ee ne wo k a ailable a e in cha ge o ood dis ibu ion. O he ac ions ca ied ou by NGOs we e e e als o o he suppo de ices. I mean, he e a [NGO] we ha e no esou ces, I can’ eed hem, I ha e o send hem o [NGO], you know wha i ’s like. I’m in cha ge o ulne abili y p og ams. So abou aid, i we ge one o hem he e, hen we ha e o send hem o e he e, whe he i ’s he shel e i hey need a place o sleep, o o [NGO] i hey need somewhe e o ea . (E27, Social wo ke , NGO, La Rioja) Ano he in e en ion highligh ed was heal h educa ion ela ed o ood p ocessing and hygiene o p e en illnesses om ood con amina ion. A he same ime, he p o essionals hemsel es ecog- nized ha li ing condi ions o en do no allow MSAFW’s o gua an ee hese measu es. One o he hings NGOs do is all he en i onmen al s u , like helping hem clean up he camp and explaining some basic simple s u like i hey used a ba e y, hen don’ lea e i nea he ood s o age o wa e supply, o a oid con amina ion. (E2, Nu se, Heal hca e, Andalusia) Food dis ibu ion du ing he COVID-19 pandemic Du ing he i s wa e o he COVID-19 pandemic in 2020 and 2021, ci y halls and NGOs ha e p o- ided di e en ypes o humani a ian aid o co e he basic needs o MSAFW’s, such as hygiene (laun- d y, showe s) and ood. The in e iewees indica ed ha he municipali ies we e esponsible o coo dina ing he dis ibu ion o ood and hygiene ki s ollowing COVID-19 p e en ion egula ions. NGOs also wo ked collabo a i ely o dis ibu e ood and e e als o o he suppo mechanisms. [O he NGO] hey’d p o ide a special an o dis ibu ing meals. We we e making he ood, we mo ed o a ki chen ha was se up he e, om a en in he s ee so he e would be en ila ion. On each ip we’d eed some 25 people, so we had o se up ou , ou ood s a ions. (E50, Social wo ke , NGO, La Rioja) Nu i ion cha ac e is ics o MSAFW’s Die cha ac e is ics o MSAFW’s The in e iewees explained ha he die o he MSAFW’s was based on essen ial p oduc s and, wi h li le a iabili y, cheap ood deli e ed by associa ions and NGOs based on ice, lou , and pulses. While consuming ui and p o ein was limi ed, oods high in suga we e high. Some o hem wo k e e y o he day, ge ing hei wages one day a a ime, don’ hey? Well, hose esou ces a e wha hey buy hei ood wi h, bu he ood hey can buy is e y basic ood, like maybe some lou , o some GLOBAL PUBLIC HEALTH 5 beans, bu hei access o a balanced die is limi ed, hey don’ … So hey do ha e access o he bes ege ables hey can ge in he g eenhouses whe e hey’ e hi ed, o whe e one o hei na ionals is hi ed, bu no access o a balanced die whe e hey ge hei mea and hei ish, well, none o ha . (E87, Coo dina o , NGO, Andalusia) As a esul , p o essionals desc ibed MSAFW’s die s as based on essen ial p oduc s, unbalanced and incomple e. They explained i because o hei p eca ious wo king condi ions, which p e en hem om buying enough ood. In his ega d, pa icipan s iden i ied he die o MSAFW’s li ing in shan y se lemen s and wi hou a amily as wo se han hose li ing wi h hei amilies. Pa icipan s also sugges ed ha occasionally, o su i al easons, MSAFW’s eso ed o socially unaccep able ood-hoa ding s a egies, such as s ealing ood o ea ing dog mea in he se lemen s. We ge newcome immig an s, bu hey ha e amily he e al eady … Thei die is usually a bi be e , bu he ones li ing in he camps don’ usually ge any amily suppo , hey don’ ha e he suppo om a iend. So hen hei die is e y limi ed. (E4, P ima y Ca e Physician, Heal hca e, Andalusia) Cul u al di e ences among MSAFW’s The in e iewees no ed ha ood consump ion a ied acco ding o he o igin o he MSAFW’s. They explained ha MSAFW’s wo king in he Spanish