A Farmer Becoming a Quasi-doctor: The Daegok Diary and Rural Healthcare from the 1960s to the 1980s.

This article attempts to review the reality of rural health care in Korea from the 1960s to the 1980s by analyzing the Daegok Diary. There has been two myths about rural healthcare. One is that the absence of institutional medicine was replaced by folk medicine, which could be identified with folk remedies or shamanic healing distinguished from Western medicine. This is a frame that understands institutional and Western medicine as a pair and folk medicine and traditional medicine as another. Another popular belief is that rural healthcare had remained almost nonexistent, and only dramatically improved after the Regional Health Insurance was implemented. Of course, some claim that the Regional Health Insurance was disadvantageous to farmers, but it is generally understood that there was an absence of government policy regarding medical care. The Daegok Diary, telling many aspects of rural life, is a good source to reflect on these common notions. Unlike other farmers' diaries, the diary of Shin Kwonsik contains a wealth of medical culture records because he chose unique ways to cure his and neighbors' illnesses by himself. It can be summarized as the life of "quasi-doctor". Shin was distinguished from quacks in that he practiced as an intellectual in the village rather than as a profession, and that he learned official medical knowledge and recognized the difference between a licensed physician and himself. Also, he was different from doctors because of the lack of a medical license and the limited range of diseases that he could treat. The life of quasi-doctor shows the social structure of rural areas in Korea from the 1960s to the 1980s. The reality of rural healthcare can be summarized in two ways. First, the medical vacuum was filled by civilian efforts. There was virtually no institutional healthcare in rural areas, but the government did little to improve the situation . The policy of sending doctors to the countryside proved to be ineffective, and the community doctor system did not work properly. Health Insurance was also a system for city workers rather than farmers. In the late 1970s, the situation only slightly improved due to reasons unrelated to the government policy regarding rural healthcare. These were improvements in traffic conditions and the increasing popularity of private insurance, which improved the physical and economic accessibility to medical institutions. Second, Western medicine had become a part of folk medicine. Those who could not go to a hospital utilized Western medicine, which had penetrated the folk medical culture. When people were sick, they bought Western drugs from pharmacies, drug dealers, and sometimes quacks. The knowledge of Western medicine also spread widely, with family medical books such as Million People's Medicine as the medium. These two characteristics show that the existing myths that regard the absence of government policy as that of medical care and interpret the medical vacuum as the prevalence of folk remedies and shamanic healing are far from the truth. From the 1960s to the 1980s, gaps in institutional medicine was filled by Western medicine which had become part of the folk medicine already, and the accessibility of institutional medicine was improved through civilian efforts. Of course, the Daegok Diary shows more than the social structure of rural areas. It also reveals a lot about the man who wrote it, Shin Kwonsik. Unlike the others, Shin chose to become a quasi-doctor because of his separation from the tradition and his desire to learn. He grew up alone without parental care and later moved to Seoul by himself. This meant a break with the tradition. He joined the army in the wake of the Korean War and learned how to give injections there. After he was discharged, he devoured many books and newspapers including Million People's Medicine. In short, the existence of a quasi-doctor like Shin was the result of the combination of the absence of institutional medicine, the predominance of Western medicine, and the characteristic of Shin as a 'learning modern.'

The Threat and Opportunity of Digital Technology in Agriculture.

Investment in ag tech startups has increased 370% since 2013. Many of these new companies market their technology to reduce or eliminate farm work altogether. But at what cost? Workers will lose their livelihoods. Farmers in the Pacific Northwest are struggling to find the capital needed to replant orchards to accommodate this new technology, resulting in changes to farm ownership. Rural economies who depend on the revenue agriculture generates stand directly in harm's way as wages are eliminated along with jobs. Technology also generates data, what has been called the "new gold". Current trends suggest that workers, growers and rural communities will not share in this newly created wealth. Technology contains the biases of those who design it and when deployed can result in both discriminatory practices and making workplaces more dangerous for those workers who remain. Rather than eliminating and diminishing agricultural work, technology should be designed to improve the quality of work and build the economic resilience of rural communities.

