Gaps in Knowledge of Infectious Disease: Particularly a lack of information about such as completely enclosed systems of infectious diseases in immunosuppressed pesticide handling, whereas performance standards, would stress methods such as populations and effects on women of cer- tain infectious diseases was noted as a daily monitoring of pesticides. significant knowledge gap. Needlesticks, associated with the incidental use of inject- The lack of industrial hygiene services, the able antibiotics and veterinary biologicals, variation in the climates, the work practice, have been noted as a problem. seasonality, are all not typical of industrial settings. Therefore, emphasizing practice standards only makes sense. Gases, Vapors, and Liquids William Popendorf had the topic of gases, Gaps in knowledge here include the prob- vapors, and liquids. He approached it lem of additive and multiple exposures. from a rather generic standpoint. He We do have a situation in agriculture that discussed a new paradigm for industrial is, again, different from industry-always a hygiene in agriculture. He argued that we variety of different exposures in any one given case. really have a special type of industrial hygiene, and that is agricultural hygiene. There are additive and synergistic health effects that are unknown. There is a need What is agricultural hygiene? The old paradigm for industrial hygiene was recog- for more agricultural hygienists. There are nition, evaluation and control. But in precious few in this country that have the agriculture here we do not have the typical particular training and understanding of industrial setting. We cannot do monitor- the agricultural processes and of the socioeconomic and cultural differences ing on a daily basis. So we have to rely on anticipating the problems that may be between the industry and agriculture ap- occurring so that we can target the recog- proaches, which include cultural implica- tions as well. nition and evaluation. The key part of this paradigm is anticipation. NEED FOR A COALITION The usual paradigm of control is source, pathway, and person. Here we have to Finally, I would like to try to put together concentrate on the source. the spirit I mentioned earlier and a para- digm of what a national coalition for local It is difficult, often impossible, to control action might be. These thoughts came the pathway. It is impossible to ventilate a through in our group in various ways. strawberry field. It is difficult to put a respirator and a rubber suit on somebody If you can, envision in Figure 1 at the who is working in 1lO"F heat in an or- center of the circle the farm family and chard. farmworker who are the target. They are surrounded by a community, which in- The third part of the paradigm is empha- cludes a variety of different services and sizing practice standards rather than per- groups: local extensions, farm groups, the formance standards in agriculture. Prac- health care system, the public health de- tice standards emphasize good practice, partments, media, and schools. Surgeon General's Conference on Agricultural Safety and Health - 1991 451 Research - Chemical and Biological Hazards, May 3, 1991 Elements of a Natlonal Agenda o Communication o Community o Surveilence Medical I Health Health Departments Extension Land Grant - -I Universities Figure 1. A National Coalition for Local Action. Surrounding that, yet, are the national resources that we have, including NIOSH, other Federal agencies, medical and health universities, land-grant universities, nation- al extension service, agribusiness, and foundations. There has to be com- munication within that outer circle and between that outer circle, to coordinate the services that are available. Also communication is needed directly to that farm family and farmworker so that we are working on the problems that are of concern to them and are real for them and of importance for them. We must also utilize the community in which they live and work to help them solve their own 452 problems. That whole communication system has to work. Included in that is the surveillance and evaluation of the programs that are in place to make sure. that whatever programs that are in place are modified according to the results of that surveillance and evaluation system. That is the paradigm that I think can result in a true "National Coalition for Local Action." Hopefully with the spirit of this conference, we can be striving for that. I think this conference has gone a long way in helping to realize that end.0 Papers and Proceedings Su@xm General's Confersme on AgricuttumI Sahiy and Heatth FAFIMSAFE 2000 o A National Coalition fix Local Action Conimmd by the National lnstituie br Occupational Salty and Health ApR 30 - May 3, 1991, Des Moines, Iowa RESEARCH - MECHANICAL AND PHYSICAL HmRDS By Lorann Stallones, M.P.H., Ph.D. Associate Professor, Department of Environmental Health Colorado State University I 1 Dr. Richard A. Lemen: Our next speaker will summarize the sessions on Research - Mechanical and Physical Hazards. To do that is Dr. Lorann Stallones, who received her bachelor's degree from the University of California in Santa Barbara, and her MPH and her Ph.D. from the University of Texas, School of Public Health, in Houston. Dr. Stallones: Well, that introduction does not give you a very good idea about why I am up here presenting physical and mechanical hazards when ordinarily these are in the realm of an engineer or an agriculture safety spe- cialist. I would like to acknowledge those people who made a contribution to my being here. One of them is on the plat- form with me, Dr. David Pratt; one of them, I am sure, is in the audience, Dr. John May. After I finished my Ph.D. in Houston, I went up to Cooperstown, New York, where I worked at the Mary Imogene Bassett Hospital with the two of them. There are two things that you have to know about David. One of the first things that anybody ever told me about him was that he could sell ice to Eskimos. I think in this case, I was the Eskimo. The ice was that we were in a farming community and really needed to look at what the problems were in that particular communi- ty. As public health professionals, I think that really is our obligation--one that we have been remiss in fulfilling the agricultural safety and health area. The second thing you have to know about David is that someone-the same person, of course-told me that if you sat David down in the middle of a desert he would start to count sand. So, there he was in the center of an agricultural community, and he start- ed counting. What we wanted to do, be- cause David is a pulmonary physician, is look at pulmonary disease among the far- mers-f course a major problem. So we put together a very detailed survey, and we asked a lot of questions about pulmonary disease. The last day before this questionnaire went into print David said, "I've heard that farmers have a lot of injuries. Don't you think, perhaps, we should ask that question?" So we did. When the questionnaires came back, about 10 percent of the farmers had had a work-- related injury in the past 12 months. We thought that was extremely high and that gave rise to ongoing surveillance where we called this same group of farmers every other month. Much of the data have been reported in national meetings, and I think it was an extremely important step in our development. From there I went to the University of Kentucky where I met the other side of this whole business. He was Larry Piercy, who is an agricultural safety specialist who has his master's degree from the University of Iowa, and who trained at the Institute of Agricultural Medicine. He and a number of other people work with the Kentucky Farm and Home Safety Council. Surgeon General's Conference on Agricultural Safety and Health - 1991 453 Elements of a National Agenda My advice to anyone who goes to Ken- tucky is, if you do not want to become involved, stay away from that group, be- cause they get you involved. You will automatically move through the ranks of going to the meetings and suddenly one day you will find yourself president of the organization. The Kentucky Farm Bureau is very active in that particular organiza- tion. But the person I really want to acknowl- edge in all this is my uncle, who is a farm- er in Idaho whose youngest son decided that after spending quite a number of years being a carpenter, he wanted to go back and work on the farm. Really, the reason we are here is to make sure that those people who want to go back and work on a farm will be able to work in a safe and healthful environment. MACHINERY AND VEHICLE HAZARDS We have heard a lot about how important injuries are among children and the elder- ly, and I would like to introduce Tom Bean's (Ohio State University) general duty clause. The general duty clause that he proposed in our session was that old tractors and old equipment are usually used on the farm for general duty, and the people who are responsible for that gener- al duty are the old and the young, So that gives rise to a situation where they are at risk of injury because of the age of the equipment that they are dealing with. They also are the most vulnerable of the population in terms of injury risk. His major recommendations were that we need to continue to aggressively evaluate the safety standards that are developed by the American Society of Agricultural Engi- neers. 