agriculture, health and medicine: promoting people, places ... · • ‘agricultural medicine’11...
TRANSCRIPT
Agriculture, Health and Medicine: promoting people, places, and possibilities across disciplines.
Susan Brumby PhD, Jacquie Cotton PhD, Bianca ToddNational Centre for Farmer Health
www.farmerhealth.org.auP: +61 3 55518460
• Background
• Rural Health and Agriculture
• Agricultural Health and Medicine
• Curriculum
• Methods
• Results
• Conclusions/Recommendations
• Discipline of Rural Health—the interdisciplinary study of
health and health care delivery in rural environments
• Well-recognised discipline delivered Rural Clinical
Schools, University Departments, Schools of Rural
Health
• Supported with numerous academic journals
• Within rural populations, farm men, women,
agricultural workers also live and work
Largest exporter of wool1 3rd largest exporter of dairy2
3rd largest exporter of beef 3 4th largest exporter of cotton 4
Largest exporter of barley 5
• Predominately family owned and operated6
• Responsible for 61% of Australia's land mass6
• Contribute $43.1billion (farm gate) to Australian economy6
• Remains one of the most dangerous industries in Australia7
• Compounding injury rates are poor physical and mental health indicators
• Oldest workforce in Australia8
Continuing the conversation: Collaboration
• Life threatening injuries—farms and roads
• Increased risk of suicide
• Higher death rate—cardiovascular disease
• Higher death rate—skin cancers
• Double risk death—prostate cancer
• 40% higher rates of deaths for cancer of colon
• Double death rate—haemopoietic and lymphatic
• Slips, trips and falls
Fragar L, Depczynski J, Lower T. (2011) Mortality patterns of Australian male farmers and farm managers. The Australian Journal Of Rural Health [serial online]. August 2011;19(4):179-184. Available from: MEDLINE, Ipswich, MA. Accessed January 30, 2013
42.5%
21.8%
39.0%
54.0%
25.3%
39.0%
20.6%
30.3% 28.8%
23.8%
0%
10%
20%
30%
40%
50%
60%
Overweight Obesity(BMI) Obesity(WC) Hypertension Risk Diabetes Risk
Farmers
National
Ref: Brumby, S., Chandrasekara, A., McCoombe, S., Kremer, P. and Lewandowski, P (2012), Cardiovascular risk factors and psychological distress in Australian farming communities, Australian Journal of Rural Health, Vol.20, no. 3, pp.131-137
•Accidents
•Farm acquired illnesses (Zoonoses)
•Skin complaints
•Musculoskeletal disorders
•Chemical/pesticide exposures
•Medical emergencies
•Hearing loss
•Depression and suicide
•Stress and anxiety
•Domestic violence
•Drug and alcohol abuse
•Respiratory diseases
•Cardiovascular disease
•Cancers - some
•Diabetes
Compounded by reduced access to health services and cultural barriers
• Few formal programs globally focus on Agricultural
Health and Medicine (AH&M).
• Specialty postgraduate unit developed in 2010.
• Curriculum designed to enable health care providers to
deal more efficaciously with particular conditions which
farmers, as distinct from other rural people, present.
• Support agricultural professionals
(agronomists, agricultural extension officers, veterinary
surgeons) to play a role in preventing occupational
illness and injury through increased health literacy.
• ‘Agricultural medicine’11 has been defined as the multidisciplinary specialty area of occupational and environmental health focusing on the anticipation, evaluation, diagnosis, treatment and prevention of occupational illnesses and injuries in agricultural populations.
Topic/Content area YesIntroduction and overview ✓
Addiction in farming populations ✓
Agricultural chemicals and toxicology
✓
Agricultural populations’ comorbidities
✓
Agricultural environmental health issues
✓
Agricultural respiratory illnesses ✓
Agricultural trauma ✓aAgriSafe—clinical preventive occupational health care
✓
At-risk populations ✓
Behavioural and mental-health issues in the farming community
✓
Biosecurity ✓
Cancer in the farm environment and agricultural setting
✓
Ergonomics in agriculture ✓
Topic/Content area Yes
Farm dangers/injuries from physical agents (vibration, noise, heat/cold)
✓
Farm children and youth at risk ✓
Health assessments for agricultural populations
✓
Hearing loss and eye injury ✓
Musculoskeletal injuries and occupational low-back pain
✓
Occupation and environmental concerns for veterinary pharmaceuticals and chemicals
✓
Personal protective equipment (including respirators)
✓
Prevention of illness and injury in agricultural populations (including women, minorities, youth)
✓
Remote emergency medicine ✓
Skin cancers of agricultural workers ✓
Zoonotic diseases ✓
Quantitative data collected from students (N=90) who completed AH&M unit 2010-13 to determine:
1. Changes in students attitudes
2. Any self-reported behavioral changes as a result of completing the unit
3. If students found the course to be professionally valuable and useful
4. Future topics of interest.
Data analysed using descriptive statistics, frequencies and the chi-square test.
