Summary and Postscript
My aim – to tell a story, tracing the thread of a concept from a meeting of two friends with public health interest who formed a public-private Iowa idea— The IAM. Young professionals, often novices in the academic community, founded the IAM without a script. The founders used their intuition, heart, hard work, and vision to reduce trauma and disease and to save lives of people engaged in the fundamental industry of Iowa. I was a novice taken in by the founders. They gave me (paraphrasing Dr. Clyde Berry) “opportunity and hard work”. The IAM idea was a novel idea, an incubator, the beginning, the grandparent of a new specialty— Agricultural Medicine. The IAM was a one-health approach combining faculty and staff with diverse expertise, training, and professions, working together to make a better life for farmers, their families and workers. If there had not been the Iowa IAM idea in1955, it is questionable that we would have today, the two centers that focus on agricultural health and safety and five other centers that have some component of their activity in rural and agricultural health. Beyond Iowa, the IAM contributed to the spawning of 12 other agricultural health centers in the US, one in Canada, one in Australia, along with activities in Turkey and Sweden. The IAM was the foundation, which expanded the Department of Preventive Medicine and Environmental Health in the College of Medicine to a higher level of academic capacity and resources enabling the Department to transition to the College of Public Health.
Have the efforts of those involved with the IAM and follow-on over the years been successful in making agriculture more safe and healthful?
Have we reduced injuries and illnesses in agriculture? If so, what is the evidence?
Over that past 64 years, a lot of money was spent, for human resources, research, education, and outreach to reduce the injury and illness burden in our farming population. It is obvious that the total number of farm fatalities has declined. In Iowa in the ICASH 2009 annual report, we reported that fatalities per farm in Iowa decreased by 48% from 1990 to 2009. However, on a national basis, the risk rate per 100,000 at risk has remained relatively constant at about 20 fatalities per 100,000 exposed. The industry of agricultural (which includes forestry and fishing) remains the most hazardous industry based on risk of fatalities. Coal mining and construction were at one time more hazardous than agriculture. However, since the Occupational Safety and Health Act of 1971, there have been important reductions in risk rates in coal mining and construction, leaving agriculture in the unenviable position of first place.
What is Needed to Make a Real and Lasting Improvement in Agricultural Health and Safety?
From my point of view, further progress will be enhanced if three things happen:
- 1) The agricultural community, including individual producers, farm organizations and commodity groups, needs to become proactive on this issue. They must take the lead, working with academia and public health to reduce the injuries and illnesses;
- 2) Programs need to be put into place that are broad programs that cover all occupational illnesses and injuries and wellness through identification and removal of the hazards that may occur on a given farm, rather than targeting single hazards such as noise or respiratory exposures);
- 3) Incentives must become available to farmers to drive positive health and safety practices. Those incentives do not necessarily need to come from the government. They can come from businesses that serve agriculture (e.g. insurances, lenders, machinery manufacturers and dealers, supply and service companies). All businesses that serve agriculture benefit financially from healthy, happy, and productive producers. These businesses should share this economic benefit, rewarding producers who meet designated health and safety goals.
Will this occur? It can happen if stakeholders involved (farm community, agricultural health and safety specialists, and farm organizations) focus on the big picture and activate the above conditions, investing, and incentivizing comprehensive programs to remove health and safety hazards and promote wellness.
Will time tell?