454 The general duty clause that he proposed in our session was that old tractors and old equipment are usually used on the farm for general duty, and the people who are responsible for that general duty are the old and the young. One of the problems that has not been looked at and that needs to be addressed is to develop model standards for the tran- sport of farm equipment and self-propelled farm vehicles on the highways and public roads. We may not pick up fatalities relat- ed to road use of farm equipment, because the person who dies may be the person who is in the motor vehicle, not on the tractor. This is a very important area because, for most equipment, there are no highway standards for the transport of farm equip- ment. In keeping with this, his proposal was also to improve the lighting and the marking of farm equipment. He also be- lieved that it was very important to contin- ue studies on educational techniques that are successful. MUSCULOSKELETAL HAZARDS David Cochran is from the U.S. Occupa- tional Safety and Health Administration, and he addressed musculoskeletal hazards. He focused primarily on cumulative trau- ma disorders, about which we know very little. If you look at the combined influ- ences of stress and heat and the type of work that is done on a farm, there are some areas of research that are pressing. His major proposal to reduce some of the hazards was to consider packaging of ma- terials to reduce back injuries. Materials Papers and Proceedings can come to the farm in anywhere from l-pound bags to 50-pound bags, which will begins in the early ages, and that one of be lifted. the critical needs in this area is to improve hearing protection in order to make the The point of view of the people who are equipment more acceptable for people who need to wear it. the moving materials around needs to be considered in order to package them in a safer manner. He also thought it was important to identify hazards and create solutions acceptable to the farmers. TECHNOLOGY TRANSFER Murray Madsen from Deere Company discussed technology transfer, and he fo- ELECTRICAL HAZARDS cused on the need for improved sensors, radar systems, systems to anticipate and Robert McLymore from North Carolina avoid overturns of tractors and systems to alter collision courses. He believes that State University discussed electrical power. There were three basic recommendations. there is a great need to incorporate human factors into the engineering design commu- b One is that inspections of electrical wir- ing are critical and need to be done on a nity, and he posed some rather interesting questions, which I would like to read to you. periodic basis. b The second is the need to adhere to the p How does safety become a cultural value National Electric Codes on the farms, and that permeates all that each of us does? that is frequently not done. Safety proce- b What are the skills needed to excel in dures need to be established, particularly when a farmer does the electrical wiring. hazard recognition in the earliest stages of Inspections should be done upon comple- design? tion of the work and must be done by a trained electrician. b What is the measure of safety improvement at the stage when only con- b Finally, of course, there is the issue of overhead wires about which we have no good solutions, but farm equipment fre- quently does come in contact with over- ceptual alternatives are being studied? In order to have better technology transfer, researchers need to participate in safety research and intervention networks. head wires on farms, and this is the agent in many deaths. NOISE Matthew Marvel from Oneonta Health Center discussed noise and stress. His primary focus was on noise. RESEARCH RESPONSIBILITY John Crowley from the Farm and Industri- al Equipment Manufacturers discussed research and the responsibility of manufac- turers for doing research and the public sector responsibility for areas of research. He said that in those few studies that have Many of the areas that he touched on were been done hearing loss is increased greatly also addressed by surveillance and by the among farmers, that the loss of hearing previous speaker, so I will skip over some of those; but I would like to discuss a few Research - Mechanical and Physical Hazards, May 3, 1991 Surgeon General's Conference on Agricultural Safety and Health - 1991 455 Elements of a National Agenda of the things that have not been addressed in great detail. One of them was improving the handling of agricultural chemicals, including closed systems, improved worker protection, and techniques that will minimize the loss of chemicals so that we can reduce the total amount of chemicals that are being used. He also discussed the need for improved air filtration systems-particularly in trac- tors and in work environments where you address not just dust levels but also chemi- cal, gas, and vapor exposures. Loggers are at even a higher risk of injury death than farmers, but many of the risks they encounter, farmers will encounter as well because farmers do logging activities. I He discussed the need for devices to de- tect hazardous materials, particularly gases and vapors in enclosed, confined spaces. We need to develop effective ways to gain support and cooperation to fund projects. FORESTRY Penn Peters from the U.S. Forest Service discussed the forestry perspective. Deaths among loggers are about 30 times more common than among other occupational groups. Loggers are at even a higher risk of injury death than farmers, but many of the risks they encounter, farmers will en- counter as well because farmers do logging activities. There is a marked lack of awareness of the hazards of logging. Data systems need to be developed to increase the understand- ing of the circumstances in which the fatal- ities and injuries occur. REGULATION Thomas Seymour from the Occupational Safety and Health Administration (OSHA) discussed the regulatory perspective and made his three main points. b One point was that existing standards need to be fully evaluated. > Second, we are in need of better injury data. b Third, data-gathering needs to be im- proved so that we can further understand the problems. Farmers and ranchers must be involved in the development of standards, because OSHA has had problems in the ways that they have attempted to address safety and health on farms. 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 per- formed within priority areas. There is a need to address the role of behavior in prevention of injuries and illnesses among farmers. Finally, some of the comments from the audience that should be addressed were the need for more coalitions, which do more than raise funds for research but also raise awareness, the need to identify the interventions that work, and the need to promulgate those interventions. Probably most important was understanding more about what incentives work so people do the things that we know and we believe are right.0 456 Papers and Proceedings Swgeon General's Conkmnce on Agricuthml Safety and Health FARHEAFE 2000 o A National Coalition for Local Action Conwned by the National lnstifute Ibr Occupational Safety and He&h April 30 - May 3, 1991, Des Moines, lowa INTERVENTION - AGRICULTURAL WORKERS' PROTECTION FROM HAZARDS By David S. Pmtt, M.D. Director, New York Center for Agricultural Medicine and Health Cooperstown, NY I would like to also take a moment not only to thank Dr. Stallones, but also to make special note of Jack Parker's contri- bution to our group. Jack was on the phone with us on a continuing basis and did a wonderful job getting our group organized, and I appreciate his efforts very much. About the members of my group: it was little bit like Dr. Stallones' experience- here I am a physician. You can see we have lots of engineers here. I would like just to make a note that we were privileged to have an active farmer, Gary Erisman, in our group. We were also particularly happy to have Dr. Hogliind join us, from Stockholm. You will see some of his materials in just a moment. Let us look to the future. He really showed us what a bright and shining future could look like for American agriculture. We also had the special expertise of Dr. Konz, who talked to us about application of ergonomics-the notion of how people interact with machines; and he gave some special insights into how ergonomics might help in the future of agriculture. You have already heard about Vector control from Kelley Donham today. We heard from Dr. Richard A. Lemen: Our next subject is to deal with Intervention - Agricultural