Further detail sought from qualitative responses to open-ended survey questions about places of work and current practice.
• Overall response rate of 54.5% (51), 31.4% from 2011 group.
• Main vocations were nursing 45%, medicine 24%, farmers or agribusiness 24%
• 11+ years working in rural areas or work affecting rural areas 66.7 %
• Majority (86.3%) were female (stat. significant p<0.05) with age distribution of students fairly evenly spread.
• Over 80% working in rural or mixed populations
• 96% of respondents said they would recommend studying AH&M to a colleague.
Self-reported professional behavioural changes in students n=51 *no strongly disagree responses
Additional comments • ‘The most valuable part of the course was seeing
and hearing the good evidence and data on the impact of health in the agricultural industry and receiving a solid background from the lecturers. Now that I have a solid base, I can feed this into my work, backed up by research’. 2010 student now working in agricultural industry
Source: http://www.farmerhealth.org.au/page/education/what-is-gcahm
Conclusions
1. Indicates the benefits of the AH&M unit to both health care providers and agricultural professions
2. Respondents rated the education highly and reported improved work practices in their agricultural and rural communities.
3. Bodes well for supporting the multidisciplinary and cross-sector scholarship of AH&M, and for addressing health inequities and poorer health outcomes in agricultural populations.
Credit for GP Registrars:Deakin University formally recognises the Australian College of Rural and Remote Medicine (ACRRM) and Royal Australian College of General Practitioners (RACGP) fellowships as credit for prior learning for GP registrars enrolled in the Graduate Certificate of Agricultural Health and Medicine (GCAHM). Students will be granted two credit points of Credit for Prior Learning into GCAHM on completion of the Australian General Practice Training program.
To address unacceptable and ongoing health disparities prioritisation is required to ensure health care providers are culturally competent to work in agricultural communities and health literacy is increased in the agricultural professions.
• We recommend— as a minimum— the establishment of an AH&M network to develop, and support those professionals who have studied or have an interest in Agricultural Health and Medicine.
1. Department of Primary Industries. (2012). Central West Region Pilot Area–Wool Profile Factsheet No.5. Retrieved 10 March, 2014, from http://www.dpi.nsw.gov.au/__data/assets/pdf_file/0005/457592/Wool-profile-central-west-region.pdf
2. Dairy Australia. (2012). Industry overview. Retrieved 10 March, 2014, from http://www.dairyaustralia.com.au/Industry-overview/About-Dairy-Australia/~/media/Documents/2012.pdf
3. Meat and Livestock Australia. (2014). Australias beef industry–fast facts. Retrieved 10 March, 2014, from http://www.mla.com.au/Cattle-sheep-and-goat-industries/Industry-overview/Cattle
4. Cotton Australia. (2012). The economics of cotton in Australia. Factsheet. Retrieved 10 March, 2014, from http://cottonaustralia.com.au/cotton-library/fact-sheets/cotton-fact-file-the-economics-of-cotton-in-australia
5. Food and Agriculture Organization of the United Nations. (2011). FAOSTAT-Trade. Countries by commodity. Retrieved 10 March, 2014, from http://faostat.fao.org/site/342/default.aspx
6. National Farmers Federation. (2012). NFF Farm Facts 2012. Retrieved 10 March, 2012, from http://www.nff.org.au/farm-facts.html
7. Safe Work Australia. (2012). Work-related traumatic injury fatalities, Australia 2010-2011. Canberra: Safe Work Australia.
8. Australian Bureau of Statistics. (2011). Labour Force Survey.(cat. no. 6291.0.55.003). Canberra: ABS
9. Brumby, S. (2005). The flow on effect of poor health on farmers, families, farms and communities. Paper presented at the Policy launch presentation: Rural directions for a better state of health, Echuca, VIC.
10. Depczynski, J., Franklin, R., Challinor, K., Williams, W., & Fragar, L. (2005). Farm Noise Emissions During Common Agricultural Activities. Journal of Agricultural Safety and Health, 11(3
11. Brumby, S., Chandrasekara, A., McCoombe, S., Kremer, P. and Lewandowski, P (2012), Cardiovascular risk factors and psychological distress in Australian farming communities, Australian Journal of Rural Health, Vol.20, no. 3, pp.131-137
11. Donham K, J., & Mutel, C. F. (1982). Agricultural medicine: the missing component of the Rural Health Movement. Journal of Family Practice, Mar 14(3), 511-520.