Paul Gunderson, Ph.D. Emeritus
Marshfield Medical Research Foundation
of Marshfield Clinic
Kelley J. Donham, M.S., D.V.M.
College of Public Health, University
of Iowa
Julia F. Storm, M.S.P.H.
College of Agriculture and Life
Sciences
North Carolina State University
A four-part
action oriented process, called “Agricultural Occupational and Environmental
Health: Policy Strategies for the Future” was initiated in Iowa in 1988. This three-year process involved a broad
representation of members of the relevant scientific community and farm
constituency in the United States. This
consensus-based process brought about substantially greater recognition of
agricultural health and safety as an important public health issue in the
United States. As a result, greater resources were directed to address the
issue. Among many accomplishments, the
process achieved new funding for the National Institute of Occupational Safety
and Health (NIOSH) to initiate an agricultural health and safety initiative. It
was also influential in facilitating the development of other areas of
agricultural health and safety work, such as the Kellogg agricultural health
and safety initiative and the Agricultural Health Study. The most visible piece of the process, the
proceedings document entitled Agriculture
At Risk: A Report to the Nation, described the situation and outlined
specific recommendations. This report title shall hereafter refer to the entire
three-year process and the results.
The
Agriculture at Risk process was initiated because of the magnitude of the
problem, and the lack of resources available to address the problem. At the time, there was no policy on the issue,
and there was little medical or public health involvement. Additionally, there was a need for an
interdisciplinary effort joining medical, public health, Extension, and other
professionals to identify and solve problems.
This paper
reviews in detail the specific objectives and processes of Agriculture at
Risk. The outcomes are reviewed,
including the formation of the National Coalition for Agricultural Safety and
Health, the NIOSH agricultural initiative, and the Surgeon General’s Conference
on agricultural safety and health.
The authors
evaluate each recommendation outlined in Agriculture at Risk relative to the
degree of accomplishment. Furthermore,
the limitations of the process and accomplishments are reviewed, such as the
exclusion of forestry and fisheries.
A summary
and conclusions, including the authors’ perspective on future directions for
the first decade of the new millennium relative to changing agricultural
demographics, the growth of industrial agriculture, and changing technologies
is presented.
WOMEN IN AGRICULTURE:
RISKS FOR OCCUPATIONAL INJURY WITHIN THE CONTEXTS OF ROLE
AND HADDON’S INJURY MODEL
Carrie A. McCoy, Ph.D., M.S.P.H., R.N.,
C.E.N.
Northern Kentucky University
Ann K. Carruth, D.N.S., R.N.
Southeastern Louisiana University
Deborah B. Reed, Ph.D., M.S.P.H.,
R.N.C.
University of Kentucky
This paper
examines exposure to occupational injury producing events among women within
the context of role and Haddon’s Injury Model.
According to the 1998 Statistical Abstract of the United States, 23% of
farm operators and managers and 19% of farm workers were female. Until recently
few studies have focused on occupational injury in farm women. Sociologists
suggest that contributing factors may be the gendered division of labor on
farms and the invisibility of farm women’s work. This gendered division of
labor is culturally mediated and influences the types of farm tasks performed
and subsequent exposure to agents of injury. Role, commodity and economics all
influence the number and types of farm tasks. Women on farms are exposed to a
multitude of biologic, chemical, physical, and mechanical agents while
performing farm tasks. Whether these
exposures result in an injury outcome is dependent upon factors intrinsic to
the individual (host), a catalyst that produces the outcome (agent), and
external factors (environment). Research to date has focused on the injury
event. There is a lack of studies examining both the pre-event phase, and the
interaction between host, agent, and environment among women in agriculture.
Barbara C. Lee, Ph.D.
National Farm Medicine Center
Barbara L. Marlenga, Ph.D.
National Farm Medicine Center
This past
decade had witnessed considerable attention to the persistent problem of
childhood agricultural diseases and injuries.
While this topic was not specifically addressed in the 1987 Agriculture at Risk report, there have
been multiple efforts at regional and national levels since that time. Most notable activities have been the
development and implementation of the 1996 national action plan, funded
primarily through federal funds – including federal agency coordination, injury
surveillance, research, and intervention evaluations; development of the North American Guidelines for Children’s
Agricultural Tasks released in 1999; and the implementation of grass-roots
farm safety for youth programs funded by agribusinesses and individual
donors. While considerable efforts have
addressed educational approaches, there are few comprehensive evaluations to
confirm their efficacy. Momentum for
using public policy approaches may be mounting but this approach remains
controversial and would encounter considerable resistance. Childhood disease and injury prevention
remains a complex issue because of the wide diversity of issues such as
residency, tradition, parenting practices, status of child working versus
bystander or visitor, child labor laws with multiple exemptions, and spectrum
of adverse exposures. Future directions
will be influenced by the changing role of children associated with the
industrialization of agriculture and globalization of trade.
OLDER FARMERS: FACTORS
AFFECTING THEIR HEALTH AND SAFETY
Maria C. Hernandez-Peck, Ph.D.
Center for Studies in Aging
School of Social Work and Human
Services
Eastern Washington University
Agriculture
has been recognized as one of the most hazardous occupations in the United
States. In an industry where according
to the 1997 Agricultural Census, an estimated 500,000 farm workers, 1/4 of all
farm operators are 65 years of age or older, age becomes a serious factor when
considering potential risk for injuries among this population. Because no mandatory retirement age exists
for older farmers, many may continue to perform some tasks beyond their ability
to safely accomplish their work.
Older
farmers have been said to be a “special needs population that needs recognition
and attention.” To date, however, this
particular group has been underrepresented within the research literature
dealing with Farm Health and Safety.
This White Paper seeks to highlight currently available research
literature on older farmers. Areas to
be addressed include, the work histories of older farmers, factors involved in
their decisions to retire, lifetime experiences with farm accidents, existing
chronic health conditions, and access to health care.
