Stakeholder Panel Migrant Farmworker Health Edward L. Zuroweste MD International Conference on Pesticide Exposure and Health July 9, 2002 NIH—Bethesda, Maryland Stakeholder Panel Migrant Farmworker Health Edward L. Zuroweste MD

Migrant Farmworker Health Status 2002 Poor Nutrition Poor Sanitation Poor Housing

Migrant Farmworker Health Status 2002 Poor access to health care Poor general health status Poverty

Migrant Farmworker Health Status 2002 Mobility Dangerous working conditions High pesticide exposure rate

Stoop Labor

Plane Spraying Pesticides Migrant Housing

What We Know About Migrant Farmworkers And Pesticides California Pesticide Illness Surveillance Program 1998-2000 Cancer Incidence in the United Farmworkers of America 1987-1997 California Cholinesterase levels of pesticide mixers/handlers Washington pesticide dose estimates for children in an agricultural community

California Pesticide Illness Surveillance Program 1998-2000 4,254 reports 3,092 pesticides possibly responsible 1,338 occurred in agricultural setting 465 occurred in field workers 303 occurred in packers/applicators 58% due to exposure to residue 42% due to exposure to drift

Cancer Incidence in the United Farmworkers of America 1987-1997 Several types of cancer were elevated in the UFW membership in comparison to the California Hispanic population. Incidence of leukemia, stomach, cervix, uterine cancers were all statistically significantly elevated Incidence of brain cancer was elevated but not statistically significant. Am.J.Industrial Med. 40:596-603 (2001)

Cholinesterase Testing Program for Pesticide Applicators Of the monitored workers, 24% were removed from duty for decreased plasma cholinesterase activity levels below 60% of their baseline. JOM vol. 35 no. 1 pg. 61-70 (Jan. 1993)

Biologically Based Pesticide Dose Estimates for Children in an Agricultural Community “The findings indicate that children living in agricultural regions represent an important subpopulation for public health evaluation, and that their exposures fall within a range of regulatory concern.” Environ. Health Perspectives 108:515-520 (2000)

Why This is the Tip of the Iceberg Most states/health care providers do a poor job at reporting pesticide exposure Pesticide illness/injury not a frequent health concern for farmworkers

Migrant Farmworker Survey Most Frequent Health Concerns 1) Tooth/gum problem 14) Arthritis 2) Eye problem 15) Coughing 3) Headache 16) High blood pressure 4) Backache 17) Digestive problem 5) Strong anger 18) Bladder problem 6) Nervousness 19) Skin rash 7) Irritability 20) Swollen joints 8) Menstrual problems 21) Allergies 9) Stomach pain 22) Ear pain 10) Low spirits 23) Anemia 11) Short of Breath 24) Diabetes Mellitus 12) Insomnia 25) Asthma 13) Chest pain 26) VD

Why This is the Tip of the Iceberg Migrant farmworkers present to health care providers at advanced stages of illness

What We Don’t Know about Migrant Farmworkers and Pesticides Low level and combination pesticide effects: Especially in children/pregnant women National statistics on pesticide-related illness and injury National statistics on cholinesterase monitoring of pesticide handlers

What Should We Do As Healthcare Providers?? We could just “hope” that things will get better.

What We Need Regarding Migrant Farmworkers and Pesticides National pesticide illness reporting Extend the Food Quality Protection Act’s (FQPA) “reasonable certainty of no harm” standard to regulate occupational risks. Require growers to monitor the cholinesterase levels of pesticide handlers.

What We Need Regarding Migrant Farmworkers and Pesticides (cont) Extend full workers compensation coverage to farmworkers in all states. Systematically eliminate the most harmful pesticides. Increase research/usage of nonchemical/biopesticides.