camps we e mainly om he Magh eb p o inces, especially Mo occo, and sub-Saha an A ica; while he o me a e meals wi h a a ie y o oods (mea , ege ables, and hei adi ional ood) and indi idual ea ing p ac ices; he la e a e low-cos , inexpensi e ood (such as ice o b eak as , lunch, and dinne ) as hey canno a o d o buy mea due o i s high p ice, and end o eso o communi y o ganiza ional s a - egies o educe ood cos s, such as making e e yday pu chases o sacks o ice ha hey cook oge he . No h A icans ha e a di e en a i ude, hey espec p i acy mo e … Making a communal la ine, sha ing he cooking spaces and all ha is much mo e common among Sub-Saha ans han among No h A icans. No h A icans look o mo e p i acy. I hey ge a oom, hen hey’ll ha e a cooke , hei ke le, hey ha e e e y hing in hei own oom … (E12, P ojec coo dina o , NGO, Mu cia) In his sense, he in e iewees explained ha some imes he ood dis ibu ed by NGOs is no he mos app op ia e and could be ejec ed by MSAFW’s i i is no conside ed cul u ally accep able o i hey need o lea n how o cook i . Then, he impo ance o conside ing p e e ences when dis i- bu ing ood was highligh ed. I ’s a bi o a p oblem o us some imes, when we go a ound gi ing ou ood. Because, o example, we’ll gi e hem beans and people don’ know how o cook hem. So he e’s no poin in gi ing hem ha . Then we ha e o conside hings like ha when we gi e ou ood. (E6, Nu se, Heal hca e, Andalusia) They won’ ea his ype o ood and hen his ood ge s h own away. Appa en ly, a lo o i goes o was e. (E54, Media o , Ci yhall, Ca alonia) Nu i ion- ela ed heal h p oblems o MSAFW’s Risky die a y p ac ices- ela ed isky p oblems o MSAFW’s The in e iews e ealed se e al ailmen s and heal h p oblems a ising om sca ci y o ood and poo hygienic p ac ices. The pa icipan s iden i ied diges i e p oblems, such as s omach ache o gas o- en e i is, and o al p oblems among he MSAFW’s. This si ua ion was especially acu e in i egula se lemen s whe e many MSAFW’s li e in unsani a y condi ions. They ela ed i o an unheal hy die , li le a ie y in hei ood, and a lack o hygiene. Fo ins ance, in e iewees in e ed ha omi - ing, i ching, headaches, and s omach pain could be due o ea ing unwashed ui exposed o pes i- cides, con amina ed wa e , and sani a y p oduc s. And hen s omach aches o s omach discom o , omi ing … […] They say i chy, i chiness, a lo o i , head- aches, and especially i ching, and s omach aches, s omach … Because hey ea ui , some imes hey won’ wash i . (E9, Nu se, Heal hca e, Ca alonia) 6 L. A. RODRÍGUEZ-GUERRERO ET AL. On he one hand, o he heal h p oblems desc ibed among MSAFW’s we e skin and eye p oblems ela ed o i amin de ici s. E en some in e iews iden i ied ha MSAFW’s unheal hy die could ac as a p ecu so o p oblems such as hype choles e olemia, kidney disease, and diabe es – which in u n could be unde -diagnosed; In women, we did see some signi ican nu i ional de ici s, some o hem, o ins ance, ha e de eloped skin o ocula condi ions … (E4, P ima y Ca e Physician, Heal hca e, Andalusia) Thei die s a e e ible. So hey ge choles e ol p oblems e y ea ly on, a a e y young age, and kidney issues. Righ ? And so I hink we’ e s ill a he beginning, so we’ll see a wa e o ch onic condi ions ha a e ypical o ma ginalized popula ions … (E24, Ac i is , Andalucía) On he o he hand, o he in e iewed p o essionals indica ed ha nu i ional diso de s in MSAFW’s we e sca e. We hough ha maybe he disease, diabe es, could be mo e p e alen in hese people, whe e we hink i could be linked o hei die s; hey d ink lo s o suga y be e ages, hey ha e lo s o ca bohyd a