Occupational hierarchy, racialization, and COVID-19 health outcomes among meat processing plant workers in Alberta: a community-engaged mixed-methods study
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Background
Meat processing plants in Alberta, Canada experienced among North America’s largest COVID-19 outbreaks. We examined health impacts among workers by occupational hierarchy and equity-relevant characteristics.
Methods
This exploratory sequential mixed-methods study was guided by community-based participatory research and the PROGRESS-Plus framework. Multilingual qualitative interviews and surveys using validated instruments were conducted among meat plant workers who experienced outbreaks. Interviews were analysed using inductive-deductive thematic analysis. Multivariable logistic regression and linear regression estimated associations between occupational group, racialization, facility, and self-reported COVID-19 diagnosis, physical and mental health, and mean Everyday Discrimination Scale score. We integrated findings using joint displays.
Findings
Qualitative and integrated analysis of thirty-six interviews described occupational hierarchy shaping unequal protection, limited communication, constrained agency, and psychosocial harms, amplified by income insecurity and family separation. Among 187 survey respondents, compared with general labour, skilled labour (aOR 0·38; 95% CI 0·15–0·89) and management (aOR 0·13; 95% CI 0·01–0·75) had lower odds of reported COVID-19 diagnosis. Compared with Black workers, other racialized workers had lower odds of reporting fair or poor mental (aOR 0·24; 95% CI 0·09–0·58) and physical health (aOR 0·20; 95% CI 0·06–0·54). Compared with workers from the primary facility, others reported lower mean everyday discrimination scores (β = –0·54; 95% CI –0·96 to –0·12).
Interpretation
COVID-19 harms followed workplace social hierarchies. Pandemic preparedness should combine infection-control measures with paid sick leave and income protection, multilingual communication, enforceable anti-discrimination standards, and independent reporting mechanisms.
Funding
Canadian Institutes for Health Research (CIHR Application no. 469206).
Research in Context
Evidence before this study
We searched PubMed/MEDLINE, Scopus, and Web of Science from June 2020 to December 2025, using terms for COVID-19, meat processing, meatpacking, occupation, and workers including migrants, racialized workers, refugees or immigrants for empirical studies published without language restrictions. Existing studies showed that meat processing plants were sites of occupational COVID-19 outbreaks and that immigrant and racialized workers experienced disproportionate infections and adverse health outcomes. The literature described pre-existing structural vulnerabilities in these settings including crowded working conditions, inadequate occupational protections, and barriers related to language, job security, and access to health information. These inequities intensified during the pandemic, leading to disproportionate infection rates, morbidity, mortality, and psychosocial stress.
Added value of this study
This exploratory sequential mixed-methods study used the PROGRESS-Plus framework and a community-based participatory research approach to examine COVID-19-related health impacts after large outbreaks among meat processing plant workers in Alberta, Canada. By integrating multilingual qualitative interviews with quantitative survey data, the study identified how occupational hierarchy, racialization, and processing plant shaped self-reported COVID-19 diagnosis, physical and mental health, and experiences of discrimination. The study also centres workers’ perspectives to show how workplace hierarchy, unequal communication, and limited agency contributed to health inequities during the pandemic.
Implications of all the available evidence
Previous and current findings suggest that COVID-19 harms in meat processing plants were shaped by pre-existing structural and workplace inequities rather than by exposure alone. Working conditions in large meat processing plants were already difficult for immigrant and racialized workers, particularly those in labour-intensive roles, and the COVID-19 pandemic exacerbated existing health inequities. Preparedness and response in high-risk industrial settings should therefore combine infection-control measures with multilingual communication, stronger worker protections, explicit anti-discrimination safeguards addressing ethnicity, language, and gender, and material supports that reduce the need to work while ill.
