Evaluating health risks from occupational exposure to pesticides and the regulatory response.

In this study, we used measurements of occupational exposures to pesticides in agriculture to evaluate health risks and analyzed how the federal regulatory program is addressing these risks. Dose estimates developed by the State of California from measured occupational exposures to 41 pesticides were compared to standard indices of acute toxicity (LD50) and chronic effects (reference dose). Lifetime cancer risks were estimated using cancer potencies. Estimated absorbed daily doses for mixers, loaders, and applicators of pesticides ranged from less than 0.0001% to 48% of the estimated human LD50 values, and doses for 10 of 40 pesticides exceeded 1% of the estimated human LD50 values. Estimated lifetime absorbed daily doses ranged from 0.1% to 114,000% of the reference doses developed by the U.S. Environmental Protection Agency, and doses for 13 of 25 pesticides were above them. Lifetime cancer risks ranged from 1 per million to 1700 per million, and estimates for 12 of 13 pesticides were above 1 per million. Similar results were obtained for field workers and flaggers. For the pesticides examined, exposures pose greater risks of chronic effects than acute effects. Exposure reduction measures, including use of closed mixing systems and personal protective equipment, significantly reduced exposures. Proposed regulations rely primarily on requirements for personal protective equipment and use restrictions to protect workers. Chronic health risks are not considered in setting these requirements. Reviews of pesticides by the federal pesticide regulatory program have had little effect on occupational risks. Policy strategies that offer immediate protection for workers and that are not dependent on extensive review of individual pesticides should be pursued.     

Status of legislation and regulatory control of public health pesticides in countries endemic with or at risk of major vector-borne diseases

Background: Legislation and regulation of pesticides used in public health are essential for reducing risks to human health and the environment.Objective: We assessed the global situation on legislation and regulatory control of public health pesticides.Methods: A peer-reviewed and field-tested questionnaire was distributed to 142 member states of the World Health Organization (WHO); 113 states completed the questionnaire.Results: Legislation on public health pesticides was absent in 25% of the countries. Where present, legislation often lacked comprehensiveness, for example, on basic aspects such as labeling, storage, transport, and disposal of public health pesticides. Guidelines or essential requirements for the process of pesticide registration were lacking in many countries. The capacity to enforce regulations was considered to be weak across WHO regions. Half of all countries lacked pesticide quality control laboratories, and two-thirds reported high concern over quality of products on the market. National statistics on production and trade of pesticides and poisoning incidents were lacking in many countries. Despite the shortcomings, WHO recommendations were considered to constitute a supportive or sole basis in national registration. Also, some regions showed high participation of countries in regional schemes to harmonize pesticide registration requirements.Conclusions: Critical deficiencies are evident in the legislative and regulatory framework for public health pesticides across regions, posing risks to human health and the environment. Recent experience in some countries with situational analysis, needs assessment, action planning, and regional collaboration has signaled a promising way forward.     

The politics behind the implementation of the WTO Paragraph 6 Decision in Canada to increase global drug access

Background

The U.S. imports a substantial and increasing portion of its fruits and vegetables. The U.S. Food and Drug Administration currently inspects less than one percent of import shipments. While countries exporting to the U.S. are expected to comply with U.S. tolerances, including allowable pesticide residue levels, there is a low rate of import inspections and few other incentives for compliance.

Methods

This analysis estimates the quantity of excess pesticide residue that could enter the U.S. if exporters followed originating country requirements but not U.S. pesticide tolerances, for the top 20 imported produce items based on quantities imported and U.S. consumption levels. Pesticide health effects data are also shown.

Results

The model estimates that for the identified items, 120 439 kg of pesticides in excess of U.S. tolerances could potentially be imported to the U.S., in cases where U.S. regulations are more protective than those of originating countries. This figure is in addition to residues allowed on domestic produce. In the modeling, the top produce item, market, and pesticide of concern were oranges, Chile, and Zeta-Cypermethrin. Pesticides in this review are associated with health effects on 13 body systems, and some are associated with carcinogenic effects.

Conclusions

There is a critical information gap regarding pesticide residues on produce imported to the U.S. Without a more thorough sampling program, it is not possible accurately to characterize risks introduced by produce importation. The scenario presented herein relies on assumptions, and should be considered illustrative. The analysis highlights the need for additional investigation and resources for monitoring, enforcement, and other interventions, to improve import food safety and reduce pesticide exposures in originating countries.     

The federal response to the AIDS epidemic.

The response of the U.S. government to the AIDS epidemic is reviewed within the context of health policy making in the U.S.A. in general and the reduced role of the federal government in domestic social programs in particular. This review involves multiple levels of government, the relationship of government to the private sector, the diffusion of authority within a federal system, the long delays in policy implementation because of the absence of mechanisms to deal with emergency situations, the tendency to fund the response to AIDS from reallocation of appropriated funds, thereby creating financial distress for existing programs. The federal response to AIDS is considered uncoordinated, insufficient and inadequate in particular with respect to the support of public health education and the financing of health care for AIDS patients. These are needed while a vaccine may still be years away.     

