This would not prepare her very well for
following in the family tradition of raising
hogs as 4-H projects and knowing generally
what goes on on a farm.

 

We know that about half of farm women

work outside the home.

 

As a result, Successful Farming has
featured child care stories. This is another
departure for farm magazines. It is a risk,
of course, since a certain percentage of our
readers do not approve of child care. I
could read you their letters.

We know that about half of farm women
work outside the home. If they do not
work off-farm, they are often expected to
help with the livestock or drive and oper-
ate equipment during planting and harvest.

Our most recent child care article featured
an Iowa day care center and a farm
woman’s role in helping to lead a commu-
nity effort to expand that center. We con-
tributed a modest amount to its comple-
tion as a sign of our support for the impor-
tance of this issue to farm safety for chil-
dren.

Last year, I made a comment in my
monthly magazine column that a tractor
cab was no place for a small child. That
provoked a very forceful letter from a
Michigan farm woman. She said that tak-
ing a child in a tractor cab was safer than

in a car travelling sixty miles per hour.

I ran her letter in a subsequent column
and asked readers to comment. I received
about 30-35 letters in response, a fair
amount of response for any item in the
magazine.

Surgeon General’s Conference on Agricultural Safety and Health - 1991

The Mass Media and Agriculture, May 1, 1991

The letters reflected a mixture of opinions.
There were many from women who agreed
with my Michigan critic. Many women
who were grandmothers wrote to say that
they had taken their children with them as
they worked on the farm and never had
any reason to regret it.

Other younger farm women said that their
labor was needed on the farm today. They
did not, number one, have enough money
to pay someone to watch the children, or,
two, close relatives who were available for
babysitting.

As a result, five-year-olds are playing in
pick-up campers or pick-ups parked at the
end of the field. Their mothers are check-
ing on them at the end of each round.
Smaller kids are riding in the tractor cab
and combine. The mothers feel as if they
have no choice.

On the other hand, I received a good num-
ber of letters from women and men who
said that taking children in the tractor was
unsafe. The children could suffer from
hearing damage, dust, and fumes. They
said they would not try to care for a child
in a moving tractor as they would not in a
moving car.

The topic of farm safety, particularly for
children, is now in the limelight. When
the awareness level is high, we have a
golden opportunity to make the leap to
changing behaviors.

In farm health, we are confronting
obstacles such as inadequate financial
resources in rural communities, lack of
health insurance among rural individuals,
and a financially threatened network of
hospitals. These problems are compound-
ed, in some cases, by uninformed policy
makers.

401
Intervention - Safe Behaviors Among Adults and Children

For instance, just last week I picked up an
article featuring an interview with the
chairman of a nonprofit health policy re-
search organization in Minnesota called
Interstudy. I cannot tell you how amazed I
was to learn that:

There’s very little evidence that the lesser
amounts of health resources in the upper
Midwest rural areas are having an ad-
verse effect on people’s health. Perhaps,
because they live healthy lives. They’re
not exposed to the detrimental effects of
the city like pollution, for example, and
they generally get more exercise. So, I am
not persuaded that the lesser intensity of
health care that’s available in rural areas
is necessarily bad for rural residents’
health.

I am here to tell you today that farm life is
not necessarily healthy. As you know,
there are people living in urban areas who
worry about applying pesticides to their
lawns to make their lawns look more at-
tractive. How would they like to apply
pesticides to 1,400 acres of land every year
to make a livelihood?

Urban people do not have to worry about
the long-range effect of pesticide and ni-
trate residues in their well-water. They do
not get hog lung from their life’s work.
OSHA is there to help protect them from
being injured and killed on the job. Rural
people, especially farmers, are exposed to
a host of hazards and illnesses that
demand adequate health care as well as a
medical profession that is trained in these
unique occupationally related illnesses.

I believe that the consciousness of the
farm community is being raised concerning
farm safety and health. In fact, the Farm
Family Survey conducted by the University
of Iowa showed that farm safety and health

402

ranked equal to or higher than other con-
cerns such as farm commodity prices, so-
cial erosion, and environmental issues.

This same survey showed that farm maga-
zines ranked as a top source of informa-
tion for farm families and a great vehicle
for health and safety articles. There is no
question that the media can play a large
role in keeping people interested and
aware of farm safety and health. I must
say that it is difficult for farm magazines
like mine to sustain heavy coverage of
farm health and safety articles without,
number one, considerable research and
activity in this area by other interested
parties; and, two, positive feedback from
our readers demonstrating readership of
these issues.

 

More recently, as a member of the farm
media, I have been reminded of the re-
sponsibility not only to write about these

issues but also to portray proper safety
and health practices throughout the maga-
zine in the photographs that we feature.

 

For instance, as I mentioned earlier, in the
late 1970’s and early 1980's, it was less
common to feature farm safety and health
in our magazine. My editors would tell me
that we are not in the business of "remind-
er journalism." That means that because
farming is hazardous, and we are a farm
magazine, we cannot write an article every
month reminding our audience that they
need to be careful. That is unless, of
course, we have a news angle or new re-
search to feature.

For many years, extension safety

specialists, such as Bill Field, at Purdue
University, and Rollin Schnieder at the

Papers and Proceedings
University of Nebraska, were laboring
trying to make a difference. This was
despite government cutbacks in funding
farm safety at land-grant universities.
They were and still are operating on a
shoestring. It is difficult for the few of
them who work so hard to generate
enough research or programs to keep up a
continuous flow of agricultural health and
safety stories for the media.

Now other organizations, agencies, and
institutions have begun to focus on farm
safety and health as an issue and to obtain
funding for activities and research. It is
much easier for me to propose a story and
have it accepted by my editors. The topics
of safety and health still need to compete
for space in our magazine with articles
about production and business.

More recently, as a member of the farm
media, I have been reminded of the re-
sponsibility not only to write about these
issues but also to portray proper safety and
health practices throughout the magazine
in the photographs that we feature. For
instance, if a photographer takes a picture
of a farmer driving a tractor with an extra
rider and we use it on the cover of the
magazine, are we giving tacit approval to
this unsafe practice? Or if a photographer
shows a farmer applying chemicals without
proper protective clothing and equipment,
are we encouraging unsafe behaviors?

This is a difficult area. In reality, of
course these situations are the norm in
farm communities. Another factor is that
virtually all of our photographers are
freelancers who have no farm background.
I am a member of the Iowa Farm Safety
Council. At their suggestion, I am contact-
ing all of our freelancers, sending them
materials explaining the need to portray
safety and health in photos as well.

Surgeon General's Conference on Agricultural Safety and Health - 1991

The Mass Media and Agriculture, May 1, 1991

It is an uphill battle, and we will not ac-
complish as much unless we all work to-
gether. As I interview sources and write
stories about farm safety, however, I have
become aware of professional jealousies
and heard harsh criticisms.

The issue is not, I think, which group has
done the most. We are all needed. This
includes traditional groups such as exten-
sion safety specialists, who have paved the
way, as well as hospitals and universities
who have begun to make a substantial
contribution. Each group has its own
strengths and weaknesses.

We are working on an issue that affects
people’s lives. As a farm writer, I appreci-
ate the perspectives of the entire spectrum
of individuals committed to the cause of
farm safety and health.

