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Parker, M.D. David L. Hard, Ph.D. Katherine Wilson, M.P.H. Public Law 101-517 April 30 - May 3, 1991 Des Moines, Iowa Convened by U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Centers for Disease Control National Institute for Occupational Safety and Health September 1992 DISCLAIMER Sponsorship of this Conference and these Papers and Proceedings by the National Institute for Occupational Safety and Health (NIOSH) does not constitute endorsement of the views expressed or recommendations for use of any commercial product, commodity, or service mentioned. The opinions and conclusions expressed in the papers and abstracts are those of the authors and not necessarily those of NIOSH. Recommendations are not to be considered as final statements of NIOSH policy or of any agency or individual who was involved. They are intended to be used in advancing the knowledge needed for improving worker safety and health. This document is in the Public Domain and may be freely copied or reprinted. Copies of this and other NIOSH documents are available from: Publication Dissemination, DSDll National Institute for Occupational Safety and Health 4676 Columbia Parkway Cincinnati, Ohio 45226 FAX (513) 533-8573 U.S. Department of Commerce National Technical Information Services Springfield, VA 22161 NTIS PB 93-114890/$77.00 or A/O6 Superintendent of Documents U.S. Government Printing Office Washington, DC 20402 GPO 017-033-00463-3 DHHS (NIOSH) PUBLICATION NUMBER 92-105 For information on other occupational safety and health problems, call: I-800-35NIOSH ii National Farm Safety Week, 1991 By the President of the United States of America A Fro&math The men and women who work in America's agrIcultura1 aector make a vital contribution to our Nation's well-being. By providing conmunera with a variety of high-quality food and fiber at reasonable costs, they help to keep our work force strong and healthy and, tn so doing. help to maintain the Nation's economic productivity and competitiveness. Because we count on farmem and ranchers for 80 much, both as individuals and aa a Nation, it is fIttIng that we observe National Farm Safety Week-a concerted public awareness campaign aimed at promoting their health and safety. Over the years much hae been done to Improve the safety of agricultural production. Advances in science and technology and increased attention to avoiding safety rilrka have made farms and ranchen safer places to work. Moreover, dedicated profeaeionale and volunteers have been working together to promote health and safety In rural communities. These efforts are reflected by a welcome downturn in farm accident rates. Unfortunately, however, while important strides have been made in reducing the risks of farming and ranching, agricultural production remains one of our most hazardous lnduetrlee, with an accident death rate that is more than four tImea the average of all induetriee. More must be done to reduce the toll of farm-related accidents. Most accidenta on the Nation'8 farme and ranches can be prevented by sensible meaauree that involve little extra time, effort, or expense. For example, farmers and ranchers can reduce their risk of serious injury and illness by following manufacturers' instructions on the use of chemicals and machinery and by utilizing protective apparel and safety equipment when the job calls for it. Children should be kept away from $ardous machinery, and all family members and employees should be trained in safety procedures and first For generations. the men and women who work on our Nation's farme and ranches have endured long hours of tough, physical labor. However, they have continually met the challenges of their vocation with determlna- tion and pride--and with unparalleled success. During National Farm Safety Week, let us resolve to make excellence in health and safety another one of America's great farming traditions. NOW, THEREFORE I. GEORGE BUSH, President of the United States of America, by virtue of the authority vested in me by the Constitution and laws of the United States. do hereby proclaim the week of September 15 through September 21. 19Ql, ae National Farm Safety Week. 1 urge all who live and work on our Nation's farms and ranches to make the presematlon of personal health and safety an Integral part of their daily activities. I also urge them to protect their children, not only by inetructlon In safety habits, but also by setting an example of carefulness and by avoiding needless rmke. I also call upon organizations that serve agricultural producers to strengthen their support for rural health and safety programs, and I encourage all Americans to observe this week with appropriate activities as we express our appreciation for the many contributions that men and women in agriculture make to our Nation. IN WITNESS WHRREOF, I have hereunto set my hand this fifteenth day of April, in the year of our Lord nineteen hundred and ninety-one. and of the Independence of the United States of America the two hundred and fifteenth. . . . 111 Surgeon General's Conference on Agricultural Safety and Health FARM&E 2000 o A National Coalition tbr Local Action Convened by the National institute for Occupational Safety and Health April 30 - May 3, 1991, Des Moines, lowa PREFACE In 1990, the Congress established a national initiative in agricultural safety and health under Public Law 101-517. The Congress directed that this initiative, when sustained over a period of time, would result in a significant and measurable impact on . . . health effects among rural Americans. As part of that initiative, the Congress appropriated funds for the National Institute for Occupational Safety and Health (NIOSH) to convene a Surgeon General's Conference on Agricultural Safety and Health. This Conference was held in 1991 and was chaired by Assistant Surgeon General J. Donald Millar, the Director of NIOSH. The purpose of this Conference was to raise consciousness, build coalitions, disseminate information, and encourage action to prevent injury and disease in agriculture. The Conference fulfilled this purpose and established a vision for improving the total quality of health and safety for agricultural workers and their families in America: b Raise Consciousness. The Congress found that agricultural workers and their families experienced excessive rates of injuries, many kinds of cancers and lung diseases, and various health effects from exposures to agricultural chemicals. Their findings indicated significant disparities in the quality of health among agricultural workers and their families and a national need to improve the quality of their health. The Surgeon General's Conference reinforced this need, and the evidence was broadened into musculoskeletal problems, noise-induced hearing loss, dermatological conditions, stress, and infectious diseases. Furthermore, participants at the Conference emphasized the need to improve the health of agricultural workers and their families. b Build Coalitions. The Surgeon General's Conference raised the consciousness of many officials in the fields of agriculture, education, labor, and public health at the national, state, and local levels. The need for a concerted effort was recognized by the par- ticipants. Over 500 people participated from 41 states and the Commonwealth of Puerto Rico as well as from other countries. As a result, a growing network of the participants are reaching out among themselves and to others to offer and to receive help. b Disseminate Information, The most visible manifestation of information dissemination is these Proceedings and Papers: Surgeon General's Conference on Agricultural Safety and Health of that Conference, which will be distributed to participants and key prevention leaders at the national, state, and local levels across the nation. b Encourage Action. The action that was overwhelmingly encouraged was to improve 1 health and safety of agricultural workers and their families. Moreover, the word, PREVENTION, came through loud and clear--over and over-at the Conference. This action, the improvement of agricultural safety and health through prevention, was identified with three views: as an action for the 1990's, with national leadership, and through people at the local level. :he Surgeon General's Conference on Agricultural Safety and Health - 1991 V Preface With the recognition of a need for improvement, the Congress, through its national initiative at NIOSH, launched a program for improving the health and safety of agricul- tural workers and their families. This program was comprised of: b A Suwey. The Congress directed NIOSH to undertake a Farm Family Health and Hazard Survey to develop more complete information on the circumstances of agricul- tural injury and disease problems. Based upon this information, informed priority-setting for prevention can be implemented and a baseline for measuring improvement can be established. b Research. To insure that preventive actions are taken based upon scientific findings, including the etiology of the injuries and diseases, the Congress also directed NIOSH to conduct research both intramurally and through university-based Centers for Agricultural Health and Safety. k Intewention. To actively promote and implement the research findings, the Congress directed NIOSH to establish a national Agricultural Health Promotion System in collaboration with county extension agents. The Congress also directed NIOSH to devise an early detection strategy to reduce the number of cancer deaths among farmers through Cancer Control Demonstration Projects for Farmers. In addition, funds were provided for the training of professionals in agricultural safety and health. b SuMZlance. To monitor results, the Congress directed NIOSH to establish an Agricultural Health Nurse Program in which rural hospitals would provide ongoing responsive (focused at intervention) surveillance to identify agriculture-related disease and injury problems through the support of nurses at rural hospitals. In 1991, the Secretary of Health and Human Services issued a report, Healthy People 2000, which included national goals and objectives for improving the health of Americans. Three overarching goals emerged from this effort, each of which apply to agricultural workers and their families. These goals are: increase the span of healthy life for Americans, reduce health disparities among Americans, and achieve access to preventive health services for all Americans. Emerging from the purpose established by the Congress for a national initiative for agricultural safety and health from the goals of Healthy People 2000, and from the Surgeon General's Conference on Agricultural Safety and Health is a national vision for the 1990's for implementing the initiative: To continuously and measurably improve the safety and health of every working man and woman in American agriculture through the prevention of Leading Work-Related Diseases and Injuries consistent with the goals and objectives of `Healthy People 2000.' O (%c?$wc Antonia C. Novello, M.D. Surgeon General vi Papers and Proceedings Surgeon General's Conference on Agricultural Safety and Health FARMSAFE 2000 . A National Coalition f?~ Local Action Convened by the National institute tir Occupational Safety and Health April 30 - May 3, 1991, Des Moines, Iowa FOREWORD The Surgeon General's Conference on Agricultural Safety and Health was convened by the National Institute for Occupational Safety and Health (NIOSH) in 1991. NIOSH was created in 1970 as a result of the passage of the Occupational Safety and Health Act. NIOSH is the national public health organization responsible for the occupational safety and health of all of the nation's workers. Moreover, NIOSH is a component of the Centers for Disease Control (CDC), The Nation's Prevention Agency. In 1990, the Congress expressed concern that agricultural workers and their families experience a disproportionate share of injuries and diseases associated with numerous chemical, biological, and physical hazards. For example, agricultural workers have the second highest occupational fatality rate. They run a significantly higher risk of dying of certain types of cancer than persons in other occupations. The Congress also observed that inhalation of organic dusts from plant, soil, and animal sources, and from chemical and other substances, results in occupational health risks to agricultural workers. The Congress, recognizing that agricultural workers continue to suffer high levels of injury and illness, directed NIOSH to lead a comprehensive national program and undertake a series of initiatives in surveillance, research, and intervention to prevent occupational injuries and diseases in agriculture. The Congress believed that NIOSH was in a unique position to lead a comprehensive national effort to prevent injury and disease in agriculture. The NIOSH initiative is intended to provide a balanced approach to substantially reduce the incidence of fatal and nonfatal traumatic injury, chronic injury, and occupational diseases among the 3.4 million agricultural workers in the United States. NIOSH expanded its research program to address the safety and health of workers in agriculture and awarded cooperative agreements to enhance the Institute's existing program in the areas of surveillance, research, and intervention. The Congress also directed that NIOSH convene a Surgeon General's Conference on Agricultural Safety and Health. Held in 1991, its purpose was to raise consciousness, build coalitions, disseminate information, and encourage action to prevent injury and disease in rural areas. Several solutions for preventing diseases and injuries were presented and discussed at this Conference. The following is a summary of the Con- ference through the words of its participants, followed by a statement of the problem that emerged from the Conference, and a vision for the future of agricultural safety and health in America as well as a special mention of a particular, fully preventable agricul- tural injury-"an occupational obscenity"-which was repeatedly emphasized at the Conference. CONFERENCE SUMMARY The general design of the Conference was to, first in plenary session, address its purpose, then provide direction through keynote speeches and questions, and pose some as- sumptions about the future of both the agricultural workforce and workplace. The titles Surgeon General's Conference on Agricultural Safety and Health - 1991 vii Foreword of the sessions and titles in this document corresponding to this part of the Conference are: The Potential for a National Coalition, Looking Ahead to the Next Century, Questions to Guide the National Agenda, Medical Intervention Problems and Opportunities, and Issues That Affect the National Agenda. The Conference included five concurrent sessions dealing with the issues of surveillance, research, and