U.S. Funding Is Insufficient to Address the Human Health Impacts of and Public Health Responses to Climate Variability and Change

Background

The need to identify and try to prevent adverse health impacts of climate change has risen to the forefront of climate change policy debates and become a top priority of the public health community. Given the observed and projected changes in climate and weather patterns, their current and anticipated health impacts, and the significant degree of regulatory discussion underway in the U.S. government, it is reasonable to determine the extent of federal investment in research to understand, avoid, prepare for, and respond to the human health impacts of climate change in the United States.

Objective

In this commentary we summarize the health risks of climate change in the United States and examine the extent of federal funding devoted to understanding, avoiding, preparing for, and responding to the human health risks of climate change.

Discussion

Future climate change is projected to exacerbate various current health problems, including heat-related mortality, diarrheal diseases, and diseases associated with exposure to ozone and aeroallergens. Demographic trends and geophysical and socioeconomic factors could increase overall vulnerability. Despite these risks, extramural federal funding of climate change and health research is estimated to be < $3 million per year.

Conclusions

Given the real risks that climate change poses for U.S. populations, the National Institutes of Health, Centers for Disease Control and Prevention, U.S. Environmental Protection Agency, and other agencies need to have robust intramural and extramural programs, with funding of > $200 million annually. Oversight of the size and priorities of these programs could be provided by a standing committee within the National Academy of Sciences.     

Food fight: the battle over redefining competitive foods

BACKGROUND: Environmental and policy influences are potentially the most powerful-and yet the least understood-strategies for reversing the current childhood obesity epidemic. METHODS: This essay focuses on the school lunch environment and examines the key legal and policy factors that affect competitive foods or foods of minimal nutritional value (FMNV) in schools. The essay also analyzes the latest, proposed federal legislation on redefining competitive foods. RESULTS: FMNV compete for children's coins and calories in the school food environment. The emerging scientific record on the negative impact competitive foods have on children's diet and health is significantly stronger than when Congress and the United States Department of Agriculture (USDA) secretary first deemed the connection sufficient to take action. The Child Nutrition Promotion and School Lunch Protection Act of 2006, if enacted, will provide additional authority to the USDA and supply science-based federal guidance to local schools. Opposition to this legislation may come from the local school districts, the food industry, parents, and children. CONCLUSIONS: Defining competitive foods in a federally consistent manner and eliminating competitive foods from our nation's schools are food fight that will evidently be fought by legislative efforts at the local, state, and federal level. The food industry, as history illustrates, will likely work hard to weaken any regulatory efforts and could potentially demand that this fight end up requiring judicial review.     

Achieving U.S. Health information technology adoption: the need for a third hand

The U.S. health care information technology (HIT) market is broken; broad-scale adoption of HIT is not occurring despite considerable evidence of its impact on the quality of care and patient safety. Although adoption of HIT will not cure all that ails health care, it is an important step toward transformation of the U.S. health care delivery system. In this commentary I describe several critical issues pertaining to the HIT market failure and several ways in which the federal government may act as a deft and gentle "Third Hand" to assist the Invisible Hand of Adam Smith.     

Risk management and intrusions on medical practice: striking a balance

All drugs have risks. Scott Gottlieb suggests that the federal government should leave management of those risks to medical professionals. At issue is legislation to strengthen the Food and Drug Administration's (FDA's) authority and ability to manage those risks over a drug's life cycle. The Enhancing Drug Safety and Innovation Act (S. 484) would codify the FDA's authority to impose restrictions on distribution and use after approval of a drug and require those restrictions to be adapted to new information about the safety of the drug. The legislation strikes a realistic balance between risk management and intrusions on medical practice.     

Selected myths guiding the Reagan Administration's health policies

This article analyzes four major assumptions that guide the Reagan Administration's health policies: 1) the Administration received an overwhelming popular mandate to reduce the federal role in the U.S. health sector; 2) the size and growth of federal social (including health) expenditures are contributing to the current economic recession; 3) the costs to business of federally imposed health and safety regulations have contributed to making the U.S. economy less competitive; and 4) market intervention is intrinsically more efficient than government intervention in regulating the costs and distribution of health resources. Based on these assumptions, the main characteristics of the Reagan Administration's health policies have been 1) a reduction of federal health expenditures and, very much in particular, expenditures to the poor, handicapped, and elderly; 2) a weakening of federal health and safety regulations to protect workers, consumers, and the environment; and 3) the further privatization and commodification of medical services. This article shows that there is no evidence to support the assumptions on which these policies are based. Quite to the contrary, all available evidence shows the opposite: 1) the majority of Americans want an expansion of federal health expenditures and a strengthening of federal health regulation; 2) U.S. government expenditures and regulations are much more limited than those of other countries whose economies are performing more satisfactorily; and 3) those countries with larger government interventions have more efficient health care systems than the American one, where the "free market" forces are primarily responsible for the allocation of resources. Thus, major Reagan Administration health policies are based on myth rather than reality.     

