FARMING IS A REWARDING WAY OF LIFE, and in many ways a very healthy one. Yet each year, thousands of men and women in the United States are injured or made ill by hazards encountered in routine farming activities. Children living on or around farms are also at risk. Research focused on the identification of modifiable risk factors and on the development of effective interventions may minimize the loss of life or health in the agricultural workplace. Regulations and enforcement activities designed to reduce illness and injury in agriculture can sometimes be controversial, but there is general agreement that sound scientific knowledge is essential in preventing disease and improving our quality of life.
In the late 1980s, a broad coalition of private sector and professional groups joined together to discuss the very serious health and safety issues facing American agriculture. The resulting document, Agriculture at Risk: A Report to the Nation, made a persuasive case that health and safety needed to be addressed systematically in farming communities across the nation. In 1989, the US Congress directed the Centers for Disease Control and Prevention and the National Institute for Occupational Safety and Health (NIOSH) to create new programs that focused on the prevention of illness and injury in agriculture. NIOSH, in turn, created a network of regional centers for research and education in agricultural safety and health. The Pacific Northwest Agricultural Safety and Health Center was established in 1996 as a regional resource for research and education in farming, fishing, and forestry. Its purpose is to assist producers, workers, health professionals, and government agencies in the identification of hazards, and the implementation of practical solutions that will prevent or reduce workplace injury and illness rates.
The Occupational Research Agenda for Northwest Farming, described in the following pages, is the result of a process that involved key stakeholders throughout the region. We hope this document will serve as a useful guide for anyone concerned with farming health and safety in the Northwest. The Agenda can improve the use of existing resources by focusing our efforts in areas that can be effectively addressed by research. We thank all of the participants in our telephone interviews and in the subsequent Farm Summit, held in Portland in Spring 1998. We look forward to continued collaborations and partnerships aimed at investigating and solving the most pressing health and safety problems in our region’s farming communities.
-- Richard Fenske, PhD, MPH, Director
What is the Occupational Research Agenda for Northwest Farming ?
The Occupational Research Agenda for Northwest Farming identifies health and safety research priorities for farming in Idaho, Oregon, and Washington. The Agenda process elicited the views of producers, labor, health care professionals, academicians, public agency officials, and others familiar with the region’s farming health and safety issues. The Agenda focuses on areas where research can make a difference in reducing disease and injury among farm operators, farm workers, and their families.
How can research make a difference in farm health and safety?
Research is the systematic application of scientific principles to answer well-defined questions. It normally involves development of a study design, and the collection and analysis of data. When there is a lack of basic knowledge about injuries or illness, research efforts are aimed at a new understanding of causes. Why are disease rates higher for one occupation than for another? Why do workers in a particular industry develop serious lower back problems? Why do certain workers get sick or injured when others do not? What level of pesticide exposure is a public health concern? What causes skin disease in farming? When we have a clear understanding of why illnesses and injuries occur, research can also be helpful in testing solutions. Does a new work practice designed to reduce back stress really reduce injury rates and time lost from work? Do new regulations produce changes that improve health and safety? Does new protective clothing or worker training reduce pesticide exposure or dermatitis? The systematic evaluation of interventions has become an important part of public health research, and is particularly valuable in farming.
How was the Agenda developed?
The Agenda was initiated by the Pacific Northwest Agricultural Safety and Health Center (PNASH), one of nine regional centers in the United States charged with improving health and safety in farming communities. The agenda process was modeled on the successful National Occupational Research Agenda (NORA) that was developed by the National Institute for Occupational Safety and Health (NIOSH). Our own process was guided by the following goals:
-
Examine the issues of farm health and safety in our region, including technical,
social, and economic dimensions.
- Involve a diverse group of stakeholders in identifying issues that can be addressed by
occupational safety and health research.
- Establish a priority list, or agenda, of occupational safety and health research topics
relevant to Northwest farming.
- Provide a continuing forum for discussion of key health and safety issues for the
region.
PNASH staff conducted more than 100 telephone interviews between November
1997 and February 1998 to learn the views of farm owners, cooperative extension agents,
health care providers, labor representatives, academicians, government agency officials,
and others familiar with health and safety issues in the region. In March of 1998 we
sponsored a day-long conference (Farm Summit) attended by 30 representatives of the
region's agricultural health and safety community. The results of the telephone interviews
and discussions at the Farm Summit are the foundation of the Occupational
Research Agenda for Northwest Farming. We have worked hard to ensure that the
Agenda reflects the careful thought and effort that each individual contributed to the
process.