In
addition, need for further research, not only on the subject of Farm Health and
Safety, but on the topic of successfully aging in place within rural
communities will be highlighted. The
need to connect with already established community based service networks under
Older Americans Act to enhance successful aging will be addressed.
Barbara McCarthy, Ph.D.
Colorado State University
AGRICULTURAL
HEALTH AND SAFETY AMONG MINORITY POPULATIONS
Giulia Earle-Richardson, M.P.H.
Northeast Center
New York Center for Agricultural Medicine
and Health
Describing
the agricultural health and safety risks of a population that is defined
primarily by what it is not is a daunting task. The term "minority" refers to all farm owners,
employees and temporary laborers who are not Caucasian of Northern European
descent. Available research to date
provides little data on the health and safety risks to minorities in
agriculture.
While
concerns about differences in risk among minority populations are appropriate,
it is important to acknowledge that for minorities, as with majority
populations, occupational hazards are a function of what work is
undertaken. Risk varies to the extent
that distribution of tasks varies and to the extent that similar work is done
in different ways. Research on risk to
minorities should focus on sociologic and economic factors that explain these
variations.
Analyses of
national occupational fatality data by race and role on the farm have shown
elevated rates of fatality among black farmers, and conflicting evidence with
regard to other minorities. The challenge for researchers will be to
characterize work tasks for these groups in more detail as well as other
factors that might explain any observed risk differences.
The paper
will identify key agricultural tasks done ethnic and racial minority groups and
review existing research on majority / minority occupational risk in these
areas. In addition, ongoing prevention
activities to serve these sectors and groups will be described.
William E. Field, Ed.D.
Department of Agricultural and
Biological Engineering
Purdue University
Paul Jones
Breaking New Ground Resource Center
Purdue University
The Amish
and other Old Order Anabaptists have been inseparably linked with agriculture
since first coming to America in the 1700s. However, few efforts have been
identified which analyze the issues involved with Old Order Anabaptist farm
injuries or present best practices for addressing these problems. As part of an
effort to develop culturally appropriate and effective injury prevention strategies
for use within the Old Order Anabaptist community, this article identifies
important cultural issues that should be considered in understanding and
attempting to reduce farm injures in this population, summarizes statistics
concerning farm related fatalities among Old Order Anabaptists, and discusses
methods which have been effectively used to address farm injuries within these
communities. As this population continues to double approximately every 22
years, the implications of farm-related safety and health issues among Old
Order Anabaptists will become increasingly significant in relation to the
larger agricultural community.
Kendall M. Thu, Ph.D.
Northern Illinois University
I describe
the emergence of research examining linkages between large-scale swine
operations and the health of neighbors. I specifically outline recent public
research as they relate to research traditions examining interior occupational
health issues among workers in confinement operations and exterior emission
issues as odor nuisances. I then characterize and discuss recent research that
assesses constellations of health symptoms reported at significantly higher
rates among exposed neighbors. I also discuss public policy consequences of
recent research that indicates neighbors are experiencing health problems as
the results of exposure to large-scale swine operations.
THE RESPIRATORY INFLAMMATORY RESPONSE
TO THE SWINE CONFINEMENT BUILDING ENVIRONMENT
Susanna Von Essen, M.D., M.P.H.
Department of Internal Medicine
Pulmonary and Critical Care Medicine
Section
University of Nebraska Medical
Center
Debra Romberger, M.D.
Department of Internal Medicine
Pulmonary and Critical Care Medicine
Section
University of Nebraska Medical Center
Swine
confinement facility workers often develop respiratory problems secondary to
their work, including acute bronchitis, the asthma-like syndrome, exacerbation
of asthma, chronic bronchitis and mucuous membrane irritation syndrome. Organic
dust toxic syndrome is seen in these workers as well. Swine confinement barns are characterized by the presence of
multiple factors that can cause respiratory tract and systemic inflammation symptoms, including dust, endotoxin and
ammonia. Investigators have found
evidence of inflammation characterized by increased numbers of neutrophils,
macrophages and to a lesser degree,
lymphocytes in both naïve subjects and swine confinement building workers.
Interestingly, this inflammation is most pronounced in subjects with no prior
exposure to this environment. This
finding raises the question of whether or not tolerance to endotoxin or other
substances in this environment is induced after repeated exposures. There is a
great need for implementation of feasible interventions for reduction of the
risk of having symptomatic respiratory disease as a result of working in a
swine confinement facility.
Melvin L. Myers, M.P.A.
Consultant
The
agricultural tractor was the principal source of fatal injury on American farms
for the latter part of the 20th century, and they maintain that distinction
today. Much has been learned about the toll of these fatalities and how to
prevent them over the last ten years, yet public policy has generally been
unsuccessful in reducing this toll. A policy conference entitled, Tractor Risk
Abatement and Control, convened in 1997 to develop recommendations to reduce
this death toll. Several stakeholders at the conference agreed on twenty-five
action items, which if implemented would reduce the number of tractor-related
deaths by more than 2,000 by the year 2015. These items relate to tractor
overturns, runovers, and traffic collisions as well as youth operators.
Priorities for action include increasing the number of retrofit designs of
roll-over protection structures for old tractors, intervening in discussion
groups on the internet regarding tractor safety, and establishing regulations
to improve tractor safety on the public roads. In addition, economic incentive
programs need to be established, as do social marketing programs that raise
social norms for recognizing unsafe tractors and their operation.
Therese Willkomm, Ph.D.
National AgrAbility Project
University of Wisconsin-Madison, Cooperative
Extension
Nationwide,
approximately 500,000 farmers, ranchers and other agricultural workers have
physical disabilities that interfere with their ability to perform essential
farm tasks due to injuries, illnesses or other health related conditions. For
many individuals disability jeopardizes their rural and agricultural futures.