Colorado Agricultural Workers' Rights of Access to Key Healthcare Providers: A Policy Brief.

Health is a human right. In order to exercise their right to health, agricultural workers need to have access to medical, dental, and behavioral health care. Agricultural workers need to have medical, dental, and behavioral health care available at times and locations that are amenable to their work schedules and worksites. Many agricultural workers do not have access to transportation due to the nature of their working conditions, therefore policies to provide transportation will increase access to medical, dental, and behavioral health services.

Promoting farming sustainability: The effects of age, training, history of accidents and social-psychological variables on the adoption of on-farm safety behaviors.

INTRODUCTION: Occupational safety and health (OSH) have a remarkable impact on the sustainability of firms and organizations. However, the sustainability perspective has often focused primarily on environmental and economic concerns, leaving key social and workplace aspects, such as OSH, underemphasized. The link between all these aspects is particularly relevant in agriculture. METHOD: In the present study we analyzed the paths by which the worker's age, participation in safety training, and previous history of accidents and near misses can influence the adoption of safety behaviors in agriculture through the mediation of attitudes towards safety and perceived behavioral control. Three hundred and ten Italian agricultural operators were administered an ad-hoc questionnaire. RESULTS: Having attended safety training courses, having been exposed to previous accidents and near misses, and age showed a positive association with the adoption of on-farm safety behaviors, through the mediation of perceived behavioral control. In more detail, participation in training courses and age showed a positive association with perceived behavioral control, while the previous history of accidents and near misses showed a negative association with behavioral control. In turn, perceived behavioral control was positively associated with the adoption of safety behaviors. CONCLUSIONS: The present study focused on the chain of events leading to the adoption of on-farm safety behaviors, which can prevent an accidents, pointing out the more critical variables and the level at which they intervene, identifying possible areas of targeted interventions. Practical applications: Implications for the development of targeted interventions may deal with: (a) training activities increasing farm operators' sense of control over their safety, (b) older farmers involvement in mentoring initiatives, and (c) systematic recording and use of previous history of accidents and near misses as inputs for training activities to discuss their implications for on-farm safety.

Compensation incentives and heat exposure affect farm worker effort.

Farm workers are exposed to high risk of heat-related illness, especially when their jobs require working outside at a fast pace during hot days. Climate change has increased the number of days with high temperatures, and thereby the amount of time that farm workers are likely exposed to extreme heat. To better understand how high heat exposure affects farm workers, this study investigates how crop workers respond to heat exposure and estimates the effects of different pay and work arrangements on workers' responses to heat exposure. We explore, specifically, whether piece-rate arrangements increase workers' effort during periods with high heat exposure compared to workers paid by hourly wages. We use observational data from detailed measurements of localized heat exposure and individual workers' effort in the field. First, these results show workers adjust their effort in response to heat exposure when the heat exposure level changes. Second, piece-rate arrangements increase workers' effort during work shifts. Third, piece-rate arrangements allow workers to modify their effort more easily during different heat exposure levels. When facing low levels of heat exposure, workers who were paid by piece-rate arrangements exert a higher effort than workers paid by hourly wages, up until WBGT is 26.6˚C. When facing high levels of heat exposure (with WBGT exceeding 29.6˚C), workers paid by piece-rate arrangements lower their effort compared to workers paid by hourly wage arrangements.

Yakima Valley Farm Workers Clinic oral health transformation project.

The Yakima Valley Farm Workers Clinic (YVFWC) is one of the largest community health centers in the country with clinics throughout south-central Washington and northern Oregon. Its dental program consists of 14 dental clinics providing general and specialty services to the low-income populations it serves. Modeling itself after the YVFWC medical managed care program; the Dental program recently added value-based metrics to its dental practice after Oregon offered a value-based dental reimbursement plan in 2019. This is the first-step YVFWC's dental program that has taken to prepare for value-based reimbursement and transform its dental practice in order to reduce the disease burden in its patient population. The purpose of this article is to describe the processes YVFWC undertook to prepare itself for the new reimbursement model, which included the development of metrics, a metric validation process, a clinical dashboard, and a method for improving metrics. It also outlines its medical/dental integration improvement brought about by embedding hygienists into the medical primary care teams.

