The problem goes back decades, even centuries: our farmers live at risk.

They work with loud, dangerous machinery; breathe chemicals, pesticides, and irritating grain dust; and push themselves long days without adequate rest. Compounding all this, farm families typically pay steep prices for private health insurance with high out-of-pocket costs and deductibles. Despite the need, farmers rarely seek medical care until they are injured or critically ill.

Back in 1990, Iowa’s Center for Agricultural Safety and Health (I-CASH) was formed. Headquartered within the College of Public Health at The University of Iowa, the center coordinates with Iowa State University, the Iowa Department of Public Health, and the Iowa Department of Agriculture, reaching out to the agricultural community to reduce injuries and illnesses.

One of its programs is a network of AgriSafe clinics across Iowa, and within this network is an innovative intervention called Certified Safe Farm (CSF). In 1996, families living on 300 farms in a nine-county area around Spencer, Iowa, began participating in CSF, receiving preventive health care, education, and remediation assistance.

"We have three primary forms of intervention," says Sara Schneiders, CSF coordinator. "We offer a free health screening at the AgriSafe clinic in Spencer, an education program, and an on-site farm safety review."

AgriSafe tests farmers’ hearing, screens their blood for abnormal pesticide exposure, and performs several measures of pulmonary function and lung capacity. For many of the program’s enrollees, it is their only medical contact all year.

"The clinic saw one farmer who hadn’t seen a physician for more than 20 years before enrolling in CSF," Schneiders says. "They discovered he had advanced heart disease and got him into the hospital immediately for bypass surgery."

Farm reviewers from CSF visit each participating farm to do a complete safety audit of machinery, chemical storage, buildings, livestock pens, vehicles, and fields. Each farm receives points that are tallied at the end of the review and must have an 85 percent success rate to pass and become certified.

Carolyn Jones runs a 720-acre farm with her husband and 11-year-old son in Linn Grove, Iowa. Together they raise 1,000 hogs and 65 cattle a year, and they cultivate corn, soybeans, and alfalfa. She attended a CSF advisory meeting when the program was young and received a job offer just one week later. Following a period of intensive training, she’s now one of the most experienced farm reviewers in the program, visiting 30-70 farms a year.

"Whenever I go out to a farm, I try to get the whole family involved," Jones says. "I’ll look at chemicals with a special eye to see if they’re locked up where kids can’t get into them. I’ve learned a lot, too, by looking at other people’s farms. For instance, I’ve always had ‘Slow-Moving-Vehicle’ signs on our tractors, but I realized they’re not as effective when they get old and faded. So I’ve replaced all my SMV signs."

Eventually, CSF hopes to partner with insurance companies and offer farmers lower health and land insurance premiums in return for certification. But meanwhile, Jones says, the program is paying off.

"Even if people do just one thing to improve safety on their farms," Jones says, "their families live a better life."