Workers' Protection from Hazards. You have heard a much better introduction of our next presenter by our previous presenter. Dr. Pratt is a physician who trained with his undergraduate degree at the University of New Hampshire, his medical degree from Tuft University, and was also in the U.S. Public Health Service for a period of time. Dr. Pratt: Robert Pinger about some of the Vector control problems. I will speak more about some of the pest problems that affect farmers and farmworkers. Then, finally, Richard Fenske gave us a very nice discus- sion approaching personal protective equipment; I will share some of his slides as well. Then we had responders who brought us back to Earth, told us what it was like in the real world, and what goes on from the perspective of a consulting engineer, Ray Crammond, from the perspective of an extension safety specialist with a wealth of information, Rollin Schneider; and then also from the perspective of an agricultural engineer, L. Dale Baker, who is involved every day in design and in product devel- opment. We entered the deliberations and discus- sions by recognizing that the American farmer and farm family face unique haz- ards in this environment. In order to make it safer for these people, we needed to understand the special risks to which they are exposed on an ongoing basis, often recalling that farming and the home environment are a single, contiguous, and shared continuum. Surgeon General's Conference on Agricultural Safety and Health - 1991 457 Elements of a National Agenda Thus, the children on the farm are at risk for injuries from equipment, from animals, and from chemicals on a frequent and ongoing basis. The farm workforce is older, as we have heard, and often includes family members, part-time help, and mi- grant workers, presenting a special and unique variety of problems that need to be dealt with. The evolution of American agriculture as it is today has led to decreasing profit margins and increased levels of stress. Demands on farmers today are very great, indeed. As we have heard previously, they are expected to be meteorologists, econo- mists, agronomists, crop specialists, repair- men, livestock breeders, and personnel experts. The special health risks and hazards pre- sented by farm equipment, including the ubiquitous tractor range from acute traumatic injuries to chronic musculoskele- tal disorders. Farmers and farmworkers also face vector-borne diseases, as I men- tioned earlier. Dr. Donham pointed out that we are see- ing cases of encephalitis in the northeast, and in Wisconsin we are seeing an in- creased amount of Lyme disease; also, interestingly and preplexingly, malaria and dengue fever. Agri-chemicals are also an important issue here, and there are other-in addition to agri-chemicals-toxic exposures that can occur in this work envi- ronment. Skin, the major organ systems, and also the lung are at risk from toxins and agri-chemicals. Now, with that background, our group decided to look at the strategies from the experts that I told you about. What Dr. Parker and I did yesterday afternoon at the conclusion of the deliberations is try to 458 distill from those presentations the guiding principles that we gathered. major We also had it emphasized to us that, all players, including the farmer and the farmworker, need to be at the table when we begin to redesign the strategies for intervention. Those principles include the following: There are major interventions available to us as a community of interested engineers, scientists, physicians, and farmers. These would include three major options. . One is the complete elimination of the hazard. b Two would be what we call passive con- trols; that is, the operator would not neces- sarily have to do anything to be protected. b Three is active controls, where volitional choices need to be made. We also had it emphasized to us that, as Dr. Stallones said, all players, including the farmer and the farmworker, need to be at the table when we begin to redesign the strategies for intervention. ELIMINATION OF HAZARDS Many of the speakers emphasized that one must apply the earliest possible interven- tions to maximally reduce hazard expo- sures. The elimination of hazards could include machine redesign, job redesign, and product substitution, or all three. Now the benefits of redesign include the fact that it would eliminate the problem at the beginning. It is a permanent solution Papers and Proceedings to what was the problem, and it has-in the nature of the design from the engineers- planned for the potential misuse of that equipment. The IPM, as many of you know, often will have a significant reduction in pesticide application and frequently prompts the I would like to give an example of some extremely innovative product design in the agricultural realm: a Finnish tractor made by the Valmet Company. choice of a less toxic compound in the work environment. We were also told that the use of integrat- It has some unusual and unique features ed pest management (IPM) is a solution that we were apprised of. First of all, the that involves product substitution and ad- controls in the cab, including the steering ministrative control. The IPM, as many of apparatus, can rotate through 180". A you know, often will have a significant farmer can face backwards with all his con- reduction in pesticide application and trols facing the load that he is lifting. frequently prompts the choice of a less toxic compound in the work environment. This tractor also is articulated. The wheels Please be mindful of the fact, as was em- turn independently, and also it has an phasized in our group, that hazard elimina- automatic transmission. So the amount of tion, at times, may need to be driven by pressure that would have been needed to legislation or regulation, especially when depress a clutch is no longer an issue, there are severe hazards and recognized thereby eliminating some of the left knee effective interventions are available. problems that had been identified by our Swedish colleagues. PASSIVE CONTROLS In addition, job redesign was discussed in The next topic for discussion was passive our group. A Swedish woman was shown controls. Our presenters and responders working in a dairy barn, She was carrying pointed out that in settings where com- numerous milking hoses. plete hazard elimination is not possible, then passive controls may be applied. It was calculated by the Swedish Farm- workers Health and Safety Association that Perhaps the best example of passive con- she would have carried about 270 tons of trols is roll-over protective structures equipment during the milking year in a (ROPS). Now, unfortunately, even if you 60-cow barn. This caused a lot of shoulder have a ROPS you should not be opening and neck problems. the back window of an enclosed cab on a tractor and certainly should never have a The engineering job redesign group went out to look at this, and they came up with a solution: an overhead track on which YOU can hang the milking apparatus and slide it from cow to cow. This reduced, considerably, the workload and also reduced the rate of injury and problems with the shoulders in these workers. child back there. So, the passive systems are only as good as the operator, and in this instance some of the safety features of this cab have been subverted by removing the rear window. This breaks the sound reduction, as well as Intervention - Agricultural Workers' Protection from Hazards, May 3, 1991 Surgeon General's Conference on Agricultural Safety and Health - 1991 459 Elements of a Natlonal Agenda the internal environmental controls and, indeed, puts a child at risk. Other examples of passive controls include special kill-switches on chain saws such that when they buck or kick back they will automatically be turned off. Finally, another example of passive con- trols includes what are called closed pesti- cide loading and mixing systems. Those particular systems allow a completely closed operation from the container into the mixing vats, thereby never exposing the worker. ACTIVE CONTROLS The next group of strategies was termed active controls. Active controls are neces- sary when full hazard elimination or pas- sive controls are not possible. Active con- trols require that the worker carry out a protective behavior such as donning per- sonal protective equipment, applying an insect repellent, or reading and heeding warning labels. The ultimate in personal protective equip- ment was shown. Astronauts were in- volved in working outside a space shuttle, which our colleagues at NASA call extra- vehicular activity. This is a situation where an active control system is absolutely man- datory, since one could not even live in that environment without that kind of gear and garb. You immediately recognize that that equi- pment is wonderful, if you are going to be in the cargo bay of a shuttle, but it would be lousy to do your everyday activities, whether at work or at home, ,in that kind of a get-up. There