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12 Recommendations for Program Improvement The National Institute for Occupational Safety and Health (NIOSH) Agricul- ture, Forestry, and Fishing Research Program (AFF Program) is the sole federal research program dedicated to enhancing the safety and health of workers in ag- riculture, forestry, and fishing. As such, the AFF Program should be the definitive leader and source of expertise in occupational safety and health in agriculture, forestry, and fishing. From its evaluation of the relevance and impact of the pro- gram (Chapter 10) and its assessment of new and emerging research (Chapter 11), the Committee to Review the NIOSH Agriculture, Forestry, and Fishing Research Program identified several potential opportunities to improve the relevance of the programâs work and strengthen its impact on reducing injuries and illness in the AFF sectors. This chapter presents the committeeâs recommendations for program improvement. As the committee reviewed materials provided by the AFF Program, gathered information from key stakeholders, and reviewed comments from the public, sev- eral barriers to the effectiveness of the program were apparent. The committeeâs recommendations are aimed at improving the program as a whole. 195
196 A g r i c u lt u r e , F o r e s t r y , and Fishing Research at NIOSH RECOMMENDATIONS Establish Strategic Goals for Improvement in Administration and Evaluation Recommendation 1:â The AFF Program should establish strategic goals for the overall program and for separate subpopulations to provide a basis for improving program leadership, administrative oversight, and program evaluation. AFF Program strategic goals should flow from the original enabling legisla- tion, with the obvious expansion of the program to include strategic goals for forestry and fishing. The committee has highlighted the need for basic surveillance; worker health status assessment; design, field testing, and evaluation of efficacious interventions; provision of critical oversight mechanisms for professional educa- tion; and research to track key drivers that affect AFF worksites. Such goals must include capacity for NIOSH administration, inclusion of extramural centers, and a mechanism for external advice. 1.a:â The AFF Program lacks a concerted effort and should focus its admin- istrative efforts on improving program leadership, administrative oversight, and program documentation. Improve Program Leadership NIOSH is capable of deploying leadership across the AFF sectors. As mentioned in the ideal research program (Chapter 2), the committee recommends that a single person be charged with directing the entire program and overseeing, evaluating, and communicating its plans. However, content experts would be in charge of each arm of the program: a separate leader for agriculture, for forestry, and for fishing. Accordingly, the AFF Program should cultivate a proactive leadership approach that demonstrates inclusiveness and keen awareness of changes that take place across agriculture, forestry, and fishing. Improve Administrative Oversight NIOSH should specifically re-examine its internal coordination mechanisms, and implement simpler and more expedient means to ensure that all intramural program elements are functioning in a manner consistent with epidemiological insight and best management practices. The committee has serious reservations about the extraordinarily complex matrix system currently developed for program coordination, and instead recommends a relatively flat organization chart where
R e c o m m e n dat i o n s for Program Improvement 197 the person in charge of each arm would have a fair amount of responsibility and latitude to make appropriate decisions. The management matrix or organization structure should be flexible so that the AFF research teams can recognize and re- act quickly to changes in the AFF industries, the economy, new technologies, and relevant results of research in other programs, and managed in such a way that AFF research teams are encouraged to be proactive in anticipating and mitigating emerging risks and hazards. Improve Program Documentation NIOSH should move expeditiously to create a plan for open sharing of sci- entific information and best practices from past, present, and future intramural and extramural projects. To achieve that goal, the existing electronic centralized archival repository should be enhanced and be made more user-friendly. To facili- tate the creation and maintenance of the archival repository, every project should be required to have an electronic submission form that permits information to be automatically uploaded into the repository within 90 days after project completion. Additional outputs include publications resulting from the research. The central- ized repository should be easily accessible to researchers and to the general public. Search tools should be developed by NIOSH and made available to researchers. An incentive to do that will be to have publications and project reports listed with popular search engines so that they can be found and cited in the literature. C Â enters for Disease Control and Prevention (CDC)/NIOSH will have oversight and responsibility for the maintenance of this database. The National Agricultural Safety Database (NASD) is a unique and valuable resource, but it is used by only 34 states. All states are represented by the NIOSH Centers for Agricultural Disease and Injury Research, Education, and Prevention (Ag Centers), and every state should be connected to the NASD. Information should be regularly evaluated and added to the database. The NASD could become the networking center for conferences, data, safety information, and research results. 