It is great to think that the Surgeon
General’s Conference is focusing on farm
safety and health. It is gratifying to see so
many of you here today. As I look out
over the audience, however, I can not keep
myself from thinking about others who are
not here today to benefit from these ses-
sions about farm safety and health.

For instance, I think about Lloyd Hinshaw.
He was a 41-year-old farmer who killed
himself, a victim of depression and stress.
In the winter of 1981, I interviewed his
widow and two other farm couples
attempting to cope with financial stress.
Then I wrote an eight-page article about
the effects of stress on farm families.

I wish that we could turn back the hands
of time so that Indiana farmers Bill and
Ann Friend could be here today. I grieved
with them at their kitchen table 8 years
ago over the loss of their 17-month-old
daughter in an accident in their farm

403
Intervention - Safe Behaviors Among Adults and Children

driveway. I wrote about their nightmare in
the magazine in 1983. For several years
afterwards, Bill could not bear to continue
his volunteer work as an EMT. Today,
however, he is back helping others in his
community again, at accident scenes.

It is too late for Jim Arnold. After study-
ing accounting and agricultural economics
for 3 years, he quit college to return to
farming. His love of farming and over
powering desire to make it his life’s work
despite the obstacles is not unique. In
Arnold’s case, however, the challenges are
greater. The 36-year-old Nevadan lost
both arms and legs 10 years ago ina
powerline accident on a farm. Successful
Farming helped to sponsor two national
conferences for disabled farmers. We also
sponsored the Iowa Easter Seals Farm
Program and are breaking new ground at
Purdue University.

 

I think about Jeannie Johnson of Canton,
Missouri, who was widowed with a 5-

404

month-old son and a 7-year-old daughter.
She will never forget the day 9 years ago
when her husband was killed in a grinder-
mixer accident. Her story appeared in our
magazine 4 years ago.

I do not believe that I will ever forget
these people or their stories. I wish that
they could have benefited from the atten-
tion that farm health and safety is getting
here today. It is my hope that, as a result
of this conference, in the future others will.
We are all here today because we are
involved in safety and health issues. I am
grateful for the opportunity, which my job
gives, to me to meet people like you who
are so vitally involved. As concerned indi-
viduals and members of the medical pro-
fession, we all have a role to play in the
future health and safety of agriculture and
its people.

Thank you very much for your attention. I

would be happy to visit with you after-
ward.O

Papers and Proceedings
Surgeon General's Conference on Agricultural Safety and Health

FARMSAFE 2000 ¢ A National Coalition for Local Action

Convened by the National institute for Occupational Safety and Health

April 30 - May 3, 1991, Des Moines, lowa

MULTILINGUAL TRAINING

By Malanie Zavala, B.S.
Farm Worker Safety Coordinator
University of California~Davis

 

Although the topic is multilingual training,
my own expertise is Spanish-language
training specific to pesticides. I am going
to limit my comments to those two particu-
lar aspects of this larger question. That is
what I know.

My job at the University of California is to
develop and present pesticide safety train-
ing material to the people who handle
pesticides on the farms and who are not
necessarily certified. They have not passed
any examination or had formal study on
how to handle pesticides. I also provide
training for farmworkers who never handle
the pesticides but work around them.

In California and a lot of other states,
many people who work in the field are
foreign. Certainly, the largest percentage
are Spanish-speaking people, from Mexico
mostly, and also from Cuba, and a number

of other countries, as well as from Puerto
Rico.

These people will require some training in
California if they handle pesticides. In
other states, the training is not required,
but these people need to know a lot about
pesticide safety, because they are working
with or around them.

In California, there are stories every year,
and you have already heard some of them.
Ellen Widess yesterday mentioned the
Story of a crew that was directed to go into
a field that had been recently sprayed.

Surgeon General’s Conference on Agricultural Safety and Health - 1991

They all got sick because they had gone in
too soon.

There were no re-entry signs up warning
them to stay away, and since they did not
know the symptoms of pesticide poisoning,
they did not know what was happening to
them. Even their crew leader did not
know what was happening. That is not a
good situation.

What I plan to do in this presentation is to
talk about some of the requirements for
developing successful and creative pesti-
cide safety training material and any kind
of safety training material for people from
other language culture groups. Even
though my comments are going to be limit-
ed to Spanish-speaking people, I am pretty
sure this sort of information can be
extrapolated and would fit any culture or

group.

Also, I want to talk about some of the
common errors and problems that come up
when you are trying to develop educational
materials to reach other language groups,
and finally to suggest, perhaps, some ways
to facilitate effective communication.

REQUIRED SKILLS FOR SUCCESSFUL
COMMUNICATION

Let me talk about some of the required
skills for doing a good job of developing
multilingual pesticide or other kind of
informational training material.

405
Intervention - Safe Behaviors Among Adults and Children

> First—some of this is going to seem pret-
ty obvious or simple-minded to you—but
you would be surprised, however, how
often it comes up—the translator, or the
interpreter, the communicator, the person
who is either translating the material or
who is talking directly to the target group,
needs to have a reasonable understanding
of the subject matter.

It is not enough to speak both languages.
You need to know the appropriate terms.
You need to know enough so that when
you are doing your translation, you do not
misinterpret something that is written in
English or that was told you in English, in
such a way that it means something else
when it is said in Spanish or the other
language. I have seen this happen
frequently. So it is important that person
have that skill, that they must know some-
thing about the subject they are talking
about.

>» Second, the person needs not only to be
able to speak both languages, but they also
need to be articulate in both languages. It
is one thing to be bilingual or multilingual
and another thing to know how to effec-
tively communicate in the language(s) you
speak. Suppose you were raised in a
Spanish-speaking home, for instance. You
grew up speaking Spanish. You learned
English in school. English is a preferred
language for you, which is usually the case
for kids who grow up in another-language
home. You know how to speak Spanish.

That does not mean you can put together
articulate sentences and communicate with
people. It is not the same thing. Interpre-
tation and translation require very real and
very significant skills. That is something I
am afraid is often overlooked.

406

» Finally, what you need to have for a suc-
cessful training or information provision to
other language groups is a basic under-
Standing of the social characteristics of the
target group. To put it differently, you
need a cultural awareness. For instance,
Suppose you are a graduate student in
Spanish. Your Spanish is great. You can
speak very well. That is just fine, if the
people you are communicating with are
people with similar cultural and social-eco-
nomic backgrounds.

You would know how to talk to them.
You would be able to communicate with
them in English too. But that does not
necessarily mean that you are able to
speak to a typical farmworker.

The register of the language is different.
The kinds of terms that farmworkers are
familiar with are going to be different.
Often you see the mistake of somebody
using language that is too technical with
terms that people do not know, and that
mistake needs to be avoided.

In order to successfully teach something,
you need to understand a number of things
about your audience. You need to under-
stand their prior learning and reading
experience. Frequently Spanish-speaking
people who come to this country to work,
and I am sure this is true of other cultural
groups as well, have a sixth-grade or less
education.

Somebody like that is not going to want to
sit down and read an eight-page leaflet. It
is not something that is going to appeal to
them. I am not saying that they cannot.
Certainly, there are people who come here
who have had a better education and who
would be comfortable with this means of
communication. It is not the kind of thing

Papers and Proceedings
that is going to be real appealing to the
majority. That is just a fact.

