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Article Excerpt
Minority farmers in the Mississippi Delta are among the poorest people in the United States. Being a minority _farmer is a quadruple health disadvantage. First, farmers live in rural areas where it is more difficult to provide or access services (Larsen & Foley, 1992; Lishner, Richardson, Levine & Patrick, 1996; Lustig, Strauser & Weems, 2004). Rural Americans are more likely than urban Americans to be older, to describe their health as poor or fair, to lack private health insurance, and to live longer distances from hospitals or other health care services (AHRQ, 2005). Rural people have inadequate insurance coverage and lower rates of service use (Ormond, Wallin & Goldenson, 2000). Although minorities fare worse than majorities, rural minorities fare even worse than urban minorities (Mueller, Ortega, Parker, Patil & Askenazi, 1999). Rural people face different social and physical conditions therefore methods of serving them have to be different from those used on urban populations. Consequently, urban models of service provision are inappropriate for rural clients (Rowjewski, 1992).
Second, farmers are in a hazardous profession (Cole, Myers & Westneat, 2006; Rautiainen & Reynolds, 2002) The National Safety Council (1996, 2002) ranks farming as one of the most hazardous occupations with high rates of job related illnesses, injuries and disabilities that are costly to families and to the economy at large. For example, in 1996 National Safety Council ranked agriculture as the second most dangerous occupation with an incidence of 140,000 disabilities per year. It should be noted that this number is an under-estimate because Occupational Safety and Health Administration (OSHA) regulations exempt farms employing ten or fewer workers, and those that do not maintain labor camps from reporting work-related injuries and illnesses. Farmers experience: injuries from machinery, livestock, tools, and work surfaces (National Coalition for Agricultural Safety and Health, 1988; NIOSH, 1993; 1994; Young, Strasser, & Murphy, 2004) deafening noise (EPA 1981; May & Dennis, 1992; National Safety Council, 2002; Oskam & Mitchell, 2002;); long hours in the sun; concentrated toxic chemicals (such as nitrates, pesticides) gases, and fuels; excessive occurrences of some cancers among farmers such as leukemia, Hodgkin's disease, multiple myeloma and cancers of the lip, skin, stomach, prostate and brain (Novello, 1991). Farmers are also exposed to grain and hay dust, and dust from farm chemicals such as insecticides, fertilizers and animal feeds. They often work in animal enclosures, silos, and manure pits where they are exposed to high levels of potentially toxic gases such as carbon dioxide, carbon monoxide, methane, and hydrogen sulphide. Some of the more common respiratory illnesses they suffer are organic dust toxic syndrome, chronic bronchitis, asthma, hypersensitivity pneumonitis (Runyan, 1993) and they are exposed to zoonotic diseases. Musculoskeletal syndromes are widespread among farm workers due to repetitive trauma and vibrations from farm machinery (NIOSH, 1993; National Coalition for Agricultural Safety and Health, 1988). Farming has one of the highest levels of job-related stress (NIOSH, 1993). Besides the physical stress of farm work, farmers take high economic risks resulting in stress. Research has also found higher injury levels among minority farmers (McGwin, Enochs & Roseman, 2000) with more adverse economic consequences than among majority farmers (McGwin, Scotten, Aranas, Enochs, & Roseman, 2000).
Third, minority populations have higher disability rates than those of majority populations (Bowe 1992; U.S. Census Bureau, 1997, 2002, 2005a, 2006' de Leon, Fillenbaum, Williams,1995; Walker 1988;). American Indians and African Americans have the highest disability rates in all age groups. The severe disability rate among African-Americans of all ages is 12.7% but among whites it is 9.9%. Within the 55-65 year old group, the proportion with severe disability was 20% among Whites, and 35% among African-Americans (U.S. Census Bureau, 1997). Recent data estimates from the U.S. Census (2005b, 2006) indicate that African Americans, American Indians, and Alaska Native shared the highest overall estimated disability rate of 24.3 percent. The overall disability rate for Hispanics (20.9 percent) was also higher than the national average rate. Other data indicate that the proportion of minorities among people with disabilities is increasing (Rehabilitation Research and Training Center on Disability Demographics and Statistics, 2005).
Furthermore, minority populations receive proportionately fewer rehabilitation services than do majority populations. They are less likely to seek rehabilitation services and when they do get into rehabilitation programs, they are less likely to successfully complete the programs and to find suitable job placements (Herbert & Cheatham, 1988). Wilson (2004) documents that African Americans are more likely than Asians, Pacific Islanders, or Whites to be rejected for VR services. There are significant cultural differences in attitudes and perceptions toward disabilities (Westbrook, Legge, & Pennay 1993). Psycho-social variables are significant predictors of adjustment and rehabilitation success (Belgrave, 1991). Therefore it is important to create service provision/access systems on a sound understanding of the cultural, social, and psychological factors of the recipient population. Such access systems require thorough research to document the necessary information.
Fourth, like minorities in other professions, their minority status puts farmers at a health disadvantage. Research documents substantial and persistent minority health disparities (Institute of Medicine, 2002). There are disparities throughout the spectrum of health care from preventive services to pain relief at the end of life (Nelson, 2003).The most important predictor of quality health care is access (Cohen, 2003). There are serious disparities in access to care (Kaiser Commission, 2000).
Stodden, Stodden, Kim-Rupnow, Thai and Gallowy (2003) document the increasingly disproportionate distribution of culturally and linguistically diverse people with disabilities, and their inequitable treatment. They go on to show that serving minority populations is a challenge to the VR system, and that disability researchers, practitioners, instructors, and support personnel have not adequately understood the unique issues related to disability in minority communities. They list three categories of barriers to an effective relationship between VR and minority populations: (a) lack of cultural sensitivity or knowledge (b) not considering environmental determinants of disability, including natural, social, cultural, and built environments; and (c) inadequate research and service delivery methods for minority populations with disabilities.
Project Goal
There were indications from the state Vocational Rehabilitation Services (VR) in the lower Mississippi delta that minority farmers were not accessing services to the level expected. The purpose of the project that gathered the data used in this study, was to determine and document barriers to VR effective service provision to minority farmers with disabilities and to recommend methods for improvements. The barriers would be determined through data collected from consumers, prospective consumers and from service providers employed by the VR. An analysis of the data would point at service provision barriers. Because field agents from the United States Department of Agriculture (USDA) agencies including Farm Service Agency (FSA), Cooperative Extension Service (Extension), and Natural Resource Conservation Service (NRCS) serve farmers, they have invaluable insights about serving delivery/access by minority farmers. The project would interview USDA field agents to gather such insights and use them in recommending methods of improving VR access to minority farmers.
The purpose of this study is to analyze data gathered from VR counselors and from USDA field agents in order to address four questions:
* What do VR counselors perceive to be factors that deter effective service provision to minority farmers?
* What can VR learn from the USDA field agents about serving minority farmers?
* What are VR counselors' recommendations for improving service provision to minority farmers?
Methods
Counselors are pivotal to VR service delivery and have information that is critical to improving service provision effectiveness. The project surveyed random samples of VR counselors, and USDA field agents by mail with three follow-up reminders.
USDA is the federal department with the closest ties to rural households and rural issues. USDA field personnel/agents are trained and experienced in serving rural people and a major focus of their daily activities is service provision to farmers. Given their emersion in rural areas and in serving farm households, USDA field agents have insights about the nuances of such service provision that VR or other agencies might not have. Thus...
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