Are tick medications pesticides? Implications for health and risk perception for workers in the dairy cattle sector

This article seeks to characterize the risks related to the use of pesticides in dairy production, in terms of legislation, health and perception of risk for workers involved in this activity. It is based on methodological articulation that included: a) systematic review of the reference literature on the research topic; b) analysis of related legislation (veterinary products and pesticides); c) risk identification regarding the use of veterinary products formulated using active ingredients listed as pesticides; d) and risk perception analysis of a group of dairy production workers. Results indicate a situation of particular interest to Public Health. Regarding dairy production workers, the invisibility of risks associated with handling pesticides for veterinary use, increases their exposure and is related to several health problems, especially for women. This same invisibility leads to a neglect of the prohibition period between pesticide use and consumption of other products. Part of the problem may be associated with the non-classification of pesticides for veterinary use as 'pesticides' (they are classified as veterinary products), which highlights the importance and the urgency of discussion of the theme.     

Pesticide exposures, cholinesterase depression, and symptoms among North Carolina migrant farmworkers.

OBJECTIVES. We conducted a clinic-based study of erythrocyte cholinesterase levels, pesticide exposures, and health effects among farmworkers and nonfarmworkers to determine risks for exposure and associated morbidity. METHODS. Two hundred two farmworkers and 42 nonfarmworkers were recruited sequentially at two community health centers. Erythrocyte cholinesterase levels were measured colorimetrically. Questionnaires obtained data on demographics, occupational history, exposures, and symptoms. RESULTS. Cholinesterase levels were significantly lower among farmworkers (30.28 U/g hemoglobin) than among nonfarmworkers (32.3 U/g hemoglobin). Twelve percent of farmworkers, but no nonfarmworkers, had very low levels. Farmworkers applying pesticides also had lower cholinesterase levels. One half of farmworkers reported being sprayed by pesticides and working in fields with an obvious chemical smell. Of reported symptoms, only diarrhea was associated with cholinesterase levels. Reported exposures, however, were strongly associated with symptoms. CONCLUSIONS. Farmworkers reported many pesticide exposures that violate state and federal regulations. Farmworkers had cholinesterase levels significantly lower than those of nonfarmworkers, although only spraying pesticides was associated with very low levels.     

Pesticide exports from U.S. ports, 2001-2003

Analysis of U.S. Custom Service records for 2001-2003 indicates that nearly 1.7 billion pounds of pesticide products were exported from U.S. ports, a rate >32 tons/hour. Exports included >27 million pounds of pesticides whose use is forbidden in the United States. WHO Class 1a and 1b pesticides were exported at an average rate of >16 tons/day. Pesticide exports included >500,000 pounds of known or suspected carcinogens, with most going to developing countries; pesticides associated with endocrine disruption were exported at an average rate of >100 tons/day. Although the rate of export of banned products declined, as did exports of pesticides included in global conventions on Prior Informed Consent and Persistent Organic Pollutions, substantial quantities of hazardous products remain in trade. These products pose unacceptable risks in countries where unsafe use and storage practices are prevalent. Policy makers, growers, and scientists must undertake more aggressive efforts to foster sustainable agricultural practices globally.     

Risk assessment and management of occupational exposure to pesticides in agriculture

Nearly 50% of the world labour force is employed in agriculture. Over the last 50 years, agriculture has deeply changed with a massive utilisation of pesticides and fertilisers to enhance crop protection and production, food quality and food preservation. Pesticides are also increasingly employed for public health purposes and for domestic use. Pesticide are unique chemicals as they are intrinsically toxic for several biological targets, are deliberately spread into the environment, and their toxicity has a limited species selectivity. Pesticide toxicity depends on the compound family and is generally greater for the older compounds; in humans, they are responsible for acute poisonings as well as for long term health effects, including cancer and adverse effects on reproduction. Due to their intrinsic toxicity, in most countries a specific and complex legislation prescribes a thorough risk assessment process for pesticides prior to their entrance to the market (pre-marketing risk assessment). The post-marketing risk assessment takes place during the use of pesticides and aims at assessing the risk for exposed operators. The results of the risk assessment are the base for the health surveillance of exposed workers. Occupational exposure to pesticides in agriculture concerns product distributors, mixers and loaders, applicators, bystanders, and rural workers re-entering the fields shortly after treatment. Assessing and managing the occupational health risks posed by the use of pesticides in agriculture is a complex but essential task for occupational health specialists and toxicologists. In spite of the economic and social importance of agriculture, the health protection of agricultural workforce has been overlooked for too many years, causing an heavy tribute paid in terms of avoidable diseases, human sufferance, and economic losses. Particularly in the developing countries, where agricultural work is one of the predominant job, a sustainable model of development calls for more attention to occupational risks in agriculture. The experience of many countries has shown that prevention of health risk caused by pesticides is technically feasible and economically rewarding for the individuals and the whole community. A proper risk assessment and management of pesticide use is an essential component of this preventative     

Pesticide exports from U.S. ports, 1997-2000.