intervention. The proceedings from these sessions are addressed in this document in the chapters entitled Surveillance-Agriculture-Related Diseases, Injuries, and Hazards, Research-Chemical and Biological Hazards, Research-Mechanical and Physical Hazards, Intervention-Worker Protection from Environmental Hazards, Intervention-Safe Behaviors among Adults and Children. Within each of these sessions, presentations of factual information were made, and discussions ensued from the perspectives of a range of interested parties. Returning to plenary sessions, the chair of each concurrent session reported the results of deliberations in their session. In addition, a report was made on the issues raised at another conference held concurrently on migrant and seasonal labor. These reports are presented in the chapter entitled Elements of a National Agenda. The closing plenary session provided an opportunity for concluding remarks from a variety of participants who ranged from governmental to those representing farm organizations to a victim. These remarks are documented herein in the chapter entitled Actions for the Future. The Conference included a poster and video tape session with 102 posters presented. The abstracts of the posters and titles of the video tapes are presented in the chapter entitled Making Connections. Six unifying principles emerged from the Conference as operational concepts for the future. They are found in the words of 72 speakers at the Conference-these themes offer a verbal tour through these Papers and Proceedings: b CONTINUOUS IMPROVEMENT THROUGH PREVENTION. The Congress has directed that a national initiative, of which this Conference was a part, be launched so that when sustained over a period of time, would result in a significant and measurable impact on . . . health effects among rural Americans. Augmenting this direction for continuous improve- ment, the Surgeon General's Conference consistently and in multiple ways demonstrated the need to prevent problems in order to improve the safety and health of agricultural workers and their families. Senator Tom Harkin of Iowa asserted, " . . . we need to make "Prevention First" our motto for health care in the 90's." Dr. Thomas Dean of the National Rural Health Association challenged the Conference, " . . . to go forth in these deliberations with a sense of urgency and with an understanding that every day lives are lost because families are being devastated and futures are being ruined because of our failure in the past to build these coalitions." . . . VIII Papers and Proceedings Foreword Speaking to a paradigm for prevention, Dr. William Popendorf from The University of Iowa said, " . . . we face yet another challenge; how to translate them (parameters of health effects) into "agricultural hygiene," the industrial hygiene paradigm of "anticipa- tion, recognition, evaluation, and control learned in general industry . . . " Jeffrey Human of the Office of Rural Health Policy encouraged the Conference to, ' . . . confront conventional approaches and make new choices with limited funds, choices that help solve rural health problems." Willis Eken of the Minnesota Farmers' Union contended, " . . . that it is something of a sham if the most effective tool for safer environmental protection regarding machinery is a law suit." Joseph Kinney of the National Safe Workplace Institute urged the Con- ference, " . . . to begin to get realistic about how you would like to see these issues ad- dressed." Merlin Plagge of the Iowa Farm Bureau observed about OSHA standards that, (1 . . . knowing they exist has encouraged farmers to work for safer farmsteads." b RECOGNIZETHENEEDS OF THE POPULATIONAT RISK. Fundamentaltoprevention is recognizing the needs of agricultural workers and their families, a population at disproportionately high risk of work-related disease and injury. Dr. Myron Johnsrud of the U.S. Extension Service asserted, "A national strategy could rest on the belief that the most effective preventive efforts will emerge from a process that emphasizes identifying and characterizing problem areas and populations at risk." Relatedly, Dr. James Merchant of the Institute of Agricultural Medicine and Oc- cupational Health at The University of Iowa reported, "Agricultural production is now changing dynamically, resulting in a substantial increase in farmers with non-farm jobs, greater involvement of women and seasonal workers, and involvement of children and recreational farmers in agricultural operations." Dr. Leslie Whitener of the Economic Research Service at the U.S. Department of Agriculture defined this population: `The largest component (46 percent) of the agricultural work force in 1987 was made up of the 3.6 million people who did unpaid farmwork . . . .the hired component of the agricultural work force will continue to grow in importance as hired workers increasingly replace family workers on farms and as the number of large, labor-intensive commercial farms continues to increase." Christopher Atchison of the Iowa Department of Public Health noted, "Because farming has traditionally been a family business, that it is not just the professional farmer, it is the farm family that is at risk for injury." Cheryl Tevis from Succes@Z Faming Magazine observed, " . . . that about half of farm women work outside the home." Todd Frazier from NIOSH expressed his viewpoint, "Because I am from a public health background and have always been interested in the population at risk, these demographics spell out to me a very serious challenge that we are facing when we look at projects that address the problems of farm families in generally rural areas." Surgeon General's Conference on Agricuttural Safety and Health - 1991 ix Foreword Speaking of the migrant labor portion of the population, Roberta Ryder of the National Migrant Resource Program asked, "Is it really acceptable that such a large poriion of our population be relegated to the edge for the duration of their lives?" Dr. Russell Currier from the Iowa Department of Public Health recognized two patterns of disease among agricultural workers, "Migrant farm workers experiencing human-host illnesses, often episodic and exacerbated by substandard living and employment conditions. All other farm workers experiencing sporadic, isolated illness that is most frequently zoonotic, vector-borne, or environmentally acquired in nature." b SURVEILLANCE TO MEASURE IMPROVEMENTS. Part ofpreventionis the study of trends so as to measure progress. Surveillance is the means of doing so. Through surveillance, we can systematically and continually collect, analyze, and interpret data related to health and safety and direct prevention programs so as to control and, when possible, eliminate the occurrence of diseases and injuries. With reference to John Donne's 16th century poem, Dr. William Halperin from NIOSH spoke to the role of surveillance as a guide to preventive action, "Surveillance in modern times is the equivalent of the tolling of the bells with the added commitment to inves- tigation of the causation of morbidity and mortality and dissemination of data and analysis with the goal of prevention." Dr. John May from the New York Center for Agricultural Medicine and Health speaking to the use of sentinel events in surveillance relayed that, " . . . intervention should affect other workers by either addressing the hazardous exposure, by screening similarly exposed workers, or by insuring that at least adequate protection is provided to similarly exposed workers." About surveillance and priorities, Dr. Dennis Murphy from Penn State University contended, "If we are going to let data guide us, we have to get to some specific categories to have some guidance." Dr. Henry Anderson from the Wisconsin Department of Health and Social Services reported, "We need to move away from the broad view to some specific, high-priority activities." Regarding the role of the "helping" professions, Rodney Gilmore from the North Dakota State Department of Public Health related, "We learned that in order to keep a good surveillance system going, you must keep direct and frequent contact with the medical facilities and with the providers who are giving you the information." Dr. Eugene Freund from NIOSH suggested, "Inasmuch as the nurses, through their interactions with providers, can do case surveillance, they can help with the recognition of problems that may not be identified in the community." b RESEARCH TO FIND ROOT CAUSES. A principle that emerged at the Conference was to base actions on facts. Research is a way of finding the facts, and through research, we work to understand the causes of work-related diseases, injuries, and hazards; detect their vulnerabilities to prevention; and discover, assess, and improve measures to reduce them. Dr. Lorann Stallones from Colorado State University reported, "National policy guidance is needed in order to provide focus for targeting proper areas of research and to define the scope of research to be performed within priority areas." x Papers and Proceedings Foreword Regarding high technology, Dr. Ronald Eckoff of the Iowa Department of Public Health introduced two speakers saying that they, " . . . will reveal changes in the agricultural work place as it is affected by new and different crops and by biotechnology." Dr. Daniel Kugler from the Office of Agricultural Materials at the U.S. Department of Agriculture noted, " . . . that agriculture, indeed, is a very high-tech business." Dr. Jane Rissler from the National Wildlife Federation challenged the Conference with, "I hope that this presentation will provoke a wide-ranging consideration and evaluation of the potential impacts of biotechnology on farm worker health." Regarding noise-induced hearing loss, Dr. Matthew Marvel from the Oneonta Health Center observed that, "We also might find some high-technology solutions like using sound cancellation." The occupational problems faced by farmers were seen to be numerous, significant, and preventable. Dr. Susanna Von Essen from the University of Nebraska summarized the problems with lung diseases on the farm, `The presence of inflammation is a common theme in these disorders." Other problems were addressed by Dr. Linda Rosenstock from the University of Washington when she maintained that, "On the basis of this study and the accumulating evidence in the medical literature, we feel that even episodes of acute organophosphate poisoning can cause permanent neurologic dysfunction." Dr. Aaron Blair from the National Cancer Institute observed, "A critical role for suppression of immune responsiveness by pesticides has been demonstrated for infectious disease and maybe for other diseases." The injury problem was addressed by Dr. Sverker Hoghind from the Swedish Farmers Safety and Preventive Health Association who explained that, "Machine design may be related to hazards of two kinds. One is accidents causing acute injuries. The other is chronic injuries or illnesses because of long-term, unfavorable effects on the body during work operations." Murray Madsen from Deere and Company observed that, "Sometimes equipment is in mint condition; other times it is not, or modified, or built from scratch in a local shop." Dr. Thomas Bean from Ohio State University reported that, "In either case, the majority of studies indicated that farm equipment was the single factor most associated with on-farm injury." John Crowley from the Equipment Manufacturers Institute urged that, "Behavioral research is needed to guide engineers on how equip- ment can be designed for safer operation and maintenance." Dr. Susan Gerberich from the University of Minnesota maintained that, "A major barrier to progress in the prevention of agricultural injuries has not only been a lack of knowledge about the magnitude of the problem but also a lack of knowledge about specific causes or risk factors due to the lack of analytical studies." Penn Peters of the U.S. Forest Service stated that, "A high-priorityresearch area is in the injuries that result from a felled tree having hit another tree, which includes hangup fell, broken limbs or tops, and butt rebound." Regarding the hazards of overhead electrical lines, Robert McLymore from North Carolina State University remarked, `That moment of carelessness may end up with that piece of equipment getting in contact with that line. We know how electricity kills." Governor Robert Ray, Chairman of the National Advisory Committee on Rural Health Surgeon General's Conference on Agricultural Safety and Health - 1991 xi Foreword Policy, observed that, "the suicide rate for farmers is now 30 to 40 percent above the national non-farm rate." Dr. David Co&ran of the Occupational Safety and Health Administration recounted a conversation' "She was telling me that the top occupational category suffering from tendinitis in the state of Washington is farmworkers." Regarding greenhouse workers, Dr. John Coumbis of the Agency for Toxic Substance and Disease Registry related that, I' . you find some of the reports of back pain in roughly a third of the work force, pain id multiple joints in 19 percent, pain of the upper extremities in 11 percent of the workers, lower extremities in 8 percent, and neck pain in 2 percent." b RESPECT PEOPLE WHILE CONTROLLING THE PIROBLEMS. Another principle that emerged overwhelmingly at the conference was respect for people, and also consistent with our Conference theme of A National Coalition for Local Action, our intervention must be based upon such respect. Speaking to this theme through a video message, Secretary Louis Sullivan of Health and Human Services stated, "The key to making those strategies effective--the critical, vital factor that will determine our success in lowering the risks of agricultural work-is local initiatives and efforts," Assistant Surgeon General William Roper declared, "As the theme of this meeting, N&ionaZ Coalition for Local Action, clearly portends, the foun- dation of our public health system' as it functions in agriculture and other sectors, must be the local public health agency." Dr. James Dosman from the University of Saskatchewan recommended, " . . . the estab- lishment of health and safety committees at the local level, organized by target pop- ulations, for the purpose of identifying issues, facilitating programming, and achieving results." Referring to agricultural workers, Ellen Widess' Children's Advocacy Institute contended, `Unless we also deal with those economic realities of their lives and their limited choices, we will fail in our efforts to improve health and safety." Regarding networking and community involvement' Dr. Dean Stueland from the National Farm Medicine Center related, "We need to close the loop between what is happening on the farm and what is happening in medicine so that people understand each other." Wayne Sprick of the National Young Farmer Educational