are sigmficant limita- tions in personal protective equipment, and they were enumerated in our group as follows: it is uncomfortable, it may im- pose ventilatory stress, it certainly would reduce dexterity, and it may lead to heat loading and heat stress on the workers. This is especially true in people who work in warm climates and need to be fully covered. Another point I should make about the limitations: a pesticide worker was shown wearing a non-woven garment that had a materials failure, The armpit was torn out. There was a gap in the underside of the garment, so that would allow a pesticide to escape onto the individual. Finally, we heard that warnings, for all the emphasis we put on them, frequently do not work. They are temporary. They can be wiped off, erased, or removed. They have serious limitations. That is not to say that our group completely rejected train- ing, education, and knowledge. In fact, one final thing that is shown here is an attempt to inform, to make sure that the agricultural population of Sweden is an informed population, about tractors that are designed with ergonomics in mind and with safety in mind. We saw what you might think of as Swed- ish "Consumer Reports" of tractors that are ergonomically sound. The document was developed by the Swedish Farmers Health and Safety Association. It was like a Michelin guide for restau- rants. Four stars is excellent; three stars is good; and so on and so forth. Such scor- ing was resisted by the manufacturers in Sweden but has been very popular among the farmers and farmworkers. Let me conclude by saying that our group decided that intervention strategies are most effective when they are applied early 460 Papers and Proceedings intervention - Agricultural Workers' Protection from Hazards, May 3, 1991 in the process. Passive controls are less desirable but at times may be life-preserv- ing and life-saving. Active controls are the least desirable interventions because they require forethought, modifications of be- havior and, often, discomfort. Intervention strategies should always incorporate the knowledge of the users. Intervention strategies are most effective when they are applied early in the pro- cess. I I am reminded of that little aphorism from Japanese management that says, "The worker has intimate knowledge of the process." In this instance it is the farmer and farmworker who have valuable, inti- mate knowledge. Finally, in conclusion, we agreed that seri- ous attention should be paid to using all the options to deal with what we all recog- nize as a clear and present danger to the American farmer and farmworker.0 Surgeon General's Conference on Agricultural Safety and Health - 1991 461 Surgeon General's Conference on A~r~cultml Safety and Health FAWSAFE 2000 . A National Coalition Ibr Local Action Convened by the National institute for Occupational Safety and Heattb April 30 - May 3, 1991, Des Moines, Iowa /NTERVENTlON - SAFE BEHAVIORS AMONG ADULTS AND CHILDREN By Walter J. Ambruster, Ph.D. Associate Managing Director, Farm Foundation 1 Dr. Richard A. Lemen: Our next speaker will look at Intervention - Safe Behaviors Among Adults and Children. To do this, we have Dr. Waiter J. Armbruster, who received a bachelor's degree and a master's degree in Agricultural Economics from Purdue University, and a doctorate in Agricultural Economics from Oregon State University. Dr. Armbruster: We know that surveillance and research are, indeed, often precursors to interven- tion. Some of the discussion groups appar- ently did more than work on the necessary input to intervention, they even delivered some of our group's ideas for us. Be that as it may, I hope we will not be too repetitive. The rapporteur for our discussion group, Dr. David Hard, deserves a great deal of credit for helping me put together an over- view of what we discussed. I was admonished by our group not to generalize our discussion to the point that we could have written the report before we arrived. I see some of them in the audi- ence monitoring my reporting. I hope they recognize our discussion. In some ways, Kelley Donham's diagram of a national coalition for local action could be viewed as the game plan for our whole discussion. Achieving safe behaviors among adults and children, which we hope to foster through intervention, is an ongoing challenge. We grappled with ideas on how to better inter- vene to foster such behavior, so that it will avoid unintentional injuries in the agricul- tural occupations and create a safer and 462 healthier environment in which to live and work. Our recommendations consist of a combi- nation of short- and long-term implications or suggested actions that are aimed at immediate as well as future improvement in agricultural safety and health. While our discussion considered short- and long- term differences, the ideas did not lead to that framework very well. We will introduce the ideas with the intent that some are short-term and some longer term in nature. We need to pay attention to this as we think about how to imple- ment these ideas and recommendations. BEHAVIORAL CHANGE There was rather widespread agreement in our discussion group that our overall goal is to achieve behavioral change that will result in a safer, healthier living and work- ing environment for those engaged in agri- culture. We have a good deal of evidence, e.g., from automobile seat belts, that pro- viding education or information is not sufficient, though we feel it is a necessary precursor to achieve behavioral change. What is necessary to change attitudes re- garding health and safety. Papers and Proceedings Mental health is an important aspect of sary duplication, and provide funding for overall health and a necessary ingredient the larger research base, intervention pro- of safe behavior. We had a bit of discus- grams and mandated programs. sion about that, although we did not focus There was widespread recognition that on it a great deal. while local coalitions may be very effective In trying to achieve behavioral change, in delivery, they need a lot of help from federal and state levels in achieving or youth may provide a more readily adapt- obtaining the resources with which to do able audience than some of the older cli- their work at the local level. We need to ents that we try to reach. Hence, a focus think carefully about funding to make on youth education and youth intervention coalitions functional. may be very effective in changing their behaviors for their lifetime. We also be- At the local level, it was pointed out that lieve that reaching adults through youth is even a small amount of money is often a very effective channel for modifying quite significant and creates the opportuni- adult behavior. ty for leveraging into significant activities that can have a realistic impact. I think Similarly, we had some discussion about some of the discussion was in the context the possibility of working with spouses to that there is a lot of federal money and let help them understand the need for behav- us get it down to the local level where it ioral change, to reach the farmer whose will do some good. behavior we are trying to change. We discussed it generally in terms of the spou- As you think about it, the implication may ses being the wives who would help the also be that at the local level you may be husbands change his behavior. able to raise the funds within the commu- nity to put on some of the educational or But we all know that there are many wom- intervention activities that may be very en farmers, so I assume that it works the effective. Someone suggested that we other way also. We had a fair amount of should not overlook the general businesses agreement that the husbands listen to the in our community as a funding source. wives; we did not have much discussion about whether it works the other way. So Knowing that more than half of the farm- that is a hypothesis on my part. The point ers in the U.S. receive more than half of is, indirect access for delivery of messages their income from off-farm sources, there as well as direct access, to our target audi- is a very direct stake in agricultural safety ences, may be a very effective strategy for achieving behavioral modification. and health for those employers who do not necessarily have a direct connection with agriculture. These employees who count LOCAL EFFORTS on having healthy employees who can be We discussed local and state coalitions for on the job and are not using the insurance benefits from that company's program to working on agricultural health and safety issues! educational resources, and access to recover from injuries because of unsafe what is available in the various states. The practices or unhealthy conditions in their federal role in coalitions is to help coordi- farming operation. nate the state efforts, help avoid unneces- Intervention - Safe Behaviors Among Adults and Children, May 3, 1991 Surgeon General's Conference on Agricultural Safety and Health - 1991 463 