U.S. Customs records reveal that 3.2 billion pounds of pesticide products were exported in 1997-2000, an average rate of 45 tons per hour. Nearly 65 million pounds of the exported pesticides were either forbidden or severely restricted in the United States; however, no banned pesticide export was recorded for the year 2000. 2.2 million pounds of pesticides regulated under a treaty on persistent organic pollutants (POPs) were exported between 1997 and 1999, with no such export in 2000. Exports of pesticides subject to the prior informed consent (PIC) treaty decreased 97% from the 1997 total of nearly 3 million pounds. Thus, international efforts to reduce the trade in hazardous pesticides may be bearing fruit. However, they are balanced by high rates of export of pesticides designated "extremely hazardous" by the WHO (89 million pounds), pesticides associated with cancer (170 million pounds), and pesticides associated with endocrine disrupting effects (368 million pounds), mostly to developing countries. These findings point in two directions: first, progress is possible, and second, the focus of international efforts should be expanded. From public health and environmental protection perspectives, exports of hazardous pesticides remain unacceptably high.     

Pesticide Exports from U.S. Ports, 2001–2003

Abstract

Analysis of U.S. Custom Service records for 2001-2003 indicates that nearly 1.7 billion pounds of pesticide products were exported from U.S. ports, a rate >32 tons/hour. Exports included >27 million pounds of pesticides whose use is forbidden in the United States. WHO Class la and Ib pesticides were exported at an average rate of >16 tons/day. Pesticide exports included >500,000 pounds of known or suspected carcinogens, with most going to developing countries; pesticides associated with endocrine disruption were exported at an average rate of >100 tons/day. Although the rate of export of banned products declined, as did exports of pesticides included in global conventions on Prior Informed Consent and Persistent Organic Pollutions, substantial quantities of hazardous products remain in trade. These products pose unacceptable risks in countries where unsafe use and storage practices are prevalent. Policy makers, growers, and scientists must undertake more aggressive efforts to foster sustainable agricultural practices globally.     

Pesticides and human health: why public health officials should support a ban on non-essential residential use

The College of Family Physicians of Ontario recently released a comprehensive report on pesticide exposure and health risk, concluding that various pesticides had adverse health effects. The pesticide industry says that pesticides are "safe" when used as directed because they are studied and approved by governmental agencies. Yet many municipalities, including Canada's three largest, and the province of Quebec have enacted bans on cosmetic use of pesticides, largely in response to health concerns. Reviewing the report, the status of regulation of pesticides and the limitations of studies and of regulation in Canada, it appears that on the basis of evidence available to date, public health officials should support a ban on cosmetic use of pesticides.     

The history and future of food fortification in the United States: a public health perspective

For more than 50 years, the United States federal government has regulated food fortification. During this time, the nutritional situation in the United States has improved greatly, whereas scientific information about the role of vitamins and minerals in human growth and development has increased exponentially. Concurrently, government authority to regulate food fortification has declined. This paper provides a brief history of U.S. food fortification policy and describes the contribution of food fortification to U.S. nutrient intakes. The paper highlights future directions of food fortification in the United States in light of these important developments, and addresses the issue of risk and the need to balance deficiency and toxicity in a generally well nourished population.     

Federal health program reforms: implications for child health care

The "Omnibus Budget Reconciliation Act of 1981" included a number of provisions designed to reduce federal spending for health care and to increase state authority over health programs. Evidence concerning the financial condition and health care needs of children served by federally-financed health programs, and recent trends in coverage and eligibility, make it possible to assess the likely impact of the new legislation. One conclusion seems clear: extensive federal funding reductions cannot be accommodated by eliminating excesses. While reforms of the Medicaid program may be advisable for a number of reasons, a simple reduction to funding will have serious, adverse consequences for poor children.     

Nursing home reform: five years later

In 1987 Congress enacted landmark legislation designed to overhaul federal oversight of the U.S. nursing home industry. Changes included creation of a "bill of rights" for residents, a new outcome-oriented inspection system, and new staffing requirements. Five years later, despite delays in the issuance of necessary regulations, portions of the law have succeeded in improving the quality of life of the estimated 1.5 million elderly and disabled American confined to a nursing home.