EPA’s Health Care Provider Initiative Kevin Keaney, Chief Pesticide Worker Safety Programs U. S. EPA 2005

EPA’s Health Care Provider Initiative

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EPA’s Health Care Provider Initiative

EPA’s Health Care Provider Initiative Pacific Northwest Agricultural Safety & Health Center (PNASH) Established in 1996 One of nine Agricultural Safety & Health Centers created by NIOSH Part of the Dept. of Environmental & Occupational Health Sciences at the University of Washington School of Public Health & Community Medicine. Ranked as fourth best school of public health in the nation. Goal: Reduce occupational disease and injury among those who work in agriculture and their families. Emphasizes partnerships and collaboration with a wide range of stakeholders, from employers to community organizations.

EPA’s Health Care Provider Initiative

EPA’s Health Care Provider Initiative Migrant Clinicians Network A national, not-for-profit organization Founded in 1984 by clinicians working in migrant health. Nearly 2,000 members The oldest and second largest clinical network serving the underserved Goal: Improve health care of migrants and other mobile poor populations by providing support, technical assistance, and professional development services to clinicians.

Tracking Occupational Pesticide Incidents for Pesticide Worker Safety.

Occupational Pesticide Incidents Incidents: “health” = a well-documented exposure from pesticide use in an occupational context resulting in adverse health effects. The source of the data must be credible, accurate and unbiased. “enforcement” = a well documented regulatory agency’s pesticide enforcement action.

Problem and Intent Problem: Currently there is no national program that collects accurate, unbiased pesticide incident data. Statement of Intent: Collect, analyze and communicate accurate, unbiased incident data in order to improve risk assessment, risk management and field programs that affect occupational pesticide workers.

Goals Utilize incident data to: 1. Improve field programs 2. Improve risk assessment 3. Improve risk management 4. Enhance communications with stakeholders 5. Evaluate program progress

Workers Exposed to Pesticides Establish & Communicate Safety Measures Risk Management Data Analysis Outcome Measures Trend Analyses Feedback to Data Selection Data Selection Identify Evaluate Select Pesticide Worker Safety Communicate to the public

Data Selection: Incident Databases There are a number of databases which capture worker incident data. Specific criteria will be used to evaluate and make proposed decisions for our use of these data bases.

Data Selection Are the data valuable, acceptable, useful, and meaningful?Are the data valuable, acceptable, useful, and meaningful? Is the associated burden low – easy to collect, costs are acceptable, small number of measures, and user friendlyIs the associated burden low – easy to collect, costs are acceptable, small number of measures, and user friendly Data that can be used nowData that can be used now Data that could be used, if modifiedData that could be used, if modified

Data Selection List HealthSENSOR CA Program Poison Control FIFRA 6(a)2 NPIC Worker’s Comp WA ChE WA ChEEnforcement National Pesticide Field Data plan Compliance Action Tracking Systems Support Data National Agricultural Workers Survey Bureau of Labor Statistics Usage Data Cert. Applic. #s

Data Collection Evaluation Criteria Content Occupational extractability Chemical type - active ingredient Level of detail in case description, raw data Link to enforcement - specific violations, investigations, independent verification Classification of probability - causality, confidence in pesticides being cause Severity index - how serious were symptoms Representative Data reliability - collection method; are incidents self-reported or do the data originate from health care practitioner; is there follow-up on the cases Baseline availability - data longevity, depth and breadth of database Presentation Accessibility - can we get the data, is it in a database, are the formats consistent, cooperation of owner Cost $, FTE

Health Data Selection: Evaluation Data Source Che mica l colle cted Occu pation al expos ure Represen tative sample for nation User - frien dline ss Classific ation of probabil ity Seve rity inde x Link with enforc ement Data reliabi lity Data acces sibilit y Level of detail Baselin e availab le Cos t Propose d Decisio n SENSO R YYYYYYNHYMYMaccep t PISP YYNYYNYHYHYLaccep t PCC/ TESS Y Not well ??NYNLYMYMaccep t FIFRA 6(a)2 Y Not well NNNYNLNLYLimpro ve NPIC Y Not well YNYYNLNLYHreject Workers Comp NYNNNYNHNHNHreject

Enforcement Data Information on regulatory investigations linked to specific incidents useful for: Information on regulatory investigations linked to specific incidents useful for: Determining application specifics and why incident occurred,Determining application specifics and why incident occurred, If a violation, which part of the regulatory scheme was not followedIf a violation, which part of the regulatory scheme was not followed Tracking incident cause in order to formulate program improvementsTracking incident cause in order to formulate program improvements OECA “5700” Forms summarize state inspection totals - includes totals by WP rule sections OECA “5700” Forms summarize state inspection totals - includes totals by WP rule sections Most states only report federally funded inspections - enforcement data is subset of state total Most states only report federally funded inspections - enforcement data is subset of state total

National Pesticide Field Data – Enforcement Database is a collection of closed pesticide enforcement cases from several states Database is a collection of closed pesticide enforcement cases from several states - Severely limited in content for purposes of incident analysis, exact violation not collected -No quality control of the data - no plan for links to incident data to incident data Proposed action: enforcement and state liaisons should pursue development to improve usefulness for measures. In its current state, the data are not useful.

Compliance Action Tracking Systems - Enforcement Systems were developed to help state lead agencies communicate their enforcement activities. Two regions and several states outside those regions use these tracking systems for their enforcement data. Systems were developed to help state lead agencies communicate their enforcement activities. Two regions and several states outside those regions use these tracking systems for their enforcement data. + Collects enforcement data - Unclear whether adequate detail is available - Link to incident data seems absent Proposed Action: continue review and work with enforcement and state liaisons on gathering enforcement data

Supporting Data Information about pesticide use patterns, migrant worker demographics, worker attributes Used to characterize exposed populations and develop incident rate estimates Important in understanding the context of pesticide and agricultural worker issues.

Supporting Data National Agricultural Worker Survey National Agricultural Worker Survey Bureau of Labor Statistics Bureau of Labor Statistics Pesticide usage data – amount used on crops by state - includes USDA / NASS, Doane, CA pesticide use reporting Pesticide usage data – amount used on crops by state - includes USDA / NASS, Doane, CA pesticide use reporting Certified applicator numbers Certified applicator numbers

Health Care Provider Initiative & National Incidents Report ANY QUESTIONS ?