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Rural Health Care: Challenges & Opportunities

Health & Safety Issues


Jeff Wilson, Turning Point and Strategic Planning Coordinator, Virginia Department of Health, Richmond, VA.

Carolyn Sheridan, R.N., State and Regional Network Coordinator, Iowa Agricultural Health and Safety Network, Agrisafe, Spencer, IA.

Turning Point is an initiative funded by the Robert Wood Johnson Foundation (RWJF) and the W.K. Kellogg Foundation (WKKF) to strengthen and transform the Nation's public health system. Turning Point research and workgroups strive toward community health improvement, incorporating the value of prevention activities, community health concerns, and an awareness of what can be done to address health needs. The program is completing its 2-year planning phase with 21 State-level grantees and 41 community-level grantees with those States.

Rural health lessons learned in Virginia through Turning Point include:

  • Link public health with economic development.
  • Create non-traditional partnerships.
  • Establish regional health initiatives.

Challenges affecting rural health care in Virginia that arose in Turning Point include:

  • Access to care.
  • Water quality and water resource planning.
  • Food safety.
  • On-site sewage systems.

Providing a different public health perspective, Ms. Sheridan began her presentation with some startling statistics that support the need for agricultural occupational health and safety services:

  • Although farmers comprise less than 2 percent of the U.S. population, they experience 14 percent of work-related deaths.
  • As many as 1,200 lives are claimed each year, and close to 130,000 injuries are caused by farm incidents and other work-related health problems.
  • Farmers are at increased risk for noise-induced hearing loss and chronic respiratory and musculoskeletal problems.
  • Farmers feel that preventive agricultural health services are needed and that such services should be covered under their health plan.
  • Farmers tend to seek medical attention only when faced with illness or injury.

The Iowa Agricultural Health and Safety Network is a community-based comprehensive agricultural occupational health and safety program. Piloted in 1987 at the University of Iowa, the program is funded by the Iowa Center for Agricultural Health (ICASH), which also provides technical and educational support to the network.

Network members include the following community partners:

  • Social services and public health.
  • Churches and schools.
  • Physicians.
  • Government.
  • Insurance companies and other businesses.
  • Mental health providers.
  • Rural hospitals.

The 24 clinics that are currently involved in the network are located in hospitals, medical clinics, occupational health centers, parish nurse programs, and other public health arenas. The program encompasses an array of occupational and public health approaches such as:

  • Preventive health services.
  • Identification of high-risk areas.
  • Health and safety education.
  • Proper use of personal protective equipment.
  • Farm site evaluation.
  • Industrial hygiene support and safety analysis.
  • Farm Safety Day Camp for Progressive Farmers.

Ms. Sheridan also discussed the Certified Safe Farm (CSF) Project, now in its third year, that involves financial incentives to:

  • Remove or modify on-farm work hazards.
  • Participate in prevention health screening services to detect and prevent high-risk health conditions on the farm.
  • Identify informational needs and provide educational material.

Both of the programs discussed by Ms. Sheridan are replicable in other States.


Cordes DH, Foster D. Preventative measures in agricultural settings. Occup Med 1991 July-Sept;6(3):541-50.

Meyers JM. It's time for serious reform of our approach to agricultural injury prevention. Journal of Agricultural Safety and Health 1998 Aug;4(3):153-5.

Thu KM, Pies B, Roy N, et al. A qualitative assessment of farmer responses to the Certified Safe Farm concept in Iowa and Nebraska. Journal of Agricultural Safety and Health 1998 Aug;4(3):161-71.

Turning Point: Collaborating for a New Century in Public Health. Virginia Hospital and Healthcare Association and Virginia Department of Health.

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