Occupational Syndemics in Farmworkers in the Cape Winelands, South Africa

Occupational exposures in the agricultural industry globally have been associated with heightened risk for several diseases. Reports written in South Africa in the last decade have raised awareness of the harsh occupational conditions and human rights abuses suffered by farmworker communities in the wine industry. Despite receiving "fair trade" labels upon reentry into the global market in the 1990s, the working conditions on wine farms in South Africa have remained unchanged and exploitative for centuries. Farmworkers remain dependent on substandard farm housing, have insecure land tenure rights, are exposed to toxic pesticides, are denied access to benefits and unionization, and endure long working hours in harsh environmental conditions with low pay. These occupational conditions are linked to interacting disease clusters: metabolic syndrome, problematic drinking, and communicable diseases including tuberculosis, HIV, and COVID-19. This milieu of interacting diseases with deleterious outcomes is an under-considered occupational syndemic that will likely worsen given both the lasting impacts of COVID-19 and more recent shifts in global public health funding.