Elements of a National Agenda Another point we discussed was the need to find ways to make it easy for individuals to achieve change in behavior. One sug- gestion was that when a farmer buys a significant amount of chemicals, protective clothing or protective gear needed to safely handle the chemicals could be packaged as part of the total product purchased. You would not be given just a large can of pesticides, but rather a large can of pesti- cides with a safety suit attached directly to it. Obviously, there are some cost con- siderations that would need to be taken into account. A related point was made about making it easy for farmers and agriculture workers to purchase safety equipment in general. In some cases it is very difficult to locate a local source. The individual may have to find catalogs or go to significant effort to locate the safety equipment needed. So one of the opportunities or challenges for local or state coalitions might be to somehow assure that at least one source of supply for necessary safety equipment is available locally-a local cooperative or some private outlet. Making sure that those who need to purchase safety materi- als can find them easily, should they listen to our messages delivered through inter- vention, ought to be emphasized. RESEARCH Then we turned our discussion to research. There was a strong feeling that we need better research on evaluating the effective- ness of the various intervention programs that are ongoing. I think somebody al- ready made this point: if we are able to measure changes in behavior and sort out the links that they have to various inter- ventions, then we can perhaps identify which of those interventions are more effective than others. We know that bud- gets are tight. So that would imply with- drawing funds from programs that are not achieving, in order to obtain funding for those that are successful or for new programs. The second issue regarding research that we talked about was the need for more basic research on the relationship between behavioral change and intervention alter- natives, whether it be education, regulation or automatic protection from agents of injury. We do not know the linkages very well, so it makes it difficult to design new programs or better programs. There was some feeling that legislation may be needed because education or other forms of intervention are not very success- ful, but there is also a feeling that legisla- tion alone is unlikely to be effective. We have a lot of evidence, again going back to the seat belt example. Most or all states have seat belt laws now, but that does not mean that we have 100 percent of people buckling up. We need to motivate individuals and com- munities, through education, to help modi- fy behavior and accept or take advantage of safety equipment and healthy choices. We have a lot of anecdotal evidence, and I think more than that, of individuals over- riding built-in safety features. So we need to use all of our approaches to achieve safe behavior in the agricultural occupa- tions. COMMUNICATIONS Finally, we had some discussion about the important role of communications in achie- ving behavioral change. We must pay attention to communications and carefully 464 Papers and Proceedings consider how to deliver intervention in a educational strategies, or cultural differ- manner that causes individuals to follow through to implement the desired changes. ences, or who is not a proficient translator, may do more harm than good. That per- n[ son may garble the message or weaken the impact of materials that could have much more effect by getting the proper expertise through youth is a very effective channel involved. Another point regarding communications is the use of a range of media, organizations, We must carefully consider the background and people to reach the target audience. of targeted audiences, for example, age-ap- Direct as well as indirect approaches, as I propriate programs for youth and educa- indicated earlier, repetitive messages, and tion-level considerations, which dictate varying approaches are needed. Use all delivery approaches. If you have a farm or the media, program opportunities, and the agricultural clientele or agricultural worke- organizational efforts to repeat messages rs' group who are not highly educated, you in various ways. may have to use cartoons, comic books, and posters requiring minimal amounts of Finally, in communication, we need to be reading. careful that proper communication takes place not only within coalitions at the Pictorial images way have to be used to get local, federal and state levels, but also up your point across. People with a low level and down the line. of education are not going to read a six-page handout with many details related We cannot have only top-down ap- to safe behavior. proaches. We know they will not work. We cannot have only bottom-up approach- Similarly, if you are dealing with various es, because we know we will have difficulty cultures-Hispanic comes to mind--culture achieving access to good materials, etc. is quite important in how messages are We need to make sure that the communi- normally delivered or more favorably re- cations between the coalitions at different ceived. Pictorial presentations and comic levels are fully utilized. book kinds of educational materials appar- ently have a tradition of acceptance and Finally, in closing, let me say that despite use in Spanish cultures. the admonition of the participants in our group, which was a large and actively in- A point was made that we need to be volved group of probably 75 or so, I may careful that we draw on proper expertise- have generalized too much in summarizing. whether we are trying to create age- A written report will contain some of the focused, education, or culturally appropri- richness of discussion that I had to gener- ate materials. A partial understanding by alize away from this morning.o somebody who is an expert in a particular aspect of health or safety, but who knows very little about child development stages, Intervention - Safe Behaviors Among Adults and Children, May 3, 1991 Surgeon General's Conference on Agricultural Safety and Health - 1991 465 One of the advantages of speaking abso- lutely last on a panel is that a lot of the previous speakers said some of the things that I was planning to say, so it makes my job easier. This is my first chance to attend this con- ference, because for the last four days I was in Buffalo, New York. During the days of your conference, there was another national agricultural conference-the 1991 National Conference on Migrant and Sea- sonal Farmworkers. It brought together over 1,300 migrant educators, farmworkers, Migrant Head Start educators and direc- tors, employment training workers, attor- neys and health care workers-both clini- cians as well as non-clinicians-people like the physicians, nurses, and physician's assistants, as well as environmental special- ists, health educators, and outreach work- ers. The theme of the conference was "United for Progress." Over the four days, the conference participants had a chance to choose from over 160 workshops and ple- nary sessions. The sessions were heard in Surgeon General's Conference on Agticultwai Safiaty end Health FARMSAFE 2000 o A National Coalkion Ibr Local Action Convmed by the National /nstitute kr Occupational Safeiy and HeaM April 30 - May 3, 7991, Des Moines, lowe REPORT ON M/GRANT AND SEASONAL FARMWORKERS By Valerie A. Wilk, MS. Health Specialist, Farmworker Justice Fund, inc. Dr. Richard A. Lemen: The last speaker whom we have today will provide a Report on Migrant and Seasonal Farmworkers. Valerie A. Wilk received a bachelor's degree from Knox College in Illinois, and a master's degree in preventive medicine and environmental health from the University of Iowa. She is currently a health specialist with the Farmworker Justice Fund in Washington, D.C. I just want to read a couple of things that her organization does, and I am sure she is going to tell you more about this; but, as I see it, they try to make sense out of national and state-level occupational health policy issues facing farmworkers, and they develop strategies to address these issues. They attempt to educate the public, and they attempt to develop coalitions about these issues. Secondly, she also directs the Farmworker Women's Health Project, and she has just returned from a meeting on migrant and seasonal farmworkers. She will tell us about that meeting, and tell you about some of the problems that face these farmworkers. Ms. Wilk: English, some in Spanish only, and some were bilingual. I am specifically focusing on the health workshops of the conference. Then what I'd like to do is go over some of the recur- ring themes and recommendations that came out of that conference and leave you with a couple of my observations from my 11 years of working with farmworker or- ganizations. THE NATIONAL CONFERENCE ON MIGRANT AND SEASONAL FARMWORKERS I know that at least one of the previous speakers on Monday spoke somewhat about farmworkers, but I just want to tell you, when we talk about migrant and sea- sonal or non-migrant farmworkers, we are talking about hired workers. In a 1990 demographic report, the Federal Office of Migrant Health estimated that there are four million farmworkers and their family members in the United States. 