Association said, `The FFA chapters and those younger people are looking for opportunities to conduct community-service types of projects." Robert Graham with the National Vocational Agriculture Teachers' Association commented, "We encourage students to sit down and do a community review by interviewing resource people with organizations, such as the community health organizations, the district representatives of OSHA and NIOSH, the Farm Bureaus, and National Grange Affiliates." Valerie Wilk from the Farmworker Justice Fund reported, "In a number of the workshops there were very concrete examples of groups who had worked in coalition, either within their community or statewide, on particular health and safety issues: workers' compensation or field sanitation." xii Papers and Proceedings Foreword Gene Graham with the W.K Kellogg Foundation challenged the Conference, " . . . (how can we) develop meaningful opportunities for enfranchisement, access to the institutions of society, and the much needed occupational safety and health interventions for migrant and seasonal workers?" Craig Merrilees with the Consumer Pesticide Project contended, "Health and safety improvements come only when people are organized and when they are able to control their own destiny"' Thomas Seymour from the Occupational Safety and Health Administration observed, "In the OSHA history of writing rules, regulations and enforcement, we have found that the people who are interested in trying to correct these problems need to be on board and in support of the process." Regarding the issue of training, Cynthia Douglass from the Occupational Safety and Health Administration conveyed, `The answer lies in education, training, and increasing awareness of those hazards and how they can be reduced." Malanie Zavala from the University of California-Davis pointed out that, " . . . a lot of these people come here without an excellent education' and this is going to make a difference as to what they can understand in terms of reading-not so much in terms of spoken language, I think' but in terms of things that they are going to have to read." On children and women, Marilyn Adams of Farm Safety for "Just Kids" proposed, "My experience with the youth tells me that they are our best bridge to the farm family. If you take this one step further and train farm women in tractor safety, chemical safety, rescue, and the other aspects of farming along with the youth, Dad and Grandpa will not have a chance after we start rocking the boat and making waves." Surgeon General Antonia Novello declared, "As a woman' I totally agree with the philosophy of Marilyn Adams' group, Farm Safety for "Just Rids"' who say that the one person on a farm who can play the most pivotal role in educating farmers and farm children about the dangers of working on a farm is the woman." Nineteen-year-old Mark Timm from the National FFA Organization related, "Not only does America need its young, but young people need your help, support, guidance, and leadership." Dr. Walter Armbruster of the Farm Foundation observed, "We also know that reaching adults through youth is a very effective channel for modifying adult behavior." b UNDERSTAND 'THE SYSTEMYNORDERTO CONTROLTHEPROBLEMS. Ageneral principle that emerged was to develop win-win situations by understanding the system, recognizing people as part of the system' and intervening early in that system in its design. Dr. Rice Leach, Chief of Staff to the Surgeon General' in speaking to a `win-win' strategy conveyed it succinctly, " . . . I submit that the purpose of this endeavor or our mission is to prepare the next generation to live in harmony with nature." Judith Heffeman of the University of Missouri-Columbia remarked, `There is a social movement afoot that looks at environmental and food safety and a whole host of issues that are . . . put together, and so pesticide usage and water quality-and you know the litany-we have heard much of it here." Dr. Robert Pinger from Ball State University reported, "Integrated Pest Management is the use of the safest and most appropriate Surgeon General's Conference on Agricultural Safety and Health - 1991 . . . XIII Foreword combination of methods (physical, chemical, and biological) to control vector popu- lations." Dr. Kelley Donham from the University of Iowa reported, "One of the items that came out of the group was a call for a sustainable human resource in agriculture. This was based on an analogy to the sustainable agriculture movement from a natural resources conservation perspective." Larry Belmont from the Idaho Panhandle Health District 1 stated, "Our next best alternative is to develop new solutions or new systems of service to cover those areas." Recognizing human behavior as an important part of the system, Dr. Robert Aherin from the University of Illinois propounded, `This theory has proven that intention is strongly correlated to one's behavior and behavioral intentions are formed by two basic determinants, one personal in nature and the other reflecting social influence." Assistant Surgeon General Michael McGinnis offered an avenue for prevention by noting that, ,I the prominent role of behavior in health threats is not novel or unique, some of the lessons that can be gleaned from other public health areas may be germane to the kinds of approaches that we seek to establish for agricultural health and safety." In contrast, Dr. Pamela Elkind from Eastern Washington University contended, "This assumption, simply stated, is that to make agriculture safe for the farm families and workers, it is necessary to motivate them to protect themselves from health and safety hazards . . . I shall attempt to demonstrate to you that these assumptions lack validity." Regarding design, Dr. David Pratt of the New York Center for Agricultural Medicine and Health reported, "Intervention strategies are most effective when they are applied early in the process." Dr. Gary Erisman, a private farmer, declared, " . . . design is the most critical stage for the prevention of hazards and hazardous products." Ray Crammond, consulting engineer, said of design, "I think the biggest problem is people who ignore the human input." Rollin Schnieder from the University of Nebraska stated, "You have to realize that a lot of the equipment that we have in agriculture is not totally designed." Professor Stephan Konz from Kansas State University maintained, "Designing out the problem is the best approach because it is a permanent solution." Dr. Richard Fenske from the University of Washington said, " . . . there are many opportunities, if we are creative, to reduce the hazard before we ever have to worry about personal protec- tive equipment." Dale Baker from J.I. Case Company challenged the Conference, "Is anyone going to invest the time and effort to develop new designs unless there is, in fact, a demand?" THE PROBLEM: DISEASE AND INJURY To help establish priorities for the field of occupational safety and health, NIOSH in 1983 developed a list of 10 Leading Work-Related Diseases and Injuries and proposed national strategies to prevent each of them. NIOSH invited leading experts to improve xiv Papers and Proceedings Foreword and elaborate on these strategies at two national symposia held in 1985 and 1986.' The initial list was based upon three criteria: the scope of the problem, the severity of the problem in the individual case, and the vulnerability of the problem to prevention. More recently, infectious diseases have also emerged as a significant problem in occupational safety and health.' The problem is disease and injury, our common enemy. We have seen how this enemy attacks American agricultural workers and their families. Recognized at this Conference were a number of The Leading Work-Related Diseases and Injuries: 1. 2. 3. 4. 5. 6. 7. 8. 9. IO. 11. Occupational Lung Diseases - farmers' lung, asthma, hog lung, silo fillers' disease, etc. Musculoskeletal Injuries - milkers' knee, tractor drivers' syndrome, tendinitis, repetitive motion trauma, etc. Occupational Cancers - skin, bladder, and brain cancer, leukemia, etc. Severe Occupational Traumatic Injuries - machine-related fatalities, electrocutions, suffocations, suicides, amputations, eye injuries, etc. Occupational Cardiovascular Diseases - heat stroke. Disorders of Reproduction - miscarriages, infertility, etc. Neurotoxic Disorders - dementia, neurologic dysfunction, etc. Noise-Induced Hearing Loss Dermatological Conditions - burns, lacerations, dermatitis, etc. Psychological Disorders - depression, stress, etc. Infectious Diseases - zoonosis, tuberculosis, etc. A VISION FOR THE FUTURE In 1990, the Congress directed NIOSH to lead a comprehensive national program to prevent occupational injuries and diseases in agriculture. NIOSH gains its authority for responding to this direction from the Occupational Safety and Health Act of 1970, which 1 Proposed Natiottal Strategies for the Prevention of Leading Work-Related Diseases and Injuries. Part 1 in 1986 and Part 2 in 1988, Published by the Association of Schools of Public Health under a Cooperative Agreement with the National Institute for Occupational Safety and Health. 2 For an example related to agricultural workers see: Centers for Disease Control. "Prevention and Control of Tuberculosis in Migrant Farm Workers: Recommendations of the Advisory Council for the Elimination of Tuberculosis," MLVIXI? 1992;41 (No. RR-lo). Surgeon General's Conference on Agricultural Safety and Health - 1991 xv Foreword established the national goal "to assure so far as possible every working man and woman in the Nation safe and healthful working conditions and to preserve our human resour- ces." NIOSH is charged in the Act to undertake scientific activities that will enable the goal to be won. In response to this charge, NIOSH identifies those populations at highest risk, defines risk factors that guide our efforts to reduce those risks, and provides information to whomever has the ability to act in preventing the problem. The Surgeon General's Conference of 1991 has established a national commitment to the continuous improvement of safety and health among agricultural workers and {heir families. It is a "Total Quality" commitment! As a result of the Conference, the Surgeon General has identified a VISION for a national program for agricultural safety and health in America: To continuously and measurably improve the safety and health of every working man and woman in American agriculture through the prevention of Leading Work-Related Diseases and Injuries consistent with the goals and objectives of `Healthy People 2000. ' In 1991, the U.S. Public Health Service published a report, Healthy People 2000: National Health Promotion and Disease Prevention Objectives. This document is a statement of national opportunities. This report is not intended as a statement of Federal standards and requirements, but as a product of a national effort that involved over 10,000 people. The Surgeon General addressed three overarching goals from this report in the Preface. These goals are buttressed by specific and substantive objectives, which are aimed at guiding decisions about programs, resource allocations, and profes- sional and personal commitments. The objectives enumerated in Healthy People 2000 deal with Health Status, Risk Reduc- tion, Services and Protection, and Surveillance. The Health Status Objectives address the problem of disease and injury, the Risk Reduction Objectives address the control of the causes of the disease and injury problem. The Services and Protection Objectives relate to the processes that require improvement so that risk can be reduced. The Surveillance Objectives address the process of diagnosing and reporting information about health status, risk reduction, and services and protection so as to better guide and focus our intervention to control disease and injury. With the vision of the future in mind, FarmSafe 2000 is a program commitment to Healthy People 2000. Consistent with this commitment, we have listed, as illustrative examples, 11 Health Status Objectives for the year 2000 that correspond with the xvi Papers and Proceedings Foreword problem, the 10 Leading Work-Related Diseases and Injuries plus infectious diseases.3 Each objective represents a significant improvement in health status over an existing baseline by the year 2000. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Occupational Lung Diseases - Reduce asthma morbidity, as measured by a reduction in asthma hospitalizations to no more than 160 per 100,000 people (11.1). Musculoskeletal Injuries - Reduce cumulative trauma disorders to an incidence of no more than 60 cases per 100,000 full-time workers (10.3). Occupational Cancers - Reverse the rise in cancer deaths to achieve a rate of no more than 130 per 100,000 people (16.1). Severe Occupational Traumatic Injuries - Reduce work-related injuries resulting in- medical treatment, lost time from work, or restricted work activity to no more than 6 cases per 100 full-time agricultural workers (10.2~). Occupational Cardiovascular Diseases - Reduce stroke deaths to no more than 20 per 100,000 people (15.1). Disorders of Reproduction - Reduce the prevalence of infertility to no more than 6.5 percent (5.3). Neurotoxic Disorders - Reduce nonfatal poisoning to no more than 88 emergency department treatments per 100,000 people (9.8). Noise-Induced Hearing Loss - Reduce significant hearing impairment to a prevalence of no more than 82 per 1,000 people (17.6). Dermatological Conditions - Reduce occupational skin disorders or diseases to an incidence of no more than 55 per 100,000 full-time workers (10.4). Psychological Disorders - Reduce suicides to no more than 10.5 per 100,000 people (6.1). Infectious Diseases - Reduce tuberculosis to an incidence of no more than 3.5 cases per 100,000 people (20.4). Another Health Status Objective, which would be classified under Severe Occupational Traumatic Injuries, is to reduce deaths from work-related injuries to no more than 4 per 100,000 full-time agricultural workers. There was an annual average of 6 deaths per 100,000 for the period, 1983 to 1987. The next issue that I will discuss relates directly to this objective. 3 Each Objective is parenthetically followed by an identifying number. This number uniquely identifies each Objective within the document: U.S. Department of Health and Human Services, Public Health Service. Healthy People 2000: National Health Promotion and Disease Prevention Objectives. 