Obstacles in diagnosing and confirmation of occupational diseases in private farming in Poland.

The World Health Organization (WHO) documents state that the improvement of public health is the primary aim of social and economic development. It is emphasised in these documents that the important goal is the reduction of the ‘health gap’ i.e. inequalities in the state of health and availability of health care between communities, both on the level of the European Region and in the individual countries, in order to improve the health of the whole population. Adequate and well-developed health policies of the European Union member States should create the basis for necessary progress. Private farmers in Poland constitute approximately 20% of the total population employed in the national economy. Despite this, to date, this population group has been neglected by both the opinion forming and decision making circles shaping the system for the safety and protection of human health in the work environment. Furthermore, prior to 1977, private farmers in Poland were not covered by any organized medical care. This was not until the Act in the Matter of Retirement Programme and Other Benefits for Farmers and their Families acknowledged their right to free medical care and use of all benefits associated with it, on the same principles as for other social groups [7, 11, 12, 13]. However, occupational diseases in private farming have only been recognized since 1992, after the promulgation of the Act in the Matter of Farmers’ Social Insurance, which simultaneously established the Agricultural Social Insurance Fund [4]. Nevertheless, unlike all other occupational groups, private farmers remained outside any system providing them with prophylactic medical care in association with the occupation performed. Such a situation is difficult to understand when one considers the fact that private farmers are at higher risk of occupational accident, health, or even loss of life, compared to employees in other sectors of the economy [5, 14]. Occupational disease is a medical and legal term which, from the medical point of view, is a health disorder caused by factors harmful to human health present in the work environment. Legislation limits the term “occupational disease” to a disease listed in the index of occupational diseases as an annex to the Regulation by the Council of Ministers of 18 November 1983 in the Matter of Occupational Diseases [3]. According to Article 12 of the Act in the Matter of Farmers’ Social Insurance, an agricultural occupational disease is a disease which occurs in association with work on a farm, if this disease is included in the index of occupational diseases specified by regulations issued based on the Labour Code [4]. The number of occupational diseases registered in private farming is low. The data by the Agricultural Social Insurance Fund show that within the population of over 3.5 million of private farmers, between 1992 and 2006 there were, respectively: 8, 20, 61, 80, 82, 139, 141, 142, 116, 113, 135, 104, 122, 136 and 107 cases of occupational diseases registered, while within the 10-fold smaller group of state agricultural workers, during the same period, over 200 cases of occupational diseases were registered annually [2, 5, 10]. This clearly shows that the system of adjudication of occupational diseases in effect in Poland has not been adjusted to cover private farmers. It is also difficult to assume that strenuous work, typical of agricultural production, as well as the low level of concern about health, common in rural areas, and frequent lack of knowledge concerning health hazards caused by various factors occurring in the work environment, would not have been reflected by the prevalence of diseases which, according to the current regulations, could qualify as occupational diseases [1, 8, 9]. The whole procedure in the case of adjudication of occupational diseases, from the stage of suspicion of such a disease, followed by medical certification, and finalised by administrative corroboration of the disease, is covered by it own legislative regulation [6]. The adjudication procedure in the case of occupational diseases consists of three stages: 1. Suspicion of an occupational disease 2. Medical diagnosis and certification of an occupational disease 3. Issuing of an administrative decision corroborating an occupational disease.