Another thing you need to keep in mind is
when you are presenting information to
somebody, you have got to consider their
background, opinions, or assumptions re-
garding the subject matter. In the case of
pesticides, it is common in Spanish to refer
to pesticides as medicinas, medicines for
the plants.

This means that even though pesticides
have gotten bad press and people are very
nervous about them, for many farm work-
ers pesticides are seen as something good.
They are good, of course. They have a
very important function. But at the same
time, they are dangerous.

It is hard to communicate the idea of som-
ething being dangerous to a group of peo-
ple if they think of it as medicine. You
need to deal with that kind of assumption
first and clarify to people that pesticides
indeed are dangerous. This is again just
one example.

Another thing about pesticide information.
When people get poisoned by pesticides in
the field, it is usually through skin contact.
Normally, most people think of poisoning
as something that happens when you swal-
low a poison. So you need to get past that
idea and get people to understand that
pesticide poisoning can, and indeed does,
occur because of skin contact. These are
just a couple of examples of the sorts of
assumptions that people come into meet-
ings with, or start reading something with.
You have to take that into account and
deal with these assumptions at the very
beginning so that understanding is reached.

Surgeon General’s Conference on Agricultural Safety and Health - 1991

Multilingual Training, May 1, 1991

I think we need a knowledge of the kind of
reading and educational materials that the
people are used to seeing.

The University of California just developed
a training booklet to help farmers comply
with the California regulations requiring
that all people who handle pesticides, who
have not passed an examination for cer-
tification, receive training. This training
covers a number of specific points, and is
pesticide-specific.

If you train a worker to use malathion, and
next week he is going to be using
Round-Up, then he must be retrained for
that other material. This pesticide training
must be repeated each year, so that when
a year has gone by, and he is starting to
use Round-Up again, the training must be
repeated for Round-Up. That is a very
good law.

It is important that pesticide handlers
understand about pesticide safety and how
to take care of themselves and protect
other people and the environment when
handling these materials. Unfortunately,
with a labor force like the one in
California where almost everybody in the
field is Spanish-speaking, it is very difficult
to do that training. So this publication is
bilingual. It is in English first and then
Spanish, and then there is a picture.

We are hoping that by using this booklet,
the trainer can go over the material with
the trainee, reading in Spanish what the

trainer is reading in English and then the
picture will act as a pictorial link; we are
optimistic that this will make compliance
with training requirements much easier.

We chose a particular kind of "comic

book" format because it is a very popular
form of literature in Mexico. Hispanic

407
Intervention - Safe Behaviors Among Adults and Children

people—I do not know about Puerto Rican
and other Hispanic groups—but in Mexico,
this particular kind of comic format is very
common.

They have what they call novelas—novels
written in a comic book format. So it is
going to be more appealing than just a lot
of words. Plus, I think the pictures help
bring the point home.

COMMON ERRORS AND PROBLEMS
ENCOUNTERED IN CROSS-CULTURAL
COMMUNICATION

I am going to talk about some of the com-
mon errors and problems made when pro-
viding information to people from other
cultures. I already touched on one:
choosing the wrong level of language. As I
pointed out, a lot of these people come
here without an excellent education, and
this is going to make a difference as to
what they can understand in terms of read-
ing—not so much in terms of spoken lan-
guage, I think, but in terms of things that
they are going to have to read. You want
to choose a language that they are going to
feel comfortable with, and this is going to
take some knowledge of where they are
coming from basically.

I already mentioned that if you give work-
ers a multi-page leaflet to read, they are
unlikely to feel comfortable with it. They
might feel uninspired to read it, whereas
the comic format or something like that
would be more readable.

Then of course the language: you do not
want language that is too technical or too
academic. Again, do not misunderstand
me. This is a question of education, cer-
tainly not intelligence, but education is a
very real thing, and it needs to be taken
into consideration.

408

On the other hand, like most Americans,
the majority of workers listen to news
shows and other TV programs, and they
understand the level of Spanish, of course,
that is being spoken on those shows. That
is why when it comes to spoken presenta-
tions the same problem does not necessari-
ly exist as does with written material. The
audience will not have the same difficulty
listening to something spoken as they
would when it comes to the written word,
and they will be able to understand things
at the same level you would use to address
any other audience.

 

As I pointed out, a lot of these people
come here without an excellent education,
and this is going to make a difference as
to what they can understand in terms of

reading—not so much in terms of spoken
language, I think, but in terms of things
that they are going to have to read.

 

Choosing informational formats, which the
audience does not like: I have already
talked about that. Again, I cannot encour-
age too much the use of things like comic
books, or photo novelas.

The photo novela is a very popular form of
literature for many Spanish-speaking peo-
ple. A particular photo novela comes to
us courtesy—except I did not tell him about
it—of Jim Grieshop, who is sitting in the
back. He was working in Ecuador for a
number of years developing informational
material, and he and other people came up
with this particular idea.

This is similar to the comic book idea,
where you have got photos of people act-
ing, and then you have the caption. It is
an appealing form of literature and a com-

Papers and Proceedings
mon one, like the comic book, for at least
Mexican people who come to the United
States to work. This is another way to
communicate, and I will have some other
examples as we go on.

Another problem is choosing a translator
or communicator who is not good. This is
so common. When materials need to be
translated, find somebody who knows how
to do it. Especially in states like Califor-
nia, which has a large Hispanic population,
there tend to be a lot of people around
who speak Spanish. You can find
somebody, perhaps, in your office—the
receptionist who speaks Spanish or a staff
member. Knowing both languages is not
the same as being skilled at translating
from one language to another, and I have
seen some remarkably awful translations
because of that.

You need somebody who is skilled, some-
body who is a professional translator. It is
expensive, but I dare say, it is worth doing
when you have such a large number of
Spanish-speaking or other language-
speaking people working in agriculture in
your state. It is worth the effort and the
cost to get it done right. The trouble is, if
you have somebody who does the transla-
tion for you, you do not speak the languag-
e yourself, and you have no way of kno-
wing how good that translation is. How
are you supposed to know?

That is the other thing. You should get
somebody who edits translations so you
have first a professional translator and
then a professional editor who will read
over translated material.

I have got a great example of a horrible
translation. Here is a little example of sort
of a syntactical error, I guess you would
call it.

Surgeon General's Conference on Agricultural Safety and Health - 1991

Multilingual Training, May 1, 1991

In English, you know, you sometimes hear
"where possible"—that is not very common
but you hear it—"where possible, do such
and such." Literal translation of that par-
ticular phrase does not make much sense
in Spanish.

Let me go over another translation. That
is a really good example. "Slow squeeze at
the turn, crossing obliquely on rough to
polish or muddy surface.” I will not say
which state agency or from state it came
because I do not want to embarrass any-
body. But the whole thing this came from
was like that. That was the very worst
example. In the first place, there are
wrong words for some things. Everything
that could be wrong with this thing is
wrong. It is a terrible translation.

Anonymous: What is it supposed to say?
Well, my best guess is, "Drive slowly at
turns... slow down when trying oblique
turns on... rough and slick surfaces."

Not getting translations reviewed and edit-
ed by a second person who is also skilled
in the language and knowledgeable about
the subject matter is an error.