1990; DHHS Publication No. (PHS) 91450212, Washington, DC: Government Printing Office. Surgeon General's Conference on Agricultural Safety and Health - 1991 xvii Foreword AN "OCCUPATIONAL OBSCENITY One final issue that was raised at the Conference cannot go without special mention. Amidst expressions of anguish and pleas for reason, there was an overwhelming interest in a particular issue, namely the need to reduce the risk of fatalities related to tractor roll-overs. Deaths from tractor roll-overs are the leading cause of traumatic fatalities on the farm. There is no acceptable excuse for the persistence of this problem as deaths from tractor roll-overs are fully preventable. The problem justifies the term, "occupational obscenity." Twenty-seven speakers at the Conference addressed this problem. Categorized by the six principles that emerged as unifying concepts at the Conference, here is what they said: b CONTINUOUS IMPROVEMENT THROUGH PREVENTION. A good example of the need for such a model is the prevention of tractor roll-over deaths througlz the application of roll-over protective structures (ROPS) on both new and older tractors. The epidemiological evidence for the very significant risk posed by tractors without ROPS is clear. . . The data available from Sweden, which mandated such a program, makes it equally clear that ROPS can prevent almost all tractor roll-over deaths. An important question for this conference is whether an American intervention model can be developed that can produce a significant reduction of tractor roll-over deaths and injuries. A second question, with much broader ramifications, is, "Yf we cannot develop a U.S. model for a proven intervention on the single most important cause of agricultural mortality, how can we succeed in addressing less dramatic yet still impotiant causes of agricultural d&eases and injuries?" - Dr. James A. Merchant Director, Institute of Agricultural Medicine and Occupational Health The University of Iowa IJZ Sweden in 1959 the law was put forward concerning safeq frames (ROPS) in new tractors. It was also decided that employed agricultural workers were not allowed to work in tractors lacking such frames. Self-el?tployed farmers and family members for many years were excluded from this law and could use old tractors without frames in farm work A new tractor, of course, had this device. IJI 1983 the law was extended to include family farmers. It was later decided that even old tractors had to have frames if they were to be used in agn'cultural work The effect on fatalities due to tractor turn-over since the year of legtilation was striking. It is obvious that thti action from the authorities, unpopular as it might have been, has had quite a significant effect in preventing severe accidents. - Dr. Sverker Hogliind Director, Swedish Farmers Safety and Preventive Health Association Stockholm, Sweden b RECOGNIZE THENEEDS OFTHEPOPULATIONAT RISK. Even though the land is so jlat, we still have a tendency to have tractor roll-overs in the eastern part of the state . . . Tractor roll-overs are still a major source of fatalities in the state. - Rodney Gilmore Injury Control Program Manager North Dakota State Department of Public Health Bob Aherin said something about ROPS that really interested me. He said to ident@ the farmers with high risk exposure and to identify appropriate intervention strategies . . . As a farmer, this makes much more sense to me than suggesting that all farmers should put ROPS on all tractors. . . . XVIII Papers and Proceedings Foreword We need to start somewhere and give the farmer a realistic picture of the high-risk exposure with all tractors with end loaders or whatever the highest rirk is . . . I heard Wes Buchele address the issue of retrojits. By all means, guarding for the older equipment neea3 to be made accessible and marketed It is my personal feeling that dealers should not resell equipment without all protective shields. They have a responsibility to their customem to market the proper shielding for their own products. - Marilyn Adams President, Farm Safety for "Just Kids" Farm children have been injured and killed for years. I was too young to remember a tragic tractor roll-over accident that claimed the life of our neighbor's son, Years later I remember finding the yellowed and brittle newspaper articles about it that my mother had saved On looking back, I think that that accident may have bud a lot to do with the fact that my brothers were not expected to function as hired hands at a young age. . . When askeg `!lf cost were not a consideration, would you use roll-overprotection ?" 89percent said they woukl; 96percent would use safety shielding; and 50 percent would use day care. These figures may be slightly high. We all know it is good to have good in ten tions. - Cheryl Tevis Senior Farm Issue Editor Successful Farming Magazine We have had a great deal of discussion, in thk session, about ROPS. We have all seen the slide, many times, of the success of ROPS in Sweden. In 1985, we had a commitment by the North American tractor manufacturers to make ROPS standard on all tractors. With a few exceptions of tractors that are being imported into thk country and those that are for orchard applications, all tractors since that time are equipped with ROPS. By 1970, ROPS in this country became available OJZ virtually all major manufacturers'product lines. There was no demand for them. Therefore, we have a significant number of tractors in operation in the U.S. that were built in that interval between 1970 and 1985 that are not equipped with ROPS. I would suggest, in gross temzs, that there are about a million tractors that are equipped with ROPS or that have ROPS built into the cab. About a million tractors that are out there could have a ROPS installed on them but do not. Another million tractors that are in use were built prior to thir introduction of ROPS and here installation of ROPS becomes a real technological fisue. Now we should look at those two issues separately. IJZ putting ROPS onto tractors that were built prior to 1970, there are some significant technical issues. Will the tractor structure survive an impact with this ROPS attached? The structure was not built for that kind of use. New frames could be designect, possibly, to accommodate the design by sharing the load forward to the transmtision housing. There is now a need to develop that new structure. There were many applications for those old tractors where implements were attached to the same location that we would attach thti ROP structure. If you destroy that, you have destroyed the utility of that tractor. There is also the tisue of the economics ofpum'ng those ROPS OJI old tractors. If there is to be a program of that nature, it is going to have to start with the development of some pubic policy change that will create that demand Is anyone going to invest the time and effort to develop new designs unless there ti, in fact, a demand? The issue for tractors built in the interval between 1970 and 1985 where a ROPS can be installed becolnes an issue of how to create an environment where the public demands those ROPS. They are available. A demand undoubtedly could bring down the cost that was mentioned earlier. Until there is a demand, there will not be any initiative that will cause that to happen. It is the chicken and the egg situation. If you could decrease the cost, maybe you could increase the demand You Surgeon General's Conference on Agricultural Safety and Health - 1991 xix Foreword cannot decrease the cost, however, until there is a demand We are now again looking at what is a public policy issue of how you create that demand I would say to you that my brother is aware of the &sues of ROPS and tractor overturns. But fatal tmctor overtumr are a rare event (a farmer is far more likely to be killed in a car accident than a tractor overturn). Virtually all farmers are aware of the issue of fatal tractor 0veWm.s in the same sense that farmers (and the general public) are aware of the issue of cigarette smoking causing cancer. - L. Dale Baker Product Safety Engineer J.I. Case Company b SURVEILLANCETOMEASUREIMPROVEMENTS. For many conditions we are at different surveillance stages in this scheme. For one condition that we have heard much about, that of famt fatalities due to tractor roll-over, we have identified the problem, we large@ know the scope of the problem, and we know what needs to be done to target interventions. -Dr. Henry A, Anderson Chief, Section of Environmental Epidemiology Wisconsin Department of Health and Social Services For example, in 1958, Sweden instituted a law that any new tractor that wasproduced had to have roll-over protection. In the years thereafter, surveillance data indicate a decline in roll-over fatalities. In 1978 Sweden instituted another law that any tractor in use had to have roll-over protection, and the problem was eradicated - Dr. William E. Halperin Associate Director for Surveillance Division of Surveillance, Hazard Evaluations, and Field Studies National Institute for Occupational Safety and Health The Olmstead Agricultural Trauma Study provided the basis for the Regional Rural Injury Study, currently being conducted in a five-state region: Minnesota, Wuconsin, North Dakota, South Dakota, and Nebraska. Data collection covers a twelve-month period of time for over 4,000 rural households, utilizing computer-assisted telephone interviews. This effort will enable the identification of injury rates for each state and the region as well as multiple analytic substudies, including tractor-roll-avers and animal-human injuries. The project also includes application of the results to the development of intervention strategies, to be achieved by convening nationally recognized experts and the regional participants in the Agricultural Injury Intervention Strategy Workshop. - Dr. Susan Goodwin Gerberich Division of Environmental and Occupational Health School of Public Health, University of Minnesota, Minneapolis, Minnesota We will look at safety risk factors, injuries, ergonomics, roll-overs, power-take-offs, and secondary occupations. -Todd M. Frazier Chief, Surveillance Branch Division of Surveillance, Hazard Evaluations, and Field Studies National Institute for Occupational Safety and Health They (nurses) can ident@ that as a problem and trigger efforts to prevent it from happening again. Since they will be located in their own regions, they will often be able to identifi all cases of a given condition, tractor roll-overs or power take-off injuries. They can ident@ the scope of those problems, use that information to target intervention efforts, and after intervention efforts, evaluate how effective they have been . . . The Extension service havepeople who know how to retrofit trac- tors with roll-over protection, if that is something someone wants to do. - Dr. Eugene Freund Medical Officer, Surveillance Branch Division of Surveillance, Hazard Evaluations, and Field Studies National Institute for Occupational Safety and Health xx Papers and Proceedings Foreword w RESEARCH TO FIND ROOT CAUSES. Farm equipment accounted for 40 to 60percent of deaths and injuries in the majority of studies, followed very closely by livestock injuries and jalk Numerous types of farm machinery have been implicated in all sties. Since the majon@ offm machinery is associated with tractors, it stana to reason that injuries "involving" tractors were the most common type of machinery-related trauma. Tractor over-tunas, it appeared, were involved in the majority of agricultural fatalities. Many studies indicated that youth and the elderly were most often associated as an at-risk population , . . The studies varieci, though, when you compared those using statistics porn government agencies that were not gathering the appropriate and associated data with youth . . . The opportunity presents itselj to include some homespun theory. This happens to be a theory of mine: on family fam, older tractors and equipment are ofren reserved for general duty while newer pieces of machinery are delegated to more production types of tasks. The general duty may be more hazardous than the normal production tasks on farms. As a result, general duty fi often done by the youth or the elder&, The typical fmer, the principal operator, is using the newer machinery to plow and till the field, etc., while the older machinery may be relegated to cutting the fence rows or ditch banks and stationary operations that may be more hazardous than doingfield- related operations. As a result, when you combine the inexperience of youth and the diminished capacity that comes with aging (because the elderly or youth usually do this general duty) with the inherent danger of the equipment, you have an increasedpotential for trauma. . . Research on roll- over protection on older tractors should continue. - Dr. Thomas L. Bean Safety Leader, Ohio Cooperative Extension Service Ohio State University Dr. Bean stressed the need to install ROPS on farm tractors . . , "R OPS is a proven intervention strategy. Wlzy can we not implement it. 3" Is the problem the cost, the infrastructure, the regulation, or the legal system? - Penn A. Peters Project Leader U.S. Forest Service In the late 1950's and early 1960's, extensive research and development work was done by the industry to establish the eficacy of ROPS designs for the kinds of tractor overturns that can occur in normal farming and road transport. Manufacturers began supplying ROPS commercially in the late 1960's. The experience in both the United States and Europe has proven ROPS to be an effective sajev device. There is a need for additional research on small tractors' ROPS. The standard `protective zone" around the tractor operator, which controls the size of the ROPS envelope, was defined on the basis of the ergonomic data that existed in the 1950's and 1960's. The zone remains essentially un- changed today. The Equipment Manufacturers Institute (EMI) sponsored a literature review of the different protective zones used for the design of several kinds of vehicles, including aircraft, automobiles, racing cars, farm equipment, construction equipment, and mining equipment. This study, which was perjonned by Triodyne, Inc. of Skokie, Illinois, has been completed Publication will be through both the Society of Automotive Engineers (SAE) and the American Society of Agricultural Engineers (ASAE) before the end of 1991. The basic conclusion of the Triodyne study was that it did not appear, from the kindr of systems that are in place, that sufficient research had been done that could serve as the basis for making the protective zone of a ROPS, as specified by current standards, for smaller for small tractors. Small tractors are often used in low overhead clearance settingsin vineyards, orchards, storage buildings, and machine shed. Surgeon General's Conference on Agricultural Safety and Health - 1991 xxi Foreword The higher the profile of a ROPS relative to an overhead object such as a tree branch, the greater the likelihood that a farmer will not want to equip a tractor with ROPS or, if there is one on a tractor, to keep it in place. Clearly, there is potential safety value in making the ROPS as compact as possible without compromising protection in the event of a tip-over. As Murray Madsen mentioned in his presentation, one approach to addressing this situation is to make ROPS that can be raised or lowered They telescope or fold down for temporary use in the lowered position under low clearance conditions. There are some companies that have such ROPS on the market tooday. Industry's research capabilities concerning ROPS are limited to mechanical and structural aspects. There is little more to be done there with the exception of the small tractor ROPS. Accident data ident@ tractor roll-overs as the leading cause of machinery-related death on the f arm. Therefore, perhaps the most pressing challenge for behavioral researchers and health professionals is to find an effective way to ensure, short of compulsory measures such as regulation, that ROPS are installed and kept on tractors. EMI believes that behavioral research in this area holds promise of effecting a substantial reduction in roll-over injury and fatality rates. The starting point for such research, we submit, may be recognition that over one million of the approximately 3.6 million agricultural tractors in use today in the United States do have ROPS on them. There are over one million farmers who chose to equip their tractors with ROPS when they purchased t?tem. The question should be asked how these farmers arrived at their decision to equip the tractors with ROPS. Was it because of the Occupational Safety and Health Administration's (OSHA) rule? Was it because manufacturers were able to package the ROPS in a cab that was noise-insulated and isolated from vibration of the tractor. 