In the 1990 Farm Bill, Congress authorized the establishment of AgrAbility to
provide education and assistance to individuals affected by disabilities and
who are employed in agriculture. Since
1991, AgrAbility Projects in 24 states have assisted more than 10,000 farmers
nationwide in continuing this rural way of life. The program engages extension
educators, disability experts, rural professionals and volunteers in offering
an array of services including: on-site technical assistance on worksite
modifications to accommodate for the disability; education to prevent further
injury and disability; training to extension educators and rural professionals
to upgrade their skills in assisting farmers with disabilities and developing
and coordinating peer counseling networks. The incidence of disability on the
farm continues to increase. Changes in
agriculture present on-going unique challenges to farmers and ranchers affected
by disability. Innovative strategies are needed to achieve success and to
support the choice to continue in agricultural production. Newer assistive
technologies will promote prevention or reduction of secondary injuries.
INFLUENCES OF DISABLING CONDITIONS ON
THE NATURE
AND FREQUENCY OF FARM/RANCH-RELATED INJURIES
William E. Field, Ed.D.
Department of Agricultural and
Biological Engineering
Purdue University
Aaron Yoder, M.S.
Agricultural Safety and Health
Program
Department of Agricultural and Biological Engineering
Purdue University
Douglas Kingman, M.S.
Agricultural Safety and Health
Program
Department of Agricultural and
Biological Engineering
Purdue University
Agricultural
production remains one of the most hazardous occupations in the United States
(Accident Facts 2000). Studies done approximately 20 years ago found that
approximately 65% of reported farm-related injuries were severe enough to cause
temporary disability, almost 2% resulted in permanent disability (Hanford, et.al.,
1982), and about 17% of farm operators had disabilities that prevented them
from completing essential farm work-related tasks (Tormoehlen, 1982). More
recent studies (Whitman, 1995) suggest that the incidence of disabilities have
not changed substantially and as the mean age of farm operators has continued
to increase, the incidence of disabling conditions due to age-related diseases
such as arthritis, heart disease, impaired vision and loss of hearing, may have
increased. The impact of disabling conditions on the frequency and nature of
farm workplace injuries is not well understood and little has been published on
the topic. There are, however, a significant number of farm operators and
workers who may be exposed to increased risk of injury, including secondary
injury, due to physical or mental limitations that impair judgment, behavior,
physical mobility, response time, hearing, sight, touch and other human
capacities. The focus of this paper will be to address the known
characteristics of those working in agricultural production who are at risk due
to physical or mental limitations, how these limitations translate into
increased risk of injury, suggestions for intervention strategies that could
reduce the risk and recommended areas for future research.
Michael R. Rosmann, Ph.D.
Sharing Help Awareness United Network
Not only is
farming dangerous in terms of occupation-related physical injuries, illnesses
and fatalities, but farming also is associated with high risk for serious
mental health disorders. The suicide
rate of farmers and farm workers is well above average during normal economic
conditions, and rises to between two and three times the national average
during economically stressful times.
Yet the mental health of farmers, farm workers and their families is one
of the most neglected areas of scientific endeavor and service provision. There is a paucity of mental health
professionals in rural areas and even fewer who are culturally competent to
serve farmers and ranchers.
To address
these knowledge and service gaps, research and service programs are needed to
reduce barriers to effective mental health and substance abuse treatment for
farmers and ranchers. Specifically,
Sharing Help Awareness United Network, in collaboration with the National
Association for Rural Mental Health, has begun assimilating scientific
knowledge into a textbook and curriculum to train mental health professionals
to serve the agricultural population.
Outreach workers, who are farm men and women, and telehealth are being
utilized. Agricultural mental health
concepts also are being integrated into the training of nurses and physicians
at the University of Iowa's Agricultural Occupational Health Training program.
This paper
summarizes progress in agricultural mental health and proposes a nationwide
mental health support program for all persons engaged in agricultural
production.
Rich Fenske, Ph.D.
University of Washington
FACING
THE CHALLENGES OF AGRICULTURAL TECHNOLOGY AND ITS IMPACT ON HEALTH
Teresa Niedda, M.A.
The Farmworker Health and Safety
Institute
Joan Flocks, J.D.
University of Florida
It is often
stated that the current state of agricultural health and safety is not adequately
resolved. Yet, as food production shifts from small farms to agribusinesses and
our food system becomes increasingly consolidated, a whole new set of potential
health hazards is emerging.
Corporations are focusing on large-scale production, mechanization,
monoculture operations and biotechnology as a means to provide an abundant and
low cost food supply while increasing their bottom line. Yet, there is little discussion of the
potential health and safety effects caused by this trend on both those who work
in the industries and those who consume the products. Higher crop yields and rapid farm animal growth can lead to a
greater dependence on pesticides and antibiotics. Genetically altered crops may produce new forms of allergens and
toxins. The use of industrial sludge as fertilizer and the proposed use of low
level contaminated soil from nuclear power plants on our nation's farmlands may
have severe, unforeseen dangers.
Alternative solutions need to be explored in order to preserve the
health and safety of all.
MIGRANT AND
SEASONAL ADOLESCENT FARMWORKERS: NEW CHALLENGES
Martha S. Vela Acosta, M.D., M.S.,
Ph.D.
National Farm Medicine Center
Migrant and seasonal farmworkers perform essential labor in
producing food, contributing to the farm economy. This workforce persists as an under-served and understudied
population facing numerous conditions that increases their risks of developing
work related injuries and illnesses. Efforts to date have primarily focused on
adult farmworkers, yet many adolescents are employed in agriculture. The total adolescent workforce (12 to 17
years old) in agriculture continues to be uncertain. The National Agricultural Worker's Survey (NAWS) data estimates
that about 128,000 14 to 17 year old farmworkers were working in crop
production each year (1993-1996). Demographics of adolescent farmworkers based
in NAWS data accounted 7% of migrant workforce in crop agriculture.