466 Papers and Proceedings They are predominantly people of color, sprayed, so is the home, so are the chil- They are men and women; they are chil- dren. They are Hispanic, African- dren, even if they are not directly working in the fields at that time. American, Haitian, West Indian, Southeast Asian, or Native American. They pick the We also dealt with the issue of farm ma- fruits and vegetables; work in nurseries, greenhouses, and mushroom sheds. They chinery-related injuries, heat disorders, and a major occupational hazard for hired hoe, weed, thin, and prune crops. farmworkers, which is transportation-relat- ed injuries. Farm labor contractors too Almost one million farmworkers and their families migrate. Migrant workers travel throughout most of the United States. often transport workers in unsafe vans and trucks. This unsafe transportation has resulted in deaths and serious injuries of a number of workers. The farmworker conference dealt with the issue of child labor; it dealt with farm Most recently, in December 1990, in injuries such as those related to falls from Florida, four farmworkers were killed and ladders. We focused on issues of disability seven were seriously injured when a farm and injuries from prolonged bending, stoo- labor contractor's truck was broadsided by ping, heavy lifting, and carrying, and repet- a van, and the truck carrying the farm- itive motion, including the musculoskeletal workers rolled over repeatedly. The effects on children and results seen in the farmworkers had been riding in the back elderly. of the truck on makeshift benches of planks and cement blocks, which is a viola- One of the workshops dealt with workers' tion of the Migrant and Seasonal Agricul- compensation and the fact that in about tural Worker Protection Act. half of the states in the United States farmworkers are not covered at all by Farmworker advocates in the area had workers' compensation. We also dealt reported this particular farm labor contrac- with the issue of pesticides, including farm- tor for violations six months previously, but worker poisonings from direct spray, from nothing had been done. Because of this drift, and from residues on the plants, inaction, four workers died and seven were seriously injured. We talked about effective methods of educating farmworkers and employers We also discussed the issue of field sanita- about pesticide use and hazards. We also tion. In 1987 OSHA promulgated regula- talked about research projects being done, tions to require that drinking water, toilets and about farmworker health status in and hand washing facilities be provided by general. employers for workers with 11 or more One of the points that came through, and workers on any given day in the fields. The reality is that compliance is very low. one of the other speakers on the panel today has mentioned it, is that the work- place and home are one and the same- There have been a couple of studies in the last year. In 1990, a study done with the North Carolina School of Public Health particularly in terms of migrant workers where migrant labor camps are right in the found that only 4 percent of farms were in middle of fields. So when fields are complete compliance with the Federal Field Sanitation Standard. There was a Report on Migrant and Seasonal Farmworkers, May 3, 1991 Surgeon General's Conference on Agricultural Safety and Health - 1991 467 Elements of a National Agenda study done in New Jersey in 1990 that showed a figure of 16 percent compliance. We discussed strategies to improve em- ployer compliance and OSHA enforce- ment. One of the issues that came out in that workshop was the fact that the threat of employer retaliation is so great. If you have to rely on formal worker complaints, there are very few workers who are willing to risk their job if they know that OSHA may not be out to inspect for a week or two weeks or maybe 30 days. By that time, the labor crew has already left that farm and that work. Another aspect of the field sanitation stan- dard is drinking water. Common drinking cups are a major problem, as is clean and sanitary drinking water at the worksite. We also talked about children's health and safety. Children drink and bath in contam- inated water-water contaminated with pes- ticides and fertilizers. We also talked about injuries and about drownings in rivers and irrigation ditches. Another workshop that attracted a lot of attention had to do with farmworker wom- en and health. In March of this year, the Farmworker Justice Fund sponsored the First National Farmworker Women's Con- ference. It was the first event of our Far- mworker Women's Health Project. We brought 63 farmworker women and trainers to San Antonio for a three-day conference, and all of the farmworker women were women of color. They were Hispanic, African-American, Haitian, and Southeast Asian. The meeting was held in three languages: Spanish, English, and Haitian-Creole. We will be publishing proceedings of that mee- ting later this year. We brought two of the farmworker women, who had been elected by the nr oup in San Antonio, to the Buffa- lo Co erence to present to that confer- ence about the health priorities and rec- ommendations that the women made in San Antonio. There are a number of health issues spe- cific to women. For example, with regard to field sanitation, urinary tract infections. If there is no privacy or no clean facilities, farmworker women will wait an entire day before going to the bathroom. This is particularly troublesome for women during their menstrual period and for pregnant women. With regard to farmworker women and their exposure to pesticides, there are consequences of long-term exposure to the reproductive system, such as infertility, as well as the risk of miscarriages and birth defects. In November of 1989, there was a mass poisoning near Ruskin, Florida, and there were about six pregnant women, most of them in their first trimester, who were among the workers who were poi- soned. Of those women, the medical director of the clinic who treated the workers knows of two women-one who miscarried and another who had a baby with birth defects of the face and hand. There was another case, which was unconfirmed, of a still- birth. Another issue facing farmworker women is sexual harassment, rape, and even sexual slavery in labor camps. Housing is a major concern and occupied various workshops at the conference- substandard housing, overcrowded housing, or no housing at all. 468 Papers and Proceedings We have had reports of hundreds of work- ers in Arizona living in the citrus groves, farmworkers; and that advocacy to correct occu ational and environmental health sleeping under tarps with cardboard on the prob ems was, indeed, preventive medicine P ground. Also, in southern California there are cases of workers who have been living and extremely important. I have been in holes in the ground in the canyons. I gratified to see over the years that this has just heard in Buffalo that in at least one been a growing sentiment among migrant case, workers were being charged for rent health and migrant service providers. for the tree that they were sleeping under. There was a commitment to continued and better coordination and communication 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' compen- sation or field sanitation. What I have not shown you in these slides health and safety issues: workers' compen- are other occupational hazards that farm- sation or field sanitation, for example. workers face: tuberculosis, involuntary servitude, and employer retaliation. I have Another theme was the importance of the heard through my office of a number of need for and the barriers to getting work- situations where farmworkers have gotten place information, most strikingly the right fired simply for asking a question about to know which pesticides are used and the safety of farm equipment or about the when they are applied in the fields. An- location of field sanitation facilities, or for other theme was the importance of the use refusing to return to a recently sprayed of popular education methods to teach field, or for taking action and getting out farmworkers, that is, getting farmworkers of a field while it was being sprayed. involved in a egalitarian way in training by There are no anti-retaliation protections doing skits and interacting with volunteers under the Federal Pesticide Law, and from the audience so you are not just OSHA's anti-retaliation protections are so doing straight lecturing about health and time-consuming that with the seasonality of safety and pesticide safety. farmwork, they offer little protection for farmworkers. The other thing, which I mentioned earlier, is the extent of farmworker intimidation by THEMES AND RECOMMENDATIONS employers, and the lack of protection for workers who demand and who question What are some of the recurring themes from the Buffalo conference? First of all, there was the recognition of the impor- tance of service providers, particularly health care providers, being advocates for Report on Migrant and Seasonal Farmworkers, May 3, 1991 among programs to most effectively use the resources available. Related to that was the importance of coalition building within one's community and beyond on farmworker health and safety issues. 