National Rural Health Alliance. Farm Health

Transcription

1 NRHA National Rural Health Alliance Farm Health Lyn Clarke Agricultural Health Unit Moree District Hospital Moree, NSW 1st National Rural Health Conference Toowoomba 14th - 16th February 1991 Proceedings

2 IDENTIFYING THE HEALTH NEEDS OF REMOTE AND RURAL COMMUNITIES Farm Health Dr Lyn Clarke Director Agricultural Health Unit Moree District Hospital Moree, NSW Agricultural production and services to farming form the socioeconomic base for most rural communities and specialised skills and knowledge in the area of farm health and safety are required for provision of health services appropriate to meet the needs of this important group of rural Australia. Farm work, farm life and leisure are inextricably intertwined. Health services required by farmers, farm families and farm workers and those servicing agricultural industries cannot be divided into mainline services and occupational health services. Indeed such a division has previously consigned farm health into an occupational health category and if continued would ensure that specific health needs of farmers are not met, as specialist resources cannot be provided in occupational health and safety across all rural Australia. (This is in contrast to a number of Scandinavian countries where specialised services have been developed). Australian Agricultural Agriculture remains one of the most important industries for Australia. Australia has occupied a prominent position in the world in terms of export of its major products - wool, meat, wheat and sugar. In the total value of agricultural production was A$20,15 1 million. Dramatic changes in market conditions for wheat and wool will change this position although other commodities, such as cotton, look bright. In the 200 years of agricultural development of Australia, farmers had to face a harsh and uncertain climate and environment in all but some coastal areas, and the agricultural systems and technology became highly specialised. Australia has about 130,000 farms, ranging in size from huge grazing properties of over a million hectares, to tiny farms of just a few hectares. The average size of farming establishments is about 3,700 hectares. Continuing economic pressures on Australia agriculture, and improved farming technology have resulted in a reduction in the number of farming enterprises - there were more than 205,000 farms in the early 1950 s. On the other hand, around the perimeter of city centres there has been an increase in the number of hobby farms, run by persons who derive their main income from other activities and farming. One of the most remarkable features of Australian agriculture over the past few decades has been its ability to increase production despite intense and often crippling cost price

3 88 NATIONAL RURAL HEALTH CONFERENCE - pressures. Over a period of 30 years, farm costs have increased by 653% while prices paid for agricultural products have risen by only 208%. In 1988 there were 402,000 persons working in agriculture and providing services to agriculture. This represents 5.5% of the Australian work force. 1. Problems of Farming Health and Safety Although there was some development of mechanical tillage, seeding and harvesting during the last century, agriculture was generally dependent on horses for power until the 1920 s, when the first all purpose tractor was manufactured. The earliest insecticide, DDT, was only introduced in This compares with the major developments in the manufacturing industries which occurred in the early 1800 s. In addition to this historical lag in large scale technological change, there are other important characteristics of farm work that make the generally applicable occupational health and safety principles either irrelevant, or difficult to apply in agriculture. The traditional approach to tackling work safety problems involves consideration of the system- the work environment, the work process involved (tools, machinery, chemicals and their use) and worker and his or her fitness for the task at hand. Let us quickly review the agricultural work using this framework. 2. The Farm Environment The following aspects of the farm environment contrasts to a considerable degree with most other industries. o Biological hazards - tetanus, Leptospirosis etc associated with soil and water. Organic dust - wheat, grain, cotton. Chemical hazards - on surfaces, in the air and in water. Remoteness and isolation of farm work. The extremes of heat and cold over which farmers lack control. 2.2 The Farm Work Process One of the major differences between farm work and other work lies with the fact that most farm work is not stationary. Machinery used is not static, rather it is made to move, to thrush, to tear, and grab, leaving moving parts exposed by the very nature of the work to be done. Other aspects of farm work process are of interest: Increasing mechanisation, Animal handling - involving animal related accidents and zoonosis. The increasing use of agro chemicals. Farm work is often performed alone. Farm work requires irregularity of working hours. The diversity of tasks to be undertaken within one day, or one season, or one year. 2.3 The Farm Worker 90% of farms in Australia are owned and operated by the farm family. Thus farming has to accept the presence of children and also accept that many older people continue to be involved in farm production. The acquisition of farm skills has previously been a matter of learning on the job or within the family setting. Increasingly, however, young farmers are taking advantage