1.b:â The AFF Program should develop a comprehensive program evalu- ation mechanism to assess and set priorities among its research and transfer activities. It is important that effective evaluation be conducted as indicated in the logic model (Figure A-1). That cannot be accomplished in the absence of specific strategic goals against which progress can be measured. All aspects of the programsâincluding activities, outputs, and outcomesâshould be systematically evaluated for relevance and impact. Assessment of program impact and feedback into the priority-setting process is essential because it leads to the identification of best practices. An evaluation process, such as the CDC Framework for Program
198 A g r i c u lt u r e , F o r e s t r y , and Fishing Research at NIOSH Evaluation in Public Health, should be adopted and consistently applied to all NIOSH programs. Develop a Cohesive Program Recommendation 2:â The AFF Program should provide national leadership and coordination of research and transfer activities in agricultural, forestry, and fishing safety and health. NIOSH has a unique role as a federal agency that directly funds occupational safety and health research through its intramural and extramural programs. As such, it is able to shape national priorities, strategies for action, and evaluation of health and safety programs in AFF. NIOSH is in a position to influence the direc- tion and priorities of the regional and topical Ag Centers that it funds, and to lead and coordinate the work of related non-Ag Center projects. Those efforts need to be based on national goals and strategic planning, as mentioned in the previous recommendation, and should result in a coordinated effort aimed at develop- ing and maintaining systems for comprehensive data collection, archiving, and sharing, and for research in and surveillance and evaluation of transfer activities. Exercising such national leadership would provide coherence and linkage among the diverse organizations engaged in intramural and extramural research and external partners. The national tractor initiative should not be the only project in which activities and strategies are nationally coordinated. Other agenciesâsuch as the National Institutes of Health (NIH), the National Science Foundation, and the U.S. Department of Agriculture (USDA)âachieve such coherence by linking databases and structuring the request for application (RFA) and request for pro- posal (RFP) processes. To follow this recommendation, NIOSH should create a national coordinat- ing council that includes key stakeholders and the directors of the Ag Centers. The council would oversee strategic research goals (for example, in health effects, intervention, and health services research) and provide direction for occupational safety and health training so that the most pressing clinical needs are addressed. Coordination requires a process for maintaining continuous communication with all stakeholders; annual regional and national workshops and conferences are examples of an appropriate mechanism for strengthening leadership and coordi- nation. The AFF Program should continue to convene symposia to explore con- temporary AFF worksite and environmental exposures, because it has an essential role in the training of health services professionals. Discussion of basic methods already in use in the field is slow to reach health and safety practitioners in rural areas, and the meetings would help to educate rural practitioners. Practitionersâ
R e c o m m e n dat i o n s for Program Improvement 199 insights about real-world clinical problems that affect rural populations would be invaluable to investigators. The Ag Centers are superbly positioned to assist the AFF Program with coordi- nating national and regional initiatives, as they are strategically placed at university- affiliated or located at not-for-profit medical centers and are placed to reflect agricultural programmatic and regional differences (NIOSH, 2000a). To reflect the comprehensive charge of the AFF Program, the Ag Centers should consider under- taking additional responsibility in forestry and fishing, where regional issues apply, to obviate the creation of separate infrastructures to serve the needs of workers in forestry and fishing. Alternatively, providing R01 and R21 awards to non-Ag Center researchers might be a cost-effective way to further research objectives in forestry and fishing. Should the