Man Vs chemical misuses and consequences Dr. Inoka Suraweera MBBS,MSc, MD (Community Medicine) Consultant Community Physician Environmental and Occupational Health Directorate Ministry of Health

CHEMICALS ARE USED IN EVERYDAY LIFE Benefits Promote hygiene Protect crops Control vectors Risks Adverse health effects Unwanted pollutants in the environment Persistence <<READ SLIDE>> Chemicals are used in everyday life – they bring in numerous benefits, such as protecting human and animal health, promoting hygiene, protecting crops, controlling vectors of disease. However, chemicals may also pose risks to human and animal health. Exposures to chemicals in the micro- and macro-environments of children may cause functional and organic damage, especially during periods of vulnerability. Many become unwanted pollutants and some of these are persistent in the environment. Ref: Goldman L, Tran N. Toxics and poverty: the impact of toxic substances on the poor in developing countries. The World Bank, Washington DC, 2002. WHO. Children's health and the environment: a global perspective. Pronczuk J, ed. WHO, Geneva, 2005 WHO/UNEP. Healthy environments for healthy children. Key messages for action. WHO, Geneva, 2010. Available at www.who.int/ceh/publications/hehc_booklet/en/index.html – accessed May 2011. Image: WHO WHO 2

So Many Chemicals so Little Data 2863 above 1 Million pounds 12 or 0.4% good data 21.4% some data 78.2% no data www.preventingharm.org

Current Chemical Facts April 23, 2017 Current Chemical Facts Approximately 80,000 chemicals listed by EPA Most of these chemicals have not been tested for developmental toxicity For example, High Production Volume (HPV) Chemicals Chemicals produced at >1 million lbs/year Approximately 3,000 chemicals identified internationally Few tested for both reproductive and developmental toxicity ELSI - 2/10/04

Ancient Awareness 399 BC Death of Socrates by Hemlock Socrates was charged with religious heresy and corrupting the morals of local youth. The active chemical used was the alkaloid coniine which, when ingested causes paralysis, convulsions and potentially death.

Historical Awareness From Romeo and Juliet - act 5 Come bitter pilot, now at once run on The dashing rocks thy seasick weary bark! Here’s to my love! O true apothecary! Thy drugs are quick. Thus with a kiss I die. Shakespeare (1564-1616)

Paracelsus “All substances are poisons; there is none which is not a poison. The right dose differentiates a poison from a remedy.” Paracelsus (1493-1541)

April 23, 2017 Silent Spring “As crude a weapon as a cave man’s club, the chemical barrage has been hurled against the fabric of life.” Rachel Carson – Silent Spring (1962) A Small Dose of Toxicology - Overview

Improper transportation Improper manufacturing practices Too much Too little Chemical weapons Improper disposal Improper transportation Chemical Misuse Improper storage Improper manufacturing practices Improper handling

Who will be affected? Individuals Populations Especially children Workers

Individuals Deliberate self harm with chemicals A public health problem Though the rate of suicide has declined to 16 per 100,000 in 2011, it remains among the worst globally.  Around 60% suicides are due to pesticide poisonings Mostly due to ingestion of highly toxic pesticides Paracetamol Kaneru / niyagala Washing powder Decline is due to many interventions and especially due to banning some of the highly toxic pesticides.

Workers and misuse of chemicals Characteristics of Sri Lankan workforce (Sri Lanka Labour Force Survey Annual Report – 2013) Employed population in Sri Lanka 8,417,674 Males 5,498,815 (65.5%) Females 2,918,859 (34.5%) Formal sector 39.2% Informal sector 60.8 % Agriculture 86.8 % Non agriculture 49.8 %

Selected occupational carcinogens and health outcomes Benzene Leukaemia Ethylene oxide Silica Cancer of the trachea, bronchus, or lung Asbestos Malignant mesothelioma, Lung cancers Diesel exhaust

Available data on chemicals in occupations WHO: Chemicals burden of disease | 20 May 2011 Chemical groups Disease outcomes Attributable fraction Deaths Per year DALYs Chemicals in occupational exposures (longer term effects) 581,000 (sub-total) 6,763,000 (sub-total) Asbestos Mesothelioma; lung cancer 107,000 1,523,000 Occupational lung carcinogens (8 selected carcinogens) Lung cancer (8 6%) 111000 1 011 000 Occupational leukaemogens (benzene ethylene oxide ionizing rad ) Leukaemia (2.3%) 7400 113,000 Occupational particulates – causing COPD (dusts, fumes/gas) COPD (13%) 375,000 3,804,000 Occupational particulates - other respiratory diseases than COPD (silica, asbestos and coal mine dust) Asbestosis; silicosis pneumoconiosis 29000 1,062,000

More than 8% of all cancer deaths in men are due to occupational exposures, and for lung cancer, the most important occupational cancer, the estimate for men is above 20% Estimating the burden of occupational cancer as a strategic step to prevention Kurt Straif1,* British Journal of Cancer. 2012 Jun 19; 107(Suppl 1): S1–S2 2.0% of global deaths (1.7% of DALYs) are from industrial and agricultural chemicals, and accidental poisonings

Pesticide Definition - Simple April 23, 2017 Pesticide Definition - Simple The function of a pesticide is to kill or harm some form of life A Small Dose of Toxicology - Overview

Concerns about Pesticide-Use Health Outcomes Vulnerable Populations Environmental Damage Pest Resistance Immediate Flu-like symptoms Skin Rash Breathing problems Long-Term Asthma Cancer Damage to brain and nervous system Immune system damage Endocrine disruption There are many concerns associated with pesticide-use. In fact, risk from exposure may outweigh the benefit of killing pests. One significant concern is health outcomes. Many studies have shown that exposure to pesticides can cause immediate reactions, and we know that there can also be long-term health problems. Exposure to pesticides over a long time may also cause sickness or affect development. New studies show that children regularly exposed to low levels of pesticides may not be poisoned or get sick right away, but they may suffer from health problems that don’t show up for many years. This image is from a study from Mexico on exposure to pesticides. Children ages 4-5 years old in two different communities were asked to draw a picture of a person. On the left are children’s drawings who lived in the foothills where pesticide were not used and on the right are children’s drawings who lived in the valley where pesticide use was used widely. You can see the difference in the drawings of the kids. www.toxicsoy.org/toxicsoy/news/Artikelen/2009/7/1_Girl_suffering_from_pesticide_poisoning.html E A Guillette, M M Meza, M G Aquilar, A D Soto, and I E Garcia, (1998), An anthropological approach to the evaluation of preschool children exposed to pesticides in Mexico. Environ Health Perspect.,106(6)

Long-Term Exposure to Pesticides Cancer Develop-mental Others? Behavioral Allergies Brain Damage Infertility Asthma Birth Defects Chronic Exposure: Asthma Cancer Neurological damage Immune system damage Permanent chemical sensitivity Endocrine disruption

Chemical accidents

Event Sudden leakage of a gas (??Ammonia) Around midnight Only the security guard was available at the time of the accident

Immediate effects Around 70 hospitalized to Piliyandala Divisional Hospital Some had been transferred to Kalubowila Teaching Hospital Majority had difficulty in breathing Severe eye irritation Burning sensation of the skin

Other effects Mental health problems Public Health issues such as Water safety Food safety (Veterinary health issues)