The National Children's Center for Rural and Agricultural
Health and Safety has a new consensus development initiative, generating
recommendations for working conditions of adolescent farmworkers. This research process involves critical
input from agricultural employers and encourages open dialogue from groups with
diverse perspectives, such as migrant advocates, farmworkers, agricultural
employers and researchers. A complete
report with recommendations is expected by Spring 2001. Future issues for adolescent farmworkers
require to address their housing, transportation, recreation and sociological
needs.
Health
and safety issues among non-migrant adult farm workers
Lorann Stallones, M.P.H, Ph.D.
Colorado Injury Control Research
Center
Department of Environmental Health
Colorado State University
The purpose
of this paper is to discuss health and safety issues for adult farm workers in
the United States who are not migrant workers.
The agricultural work force is diverse, with farm operators representing
approximately 35% of the total population in 1987. Some farm operators also hire themselves out for wages to other
farmers. In 1987, unpaid agricultural
workers included 2.9 million people, comprising the largest percentage of the
agricultural work force (37%). Hired
workers, not including migrant and undocumented foreign workers, comprised 28%
of the agricultural workforce (2.2 million people). With the shift toward larger farms, hired labor use has become
concentrated on larger farms in California, Texas, Florida, Washington,
Wisconsin, North Carolina, and Pennsylvania accounting for almost half of hired
labor expenditures. Unpaid and domestic
hired farm workers are predominantly young males. Unpaid workers had relatively high educational attainment, while
paid workers had lower educational status. Farm work for hired workers is sporadic,
frequently unstable, and of short duration, with only one-fifth of the workers
being year-round employees. Hired
workers are involved in a wide range of activities including sugarcane, strip
and baling tobacco, herding sheep, combine operation, milking, shearing
Christmas trees, stocking catfish ponds, and farm management. Although this population contributes
significantly to agricultural production, they have rarely been considered in
research related to agricultural safety and health. Most studies provide information on farmers and some work has
specifically addressed migrant workers, but there are relatively few studies
that provide data separately for this portion of the agricultural
workforce.
Larry Chapman, Ph.D.
Department of Biological Systems
Engineering
University of Wisconsin
Jim Meyers, Ph.D.
Center for Occupational and
Environmental Health
University of California at Berkeley
Farmers and
farm workers face risks of work-related musculoskeletal injury and disease
ranking among the highest in the nation.
While the problem is little recognized within or without agriculture
there is growing evidence that these potentially permanently disabling injuries
can be readily prevented with attention to modified tools and practices. Improving prevention will reduce severe
costs to both farmers and farmworkers and can result in improved productivity
and a better place to work.
Analyses of
1988 NHIS data reported that one year period prevalence rate of back pain among
individuals working in agriculture was about one and one-half times higher than
the average for all US industries, and that farming was the occupation most
often associated with disability in females and the second most often in
males. Studies on agricultural workers
in California report rates of MSD incidence ranking among the nation's highest
risk industries and 100 times greater than rates suggested as industrial
targets by NIOSH.
At the same
time, these potentially permanently disabling injuries are readily preventable
using ergonomics approaches. Examples
of demonstrated preventive interventions from mulitple crops and commodities
are reported and a suggested approach to improving on-farm prevention of these
injuries is presented.
HUMAN HEALTH
EFFECTS OF AGRICULTURE:
PHYSICAL DISEASES AND ILLNESSES
Steven R. Kirkhorn, M.D., M.P.H.,
F.A.C.O.E.M.
Occupational Health Resources
Immanuel St. Joseph’s-Mayo Health
System
Faculty-University of Minnesota
Rural Family Practice Residency-Waseca, MN
Clinical Associate Professor,
University of Minnesota Family Practice and Community Medicine
Marc Schenker, M.D., M.P.H.,
F.A.C.P.
UC Center of Agricultural Health and
Safety at Davis
University of California at Davis School
of Medicine
Agriculture
has experienced both major bio-technological advances and economic and
socio-cultural disruptions since the publication of the white paper
“Agriculture at Risk” in 1988. At that
time it was recognized that there were acute needs in the prevention of
musculoskeletal syndromes and injuries, agricultural respiratory disease,
noise-induced hearing loss, stress-induced mental disorders, contact
dermatitis, and pesticide-related illnesses.
There were also concerns regarding the excesses of cancers noted in
epidemiological studies of farmers. In the ensuing twelve years, there
continues to be inadequate application of methods to prevent respiratory
disease and fatal incidents on the farm site and agricultural workplace. Considerable concern remains regarding the
long-term effects of chronic pesticide exposure, including lymphomas and birth
defects, without significant progress made in the isolation of the causative
agents.
In this
paper, we will discuss the progress made in the identification of new
respiratory disease risks and illnesses, the rationale for promoting better
monitoring of respiratory exposures, and for setting lower permissible exposure
levels for airborne organic dusts and gases.
Additional discussion will include emerging agricultural-related
infectious diseases, pesticide-related illnesses, and ergonomic issues. The focus will be upon the current state of
knowledge in these areas and recommendations for further research and
application methods.
David L. Hard, Ph.D.
NIOSH/DSR/AFEB
John R. Myers
NIOSH/DSR/SFIB
Susan G. Gerberich
School of Public Health/EOH/RIPRC
University of Minnesota
Traumatic
injury in agriculture has been identified as a major cause of mortality and morbidity among farm workers
and others exposed in this environment.
In 1988, there was consensus on the need for a national surveillance
system that captured both agricultural mortality and morbidity. Additionally, surveillance systems were
needed to identify exposure data and risk factors for workers in agriculture.
While no single national surveillance system presently exists for the
collection of data on all agricultural injuries, strides have been made in
addressing specific concerns and recommendations. In 1992, BLS instituted the Census of Fatal Occupational Injuries
and revised the Annual Survey for non-fatal injuries, resulting in a more
accurate picture of the scope and magnitude of agricultural injuries on larger
farms. NIOSH conducted a national
survey, the Traumatic Injury Surveillance of Farmers project, between 1994 and
1996 to obtain national agricultural nonfatal injury estimates. In addition, grants have been funded to
explore regional surveillance efforts, such as RRIS-II. In recent years, national and regional
injury surveillance efforts, that include nonfatal events, have focused on
targeted agricultural populations such as youth. These efforts serve as potential models for future efforts.