former be considered, the Ag Centers should in name also echo the array of issues covered and be referred to as AFF Centers. Implement a Comprehensive Surveillance System Recommendation 3:â The AFF Program should implement a comprehensive surveillance system. Surveillance is critical for developing and evaluating intervention programs and provides information needed to guide in-depth research areas. Current surveillance systems that cover occupational health, hazard, and injury are not comprehensive in that they do not cover the AFF workforce. The surveillance activities described in the NIOSH AFF evidence package reflect a piecemeal approach to surveillance and fail to address such critical issues as the population at risk and the incorporation of disease surveillance that includes more than respiratory disease, hazard surveil- lance that includes exposures other than to pesticides, and injury surveillance that includes a national focus on fatal and nonfatal injuries in all AFF workers. Basic demographic and health effects surveillance of each population at risk of exposure in connection with worksite activity is essential; without it, no effec- tive targeting of other programmatic elements can occur. Surveillance must be broad-based with respect to population targets because the sector is diverse in settings and employment practices and places some specific populationsâsuch as children, female spouses, and the elderlyâat risk. For various reasons, NIOSH has had considerable difficulty engaging in surveillance, although attempts were made for agriculture in the 1990s through the Farm Family Health and Hazard Surveillance program and the Occupational Health Nurses in Agricultural Com- munities initiative. Additionally, it also funded the National Farm Medicine Cen- ter in Wisconsin and the Great Plains Center for Agricultural Health in Iowa to conduct limited surveillance. More recently, NIOSH has funded USDAâs National Agricultural Statistics Service (NASS) and the Department of Labor (DOL) to
200 A g r i c u lt u r e , F o r e s t r y , and Fishing Research at NIOSH conduct targeted surveillance of youthful workers, adult owners and operators, and agricultural employees. The committee received numerous written comments from the public that specifically mentioned the primary need for a comprehensive surveillance system. The AFF workforce continues to change rapidly in the following ways: a decline in self-employed and unpaid family workers; an increase in regular or year-round hired farm workers from 712,715 in 1974 to 927,708 in 2002 (U.S. Department of Commerce, 1977; USDA, 2002a); an increase in reliance on contract labor and farm-management firms; and marked shifts in demographics among hired and con- tract workers, such as Africans in the fishing industry in Alaska, Mayan-speaking Guatemaltecos in New York state dairies, and indigenous immigrants throughout the nation. The committee strongly urges NIOSH to update and broaden its underÂ standing of hired workers to includeâwithout regard to immigration status or ethnicityâall hired AFF laborers, such as confined livestock, fishing vessel, fish farm, and forestry fire abatement workers. New approaches to surveillance may be necessary to explore and could include more orientation toward regional surveil- lance and more involvement with local and state health departments. Expanding on existing expertise with the state-based Fatality Assessment and Control Evalu- ation (FACE) programs to incorporate disease surveillance provides an avenue to become more comprehensive in the surveillance approach. Additionally, there is little evidence that AFF Program staff have considered workplace injury and illness in H-2A workers. That is an important topic in the context of the policy debate regarding immigration reform and the Agricultural Jobs congressional proposal advocated by both AFF employers and workersâ unions. Involving other federal, state, and local agencies in the discussion of expanded surveillance, which includes temporary workers, would begin to address this gap. NIOSH must demonstrate greater willingness to use results of surveillance by its partners, including the CDC Injury Center, the regional Ag Centers, the Na- tional Childrenâs Center for Rural and Agricultural Health and Safety, agricultural safety specialists in the nationâs land-grant institutions, equipment manufacturers, and other organizations representing agriculture, fishing, or forestry workers and employers groups. NIOSH should evaluate opportunities to use National Agricul- tural Statistics Services, the National Animal Health Monitoring System, and other existing programs for surveillance purposes. The committee has concluded that NIOSH should: 1. Conduct research on the potential use of both ongoing and non-routine surveillance systems to identify priority topics for future research or intervention. A focus on hazard surveillance, sentinel health and injury events, and occupational illness outbreak investigations similar to the FACE investigations may be more cost-effective than the current piecemeal approach.
