M.J. Perry
The George Washington University,
Washington, DC, USA
(© 2014 Elsevier Inc. All rights reserved.)
 |
| Melissa Perry |
Scope of the Problem
Agriculture originated more than 11 000 years
ago and is one of the world’s oldest and largest industries. Currently more
than a third of the world’s employed population is engaged in agriculture,
totaling 1.05 billion people in 2012 (International Labour Organization,
ILO, 2013a). Agriculture employment patterns vary in part by the level of a
country’s economic development. In many developed nations, the largest share of
employment is in the services sector, followed by industry, with a small
proportion, usually less than 10%, in agriculture. In other nations,
predominantly transitional economies, agriculture accounts for the largest
proportion of employment, followed by services and then industry (International
Labour Organization, ILO, 2013a). For example, in North America 7 million
people are engaged in agriculture, whereas in Asia about 400 million people are
working on farms consisting primarily of family-owned plots. Farming in
developed countries has transitioned into large-scale production agriculture
involving larger farms often owned by companies rather than individuals. In
North America and Europe, the number of family owned farms is shrinking and the
holdings of the remaining farms are increasing. In developed and developing
nations, peasants and subsistence farmers working only small plots of land
produce four-fifths of developing countries’ food supply, yet these
agricultural workers may be among the poorest sectors of society. They may live
in isolated rural conditions with substandard housing, inadequate access to
clean water and health care, and with little or no educational opportunities or
other economic options.
The economic hardships of rural poverty are compounded by
the health demands intrinsic to agricultural labor. Farming is one of the most
hazardous occupations and people working on farms worldwide experience injuries
and disease associated with both subsistence and production agriculture.
Sources of hazards can be broadly grouped into those from trauma, chemical
exposure, psychosocial stressors, and pulmonary exposures. Regardless of the
scale of operations, agricultural work entails numerous occupational health
risks, many of which can be targeted for prevention. For the most part, this
article discusses health issues experienced by individuals working in
agriculture including farm owners, farm family members, and farmworkers. Risks
to children living or working in the farm environment are also discussed.
Agricultural Workers and Their Families
Agricultural Workers and Their Families
Some of the major health problems, both
acute and chronic, among adult farming populations include respiratory
disorders, cancer, neurologic problems, injuries and traumatic deaths, skin
diseases, hearing loss, stress, and problems in reproduction. In countries
where mechanization is a routine part of farming, the leading agents of fatal
and nonfatal injuries to farmers and farmworkers are tractors and farm
machinery, followed by livestock, building structures, falls, and bodies of
water. Environmental exposures include pesticides, volatile organic compounds
(fuel), noxious gases, airborne irritants, noise, vibration, zoonoses, and
stress. Farm family members may also be exposed to these hazards, making
agriculture a unique example of the intersection of occupational and
environmental exposures. On the approximately 2.2 million farms in the United
States in 2010, for example, there were about 800,000 farm workers and 6.2
million farm residents. In 2010 the number employed in the agriculture sector
in the 27 member countries of the European Union (EU27) was over 10 million
people. The 2011 rate of nonfatal injuries in the EU27 was 1870 per 100 000
workers, and the leading agents responsible are similar to those in the United
States, which includes machinery, falls, and hazardous environmental exposures.
In countries where mechanization is not routine, the leading agents of fatal
and nonfatal injuries to farmers and farmworkers are livestock, pesticides,
zoonoses, and stress.
Farming is also unique in that child labor is common.
Special consideration must be given to the health risks faced by children
working in agriculture. The maturing organ systems of children and adolescents
may be especially vulnerable to the harmful effects of hazards commonplace in
agriculture, such as chemical exposures and physical stressors. Data on the
scope of child farm labor in developing countries are scarce; however,
estimates from 2012 suggest around 101 million children worldwide are working
in agriculture (International Labour Organization, ILO, 2013b). Globally, child
labor has been a part of plantation agriculture throughout its history;
families working on plantations as contract laborers must rely on all members
of the family unit working together to increase productivity and in turn, their
compensation. On family-owned farms in the United States, approximately 27% of
farm residents are youths less than 20 years old, and at least 300 000 youths
between the ages of 15 and 17 work alongside their parents as farmworkers.
Although the exact number of youths exposed to farm hazards annually in the
United States is unknown, it has been estimated at more than 2 million.
Women account for over half of the global
agricultural workforce; however, they are often overlooked in international
labor statistics. In addition to facing the same hazards as male agricultural
workers face, women working in agriculture during their reproductive years may
be exposed to toxic chemicals or physical demands that can also cause problems
with reproduction and pregnancy maintenance. There is also concern that women
who are exposed to biologically active chemicals during agricultural work may
be at risk for hormone disruption across the lifespan, from their
pre-reproductive years through menopause and beyond.