Another problem is typos when doing the
final written version of something that has
been translated into or written in a second
language. The person who types written
material is often someone who does not
speak the second language. Therefore
they will not be able to detect their own
typos, and if they are working from hand-
written or poorly typed text, they are sure
to make mistakes.

There is a perceived problem with "differ-

ences in language." There are some differ-
ences between the kind of Spanish spoken
by Puerto Rican workers on the east coast
and Mexican workers on the west coast,

409
Intervention - Safe Behaviors Among Adults and Children

but those differences are not so great as to
preclude understanding by one group of
materials developed for the other group.
This problem seems to be somewhat exag-
gerated in the minds of many people. In
fact, Spanish-speaking people in the U.S.
all listen to the same TV shows and news
programs.

Overconcern with making materials cultur-
ally appropriate, e.g., the pork rinds vs.
potato chips story.

Planning meetings and not getting people
to come: many times these are not people
in the habit of attending meetings.

Agendas: when you are trying to inform
people, present the facts. Try to avoid
hidden agendas, either in the form of "pro-
tecting" employers at the expense of work-
ers, Or Suggesting to workers that all the
responsibility for their safety falls on the
employer.

1. Talk about employer responsibilities
where it is relevant to the topic.

2. Talk about the worker’s role in taking
care of him- or herself.

SOME SUGGESTIONS FOR
EFFECTIVE FORMS OF
COMMUNICATION

Illustrated guides instead of leaflets and
manuals.

Informational videos, which are shorter
than % hour, preferably about 15 minutes.
Make them appealing; put in a little dra-
ma, some cute children, some humor, if
possible.

Using appropriate forms of com-
munication, i.e., find out what the target

410

audience likes to read and look at. Find
out something about traditional forms of
information transfer for your target group
and develop materials using these formats.
Mexican farmworkers often choose to read
comic-style novelas, photo novelas and
humorous comic books. Calendars with
photographs are popular as wall hangings,
and often more than one will be hung on
walls, especially kitchen walls.

Because illiteracy is not uncommon among
Spanish-speaking farmworkers, some picto-
rial materials, as well as the video format,
should be developed to complement writ-
ten materials. Public service announce-
ments on radio and TV are very effective
in reaching large numbers of people.

Use some organizations as a vehicle for
getting people together if you want to give
an informative presentation, such as:

¢ Secure employer cooperation to provide
safety during work time.

* Hold migrant housing meetings.

¢ Offer something attractive to attendees,
other than information (food, music).

¢ Involve organizations to which they will
respond, such as the church.

Find an effective means to distribute writ-
ten material, such as:

Through church,

At health clinics.

Through employers.

Through TV and radio announcements.

Papers and Proceedings
CONCLUSION

There are large numbers of foreign speak-
ing/reading people working in agriculture
in the United States. They are largely
responsible for our cheap food. Since
there are real dangers associated with
agriculture, we have a responsibility for
giving the kind of information to these
people and their families, which will help
keep them healthy.

Multilingual Training, May 1, 1991

Going through the motions of providing
information without focusing on the effec-
tiveness of the material we produce is not
enough. Materials that do not get infor-
mation across to the audience can be
worse than no materials at all. Employers,
public officials, health professionals, etc.
may end up believing that adequate warn-
ings, prevention instructions, health hints,
etc. have been given when that is not the
case.O

Surgeon General’s Conference on Agricultural Safety and Health - 1991 411
Surgeon General's Conference on Agricuttural Safety and Health

FARMSAFE 2000 « A National Coalition for Local Action

Convened by the National Institute for Occupational Safety and Health

April 30 - May 3, 1991, Des Moines, lowa

COUNTY HEALTH EDUCATION

By Larry Belmont, M.P.H.
County Health Education
Director, Idaho Panhandle Health District 1

 

We cannot expect physicians to locate in
all of our small rural communities. Our
next best alternative is to develop new
solutions or new systems of service to
cover those areas. Our rural citizens and
our rural environment are worth protect-
ing, for this is our heartland.

Idaho has such a system and I would like
to show you how we have been able to
serve our rural citizens quite well through
our local public health system of decentral-
ization with coordinated control.

We will focus on the elderly in Idaho be-
cause they make up the growing popula-
tion in our rural environment.

"Rural" is defined as "those counties that
do not have a city of 20,000 or greater
population.” This applies to 37 of our 44
counties.

Our presentation describes how our district
health department system implemented an
urban program in a rural environment.
Idaho’s regionalized and decentralized
public health system may serve as an inter-
esting model for other states.

Dr. Roper mentioned that the Institute of
Medicine report, The Future of Public
Health,' states that public health in Ameri-
ca is in "disarray," and as a nation we have
‘lost sight of" our "public health goals." In
Idaho we decentralized public health ser-
vices, but we maintain coordinated control

412

among seven district health departments.
We are not in “disarray.”

The concept of regionalization and decen-
tralization with coordinated control helped
Idaho to develop district health depart-
ments that provide public health services
throughout the state in a coordinated,
efficient, and effective manner.

Regionalization and decentralization with
coordinated control greatly enhance the
Senior Companion Program of the Pan-
handle Health District. This service pro-
vides many part-time volunteer opportuni-
ties for low to moderate income persons
age 60 and over. The program renders
supportive person-to-person services to
older adults.

There are 44 counties in the state of Ida-
ho. Each county is divided into one of the
seven health districts. The PHD, used in
this discussion, is composed of the five
northern counties bordered on the north
by Canada, the east by Montana, and the
west by Washington (Figure 1). The Pan-
handle is in a unique situation and must be
able to respond to several different influ-
ences from two different states and anoth-
er country.

The health districts were formed in 1970
and began operation in 1971. Before that
time, only half of the 44 counties received
local public health services. Now such
services exist in every county.

Papers and Proceedings
CANADA

 

 

    

Montana

 

 

 

Washington

 

Figure 1. Five Counties of the Panhandle Health
District in Idaho.

Walter J. McNearny and Donald C. Riedel
wrote a book entitled Regionalization and
Rural Health Care several years ago. Their
definition of regionalization remains rele-
vant to current health care and delivery
issues. They state "in its simplest terms
applied to the health field, regionalization
refers to the establishment of working rela-
tions among various health facilities and
programs within a defined geographical
area." The health districts have been do-
ing exactly that over the last 20 years.

Some of you may have been around in the
late 1960’s and 1970’s and recall the Re-

Surgeon General’s Conference on Agricultural Safety and Health - 1991

County Health Education, May 1, 1991

gional Medical Programs associated with
medical schools.

1. Their function was to develop
regionalized medical care systems in
order to improve heart disease, cancer,
and stroke. The Regional Medical
Programs defined some key elements of
a functional region. A region has a
population and needs that are identifi-
able and quantifiable. This can produce
identifiable performance indicators for
specific problems to be attacked and,
thereby, be easily measured.

2. There are cooperative arrangements
among components of the medical care
system in that region. This certainly
was true with the health districts of
Idaho. For example, we all have con-
tracts with private physicians who work
in our local clinics.

3. The region should represent a defined
geographical area.

Again, each of the districts is
geographically defined. There are needs
being met by local effort with help coming
from outside the region.