R e c o m m e n dat i o n s for Program Improvement 201 2. Convene a panel of surveillance experts from state health departments, FACE program experts, universities, the State and Territorial Injury Prevention D Â irectors Association, workersâ compensation insurance experts, labor organiza- tions representing all AFF sectors including temporary workers, and the Coun- cil of State and Territorial Epidemiologists to develop new approaches to AFF surveillance. 3. Implement pilot surveillance systems based on the new approaches pro- posed by the convened experts. 4. Develop an evaluation plan to assess the quality of the pilot surveillance systems. Identify and Track AFF Populations at Risk Recommendation 4:â The NIOSH AFF Program should clearly identify and track its target populations. Because of the scope and diversity of workplace activities in AFF, it is impos- sible to conduct effective research covering this broad range of hazards and risks. Therefore, the committee underscores the necessity of the initial needs assessment stage of at-risk population exposure rates and hazardous work conditions. 4.a:â A clear definition of worker populations âat riskâ is needed. It is not apparent from materials and responses provided to the committee how the AFF Program has defined those populations. The term special populations at risk is not suitable for identifying a person or group of people working in AFF activities. A revised definition should reflect persons at risk for occupational injuries and illnesses in AFF enterprises and those visiting AFF worksites (see Chapter 2 and Appendix E). NIOSHâs use of child labor as a way of defining exposure of children is inad- equate because the current definition used in NIOSH-supported programs includes myriad activities and situations that do not accurately represent âlaborâ. The pri- mary focus of NIOSH research is attention to hazards faced by workers that are di- rectly associated with the tasks they perform. Agricultural work is considered (with exemptions) hazardous to children under 18 years old by the International Labour Organization and DOL. Therefore, the AFF Program should primarily focus on risks faced by children under age 18, whether they are unpaid family workers or hired workers. Visiting a farm or playing in a safe area at a farm does not constitute labor, although it entails risk given that a farm is a work environment. In addition, various age groups, including persons over age 18, have been targeted for different studies, and this further complicates NIOSHâs apparent definition of child labor. The definitions of minority populationsâwhich include children, the Navajo, and Hispanics and Latinosâare combined with occupation type, and this compli-
202 A g r i c u lt u r e , F o r e s t r y , and Fishing Research at NIOSH cates the definition of labor and adds confusion to the goal of unambiguous surveil- lance and to the socio-cultural implications associated with minority populations that face AFF exposures. The definition of migrant and seasonal workers, which has historically only included crop workers and thereby ignored the serious occupa- tional hazards faced by livestock and other workers, should be in accordance with USDA definitions of hired and contract labor and should be clearly differentiated from self-employed workers and family workers (see Appendix F for methods of identifying workforce populations). 4.b:â The AFF Program should conduct comparative studies across agri- culture, forestry, and fishing to set priorities better and to respond to dynamic workforce and workplace conditions. The AFF Programâs research, prevention, and outreach efforts have been specific to settings, with few comparative studies across the different AFF sectors. It is not clear how priorities are decided on or determined; the studies had different objectives, used different definitions for es- sentially similar populations, used various numerators and denominators, and used non-comparable classification schemes to characterize exposure. In the last 2 decades, the AFF workforce has changed with the influx of non- English speaking workers, the aging of the workforce, industrialization of the three sectors, and diversification of food, fiber, and fuel production. The committee believes that there is a need for NIOSH to monitor the workforce better to track changes and determine needs for research, prevention, and outreach. Conduct Research on Knowledge Diffusion Processes Recommendation 5:â NIOSH should conduct research on the science of knowledge diffusion to identify effective methods for AFF research-to- practice programs. Knowledge diffusion and its impacts on target populations warrant in-depth research. In the AFF sector, the workforce is inaccessible through standard meth- ods because of the diversity in the population with respect to culture, geography, language, and work subculture and because it is dispersed throughout industries involving farms, boats and ships, and the forest without an easy access point to provide educational materials or equipment training. To reach those populations, new methods should be developed to address language and cultural barriers. The role of cultural contextâfor example, in child labor policy on farmsâneeds to be incorporated into knowledge diffusion programs. That is also relevant for adult AFF workers. The use of theory-based research in educational programs designed to increase safety and health behaviors holds promise for improving the effective- ness and efficiency of knowledge diffusion (Cole, 2002; Morgan et al., 2002).
