Recommendations for Program Improvement - Agriculture Forestry and Fishing Research at NIOSH - page 185

insights about real-world clinical problems that affect rural populations would be
invaluable to investigators.
The Ag Centers are superbly positioned to assist the AFF Program with coordi-
nating national and regional initiatives, as they are strategically placed at university-
affiliated or located at not-for-profit medical centers and are placed to reflect
agricultural programmatic and regional differences (NIOSH, 2000a). To reflect the
comprehensive charge of the AFF Program, the Ag Centers should consider under-
taking additional responsibility in forestry and fishing, where regional issues apply,
to obviate the creation of separate infrastructures to serve the needs of workers in
forestry and fishing. Alternatively, providing R01 and R21 awards to non-Ag Center
researchers might be a cost-effective way to further research objectives in forestry
and fishing. Should the former be considered, the Ag Centers should in name also
echo the array of issues covered and be referred to as AFF Centers.
Implement a Comprehensive Surveillance System
Recommendation 3: The AFF Program should implement a comprehensive
surveillance system.
Surveillance is critical for developing and evaluating intervention programs and
provides information needed to guide in-depth research areas. Current surveillance
systems that cover occupational health, hazard, and injury are not comprehensive
in that they do not cover the AFF workforce. The surveillance activities described in
the NIOSH AFF evidence package reflect a piecemeal approach to surveillance and
fail to address such critical issues as the population at risk and the incorporation
of disease surveillance that includes more than respiratory disease, hazard surveil-
lance that includes exposures other than to pesticides, and injury surveillance that
includes a national focus on fatal and nonfatal injuries in all AFF workers.
Basic demographic and health effects surveillance of each population at risk
of exposure in connection with worksite activity is essential; without it, no effec-
tive targeting of other programmatic elements can occur. Surveillance must be
broad-based with respect to population targets because the sector is diverse in
settings and employment practices and places some specific populations—such
as children, female spouses, and the elderly—at risk. For various reasons, NIOSH
has had considerable difficulty engaging in surveillance, although attempts were
made for agriculture in the 1990s through the Farm Family Health and Hazard
Surveillance program and the Occupational Health Nurses in Agricultural Com-
munities initiative. Additionally, it also funded the National Farm Medicine Cen-
ter in Wisconsin and the Great Plains Center for Agricultural Health in Iowa to
conduct limited surveillance. More recently, NIOSH has funded USDA's National
Agricultural Statistics Service (NASS) and the Department of Labor (DOL) to