3 It provided air conditioning, heating, and stereo; i.e., it was made so attractive in other respects that the farmer was willing to pay for the ROPS cab. Or were there other factors? The key to getting ROPS on the over-2.5 million tractors that do not now have them may indeed be found by examining the factors in the decisions of the approximately one million farmers who did decide to equip their tractors with ROPS. The third essential criterion is that a safety device must not by its presence, introduce different r&ks that would not exist without it. Murray Madsen referred to a study that showed that some accidents occurred because of an operator presence-type device. I am reminded of a situation that exbted several years ago when OSPi%, with all good intent, promulgated its ROPS rule for agriculture. As it turned out, there were some small tractors t?lat had backhoes mounted to the three-point hitch, with a separate seat for the operator affud to the backhoe frame behind the tractor. Without the ROPS there was not any problem. It was discovered that when a ROPS was installed on a tractor with the threepoint-hitch-mounted backhoe, a crush point between the elevating backhoe boom and the rigid ROPS structure was created A number of fatalities occurred because of that condition. The solution was to do away with the three-point-hitch-mounted backhoe or redesign the ROPS or both. A combination of these measures was implemented through various field reworkprograms to eliminate the hazard When tractor ROPS were being developed, manufacturers' test programs included actual roll-overs of tractors with experimental ROPS designs at different attitudes and speeds. There is a need in many cases, to verify that a new safety feature will be acceptable to the farmer. -John H. Crowley Director of Safety Programs Equipment Manufacturers Institute It has been learned in recent times that amuude measures do not correspond with behavioral criterions. The early attitudinal studies would evaluate a very general behavioral statement. An example of this would be when evaluating the potential purchase of ROPS on a tractor a subject xxii Papers and Proceedings Foreword might be asked to evaluate a statement such as, "Roll-overprotective structures are . " A more appropriate evaluative statement for predicting ROPS purchasing behavior would be to ask farmers their attitude toward buying roll-overprotective structures. The am'tude question would look as follows: "My buying a roll-overprotective structure in the next two years for one of my non- ROPS equipped tractors is ," The attituaZna1 question must match the corresponding behavioral criterion in terms of 1) action, 2) target, 3) context, and 4) time. In the previous example the action was "my buying," the target was "ROPS for one of my (the subject) non-ROPS equipped tractors, " the context was "general, n and time was "within the next two years. " In summary, there may be a substantial difference between people's amtt.&es toward objects (in this example, ROPS) and people's am*tudes toward behaviors associated with objects (in this example, buying ROPS). To predict behavior, this distinction is crucial An example of an issue that might benefit from Theory of Reasoned Action type of analysis would be the installing of ROPS on tractors. Tractor roll-overs are a major factor in farm work- related deaths. It is well known that if a tractor has a ROPS it almost eliminates the death potential in a tractor roll-over incident. But only about 30 percent of the farm tractors in the United States have a ROPS. Thus, at issue is what it would take to persuade farm tractor owners to install a ROPS on non-ROPS tractors. There have been significant educational programs to promote the purchase of ROPS among farm tractor owners. But there has been no signijicant increase in the retrofitting of ROPS on non-ROPS equipped tractors. If an analysis was conducted among US farm tractor operators utilizing the Theory of Reasoned Action, one could learn what intervention initiatives would be necessary to effect a significant change in this behavior. For example, it could be learned how much if anything farmers would be willing to spend for a ROPS, their general perception of the need for ROPS on their tractors, tractor use problems that they may encounter with ROPS, and so on. This type of information would provide focus for initiatives to deal with this issue rather than using the traditional `Shotgun" approach of trying anything and seeing if it works. - Dr. Robert Aherin Professor, Department of Agricultural Engineering University of Illinois b RESPECT PEOPLE WHILE CONTROLLINGTHEPROBLEMS. Again, economic realities make choices very dificult. Take for example, ROPS protection. Most farmers know the dangers and would willingly retrofit their tractors, but there is economic reality. - Ellen G. Widess Director of Health and Safety Policy, Children's Advocacy Institute Center for Public Interest Law "I think I am going to invest in (it) whatever it costs," although I did hear myself saying to my husband last night, "Honey, we have got to buy roll-over bars. " That is on the agenda. But we, with other income, can probably do that; but I knowpeople who are borrowing money to put bread on the table. -Judith Bortner Heffernan Executive Director of Heartland Nehvork for Town and Rural Ministries University of Missouri-Columbia I heard one presenter say that her family was going to buy the roll-over protective device for their tractor. I encourage her to follow through on this commitment. - Dr. Rice C. Leach Chief of Staff, Office of the Surgeon General When we looked at the tractor roll-over problem with Marshfield, we decided that there was no need for further research on the problem. What we decided we needed was a way to help farmers who wanted to retrofit older tractors with roll bars or other roll-overprotective devices to find those Surgeon General's Conference on Agricultural Safety and Health - 1991 XXIII Foreword "ROPS," as tltey are called So we asked Marshjield to develop and publish a catalog of all American manufacturers of `ROPS, " all products they produce and what make of tractor, model of tractor, and year of tractor they will build Then Marshfield sent the catalog to all extension agents in tJze country, so it is available where it is needed Producing that catalog is not the best step we could take as a society. As we have seen in the slide on the Swedish experience, tJze best step we could take would be to require "ROPS." But as an Office, it was the best we could do, -Jeffrey Human Director, Office of Rural Health Policy U.S. Public Health Service We have also seen ROPS development and the recent development of retractable or foldable ROPS for tlzose essential applications where you must go into a buil&ng that is shorter - not as tall as your tractor's ROPS. I would also say to those of you who wonder about ROPS that since 1985 virtually every tractor produced Aas been sold with a ROPS on it or right at the fingertips. Since 1970, virtually every tractor could have a ROPS put on it, and some have since I960. Consider, for example, Jzow to convince tlze owner of a 30-year-old tractor worth, at most, $1,000, to put a $500 ROPS OJZ it. Tile University of Illinois, NIOSH, and the University of Iowa are doing researclt to Jtelp find some of tlzose kinds of answers. A ROPS that provides protection and still meets tlze needs of users under limbs, vines, and rafters holds promise. It is likely that this kind of roll-over protection will produce more acceptable designs for the user. Perhaps it may not produce as much protection as users have become accustomed to with larger or more conventional roll-overprotective structures. Is tlzere an opportunity for validating acceptable ROPS for more compact tractors? - Murray Madsen Product Safety Engineer for Agricultural Equipment Deere and Company TJtere are also recommendations aimed at reducing specific hazards, such as the danger of injury or deatla in tractor roll-over or from moving machinery parts . . . OSHA also reviews existing standards tlzat apply to agriculture, such as the ROPS standard We look at wlzether tltese standards should be modified to reflect changing conditions in the United States, in the world, and in the industry. We need your Jzelp, tlzouglz, on reviewing and modibing these standards, if we are to Jtave good, common-sense safety standards. In another area, a member of our staff leas been comparing tlte new standard OJI ROPS for tractors and other vehicles, which was adopted by SAE, to the existing OSHA standard We have received design and test data from American tractor manufacturers and otlters. We have made a preliminary conclusion that the new SAE standard is equal to or exceeds the current OSHA standard and therefore, is acceptable to the agency. A final decision on this will be made slzortly. Hopefully, this will make it easier for American farm equipment manufacturers to compete in the European market. - Cynthia Douglass Deputy Assistant Secretary of Labor U.S. Occupational Safety and Health Administration b UNDERSTAND"THE SYSTEM"IN ORDERTO CONTROLTHEPROBLEMS. Look no furtlzer than tile agriculture-implement lobby here today, This lobby has blocked roll-over protection in tJtis country for 30 years with bee-jerk, protective, self-interested arguments tlzat continue to allow farmworkers to die in thk country, out of their narrow interest. That is wrong. Tire reason that it Jzappened i.s not because we have not done enough scientific research to document the problem. - Craig Merrilees Director, Consumer Pesticide Project xxiv Papers and Proceedings Foreword ROPS for tractors and tractor seat-belt use couldprevent the majoriv of tractor-related deaths. Vir- tually all new tractors sold in the United States have ROPS . . . Because of the relatively long life of tractors, most agricultural tractors in use do not have ROPS in place. Nearly half of the approximately 400 tractor-related deaths that occur each year in this nation involve roll-overs. How do we ensure that the older tractors and machines without these modem safety features get retrojitted with modern safety features when feasible or get taken out of use? The issue of how such updating and retrofitting is practical presents a significant challenge . . . Although more research and more data are needed to direct intervention, we know certain health and safev precautions work; ROPS work - Dr. Myron D. Johnsrud Administrator, Extension Setice U.S. Department of Agriculture Perhaps the best example of passive controls is ROPS. - Dr. David S. Pratt Director, New York Center for Agricultural Medicine and Health Cooperstown, NY There are some issues, the ROPS issue is the most typical one, that we can approach from a national perspective. - Dr. Dennis Murphy Professor, Penn State University The committee divided itself into working groups to develop suggestions and recommendations in the areas of training, and also in the need.s for standards like ROPS and machine guarding. In 1972, the full committee recommended its first standard They recommended that we do a ROPS rule for farm tractors. The first agricultural standard that OSHA issued under its normal rule-making was the ROPS standard We proposed that back in 1975, we finalized it in 197.5, and it becar?re effective in October, 1976. It dealt with all farm tractors made after October, 1976; they had to be equipped with the ROPS. The standard is based on the ASAE Standard, Jll-94. The complete text of that Standard was put into the OSHA standard Even though tractors were required to have ROPS, we continue to see deaths of tractor operators from roll-overs. We have seen seat belts cut off or cut out; seat belts were not used in several roll- over deaths. Obviously, we have not seen the results that the Swedes have achieved with tlteir standardization efforts. OSHA wants to see its standard evaluated We want to see this standard looked at very thoroughly to see why it is not working. What can we do to mod@ it, to make it work, to become more effective ? We know that seat belts are considered by many farmers and farmworkers as a hassle in hooking and unhooking, especially when you have to get off the tractor a number of times. The new ASAE Standard J2l-9.4, is a revision of this effort. We have said publicly that the standard is acceptable in meeting our ROPS standard that we require here. We have done that administratively. The International Standards Organization (ISO) is also involved in wn'ting standards for ROPS, and the IS0 Standards 5700 and 34-63 are additional new ROPS standards. Our ROPS standard is not as stringent as theirs. In our opinion, if you have a ROPS design that meets all the tests of the IS0 Standards, that will be acceptable in meeting the OSlZ4 Standard as well. -Thomas H. Seymour Fire Protection Engineer, Directorate of Safety Standards U.S. Occupational Safety and Health Administration Due to engineering advances in the last three decades, farm equipment manufacturers have incor- porated more safety devices on their equipment. Integral rotary shield for power take-off shafts and roll-over protective structures for tractors have been two major accomplishments in making farm machinery more user-safe. Since tractor roll-overs are involved in a large portion