R e c o m m e n dat i o n s for Program Improvement 203 5.a:â The AFF Program should incorporate broader social science expertise into the research diffusion process. Knowledge translation, communication of research findings, and interventions developed by the AFF Program require special attention. There has been some success when the topic of health has been intro- duced as a means of changing behaviors (Perry et al., 1999; Rydholm and Kirkhorn, 2005); however, serious gaps remain in health literacy, knowledge translation, and communication with affected populations and the public at large. This is an es- pecially difficult problem in production agriculture in light of the diversity in the populations at risk. Professionals in disciplines such as cultural anthropology and rhetoric would be consulted to assist AFF Program scientists and national program staff to develop outreach materials; it is not realistic to expect working populations to follow recent developments through websites and printed reports. The use of traditional forms of communication needs to be re-evaluated by NIOSH staff, inasmuch as an increasing number of workers are from other countries and may not be literate in either English or Spanish. The utility of hazard-related pictures or narrative stories where language barriers exist needs to be researched further for use with AFF workers. Academe is especially well suited to explore such strategies and communicate new findings. 5.b:â The AFF Program should explore communication tools capable of reaching the AFF workforce. The AFF workforce comprises a wide array of eth- nic groups, many of whose people speak only their native language, not English. Moreover, low literacy is common in the AFF workforce. Further complicating the communication difficulty is the strong preference in many cultures for face-to-face discourse. Thus, a communication problem can arise in conveying facts and ideas from scientists who regularly rely on the Internet or other forms of modern com- munication to populations that rely on more personal interactions. NIOSH should endeavor to engage practitioners who have long experience in communication with the AFF workforce. The objective would be to develop a more realistic method of engaging in policy and regulatory discussion with these highly diverse groups. As early as 1990, studies were being conducted on the best modes of com- munication for farming populations (Thu et al., 1990). Farmers recognized the hazardous nature of their work and reported a desire to have access to occupational safety and health services and a willingness to pay for services (Thu et al., 1990). They reported that they most commonly turn to farm magazines, Cooperative Extension, medical centers, and veterinarians for information (Thu et al., 1990), but these do not appear to be the modes of communication being used widely by NIOSH staff. The AFF Program should ask its partners to publish summary reports of relevant findings in suitable trade publications. For example, National Fisherman and The Packer are widely respected sources of information among practitioners in the fishing and fruit and vegetable industries, respectively. Newsletters directed
204 A g r i c u lt u r e , F o r e s t r y , and Fishing Research at NIOSH to healthcare workers are another important venue for dissemination of research findings and intervention initiatives. Successful projects have used clinical services, education, and on-farm safety reviews; social marketing, electronic communication, and networking to provide education, train the trainers, and communicate with agricultural workers; and diverse audience-specific methods for communication with Hispanic children, parents, and farm workers. Improve Stakeholder Engagement and Partnerships The path on which NIOSH embarked when given its congressional mandate in 1990 is so important that only first-class principles for engaging stakeholders will do; anything less will make a travesty of congressional appropriation of resources. In recent years, NIOSH has embraced stakeholders in a number of occupational safety and health initiatives, as evidenced by the successful National Occupational Research Agenda (NORA) and NORA II initiatives. The participatory approach between NIOSH and stakeholders involves both parties early in the decisionmaking process and leads to more successful outcomes for employers and employees. Recommendation 6:â The AFF Program should establish a new model to involve stakeholders throughout the research process, and should also es- tablish an effective multipartite stakeholder mechanism that includes at- risk workers and other organizations to focus on occupational safety and health. 6.a:â The AFF Program should develop a new model for targeting all key stakeholders as full participants in its research program design and execution. The most-effective research projects have proactively involved workers through various stages of the research process. As mentioned in the ideal research program (Chapter 2), research must be participatory and community- or work population- based so that there is buy-in from the AFF community and stakeholder involvement should not be limited to the beginning and end stages. A participatory research model would involve different target populations from the prioritization of candi- date projects to the inception, design, conduct, analysis, publication, and outreach of experiments and their conclusions. 6.b:â The AFF Program should establish a coordinating council that would serve as a public advisory committee and would assume lead responsibility for informing public discourse on occupational safety and health issues. As men- tioned in recommendation 2, this group would be critical in advising and coordi- nating the AFF Programâs efforts. The evaluation committee strongly believes that a public advisory committee should be representative of all workers in agriculture,
