Farming activities contribute to soil antibiotic pollution, posing health risks for rural farm workers, especially on small farms in impoverished regions. The effectiveness of large farms in reducing poverty-induced soil antibiotic exposure risk (SABER) remains uncertain. Here we integrate global datasets on concentration of soil antibiotics, rural farm-worker employments and on-farm working hours to quantify SABER. We find that exposure-weighted relative populations are concentrated in underdeveloped regions, particularly East Africa and South and Southeast Asia. A 1,000 ha farm is optimal for SABER reduction, farm employment and working hours, outperforming both smaller and larger farms. Establishing large farms in the top 20% of priority areas can cover 47.3-75.5% of SABER hotspots, while establishing large farms in the top 44% of priority areas achieves the highest coverage of SABER hotspots without substantial declines in rural employment. This approach offers practical strategies to mitigate SABER while maintaining rural farm-worker employment.
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