David Garcia fulfills a promise by working for health justice

David Garcia promised his grandmother this: if there was anything he could do to improve conditions for their people, migrant farmworkers, he would do it.

"That's why I'm here," said the associate dean for community, health equity, and belonging at the Elson S. Floyd College of Medicine at Washington State University.

Garcia is proud to come from a family and community of people who immigrated from Mexico to the United States. Many of his family members worked in the fields, as did Garcia for a time.

His upbringing was a beautiful example of the power of community, he said.

"The concept of 'I' is something that was never really taught to us. It was always about 'we.' If we had anything, we shared it. If we had open space in our house, we had someone staying with us." With community, progress was possible despite structural and systemic barriers.

But it was also a hard life, one that takes a toll on a person's health. Access to quality health care was not great. Garcia's grandmother was injured working in the fields, but didn't get the right care and ended up bedridden during some of the most significant years of her life. That's when he promised he'd take action if he could.

At the WSU College of Medicine, he's in a position to do that.

One of Garcia's jobs at the college is to bring attention to health inequities that still exist between groups of people. Agricultural workers experience high rates of work-related injury, for example, and face exposure to heat, smoke, and pesticides. Farmworkers were disproportionately affected by the COVID-19pandemic.

This isn't a matter of interpretation. "We have all the evidence we need when it comes to people living shorter and unhealthier lives than others," he said.

Approaches to the problems must be multifaceted. Partnering with communities, listening to them, and learning what they need. Recruiting students, staff, and faculty from rural and historically minoritized communities. Educating all future healthcare providers so they have the skills and desire to serve patients in traditionally underserved areas. Supporting research that targets health inequities.

The Elson S. Floyd College of Medicine prioritizes all of these, with the goal of helping all people reach optimal health and well-being, Garcia said.

"It's what drew me here in 2018 and keeps me here," he said. "We recognize that so much of what makes up health is outside the walls of clinics, and we're always thinking about what we can do to improve that."

One of Garcia's initiatives has been the Health Justice & Belonging Conference held in February. The free, virtual event highlights teaching, scholarship and research, and successful practices. It drew more than 500 people this year and is expected to have more than 1,000 participants in 2025. It's open to anyone, not just health care professionals.

So, has health care improved for Washington's agricultural workers? What would Garcia tell his grandmother today?

In some areas there have been advances, through telehealth, street medicine, and community-informed practices, he said. In other areas, inequities not only exist but have increased and need to be addressed with urgency.

The work continues. Said Garcia, "For me, it is important to remain steadfast in doing whatever we can to ensure things are getting better."