R e c o m m e n dat i o n s for Program Improvement 205 forestry, and fishing. The AFF Program should use this council to establish an effec- tive mechanism for input into policy and programs that includes representation of principal stakeholders, including AFF producers, workers, and their representatives; labor and farm management contracting agencies; the private sector, including AFF corporations and AFF service and supply industries; those delivering health and safety programming; researchers; and appropriate government policyÂmakers. Most Ag Centers already have regional advisory structures whose members in- clude farmers, ranchers, and other commodity growers, thereby insuring access to stakeholders. By establishing a meaningful national advisory group that truly represents the needs and concerns of all worker groups, AFF Program research and interventions will more fully meet their objectives. The committee commends recent NIOSH efforts to establish advisory mechanisms for the agricultural and fishing sectors. Such efforts need to be broadened to cover all of AFF in a more representative manner. 6.c:â The AFF Program should continue to partner with appropriate federal and state agencies and establish additional interagency partnerships to increase the capacity for carrying out research and transfer activities. Federal and state governments are secondary stakeholders that if fully engaged could profoundly amplify NIOSHâs efforts; such federal agencies as the USDA, the National Institutes of Health (NIH), and the U.S. Environmental Protection Agency (EPA) are natu- ral allies to engage in such partnerships. The committee commends NIOSH for its partnerships with EPA and NIHâs National Institute of Environmental Health Sciences (NIEHS), which continue to bolster work in organophosphates and other pesticide exposures. The AFF Program could expand its interagency partnerships to include federal agencies that handle food and animal issues, such as the U.S. Food and Drug Administration and USDAâs Agricultural Research Service, Animal and Plant Health Inspection Service, and Food Safety and Inspection Service. The USDA Forest Service should serve as a partner in providing information and col- laboration on forestry research, a field lacking sufficient expertise in the nascent forestry component of the AFF Program. AFF Program staff could work more closely with DOL to devise methods for more accurately capturing employment data on agriculture, forestry, and fishing. For transportation injuries, the AFF Program would be well served with interagency collaborations and non-profit partnerships, such as with the U.S. Department of Transportation and the National Safety Council, respectively. Given the regional nature of the 10 NIOSH Ag Centers, state agencies serve as vital resources and potential partners. Some Ag Centers have successfully worked with cooperative extension services, state occupational safety and health agencies, state environmental protection agencies, and state departments of agriculture and should continue to engage in these valuable partnerships.
206 A g r i c u lt u r e , F o r e s t r y , and Fishing Research at NIOSH NIOSH should be commended for its collaboration with the National Cancer Institute, NIEHS, and EPA on the Agricultural Health Study, a prospective study of 90,000 people that has the potential to elucidate relationships between farm exposures and various chronic and other health outcomes. The committee recom- mends that NIOSH increase involvement in this joint initiative relative to cancer (and other diseases) because it could resolve questions about glioma etiology; explore the role of exposure to selected airborne toxins, such as cattle urine and metabolites of long-term manure storage; identify potential contributions to hu- man disease of volatile organic chemicals, such as benzene and toluene, that are ubiquitous in agricultural, forestry, and fishing environments; identify other non- farm employment exposures as potential occupational confounders; and develop and promulgate guidelines for organizing cancer prevention and control projects in AFF populations. Even though the program has invested little in reproductive health research, NIOSH should also be applauded for its involvement with the CDC state birth defects registries, which make it possible to identify testable hypotheses and explore potential relationships between AFF occupational exposures and detectable birth defects. Other federal initiatives warranting NIOSH attention include the Genes, Environment, and Health Initiative (http://genesandenvironment.nih.gov) spon- sored by NIH, which will develop new tools for measuring environmental exposures that affect health, and the National Childrenâs Study (http://nationalchildrensstudy. gov) sponsored by NIH, CDC, EPA, and the Department of Education, which will explore the effects of occupational exposures on children and other matters. 6.d:â The AFF Program should establish public-private partnerships to work more closely with equipment, facility, and pesticide manufacturers in design and development processes. Sound engineering methods and products should always be preferred for intervention so that the risk of hazard exposure can be minimized or eliminated and the human element of âgood work practicesâ does not have to be depended on. Stakeholders should be included at all levels of intervention research, from the manufacturer to the user of AFF equipment, facilities, and pesticides. A participatory approach needs to be cultivated with equipment manufacturers, facility designers, and pesticide manufacturers. A German automobile manufac- turer once said in a television commercial about safety that âsome things are too important not to share,â referring to the patented crumple zone body design that it shared with other car makers and which are now standard in automobiles. The goal of bringing NIOSH into the equation of occupational safety and health is to establish the spirit of sharing by prevention through design. NIOSH should be encouraged to partner with non-profit organizations, such as the National Safety Council, and to leverage support from one or more private