COALITIONS: BUILDING
PARTNERSHIPS TO PROMOTE
AGRICULTURAL HEALTH AND SAFETY
Teri Palermo, R.N.
National Institute for Occupational
Safety and Health
Janet Ehlers
National Institute for Occupational
Safety and Health
Susan Jones, R.N., Ph.D.
Western Kentucky University
The
Agriculture at Risk Report identifies the need for the development of
coalitions, but with little additional detail.
Throughout the 1990s, a variety of partnerships and community-based
organizations with the primary mission to promote agricultural safety and
health have been formed. These groups
are altruistic, creative, energetic, and provide a critical perspective to the
effort of improving the safety and health of the agricultural workforce at the
local, regional, and national levels.
These coalitions have been created as a result of philanthropic support,
public funding, grass-roots interest, and personal experiences with
agricultural injuries and fatalities.
They are playing important roles in collaborating with researchers and
in reaching the individual agricultural communities. They have been
instrumental in conducting needs assessments and critical to the development
and implementation of successful surveillance and interventions. Outreach and dissemination of research
findings and other safety and health information to target audiences are a
strength of these diverse groups. This
paper will focus on community- based coalitions, providing an overview of the
types, foci, activities, and results or impact of these groups during the 1990s
and the challenges in maintaining and sustaining the coalitions. We will conclude by projecting the role of
coalitions for the future.
Richard Mandelbaum
El Comité de Apoyo a los Trabajadores
Agricolas
(CATA / Farmworker Support Committee)
The current
food system within the United States is based on the industrial model. Large scale operations are favored over
small scale producers. The family
farmer is unable to compete with an agribusiness supported by various direct
and hidden subsidies, including an abundant and cheap labor supply. The underlying factors behind the poor
health and safety record within the agricultural sector come more clearly into
focus when viewed within this broader political and economic context.
There is a growing consciousness of the need to create alternative
models that recognize the ties that bind small farmers, farmworkers, and the
public at large. Such a model would be
based upon a vision of the food system in which those who work the land, as well as those who
depend on the food produced there, are provided a life of dignity and quality.
This model
could embrace the growing consumer movement linking people directly to products
generated under specific ecologically sustainable and socially just
conditions. The most successful example
of this type of program within U.S. agriculture has been that of organic
certification. Such programs can and
should be expanded to include social criteria benefiting both farmers and
farmworkers, and would include (although not be limited to) significant
improvements in health and safety.
Risto H. Rautiainen, M.S.
Great Plains Center for Agricultural
Health
The University of Iowa
The “three
E’s”: engineering, education, and enforcement, have been traditional approaches
in occupational health and safety promotion. These approaches have limitations
in agriculture and there have been efforts to develop new financial incentive
based programs. Incentives have included reduced insurance premiums, grants for
purchasing Rollover Protective Structures (ROPS) and safety devises, and other
discounts and benefits.
Following
are examples of some incentive programs. The Ontario Farm Management, Safety
and Repair Program in 1987-88 provided grants for farm safety improvements. CAD
$7.2 million was used for safety improvements; maximum of $2,500 per farm, and
80% of the improvement costs were funded. The demand was much greater than the
available funds (27,827 applicants). No evaluation was conducted regarding
injuries, and the program was discontinued. The Swedish Working Life Fund
provided grants in 1990-95 to about 2,000 farm employers for safety
improvements totaling SEK 175 million ($23 million USD). A study of
participating diary/beef farmers reported a 22% decrease in injury rate, 29%
decrease in musculoskeletal disorders, and 16% decrease in working time. In
Washington State, the Farm Bureau administered a Retro Program, which required
that the members pass a safety inspection. In 1984-89 this program returned
over $3 million in saved workers compensation costs to the member participants.
New York Agricultural Hazard Abatement and Training (AHAT) Project among dairy
farmers included hazard corrections and training sessions. Farmers received up
to 14% rebates of their 1996 workers compensation premiums. 27% decrease in
claims was observed, and there were significant changes in attitudes and
beliefs. The Ohio Tailgate Safety Training Program included two $40 gift
certificates for each participant for purchases of personal protective
equipment (PPE). Initial results showed that 27% of the certificates were
redeemed. Rollover Protective Structure (ROPS) grant campaign was conducted by
Virginia Farm Bureau in 1995-97. A $150 rebate was offered for ROPS
installation. The program was advertised among 140,000 Farm Bureau members. The
number of retrofits was 5 in 1995, 11 in 1996, and 33 in 1997. Manufacturers
and dealers have promoted “ROPS at cost” incentive programs for many years,
however the success of these programs has not been documented. In New York, a
study was conducted which showed that most farmers were not willing to retrofit
ROPS on older tractors, unless the incentive was at least 75% of the total cost
of the retrofit. The Finnish farmer’s
occupational health service program includes a farm visit, health examination
and education. Since 1999, members receive a 20% discount in worker
compensation premiums. This benefit significantly increased participation in
the occupational health service program. A similar program in Norway enabled
the participating farmers to receive discounts in insurance premiums. The Iowa
Certified Safe Farm program includes a preventive health screening, an on-farm safety
review with a passing score of 85%, and personal education. The program is
currently pilot tested and members are anticipated to receive discounts in
health insurance and farm supply purchases.
Incentive
based programs show varying success. The available data indicates that safety
improvements such as ROPS and PPE require high levels of incentives before
farmers become interested. Programs with more significant amounts of support
have been popular, however, it is not clearly demonstrated whether they are
effective in reducing injuries. The insurers have shown interest in offering
incentives. These programs show promising results and suggest that more efforts
should be placed in designing programs, which can effectively reduce injuries
and insurance costs and benefit both insurers and farmers.