of agricultural fatalities, elimination of this type of incident alone would cause the death rate on Surgeon General's Conference on Agricultural Safety and Health - 1991 xxv Foreword American farms to plunge. But farmers themselves murt make the commitment to run a safe operation. When they see the dangers and learn the advantage, safety happens. In Nebraska, for example, university safety experts have conducted 450 tractor roll-over demonstrations since 1970 to convince farmers of the dangers. About 23,000 young people were trained in tractor safety. There have been two known fatalities in this group. The national average for a group that size would be five deaths. - Merlin Plagge President, Iowa Farm Bureau In conclusion, I wish to thank CAPT Melvin L. Myers for his hard work in planning and managing both the Surgeon General's Conference on Agricultural Safety and Health and the production of these Papers and Proceedings. I also wish to thank the rapporteurs, CAPT Robert F. Herrick, CAPT Stephen A. Olenchock, Mr. John R. Myers, CDR John E. Parker, and Dr. David L. Hard, who assisted with the concurrent sessions and the editing of the papers presented at those sessions. I wish to thank Ms. Katherine Wilson who coordinated the poster and video tape session md reviewed the abstracts from those posters for this publication. Many others who ilelped to make this Conference a success are named in the acknowledgements of this document. But most of all, it was the work of the 540 participants at this Conference who made it a success through honest engagement with the issues and interaction with others. Their names are listed by their respective state near the end of this document. My thanks to all for making this Conference a splendid success in our national movement to improve the safety and health of agricultural workers and their fami1ies.U J. Donald Millar, M.D., D.T.P.H. (Lond.) Assistant Surgeon General Director, National Institute for Occupational Safety and Health xxvi Papers and Proceedings Surgeon General's Conference on Agricultural Safety and Health FARM&FE 2000 . A National Coalition for Local Action Convened by the National Institute for Occupational Safety and Health April 30 - May 3, 1991, Des Moines, Iowa THE PLANNING COMMITTEE Melvin L. Myers, M.P.A. - Chair Office of the Director NIOSH, CDC 1600 Clifton Rd, NE Atlanta, GA 30333 Robert W. Mason, Ph.D. Division of Standards Development and Technology Transfer, NIOSH, CDC 4676 Columbia Pkwy Cincinnati, OH 45213 Stephen A. Olenchock, Ph.D. Division of Respiratory Disease Studies, NIOSH, CDC 944 Chestnut Ridge Rd Morgantown, WV 26505 Katherine Wilson, M.P.H. Division for Chronic Disease Control and Community Intervention, NCCDPHP, CDC 3005 Chamblee-Tucker Rd Chamblee, GA 30341 Robert A. Wright Office of Vital and Health Statistics Systems, NCHS, CDC 6525 Belcrest Rd Hyattsville, MD 20782 Lawrence J. Doemeny, Ph.D. Division of Physical Sciences and Engineering, NIOSH, CDC 5555 Ridge Ave Cincinnati, OH 45226 Pantelis G. Rentos, Ph.D. Division of Training and Manpower Development NIOSH, CDC 4676 Columbia Pkwy Cincinnati, OH 45213 John R. Myers, M.S.F. Division of Safety Research NIOSH, CDC 944 Chestnut Ridge Rd Morgantown, WV 26505 John J. Coumbis, M.D. Oak Ridge Fellow, ATSDR 1600 Clifton Rd, NE Atlanta, GA 30333 Stephen M. Ostroff, M.D. Division of Bacterial and Mycotic Diseases, NCID, CDC 1600 Clifton Rd, NE Atlanta, GA 30333 Russell E. Savage, Ph.D Division of Biomedical and Behavioral Science, NIOSH, CDC 4676 Columbia Pkwy Cincinnati, OH 45213 Robert F. Herrick, Sc.D. Division of Surveillance, Hazard Evaluation, and Field Studies NIOSH, CDC 5555 Ridge Ave Cincinnati, OH 45226 Paul Burlack Division of Injury Control NCEHIC, CDC 2858 Woodcock Blvd Chamblee, GA 30341 William H. Gimson Financial Management Office OPS, CDC 255 E Paces Ferry Rd Atlanta, GA 30305 Surgeon General's Conference on Agricultural Safety and Health - 1991 xxvii The Planning Committee - ADVISORS TO THE PLANNING COMMWEE - John E. Parker, M.D. Division of Safety Research NIOSH, CDC 944 Chestnut Ridge Rd Morgantown, WV 26505 Bradley K. Rein, P.E. Extension Service, USDA Rm 3346, South 14th and Industrial Ave, SW Washington, DC 20250 Jeffrey H. Lancashire Office of the Director NIOSH, CDC 1600 Clifton Rd, NE Atlanta, GA 30333 Ann M. Cronin Office of the Director NIOSH, CDC 1600 Clifton Rd, NE Atlanta, GA 30333 David L Hard, Ph.D. Division of Safety Research NIOSH, CDC 944 Chestnut Ridge Rd Morgantown, WV 26505 Cathy J. Wasem, RN, MN Office of Rural Health Policy Health Resources and Services Administration 5600 Fishers Ln, Rm 14-22 Rockville, MD 20857 Vivian K. Morgan Division of Standards Development and Technology Transfer, NIOSH, CDC 4676 Columbia Pkwy Cincinnati, OH 45213 Stephen Mallinger OSHA, US Department of Labor Rm N3653 200 Constitution Ave, NW Washington, DC 20210 Dushanka V. Kleinman, D.D.S. Office of the Surgeon General USPHS, Rm 71OG 200 Independence Ave, SW Washington, DC 20201 Todd M. Frazier, Sc.M. Division of Surveillance, Hazard Evaluation, and Field Studies NIOSH, CDC 5555 Ridge Ave Cincinnati, OH 45226 . . . xxvlll Papers and Proceedings Surgeon General's Conference on Agricultural Safety and Health FARM&FE 2000 . A National Coalition for Local Act/on Convened by the National Institute for Occupational Safety and Health April 30 - May 3, 1991, Des Moines, Iowa ACKNOWLEDGEMENTS Convening and holding the Surgeon General's Conference on Agricultural Safety and Health was a team effort as was preparing these Papers and Proceedings. In addition to the planning committee and their advisors, the presenters, the panel moderators and rapporteurs, and panel members, we wish to thank the following staff to the Surgeon General, NIOSH staff, and editorial advisors for their diligent work for this Conference and for their help in the preparation of this document: For their willing and timely assistance from the Office of the Surgeon General, Dushanka V. Kleinman, D.D.S., who served as the principle liaison within the Office, Rice C. Leach, M.D., who maintained an open door for resolving the most pressing problems, and for assisting the Surgeon General, Elizabeth P. Schmidt, Theresa Hyatt, and Margaret Garikes. For their attention to detail and quality from NIOSH, Kimberly L. Barth for her diligent work in assembling and preparing much of the information that proceeded the con- ference and that is in this document including coordinating its changes; Elizabeth H. Dryden who coordinated with commitment and diplomacy the staff and the logistics of the conference with the contractor; Trevia K. Pereira for her early assistance to the planning committee; Renee L. Ross for her willing help in formatting the abstracts and appendixes of this document; Amy A. Huston, Julie A. Wasil, and Judy L. James for their assistance in making the many editorial changes during the progress of this document; Ann M. Cronin, Mary B. Griffin, Richie D. Dickerson, Kay Basile, Terry L. Stewart, Terri L. Sims, Kami L. Townsend, and Lunette IS. Utter, who helped with the logistics at the Conference; Janice M. Huy, Vivian K. Morgan, and Charlene B. Maloney for their professionalism in preparing and showing the Conference exhibit. For their assistance as editorial advisors from NIOSH, Newell E. Tozzer, Charlene B. Maloney, Shirley M. Carr, William E. Halperin, M.D., and Richard A. Lemen, Ph.D. For their added assistance as editorial advisors, Henry A. Anderson, M.D., Ph.D., Kelley J. Donham, D.V.M., Lorann Stallones, Ph.D., David S. Pratt, M.D., Walter J. Armbruster, Ph.D., Rice C. Leach, M.D., Cathy J. Wasem, RN, MN, and Valerie A. Wilk, M.S. And for her superb work as the contractor for this conference, Rosita Bachmann and to her associates.0 Surgeon General's Conference on Agricultural Safety and Health - 1991 xxix Surgeon General's Conference on Agricultural Safety and Health FARM&FE 2000 . A National Coalition for Local Action Convened by the National institute for Occupational Safety and Health April 30 - May 3, 1997, Des Moines, Iowa TABLE OF CONTENTS iii National Farm Safety Week, 1991: A Proclamation f3y the President of the United States of America v Preface vii Foreword xxvii The Planning Committee xxix Acknowledgements xxxi Table of Contents By Antonia C. Novel/o, M.D. By J. Donald Millar, M.D. 1 Welcome from the Chair of the Conference By J. Donald Millar, M.D. 2 Welcome to Des Moines By John P. Dorrian 3 Welcome to Iowa By Christopher G. Atchison, M.P.A. THE POTENTIAL FOR A NATIONAL COALITION Moderator: Antonia C. Novel/o, M.D. `."""`".`.`.`.`.`.`.`.`.`.:.:.:.'.:.:.'. . . . . . . . . . . . . . . . . .,.....,,. ..,...,.., . . . . . . . . . . . . . . .............. ......*,....,...,,..,.....,.,.,.....,..,..............,,,.,,.,......., .,...,.,...,.........,.................. .,.....,...,. . . . . .._.............. . . . . .,.,.,. ,.,.r. .,.,.,. ,.,.,.. ,A.,..., ,.....i.., ./././..,.,.,C.,...,.,.,. ,a., ,a.... . ../....,.....,.,.....i ,.... . . ..l...,....._...i...... . ..I . . . . ..v .A.... .A.. ../. .A.... . ..C.. .A.... ..A . . . . . . . :.:.:.:.:.:.:.:.:.:i . . . . . . . . . . . . . . . . . . ,. :. . `.".`!`!`! . .A.. `.`.".".:.".:.:.`.:.`.:.......:.:.....:.:...:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.~:.:.:.: 7 Raising Safety and Health Consciousness among Farmers and Farmworkers By Ellen G. Widess, J.D. 17 Building Coalitions for Preventing Injury and Disease in Agriculture By Thomas M. Dean, M.D. 22 Disseminating Safety and Health Information through Education By J. Michael McGinnis, M.D. 28 Encouraging Action in Preventing Injury and Disease in Agriculture By Louis W. Sullivan, M.D. 30 Surgeon General Conferences: A Model for the Future By Antonia C. Novello, M.D. Surgeon General's Conference on Agricultural Safety and Health - 1991 xxxi Table of Contents LOOKING AHEAD TO THE NEXT CENTURY Moderator: J. Donald Miliar, M.D. . :i::::i::::::::::::::::::::::::::Yf:::::::::::::::::::~::::~::~~:::~:~~~::::::::::::~~~::::::::::~::::::::::.~:.:.:.:.:~.~:.:.:.:.: . . ..A . . . . . . ..A. .,.,....,.... ~ . . .A... . . . . . . A. ..A. ..A .., . . . ..A.. ..,.A,.....,....., . . . . ..y...................... ~ .,... ~ ,.,..,., ~..~~~,~~~~:~~~~~~~~~~~~~~~~~~~~ A. , .f . . . . . . . . . A......%. ..A <.,A.,.. .,.A_,..,. %.A., ..,.. ..>:...>: . . . . . . . . . . . :,a ,*.,.. .,.,. .A..,.... y . . . . T . . . . . . . . . . . . .,A. w . . . . . .,, . . . . *.. . . . . . . . ..y......., . . . . ,....P. a.. A.. ,A.. A.. 35 Remarks by the Chair of the Conference By J. Donald Millar, M.D. 36 Healthy People 2000 and Agriculture By Senator Tom Harkin 43 Building Infrastructures for Prevention By William L. Roper, M.D. 48 Charge to the Conference By Antonia C. Novel/o, M.D. QUESTIONS TO GUIDE THE NATIONAL AGENDA Moderator: Mark Timm ::::::::::::j::::::::::::::::::::::::::::::::::::::~::::::::::::::::::::::::::::::::::::::::::::::~:::.:.:.:.:.:.:.:.:.: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . \.,.....,.....,...,., . . . . . .._...........i . . . . . . . i... .,:,:.~:.:.:.:.:.:.:.:.:~:.:.~~:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.~:~.:.:.:.:.:.:.:.:.:~:.:.:.:.:.:.:.:.:.:.~~~:.:.:.:~.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:~.~,:::::::::::~::::::::::::~:::~~:::::::~:::::~::::::::~::::::::::~::::~:::::~:::~~:::::::::~~ :,~,~,:.:,:.~,,.,.,,,.,.~,~.,,,~ ~ . . . . . . . . 55 Remarks by the National FFA President By Mark Timm 59 The Role of Public Policy in Agricultural Safety and Health By Joseph A. Kinney, M.P.A. 67 Surveillance for Agricultural Safety and Health By William E. Halperin, M.D. 73 Research for Agricultural Safety and Health l3y James A. Merchant, M.D. 86 Intervention for Agricultural Safety and Health By Myron D. Johnsrud, Ph.D. MEDICAL INTERVENTION PROBLEMS AND OPPORTUNITIES :::::::::::::::::.:.: ..l........_......i `;;;:`:`: ..__...._,,,,.,.,.,,,,,....,,,.,,,,,.,.,..,...................................................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . ,: :.:,:. ~ .:.:.:.:.I:.:.):.:.:.:,:,:,:,:, 93 Rural Health Policy By Jeffrey Human, M.A. 97 Medical Intervention Problems and Opportunities in Rural Areas By Governor Robert D. Ray ISSUES THAT AFFECT THE NATIONAL AGENDA Moderator: Ronald D. Eckoff, M.D. IO5 Introductory Remarks By Ronald D. Eckoff, M.D. 107 The Agricultural Workforce By Leslie A. Whitener, Ph.D. 123 Attitudes and Risk Behavior in Agriculture By Pamela D. E/kind, Ph.D. 129 Industrial Crops of the Future By Daniel E. Kugler, Ph.D. 134 Biotechnology and Agriculture By Jane Rissler, Ph.D. xxxii Surgeon General's Conference on Agricultural Safety and Health - 1991 Table of Contents PROPOSALS FOR A NATIONAL AGENDA ::~.::::::::::::::::::::::::::::~~::~~~.~::~~~~~:::::::~::::::::::~:::~::::~.:::::~::::~~:~~::::::~~:~~.:.:.:.~:.:~.~~~. . . . . . . . . . . . . ..A . . . . . .., ..A qv.., . . .p . . . .A,.,. Y. ., . . . .~..~~~~~:~~...~,...:...~:.:.:..:,n:...:...:.:.:.:~.:.:.:...:,.:.:.:.. A. (.A. I(.,. . . . . . . . . ..A.. . . ,. ,.,A ,. . . .~ . . . . ,. . . . ., A., A... . . . . . ,. . ,..A A.,.. . . . . . <.> . . . . ..A............ . ..,. . ,. ,. h,.,,., ,, ..,,. ..,, . : :j....< ..A :A:(...; .,A. A. . . . . ,.y<.):(A:.:.:.:.:.:.:+:.:<.:.:+>:+:.:. .Q.. . . . . . . . ,. .......v....,.. .., . A . . . . 1. Surveillance - Agriculture-Related Diseases, Injuries, and Hazards Moderator: Henry A. Anderson, M.D. Rapporteur: Robert F. Herrick, Ph.D. . . . . . . . . . . _, ,, _, .._...,.,.(.(,.(/...,._.,.,.,.,.,...,.,.,.,,,.,.,.,.,...,...............,.,.,.....,.,.............. . . . . . . . . . . . . . . _.........,..., . . . . . . . . . . . . . . . . . . . . . . . . ,............ .,.a . . . . . . . . . . . n., _.........,.. . . . . . . . ,........., ._/ ,.........,...,._ . . . . . . . . . . . .._...... .,.,... ,.,.,.,...........,._ .,.,... ..,...,.,........._.... . . . ..,._/........., .,. ,l..,.,.i_........ ,.,........., . . . . . . . . . . . . . . . . . . . . . .._.... . . . . . . . . . . . . . . . ..i... ..A., .,.. 143 Surveillance: A Physician's Viewpoint l3y John J. May, M.D. 151 Chemical Hazards By Linda Rosenstock, M.D. 157 Respiratory Diseases By James A. Dosman, M.D. 161 Surveillance of Injuries in Agriculture Sy Susan G. Gerberich, Ph.D., et. al. 179 Musculoskeletal Disorders and Hazards By John J. Coumbis, M.D. 184 A Government Perspective I By Todd M. Frazier, Sc.M. 189 A Government Perspective II By Eugene Freund, Jr., M.D. 192 A Consumers' Perspective f3y Craig Merrilees, B.A. 199 An Agricultural Safety Perspective By Dennis J. Murphy, Ph.D. 2. Research - Chemical and Biological Hazards Moderator: Kelley J. Donham, D.V. M. Rapporteur: Stephen A. Olenchock, Ph.D. . . . . . . . . . . . . ..,...,.,.....,.,...,.......... . . . . . . . . . . . . . . . . . . . . . ,.... . . . . . . . . . ,.............,.,.... ..,.....,....... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .._............................................................................................................................ . . . . . . . . . . . .._.... . . . . . . . ../...............................................,.,...............,.,...............,.,...........,...........,.,.. /. . . . . . . . . . . . . . . . ...\... 204 Airborne Dusts By Susanna Von Essen, M.D. 216 Infectious Diseases By Russell W. Currier, D.V.M. 229 An Overview of Potential Health Hazards among Farmers from Use of Pesticides By Aaron Blair, Ph.D. 243 Gases, Liquids, Vapors, and Drugs By William Popendorf, Ph.D. 255 The Migrant Workers' Perspective By E. Roberta Ryder, B.A. 261 A Foundation's Perspective By Gene F. Graham, M.S. 267 A Clinical Perspective f3y Dean T. Stueland, M.D. Surgeon General's Conference on Agricultural Safety and Health - 1991 xmlll Table of Contents 3. Research - Mechanical and Physical Hazards Moderator: Lorann Stallones, Ph.D. ..,.,., ..,...,.......,.....,...................,.........,.................. _.... .,....... . . . . . . . . . .,. . . . . . . . . . . . ,.......... 5. . . . . . . . . . . . . . . . . . i... .,._.,.C,C.,..I.,. ..,., ,A.. i...., .,. ,.,.i....... V..,. ,...i... . . . . . ..i.. ..i...., . . . . . . . . . . . . . . . . . . . . . . . Rapporteur: John R. Myers, M.S.F. . . . . . . . . . ..v.. . . . . . . . . . . . . .../... . . . . . . . . . . . . . . . . . . . . . . . . . . . . _...... ..,.. .,.,... ..,~/.~,..........~....,~,~.~,.,~..,....~,..~.~,..~,~,.,~,.,....~..,..~,~,~.....~.~.~.......~,........., . . .._ .,.,. . . . . . . . . . . . . . . . . . .. 274 Farm Machinery and Vehicles By Thomas L. Bean, Ph.D. 278 Musculoskeletal Hazards By David Cochran, Ph.D. 285 Electrical Power By Robert L. McLymore, M.S. 293 Noise and Stress By Matthew Marvel, M.D. 2% Technology Transfer By Murray Madsen, P.E. 308 The Manufacturers' Perspective By John H. Crowley, M.B.A. 317 A Forestry Perspective By Penn A. Peters, P. E. 321 A Regulatory Perspective By Thomas H. Seymour, P.E. 4. Intervention - Agricultural Workers' Protection from Hazards Moderator: David S. Pratt M.D. Rapporteur: John E. Parker, M.D. ..i... . . . /.....,.......,.,../.....,.......,...........,.........,...,.......,...,...............,.......... . . . . . . . . I.. .,./,.......,.,.i,.,.......,.,...,.,.............,~,.,.,...........,.,.,.,.,.............,.,.,.,.,.,.,.....,.,.,.,.,.,.,.,...,.,.,.,.,.,.,...,.,.,.,.,...,...,.,.,.....,.,...,.............,.... . . . ..,....._.. ..,.....,.,.,.,.,... ,. 327 Farming Methods and Systems Analysis By Gary Erisman, Ph.D. 334 Ergonomics By Stephan Konz, Ph.D. 340 Personal Protective Equipment By Richard A. Fenske, Ph.D. 351 Machine Design By Sverker Hogliind, M.D. 357 Vector Control f3y Robert R. finger, Ph.D. 365 A Consulting Engineer's Perspective By Ray H. Crammond, P.E. 372 An Extension Specialist's Perspective By Rot/in D. Schnieder, M.S. 378 An Agricultural Engineering Perspective By L. Dale Baker, P.E. XXXiV Surgeon General's Conference on Agricultural Safety and Health - 1991 Table of Contents 5. Intervention - Safe Behaviors among Adults and Children Moderator: Walter J. Armbruster, Ph.D. Rapporteur: David L. Hard, Ph.D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..,., ..v,.,...,. . . . . . . . ..v............ 383 Health Education 391 Vocational Agriculture 397 The Mass Media and Agriculture 405 Multilingual Training 412 County Health Education 419 A Rural Sociologist's Perspective 432 Young Farmers' Perspective 437 Farm Family Behavior Perspective f3y Rodney Gilmore, B.S., B.A. f3y Robert Graham, M.S. By Cheryl Tevis, M.A. By Malanie Zavala, B.S. By Larry Belmont, M.P.H. l3y Judith Bortner Heffernan, M.A. By Wayne Sprick By Robert Aherin, Ph.D. ELEMENTS OF A NATIONAL AGENDA Moderator: Richard A. Lemen, Ph.D. ::::::.:`:`":`:."`:`:`:`:`:`:`:`:':':':.::~:?.::::::::::::::::::::::~.::~::::::~:~:::::;~.~:;::::::::::::::::~:~.~:::::::::~~:~:.:.~:.:.:.:.:.: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\., . . . . . . . . . . . . . . ..`...`..."............................,~.~.,.,~,~.~,~. x.7 .`,;,..):.:,) :.,.f,,,,;,,,.,.i~.~.;r,.,. 2: ,:.:.: ,:.,., . . . . . . .,...,.,.. I .,...,./... . ,A., . . . . . ., A .,.. .A.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A. ,A.. A., :.>z>:.:.: .):,:.:, :,:.~.~>>:~,:~: :,:, > :.:.r,,,.,.,,,.,.~vi~,, . . . . . . 0. n . . . . . . ,.. A.. A.. A.. . . .,., . . . . . . . 445 Surveillance - Agriculture-Related Diseases, Injuries, and Hazards By Henry A. Anderson, M.D. 448 Research - Chemical and Biological Hazards By Keliey J. Donham, D.V. M. 453 Research - Physical and Mechanical Hazards By Lorann Stallones, Ph.D. 457 Intervention - Agricultural Workers' Protection from Hazards By David S. Pratt, M.D. 462 Intervention - Safe Behaviors among Adults and Children By Walter J. Armbruster, Ph.D. 466 Report on Migrant and Seasonal Farmworkers By Valerie A. Wilk, M.S. surgeon General's Conference on Agricultural Safety and Health - 1991 Table of Contents 471 Outstanding FFA Poster By Rice C. Leach, M.D. 472 OSHA Initiatives in Agricultural Safety and Health 479 Sustainable Agriculture and Safety 485 The Farm Bureau's Continuing Commitment By Cynthia Douglass By Willis R. Eken By Merlin Plagge 489 A Victim's Perspective of the Conference By Marilyn Adams 492 Conference Summary By Rice C. Leach, M.D. MAKING CONNECTIONS Coordinator: Katherine Wilson, M.P.H. . . msPM?mY . . . . *p.#.$$..#$# 498 Poster Abstracts Co-coordinator: Ann M. Cronin 582 FFA Poster Abstracts 597 Video Presenters 620 International Participants 625 Metric System of Weights and Measures 627 The Surgeon General's Conferences on Occupational Health By Anne Mather 629 Excerpts from Diseases of Workers By Bernardino Ramazzini . . ,.,.....,.,...,....., . . . . ..~........,...,.,. ,.,.(,.,., ..,., .,.,.,.,. ..,.. .,.,.,. ,.,.. /v..,.,... ,.,., . . . ..A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..~.. . . . .., ,A.,... ii, c. CA.,. 637 INDEX Surgeon General's Conference on Agricultural Safety and Health - 1991 Surgeon General's Conference on Agricultural Safety and Health F~.&AFF 2000 o A National Coalition for Local Action Convened by the National Institute for Occupational Safety and Health April 30 - May 3, 1991, Des Moines, Iowa WELCOME FROM THE CHAIR OF THE CONFERENCE By J. Donald Millar, M.D. Director, National Institute for Occupational Safety and Health Assistant Surgeon General of the United States Public Health Service I am very delighted and proud to welcome you to this Surgeon General's Conference on Agricultural Safety and Health. The nickname is "FarmSafe 2000," and the theme is "a national coalition for local action." Now all of this is by way of saying that everybody here is interested in preventing the unnecessary wastage of life, limb, and health that is associated with the oldest and noblest occupation-agriculture. Be- yond that common interest, we are a very diverse group. I would wager that some of you never heard, for instance, of NIOSH, the National Institute for Occupational Safety and Health, before this meeting. That is not unexpected, because most of the pro- fessional life of NIOSH has been devoted to the problems of smokestack indus- tries-manufacturing, mining, and other occupations-but that is very rapidly chang- ing in this rapidly changing world of ours. We were created by the Occupational Safety and Health Act of 1970, which sought to "assure safe and healthful work- ing conditions for every working man and woman," So we are obliged at this point in our national history to turn our attention to all problems that create unsafe and unhealthful working conditions for men and women. That Act created two organizations you may have heard of OSHA and NIOSH; both are quite different organizations; both are in different parts of the Federal Gov- ernment, and you will hear from leaders of both during this week. OSHA is located in the Department of Labor and has responsibility, among other things,-for promulgating and enforcing occupational standards. NIOSH is in the Public Health Service, the Department of Health and Human Services, and is expected to exercise scien- tific leadership in this field. So we are expected to produce and disseminate scien- tific information that enables the preven- tion of occupational diseases and injuries. Among the things we do best is to convene people, such as at this conference, to bring people together so that they are able to share with each other useful scientific information, which can permit the practice of prevention in every setting where it can be done. So we were very eager when the Surgeon General called on us to sponsor this conference-the first of its kind in agricultural safely and health that has ever been convened.0 Dr. J. Donald Millar: And now it is my distinct pleasure to introduce the convener of this Confer- ence, the Surgeon General of the United States Public Health Service. She is the first woman and the first Puerto Rican to hold the position of Sur- geon General. She is a dynamic and vivacious leader in the war against death and disease. I give you the fourteenth Surgeon General of the United States, Dr. Antonia C. Novello: Surgeon General's Conference on Agricultural Safety and Health - 1991 7 Sugeon Gmml's Confsmnce on Agrkulfuml SaMy and HeaM FARMSAFE2OOO~ANaiionalCmlMn~rLocalAc~n Conwned by the National lnadtuh kr Occupational Sahty and lkmUh April 30 - h&y 3, 19Q1, Des Moines, law8 WELCOME TO DES MOINES, IOWA By John P. Donian Mayor, Cii of Des Moines Dr. Anton& C. Novello: Thank you Dr. Mlllar. Ladles and Gentlemen-l welcome you to the Surgeon General's Conference on Agricultural Safety and Health, the tenth Surgeon General's Conference on Occupational Health, and the first one in 50 years. The last one was convened in 1941, but I will speak further on that history later. I would now like to introduce Mr. Dorrlan, the mayor of Des Moines, Iowa. It Is a great pleasure for me to be able to introduce him. He Is a lifelong resident of Des MOin8S, and he has served in the city government since 1983. Fdlowing service as mayor pro tern, he was elected mayor in 1957. We also know that he currently serves as the Executive Dlrector of the Central Iowa Building Trades. Among his many public service activities, he currently ~8~8s on the Governor's Commlttee of Partnership for Economic Progress. Ladles and Gentleman, I would like to welcome Mr. Dorrian: Thank you very much. On behalf of myself and all the other members of the Des Moines City Council, I want to welcome you to the City of Des Moines, and a very spe- cial welcome to Dr. Novello. Thank you for that nice introduction. We are extremely proud of our city, and we hope that if it is your first visit to Des Moines you will be pleasantly surprised. If it has been awhile since you have been to the City of Des Moines, then you have seen some good changes take place. We are the capital city of the State of Iowa, and as the stewards of the capital city, we try to prepare the city well for everyone's visit. We have spent a lot of dollars on the Sky- walk System, for example. The weather is pretty good today, but there are days when people really appreciate that Skywalk Sys- tem. Several miles of it now exist, and it is very expensive to erect, but there is a pur- pose in mind. Sometimes it snows in Iowa, and sometimes it gets extremely warm with a little bit of humidity. So we need our Skywalk System. We have a lot of neat things that we hope 2 you are able to take in while you are here. We even have a horse track running out there; I do not know if any of you are famil- iar with that or not, but for every dollar that is bet out there my property taxes may not go up-if you have it in your heart to support the horse racing. I have not been out there myself much, but we have a lot of other neat things-the botanical center and the zoo, the libraries, the Governor's Mansion and the Capital Building. We just have a lot of attractions. We like to keep all these things going, and that is where you can help, if you would have it in your heart to do so. We hope that you will find a place to spend a dollar or two while you are here in our city. But really, we do hope that you have a good conference. I have to apologize because I have to leave. We do hope that you have a good confer- ence, and again a very special welcome to you to the capital city of Des Moines, Iowa. We are extremely proud to have all of you with us. We do hope that you have a good confer- ence. Enjoy yourself and come back often. Thank you.0 Papers and Proceedings Thank you, Dr. Novello. Before I officially I am pleased to welcome such a broach- welcome you on behalf of Governor based group of individuals to this confer- Branstad to Iowa, I want to acknowledge ence. Represented here today are individ- the work that Dr. J. Donald Millar, who uals from 40 states and several foreign opened this conference and is the Assistant countries, evidence that agricultural safety Surgeon General and Chair of this confer- and health is an issue that is not only na- ence, put into organizing this great event. tional but international in scope. Your On behalf of the people of Iowa, we thank attendance here demonstrates your com- you for bringing this conference here. mitment to agricultural safety and health. Mayor Dorrian has already welcomed you to Des Moines. On behalf of Governor Terry Branstad and the Iowa Department of Public Health, I want to welcome you to Iowa and to the Surgeon General's Conference on Agricultural Safety and Health. We, of course, believe it is quite ap- propriate for this conference to be held in Iowa, a leading agricultural state. Each year Iowa farmers produce more than $9 billion in crops and livestock. Twenty-five percent of America's pork and eight per- cent of the nation's grain-fed beef are raised in Iowa. Among the states, Iowa ranks second in the value of agricultural exports, and in 1988, Iowa ranked first in the nation in the production of red meat. Though everyone here today may know that agriculture is one of the most hazar- dous occupations there is, according to the Year 2000 Health Status Objectives, farmworkers suffered 14 injuries per 100,000 during the years 1983 through 1987. The national goal would be 6 in all occupations. So, you can see agricultural injuries are high even in the statistics that we know. The health objectives further state that agricultural worker deaths may be under- estimated because many farm work forces have fewer than 11 workers and are, there- fore, not identified by national data sys- tems. The National Safety Council has estimated a rate as high as 52.1 deaths per 100,000 agricultural workers. Surgeon General's Conference on Agricultural Safety and Health FARMSAFE 2000 o A National Coalition rbr Local Action Convened by the National Institute for Occupational Safety and Health April 30 - May 3, 1991, Des Moines, Iowa WELCOME TO IOWA By Christopher G. Atchison Director, Iowa Department of Public Health Dr. Antonia