7
Disability in Agriculture
WILLIAME. FIELD ANDPAULJONES
Key words: prosthesis, return-to-work, rehabilitation, alternative employ- ment, assistive technology
There are few occupations in which the evidence of disabling injuries is more apparent than agriculture. A casual assessment of any group of farm or ranch workers will often detect missing digits and limbs, impaired mobility, or a wide range of scars from accidents with both animals and machines. In fact, the common name used for many years for the Dorrance hook, an upper limb prosthetic device, was the farmer’s hook. Over a 25-year period in Indiana beginning in the late 1940s, more than 100 farmers per year lost one or more upper extremities due to entanglements in corn pickers. The wide- spread prevalence of disability within the agricultural community has histor- ically provided support for an unfounded assumption that since many in this population of workers with disabilities continued to be productive, they generally had few if any special needs. Consequently, many of the benefits associated with recent advance in rehabilitation practices and assistive tech- nology have been slow in being realized by many of these people.
Over the past two decades, momentum has grown for ensuring that the rehabilitation needs of rural people, including farmers, ranchers, and agri- cultural workers with serious disabilities, are being met at a comparable level of enthusiasm, efficiency, expertise, and resources as is found in most urban settings. The disparities, however, are still substantial, and there is still much to be done to assist rural and agricultural communities in becoming more inclusive and accommodating of those with disabilities.
Prevalence of Disability Within Agriculture
Even though considerable attention has been given to the size of the disabil- ity community in the United States, few data sources definitively capture either the prevalence or nature of disability, especially within rural areas.
There is also considerable ambiguity over the terminology used. One data
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source, for example, defines a disability as being off work for at least 1 day, while other sources use vague terms such as “total” and “partial” to catego- rize disability types. Terms such as “rural,” “farm,” and “agricultural work- er” are also not uniformly defined. Consequently, estimating the prevalence of disability within the agricultural work force becomes more of an art form than a science.
Approximately 2.13 million farms and ranches in the United States are responsible for the production of most of the food and fiber consumed and utilized in the United States. These farms and ranches are primarily operat- ed by families that consist of 3.12 million operators and 3.49 million opera- tor household members, many of whom provide both paid and unpaid labor to the operation. In addition, approximately 1.2 million hired agricultural workers are employed in agricultural production on a full-time or seasonal basis. This relatively small proportion of the population has a significant responsibility given the dependency of the entire population on the agricul- tural products they produce (1,2).
Farm-related injury data have shown that those engaged in agriculture-relat- ed activities are especially susceptible to disabling injuries. The National Safety Council has historically classified agriculture as one of the three most haz- ardous occupations. If injuries involving children in the agricultural workplace were included, agriculture’s injury rate would be even higher. Approximately 5% of nonfatal farm injuries that occur each year are severe enough to prevent the farmer from continuing to farm due to a serious permanent disability.
Approximately 1300 individuals sustained such injuries in 2003. A greater, though undocumented, number of farmers and ranchers continue to farm fol- lowing a serious injury in spite of their inability to perform essential work- related tasks due to a permanent disabling condition. Approximately 2% of the full-time farm operators and workers who participated in the National Safety Council’s multistate agricultural injury survey had suffered permanent disabling injuries while performing farm-related work (3–5).
According to the United States Bureau of Labor Statistics, as reported by the National Safety Council, for agriculture, fishing, and forestry (not includ- ing logging), approximately 130,000 disabling injuries occurred per year in 2000 and 2001. Although frequently used to represent the number of dis- abling farm-related injuries each year, the definition for disabling injury in these reports included any workers requiring medical treatment or having lost work for more than half a day. The National Institute for Occupational Safety and Health (NIOSH) estimated that the rate of disabling injuries for agricultural workers to be 500 per day and stated that approximately 5% of these injuries result in permanent disability (2,5,6).
For example, farm-related amputations accounted for 2.6% of all reported workplace amputations in 1999 and 11% of all serious farm-related injuries.
For the period 1992 to 1999, 344 farm-related amputations were reported per year, which included only those documented by the state departments of labor and reported to the Bureau of Labor Statistics (7,8).
Farmers and agricultural workers are also disabled as the result of non–farm-related or non–work-related injuries. Of the severely disabled farmers and ranchers who contacted the Breaking New Ground Resource Center at Purdue University over the period 1990 to 2000, motor vehicle and recreational-related injuries each accounted for more disabilities than farm- related mishaps.
In addition to disabilities caused by injuries, farmers, ranchers, and other agricultural workers are also affected by health-related disabilities or a combination of disabilities that restrict their ability to perform their jobs and participate fully in daily living activities. A study of Indiana farm operators completed at Purdue University in 1981 revealed that 66% were affected by at least one physical impairment. Over 30% cited musculoskeletal impairments;
25% indicated hearing impairments; 24% cited cardiovascular impair- ments; and 22% reported respiratory impairments. Over 17% responded that there were work-related tasks on their farms that they were no longer able to perform due to their disabilities, and over 19% said that they were hindered or limited in their ability to perform necessary tasks. Nineteen percent also stated that they required assistance from a neighbor, employee, or family member to perform necessary tasks in their farm operations (9).