Responding to the health needs of migrant farm workers in South Africa: Opportunities and challenges for sustainable community-based responses.

Reflecting global trends, migrant farm workers in South Africa experience challenges in accessing healthcare. On the commercial farms in Musina, a sub-district bordering Zimbabwe, Medécins sans Frontières and the International Organization for Migration both implemented migration-aware community-based programmes that included the training of community-based healthcare workers, to address these challenges. Using qualitative data, this paper explores the experiences that migrant farm workers, specifically those involved in the programmes, had of these interventions. A total of 79 semi-structured interviews were completed with migrant farm workers, farm managers, NGO employees and civil servants between January 2017 and July 2018. These data were supplemented by a review of grey and published literature, as well as observation and field notes. Findings indicate that participants were primarily positive about the interventions. However, since the departure of both Medécins sans Frontières and the International Organization for Migration, community members have struggled to sustain the projects and the structural differences between the two programmes have created tensions. This paper highlights the ways in which local interventions that mobilise community members can improve the access that rural, migrant farming communities have to healthcare. However, it simultaneously points to the ways in which these interventions are unsustainable given the realities of non-state interventions and the fragmented state approach to community-based healthcare workers. The findings presented in this paper support global calls for the inclusion of migration and health in government policy making at all levels. However, findings also capture the limitations of community-based interventions that do not recognise community-based healthcare workers as social actors and fail to take into account their motivations, desires and need for continued supervision. As such, ensuring that the ways in which migration and health are included in policy making are sustainable emerges as a necessary element to be included in global calls.

Metabolic energy cost of workers in agriculture, construction, manufacturing, tourism, and transportation industries.

The assessment of energy cost (EC) at the workplace remains a key topic in occupational health due to the ever-increasing prevalence of work-related issues. This review provides a detailed list of EC estimations in jobs/tasks included in tourism, agriculture, construction, manufacturing, and transportation industries. A total of 61 studies evaluated the EC of 1,667 workers while performing a large number of tasks related to each of the aforementioned five industries. Agriculture includes the most energy-demanding jobs (males: 6.0 ± 2.5 kcal/min; females: 2.9 ± 1.0 kcal/min). Jobs in the construction industry were the 2nd most demanding (males: 4.9 ± 1.6 kcal/min; no data for females). The industry with the 3rd highest EC estimate was manufacturing (males: 3.8 ± 1.1 kcal/min; females: 3.0 ± 1.3 kcal/min). Transportation presented relatively moderate EC estimates (males: 3.1 ± 1.0 kcal/min; no data for females). Tourism jobs demonstrated the lowest EC values (2.5 ± 0.9 kcal/min for males and females). It is hoped that this information will aid the development of future instruments and guidelines aiming to protect workers' health, safety, and productivity. Future research should provide updated EC estimates within a wide spectrum of occupational settings taking into account the sex, age, and physiological characteristics of the workers as well as the individual characteristics of each workplace.

Safety in steep slope logging operations.

Partial results of a NIOSH-funded study for "Protecting the Logging Workforce: Development of Innovative Logging Techniques for a Safer Work Environment" by a team of researchers at Oregon State University are presented that review safety in steep slope logging. Comparisons are made for hazards and exposures of "conventional" and new technologies for steep slopes. Hazards of new technologies are identified. Safety assessments are addressed for forestry sectors internationally, for the firm and for workers. Important questions of technical feasibility, economic viability and environmental performance are raised. Ongoing research on operators using tethered and untethered systems are described. Results will help inform training and selecting operators. New Best Operating Practices and safety code regulations will result from the research. New technologies will reduce worker hazards and exposures for steep slope logging.

Post-disaster agricultural transitions in Nepal.