COMMUNITY
INTERVENTION STRATEGIES:
INSURANCE/OTHER REBATE INITIATIVES
Donald L. Griffin, CPCU, ARe, ARM,
AU
National Association of Independent
Insurers
Risto H. Rautiainen, M.S.
The University of Iowa
Stephen J. Reynolds, Ph.D., CIH
The University of Iowa
The fatal
injury rate in agriculture has been essentially the same for the past decades.
According to the Bureau of Labor Statistics (BLS), Census of Fatal Occupational
Injuries (CFOI), 807 persons died in 1999 in the agriculture industry, which
includes forestry and fishing. The injury rate was 24 fatalities per 100,000
workers. This is five times higher than the rate in other industries on the
average, and only mining has a higher fatality rate than agriculture. Tractor
remains the primary cause of farm fatalities. National Safety Council (NSC)
estimates that there were 255 tractor related fatalities in 1997, the rate
being 6.5 deaths per 100,000 tractors. Approximately 60% of tractors in the
United States lack Rollover Protective Structures (ROPS), and tractor overturn
with non-ROPS tractors is the most frequent type of fatal farm injury. Some
data shows that progress may have been made regionally to reduce fatality
rates. Research also suggests that childhood fatalities reduced from 300
annually in 1978-83 to 104 annually in 1990-93. The rate reduction during this
time period was 39%. Children are specifically at risk for runovers when bystanders
or extra riders on tractors and farm equipment. The farming population is older than most other working
populations. The elderly farmers are at
risk for fatal injuries, especially from tractor overturns.
BLS
reported 7.0 non-fatal injuries and 3.3 lost workday injuries per 100 full time
workers in agriculture in 1999. This includes data only from those farms with
11 or more employees. NSC reported 140,000 disabling injuries in agriculture in
1998, the rate being 4 disabling injuries per 100 workers. NIOSH estimated that
there were 121,936 lost-time injuries in 1994; 4.7 lost-time injuries per 100
full time workers. Some surveys have reported significantly higher injury rates
in agriculture. Variation exists in these estimates due to different data
collection methods and definitions for agriculture and injury.
According
to BLS, morbidity from work related illness was 43/10,000 workers in
agriculture. This data is limited to farms with 11 or more employees. NIOSH has
reported 51 fatalities in 1996 from hypersensitivity pneumonitis, some of which
may be agricultural work related. Research suggests that livestock farmers
experience high rates of lung disease (up to 30%). NIOSH has reported that
farmers experience lower rates of cancer (Proportional Mortality Ratio
(PMR)=0.89) than other industries in 1984-95. Especially lung cancer rates
(0.81) were lower in agriculture. Specific cancers including skin (1.22),
non-Hodgkins lymphoma (1.01), and leukemia (1.05) were elevated in agriculture.
Farmers also suffer from higher levels of suicide (1.11), and underlying stress
and depression.
The reported
rates for occupational injury and illness in agriculture are likely lower
than the actual rates as the farmers in general have no workers compensation
or surveillance, which would consistently identify and report work related
incidents. Lack of comprehensive and accurate reporting limits the possibilities
to draw conclusions regarding rates and trends. However, the available data
suggest that agriculture remains one of the most hazardous occupations in
the United States and has not experienced similar progress as other occupations.
EFFECTIVENESS
OF FARM SAFETY INTERVENTIONS
Risto H. Rautiainen, M.S.
The Great Plains Center for
Agricultural Health
University of Iowa
Lisa A. DeRoo, M.P.H.
School of Public Health and
Community Medicine
University of Washington
A
systematic review was conducted to examine the effectiveness of farm injury
prevention interventions. Electronic databases, journals, proceedings, and
technical papers were reviewed, and experts in the field were interviewed to
identify relevant information sources.
Educational and multifaceted interventions were included and engineering
and regulatory interventions were excluded. All study designs were accepted,
including those without comparison groups and those with absent or inadequate
evaluation methods.
We selected
25 studies for the review. Following
are examples of the findings. Harper (1998) found that a community program in
South Carolina distributing materials to local leaders and educators had no
significant effect on attitudes or knowledge. Rodriguez
(1997) evaluated an informational campaign in Iowa using messages
through radio, newspapers, and safety publications. Phone surveys showed
moderate but statistically significant increases in awareness, concern and
behavior indicators. Hawk (1995) found
significant differences in behaviors after a Farm Safety Walkabout in Iowa. Reed (1994) evaluated a farm safety fair in a rural
church setting, and found that over 50% of participating families incorporated
safety changes on their farms. Buchan (1993) evaluated farm safety day camps in
Colorado and found knowledge acquisition increases from 45 -100% and behavioral
changes from 31- 84.5% among participants. Wilkinson
(1993) reported that tractor certification program participants in
Wisconsin had a 15% increase in exposure to non-ROPS tractors, a slight
increase in carrying extra riders, and a 9% increase in tractor safety
inspections. Pekkarinen (1992) evaluated an educational program for reindeer
herders in Finland and found a 43% decrease in injury rate. Jansson (1988) evaluated a safety training program
for farmer-loggers in Sweden consisting of 15 one-day courses and
demonstrations. 71% reported a change in working methods; use of protective leg
guards increased from 65% to 90%; and use of protective boots changed from 65%
to 85%. Abend (1998) reported that NY Agricultural Hazard Abatement and
Training program consisting of hazard corrections, training, and insurance
incentives, showed a 27% decrease in workers compensation claims. Carstensen
(1998) evaluated an intervention in Denmark including a farm inspection, and a
one-day safety course. Injuries reduced from 33.4 to 20.1/100,000 hours. Husman (1990) evaluated a national model for
farmer’s occupational health services in Finland. Improvements were found in
knowledge and use of personal protective equipment, but not in working
conditions or work practices.
