Friday, January 25, 2013
Supporting the agricultural life
The rural life is not a particularly easy one, and yet 18 percent of Minnesotans live in rural areas. Neighbors may be few and far between; emergency rooms, grocery stores, and schools, a long drive. And if you make your living off the land, your success is extraordinarily susceptible to the weather, not to mention the markets. And as it turns out, farming is a hazardous job.
With food a primary engine of Minnesota's economy—agriculture accounts for 20 percent of Minnesota's GDP—it makes sense to keep the men and women behind the curtain—the farmers—healthy. After all, there wouldn't be much for the fork without them.
"This shift creates incentives for providers to focus on quality. We want to make sure our rural communities don't get left behind." —Rural Health Research Center director Ira Moscovice.
"Agriculture work is recognized as one of the more dangerous jobs," says Bruce Alexander, U of M professor in environmental health sciences. "It puts people in close proximity to animals, machinery, dusts, gases, and chemicals."
Alexander heads up the Upper Midwest Agricultural Safety and Health (UMASH) center whose mission is to reduce the burden of illness and injury in agricultural workers and their families. Established in September 2011, it's one of nine regional Centers of Excellence in Agricultural Disease and Injury Research, Education, and Prevention funded by the National Institute for Occupational Safety and Health.
UMASH's focus is animal agriculture, and it takes a One Health approach, a global concept that stresses the inextricable connection among animals, people, and the environment when it comes to health. UMASH is concerned with zoonotic diseases—those that pass from animals to humans—and is exploring the possibility that antibiotic resistant organisms may be affecting agricultural workers.
The center is also examining, through a series of studies, how different means of dairy and pork production—from intensive methods to more traditional practices—influence injury or illness in workers and their families. Once risk factors are identified, targeted prevention methods can be put in place. These methods, like agriculture itself, must change to meet current needs and demographics.
"The shift to larger operations has changed the workforce, which is increasingly made up of new immigrants, so disease and injury prevention must consider language, literacy, and culture in a way it hasn't before," says Alexander.
Getting good care
When people on farms do get injured, where do they go? What kind of care do they receive? And how do they pay for it? The Rural Health Research Center has been asking questions like these for 20 years as it confronts the challenges of rural health care. For farmers who work for small operations or themselves, center director Ira Moscovice cites two particular concerns: lack of insurance coverage and quality of care.
"Due to a variety of factors, people in rural areas are more likely to have preexisting conditions, and they're more likely to have chronic illnesses," says Moscovice, health policy and management professor. Both things make it more expensive to get private insurance coverage. And farming is considered a high-risk occupation, which also drives up premiums. Being uninsured or underinsured has a serious impact on seeking care.
"When you put farmers' natural stoicism together with the lack of, or inadequate, insurance coverage, they may delay going to see a doctor," Moscovice says. "Early cancer diagnosis data, for example, show that people are 2.5 times more likely to delay going to see a doctor if they don't have insurance." The federally funded Rural Health Research Center is one of six in the United States. Each was asked to choose a major theme, and the University center chose to study the quality of rural health care, an issue that has been largely ignored.
"For many people living in rural communities, if they had a local doctor or a small group of doctors, that was [considered] a success," says Moscovice. "Very few researchers have been interested in what was actually going on in rural health care and the quality of services people were receiving."
So the center has been working to develop relevant quality measures to monitor and evaluate rural health care and to make sure the quality issue is on the table as future health care reform and policy changes occur. These efforts are being helped along by the government's focus on quality care nationwide.
"Recently, necessary services that lead to good patient outcomes have been what payers (insurance companies or the government) want to support," Moscovice says. "This shift creates incentives for providers to focus on quality. We want to make sure our rural communities don't get left behind."