What priorities has the Agenda identified for Northwest farming?
Upon reviewing the results of the telephone interviews and Farm Summit, PNASH staff identified 12 research priorities which fell within the three major categories used by NIOSH in its NORA process. The priority areas are not ranked. Each is deserving of increased research efforts to improve farm health and safety in our region.
| CATEGORY |
PRIORITY RESEARCH AREAS |
| DISEASE & INJURY |
Musculoskeletal Disorders
Respiratory Disease
Skin Disease
Traumatic Injuries |
| WORK ENVIRONMENT & WORKFORCE |
Chemical Exposures
Special Populations at Risk
Social and Economic Foundations of Workplace Safety
Risk Communication Barriers |
| RESEARCH TOOLS & APPROACHES |
Diagnostic Approaches
Hazard Control Technology
Intervention Effectiveness
Surveillance Research Methods |
How will the Agenda be used?
We hope that the Agenda will serve as a useful guide to anyone concerned with farming health and safety in the Northwest. This document has been distributed to all telephone interview and Farm Summit participants, and is available to the public. The Agenda will be particularly useful for researchers throughout the region, as it focuses attention on issues where research can make a difference in reducing disease and injury, and provides specific suggestions for research activities. We hope that regional policymakers will also find the Agenda valuable in their efforts to effectively allocate existing and new resources.
PNASH will use the Agenda to direct resources to relevant research and education activities. For example, we currently sponsor a pilot project program that provides initial funding for new projects in agricultural health and safety. The Agenda will serve as an important tool to encourage pilot project applicants to consider research in specific areas of need. We support graduate students who can use the Agenda as a valuable source of project ideas. The Agenda will also guide future planning of our continuing education courses and outreach efforts.
Why is the Agenda important?
Agricultural work places high demands on the men, women, and children whose livelihood depends on farming. This industry is affected by many external factors that are beyond the control of the individual producer or worker. These include weather, national and global market changes, technological changes, labor supply, and government regulation. Farmers, farm workers, and their families are also subject to a variety of workplace hazards that result in illness and injury, most of which are preventable.
The systematic study of health and safety hazards in farming communities has emerged as a new and important public health field. Farming has high rates of fatal and nonfatal injuries and a high prevalence of certain work-related diseases when compared with other occupations. There is an extraordinary opportunity for well-focused research and education programs to improve farm health and safety while maintaining a productive industry.
How can I be involved in farm health and safety research and education?
We hope that the distribution of the Agenda marks the beginning of a process that stimulates new thinking and efforts in the area of farm health and safety. PNASH can serve to facilitate these efforts, and to provide linkages across the region. Please contact us and we will be happy to work with you to find common interests and new resources to prevent disease and injury in our region’s farming industries.
THE NORTHWEST, SPECIFICALLY IDAHO, OREGON, AND WASHINGTON, is one of the most productive and diverse agricultural regions in the United States. The efforts of the region’s farmers, farm workers, and their families contribute significantly to the local and national economy. Yet planting, management, and harvesting of crops place these groups at risk for a variety of health and safety hazards.
The occupations experiencing the highest numbers and rates of fatal occupational injuries in the Northwest are farming, fishing, and forestry. Agricultural work is characterized by a high risk of fatal traumatic injury and greater than average risk of nonfatal traumatic injury, cumulative trauma (noise and vibration exposure), respiratory, and dermatological conditions. In Washington state, workers’ compensation claims data indicate that agricultural workers are at greater risk of fatal and nonfatal injury, systemic poisoning, and dermatitis than are nonagricultural workers. These conditions affect workers’ daily living and life expectancy and are highly costly to the regional economies. Between 1988 and 1994, 145,908 workers’ compensation claims for injury and illness were filed by agricultural workers (excluding logging) with the Washington State Industrial Insurance Fund, a rate of 19.2 injuries and illnesses per 100 full-time equivalent (FTE) workers. The costs of these claims totaled more than $450 million, averaging $3,129 per claim. This translates to $600 paid in workers’ compensation benefits for every full-time agricultural worker each year.
1
In Oregon and Idaho, workers’ compensation claims filed in 1997 for agriculture and forestry ranked eighth and ninth respectively. In Idaho, the highest number (18) of job-related fatalities reached in 1997 was in farming, fishing, and forestry. Ten of these fatalities occurred in farming. This is the highest number in a single occupation following transportation and material moving occupations, for each of which 12 job-related deaths were reported.