A comparison of general and farm population data concerning the nature and scope of physical disabilities suggested that rural and farm populations have a greater proportion of persons with disabilities. Early studies by the National Center for Health Statistics reported that 16.4% of the farm popu- lation had experienced some limitation of activity due to chronic conditions, whereas only 10.5% of the total labor force encountered such problems. Back problems were more prevalent among the farm population: 17.7 people per 1000 had displaced intervertebral disks compared to 13.5 people per 1000 for the nonfarm population. The farm population was more severely plagued by arthritis with 130.7 cases per 1000 as compared with 109.2 cases per 1000 for nonfarm people. The Missouri Farmers and Arthritis Project confirmed the earlier findings when it found that one third of farmers surveyed reported that arthritis inhibits some of their activities, and one third said they had reduced their physical level of labor due to arthritis. The Arthritis Foundation–Indiana Chapter stated that farmers are at an increased risk for arthritis-related disability and that the impact can be quite profound in regard to reducing physical strength and ability to perform routine chores (10–12).
Kirkhorn and Schenker (13) noted that the reporting system for occupa- tional illnesses is still inadequate, which makes it almost impossible to accu- rately track trends in chronic illnesses that are a consequence of agricultural occupational exposure. Despite lower rates of smoking, farmers have an increased prevalence of several acute or chronic respiratory diseases, and there is increasing evidence that endotoxins, which are found in organic dusts from both grain storage and confined animal feeding operations, are signifi- cant contributors to these conditions (see Chapter 19). The authors reported
that over 700,000 workers spent part of each day working in confined animal feeding operations. The impact of long-term disability due to respiratory dis- eases is largely undocumented within the agricultural work force, especially with respect to the ability of those affected to continue engaging in produc- tive agricultural work (13).
Apart from injuries and occupation-related diseases, many farm and rural families are affected by congenital or birth defects at levels comparable to the general populations. Farmers and ranchers are diagnosed with such diseases as multiple sclerosis and retinitis pigmentosa, and thousands of rural chil- dren are also born each year with developmental disabilities such as cerebral palsy and Down syndrome.
Previous rough estimates of the total number of workers with disabilities participating in agricultural work in the United States range from an unpub- lished figure of 288,000 to 500,000 reported by the U.S. Department of Agriculture’s AgrAbility Program. The U.S. Department of Agriculture (USDA) also reported that over 13 million Americans living in rural areas have chronic or permanent disabilities. These data are considered conser- vative considering the increased risk of injury for those employed in agriculture (14).
Using the most recent Census of Agriculture data (2002) and applying a conservative value of 20% of the farm and ranch population having a dis- ability that restricts daily living, it is currently estimated that approximately 1.36 million individuals who own, operate, live on, or work on United States farms and ranches are impacted by disability (1,2,9).
Availability of Disability-Related Resources
Prior to the 1980s few published reports or resources were available to agri- cultural workers or rehabilitation professionals for solving disability-related problems within farm or ranch settings. The one well-documented exception was the Vermont Farm Family and Rural Rehabilitation Program that was established in 1967 as a cooperative effort between the Vermont Office of Vocational Rehabilitation and the University of Vermont extension service.
Few forms of rehabilitation or assistive technology appropriate for farmers or ranchers had been documented, and little effort had been made to define the unique needs of individuals with severe disabilities who desired to remain involved in production agriculture in spite of their limitations. Over the past two decades, several initiatives were undertaken to address this void of knowledge and skills within the field of vocational rehabilitation (15). These initiatives included:
1. The establishment in 1979 of Purdue University’s Breaking New Ground (BNG) Resource Center and Outreach Program and the subsequent preparation of various resource materials including four editions of
Agricultural Tools, Equipment, Machinery, and Buildings for Farmers and Ranchers with Physical Disabilities. This program was initially supported by Deere and Company and by the U.S. Department of Education’s National Institute on Disability and Rehabilitation Research (16).
2. Technical material generated by the two international conferences in 1979 and 1982 on rural rehabilitation technologies hosted by the University of North Dakota, Grand Forks. These were the first events that were designed to focus attention on the unique assistive technology needs of rural resi- dents with disabilities.
3. Service delivery experience gained by the FaRM Program in Iowa and the Breaking New Ground Outreach program in Indiana, both established in the mid-1980s. These programs used a community-based approach to the delivery of rehabilitation technology services to rural and farm families and became models for the establishment of the U.S. Department of Agriculture’s AgrAbility Program (14).
