The Evolution of Agricultural Health and Safety in the United States

It is an honor to be recognized as the Journal of Agromedicine’s “Leader in the Field” for 2019. More importantly, I am pleased to be the first recipient of this award from a Western state, and also the first to focus on the health and safety of hired farmworkers. This focus reflects a larger, overdue evolution in the focus on agricultural health, and safety in the United States. I will briefly summarize this change and why I believe it is a logical and appropriate evolution of research and prevention efforts. By evolution, I do not mean to suggest that the health and safety of Midwestern farmers and farm families is not important, but that there is a recognition of the large, and growing population of immigrant farmworkers in this country and the unique hazards and solutions needed to improve health and safety in this population.

The history of agricultural health and safety goes back centuries. It was the Swedish archbishop, Olaus Magnus, who recognized in his Historia de Gentibus Septentrionalibus¹ of 1555 that grain threshers could damage their lungs by exposure to grain dust. Fast forward to the early twentieth century, and in the United States, there was the beginning of recognition that work could be hazardous to one’s health. This effort was led by pioneers such as Alice Hamilton, whose work was summarized in her autobiography, Exploring the Dangerous trades,² published in 1942 (and still available). But Hamilton’s work was based on the hazards of meat packing and other industrial processes and exposures. In 1939, John Powers noted that “During the past quarter century the hazards of industry, transportation, mining and construction have been recognized. For agriculture…there has been no such recognition, and farming, though the oldest occupation in the world, remains the most hazardous.”³ The National Institute for Farm Safety (NIFS) was created in the 1940s to address the reality that farming was a hazardous occupation. NIFS continues, now renamed the International Society for Agricultural Safety and Health, and it has been joined more recently by other organizations such as the North American Agromedicine Consortium and the Agricultural Safety and Health Council of America.

In 1990, largely through the efforts of Iowa’s Senator Tom Harkin, the National Institute for Occupational Safety and Health (NIOSH), a part of the Centers for Disease Control and Prevention, was funded to begin a farm health and safety initiative program. This effort included the important 1991 Surgeon General’s Conference on Agricultural Safety and Health held in Des Moines, Iowa.⁴ This conference, as well as the farm safety organizations created in the 1990s, had a strong Midwestern, family farming focus, and indeed, the impetus for their creation was the recognition of the hazardous work conditions of farmers and their families on Midwestern farms. Western agriculture, while the most labor intensive and the most productive in the country by commodity value, had little or no presence in the agricultural health and safety organizations of the 1940s or the 1990s, nor was it well represented in the Surgeon General’s Conference of 1991.

One exception to this focus on Midwestern agricultural health and safety was the NIOSH Agricultural Health and Safety Centers. The first two of these Centers were located at the University of Iowa and the University of California at Davis. As the founding Director of the California Center, I recognized the need to broaden the efforts at agricultural health and safety to include the labor intensive, highly productive agricultural conditions, and practices in the Western states. Why was this important? Simply put, the workforce, farming practices, working conditions, and approaches to health and safety in Western agriculture were different from those in the Midwest. More specifically, the workforce in Western agriculture was predominantly immigrant Latino, and the health and safety efforts directed to Midwestern family farms were largely irrelevant to this immigrant, Spanish-speaking population. In California alone, there were up to one million hired farmworkers, and that number was multiplied by the labor-intensive immigrant workforces in other western states such as Washington, Arizona, and Texas.

Fortunately, the recognition of the health and safety needs of immigrant Latino farmworkers in the United States has come a long way since the first NIOSH Agricultural Health and Safety Centers were created. NIOSH now funds 11 Agricultural Health and Safety Centers, of which four (California, Washington, Colorado, Texas) can be considered to represent Western agricultural workforces and practices. All of the NIOSH Centers have research or outreach programs that address the unique needs of immigrant farmworkers. More importantly, this effort is timely, because immigrant farmworkers have increased their presence and importance in agricultural practices across the country, which were formerly the domain of native-born, English-speaking worker populations.

This trend is illustrated by the workforce evolution on dairy farms, and it was described in my 2013 article in this journal entitled “Occupational Health in the Dairy Industry Needs to Focus on Immigrant Workers, the New Normal.”⁵ Briefly, over the past two decades, there has been a dramatic change in the dairy workforce in this country, such that now up to 70% of dairy workers in the United States are immigrant, largely Latino. This transition began in the West of the country, but it has spread to the Midwest and Northeast. No longer is the typical Midwest dairy farm necessarily a small operation worked on by the iconic native-born farm family. Rather, many have evolved into larger operations dependent on immigrant workers. This trend is seen not only in dairy farming, but also in most of the labor-intensive agricultural commodities grown in this country. Indeed, it is a phenomenon seen around the world, with immigrant workers replacing native-born workers in the agricultural sector in Europe, the Americas, and Asia and the Pacific.

How is this trend relevant to agricultural health and safety? Put simply, new approaches are needed to understand the causes and solutions to reducing health and safety risks among immigrant agricultural workers. The typical farmworker is now a young, Latino immigrant with a low education, limited or no English skills, and an income at or below the poverty level. Compounding this profile is the frequent precarious immigration status. In some farmworker populations, over half the workforce is undocumented. Other factors may be superimposed on this profile, such as piece work pay arrangements, constraining H2A visas, and lack of labor representation. The result is that immigrant workers are overrepresented in occupational injury and fatality rates compared to native born workers,⁶ and solutions to this disparity are complex and overdue. Efforts targeted to immigrant farmworkers are needed by the agricultural health and safety organizations as well as NIOSH and other agencies of the Federal Government (e.g., Department of Agriculture).

I am proud to have been a part of the effort to improve the health of our immigrant, and non-immigrant, farmers, and farmworkers. Agriculture remains the most hazardous major industry in the United States, based on occupational fatalities, and there is much work to be done to reduce the disparities within the agricultural workforce, as well as to reduce the overall morbidity and mortality of workers in this oldest of professions. In 1996, I wrote an article in the Journal of Public Health Policy entitled “Preventive medicine and health promotion are overdue in the agricultural workplace.”⁷ Occupational health has come a long way since then in recognizing the unique health and safety hazards of agricultural work. It now needs to move further and recognize the unequal burden born by immigrant farmworkers, and target research and interventions to reduce the disparity that exists for the occupational health of this population.