R e c o m m e n dat i o n s for Program Improvement 207 foundations to provide supplemental resources. For example, the W.K. Kellogg Foundation, the Bill and Melinda Gates Foundation, and the California Endow- ment already have program experience and relevance in the broad arena of ag- ricultural and extractive industry policy, and they may be in a position to offer advice and exploratory evidence. The Farm Foundation recently sponsored an ad hoc committee of stakeholders to provide a forum for industry, academe, and advocacy groups to explore common themes in agricultural safety and health. A similar initiative is needed to address safety and health issues in forestry. Implement Integrative and Interdisciplinary Approaches Recommendation 7:â The AFF Program should implement integrative and interdisciplinary approaches in its research practices. It is apparent that the agriculture, forestry, and fishing sectors are different and have different subcultures. The AFF Programâs best work has been done when researchers have left their offices and âgotten their boots dirtyâ in fields, forests, and fishing docks. During the committeeâs meeting with invited stakeholders, panel members from industry and academe continued to stress the success achieved when NIOSH researchers went to worksites, met their customers, and took a hands-on approach to their work. In order for this type of interdisciplinary activity to be suc- cessful, individuals experienced in participatory research need to be involved (such as anthropologists and sociologists). Furthermore, once the research was complete, the most effective researchers returned to the field and conducted outreach to help put ideas into practice. 7.a:â Researchers that receive funding from the AFF Program should visit worksites regularly so that they can acquire understanding of the workplace environment and thus develop and integrate culturally appropriate and sensitive approaches. NIOSH program managers and staff should make it a habit to get into the field regularly to test their hypotheses with workers and should be adaptable to changing needs and demands. Once a study is complete, measurements taken, and implementation and interventions formulated, NIOSH managers and staff should revisit worksites so that they become advocates for recommended changes and improvements lest the quest for change stagnate. AFF grant guidelines issued by NIOSH should incorporate âfield timeâ in pro- posed research. The incorporation of field time can be accomplished in a number of ways, including (1) prospective documentation, in research proposals submitted for NIOSH support, of plans, endorsed over support letter signatures, to engage stakeholders; (2) written evidence in final project reports of compliance with estab- lished principles of community-based participatory research; and (3) documentary
208 A g r i c u lt u r e , F o r e s t r y , and Fishing Research at NIOSH evidence of field time in scientific articles, clinical notes, insertions in Morbidity and Mortality Weekly Report, NIOSH Alerts, and other documents. 7.b:â The AFF Program should increase the use of interdisciplinary teams to address the environmental, social, cultural, and psychological complexities of issues that face AFF workers. Industrial processes of agriculture, forestry, and fisheries are undertaken in environmental settings that often contribute to the high risk associated with the occupations involved, including weather conditions, steep slopes, and high seas that affect the machinery and equipment involved. In agricul- ture, the immediate proximity of the worksite to residences means that spouses and children are potentially affectedâfor example, by pesticide drift contamination, childrenâs injuries that take place during play, and respiratory, zoonotic, and other diseasesâeven when family members are not directly involved in farming activi- ties. Similarly, proposed solutions to AFF health and safety problemsâwhether engineering, regulatory, or educational solutions or the use of personal protective equipmentâoften require an understanding of the social, cultural, political, and psychological context of the causes and consequences of injuries or illnesses. The interdisciplinary teams should include sociologists, psychologists, anthro- pologists, political scientists, economists, and human factors specialists to help researchers understand the social processes that contribute to injury and illness, the social processes that contribute to the successful transfer of solutions, and the analysis and evaluation of what works in AFF worksites. Some examples are the impact of private-sector organizational solutions, such as the use of insurance companies for farm compliance with best practices, and social marketing strategies to overcome resistance to change. The application of such innovative solutions in other AFF contexts has the potential to increase the impact beyond the examples cited. Furthermore, a successful approach would include qualitative research train- ing experts on review panels to evaluate this type of research. Enhance Awareness of National Policy Recommendation 8:â The AFF Program staff should develop greater aware- ness of national policy activities because they can have a substantial impact on AFF worker populations and risk factors. National policy decisions affect how farming, logging, and fishing can be con- ducted; consequently, they affect conditions in which AFF workers will be at risk of occupational injury or disease. The policies include changes in the allowed catch from fisheries and limits on logging in the nationâs vast national forests that result from decisions regarding endangered habitats. NIOSH personnel that are well- informed of current national policies that affect agriculture, forestry, and fishing
