1. Incidence and trends in work-related ill-health in UK agricultural workers Jill Stocks Centre for Occupational and Environmental Health University of Manchester

2. Not reported by specialist Seen by a general practitioner (GP) No medical consultation SWI THOR-GP THOR specialist The work-related ill health Surveillance Pyramid THOR cases Occupational physician OPRA

3. Population changes in agricultural workers (Labour Force Survey,UK) LFS F&M BSE ban lifted

4. Self-reported work-related ill health in agricultural workers (England and Wales) Average days lost per worker per year (3 year average): All industries 0.81days Agriculture 0.41 days* Residential care activities + 2.16 days Wholesale trade 0.31 Professional, scientific and technical activities: 0.33 *significantly lower than all industries + Residential care for learning disabilities, mental health and substance abuse Estimated days (full-day equivalent) off work and average days lost per (full-time equivalent) worker due to self-reported illness caused or made worse by current or most recent job, by industry, for people working in the last 12 months, averaged 2009/10 - 2011/12

5. Self-reported work-related ill health in agricultural workers (England and Wales) All work-related ill health Average prevalence rate 3510 (2580-4430) per 100 000 workers (2009-2012) Average incidence rate 1430 (830-2040) per 100 000 workers (2006-2009)* Not significantly different to all sectors *too few to estimate since 2009

6. Self-reported work-related ill health in agricultural workers (England and Wales) MSD Average prevalence rate 2630(1840-3420) per 100 000 workers (2009-2012) Significantly higher than all sectors Incidence - insufficient reports Stress/anxiety Prevalence and incidence - insufficient reports (inconsistent with suicide rates)

7. Self-reported work-related injuries in agricultural workers (England and Wales) Work related injury in last 12 months Incidence 3840 (2790-4890) per 100 000 workers (2009-2012) Significantly higher than all other sectors Average days lost per worker per year due to injury 0.24 (0.084-0.40) Not significantly different to all sectors

8. Fatal injuries in agriculture (England and Wales) 41 fatalities (2011-2012) (6 non-workers; investigated by the HSE) Worst fatal accident rate of all sectors 15-20% fatal accidents (1.5% population)

9. Summary of self-reported WRI in agricultural workers (UK) Significantly raised incidence of injuries and prevalence of MSD but take little time off work.

10. The Health and Occupation Reporting Network (THOR) Reports of work-related ill-health Dermatologists, Respiratory specialists, Psychiatrists, Rheumatologists, GPs, OPs, Infectious disease specialists Core and sample reporters Denominators – GP, OPRA, LFS Standardised incidence rate ratios mitigate the uncertainty in the exact population covered by THOR

11. WRI reported by GPs in agricultural workers (2006-2012, UK) to THOR 3 year average incidence per 100, 000 workers All WRI - 2800 (SWI - 1430) MSD - 2035 Mental ill-health - 121

12. WRI in agricultural workers reported by clinical specialists (males, UK, 2002-2008)

13. WRI in agricultural workers reported by clinical specialists (UK) Significantly relative to all work related disease Skin cancer Allergic contact dermatitis Asthma Allergic alveolitis MSD Significantly relative to all work related disease Long latency respiratory disease Irritant contact dermatitis No significant difference Mental ill-health Infectious diseases

14. Ranking of causes of MSD in agricultural workers (UK, all physicians) 1. Lifting/bending/digging/manual work 2. Use of tools/heavy machinery 3. Animal related—not accidental 4. Accidents

15. Ranking of causes of asthma and allergic alveolitis in agricultural workers (UK, all physicians) 1. Hay/straw 2. Seeds/grains 3. Birds/animals 4 =. Fungal agents 4 =. Agricultural chemicals 5. Plants

16. Ranking of causes of contact dermatitis in agricultural workers (UK, all physicians) 1. Plants 2. Wet and dirty work 3. Nickel and/or chromates 4. Rubber found in boots, gloves and milking equipment 5. Soap/detergents/disinfectants 6. Colophony (pine resin)

17. Two-level longitudinal negative binomial regression model with random effects 1 Outcome variable (dependant) = no of cases per reporter per month Main predictor = time Adjusted for seasonality, first month of reporting, population offset Incidence rate ratios relative to base year Controlled ITS used to evaluate interventions 1 McNamee R et al OEM 2008: 65; 808-814 Method for analysing trends in incidence

18. Trends in work-related skin diseases in agricultural workers (UK)

19. Trends in work-related allergic respiratory diseases in agricultural workers (UK) Estimated annual change 0.92 (0.86-0.99)

20. Trends in work-related allergic respiratory diseases in agricultural workers (UK) and autumn rainfall

21. Trends in work-related MSD in agricultural workers (UK) Estimated annual change 0.94 (0.85 - 1.04)

22. EU Zoonoses Directive 2003/99/EC EU Zoonoses Regulation 2160/2003/EC Directive EC646/2007

23. Targets agreed with DEFRA, FSA, poultry industry and retailers – reduce campylobacter and salmonella - 2001 Salmonella National control programme in poultry - 2007

24. Work-related infectious diseases in agricultural workers (UK) NCP FSA

25. Trends in incidence of campylobacter in agricultural and food sectors FSA JWG

26. Trends in incidence of reports of diarrhoea and vomiting by occupation

27. Thanks to all the THOR team Raymond Agius Roseanne McNamee Melanie Carder Louise Hussey Sue Turner