The Safe and Healthy Children Initiative: Increasing the Knowledge and Confidence of Clinicians and Others to Address Farmworker Pesticide Exposures

By Marybeth Palmigiano, MPH

This essay is in response to: How does our nation's reliance on pesticides affect the health of those who plant and harvest our food?

In 2007, the United States used 684 million pounds of pesticides in agriculture, accounting for 80% of all U.S. pesticide use.[i] While this is a slight decline from past years it is still a staggering amount of toxic substances being applied to our nation’s food supply. By their very nature, most pesticides create some risk of harm to humans, animals, or the environment because they are designed to kill or otherwise adversely affect living organisms.

One group that is especially vulnerable to pesticide exposure is the American farmworker. In the U.S. there are between 3 to 5 million farmworkers and their families who labor in fields and factories across the country to bring fresh fruits, vegetables, and other agricultural products to our tables. The exact number of farmworkers in the United States is difficult to determine for reasons such as the mobile nature of the population, the seasonal nature of agricultural work, the varying agriculture tasks performed, and the fact that there is no local, state, or national agency responsible for collecting this information.

Although farmworkers are the backbone of a multi-billion dollar agricultural industry, they are excluded from the basic labor and safety standards that protect workers in other industries. Farm work has little or no overtime limits, child labor restrictions, collective bargaining rights, or workers’ compensation insurance, even though agriculture is considered to be one of the most hazardous industries in the US.[ii] The lack of regulatory oversight, enforcement, and data about farmworkers and their families leaves employers unaccountable to basic health and safety standards and leaves farmworkers vulnerable to abuse. Pesticide exposure is of particular concern.

Farmworkers are often poor, undereducated, and non English speaking. They can be tasked with complicated jobs such as mixing and applying pesticides and often do not understand the risks or the necessary precautions required to protect themselves from exposure. Exposures to toxic pesticides can occur due to spills, splashes, missing or inadequate protective equipment, direct spray, or pesticide drift. Additionally farmworkers in fields can be exposed by direct contact with pesticide residues on the crops or in the soil, or by being sprayed directly. Children can be exposed when working or playing in treated fields; when workers inadvertently take home pesticide residues on their body, clothing, or shoes; or when pesticides drift onto play areas or into farmworker housing. A study conducted in New York found that 48% of the migrant children surveyed worked in fields still wet with pesticides, with 36% having been sprayed directly with pesticides.[iii] 

Due to the lack of a national incident reporting system, the exact number of workers injured each year by pesticides is unknown; however in 1999 the Environmental Protection Agency (EPA) estimated that there were 10,000 to 20,000 incidents of physician-diagnosed pesticide illnesses and injuries per year in farm work. This estimate, as EPA has recognized, represents serious underreporting. Farmworkers may not be able to seek medical attention because of the cost of care and or transportation. Other barriers to healthcare may include the fear of job loss, retaliation by the employer, or deportation based on immigration status.

When medical attention is sought, pesticide illness is often misdiagnosed or overlooked. This can happen because often health care providers do not have proper training in environmental health and therefore do not recognize symptoms related to pesticide exposures and farmworkers are often unaware that they have been exposed to pesticides.

PSR’s Pediatric Environmental Health Toolkit (PEHT) and the Safe and Healthy Children Initiative (SHCI) in particular are tools that can help address some of these issues.   

The PEHT was developed to fill the need of pediatric and family care practices around the country for practical tools to prevent exposures to toxic chemicals. It was developed by PSR sister chapters in San Francisco and Boston in partnership with the Pediatric Environmental Health Specialty Unit at the University of California, San Francisco, and a team of pediatricians from around the county. It was peer reviewed by experts in the field of environmental health and pilot tested at 17 practices in Massachusetts and California. In 2006 it was endorsed by the American Academy of Pediatrics. To date, well over 15,000 hard copies of the PEHT have been distributed to medical and nursing schools, hospitals, health care organizations, and state health departments across the county. Greater Boston PSR teamed up with the Agency for Toxic Substances and Disease Registry's (ATSDR) Division of Toxicology and Environmental Medicine and the University of California - San Francisco Pediatric Environmental Health Specialty Unit to create a free online continuing education course based on the PEHT which can be accessed from their website.

The PEHT Training uses various case examples to highlight the relationship between environmental exposures and children’s health by teaching clinicians to identify routes of exposure to common toxic chemicals including pesticides; to recognize the links between these toxic chemicals and health effects; to take an environmental health history to identify potential exposures; and provides resources to help mitigate exposure. 

With the support of the W.K. Kellogg Foundation, PSR adapted the PEHT to address health disparities among children of migrant and seasonal farm workers. This prevention program is intended to reduce exposures to common environmental hazards that can lead to the development of learning disabilities, cancer, asthma, allergies, and other respiratory illnesses – all conditions with which this high risk population is disproportionately affected.

The SHCI is a curriculum aimed at building the capacity of community-based organizations to address the impact of environmental health exposures on migrant and seasonal farmworker children. The curriculum was piloted in 2010 in Florida and Michigan with Migrant and Seasonal Head Start staff and Migrant and Community Health Centers’ staff. 180 people were trained through primary and secondary trainings. The evaluation results indicated that the trainings and resource materials were well received. In particular the trainees appreciated the educational materials that could be used with parents and the fact that the curriculum broadened the focus of chemicals of concern beyond pesticides.

There are an estimated 90,228 migrant and seasonal farmworkers and families residing in the state of Michigan[iv] and approximately 286,725 migrant and seasonal farmworkers and families residing in the state of Florida[v] who could benefit significantly from community initiatives to reduce environmental exposures.

Clearly stronger laws and enforcement of existing laws and policies regulating the use of pesticides and protecting farmworkers is needed. By increasing the knowledge and confidence of clinicians and community health workers we hope to increase the cadre of health professionals poised to advocate for health protective policies and the enforcement of laws protecting America’s farmworkers and their families.

Editor's note: if you'd like to take action on pesticide policy, click here.

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