Becot Florence A, Inwood Shoshanah M
National Farm Medicine Center, Marshfield Clinic Research Institute, 1000 N Oak Ave, Marshfield, WI 54449 USA.
School of Environment and Natural Resources, The Ohio State University, 132 Williams Hall, 1680 Madison Avenue, Wooster, OH 44691 USA.
Agric Human Values. 2022;39(3):1097-1116. doi: 10.1007/s10460-022-10307-4. Epub 2022 Feb 16.
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.
近年来，面对持续的变化，农场家庭为何、如何以及哪些家庭继续从事农业这一长期存在的问题越来越多地通过恢复力视角进行研究。虽然这一系列工作正在提供更新颖的见解，但两个局限性，即关注农场经营面临的宏观层面挑战以及挑战规模与恢复力措施之间的不匹配，可能会限制我们对其中起作用因素的理解。我们以医疗经济脆弱性为例，这是一个传统上局限于农业家庭系统家庭领域的微观层面挑战，以此来引起对这些局限性的关注。以美国农场家庭为研究对象，我们评估：（1）在使用客观和主观结果指标时，他们在多大程度上经历医疗经济脆弱性？（2）哪些人口统计学和农场特征与经历医疗经济脆弱性相关？（3）制度安排与医疗经济脆弱性之间有何关联？我们对900多项调查的分析，再加上一个融合了来自三个文献体系互补见解的概念框架，结果显示，客观和主观指标衡量的医疗经济脆弱性患病率存在明显差异，主观指标表明大多数受访者普遍存在医疗经济脆弱感。相反，基于人口统计学和农场特征，在哪些人经历医疗脆弱性方面观察到的差异有限，更强的关联与家庭的健康保险安排有关。我们最后阐述了研究结果对农场恢复力文献的三点启示。