4 IDENTIFYING THE HEALTH NEEDS OF REMOTE AND RURAL COMMUNITIES 89 of opportunities in tertiary education facilities for the development of their farm skills. There is a group of farm workers who are itinerant workers for whom provision services is very difficult. of An important aspect of farming is that farm work and farm life can not be separated. This has significant implications for the way that health services to farmers must be provided. 3. Farm Injury and Illness in Australia Data availability regarding the health and safety status of Australia s farmers in quite inadequate, and efforts are being made at national, state and local levels to establish improved collections. In 1989 a major study of work related fatalities occurring in Austr,alia for the 3 years was reported by Worksafe Australia. This study found that the annual incidence for rural work related deaths was 22.09% per 100,000 persons and followed rnining and transportation occupational groups in significance. (All three occupational groups are heavily represented within the rural community and it would appear that provision of rural occupational health services should be a priority aside from those specifically related to farming). There were 224 farm fatalities where the deceased was involved in farming at the time of injury. A further 34 children aged less than 15 years sustained fatal injuries in the course of farming activities. The age distribution of these fatalities has been described and the high representation of children and of the elderly noted. The main agencies of injury were noted to be tractors and associated implements, other powered machinery and horses. Studies of injury on farms, not resulting in death, have been undertaken in a variety of ways and in different regions. Workers compensation data are an important source of information regarding work related injury in other industries in Australia. An analysis of the available data for New South Wales farm workers was undertaken by Webster et al for the period More than 78% of all claims were for back strain, lacerations, fractures, crush injuries and contusions and sprains. The four agencies responsible for 45% of injuries were animal handling, lifting or carrying heavy loads, shearing hand pieces and motorcycles in farm work. Local studies using inpatient data from rural hospitals have been carried out by local interest groups. These studies indicate high numbers of accidental injury resulting from farm machinery accidents, animal handling, motor vehicles, falls, and, in a number of areas, from horse handling and riding. A pilot study of 70 farms in the North West of New South Wales4 found that 7 or (10%) had sustained an injury resulting in hospital admission in the previous 5 years, and that there were 47 injuries sustained by the 70 farmers causing lost of work days. This translates to an annual injury rate of 134 per 1,000 farmers. The National Injury Surveillance Unit is undertaking to extend the Accident and Emergency based injury surveillance system to include the rural hospitals in areas of significant agricultural activity. This should yield useful information regarding the nature and extent of agricultural accidental injury for the major industries. Information regarding other health problems for Australian farmers is also sadly lacking, although results of hearing screenings services provided for farmers at National Field Days and Shows over a 5 year period in New South Wales has demonstrated that more than 60% of farmers have significant noise induced hearing loss.