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 and who actively try to make the work- place safer. Finally, I would like to leave you with two observations. First of all, a National Co- alition for Local Action, FarmSafe 2000, Surgeon General's Conference on Agricultural Safety and Health - 1991 469 Elements of a National Agenda must include migrant and seasonal farm- workers as equal partners. Not only must farmworker family occupa- tional safety and health issues be consid- ered as seriously and as fully as farm fami- ly health and safety issues-because so many of these issues are similar and be- cause farmworkers are important workers within the agriculture industry-but also farmworker leaders, community leaders, and union leaders need to be involved in the coalition as equal and active partners. Farmworker advocacy organizations such as the Farmworker Justice Fund can help identify those farmworker leaders to par- ticipate in this process. Also, when we are talking about coalition building, what struck me earlier with the four components of a coalition, quite fran- kly, was that two of those partners in a coalition have been some of the biggest barriers to farmworkers getting a safe and a health workplace. Both industry and government have opposed and have sub- verted some of the attempts to protect farmworkers, through legislation and regu- lation. A safe workplace makes economic sense, and society picks up the tab when we have unsafe workplaces. Action is needed, but actions as have happened in the past can- not continue. We need to look at different ways of working together. We need to convince industry and government that changes need to be made, and we need to support farmworkers in their efforts. Some of the most cutting edge protection for farmworkers have happened under union contracts. We need to look at all the different models to make sure that farmworkers are equally protected.0 470 Papers and Proceedings Surgeon General's Conference on Agricultural SafWy and Health FAR&&FE 2000 o A National Coalition for Local Action Conwmd by the National Institute Ibr Occupational Safety and Health April 30 - May 3, 7991. Des Moines, Iowa OUTSTANDING FFA POSTER By Rice C. Leach, M.D. Chief of Staff, Office of the Surgeon General Dr. Richard A. Lemen: Our next session is going to be chaired by Dr. Rice Leach, who Surgeon General Antonia C. Novello appointed as her Chief of Staff in April 1990. As Chief of Staff, Dr. Leach is responsible for coordinating the activities of the Office of the Surgeon General (OSG). Dr. Leach came to the OSG from the Health Resources and Services Administration, Bureau of Health Care Delivery and Assistance, where he was the Chief of the Public Health Service (PHS) Recruitment Program. He began his PHS career in 1966 as a rotating intern at the PHS Hospital in New Orleans. He has served the Indian Health Service (IHS) in numerous clinical and management assignments including director of an IHS area, manager of the IHS AIDS program and associate director of the IHS Office of Research Development. Dr. Leach has also served in the Bureau of Medical Services. Dr. Leach was born in Lexington, Kentucky and received a B.A. from Amherst College, M.D. from the University of Kentucky, and a Master of Science in Health Services Administration from the Harvard University School of Public Health. He completed his preventive medicine residency at the University of Arizona and an internal medicine residency at Tulane. Dr. Leach has sewed on the Federal constituency section of the American Hospital Association, the South Dakota Statewide Health Coordinating Council, the Board of the Arizona Hospital Association, and the education committee of the Arizona Medical Association. Dr. Leach: Dr. Novello would like to be with us today but, as she said earlier, she has other obli- grounded in Denver and will be here later this afternoon. gations. There is another physician who would love to be here today, too, Dr. J. Donald Millar. He has been de- At this point in the program, we are going tained by some occupational health stan- to the first place award for the best FFA dards that say something to the effect that poster presentation. One of the judges "There will be no planes leaving San who was recently president of an FFA Francisco with broken radar." He is association made the following statement about the posters: They were all outstanding. I spent a lot of time talking with the members, and it is obvious that they take a great deal of pride in their programs. To tell the truth, judging is not nearly as easy a task as I had thought. My compliments to NIOSH and the Surgeon General's Conference stafl Thanks for letting me be part of it all. ple so fired up about safety. It was exciting to see so manypeo- Those are the comments of Sheryl Janko, the immediate past president of the Iowa FFA Association. The group judged to have the best poster is the Amanda Clear Creek FFA Chapter from Amanda, Ohio. Representing that group are Mr. Gary Bnnnfield, the Safety Program Chair, and Mr. Charles E. Miller, the advisor.0 Surgeon General's Conference on Agricultural Safety and Health - 1991 471 Surgeon General's Confkence on Agticukutal Safety and Health F~USAFE 2ooO o A National Coalition rbr Local Action Conwned by the National Institute tbr Occupational Safety and Heatth April 30 - May 3, 1991, Des Moines, /owe OSHA INITIATIVES IN AGRICULTURAL SAFETY AN5 HEALTH By Cynthia DougZass Deputy Assistant Secretary of Labor U.S. Occupational Safety and Health Administration Dr. Rice C. Leach: Our first speaker is Cynthia Douglass, Deputy Assistant Secretary of Labor, Occupational Safety and Health Administration in the United States Department of Labor. Ms. Douglass was appointed Deputy Assistant Secretary of Labor in December 1989. She Is responsible to the Assistant Secretary for the external activities of the agency. She works with other Federal and state agencies such as the Congress, the Environmental Protection Agency, labor unions, business, and others to enhance worker safety and health. Prior to her time with the Labor Department, she was Administrator of the Research and Special Programs Administration for the Department of Transportation. Prior to that, she was Special Counsel to the Senate Commerce Committee, which worked on a wide variety of issues including automobile safety, motor carrier safety, economic deregulation, and insurance. We have a very qualified spokesperson. I give you Ms. Douglass: Thank you very much. I am delighted to be here. I am also delighted to be a par- ticipant in the first Surgeon General's Conference on Agricultural Safety and Health and want to thank Surgeon Gen- eral Novello and Dr. Millar for inviting the Occupational Safety and Health Adminis- tration (OSHA) to participate and speak at this important meeting. I assure you that OSHA wholeheartedly supports the Sur- geon General's attempts to prevent injury and disease in the agricultural workplace. My boss, the Assistant Secretary of Labor for OSHA, Jerry Scannell, wanted very much to be here to convey to you his con- cerns about farmworker safety and health. Unfortunately, as I am sure you all know, there was a catastrophic explosion at a fertilizer plant in Sterlington, Louisiana, two days ago. Eight people were killed in that explosion, and over 100 people were injured. Mr. Scannell flew there yesterday and could not get a plane out in time to be here this morning. Jerry believes that it is important to personally let the community and the workers know of OSHA's commit- ment to the workers of that facility. He also believes that it keeps his heart and soul focused on the primary goal of OSHA, which is to assure every man and woman a safe and healthful workplace. He asked me to come here and talk with you about OSHA's program, and I am delighted to be back in the Midwest, I am from Kansas and went from there to Washington, D.C. in 1976. I would note that I was there in time for the huge farm- er protest in Washington, which was in 1977, and I believe again in 1978. I still have a bumper sticker that was given to me by some Kansas wheat farmers that says: "If you don't like wheat farmers, don't talk with your mouth full." Those are my sentiments exactly. 