4. The establishment in 1985 of the Rural Rehabilitation Research and Training Center at the University of Montana, Missoula by the National Institute for Disability and Rehabilitation Research. This center has pro- vided researchers the opportunity to identify and respond to long-term research priorities on issues related to rural rehabilitation.
5. The establishment of Life Essentials of Lafayette, Indiana, in the late 1980s. Life Essentials was one of the first manufacturers to design, fabri- cate, and market assistive technology specifically for use by farmers and ranchers with disabilities. One example is a tractor-mounted lift designed to enable farmers with severe mobility impairments to gain access to the operator’s seat.
6. Passage of the 1990 Farm Bill that established the USDA AgrAbility Program. This program began providing funds through land grant univer- sities to support technical assistance training and information dissemina- tion activities for farmers and ranchers through agreements between the Cooperative Extension Services in selected states and nonprofit disability organizations such as Easter Seal affiliates and centers for independent liv- ing. At present 24 funded projects serve farmers and ranchers with disabil- ities in 26 states.
Barriers and Opportunities in Returning to Work
The most significant barriers that many individuals with disabilities face when attempting to return to work in production agriculture are the attitudes of those in their family and on the rehabilitation team. The general percep- tion held by many rehabilitation professionals that there has to be something easier, safer, and more profitable than farming or ranching has proven to be a significant hurdle for many farmers and ranchers involved in the vocation- al rehabilitation process. Family members may also discourage return to
farming or ranching due to fear of another injury or the uncertainty of suc- cess. On the other hand, a supportive family and rehabilitation team have been shown to be important indicators of a successful transition back to farming or ranching following a disabling injury or illness.
The economics associated with production agriculture has also proven to be a critical factor in determining whether a person can successfully return to the farm or ranch. If there is substantial long-term indebtedness, return- ing to agriculture may be very difficult, especially if there are substantial medical and rehabilitation expenses. A disproportionate number of farm and ranch families are uninsured or underinsured, which can be catastrophic to the business following a serious injury or disease, especially if the medical bills become personal liabilities (9).
The lack of alternative employment opportunities in most rural communi- ties often leaves the farmer or rancher with few choices concerning potential career changes. Some have moved into related occupations following a dis- ability that have allowed them to use their knowledge of agriculture to remain employed. In some cases such career shifts have resulted in substantially bet- ter income and health care benefits, which are especially important to a per- son with a disability. The potential for succeeding in agricultural production following the acquisition of a disability is extremely low if the individual was not actively engaged in some agricultural enterprise prior to the disability.
In most cases, however, the message from the farmer or rancher following a disabling injury or illness is clear: his or her goal is to return to the farm or ranch and be productive. In some cases, work-site modifications are needed, while in other cases individuals explore alternative agricultural enterprises that better suit their limitations.
Other barriers regularly identified during the rehabilitation process include:
1. Lack of local specialized health care and rehabilitation services
2. Limited educational opportunities that would provide alternative career training
3. Nonexistent public or accessible transportation that allows independent access to needed services
4. Lack of access to information on appropriate and affordable forms of assistive technology that could be used to accommodate disability within agricultural workplaces
Assistive Technology
Through the work over the past 25 years of the Breaking New Ground Resource Center, a large database of information on assistive technology appropriate for use in agricultural work sites has been developed. Portions of the database have been made available in printed form and distributed to
farmers, ranchers, and rehabilitation professionals throughout North America. The most recent release is available in CD format and includes extensive information on enhancing accessibility to agricultural work sites.
Figures 7.1 and 7.2 provide examples of the type of technologies included in the database (16). Additional information on resources available on assis- tive technology can be found at the Breaking New Ground Web site (www.breakingnewground.org).
Secondary Injuries Associated with Disability
One of the most frequent concerns raised about the decision by a farmer or rancher to return to work in agriculture following a disabling injury or illness is the fear of additional or secondary injuries caused by physical limitations associated with the disability. Individuals with considerable experience in production agricultural prior to their disability are often encouraged by physicians or rehabilitation professions to consider other safer or healthier forms of employment. These fears, generally based on the perceptions of
FIGURE7.1. Ventrac-powered mobility aid for users of wheelchairs wanting access to rough terrain. Courtesy of Venture Products Inc., Orrville, Ohio.
individuals not experienced with modern agricultural practices, have proven to be significant and in most cases unnecessary barriers to individuals who desire to return to doing what they know best and enjoy most. In reality, there is little evidence to support excessive caution about returning to agriculture if appropriate safeguards are taken (17).
Clay et al. (18), in their study of secondary injuries among Native Americans, concluded that surprisingly little is known about the incidence or prevalence of secondary disability in any population. A review of the litera- ture identified only a handful of references to secondary injuries or the effect that disability may have on the risk of farm- or ranch-related injuries.