The PHD, as a regionalized, decentralized
public health department, became a spon-
sor for the Senior Companion Program for
several reasons. It extended our home
care in more rural areas. It increased
coverage where Medicare, Medicaid, and
private insurance end. It extended our
continuum or rural health care. In doing
this, we accomplished several of our pri-
mary objectives:

1. To help people assume a greater re-
sponsibility for their own health care.

413
Intervention - Safe Behaviors Among Adults and Children

2. To help people live independently for
as long as possible.

3. To increase referral capacity with other
groups and create a sharing of services,
as in a Medical Model.

Other services offered by our home health
division are professional nursing services,
physical therapy, occupational therapy,
speech therapy, home health aides, health
maintenance services, and consultation
services. Since its inclusion in the home
health division, the Senior Companion
Program has dovetailed with these other
services to become an integral part of the
entire realm of patient care services.

Our Senior Companion Program in the
PHD fulfills several related functions:

1. To develop volunteer service oppor-
tunities through which low-income older
persons can contribute to their commu-
nities.

2. To provide a stipend and other benefits,
which enable eligible persons to partici-
pate as senior companions without cost
to themselves.

3. To establish new social service roles for
low income older persons through which
they can maintain a sense of self-worth,
retain physical health and mental alert-
ness, and enrich their social contacts.

4. To provide supportive services to older
adults in an effort to maintain indepen-
dent living.

These functions need special help when
implemented in a rural environment.
Idaho’s system provides the mechanism for
this service. The IOM study’ supports the
notion of decentralized services, such as

414

Idaho’s model, to facilitate flexibility and
self-governance at the local level. The
IOM recommends:

To promote clear accountability, public
health responsibilities should be delegated
only to a zone unit of government in a
locality (p. 8).

Where sparse populations or scarce re-
sources prevail, delegation to regional
single-purpose units, such as multi-county
health districts, may be appropriate (p. 149).

In light of Idaho’s success with
regionalized health districts and the IOM’s
recommendation, Idaho’s district health
department concept may be a viable op-
tion for other states.

There is no single entity in charge of the
seven health districts. We are autonomous
and independent of one another. How-
ever, we work very closely together on
statewide issues.

For example, the District Boards of Health
in all seven health districts meet together
to coordinate policy issues. They have just
met with certain legislators in Boise to
negotiate policies concerning environmen-
tal health programs throughout the entire
State.

The District Directors also meet monthly
to coordinate program implementation and
standardize policies on the operational
level. This process also applies to the
nursing directors and the environmental
directors of all seven health districts.

Each district health department has its
own Board of Health, which is appointed
by the County Commissioners within that
health district. They set local public health
policy. The District Directors are hired by

Papers and Proceedings
that Board of Health, and not other bu-
reaucrats in the capital, making the direc-
tor directly controlled by the local Board
of Health and the local County Commis-
sioners who set the budget. Although our
orientation is very local, we must still coor-
dinate statewide policy throughout the
state for certain programs.

The funding of the health districts comes
from several sources. County ad valorem
tax dollars are matched with state contri-
butions. In addition, the state can give the
health district additional assignments and,
hopefully, funding.

We are free to implement our own fees.
Some are standard throughout the state.
Others vary between health districts. Each
district has contracts with the state Depart-
ment of Health and Welfare and other
agencies. We seek grants and additional
federal funding, if available.

A county’s contribution to the health dis-
trict is calculated by a very equitable and
fluid formula. Seventy percent of the
county money is based upon the county
population. The remaining 30 percent is
based upon the county’s market value for
taxing purposes. This formula allows a
county to adjust its annual contribution
depending upon economic conditions,
which impact both the population and the
market value of property.

The health districts in Idaho are not state
agencies. They are independent, single-
purpose districts much like a school district
in any other state.

The health districts in Idaho are required
by law to provide physical health services,
environmental health services, health ad-
ministration, and health education. The

PHD has, in addition to those basic func-

Surgeon General’s Conference on Agricultural Safety and Health - 1991

County Health Education, May 1, 1991

tions, a superfund project; a specially fund-
ed aquifer project; a home health division;
the Senior Companion Program, which we
will talk about in more detail; and
Women’s, Infant’s, and Children’s (WIC)
Program.

Urban-designed services, like the Senior
Companion Program, benefit greatly from
Idaho’s public health concept of decentral-
ization with coordinated control when
applied to Idaho’s rural population.

The Senior Companion Program is
authorized by the Federal government
under Title II, Part C, of the Domestic
Volunteer Service Act of 1973. The
program’s dual purpose, as mentioned
before, is to create part-time stipend vol-
unteer community service opportunities for
low-income persons aged 60 and over, and
to provide supportive person-to-person
services to assist elderly adults needing
special assistance to remain living indepen-
dently.

Each Senior Companion Program is par-
tially funded by a grant from ACTION, the
Domestic Volunteer Service Agency. A
requirement of these grants is that a sum
equal to 10 percent of the Federal grant
be raised from local sources to contribute
to the program. ACTION awards these
grants to sponsor a program only to public
agencies and private non-profit organiza-
tions, which have the authority to accept
and the capability to administer such
grants, i.e., Idaho’s health districts.

There are currently about 140 Senior Com-
panion projects throughout the United
States, which provide 8,000,000 hours of
service a year to 25,000 clients. As one of
the original pilot projects in the United
States, our program has expanded from
serving about 80-100 clients to the current

415
Intervention - Safe Behaviors Among Adults and Children

average of 260-270 clients served in any
one month.

Volunteers in the program are assigned to
agencies related to specific community
services. These agencies are called volun-
teer stations and they accept the responsi-
bility for the assignment and supervision of
senior companions. Two basic types of
agencies normally serve as volunteer sta-
tions.

> The first type is social service agencies,
which include public agencies, private
non-profit agencies, multi-purpose cen-
ters, community and civic organizations,
and religious groups.

» The second type of volunteer stations is
direct health care providers. Examples
of these include acute care hospitals,
rehabilitation centers, public health
departments, private non-profit health
agencies, visiting nurse’s association,
home-health agencies, mental health
agencies, and nursing homes.

Senior companions are supervised by pro-
fessional staff at the volunteer stations to
which they are assigned. This staff devel-
ops an assignment for the senior compan-
ion, which incorporates a written plan of
care for each client served. This plan of
care is coordinated and monitored by the
same Staff, providing for periodic evalua-
tion of the client’s continued need for a
senior companion. The professional sup-
port of the PHD staff in each county lends
considerable efficiency and credibility to
the program. The volunteer, the client,
and the PHD benefit from this synergistic
relationship.

Senior companions must, in addition to

being age 60 or older, meet a moderate
income guideline based on the size of the

416

household. Companions can work a maxi-
mum of 20 hours a week for which they
receive a stipend of $2.35 an hour and
$0.20 a mile to travel to and from their
clients’ homes. These funds are intended
to reimburse senior companions for ex-
penses of volunteering and may not be
considered as wages or income for tax pur-
poses or any government program.

Recruitment of appropriate volunteers to
serve as senior companions is ac-
complished by several different methods,
which include advertising in newspapers
and other media, and by word-of-mouth
referral from volunteers serving in the
program. An unexpected source of volun-
teers has been patients who have been
senior companion clients and have recov-
ered to the point that they wish to volun-
teer their services to the program.

The total budget for the Senior Compan-
ion Program sponsored by the PHD is
$278,542, of which $211,637 is furnished by
the Federal ACTION grant. The remain-
der is furnished by the PHD and other
local sources.