R e c o m m e n dat i o n s for Program Improvement 209 are more capable of responding to the changing needs of affected worker popula- tions. AFF Program staff should be continually informed about labor law affecting the AFF workforce, such as child labor. The âFarm Billâ, emerging immigration policies, and trade policies are especially relevant for AFF Program staff. The Farm Bill The expected 2008 reauthorization of the Food, Conservation, and Energy Act, colloquially known as the Farm Bill, will contribute to shaping the economic climate in which agricultural businesses make production decisions. Federal farm support programs dictate the types of commodities that receive federal payments and thus shape the landscape of plantings, and these shifts in crop plantings can alter the farm labor market. Strong interest in biofuels production has already al- tered cropping patterns in broad swaths of the Midwest and High Plains. That will probably result in changes in the design and use of and the demand for agricultural equipment and in the development of a rural trucking industry, and thereby change worker exposures. Immigration Policies Of immediate concern is Congressâs failure to enact comprehensive immigra- tion reform. Immigrants make up a large fraction of hired AFF workers. The De- partment of Homeland Security recently promulgated new regulations requiring employers to dismiss employees who are unable to prove their legal status; such dismissals would be based on âno-matchâ findings of name and Social Security number in federal records. Enforcement of the regulation has been stayed by court order under litigation brought by a number of labor organizations and the Ameri- can Civil Liberties Union. Farm employers now face the difficult challenge of prov- ing that their hired workers are eligible to work in the United States or recruiting persons who are eligible. Many farm employers will probably turn to the existing H-2A visa program for recruiting and hiring contract laborers from Mexico, Cen- tral America, and Asia. Under current rules, H-2A visa holders will not be permitted to have family members accompany them while working in the United States, and employers will be required to provide housing and transportation costs. Immigration patterns can also affect worker health. A relatively small propor- tion of immigrant workers may carry diseases that are endemic in their regions of origin (Asia, Africa, Central and South America, and other places), such as tuberculosis and parasitic diseases, and thereby pose a potential health threat to other workers and possibly to the public at large. Other issues have an even greater impact, such as language barriers, ethnically driven social constructs, and policy shifts at the federal level.
210 A g r i c u lt u r e , F o r e s t r y , and Fishing Research at NIOSH The industry-backed âAgricultural Jobsâ proposal, supported by the United Farm Workers of America and other advocates, will be introduced as a separate, stand-alone legislative proposal. The outcome of the legislation, which is uncertain at this writing, will largely determine who will be hired to work on American farms in the future. The proposed language specifically addresses housing needs of im- migrant contract workers, and this aspect has implications for where workers will resideâin on-farm housing subject to federal regulation or, with vouchers, in any type of housing, including informal dwellings not subject to inspection by health authorities. Workers who live in on-farm housing can be subject to harassment and coercion to work unpaid overtime; but at the same time the preferred options of affordable private market, non-profit, and government-sponsored program hous- ing is shrinking. In addition, most housing provided by non-profit organizations or public agencies is family housing, and is unavailable to groups of unaccompanied men. Trade Policies Trade issues are of paramount importance to the AFF sector because of AFF commodity import and export. Trade agreements potentially can function as eco- nomic drivers for change, which could influence production capacity in the AFF sector and influence exposure of domestic workers and those outside the United States. The impact is already being felt in the sugar cane and sugar beet industries of the Deep South and far North, respectively; other impacts are seen in commodities as diverse as cotton and tuna. In the agricultural sector, another development adds complexity to the trade issue: genetically engineered organisms. Whole agricultural enterprises, such as rice and cotton production, have experienced savage swings in demand as countries have responded to reports of genetic shift in non-target crops, which have resulted in dramatic shifts in worker employment and exposure. SUMMARY The AFF Program plays a positive and crucial role in providing informa- tion and tools to promote a safer and healthier work environment in agriculture, forestry, and fishing. The committee hopes that its recommendations will help refocus and redirect program efforts, thereby enhancing the programâs impact on the safety and health of all populations at occupational risk in agriculture, forestry, and fishing.