5 90 NATIONAL RURAL HEALTH CONFERENCE Respiratory disease results in higher than average death rates in most rural regions in New South Wales although no information relating specifically tlo farmers is available. A conference on Respiratory Disease in Agriculture was held in Moree in Again the major problem identified was the lack of useful data, although the major problems noted were respiratory disease, primarily Asthma, due to pollens, grains, cotton dusts and problems caused by high levels of smoking in the rural community. Statistics relating to zoonotic diseases - leptospirosis, hydatid disease, brucellosis, Q Fever and tetanus are not available although these diseases occur in different parts of the country. Given the diversity of problems, the scattered spread of the Australian farm population and the state/federal division of responsibility, it is clear that any attempt to identify major risks and to mount effective programs to reduce risk will be a very complex task. In I988 the first ma.jor National Conference on Farm Safety was held on the campus of the University of New England in Armidale in New South Wales. This conference was jointly planned and sponsored by that University, the Department of Primary lndustj and Energy, and Worksafe Australia. For the first time all people and institutions in Australia working in the field of agricultural health and safety, had an opportunity to present their work and discuss the identified problems with farmers, farm consultants and extension officers, researchers and bureaucrats. In addition keynote addresses were given by specialists in the field of farm health and safety from overseas - Sweden. Canada and New Zealand. Following the conference a Task Force was assembled to make recommendations to the Ministers from Primary Industry and Industrial Relations regalrding a Farm Health and Safety Program suited to the needs and resources of agriculture in Australia. Briefly, recommendations were made in the following areas: 1. A National Framework to support community driven occupational health and safety programs. 2. Development of Farm Safety Action Groups - local or industry based interest groups. 3. Education and training in farm safety. 4. Data collection and analysis. 5. Information dissemination. 6. Funding of research and other programs. 7. A review of legislation. Subsequently a National Secretariat has been established with officers in the Rural Training Council of Australia in the NFF Building in Canberra. It is operated by a Managing Consortium, comprising the National Farmers Federation, The Rural Training Council of Australia, Agricultural Health Unit and the Rural Development Centre based at the University of New England. The Secretariat has responsibility for linking the network of Farrn Safety Action Programs and organisations with each other and for coordinating the various farm safety endeavours in the interests of the farming community. The strength of the Secretariat lies with its links with the Rural Training System through the states Rural Industries Training Committees and the major rural education and training

6 IDENTIFYING THE HEALTH NEEDS OF REMOTE AND RURAL. COMMUNITIES 91 institutions. The State Rural Industry Training Committees are in the process of encouraging the establishment of local farm safety action groups or industry specific safety action groups and a number of states have already established the own state FarmSafe Committee. Role of Health Service Providers in Farm Health Health professionals in rural areas have been keen participants in t.he development of local farm safety action groups. Farming people look to health professionals as the source of authoritative information on all health issues including farm-specific health issues, as well as providing care in times of ill health and injury. Rural health professionals need specific and specialised knowledge and skills in the following areas: 1. Local agricultural production, methods and systems and identified health hazard areas 2. Toxicology of locally used pesticides 3. Zoonoses including Q Fever, Hydatid disease, Leptospirosis and also other rural arboviruses such as Ross River Fever. 4. Occupational asthma, particularly relating to farm generated organic dusts, such as wheat and other grain dusts and cotton dusts. 5. Noise induced hearing loss occurring on farms. 6. Farm injury prevention. Along with a specialised understanding of these issues rural practitioners also need to have a basic understanding of epidemiology. Local professionals are often called upon to interpret agriculturally specific community problems such as the impact on the human health of populations in relation to pesticide use. Health professionals in all rural areas are encouraged to work with local farm safety action groups and, as professionals in health and safety, to encourage thlsir development. A National Rural Health Strategy must acknowledge the problems of farm health and safety across rural Australia, and should acknowledge the work being done by various agencies concerned with these problems. A formal linkage between the Rural Health Strategy and the National Farm Safety Strategy should be developed both with links between departments and agencies, and with the National Farm Safety Secretariat. References 1. Cribb J., Agriculture in the Australian Economy. Australian Agricultural Yearbook National Farmers Federation. 2. Harrison J.E., Frommer M.S, Ruck E.A, Blyth F.M. Deaths ah a result of work-related injury in Australia, M.J.A. Feb. 1989, Vol 50, Webster M.E.D., Bath P.R, Lush D.P. The Pattern and Frequency of injury and illness among farm workers in NSW. Paper presented at the Armual Conference of the Ergonomic Society of Australia and New Zealand, Clarke L.J. A pilot survey of farm injuries and illness on farms in the Moree Area of NSW. Unpublished paper 1988.