Sixty-four percent of these funds are spent
directly on stipends and travel expenses of
senior companions. With these funds, we
recruit 80 senior companions who provide
approximately 5,400 hours of service a
month to 260-270 homebound clients.

Fiscal viability is another advantage to the
affiliation of the PHD with the Senior
Companion Program. With a sizable por-
tion of the funding being provided through
the ACTION grant and other local funds,
the PHD’s financial involvement can be
kept to a manageable level.

Much of the contribution to the program
by the PHD is in-kind assistance, supervi-

Papers and Proceedings
sion, and advice by the professional nurs-
ing staff. Also, this partnership of the

PHD and Senior Companion Program
allows for all yearly physicals for the senior
companions to be done by the nursing
staff, making it easier to pick up any
health problems that might arise. This
affiliation between the program and the
PHD has enabled the program to be estab-
lished in a more medical model than other
similar programs.

The senior companions are given more
specialized training in medical areas and
are viewed as a new type of para-profes-
sional volunteer. This, coupled with the
maximum interaction with other segments
of the health care and social service com-
munity, allows optimum use of the profes-
sional staff at these other agencies.

A by-product of the Senior Companion
Program PHD medical model is an
outreach function provided by the senior
companions. With specialized training and
assignments in rural areas, they serve as
eyes and ears, often detecting problems
with homebound, unseen elderly that may
otherwise have gone undetected due to
their rural location.

The design of the Senior Companion Pro-
gram, as outlined by ACTION, seems to
make the program more geared to location
in an urban area. It is more difficult to
assign persons age 60 and over to rural
clients with less access to professional staff
for advice and assistance.

A prime consideration in placing senior
companions with clients is to match the
volunteer’s specific skills to the needs of
the particular client. This holds par-
ticularly true with clients in the very rural
areas where the companion may have
limited access to resources.

Surgeon General's Conference on Agricultural Safety and Health - 1991

County Health Education, May 1, 1991

In continuing the medical model,
specialized volunteer stations have been
established to provide services to clients
with very specific needs. Two examples
are the Alzheimer’s Association and the
discharge unit at Kootenai Medical Center
and Acute Care hospital. These volunteer
stations have clients with very specific
needs that are quite different from our
other clients.

The care provided for clients of the
Alzheimer’s Association is respite care for
the primary caregiver, enabling the client
to remain at home with the family as long
as possible. Specific training to the senior
companions working with Alzheimer’s
patients is provided by the Alzheimer’s
Association with ongoing in-service train-
ing providing updates and support for
these volunteers.

Very different although specific training,
enabling volunteers to work with recently
discharged patients from the hospital, is
provided by professional staff in the social
service and discharge units of the hospital.
Specialized volunteer stations with special-
ized training, coupled with access to pro-
fessional nursing staff at the PHD, allows
services to clients not easily found in rural
areas. This helps many clients stay in their
homes longer.

In closing, we will not get physicians into
all of our small towns of Idaho nor Iowa.
That is not all bad. We have other
solutions, other systems of rural health
care.

The concepts of regionalization and decen-
tralization with coordinated control im-
proved the efficiency and effectiveness of
Idaho’s public health services in rural ar-
eas. These concepts provide the founda-
tion for expansion of an urban program,

417
Intervention - Safe Behaviors Among Adults and Children

like the Senior Companion Program, into a Idaho’s system of regionalized and

rural environment. It allows us to move decentralized public health services with
the Senior Companion Program into a coordinated control works. I hope other
medical model in order to expand our rural states can benefit from Idaho’s suc-
continuum or rural health care. cess.0

REFERENCE

1. The Future of Public Health. Institute of Medicine, Washington, D.C.: National Academy Press, 1988.

418 Papers and Proceedings
Surgeon General’s Conference on Agricultural Safety and Health

FarMSare 2000 © A National Coalition for Local Action

Convened by the National institute for Occupational Safety and Health

April 30 - May 3, 1991, Des Moines, lowa

A RURAL SOCIOLOGIST’S PERSPECTIVE

By Judith Bortner Heffernan, M.A.
Columbia, Missouri

 

Sociologist's Perspective.

 

Dr. Walter J. Armbruster: Judith Heffernan is Executive Director of the Heartland Network for Town
and Rural Ministries located at the University of Missouri in Columbia. Her topic is A Rural

That is a pretty broad topic, which gives her lots of liberty.

Ms. Heffernan wants to focus our attention toward thinking more broadly. Ms. Heffernan:

 

 

I would second the motion that many have
made of how honored each of us feels to
be a part of this, and I know that that is
true whether you are a speaker or a partic-
ipant in other ways. It is wonderful that
such a conference could be held.

My colleagues have been sharing a bit
about their backgrounds. I think it is im-
portant to do that at this point.

I did not come to be a practicing rural
sociologist and a real honest-to-goodness
farm woman quite as I might have
planned. I thought the guy I met about 26
years ago and married 25 years ago was
going to be a professor of rural sociology,
and that our lifestyle was going to be an
academic one. While that is, indeed, part
of our "schizophrenic" existence, the other
Part of it is being a practicing rural sociol-
ogist.

We will, in the next few months, if the
contractors put the roof on the house soon,
move from our farm of 21 years to the
only farm the state of Missouri ever identi-
fied as "the Model Farm"—120 years ago.

Just so you know that I do understand this
issue of agricultural health and safety, you
need to know that I plant soy beans and
wheat, and I mow and rake hay, sometimes
under duress.

Surgeon General's Conference on Agricultural Safety and Health - 1991

I have been a midwife to more cows than J
care to count, and a substitute mom this
year to sheep—baby lambs—cutest things
you have ever seen. I have gotten sick
from breathing diesel fumes, whether on a
tractor when we were working on one in a
shed or just standing nearby. I have gotten
sunburned from being too jong on the
tractor while mowing, and I have been
pinched and poked and clobbered by more
varieties of machinery parts than I care to
tell you.

I have also been chased by angry livestock.
I have unhappily taken out a fence with a
disk, which was not the original intention.
It could not quite turn short enough.

I have been running the combine and the
stalk chopper when one or another part
has broken, and I have had the experience
all too often of driving the pick-up ahead
on a too-narrow road when behind me
were following my husband or our daugh-
ter on too wide a piece of equipment mov-
ing from one farm to another.

I have had the frightening experience of
seeing my husband climb out of the grain
bin after checking its condition and shortly
thereafter become very ill. (We had com-
pleted the wheat harvest in October of
1981 instead of in July because of an ex-
tremely wet summer and the wheat was in

419
Intervention - Safe Behaviors Among Adults and Children

poor shape.) After climbing out of the
bin, he spiked a high fever and laid down.
I recall being so panicked by his condition
that in my confusion to get help, I called
the University’s vet clinic! After calling
the Medical Center and not learning very
much, I called the Department of Plant
Pathology at the University of Missouri
and found out that very likely what he was
experiencing a serious allergic reaction to
mold, to toxins in the molds, that were
undoubtedly in the wheat that year. Even
though I had enough knowledge to know
who to call when I did not get helpful
answers from initial contacts with medical
personnel and enough assertiveness to
keep calling, the experience was still
terrifying, to say the least.