es. (E6, Nu se, NGO, Andalusia) Discussion P o essionals suppo ing MSAFW’s iden i ied hem as a isk o expe iencing challenges in he ood supply in Spain. Acco ding o he esul s, he pandemic posi i ely impac ed, c ea ing a g ea e syne gy be ween NGOs and public ins i u ions. Mo eo e , he deploymen o ood aid and e e al o speci ic ood aid mechanisms du ing he pandemic was a bene icial s a egy o educe ood sca - ci y and ackle s uc u al ba ie s like ma e ial po e y, accessing esou ces, and cul u al cha ac e - is ics o MSAFW’s. The esul s could be explained h ough he lens o he concep ual amewo k o Weise e al. (2015). Acco ding o his model, challenges in ood supply con ibu e o ood insecu - i y by ac ing a h ee le els: a communi y-s uc u al le el, a household-beha io al le el, and an indi- idual le el. The e is an in e ela ion be ween hese le els, whe e challenges o ood supply igge ood insecu i y, shape nu i ional beha io , in luence physical heal h, and ha e epe cussions on mo bidi y and mo ali y (Weise e al., 2015). A he communi y-s uc u al le el, he cons an demand o ood aid by MSAFW’s seems o be a consequence o he pa e n o ag icul u al seasons in Spain ha encou ages mo emen be ween egions (Ma in, 2016). The e o e, ood subsidies a e a necessa y sus enance, no a empo a y elie measu e. Al hough ood dis ibu ion sys ems a e a suppo ne wo k, hey a e unable o espond o all he die a y demands and needs o MSAFW’s on hei own (Baze ghi e al., 2016). Al hough mainly NGOs a e esponsible o p o iding di ec ood suppo h ough solida i y and dona ions, his s udy has iden i ied collabo a i e wo k wi h public ins i u ions, such as local go - e nmen s. Tha was he case, o example, in esponding o he needs o MSAFW’s du ing he i s wa es o he COVID-19 pandemic. The measu es aken o con ain he COVID-19 ou b eaks led o an imp o emen in baseline le els o hygiene in some se lemen s ha lacked basic se ices (Cockbu n, 2020). Howe e , his join esponse has unc ioned as a coping s a egy in esponse o he high demand o suppo ha collapsed aid sys ems (Güell & Ga cés-Masca eñas, 2020). E i- dence om he USA, whe e simila s a egies ha e been adop ed, indica es ha some o he changes in oduced ha e no necessa ily been sus ained o e ime (Acco si e al., 2020). A he household-beha iou al le el, he MSAFW’s economic p ojec ocuses on sa ing as much as possible a he expense o hei ood and ma e ial needs. Economic ma ginalisa ion, esul ing om wo king condi ions, esul s in equi ing suppo o mee hei ood needs (Rod íguez e al., 2021). Also, he epo ed ood was age by some MSAFW’s may be a consequence o cul u al di e - ences, such as un amilia i y wi h local ood and a lack o means o knowledge o ood p epa a ion, as has been epo ed in a s udy in Canada wi h a No h A ican popula ion (Hassan & Hekma , 2012). In his ega d, he s a egies used o cope wi h hunge , like ood sha ing and ecei ing GLOBAL PUBLIC HEALTH 7 dona ions desc ibed in sub-Saha an A icans, we e p e iously epo ed in o he con ex s o ex eme po e y o ace challenges ela ed o ood sca ci y (Mbhenyane e al., 2020). Mo eo e , ood accep ance migh depend on cul u al ac o s such as ma ied s a us, which has been iden i ied as a egula o o adhe ence o a mo e adi ional die in No h A ica (El Rhazi e al., 2015). In sub-Saha an A icans, ac o s such as inaccessibili y o adi ional ing edien s esul in accul u a ion o a mo e high-calo ie Wes e n die (Renzaho & Bu ns, 2006) ha migh no be ob ained in he ood aid se ices epo ed, as ou da a poin ou . These ac o s mus be conside ed o p o ide success ul ood aid se ices ha educe ood sca ci y. A he