C. Novello: Governor Branstad was unable to attend the conference today. So, I would like to introduce Christopher G. Atchison, the Assistant Director of the Illinois Department of Public Health, who is here to speak in his behalf. Mr. Atchison has served as the Assistant Director of the Illinois Department of Health since 1987. As Assistant Director, he has been responsible for program development, legislative action and executive implementation of agency programs. He has also served as a chair of the Governor's Interagency AIDS Task Force and was involved in the establish- ment of the Center for Rural Health. In addition, as a member of the Illinois Public Health Association, he recently worked on a task force to restructure public health in Illinois according to the future of public health reported by the Institute of Medicine. Mr. Atchison has just been appointed as director of the Iowa Department of Public Health and his welcome to us today marks his maiden speech to this state. Please welcome Mr. Atchison: Surgeon General's Conference on Agricultural Safety and Health - 1991 3 Opening Remarks Until now, the hazards have been under- counted and largely ignored and under- funded, but that is changing as we can see when we look at the stated purposes of this conference-to raise consciousness, build coalitions, disseminate information, and encourage action to prevent injury and disease related to agriculture-certainly all very worthwhile goals. Nationally, we are beginning to develop surveillance systems that document the kinds of injuries that are occurring and where they are occurring--efforts that are just beginning to develop interventions and strategies, which will help prevent those injuries and fatalities. In Iowa, we recently finished the first year of a surveillance program to collect infor- mation about agricultural injuries and fatalities, the Sentinel Project Researching Agricultural Injury Notification Systems, which we simplified to called SPRAINS. SPRAINS is the only statewide surveil- lance program currently in existence, and we have been astounded by some of the figures we have gathered. We know that there are currently about 116,000 full- and part-time agricultural workers in the state; and there were over 2,000 injuries and over 83 fatalities record- ed in 1990. Eleven of these fatalities were children under the age of 15. Of the total fatalities, 51 percent were in the less-than- 20-year-old age group and the over-65 age group. In any other occupation, these people would not be working. However, in agriculture-related occupations, workers span the ages from childhood to the senior years; and apparently young workers and seniors are most vulnerable to fatal inju- ries. We must note, because farming has tradi- tionally been a family business, that it is not just the professional farmer, it is the farm family that is at risk for injury. Our statistics show that 70 percent of all inju- ries are suffered by farm family mem- bers-spouses, children, grandpas and grandmas helping out. The major causes or vectors of injury fall into three groups. Number one is machin- ery. Number two is animal-related. Num- ber three is falls and slips. Where do the injuries occur? Everywhere from the barn to the pasture. At least in Iowa, no clear pattern has emerged. Iowa is developing interventions and strat- egies by building broadbased collaborative efforts. Among the organizations involved in these collaborative ventures are State government, academia, farm organizations, and community-based organizations. The Governor has appointed a task force to look at our health and safety objectives for the year 2000. The purpose of this task force is to adopt objectives and measures that will guide the planning and allocation of resources throughout the decade, result- ing in: 1. Increasing the span of life in Iowa. 2. Reducing health disparities among Iowans. 3. Achieving access to prevention services for all Iowans by the year 2000. Recently I had the pleasure of meeting with Dr. Richard Remington, who chaired the Institute of Medicine's commission on the future of public health, and the Governor has appointed him the chair of our Year 2000 effort. Dr. Remington and 4 Papers and Proceedings Welcome to Iowa, April 30, 1991 I hope to build this planning process into the development of programs and projects across all agencies and communities, which are involved in the public health system in Iowa. We must note, because farming has tradi- tionally been a family business, that it is not just the professional farmer, it is the farm family that is at risk for injury. I Another major collaborative effort, the Iowa Center for Agricultural Safety and Health, ICASH, brings together key orga- nizations concerned with agricultural health and safety. ICASH is a partnership of the University of Iowa, Iowa State University, the Iowa Department of Public Health, and the Iowa Department of Agriculture and Land Stewardship. Its mission is to coordinate the state's resourc- es and to establish programs to improve the health and safety of farm families, farm workers, and the agricultural commu- nity. Some exciting projects ICASH has under- taken include the following: 1. The expansion of the Iowa Agricultural Health and Safety Service Project to a statewide network of hospitals. This project provides comprehensive occupa- tional health and safety services. 2. The development of an illness and inju- ry prevention program for livestock confinement operators. 3. A health and safety program for school classrooms and rural youth groups. 4. Sponsorship of a community-based project to increase awareness of farm machinery hazards. 5. The dissemination of information col- lected by the statewide agricultural injury surveillance program. Another collaborative effort is Work Safe Iowa. Work Safe Iowa has established an occupational medicine and associate pro- gram at the University of Iowa with the goal of promoting occupational safety and health through education and consultation. The program was designed to assist com- munity hospitals in implementing and strengthening their occupational medicine clinics and related outreach services. In addition, the community hospitals serve as a vehicle to integrate Work Safe Iowa services into local communities. The Iowa Center for Rural Health and its advisory committee represent another collaborative effort. The Center for Rural Health, located within the Office of Health Planning at the Iowa Department of Public Health, acts as a focal point for the state's efforts in preserving quality health care in Iowa's rural areas. The Center and its broadbased advisory committee strive to identify health needs, build rural coalitions, provide technical assistance to rural areas, administer grants for rural projects, and act as an advocate and information re- source with respect to rural health issues. The Occupational Health and Safety Nurs- es Program at the Iowa Department of Public Health is the tie between the state and the communities. This program builds on existing rural health programs and links the Health Department to rural health areas. Surgeon General's Conference on Agricultural Safety and Health - 1991 Opening Remarks Yet another community-based program is the Farm Family Risk Assessment and Education Program that is targeted at farm youth. It includes a farm family "safety- walkabout" training program where farni- lies learn to recognize existing farm haz- ards and receive assistance in changing the farm workplace into a safe environment. Finally, we know that if all prevention interventions have failed, we must turn to Emergency Medical Services (EMS). In Iowa, EMS is a community-based program, and 75 percent of the medical providers are volunteers. Medical treatment begins at the scene of an injury or illness and can make the criti- cal difference between life and death. EMS has become an even more critical issue to rural Iowa over the last decade, as our population has aged and access to health care has become a pressing concern. In the movie &Zd of Dreams, Iowa was memorialized when someone asked the hero, "Is this heaven?" and the hero re- sponds, "No, this is Iowa." You and I know that Iowa is not heaven; it is close, but it is not heaven, as our agricultural injury and fatality numbers certainly prove. That is why we must work toward making Iowa and the nation a safe and healthy place to live and work. Remember, even in the movie Field of Dreams, an injury to a farm family member was almost a tragedy. Helping prevent those injuries is our goal and our challenge at this conference. Once again, on behalf of Governor Branstad and the people of Iowa, welcome to Des Moines and to this conference and to this opportunity to move preventable injury programming out of the big cities and into rural America.0 Papers and Proceedings Surgeon General's Conference on Agricultural Sathty and Health FARM&FE 2000 o A National Coalition for Local Action Convened by the National Institute for Occupational Safety and Health April 30 - May 3, 1997, Des Moines, Iowa RAISING SAFE7Y AND HEALTH CONSCIOUSNESS AMONG FARMERS AND FARM WORKERS By Ellen G. Wiakw, J.D. Director of Health and Safety Policy, Children's Advocacy Institute Center for Public Interest Law Dr. Antonia C. Novello: Now, we know that in 1990 this conference was authorized .by Congress with four purposes, which Mr. Atchison mentioned. The first topic is going to be addressed by Professor Ellen Widess, and she will speak to us on the first topic, which is raising consciousness. Professor Widess brings a breadth of experience to our conference that ranges from managing pesticide regulatory programs to protecting the safety and health of children. Professor Widess received a law degree from the University of California at Berkeley in 1974. Ms. Widess then served on the faculty post until 1978, when she became Chief of the California State Pesticide Regulatory Program within the Division of Occupational Health. From 1984 to 1986, she managed the Workers' Compensation Program for the University of California at Berkeley and later, from 1986 to 1988, managed a similar program for the Texas Department of Agriculture. Also, while in Texas, from 1986 to 1988, Professor , Widess directed the pesticide regulatory program for the Department of Agriculture. Last year, she was an adjunct professor of the University of Texas School of Law where she taught, with specific emphasis, on Toxic Torts and Occupational Health. Ellen Widess has come to us today from the Children's Advocacy Institute in San Francisco, where she is Director of Health and Safety Policy. She will speak at this moment on the topic, Raising Safety and Health Consciousness Among Farmers and Farm Workers. Professor Widess: I am very, very pleased to be here. When I was first asked to speak in the place of our new Secretary of Labor, Lynn Martin, I thought it was my fantasy come true. After working for the OSHA Program, I long had a fantasy of wanting to be the Secretary of Labor. Particularly after toiling, as Dr. Novello has indicated to you, for many years in these various lives trying to address the problems of farmers and farm workers' safety and health, I thought this would be a fabulous chance to clear up the jurisdic- tional confusion many of us have noted and to determine who protects agricultural workers, who should regulate pesticides and with what standards, and who, in fact, has responsibility for farm safety. That fantasy lasted only a few moments. Then I came to my senses. It dawned on me that were I really the Secretary of Labor, I would have to deliver. I might, in fact, make a few friends, but no doubt I would make more than an enemy or two and be saddled with all the con- straints of government. As one who has been a regulator for many years, I am delighted to come today to this conference as an advocate, openly advocating, for the interests of children, who are our future generation. I am reminded by the line from my old boss, Jim Hightower, former Agricultural Commissioner of Texas, "Ain't nothing in the middle of the road but dotted lines and dead armadillos." I hope today to be a little bit provocative, because I think it is time we got out of the middle of the road. This conference is an extremely hopeful Surgeon General's Conference on Agricultural Safety and Health - 1991 The Potential for a National Coalition beginning of a more promising future in this much-needed work. As Dr. Novello has indicated, I have had a checkered life. I would like to give you some perspective from my work, both in and out of regulatory life. I have worked for OSHA in one life and then for an agricultural department, retreating at vari- ous periods to academia-scarred from the regulatory battles-to come back and take stock of what have we accomplished in this regulatory arena. What were our successes? What are more viable options ? What have been the vari- ous creative solutions that we have de- vised? CONSCIOUSNESS-RAISING AMONG FARMERS AND FARM WORKERS I had the dubious honor of attempting to regulate pesticides in Texas, which is to most sane people pretty much a mission impossible. This is to try to somehow meet the needs of farmers while also pro- tecting workers, consumers, and the envi- ronment. That is a very tough bill. I think we took a number of very creative approaches to that mission, including pass- ing the nation's only right-to-know law. Though this law was billed as the "farmworker right-to-know law," it clearly provided critical information about pesti- cides and their health effects to thousands of farmers and farm families in Texas. The children often were applying pesti- cides where groundwater (and drinking water supply) came from contaminated well waters. They were affected by drift just as farm workers were. During those years, we also sought to change consciousness, not only among workers, but among the public who de- manded blemish-free produce. We devel- oped a model organic farming program, which would not only reorient farmers to reduce their chemical inputs, but also change consumer consciousness and pro- vide farmers with the technical assistance they needed and the economic assistance. I think that is one of the messages that I want to convey today. .We have to deal not only with the health and safety data we have-we have plenty of data-but we also have to deal in terms of raising conscious- ness among the populations of both farm- ers and farm workers. We have to realize that we deal with certain economic imper- atives, some realities in agriculture. Unless we also deal with those economic realities of their lives and their limited choices, we will fail in our efforts to im- prove health and safety. We have learned this in the industrial world, and we should apply that lesson as well in the agricultural world. Unless we also deal with those economic realities of their lives and their