Preventive medicine and health promotion are overdue in the agricultural workplace

Agriculture was one of the earliest industries in which occupational hazards were recognized, but it has been largely excluded from the mainstream of modern preventive medicine and occupational health efforts. This resulted from the heavy industry focus of occupational medicine, from the agrarian myth which stated that work in agriculture was a healthy employment, from the widely dispersed, often family-centered, nature of farming, and from neglect of migrant and seasonal farmworker populations. Since the middle of this century it has been recognized that agriculture is one of the most hazardous major industries, but whereas the injury and fatality rates in other hazardous industries (e.g. mining, construction) have fallen substantially, there has been no comparable decline in agriculture. In addition to occupational injuries and fatalities, there is a wide range of chronic diseases that result from agricultural exposures. These include musculoskeletal, respiratory, dermatologic and reproductive disorders. Hearing loss is increased among farmers, several cancers have been associated with farming or agricultural exposures, and increased suicides have been observed in some farming populations. Recommendations for disease prevention and health promotion must be sensitive to the unique nature of farming, including the demographically different farmer, farm family, and hired farmworker populations. Approaches discussed in the paper include engineering changes, education with evaluation of its effectiveness, and enforcement of appropriate laws.