The Australian Bureau of Statistics classification system groups rural health populations on the basis of geographical location rather than by employment in an agricultural industry. Rural communities also have less access to medical and health services and they need to travel long distances on less than adequate roads to obtain health services (AIHW 1998). In addition, farming itself is listed as a particularly dangerous occupation.

This report tells the story of a health education program conceived by farmer associations, for farmers, which has been developed in association with health, industry, universities, training organisations and agricultural industries. These groups have worked together to develop and pilot the Sustainable Farming Families (SFF) program. This report discusses the extension of the SFF program to cotton and sugar farm families in New South Wales and Queensland.

The report provides an insight into the current health status of rural farming families within the sugar and cotton industry. It increases our understanding of what factors impact farming family health and identifies measures to improve farming family health, well-being and safety. Many of the specific strategies to improve farming family health were provided by the farmers themselves.

Who is the report targeted at?
The report is targeted at people interested in the impact of health and well-being of farming families in rural and remote Australia. This includes farming families, the farming workforce and agricultural industries, especially those involved in policy and resource allocation decisions. Research bodies including universities, health services and agricultural industries will find the information useful in future planning to effectively service the needs of Australian agriculture. Policy makers and government agencies will find this report of value in developing better policy to improve farmers’ and rural health, and in allocating future funding for rural farming family populations. This report also gives the general reader a snapshot of the health status and needs of rural faming families and their attitude towards their own health.

Background to the SFF program
The basis for Sustainable Farm Families is proving to be versatile across a range of agricultural industries. It has been driven through the passion of two registered nurses, Susan Brumby and Stuart Willder, with an interest in farm family health and the future direction of farming throughout Australian agriculture. In association with university-based researchers and with strong organisational support from their health service, Western District Health Service, they developed the evidence-based health promotion program that is the SFF. The project was structured initially around a specific target group of farming families and covered many health issues including cardiovascular, diabetes, stress, gender specific issues, cancers, injury, farm safety and mental health. The program content reflected the primary health factors known to affect farming families and rural communities more generally and also planned to recognise the complex environment of farms as workplaces, homes and businesses.

Given this complexity, farming families were key players in the shaping, feedback and further development of the program through discussion of shared issues and common problems.

The extension of the initial SFF broad acre project into the cotton and sugar industries has allowed the project to be tested in agricultural industries with different climatic, industrial and social issues. These issues can be more closely understood using the SFF framework.

The funding allocated by the RIRDC managed Joint Research Venture in Farm Health and Safety has been a key factor in the development and implementation of both the original SFF project and the extension of that work to cotton and sugar farming families.

Aims and Objectives
The initial aims and objectives of the SFF project were developed in response to the evidence that while there are health statistics regarding rural and metropolitan health, little is known about the health status of farming families (men, women and extended families). Our aim for the SFF-BAEOF project was to build on the four research objectives from the initial SFF project in broad acre farming and to create resources to implement the learning in other agricultural industries.

Specifically, our objectives for this program were to:

1. Design and deliver a training program that assists sugar and cotton farming families to identify strategies to enhance individual and family health and relevant OH&S practices.
2. Identify and track farming family health indicators for inclusion in farm management quality assurance processes.
3. Provide information on the relationship between family health, health as a social issue in rural communities and farm productivity.
4. Communicate, disseminate and develop project findings to farming families and the health and agricultural sectors.

Methods used
The goal was to develop and trial a program that enabled farmers to increase control over and improve their health, well-being and safety. Methods used within the program incorporated a wide range of evidence-based data collection and evaluative frameworks. Participants were recruited by collaborative partners from within both cotton and sugar research and development corporations.

Structured evaluative frameworks were utilised to gather and interpret information under the guidance of Professor John Martin, Director of the Centre for Sustainable Regional Communities based at La Trobe University in Bendigo, Victoria.

The project’s research and education activities included:

• a literature search based on farmer health (health promotion, extension and farmer education workshops)
• focus group discussion regarding attitudes to health well-being and safety
• structured annual workshops over two years using established learning models and theories
• pre and post knowledge questionnaires
• program process evaluation
• physical assessment process and data collation of health indicators
• demographic and self-reported surveys
• data analysis using Statistical Packaging Social Sciences (SPSS)
• action planning to address behaviour and lifestyle decisions
• case studies.