2
In Oregon, agricultural workers’ claims ranked tenth with 3.4% of workers’ compensation claims filed in 1997.
3 Of the claims submitted by agricultural, forestry, and fishing workers, farm workers submitted the highest number of claims at 36.2%. For these three occupations, the average cost per claim closed in FY 1997 included $5,087 in medical costs, $2,671 in time loss costs, and $2,009 in permanent partial disability costs for a total of $9,767. Average time lost was 106 days. For 1997, the incidence rate per 100 full-time workers in agriculture, forestry, and fishing was 8.7 total cases and 3.8 lost workday cases.
4
Between 1993 and 1997, the highest fatality rates per year per 100,000 for Oregon occurred in agriculture, forestry, and fishing, following only construction. There were 81 fatalities among Oregon’s farming, forestry, and fishing workforce between 1993 and 1997 making these occupations the second most dangerous. Of this total, 32 were job related farmer and farm worker deaths.
5
Efforts to decrease health and safety hazards in farming at the federal, state, and local levels are complicated by the diversity of tasks, worker populations, and geographical demands inherent to the region. For example, the diverse agricultural economy of the Northwest requires a large, but fluctuating, labor force. The size of the labor force is largely determined by the season, with migrant and seasonal labor comprising a substantial proportion of the labor force. The cultivation and harvesting of many of the major crops in the Northwest, such as tree fruit, berries, hops, grapes, and forest products, are not amenable to mechanization. These crops are labor intensive, with the size of the worker population determined by the seasonal needs of the agricultural products. For example, in Washington state in 1997, the seasonal worker population fluctuated from a low of 14,300 in January, to a high of 65,100 in July when apple thinning and several harvests were underway. The population dipped to 47,700 in August, but rose again in October to 61,600 with the apple harvest. This seasonal labor force is comprised largely of persons of Hispanic origin with at least one dependent.
6
In addition, unlike most other industries, children make up a sizable proportion of the agricultural workforce. These children suffer injuries when engaged in farming, and the injuries that are reported are often severe. Minors under the age of 15 employed on farms in Washington state were over represented in the number of claims filed by all minors.
7 Furthermore, 26% of claims filed by minors employed in agriculture were for serious injuries, compared with 16% for all other occupations. In Oregon, the agricultural sector accounted for 12% of compensable claims for workers age 17 and under with 85% of young injured agricultural workers employed as farm laborers between 1986 and 1995. During this time period, 80 disability claims were accepted for agriculture workers aged 8 to 14.
8 According to the Oregon Census of Fatal Occupational Injuries, the youngest worker fatality in the state for 1997 was the death of a 16-year-old farm worker who fell from a cliff.
9
Setting priorities for health and safety research and education in Northwest farming is a challenging task in light of the many types of agricultural production and the diversity of the workforce. However, many of the occupational diseases, injuries, and hazardous working conditions in this region’s farming industry are similar to those identified in other regions and nationwide. In our efforts to develop priorities, we turned to a process recently implemented on the national level.
The National Institute for Occupational Safety and Health (NIOSH) is a federal agency within the Centers for Disease Control and Prevention, and serves as the nation’s primary research organization for occupational health and safety. NIOSH created a new process in 1996, the National Occupational Research Agenda (NORA), to better identify and prioritize significant health and safety hazards for research and public policy purposes. This Agenda process encompasses input from representatives of scientific, corporate, labor, and health care organizations. In the first phase, NIOSH compiled the results of committee meetings, public gatherings, and written comments to develop and refine the 21 research priorities (Table 1).
The criteria employed to guide the evaluation and selection of possible NIOSH NORA topics included some or all of the following:
-
Seriousness of the hazard based on death, injury, disease, disability,
and economic impact
- Number of workers exposed or magnitude of risk
- Potential for risk reduction
- Expected trend in importance of the research area
- Sufficiency of existing research
- Probability that research will make a difference
The NORA process has proven very successful, and serves as a model of broad
stakeholder influence in priority setting. Most recently, the second phase of the process
has encouraged the National Institutes for Health and other federal agencies to join
NIOSH in sponsoring a number of focused research programs directly relevant to
workplace health and safety.
