Modern Times (2008—2013)
Building the Graduate Education Program in Agricultural Safety and Health
Mentioned previously, agricultural medicine training had its beginning within the IAM in 1974. However, there was no specific program within the IAM that identified agricultural medicine as a field of study. This all changed in 2006 following a survey of U.S. universities and colleges to determine if such programs already existed. We found that some universities (mainly land-grant schools) offered an individual course or two in agricultural safety. However, no other university or college in North America (or anywhere else in the World) was found to have a program with a series of courses and credentialing in the field. Details of the results of this survey have been published (Donham and Thelin, 2016, pp 8 – 16). In response, Donham prepared a proposal for a new graduate program in agricultural safety and health that included a certificate, M.S., and PhD programs. Patrick O’Shaughnessy, Chair of the Departmental Curriculum Committee, assisted Donham in developing the proposal and moving it forward through the administrative chain for approval. This program was reviewed and vetted through the university administration including the DOEH, the CPH, the Faculty Senate, the Provost, and finally the Board of Regents. It passed in 2006 unanimously at all levels. This program was the first new graduate program at the University of Iowa in well over 20 years. It remains as of this writing (2021) an identified degree program in the College of Public Health, and the only such program in the country where a full curriculum in agricultural health and safety is offered and is so stated on the diplomas (U.I. Agricultural Health Degree). However, since Agriculture at Risk process, and the NIOSH Agricultural Health program, such courses (not specific degrees per se) have advanced at other academic institutions. Details of academic educational programs in agricultural health and safety around the world have been reviewed (Donham and Thelin 2016). The following universities among others have some degree of coursework in agricultural safety and health: The University of Illinois offers an undergraduate minor in agricultural safety and health. Purdue University, The Ohio State University have course offerings in agricultural safety. The University of Kentucky has an MPH program with an emphasis in agriculutral safety and health. In Australia, directed by Sue Brumby, the National Center for Farmers Health, in collaboration with Deakin University, offer a certificate in agricultural safety and health.
The National Consensus Processes in Agricultural Medicine
In order to achieve consistency across the country as to what should be included in the field of Agricultural Medicine study, two consensus processes were held, in 2006 and 2012 at the University of Iowa. The aim of consensus processes was to create the topics and learning objectives for a core course in agricultural medicine. These consensus processes also led to a defined curriculum in Agricultural Medicine for the graduate program in Agricultural Health and Safety at Iowa. Further the process also led to guidelines for a textbook as a principal resource to guide education in the field (Donham and Thelin, 2006, and Donham and Thelin, 2016).
Another important initiative in 2006 was “Building Capacity in Agricultural Safety and Health.” This NIOSH sponsored program aimed at training and preparing faculty and staff at other universities and institutions around the country to initiate their own Agricultural Health and Safety Core course in their region. The course was to remain consistent with the consensus process (defined above) topics and learning objectives. The initial training included inviting/recruiting health and safety professionals from targeted regions of the country, bringing them to Iowa City and putting them through the week-long University of Iowa Agricultural Medicine Core Course. Following that initial training, we continued consulting, coaching, providing teaching materials, and on-site lecturing and teaching in those courses. This continued to the point where the “home team” felt competent and comfortable in presenting the courses on their own, and achieving sustainability for their programs. Such programs were provided for nine U.S. universities or agricultural health centers, and three foreign universities. The leading persons initiating the programs in their home sites first attended the core course in Agricultural health and safety at the University of Iowa. Those programs and the lead contact person were as follows: University of Illinois (Robert Petrea PhD, Josie Rudolphi PhD), Southern Illinois University (David Stewart MD, MPH) Lakes Region State College North Dakota (Paul Gunderson PhD), University of Missouri (Karen Funkenbush MA), Marshfield Farm Medicine Center Wisconsin (Steve Kirkhorn MD), University of Alabama(Susan Guin BSN, MSN) University of Nebraska (Risto Rautiainen, PhD), Vermont Farm Health Coalition (Jean McCandless MS), North Carolina Agromedicine Institute (Robin Tutor PhD), University of Texas (Jeff Levine MD), National Center for Farmer Health, Victoria, Australia (Sue Brumby RN, PhD), Harran University, Turkey, (Zeynep Simsek MD), and Swedish Agricultural University, Sweden (Christina Lunner Kolstrup PhD and Peter Lundquist PhD). Most of these programs have found sustainability as of this writing (2021). This program was extremely successful in expanding the reach and, depth and quality of agricultural medicine education for health and safety professionals (Brumby, Rudolphi, Rohlman, and Donham 2017).
Forming the Agricultural Safety and Health Council of America (ASHCA)
The majority of the efforts in the field of Agricultural Health and Safety were instigated and led by academics, not by farmers. However, many of the leaders in the field had an agricultural background. Some even remained part time farmers. Circa 2006, Barbara Lee BSN, PhD (Marshfield Farm Medicine Center) and Dennis Murphy PhD (Pennsylvania State University) initiated an idea that an organization should be formed that included famers leading efforts in agricultural health and safety. Donham worked with them initially, sharing the concepts and practice of the Agriculture at Risk Process. With that early effort, ASHCA was founded in 2007, which now functions with agricultural producers in leadership positions within the organization (ASHCA 2019).