indi idual le el, heal h p o- blems such as o al heal h ha e been p e iously linked o MSAFW’s poo die in he USA (Kiehne & Mendoza, 2015). As iden i ied in he esul s, cons ipa ion and diges i e p oblems ela ed o an as ingen die ha e been ela ed o condi ions o po e y, wi h lowe expendi u e on high- ib e oods, such as ui and ege ables (D ewnowski & Spec e , 2004). None heless, a lack o access o he heal h sys em ansla es in o a highe incidence o heal h p oblems, such as diabe es (Quand e al., 2018). In con as , in Spain, access o he na ional heal h sys em is uni e sal, al hough he e may be o he ba ie s (Be nal-Delgado e al., 2018). The absence o delay in he diagnosis o me abolic p oblems such as dyslipidaemias, diabe es, o neph opa hies could be due o he lack o diagnos ic se ices in p ima y heal h ca e (Bawadi e al., 2012; Gil- González e al., 2015; Sa ía-San ame a e al., 2016). This could be explained because an absence o p e en i e heal h educa ion, which leads o igno ing he signs o he onse o me abolic diseases, has been documen ed (Sa ía-San ame a e al., 2016; U ego-Pa a e al., 2022). In u n, e idence indica es ha he g ea e he numbe o a ms whe e MSAFW’s wo k, he highe he incidence o diseases ela ed o pes icide and chemical con amina ion (Edelson e al., 2018). Heal h p omo ion ac ions a e equi ed o educe he impac o pes icides in he ood MSAFW’s consume. Mo eo e , a he communi y le el, MSAFW’s migh ha e me hei die a y needs by accessing eme gency ood esou ces, such as ood banks (Baze ghi e al., 2016). E idence om he USA sugges s ha when MSAFW’s a e bene icia ies o p og ams aimed a educing ood sca ci y, he e is an inc ease in die a y knowledge and an imp o emen in hei ea ing habi s (Lee & Won, 2015). Howe e , me abolic heal h p oblems unde epo ed by p o essionals in ou da a could be ela ed o he age o debu o me abolic diseases (Olson e al., 2023) o o expe iencing ba ie s in accessing heal hca e due o incompa ibili y o wo king hou s wi h heal h ca e se ices schedules (Caxaj e al., 2023). Fo example, in Mexican MSFW, only 3% epo ed me abolic heal h p oblems, possibly due o a lack o p ima y heal hca e access and low-quali y and unhygienic nu i ional se ices (O ega e al., 2016). In addi ion, in he U.S., MSAFW’s wi hou ecen heal hca e access had 83% lowe odds o epo ing known diabe es in compa ison o nonmig an a mwo ke s (Olson e al., 2023). Gua an ee access o p ima y ca e heal h is essen ial o co ec ly diagnose heal h p oblems in MSAFW’s. Limi a ions and s eng hs The limi a ions o his s udy include ha , i s ly, he in o ma ion epo ed wi hin is no exemp om a possible memo y bias o pass o e speci ic in o ma ion om p o essionals in ol ed in ea - ing MSAFW’s. Since speci ic in o ma ion ela ed o he age o he MSFWs was no discussed among he pa icipan s, he young age o mos o he MSFWs wo ke s migh lead o an unde -diagnosis o he expec ed a es o ch onic disease and heal h p oblems. The nex s ep would equi e pe o ming a de ailed die assessmen o Spanish MSAFW’s o measu e he consequences o he challenges ela ed o ood access and i s impac on heal h. Secondly, he esul s a e limi ed o he ou a o e- men ioned Spanish egions, al hough hey can be conside ed he mos ep esen a i e egions in e ms o he p esence o MSAFW’s. E en hough no gende di e ences ha e eme ged, e idence indica es ha emale MSAFW’s ace mo e challenges ela ed o ood accessibili y and ha e a mo e signi ican unpaid wo kload associa ed wi h ca e asks ela ed o ood acquisi ion and p epa - ing ood o hei amily compa ed o men (Kiehne & Mendoza, 2015). 8 L. A. RODRÍGUEZ-GUERRERO ET AL.