Allen et al. (19), in their survey of farmers and ranchers with serious per- manent disabilities, found that 81% reported that there were necessary work- related tasks on their farms and ranches that they could no longer perform or were seriously hindered from performing because of their disability. The authors noted that as many as 25% of the participants believed that they had experienced a secondary injury that they attributed to their disability. The most frequently reported injuries were related to exposure to livestock and falls. Of the reported injuries, 43% required medical attention. A high pro- portion of the Allen study involved farmers and ranchers with spinal cord injuries, a factor that was concluded to have contributed to the high incidence of secondary injury.
FIGURE7.2. Modified hand tool for upper limb prosthetic user. Photo courtesy of Texas Assistive Devices, LLC, Brazoria, Texas.
Gruver et al. (17), in a bulletin published by the Breaking New Ground Resource Center at Purdue University, identified the following hazards asso- ciated with farming with a disability:
1. Risks to caregivers, family members, and coworkers providing assistance to the person with the disability. This included children asked to assist with tasks that exceeded their maturity or physical strength.
2. Risks associated with farm equipment operation. Issues raised included the increased potential of injury due to vision and hearing impairments that may prevent an individual from recognizing the presence of hazards or responding to them appropriately.
3. Risks related to the handling of livestock, which can be extremely large and highly unpredictable. Workers with mobility impairments would have more difficulty responding quickly and avoiding contact with unruly animals.
4. Risks associated with fires in equipment and buildings. Several cases of fires on self-propelled equipment have been documented that resulted in injury to operators with impaired mobility.
5. Exposure to excessive vibration and motion that could lead to deterioration of existing disabling conditions. This phenomenon has been documented in cases where loss of feeling had occurred due to spinal cord injury.
6. Potential for falls when climbing with missing limbs or with impaired coor- dination and balance.
7. Respiratory hazards that are nearly impossible to eliminate due to envi- ronmental conditions and may result in more severe symptoms over time.
8. Added risk to some workers from temperature extremes that may not be tolerated well. This includes risks to those with spinal cord injuries who have lost some of their ability to regulate body temperature and to amputees who have highly sensitive stumps.
9. Hazards associated with the use of assistive technology that may not be designed or installed properly or may be unfamiliar to the user. Currently, there is no process in place to test the safety or efficacy of assistive tech- nology used by farmers or ranchers (17).
The potential for farm-related injuries is present for both the able-bodied and workers with disabilities involved in agricultural production. There is evi- dence to suggest that some disabling conditions may increase the risk of injury if preventative steps are not taken. Anyone involved with assisting a farmer’s or rancher’s efforts to return to work needs to understand both the potential hazards that the worker may face and the influence of the disabling conditions on safety and health. This is not, however, justification for dis- couraging or prohibiting a person with a disability from pursuing a career in agriculture. The use of more mechanized agricultural practices and the incorporation of appropriate forms of assistive technology have enabled thousands of individuals with severe disabilities to return to productive and safe engagement in agriculture.
Conclusion
As society, especially in rural communities, becomes increasingly inclusive and access to technology becomes more affordable and reliable, the unique- ness of seeing a person with a severe disability working in agricultural pro- duction will likely disappear. Vigorous, labor intensive-tasks that a few years ago required two strong arms and legs and a strong back are being rapidly taken over by highly automated machines or replaced entirely by changing agricultural practices, such as the introduction of new herbicides to control weeds. Farmers with missing limbs are compensating with spe- cialized devices that are finding their way into the toolboxes of able-bodied farmers because they make tasks easier to accomplish for everyone.
Ranchers with spinal cord injuries are gaining access to and operating large self-propelled pieces of agricultural equipment with the same ease they have in accessing and operating their modified vans. The question is no longer,
“Is it possible?” but rather, “How much does it cost and when will it be available?”
If the trend continues toward an increasingly older rural and farm popu- lation, the issues of disability within this work force will become even more significant. There will be a need for changes in public policy to ensure ade- quate funding along with innovative ways to ensure that the rehabilitation needs of this population are not neglected.
References
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14. Breaking New Ground Resource Center. Ten Year AgrAbility Report. West Lafayette, IN: Purdue University/US Department of Agriculture-CSREES, 2002.
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RR-MP-73. Burlington, VT: University of Vermont Agricultural Experiment Station, 1973.
16. Breaking New Ground Resource Center. The Toolbox, Agricultural Tools, Equipment, Machinery and Buildings for Farmers and Ranchers with Physical Disabilities (CD version). West Lafayette, IN: Breaking New Ground Resource Center, Purdue University, 2003.
17. Gruver ML, Allen PR, Field WE, Schweitzer JJ. Potential health and safety risks of farming and ranching with a disability (Plowshares technical article #27). West Lafayette, IN: Breaking New Ground Resource Center, Purdue University, 1997.
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