I have worried about my husband teaching
our young daughter, at the age of six, to
drive the Ferguson tractor, and to help
him put in an electric fence.

Just last Friday, I had the frightening expe-
rience that many farmwomen share of real-
izing that he should be home, and he was
not. So you leave a note on the counter,
in case you miss on the highway, and you
take off to the field not knowing whether
the reason he is late is because he is in-
jured. I almost break into tears thinking
about it. Fortunately, it was just that I
misunderstood how late he was going to be
home.

Last Saturday, I had another experience
that very much relates to this conference.
I was about to wash a pair of blue jeans
and a dirty shirt of my husband’s, when he
said, "Don and I were spraying Round-Up
yesterday, and these really should not be
washed with everything else."

I asked, "What does the manufacturer sug-
gest that I do with them?" I wish that

420

there were on the containers of chemicals
a little "sticky" that you could peel off and
husbands or wives or whoever is doing it
could attach to their clothing that says:

"Will the laundry person please adhere

to the following instructions: Soak

thirty minutes in hot water and deter-

gent or whatever the correct method is."
Would not this be simpler?

The point I am making here is that I am
as personally acquainted with the issues of
agricultural health and safety as I hope I
ever get.

I am also a rural sociologist by training, as
Walter indicated. Since June of 1989 I
have been working with the Heartland
Network for Town and Rural Ministries, a
effort to bring resources for hope and help
and empowerment of churches and com-
munities in America’s Heartland. While
the Network is funded mostly by the Unit-
ed Methodist Church, I work ecumenically
with a variety of faith groups.

The remarks that I am going to make
today come out of this context—not only
out of my personal lifestyle, but also out of
my professional training. It seems to me
that if we are to consider the safe behav-
iors of adults and kids, as all of us have
been in the process of doing, it would be
helpful to look at agricultural production
and processing in a larger context. We
know that there is a social, and an eco-
nomic, and even a psychological-emotional
context that impacts all human behavior.

I think we also ought to acknowledge ini-
tially that rural communities differ. There
are some rural communities that are doing
fine. Economically they are thriving.
Retired people with money are moving
into them; or the government continues to

Papers and Proceedings
fund the university, or the prison or what-
ever there is energy; but farming communi-
ties, and forestry, and rural manufacturing
communities are among those that are
hard-hit.

My three-point thrust is 1) the context of
farming as practiced in the 1980’s, and
where it appears we are heading in the
90’s and beyond, 2) the context of the rural
community, and 3) the proposed future
context of globalizing agricultural produc-
tion and consumption. All three issues
impact on the kinds of safe behaviors that
we look at with regard to adults and
children.

It is my intent to raise some important
issues and ask some thoughtful questions.
My experience over these past 5 to 10
years working with the rural crisis—
especially in the Midwest but also travel-
ling coast-to-coast, into Canada and into
other countries—looking at what has been
happening has changed my world view.

And so, that is partly what I am sharing,
FARMING IN THE 1980’s AND 90’s

As the structure of agriculture has changed
over the years from a locally oriented,
locally managed, locally run, local profit-
centered kind of agriculture into initially a
regional and then a national, and now an
internationally oriented and controlled
system, the units with which farmers have
dealt have become much bigger, much
farther away, and much fewer. We are no
longer dealing with the folks down the
Toad, the local suppliers and dealers know.

Decisions are now being made elsewhere
about nearly everything even about what
size cattle Processing plants will accept.
Farmers no longer get to decide how many

Surgeon General's Conference on Agricultural Safety and Health - 1991

A Rural Sociologist's Perspective, May 2, 1991

pounds they are going to put on those
Steers before they send them off.

In fact, feeding steers -has become so
specialized that if you live in Missouri, you
have to pay somebody to take them to

as, or maybe Nebraska, pay to have
them specially fed-out and pay the trans-
portation. Decisions like that are no lon-
ger made on the farm. They are made in
some office by a processor who Says "this is
all we want and only this will we accept."

Competition in the local market has de-
clined. There may be only one buyer at
your local sales barn, or if there are two,
they may be very friendly, and they decide
that 80¢ for cattle is just about "max."
When the price goes higher, they leave.
So much for the so-called low of supply
and demand!

With this change, the profits, I might add,
have moved away as well. Profits that
formerly went to management and capital
are no longer available in the local com-
munity.

For the most part, the profits that go to
labor are the only ones that remain.
Frankly, folks, if we put this in a larger
context, it used to be that some of the
profit went to Minneapolis or went to
Omaha, or went to other major U.S. cor-
porate centers.

In Indiana now, when you sell hogs to the
processing plants, those profits go further
away: to Milano, to Tokyo, to London.
You cannot sell a hog to be processed in
Indiana to an American firm. Ferruzzi
and Mitsubishi in Norther Indiana and
British Petroleum with a firm that they
own in Columbus are the two hog slaying
firms in the state. This is the kind of thing
that is happening.

421
Intervention ~ Safe Behaviors Among Adults and Children

 

There is a social movement afoot that
environment, food safety, pesticide usage

and water quality among others. We have
heard much of it here.

 

Larger organizations have, indeed, protect-
ed themselves by their size, their ability to
control markets, and, to some degree, their
diversity. The stories in some of the farm
magazines about whether red meat will be
able to compete with white meat is laugh-
able to some of us who have been watch-
ing what it happening. It is the same firms
that are controlling markets in both red
and white meat, so where is the competi-
tion? It is mostly with the nutritionists.

Those firms have been able to reduce their
own risk and increase their stability and, I
might add, their predictability. Just for the
record, during what was a devastating time
for production agriculture in the 1980’s,
most of those firms were able to maintain
at least 20 percent profit. Should we pro-
ducers be envious? The level of profits of
food processing firms in the 1980’s was
exceeded only by pharmaceutical firms!

So what economists have come to call risk,
namely the inability to control things in the
environment, which have a great impact on
you, psychologists and sociologists call
stress.

I recently spent some time in the Food and
Agricultural Policy Research Institute
office looking at a few of their publica-
tions. From their 1991 U.S. Agricultural
Outlook, J will read to you the last line of
the "General Outlook. "Net farm income
is small, relative to farm receipts and ex-
penses. So, relatively small changes in
estimates of receipts or expenses result in

422

very large proportional changes in net farm
income estimates." That, by any definition,
seems to me to spell "risk" and also
"stress."

There are other risk factors at the moment
that may very well alter the way farm
families and rural people look at safety
and health issues. There is a social move-
ment afoot that focuses on the environ-
ment, food safety, pesticide usage and
water quality, among others. We have
heard much of it here. All of these con-
cerns add higher levels of unpredictability
and risk in the agricultural system at the
moment.

I know farmers who find going to the Agri-
cultural Stabilization and Conservation
Service (ASCS) office very stressful. I wish
some of you in the Public Health Service
would set up little health screening clinics
right outside the ASCS office doors to
check blood pressures of farmers. I read
with interest an article in the Farm Journal
by a farmer with a computer who analyzed
three different alternatives for working
with the 1990 Farm Bill. As nearly as I
can tell, it was to choose the alternative in
which you lose the least amount of money.
That, to me, is risk~stress.