472 Papers and Proceedings As I said earlier, agricultural safety and THE OCCUPATIONAL SAFETY AND health has been one of Assistant Secretary HEALTH ADMINISTRATION Scannell's major concerns since becoming Assistant Secretary of Labor for Occupa- I want to tell you a little bit about OSHA tional Safety and Health. I know he will and how it operates. OSHA has jurisdic- be pleased that this conference has been so successful. tion over occupational safety and health in more than six million workplaces in America, employing about 90 million We are all appreciative that the Congress workers. We operate on a relatively small appropriated the funds for this conference budget for that, about $285 million, with and believe that the conference will help an authorized staff of a little over 2400 further the education and relationships people, of whom approximately 1300 are necessary to reduce the shameful accident- inspectors. rate of farming. OSHA, in particular, wants to develop a good relationship with Our mission is to ensure safe and healthful your community, because together we can working conditions for working men and make a difference. women through a variety of means, includ- ing regulations dealing with occupational The breadth and depth of the subjects that safety and health, education, training, and have been covered during the four days of technical assistance. Of course, we have this conference is impressive. So is the an enforcement program. fact that there has been participation from members of farm organizations, migrant In carrying out this mission, we rely heavily worker representatives, academic institu- on a partnership that includes labor and tions, safety and health professionals, the management, the states, the Federal gov- states, and the government agencies, all of ernment-NIOSH, for example-safety and which play an important role in this vital health professionals, and academia. area of agricultural safety and health. This is truly the kind of national coalition and Our enforcement jurisdiction in agriculture partnership that can make a difference. is limited by law to those farms that em- ploy 11 or more workers. This means that OSHA's interest in working with you to we do not enforce OSHA regulations on reduce the occupational deaths and inju- the great majority of farms; 86 percent of ries in American agriculture is evidenced by the fact that we have 17 staff people American farms are smaller, part-time operations. We do have enforcement attending this conference. In addition, a number of the representatives of states, which operate their own OSHA-approved occupational safety and health programs and OSHA-supported state consultation programs, are attending. OSHA is com- mitted to efforts to improve safety and health in agriculture. authority in migrant labor camps. We are all aware that agriculture is one of the most hazardous of American indus- tries, with 1,300 deaths and 120,000 dis- abling injuries in 1989, according to Na- tional Safety Council figures. Many of those injuries involve children. OSHA Initiatives in Agricultural Safety and Health, May 3, 1991 Surgeon General's Conference on Agricultural Safety and Health - 1991 473 Actions for the Future Therefore, OSHA has a big responsibility, working within the limitations placed on it by the appropriations language, to seek to reduce these injuries and fatalities in the farming industry. OSHA has the authority to work with small farms. The only prohi- bition is on enforcement. For years that appropriation rider was interpreted by OSHA to mean, just stay out of the farm and stay away from the farm community. We do not want OSHA-we do not even want the word spoken in the farm community. But that is not what the statutory language says. OSHA can give technical assistance to farmers. We can work with your com- munities. The answer lies in education, training, and increasing awareness of those haz- ards and how they can be reduced. I We can help develop materials and train- ing and educational seminars to aid in increasing awareness and knowledge about safety and health problems in agriculture and the actions that may be taken to mini- mize these problems. In that connection, for example, we might seek the aid of university-based agricultural safety and health centers and other government agen- cies, such as the extension service, to pro- vide necessary expertise and guidance in training staff members for outreach and consultation activities. We can also provide OSHA-supported consultation services to small agricultural employers. The consultation program is a voluntary one and helps develop mutual trust between farmers and OSHA. I might point out that the representatives of OSHA-supported consultation programs recently met in Tucson, Arizona. One of the principal items on their agenda was consultation services in agriculture. OSHA also reviews existing standards that apply to agriculture, such as the roll-over protective structures (ROPS) standard. We look at whether these standards should be modified to reflect changing conditions in the United States, in the world, and in the industry. We need your help, though, on reviewing and modifying these stan- dards, if we are to have good, common-sense safety standards. All too often OSHA is only regarded as an enforcement agency. Enforcement is not the principal answer to reducing hazards in America's agricultural worksites. The answer lies in education, training, and increasing awareness of those hazards and how they can be reduced. My boss, Jerry Scannell, has committed OSHA to developing a positive commu- nication goal. He wants to work with others such as NIOSH and your organi- zations and believes that if we do that, we can have a significant impact on agricultur- al safety and health. During the 1970's, OSHA had an advisory committee on agricultural safety and health. Jerry is considering the re-estab- lishment of this committee. We have been working to re-establish a number of relationships with government and private organizations, and we hope to 474 Papers and Proceedings continue this. The message is that OSHA contaminants in agriculture, a regulatory wants to work with all of you to further initiative, NIOSH joined with OSHA to agricultural safety, education, and aware- explain our respective agencies' work to ness. the attendees. This summer we will ask an occupational health nurse intern serving on Farmers, themselves, recognize that they our staff to further update OSHA staff on work in a hazardous occupation. The the latest research findings of NIOSH in National Coalition for Agricultural Safety agriculture and to determine how OSHA and Health (NCASH) conducted a survey can best utilize this NIOSH material to of New York and Iowa farmers. More maximize its own efforts. than 70 percent of those farmers who were surveyed said that their occupation was OSHA also has held meetings and discus- more hazardous than other occupations. sions with the Rural Safety and Health Committee of the American Farm Bureau; In connection with that, I am gratified to USDA officials; the Office of Rural Health see that one of the concurrent sessions at Policy; Agricultural Division of the Nation- this conference dealt with behavioral al Safety Council; and the Farm Safety for changes among both adults and children "Just Kids" organization. These are a few working on the farms. Strategies must of the organizations we have met and with incorporate new and innovative approaches whom we have been working. to behavior modification. One of our most successful efforts was AGRICULTURAL SAFETY AND HEALTH production of various news feature mate- rial and radio and television spot an- Let me tell you something about what nouncements for distribution to 3,500 rural OSHA has been doing in agricultural safe- media during the National Farm Safety ty and health. This is all relatively new, by Week of the National Safety Council in the way, just in the last 2 years. We have September. These public service an- been holding numerous meetings since nouncements were designed to call atten- January of 1990, developing OSHA's plans tion to the need for improved safety and and initiatives to carry out a program of health measures on the farm. The fact enhanced awareness of work-related haz- that OSHA is now taking an active role in ards in agriculture and how to cope with this area was also communicated. them. The radio announcements alone were OSHA is working closely with NIOSH staff carried by 249 stations, reaching an esti- from Dr. Millar's office, meeting with our mated 4.5 million homes with over 14 OSHA executive staff to explain activities million listeners. We hope to do this again and to share ideas. We are doing this on a this year. regular basis. We have developed a fact sheet on farm During a series of conferences on the safety that points out that most of the permissible exposure limits (PEL) for air deaths and injuries on the farm are pre- Surgeon General's Conference on Agricultural Safety and Health - 1991 475 OSHA Initiatives in Agricultural Safety and Health, May 3, 1991