SPH faculty address concerns of farm workers

Supporting the Agricultural Life

Photo credit: Dean Riggott

The rural life is not a particularly easy one. Neighbors may be few and far between; emergency rooms, grocery stores, and schools, a long drive. And if you make your living off the land, you are extraordinarily susceptible to the weather, not to mention the markets.

Yet about 18 percent of the state’s people live outside metropolitan areas, drawn to the country for its promise of self-reliance, a slower pace of life, and the opportunity to farm or ranch. Agriculture makes up 20 percent of Minnesota’s economy and producing food for our state and beyond can be a family tradition or a new and growing passion for young people eager to work the land.

If you start exploring the range of expertise at the School of Public Health, you’ll find a surprising number of faculty who tackle the practical, yet critical concerns of farmers: How do they know that the food they produce is safe for their customers? Are their animals protected from disease? What injuries and illnesses are they, themselves, most susceptible to? If they do get injured, can they get quality health care? And what will happen to them as they age?

Safe at the source

Minnesota agriculture produces $3 billion each year worth of commodity crops—corn, soybeans, sugar beets, and small grains— but more and more small farmers are growing produce and raising fruit for direct consumption. In our state, as everywhere, that food is vulnerable to contamination, often before it’s harvested.

“Increasingly, we’re seeing E. coli 157 and Salmonella in fresh produce, and those bacteria can be traced directly back to the production source,” says Craig Hedberg, an epidemiologist and professor in the Division of Environmental Health Sciences.

Hedberg and his colleagues work with other SPH faculty and members of the College of Veterinary Medicine, CFANS (College of Food, Agriculture, and Natural Resource Sciences), University Extension, and Minnesota Department of Health to explore foodborne illness outbreaks and to work with farmers on prevention.

“This multidisciplinary group is important for extending the reach of our efforts and maintaining relationships with food producers,” says Hedberg. “In a state like Minnesota, where we have this very intense and rich animal agriculture system side-by-side with fresh fruit and vegetable production, there is tremendous potential for contamination.”

According to Hedberg, E. coli 157 is not just a problem of cattle in large feedlots. It’s found in cows on small organic dairy farms as well. “

Family farms aren’t necessarily safer when it comes to this organism and its potential to contaminate [fruits and vegetables],” says Hedberg. “Small producers are trying their best to produce wholesome and quality products and are eager to address whatever may threaten that effort. We need to reach out more to them so they understand where the hazards might be and what steps they could take to prevent contamination.

Day-to-day risks

“Agriculture work is recognized as one of the more dangerous jobs,” says Bruce Alexander, professor in environmental health sciences. “It puts people in close proximity to animals, machinery, dusts, gases, and chemicals.”

Alexander heads up the Upper Midwest Agricultural Safety and Health (UMASH) center whose mission is to reduce the burden of illness and injury in agricultural workers and their families. Established in September 2011, it’s one of nine regional Centers of Excellence in Agricultural Disease and Injury Research, Education, and Prevention funded by the National Institute for Occupational Safety and Health (NIOSH).

“UMASH builds a partnership with the School of Public Health, College of Veterinary Medicine, Minnesota Department of Health, and the National Farm Medicine Center at the Marshfield Clinic,” says Alexander. “This partnership brings a unique interdisciplinary approach to agricultural health and safety.”

UMASH’s focus is animal agriculture, and it takes a One Health approach, a global concept that stresses the inextricable connection among animals, people, and the environment when it comes to health. UMASH is concerned with zoonotic diseases—those that pass from animals to humans—and is exploring the possibility that antibiotic resistant organisms may be affecting agricultural workers.

The center is also examining, through a series of studies, how different means of dairy and pork production—from intensive methods to more traditional practices—influence injury or illness in workers and their families. Once risk factors are identified, targeted prevention methods can be put in place. These methods, like agriculture itself, must change to meet current needs and demographics.

“The shift to larger operations has changed the workforce, which is increasingly made up of new immigrants, thus disease and injury prevention must consider language, literacy, and culture in a way it hasn’t before,” says Alexander.

Getting good care

Photo credit: Dean Riggott

When people on farms do get injured, where do they go? What kind of care do they receive? And how do they pay for it? The Rural Health Research Center has been asking questions like these for 20 years as it confronts the challenges of rural health care. For farmers who work for small operations or themselves, center director Ira Moscovice cites two particular concerns: lack of insurance coverage and quality of care.

“Due to a variety of factors, people in rural areas are more likely to have preexisting conditions, and they’re more likely to have chronic illnesses,” says Moscovice, health policy and management professor. Both things make it more expensive to get private insurance coverage. And farming is considered a high-risk occupation, which also drives up premiums. Being uninsured or underinsured has a serious impact on seeking care.

“When you put farmers’ natural stoicism together with the lack of, or inadequate, insurance coverage, they may delay going to see a doctor,” Moscovice says. “Early cancer diagnosis data, for example, show that people are 2.5 times more likely to delay going to see a doctor if they don’t have insurance. We want access to appropriate medical services for everyone in the United States.”

The federally funded Rural Health Research Center is one of six in the United States. Each was asked to choose a major theme, and the University center chose to study the quality of rural health care, an issue that has been largely ignored.

“For many people living in rural communities, if they had a local doctor or a small group of doctors, that was [considered] a success,” says Moscovice. “Very few researchers have been interested in what was actually going on in rural health care and the quality of services people were receiving.”

The center has been working to develop relevant quality measures to monitor and evaluate rural health care and to make sure the quality issue is on the table as future health care reform and policy changes occur. These efforts are being helped along by the government’s focus on quality care nationwide.

“Recently, necessary services that lead to good patient outcomes have been what payers (insurance companies or the government) want to support,” Moscovice says. “This shift creates incentives for providers to focus on quality. We want to make sure our rural communities don’t get left behind.”