Imagine the uproar if it had become known in the
1980s that a particular occupation had on-the-job
death rates four times higher than most other industries
combined. Imagine what would have happened if the
news media had learned that the occupation also caused
300 children to die per year.
And yet, until an eight-day national conference
at The University of Iowa in 1988 and the subsequent
conference report, few citizens, safety officials,
or government agencies realized that this occupation
was—and still is—the most hazardous in
the United States.
The occupation is farming.
“Before the conference, there was little recognition
of this fact and few funds available for it,” says
Kelley Donham, professor of occupational and environmental
health. “Out of that conference came a report
and a lot of education—there was quite a bit
of activity nationally and in Iowa.”
The report, Agriculture at Risk: A Report to the
Nation, pointed out the seriousness of the nation’s
problem. For example, while death rates in mining,
which vies with farming as the most hazardous occupation,
have decreased over the past four years, agricultural
death rates have remained relatively constant. Yet
funding for research into mining safety and health
was 300 times higher than research funding for farm-related
health and safety.
In fact, the report noted, federal funding of programs
for agricultural safety had been cut by 50 percent
in the decade before the report was written.
In response, the Iowa Legislature approved the formation
in 1990 of the Iowa Center for Agricultural Safety
and Health (I-CASH), a partnership of the University,
Iowa State University, Iowa Department of Public
Health, and Iowa Department of Agriculture and Land
Stewardship. I-CASH, located at Oakdale Research
Campus, adopted a motto: “Helping farmers stay
alive and well.”
On the federal level, Congress appropriated $24
million for the National Institute of Occupational
Safety and Health (NIOSH) to form the National Agricultural
Health Initiative. That initiative funds many national
programs, including the Great Plains Center for Agricultural
Health at The University of Iowa, which serves five
Midwestern states. I-CASH, the state-funded center,
focuses on prevention of farm health and safety hazards
in Iowa.
Although establishing funding and structures was
important, says Donham, director of I-CASH, just
as important was the fact that public policy acknowledged
that the subject was important enough to have such
a center.
Planting seeds
Each of the four state partners in I-CASH—the
two universities and two state departments—began
to set up mechanisms that would allow them to educate,
fund programs, provide services, and inform the public
about agricultural safety and health.
One of the first ideas to be implemented was a series
of agricultural health clinics across the state.
Starting with just two in 1987, the AgriSafe Network
of Clinics now numbers 22 and is still growing. The
network teaches nurses, physician assistants, and
physicians in already established clinics or medical
facilities around the state and keeps them up-to-date
on farm injuries and illnesses. The clinics also
offer agricultural safety and health classes and
seminars in their communities.
AgriSafe Network now is a private nonprofit organization
independent of I-CASH, and Donham is on the board.
That’s been the way I-CASH has worked with
other farm health organizations, functioning as an
incubator or facilitator, Donham says.
“It’s like children,” he says. “They’re
born, then they’re walking by themselves. They
go to college and soon they’re off the payroll,
on their own.”
Making farms safer
AgriSafe Network clinics are the sole providers
of a preventive program invented by I-CASH called
the Certified Safe Farm Project, which offers incentives
to farm families to receive occupational health screening
and education as well as an onsite farm safety review
once a year for five years. As of August 2003, 130
farm families had received the occupational health
screening and education and now are in a five-year
process of annual farm safety reviews to earn certification.
“The goal is to build this into a reward system,” Donham
says. “We intend that becoming certified would
reduce insurance costs and perhaps result in a cooperative
arrangement with lending agencies in which farmers
could earn a discount on loans.”
Another offspring agency established 15 years ago
is Farm Safety 4 Just Kids, which promotes a safe
farm environment to prevent health hazards, injuries,
and fatalities to children and youth. The organization
has chapters in the United States, Canada, and Australia.
It offers day camps that give farm children information
to help them remain safe on the farm.
Iowa’s
I-CASH
I-CASH operates in the Institute for Rural Environmental
Health building at Oakdale. Other staff members include
LaMar Grafft, rural health and safety specialist;
Eileen L. Fisher, associate director; Kay Mohling,
project assistant for training programs and communication;
and Carol J. Hodne, a postdoctoral fellow working
on the social and psychological effects of farming.
All are involved in teaching and research projects
at the University and in communities across the state.
Donham heads the Agricultural Health and Safety
Program in the College of Public Health. Health care
professionals can obtain MS or PhD degrees with an
emphasis in agricultural health and safety. Outreach
and continuing education is available for occupational
health nurses, respiration therapists, county public
health directors, physicians, and nurses. The curricula
cover the gamut of illnesses and injuries that medical
facilities often face in treating farmers. He also
teaches at the College of Veterinary Medicine at
Iowa State.
Fifteen years after the conference that started
I-CASH, some signs of success are evident. While
300 children died in farm accidents in the United
States each year when the conference was organized,
an article by Grafft in the Sept. 13 Iowa Farmer
Today notes the number now is 100.
NIOSH statistics from 2000 show that farming, with
22.5 deaths per 100,000 farmers, is still one of
the nation’s most dangerous occupations despite
such innovations as rollover protection for tractors
and much improved handling and safety procedures
for farm chemicals.
“The only way we can continue to attack this
problem is to cooperate and collaborate with our
state partners and others who are working on various
facets of agricultural safety and health—including
the Great Plains Center, the Heartland Center for
Occupational Safety and Health, and the Iowa Injury
Prevention Center,” Donham says.
Some of these projects are featured on I-CASH’s
web site, www.public-health.uiowa.edu/ICASH/index.html.
“Awareness of the problem is growing, especially
among farmers,” Donham adds. “By working
together, we can expand the range of services available
to farm families and their communities. Social support
is one of the best predictors of mortality and health.
We want to keep that support strong and growing.”
by Anne Tanner
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