Pioneer Chair in Agricultural and Rural Health
A relationship with Pioneer Hi-Bred International began with the Rural Health Services Outreach Program in 1985 and then with the Agricultural at-Risk Policy Process 1988-1990. Pioneer became an important partner with the University of Iowa, supporting many programs in agricultural health and safety. Examples included the previously mentioned Agricultural at-Risk Process 1988 – 1990, and formation of the Center for International Rural Environmental Health (CIREH). Merchant and Kross submitted proposals in 1991 and again in 1995 to support CIREH to translate the lessons of Agriculture at Risk to for agrarian economies in the developing world. With a focus on Central Europe and Costa Rica, total of $950,000 was awarded each in 1991 and 1995 ..
During this period, LuJean Cole, our early primary contact at Pioneer, was replaced by Thomas Phillips, who became an important advisor and supporter in developing our agricultural health and safety programs. Pioneer became an important partner in founding the CPH. Phillips served as the Co-chair along with Marvin Pomerantz on the targeted $15 million development campaign “Building Today for a Healthy Tomorrow.” The campaign aimed to fund professorships, chairs, and programs. An important part of this campaign resulted in the Pioneer Endowed Chair in Agricultural and Rural Health in the UI College of Public Health. Donham was the first appointee to this professorship. The second appointee (and current as of 2021) is Dr. Diane Rohlman PhD.
Rural Health Rather than Agricultural Medicine
Modern times have seen a near complete transition from focused, coordinated, and integrated agricultural medicine programing to dispersed programming among several federally funded centers and one state center. A unified policy to focus and coordinate agricultural medicine programming and research was replaced by the principal aims of the individual centers. In the DOEH as of 2013 there were five federally funded centers and one state center all with different PIs, all with different and not overtly coordinated principal aims. The centers (including the current PI’s as of 2021) include 1) The Environmental Health Research Sciences Center (EHSRC) PI, Dr. Peter Thorne 2) The Great Plains Center for Agricultural Health (GPCAH) PI, Dr. Rene’ Anthony, 3) The Healthier Workforce Center of the Midwest (HWCM) Dr. Diane Rohlman, 4) The Heartland Center for Occupational Health and Safety (HCOHS), PI, Dr. Patrick O’Shaughnessy, 5) The Injury Prevention Research Center (IPRC) Corrine Peek-Asa, and 6) the state funded center Iowa’s Center for Agricultural Safety and Health (ICASH) Dr. Brandi Janssen. Only ICASH, and the GPCAH have aims directed exclusively towards the occupational health and safety of farmers, their families, and their workers. However, the other four centers have had some components or projects, although not the central aims, associated with agricultural medicine. The general goals and program focus statements of the CPH regarding agriculture medicine/agricultural health and safety no longer appears in any of its working documents. The closest statement comes from the CPH where in “Collective Areas of Excellence” rural health is listed as one (the first) of these areas along with Comparative Effective Research and Community Engagement. The statement on the CPH web site regarding rural health is as follows:
Rural Health: “…By advancing the study of exposures, diseases and injuries, healthcare finance and delivery, and health outcomes affecting rural people, we can develop prevention, intervention, and policy approaches to increase the quality of health for rural populations in Iowa, the U.S., and globally”(CPH CAE, UICPH). Rural Health is not the same as Agricultural Health and Safety. Fewer than half of people living in rural areas are farmers or farm workers. The statement of “Collective Areas of Excellence” provides a broadening of the original focus of the IAM, with a greater emphasis on delivery of health care services to rural areas, as opposed to prevention of occupational injuries and illnesses to farming population. This broadening focus away from agricultural medicine began when the name of the IAM was changed to the IREH in 1989. When the previously described position of the Associate Department Head for Agricultural Medicine was discontinued in 2010, the focus, communication, collaboration in Agricultural Medicine within the DOEH became ad hoc in nature. Agricultural medicine—related research, education and outreach—continue mainly within the various centers, but not connected in any programmatic way other than by ad hoc faculty— staff interactions. This in many ways and in all practical terms ended the founding principle of the IAM.
Summary of Advances During Modern Times (2008-2013)
As the College of Public Health evolved with five departments from the former Department of Preventive Medicine and Environmental Health, agricultural medicine became just one of many different activities / in the new college. However, the College developed and designated Rural Health as one of three “Collective Areas of Excellence.” This designation, however, did not specify agricultural medicine, nor was there a plan or process to coordinate or lead these designated areas. Dr. Merchant was Dean of the College from 1999 – 2008. Professor Sue Curry was hired as Dean in 2009, serving until 2017, when she was appointed Acting Provost of the University of Iowa. The following summarizes some of the critical events in agricultural health and safety programming during this period.
2006 – The first national consensus program was held in Iowa on developing a national agricultural health and safety core educational curriculum.
2006 – The textbook Agricultural Medicine: Occupational and Environmental Health for the Health Professions was published.
2006 – The Building Capacity Program was founded.
2006 – The new (first in the world) graduate degree program (certificate, MS, PhD) in Agricultural Safety and Health was initiated.
2010 – The Pioneer Chair in Rural and Agricultural Health was established.
2012 – The second national consensus conference was held at Iowa on the national core agricultural health and safety educational curriculum.