An early aim of the Pacific Northwest Agricultural Safety and Health Center (PNASH) is to identify and prioritize health and safety hazards in the region. Starting with farming, we turned to the NORA process for guidance. Our process, like NORA, was designed to elicit the perspectives of producers, labor, health care professionals, academicians, public agency officials, and others familiar with the region’s farming health and safety issues. We hoped to find common ground among these groups in the identification of significant hazards, for which new research could make a difference at a regional level. The following discussion summarizes the process used to create an occupational research agenda relevant to Northwest farming.
Table 1. NIOSH NORA Priority Research Areas
| CATEGORY |
PRIORITY RESEARCH AREAS |
| DISEASE & INJURY |
Allergic and Irritant Dermatitis
Asthma and Chronic Obstructive Pulmonary Disease
Fertility and Pregnancy Abnormalities
Hearing Loss
Infectious Diseases
Low Back Disorders
Musculoskeletal Disorders of the Upper Extremities
Traumatic Injuries |
| WORK ENVIRONMENT & WORKFORCE |
Emerging Technologies
Indoor Environment
Mixed Exposures
Organization of Work
Special Populations at Risk |
| RESEARCH TOOLS & APPROACHES |
Cancer Research Methods
Control Technology and Personal Protective Equipment
Exposure Assessment Methods
Health Services Research
Intervention Effectiveness Research
Risk Assessment Methods
Social & Economic Consequences of Workplace Illness & Injury
Surveillance Research Methods |
The Occupational Research Agenda for Northwest Farming is a multi-phase process, the first phase of which culminated in the Farm Summit. PNASH staff began planning the Agenda process in July 1997. The aims included:
- Obtain information on health and safety concerns in regional farming, including
technical, social, and economic dimensions.
- Involve stakeholders in identifying issues that could be addressed by occupational
safety and health research.
- Establish a priority list, or agenda, of occupational safety and health research topics
relevant to Northwest farming.
- Assemble a technical advisory panel for PNASH.
Staff identified and contacted a wide range of individuals throughout the region who had farming health and safety experience. Included in this group were representatives of producers, labor, academic institutions, public agencies, health care organizations, child advocacy groups, insurance agencies, pesticide applicator associations, and farm machinery dealerships. Participants were not presented with a preselected group of research categories, but were encouraged to identify agricultural health and safety concerns and corresponding research opportunities without limits on content.
PNASH staff members conducted telephone interviews with 116 constituents between November 1997 and February 1998 (Appendix 2). The telephone interview consisted of eight questions. Respondents were first asked to name the most significant agricultural health and safety hazards in the region. They were then asked to state which of those hazards were most serious in terms of people injured and seriousness of risk. The interview also included questions about types of research, training, and other interventions that would identify and help reduce the risks, as well as sources of health and safety information. In addition, each respondent was asked for suggestions of other individuals to question and the majority of those people were contacted and interviewed.
The selection of participants at the Farm Summit was shaped by PNASH’s aim to have an equal representation of constituent groups from the Northwest. An invitation list was compiled from individuals recommended during the telephone interviews and suggestions of PNASH researchers and staff. Of the 38 people invited to the Farm Summit, 30 attended the event—eight academicians, nine public agency officials, two labor representatives, four producers, three child health and safety advocates (who were also farm owners), one health care professional, and three private consultants (Appendix 3).
It was emphasized during the Farm Summit that the aim was to develop a research agenda for the region, not specifically for PNASH. The Farm Summit was led by professional facilitators from the University of Washington Programs for Healthy Communities. PNASH staff provided support services and group facilitation.
The day-long workshop consisted of both plenary and break-out sessions. In the morning session, participants attended small groups divided into constituencies (producer, labor, public agency, academic institution, and child advocacy). Because many Farm Summit attendees have multiple roles in the agricultural community (e.g., a producer who is also involved in child safety and health), participants were encouraged to select their own groups. In the morning session, constituency groups developed a list of the priority safety and health problems in farming. Participants also recommended individuals to serve on a technical advisory panel for PNASH.
Each group submitted a priority list of health and safety hazards to the facilitators at the end of the first break-out meeting. At the conclusion of the morning session, all attendees convened to report the most significant problems selected by their group as well as nominations of members to an advisory panel. A list of the 21 recommended problems was presented to the full group. Each participant was provided with five votes to prioritize the problems that are the most significant to the region’s farming communities. After the voting process was complete, the top nine safety and health problems from the full list were selected for further discussion in the afternoon session.