The uncertainty and complexity of ever-
changing rules and regulations, such as
those administered by government agencies
have increased uncertainty and risk and
have made it very difficult for farmers to
say, "I think I am going to try a new safety
system on this farm. I think I am going to
invest in whatever it costs," although I did
hear myself saying to my husband last
night, "Honey, we have got to buy roll-over
bars." That is on the agenda. But we,
with other income, can probably do that. I
know people who are borrowing money to

Papers and Proceedings
put bread on the table who are financially
unable to buy safety equipment.

Another aspect of the stress issue is what
happens to farm families is when they
experience financial difficulties over time.
Many of you are familiar with our data, so
I am just going to spend a few moments
showing you a little bit in more detail.

Figure 1 shows the reaction to stress of the
families that we interviewed in 1985 at the
suggestion of the Department of
Agriculture. We were actually trying to
figure out a number of things that were
going on, and we went into a very produc-

A Rural Sociologist’s Perspective, May 2, 1991

tive county in north central Missouri and
interviewed every family that had left the
farm for financial reasons from January 1,
1980, through January 1, 1985. Many of
you are very familiar with these data.

Those of you in the health services will
recognize this as a list of common reac-
tions to stress. We simply said to hus-
bands and to wives separately, "Please tell
me in the process of losing your farm did
you become depressed? Do you continue
to be depressed over this issue? Did you
experience all of these other things?"
What you will note here is the astonishing
high levels of women and men who be-
came depressed.

 

 

Have Continue to
Experiences Experience
Men Women Men Women

Became depressed ............. 00.0.0 cee eves 97 100..... 56 72
Became withdrawn from family/friends ............ 62 66 ..... 26 41
Became nauseous, lost appetite ................ 49 47 ..... 18 34
Could fall asleep at night, but would awaken

and be unable to return to sleep ............... 77 53 ..... 41 38
Experienced feelings of worthlessness ............ 74 69 ..... 49 41
Became restless, unable to concentrate, agitated .... 72 81 ....., 41 38
Did anything to keep busy .................... 67 41 ..... 46 31
Increased smoking ............ 0.0.00 cece eee 23 25 ..... 16 22
Increased drinking ........... 0.0. .c cee eee eee 18 12 ...., 10 6
Showed increased fear of things, people .......... 38 31 ..... 18 25
Became more physically aggressive ............. 49 31 ..... 26 9
Experienced great changes in moods,

from low to high and back.................00. 67 81 ..... 36 47
Became confused ............ 0... cc cece eee 54° 31g... 31 19
Became unable to think or respond logically ....... 31 34 ..... 18 19
Become unusually silent for periods of time ........ 62 53 ..... 44 28

 

 

Figure 1. Reactions to Stress (percent).

Surgeon General’s Conference on Agricultural Safety and Health - 1991

423
Intervention - Safe Behaviors Among Adults and Children

It goes on further showing increased fears
of things and people, becoming more phys-
ically aggressive, perhaps a measure of
family abuse. One farmer said, "Does that
mean I spank my children more frequent-
ly?" TI said, Well that is one way of def-
ining it. You can also see in these data
high levels of confusion, withdrawal and
remaining unusually quiet for long periods
of time.

 

Loss of Farm

|

Loss of Relationships
Health Status
Self-esteem
Occupation
Symbols

|

Depression

|

Produces Inability to Function

 

 

 

Figure 2. Effect of the Loss of the Family
Farm.

These data and Figure 2 show that the loss
of the family farm was a much greater
catastrophe for those farm families than
many would like to acknowledge. It was
much more encompassing than loss of a
job. The loss we are dealing with was
huge, and I think that has been elaborated.

A psychologist I know is also a Mennonite
clergyperson put this chart together, and I
think it really does give a fair amount of
insight. The loss of the farm led to loss or
change in every relationship the family
had, not only with themselves, but within
the community as well.

424

It also led to a loss or change as far as
health was concerned. Health was affect-
ed, and those of you who know the statis-
tics on the relationships between stress and
health would understand this well.

Social status was changed. Self-esteem
was altered considerably. You notice the
numbers of those that said they felt worth-
less. Occupational status was changed.
"My granddad homesteaded this, and I lost
it," someone told me. The symbols were
gone.

That kind of loss almost inevitably depress-
es people if they are normal. I would
sometimes tell the farmers, "if you have
gone through all this and are not
depressed, there is something wrong with
you, and you need to go find out what it
is." In some cases the depression led to an
inability to function.

Last year we took the names of every
freshman that entered the College of Agri-
culture at the University of Missouri to do
a Study of the ways the rural crisis had
affected them. (We know that rural kids
study in areas other than agriculture, but
we limited our study to just them.) We
knew that they were likely eight years old
in 1980 when things began to worsen on
farms and in rural communities.

While I have not yet written papers on any
of the data, I have shared it with a few
audiences. I have taken the numbers that
we just saw on stress in our 1985 study,
and because we asked the same questions
of the students that had been part of the
farming operation or a rural business from
1980 to 1990, we show their results, in
Figure 3, with those of husbands and wives
in our earlier study.

Papers and Proceedings
By the way, a number of the students were
more interested in the spring break in
Florida than they were in my question-
naire, and so our response rate was about
30 percent.

We questioned them, "Did you become
depressed?" The depression level was
about half as high as their parents, but
understand, we are talking about kids here
who were from eight to 18 during the time
on which we are focused. By the way,
would you look at how many of them said
they became withdrawn and experienced
feelings of worthlessness. Forty percent of
the students who were adolescents when
their folks were losing the farm experi-
enced feelings of worthlessness. As you can
see, this goes on, and we could talk about

A Rural Sociologist’s Perspective, May 2, 1991

that in far more detail. I am simply indi-
cating to you what we knew was, in fact,
happening. We now have some data to
support that stress was not something that
just mom and dad experienced, but it was
very much infectious, almost in the correct
use of that term, and certainly did perme-
ate through the family.

A number of my colleagues have pointed
out that that continues. Paul Lasley at
Iowa State and Jack Geller at North Dako-
ta have indicated that the levels of farm
stress have sky-rocketed. In Geller’s study,
71 percent of over 1000 farmers indicated
that during the previous three years, which
would have been the mid 1980’s, their
stress levels had increased significantly.

 

Become Depressed

and be unable to return to sleep

Did anything to keep busy
Increased smoking
Increased Drinking

Became more physically aggressive

Became unusually silent for periods of time

 

Cr ee ee

Became withdrawn from family/friends ... .
Could fall asleep at night, but would awaken

ee erm eee eee ewe we ewe

Pe eee sees eeeeuses 62 66 57

See eee eee eee eee ees 77 53 14

Experienced feelings of worthlessness ....
Became restless, unable to concentrate, agitated .............. 72 81 39

eee ee ee wee he ee

ee se wee ee we wwe ll eh he hel hl he eH

ee eee eae 23 25 0

ae ee ewe we eee ee

Showed increased fear of things, people . .

cee et eee eens 49 31 14
Experienced great changes in moods, from low to high and back .. 67 81 39
Became confused .................5.
Became unable to think or respond logically

See eee ee eee 54 31 32

gee eee eee ee we eees 62 53 28

Have Experienced
Men Women Youth

97 100 57

74 69 40
67 41 26

18 12 14
38 31 7

vee ee ee eee 31 34 7

 

 

Figure 3. Reactions to Stress (percent).

Surgeon General’s Conference on Agricultural Safety and Health - 1991

425