Most of the
studies reported some improvements in knowledge, attitudes, and/or behaviors
after intervention. Only three studies measured actual injury outcomes. For
most of the studies, the validity and interpretation of the evaluation results
are questionable due to limitations in design such as the lack of comparison
groups and reliance on self-reported outcomes. There is some indication that
multifaceted and incentive based programs are more effective than one-time
event type programs or media campaigns although the evidence is not consistent.
The review showed both successful and unsuccessful examples of different types
of programs. This may indicate that the various aspects of program delivery are
critical for successful intervention.
Dick Steffen, Ph.D.
Southern Illinois University
FEDERAL LAWS AND
REGULATIONS AFFECTING FARM SAFETY
Jack L. Runyan, Ph.D.
Food and Rural Economics Division
Economic Research Service
U.S. Department of Agriculture
Farm
operators, their family members, and hired workers are exposed agents that can
cause fatal, permanent, long-term, and short-term injuries and illnesses. They sometimes work under conditions that
may reduce their awareness of the dangers of operating equipment and handling
livestock. The Federal government has
enacted legislation and promulgated regulations that protect most nonfarm
workers, but provide only limited protection for hired farmworkers and almost
no protection for farm operators and their family members.
The child
labor provision of the Fair Labor Standards Act does not allow anyone under 16
years of age to be employed in any agricultural occupation declared hazardous
by the Secretary of Labor. This
provision does not apply to children of farm owners or operators.
The
Occupational Safety and Health Act requires employees to furnish each employee
employment and a workplace free from recognized hazards causing or likely to
cause death or serious harm. However,
immediate family members of the farm employer and farms employing less than 11
workers are exempt from coverage.
The Worker
Protection Standard (WPS) applies to all operators of farms, forests,
nurseries, and in greenhouses used in the production of agricultural plants
(food, feed, and fiber plants, trees, turfgrass, flowers, shrubs, ornamentals,
and seedlings); operators who hire or contract for services of workers; and
those who apply pesticides to agricultural plants and crop advisors on any
farm, forest, nursery, or greenhouse.
There are no small farm or minimum number of farm employee exemptions in
the WPS. Operators and their immediate family are exempt from some of the
provisions.
The
Certification of Pesticide Applicators Standard (CAS) requires an individual
applying restricted-use pesticides to be certified by a certifying agency as
competent and thus authorized to use or supervise the use of restricted-use
pesticides. Like in the case for the WPS, operators and their immediate family
are exempt from some of the provisions.
Although
operators and family members are exempt form most Federal safety laws and
regulations, they should be aware of the prohibited practices and suggested
improved ones. Raising the awareness of these people is one challenge for
practitioners of farm safety.
FARM POPULATION, MIGRATION AND ITS
IMPLICATIONS ON HEALTH AND SAFETY:
AN ANTHROPOLOGICAL APPROACH
Carlos Buitrago, Ph.D.
University Of Puerto Rico
The paper
focuses on the analysis of ethnographic data provided by last stage of a three
year research project on migrant “farmworkers” carried on in México and in
agroindustries located in eastern United States. It focuses on complex,
somewhat dispersed, fragmented, alleatory and contingent migratory
processes.There are also transnational networks related to and that mediate
these population movements along migration “constructed pathways” that are
constantly created, transformed, discarded, modified. It states, therefore that
there is a lack of regular patterns in
the multiple contexts where the migrants operate, within the arbitrary and
highly controlled and exploitative contexts of flexible (despotic)
agroindustialism. A reconceptualization of the characterization of “migrant
farmworker” as a segment of a a multiple laboral identity is related to the
lack of patterns and to these multiple and contingent contexts. It examines specific instances, contexts and
practices that impinge upon the nature and character of these migrants flows
and displacements, such as the varied and fragmented workplaces and its
dynamics, related locations, like living quarters, transportation and
commmunication contexts. The main orientation is to show the future
implications that these processes,
contexts and practices may have on farmworkers' health and safety and to develop
specific recommendations for research.
Occupational
Safety and Health Among California Farm workers:
Results of a Statewide Survey
David Lighthall, Ph.D.
California Institute for Rural Studies
This paper
summarizes key occupational issues facing farm workers in California. It also discusses major barriers to
improvements in occupational safety in the state and their implications for
national policy. The California Institute
for Rural Studies conducted a statewide health and safety survey of California
farm workers during the 1999 cropping season.
With support from The California Endowment, the California Agricultural
Worker Health Survey (CAWHS) interviewed 971 farm workers in seven communities
distributed across all six agricultural regions of the state. Respondents provided a comprehensive range
of data in respect to occupational safety and health. This included: (1) a detailed
work history of the past 12 months, (2) a record of a workplace safety training
received and protective measures employed, (3) causes and treatments of any
major injuries received in the past 12 months of farm work, and (4) field
sanitation conditions encountered in their current job. The paper summarizes key findings of the study,
including a focus on crop/task combinations that emerged as most risk prone as
well as inadequacies in WPS training.
The paper also addresses differentials in training and injuries based on
whether workers were employed directly by growers or by farm labor
contractors.
AGRICULTURAL OCCUPATIONAL HEALTH SERVICES
AND DELIVERY:
ALTERNATIVE STRATEGIES TO DELIVER/DISTANCE LEARNING
Carol J. Lehtola, Ph.D.
The University of Florida
Tom Karsky, M.S.
University of Idaho
It was
recognized and noted in the 1988 Agriculture
at Risk: A Report to the Nation that educational initiatives are necessary
for improving the health and safety of the agricultural work force. It was stated (p. 34) that “suggestions for
improving agricultural safety and health will fare best if they are supported
by an aware and concerned general public.”
The report included recommendations to assure that the varied
educational needs would be achieved.
In order to
accomplish this, it was recognized that alternative (i.e., different from the
traditional in-the-classroom lectures) delivery methods needed to be
developed. In 1990 an agricultural
safety class was offered to off-campus students at Iowa State University via
videotape. The successful offering of
this class, led to further developments in offering safety classes via distance
education methods and technologies. Classes were designed for agricultural
safety and health professionals, agribusiness owners and employees, and farmers
and farm families.