When participants reconvened, constituency-mixed small groups were assembled to discuss the nine problem areas identified in the morning. Participants in these small groups were asked to develop solutions and research opportunities for the priority issues. The results of the afternoon session were shared with all participants at the conclusion of the Farm Summit.
The information gathered in the telephone interviews and Farm Summit was combined to determine the region’s agricultural safety and health research priorities. Upon review of these topics, it became apparent to PNASH staff that the NIOSH NORA categories provided an excellent starting point to organize the results. The following summary discusses the selection of these research priorities in more detail.
Twelve research priorities for the Occupational Research Agenda for Northwest Farming were selected based on the telephone interviews and Farm Summit results. The three major NIOSH NORA categories,
Disease and Injury, Work Environment and Work Force, and
Research Tools and Approaches, were retained as a useful framework for organizing the priorities. Each category included four research priorities, as presented in Table 2.
The first category,
Disease and Injury, included Musculoskeletal Disorders, Respiratory Disease, Skin Disease, and Traumatic Injuries as research priority areas. The second category,
Work Environment and Work Force, included Chemical Exposures, Risk Communication Barriers, Social and Economic Foundations of Workplace Safety, and Special Populations at Risk. The third category,
Research Tools and Approaches, included Diagnostic Approaches, Hazard Control Technology, Intervention Effectiveness, and Surveillance Research Methods.
The Occupational Research Agenda for Northwest Farming priorities are not ranked. However, certain topics surfaced more frequently in the telephone interviews and Farm Summit discussions. These included Traumatic Injuries, Special Populations at Risk, Chemical Exposures, and Intervention Effectiveness. The remainder of this document provides a brief overview of the 12 research priorities. Each overview reviews the importance of the priority to Northwest agriculture, and presents examples of research ideas provided by telephone interview respondents and Farm Summit attendees. We have also included a limited list of resources for additional information.
Table 2. Occupational Research Agenda for NW Farming: Priority Research Areas
| CATEGORY |
PRIORITY RESEARCH AREAS |
| DISEASE & INJURY |
Musculoskeletal Disorders
Respiratory Disease
Skin Disease
Traumatic Injuries |
| WORK ENVIRONMENT & WORKFORCE |
Chemical Exposures
Special Populations at Risk
Social & Economic Foundations of Workplace Safety
Risk Communication Barriers |
| RESEARCH TOOLS & APPROACHES |
Diagnostic Approaches
Hazard Control Technology
Intervention Effectiveness
Surveillance Research Methods |
The National Coalition for Agricultural Safety and Health. Agriculture at Risk: A Report to the Nation, Third Edition, May 1989.
National Safety Council. Accident Facts. 1998 edition. Itaca, IL: National Safety Council, 1998.
Rosenstock L, Olenec C, Wagner G. “The National Occupational Research Agenda: A Model of Broad Stakeholder Input into Priority Setting.” Am J Public Health; 88:353-356 (1998).
US NIOSH. National Occupational Research Agenda. Washington, DC: National Institute for Occupational Safety and Health, 1996.
Deep-South Agricultural Health and Safety Center homepage: [The Deep South Center was active 1999-2002.]
Eastern Washington University Center for Farm Health and Safety homepage: [No longer has an active homepage.]
Great Plains Center for Agricultural Health homepage: http://www.public-health.uiowa.edu/gpcah/
High Plains Intermountain Center for Agricultural Health and Safety homepage: http://www.hicahs.colostate.edu
Midwest Center for Agricultural Disease and Injury Research, Education and Prevention homepage: http://www.marshfieldclinic.org/nfmc/pages/default.aspx
National Institute for Occupational Safety and Health National Occupational Research Agenda homepage: http://www.cdc.gov/niosh/nora/
National Institute for Occupational Safety and Health Regional Agricultural Safety and Health Center homepage: http://www.cdc.gov/niosh/agctrhom.html
Pacific Northwest Agricultural Safety and Health Center homepage: http://depts.washington.edu/pnash
Southwest Center for Agricultural Health, Injury Prevention and Education homepage: http://www.swagcenter.org/
University of California Davis Agricultural Health and Safety Center homepage: http://agcenter.ucdavis.edu/agcenter/
Disclaimer and Reproduction Information: Information in
NASD does not represent NIOSH policy. Information included in
NASD appears by permission of the author and/or copyright holder.
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