Using these assessment and data collection methods, the project team collated information on the physical health status of de-identified participants with statistical analysis of the data (derived from questionnaires/focus groups and observations) about their own health perceptions, their initiatives to improve their health, their business decisions, and other aspects of their lives. Output from this analysis has been used to prepare conference papers, produce published papers and to share with RIRDC and other bodies interested in the health, well-being and safety of farming families. The research has also been used to gather farmer feedback and to improve the program’s content and delivery.

Results/Key Findings
The initial SFF project achieved some very important outcomes and research findings. These outcomes included:

• high retention rates of participants over set programs, considering environmental influencing factors including drought and floods
• retention of new knowledge gained over successive years by participants
• statistically significant reduction of clinical indicators which correlate to major diseases including cardiovascular disease and type 2 diabetes
• increased use of protective aids and equipment on farms
• positive lifestyle changes consistent with action planning by participants to commit to family holidays, and other stress reduction activities
• generation of further research into the health, well-being and safety of farming families
• three fully refereed conference papers published highlighting the positive health outcomes of the research with additional abstracts presented at numerous conferences
• recommendation of the program to other farming families by 100 per cent of participants.

Whilst part of the SFF program, SFF-BAEOF was designed to pilot the program with different industries in different geographical areas to see if the results were comparable. It was found that many of the key results from the SFF broad acre program were repeated in the cotton and sugar industries.

Implications for relevant stakeholders
Industry
The implications of this research for Australian agriculture are significant. Industry involvement from the Cotton and Sugar Research and Development Corporations has been a key factor in the coordination and success of this project. These two Corporations have also played a key role in the project steering committee and in the recruitment of the farmers participating in the program. Industry has also benefited from the association with this broad inter-sectoral collaboration in the development and implementation of the project. While the SFF program has been useful for the broad acre, dairy, cotton and sugar industries, it lays a foundation for similar projects in other agricultural industries.

Farming Communities
Significant community implications arising from the SFF project have occurred with many of the programs across the nation generating ongoing community activities around health, well-being and safety. Community involvement has generated the desire for programs beyond the present funding timeframes and encouraged future program development by other agricultural industry and health services. Positive community response has seen the initial program receive major awards in 2005 and 2006, the initiation of work safe programs, additional funds for health and well-being grants and general stores and supermarkets changing the foods they stock for healthier choices. All of these constitute part of the benefits of SFF to participating communities.

Policy Makers
The SFF research has seen an emerging interest from government and policy makers in gaining more understanding about farming health, well-being and the future of the family farm enterprise. This has resulted in additional funding to expand the action research, number of participants and training opportunities. The involvement of the Commonwealth Department of Health and Ageing, Victorian Department of Primary Industries, Victorian Farmers Federation and more recently the Victorian Department of Human Services, has generated a broader cross-section of institutions interested in the state of farming family health, together with training an increasing number of health professionals. On 31 July 2007 the Victorian Minister for Agriculture, Joe Helper, announced substantial funding from the state Department of Primary Industries for delivering the SFF program to over 1000 Victorian farmers in 2007-2009.

Others
Interest in the SFF program has been generated with key collaborative industry and sector partners coming together to continue the development of the SFF initiatives to improve the health, well-being and safety of farming families. This positive response from the wider Australian agricultural industry has been a key outcome for the SFF program. It is remarkable that a small rural health service has been able to draw on its grounded experience and develop this initiative to the stage where it now has such a prominent national and international focus.

Recommendations
These recommendations have implications for all levels of government, health, industry, local populations and individuals. An appropriate response will require government and industry to work collaboratively in assessing the specific policy implications of the project and to apply the resources necessary to bring significant benefits to the health and well-being of Australian farm families.

Key recommendations from this project mirror those of the broader SFF program and are:

1. The Australian government fund a national SFF program to establish regional partnerships with rural and regional health services.
2. The SFF program be included in the annual health promotion plan of rural and regional community health services with ongoing financial support from the Australian government.
3. Future SFF programs be structured around partnership arrangements with institutions and organisations in health, government, industry, education and community.
4. The evidence-based approach remains a cornerstone of the SFF project as it is adopted by rural and regional health services across Australia.
5. The Australian government work with the Western District Health Service to fund a five year program to implement the previous recommendations in the report.

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Last updated: May 2008
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