Farmers' occupational health program in Finland, 1979-1988: from research to practice.

The Kuopio Regional Institute of Occupational Health, in collaboration with the Social Insurance Institution and the National Board of Health, conducted and evaluated a national model for the farmers' occupational health services. In January 1985 the National Board of Health instructed the Finnish municipal health centers to start the provision of farmers' occupational health services based on the recommendation given by the research group. The service was evaluated by experiments carried out during 1982, 1985, and 1986. The main problem in function of the services was that the health hazards (exposures) were difficult to observe and evaluate. The system of how the occupational health nurse evaluates the working conditions should be further developed. The efficiency of the services was studied by postal inquiries in 1982 and 1986. Farmers' knowledge about the appropriate means of reducing hazardous exposures had increased significantly due to the occupational health services. At the local level, the main problem in providing services for occupational farmers is that health centers do not have the resources to offer services for all farmers at the same time. Altogether by the end of 1986, about 30% of all active farmers in Finland (45,000 farmers) were willing to have occupational health services, which is voluntary for self-employed farmers.

Farmers' occupational health programme in Finland, 1979-1987.

At the beginning of 1985, the National Board of Health in Finland issued directives for the initiation of farmers' occupational health services in municipal health care centres. The directives were based on the evaluation study on farmers' occupational health services in Finland. The main aim of this study is to analyse the current problems of the farmers' occupational health care system and to analyse how effective the system is. The efficiency of the occupational health services has been surveyed with postal inquiries twice, first in 1982 and later in 1986. The farmers' knowledge of appropriate means for reducing hazardous exposures had improved significantly since the initiation of the occupational health services. The effect of the occupational health services was evident particularly in the more effective use of personal safety devices. The limited resources at the municipal health care centres form the main obstacle in the provision of occupational health services for all farmers who would like to have them. 25-35% of the farmers in Finland (total 45,000 farmers) are willing to participate in the occupational health care system. Participation is voluntary for self-employed farmers.

Characteristics of farmers who have obtained personal dust respirators.

A postal survey was used to investigate the characteristics of farmers who have acquired dust respirators. In 1979 about a quarter of the farmers were using dust respirators, men more often than women. The more vocational training the farmer had and the larger the area of land under cultivation the more likely he was to own a dust respirator. Grain producers had purchased the protective devices more frequently than other farmers had. Farmers who participated in the occupational health intervention during 1980-82 had acquired dust respirators considerably more often than those in the control group. In the intervention group men under 30 years had most frequently purchased the dust respirators. Participation in the intervention influenced the acquisition of dust respirators more than did occurrence of symptoms of chronic bronchitis or farmer's lung.

A feasibility study of organizing occupational health services for farmers.

In Finland the Occupational Health Care Act of 1979 provides farmers the possibility of purchasing occupational health services. The main objective of the present study is to develop national model for the organization of occupational health services for farmers. The problems of providing and specifying occupational health services for farmers can be described by two parameters. The first is the type of farm production. The occupational health services to be provided are though to depend on the occupational health risks. The risks vary with the type of farm production, which in turn depends on the geographic location of the farm. The second parameter represents the supply of occupational services to be provided by the municipal health center. The supply has been characterized as occupational health inspections of farms, health examinations, and health education. For the optimization of the supply and the demand, the experiment consists of three models to be tested in respect to two matrices of risk. The feasibility of the models in the 2-a experiment will be evaluated by pre- and postexperimental surveys.