Medical economic vulnerability: a next step in expanding the farm resilience scholarship

Abstract

In recent years, the long-standing questions of why, how, and which farm families continue farming in the face of ongoing changes have increasingly been studied through the resilience lens. While this body of work is providing updated and novel insights, two limitations, a focus on macro-level challenges faced by the farm operation and a mismatch between the scale of challenges and resilience measures, likely limit our understanding of the factors at play. We use the example of medical economic vulnerability, a micro-level challenge traditionally confined to the household sphere of the agri-family system, as a way to call attention to these limitations. Focusing on United States (U.S.) farm households, we assess: (1) To what extent are they experiencing medical economic vulnerability when using objective and subjective outcome measures? (2) Which demographic and farm characteristics are associated with experiencing medical economic vulnerability? (3) What is the association between institutional arrangements and medical economic vulnerability? Our analysis of over 900 surveys coupled with a conceptual framework merging complementary insights from three bodies of literature revealed seemingly large differences in the prevalence of medical economic vulnerability across the objective and subjective measures with the subjective measure indicating a general sentiment of medical economic vulnerability in a majority of respondents. Conversely, limited variations were noted in who experiences medical vulnerability on the basis of demographic and farm characteristics, with stronger associations being connected to the households’ health insurance arrangements. We conclude with three implications of our findings for the farm resilience literature.

Childcare for farm families: A key strategy to keep children safe yet largely absent from farm programming

“…Collectively and with variations among individual interviewees aside, our findings align with those of other researchers regarding how invisible practical, lived realities of raising children on farms can be. This includes lines of research on the invisibility of women's work ( 81 , 82 ), farm women ( 31 , 51 , 83 ), and farm household-level issues ( 27 , 84 , 85 ). This also includes lines of research on the representation and integration of farm women in institutions pointing to women being underserved by educational programs ( 51 , 55 , 58 , 59 , 86 ), underrepresented in farm organizations ( 52 , 53 , 56 , 87 , 88 ), and their presence and contributions not included in farm statistics ( 54 , 89 , 90 ).…”

Examining access to health insurance and health care along the life course to shed light on interactions between farm households’ social needs, social policy and the farm business

“…These seemingly high rates of health insurance coverage and health care utilisation mask farm households’ challenges meeting their health care needs with a range of implications for the farm business. Farmers have ranked rising health‐related costs as threats to their livelihood and as a stressor (Inwood 2015; Chang et al., 2011; Freeman et al., 2008; Lottero et al., 2007) with challenges connected to underinsurance and medical economic vulnerability (Ahearn et al., 2015; Becot & Inwood 2022; Pryor et al., 2008; Pryor et al., 2009). Farmers also have difficulty meeting their health care needs due to the inability to take time off, reticence to seeking care, distance to and lack of health care providers, lack of and/or difficulties obtaining health insurance (Adaire Jones et al., 2009; Dulitz & Schrader 2013; Earle‐Richardson et al., 2015; Lottero et al., 2007).…”

“…Despite the important role played by the farm household in propping up the farm business, less is known about farm households' social and economic needs along the life course (i.e., the planned and unplanned events of life such as birth, maternity, retirement, unemployment, poverty, illness, accidents and death), and the extent to which challenges meeting these needs impacts the farm business trajectory. Indeed, a small body of research has documented difficulties farm households can face meeting their social needs including access to health insurance and health care (Amiotte-Suchet et al, 2017;Inwood et al, 2018;Chang et al, 2011;Chappuis et al, 2015;Evangelakaki et al, 2020;Stayner & Barclay 2002), childcare (Rissing et al, 2021;Becot, 2022), poverty (Contzen & Crettaz 2019;Courtenay Botterill 2007;Gundersen & Offutt 2005;Roche 2016) and retirement income (Contzen et al, 2016;Davis et al, 2009). Yet scholarly consideration of how household challenges interact with the personal and professional farm spheres has been more tangential than intentional (Becot & Inwood 2020).…”