Further
developments have led to safety classes being taught via web based instruction.
This paper
will address issues, ideas, and initiatives for teaching agricultural safety
and health via alternative strategies.
Examples will also be provided of successful activities that have been
developed to enhance teaching agricultural safety and health.
THE IMPACT OF
BIOTECHNOLOGY AND INFORMATION TECHNOLOGY
ON AGRICULTURAL WORKER SAFETY AND HEALTH
John M. Shutske, Ph.D.
Biosystems and Agricultural
Engineering Department
University of Minnesota
In recent
years, biotechnology and information technology applications have been rapidly
adopted in production agriculture.
These technologies are symbiotic.
The profitable use of biotechnology depends largely on farmers and
agricultural workers having timely and accurate information related to the food
production and processing supply chain.
Biotechnology applications include the use of genetically modified
organisms (GMO) containing genetic material from other organisms, giving the
plant or animal a desirable trait (such as herbicide resistance). Information technology applications include
the Internet, precision agriculture, and wireless communication networks that
allow producers to obtain and use context-specific information to make crucial
decisions. Both technology categories
are likely to have significant impact on the safety and health of those working
in agriculture. Production of GMO crops
and animals has the potential to change worker exposures related to pesticide
usage, confined space entry, and handling of products from modified crops and
animals. With expanding use of
information technology, knowledge providers have the opportunity to supply
needed information at a time and in a place most useful and valued by users. While this presents exciting opportunities,
there will be incredible competition from other information providers. Capturing the attention of the user with
appropriate and timely agricultural safety and health information, including
information related to new and evolving exposures will become increasingly
challenging in this rapidly changing environment.
John R. Wheat, M.D., M.P.H.
University of Alabama
Kelley J. Donham, D.V.M.
University of Iowa
W. M. Simpson
Medical University of South Carolina
Natalie Roy, M.P.H.
Innovative Public Health Strategies
Steve Kirkhorn, M.D.
University of Minnesota Rural Family
Practice Residency
Medical
education for agricultural health and safety is evolving to intersect primary
care, rural community health, and occupational and environmental medicine
(EOM). Hazards of agriculture
concentrate in rural areas among diverse primary care and community health
concerns. Family physicians who respond
to this diversity can maintain rural practices and establish credibility
necessary for acceptance as partners in programs for agricultural community
health. Rural family physicians with
expertise in community health and EOM can be the front line of agricultural
medicine.
Several
educational efforts are relevant to producing these physicians: 1) rural
medicine, 2) rural public health, 3) Family Medicine, and 4) OEM, including
agricultural medicine. Agromedicine
education to prepare physicians to partner with agricultural scientists and
cooperative extension agents should also be considered. Each of these efforts requires faculty with
special expertise and resources. Few
institutions are prepared currently to merge and coordinate these programs into
a coherent rural and agricultural medicine program.
We
recommend that a medical school in each distinctive agricultural region
construct a model for developing these agricultural medicine physicians and
seek partners and resources to operationalize the model. One example is the Alabama rural medicine
pipeline model. A vocal rural and
agricultural constituency may be required for success.
RURAL EMERGENCY
RESPONSE - THE SAFETY AND HEALTH SAFETY NET
Gary Erisman Ph.D., CSP, EMT-B
Illinois State University
The Highway
Safety Act of 1966 requires states to have highway safety programs that conform
to uniform standards set by the U.S. Department of Transportation. One of the
18 program standards contained in this Act deals with the availability of
emergency medical services.
Data from
three wars-W.W.II, Korea, and Viet Nam- strongly supports the following
assertion: speed of medical intervention and transport to the hospital
emergency room is the key to increasing
survival rates from traumatic injury. Unfortunately, the importance of
available emergency services in rural areas appears to be an area largely
overlooked in the 1989 edition of Agriculture at Risk: A Report to the
Nation.
To a large
degree, the identity of a community revolves around the services it makes
available. Emergency service availability has a direct impact on the quality of
life of a community. Rural fire fighters, rescue personnel, police, emergency
medical personnel, hospital staffs and auxiliary organizations - mostly
volunteers - exist to support and nurture those in need.
This paper
examines rural response capability with particular emphasis on emergency
medical services. Results of current research on problems within the system are
summarized and suggestions for addressing these problems are provided.
TRAINING OF AGRICULTURAL SAFETY AND HEALTH SPECIALISTS – ACADEMIC PREPARATION AND INSERVICE OF AGRICULTURE SAFETY AND HEALTH SPECIALISTS/ENGINEERS
Guided Discussion Led By
Gary Erisman, Ph.D.
Illinois State University
Henry P. Cole, Ph.D.
University of Kentucky
Surveillance
to determine whom in a community is at risk for illness or injury is basic but
not sufficient to implementing a community education intervention.
Behavioristic principles can identify the antecedent environmental conditions
and the reinforcers that maintain dangerous attitudes and behaviors among
community members. A behavioral analysis helps the researcher to understand the
logic of risky behavior from the community members’ perspective, and to not
condemn the behavior as stupid. Cognitive principles can be used to translate
surveillance data about risky behaviors and their consequences into simple
messages that are easily understood through actions, images, and stories. In
doing so, abstract epidemiology principles for prescribing safety practices
become concrete, personally relevant, and empowering. Replacing habitual risky
behaviors with safe practices requires changes in both knowledge and attitudes.
While simply showing or telling someone what they need to know can transmit
knowledge, such direct instruction is ineffective for changing attitudes.
Attitudes are changed primarily through interactions with human models and by
compelling stories we hear, tell, and live. Partnerships of researchers and the
at-risk members of the target community can best accomplish the surveillance
process, the behavioral analysis, and the translation of surveillance data to
meaningful community education.
Lloyd Redding
Equipment Manufacturers Institute
Representative