In Spring 2015, a series of earthquakes and aftershocks struck Nepal. The earthquakes caused significant changes in labor and land availability, cash income needs, and land quality. We examine how these post-earthquake impacts converged with ongoing agricultural shifts. Earthquake-related socio-economic and landscape changes specifically motivate the adoption of cardamom, Amomum subulatum, a high-value ecologically beneficial, and low labor commercial crop. We investigate reasons for the increased interest in cardamom post-earthquake, and challenges associated with it. We find that adopting cardamom serves as an important post-disaster adaptation. However, more broadly, unevenly distributed interventions coupled with the high capital costs of agricultural transition exacerbate social differentiation in communities after the disaster. Adoption is often limited to economically better off smallholder farmers. This paper extends previous research on disasters and smallholder farming by highlighting the specific potential of disasters to accelerate agricultural transitions and resulting inequality from the changes.

Structural Characteristics of Migrant Farmworkers Reporting a Relationship with a Primary Care Physician.

Migrant farmworkers are disproportionately affected by many adverse health conditions, but access healthcare sparingly. This study of migrant farmworkers examined the distribution and general characteristics associated with having access to healthcare. Access to healthcare was measured by asking whether the participants (N = 413) had a primary care physician. Majority of participants did not have a primary care physician. Female migrant workers (AOR = 2.823 CI: 1.575-4.103) with insurance (AOR = 6.183 CI: 4.956-11.937) who lived at study site for more than 5 years (AOR = 2.728 CI: 1.936-7.837) and born in the United States (AOR = 2.648 CI: 1.373-3.338) had greater odds to have a primary care physician than recent male migrants without insurance who were born outside United States. There is a need to focus on Community Health Centers and Migrant Health Centers in tailoring their services and to widen the implementation and improve funding of Accountable Care Organizations to improve access to care of migrant farmworkers.

Valores éticos en decisiones de pequeños agricultores confrontados con percepciones de estudiantes de agronomía (universidad de Caldas) / Ethical alues inn decisins of small farmers confronted with agronomy sttudents' perceptions (universidad de caldas, Colombia)

En este trabajo se determinan valores que guían a los agricultores frente a decisiones de producción, vida colectiva y ambiente en confrontación con las percepciones de los estudiantes de Agronomía y agrónomos egresados de la Universidad de Caldas. Mediante una metodología descriptiva, se trabajó con tres comunidades de pequeños agricultores para designar sus valores mediante una entrevista semiestructurada, y con sus resultados se cursó una encuesta a estudiantes y agrónomos, se identificaron puntos de encuentro y desencuentro y se sugirieron propuestas formativas en ética agronómica. Los pequeños agricultores reconocen como sus valores de expresión colectiva: responsabilidad, familia, tradición, trabajo, honorabilidad, cooperación, solidaridad, la educación como valor deseado y como valores de expresión individual: orgullo, pertenencia, bienestar, autosuficiencia. Todos los estudiantes de la Facultad coinciden en reconocer algunos de los valores sociales centrales enunciados por los productores agrarios como son: responsabilidad, solidaridad, trabajo, cooperación; en la medida en que avanzan en su formación profesional añaden otros valores y cuando egresan se centran solo en los dos primeros. Hipotéticamente, los estudiantes del programa de Agronomía se ubican de manera ideal en niveles postconvencionales en la escala de valores de Kohlberg, no obstante cuando egresan parecen retroceder en sus concepciones en la medida en que en niveles superiores y entre los egresados aparecen niveles convencionales y preconvencionales.

In this work, values that guide small farmers when facing production decisions, collective life and environment, in confrontation with the perceptions of the Agronomy alumni from Universidad de Caldas are determined. Using a descriptive methodology, three small farmer communities were worked with to designate their values using a semi-structured interview which results were used to apply a survey to students and agronomists. Agreement and disagreement points were identified and formative proposals in agronomic ethics rose. Small farmers identify their collective expression values: responsibility, family, tradition, work, honesty, cooperation, solidarity, education as a desired value; and as individual expression values: pride, membership, welfare, self-sufficiency. All the students from the Faculty coincide in recognizing some of the central social values stated by the agricultural producers such as: responsibility, solidarity, work, cooperation; as they progress in their professional education, they add other values but when they graduate they focus on the two first ones. Hypothetically, the Agronomy Program students are placed in post-conventional levels in Kohlberg's value scale. However, when they graduate it seems to be they back down in their conceptions while in superior levels and among the alumni conventional and pre-conventional levels appear.