Sources of Hazards and Health Risks
Two health specialty areas dealing with agriculture
are worth noting. Agricultural medicine refers to the subdivision of public
health and/or occupational medicine included in the training and practice of
health professionals. Agro-medicine refers to a specialty partnership between
agricultural and medical professionals invested in reducing illness and deaths
related to agriculture. Agro-medicine has focused on core health areas of
traumatic injury, pulmonary exposures, and agrochemical injury. Table 1 provides a general guide to these
agriculture-related health risks. Rather than serving as a complete guide, the
table is designed to highlight the principal exposures and possible
manifestations that public health practitioners should be aware of when
designing programs to improve health and safety in the agricultural environment
(Zejda et al., 1993).
Fatal and Nonfatal Injuries
Disabling injuries and accidental deaths represent
one of the most disturbing aspects of safety risks in agriculture. Globally 170
000 agricultural workers die each year from traumatic injuries and the
fatal injury rate in agriculture is twice that of other industries. Injuries
on the farm involve tractor rollovers, machine injuries, animal injuries, and
farmyard injuries. An estimated 15 000 children under the age of 20 years
who lived on, worked on, or visited farms and ranches were injured in 1998, and
approximately 100 unintentional injury deaths occur annually among
children and adolescents on U.S. farms (Myers and Hendricks, 2001). Children
account for about 20% of all U.S. farm fatalities and a higher proportion of
the total number of nonfatal farm injuries. Farm machinery (including
tractors) is the leading cause of fatality to farm youth less than 20 years of
age in the United States. Thirty percent of farm machinery-related deaths
are among children less than 5 years of age. Drowning is the second leading
cause of death on farms with children less than 5 years of age, accounting
for 32% of the deaths. The most common injury resulting in death is to the
head or brain, accounting for nearly two-thirds of the total. The leading
sources of nonfatal injuries are surfaces, animals,
and nonindustrial off-road vehicles; and the leading causes of these injuries
are falls, off-road transportation accidents, and being struck by objects.
The parts of the body most commonly injured are hands, head, and legs and the
most frequent types of injury are lacerations, fractures, and scrapes or
abrasions.
For all workers, especially field workers, fatigue
increases the risk of injury. Long hours, early morning hours, and work in
very hot conditions all increase fatigue, as does the heavy physical labor
entailed in most agricultural work. The relative inexperience of young
workers also increases their risk of accidents and injury. Farmers identify
stress and overwork as a main reason for forgoing pesticide
safety practices and rushing is a well-established risk factor for
machine-related injury in a variety of settings. Younger age, the presence
of hearing loss or joint trouble, and working more hours per day are also
strong predictors of severe injury (Hwang et al., 2001).
Trauma from Overexertion or Repetitive Motion
Ergonomic hazards
refer to physical demands placed on the body that can lead to disorders and
loss of function. Agricultural work in particular has been linked to
musculoskeletal trauma due to the stresses on the body of constant bending,
lifting, twisting, and other awkward or punishing work. In the European Union,
for example, close to 60% of workers in agriculture and fishing are exposed to
painful positions at work half the time or more and 50% carry heavy loads at
work half the time or more. Numerous farming tasks such as propagation and
harvesting require workers to stand, bend, or stoop in demanding positions for
long periods of time. Sprains, strains, and overexertion are all common
injuries, especially for workers engaged in manual cultivation. Nursery workers
engage in repetitive gripping and cutting. They work virtually full-time year
round without rotation to other jobs. In the short term, horticultural workers
often report pain and numbness in the hand, wrist, and arm. After an extended
time on the job, they are at high risk for carpal tunnel syndrome, a disabling
condition of the hand.
Noise
Although little population-based data are available, as
much as 55% of farmers older than 50 may have clinically significant hearing
impairment. Hearing impairment related to noise generated by farm equipment
develops early in life. Rural students have a 2.5 times greater hearing loss
than urban students and that discrepancy increases with age and number of years
worked in farming. Farmers and farm family members are exposed to excessive
noise from equipment used on the farm, including tractors, grain dryers,
combines, bush hogs, and chain saws. Noise- induced hearing loss occurs with
continued exposure to high levels of noise; it is cumulative and irreversible.
Noise-induced hearing loss results from the destruction of the cochlear hair
cells in the inner ear. There are two types of hearing damage caused by
excessive noise. Acoustic trauma occurs when the ears are exposed to a single
sudden sound above 140 dB(A) (decibels measured on the A scale, which
incorporates weighing that takes into account the ear’s varying response to
sounds of different frequencies) and the sensory cells are permanently
dislodged and destroyed. Gunshot blasts or explosions can cause acoustic
trauma. Prolonged exposure to noises above 85 dB(A) can result in damage,
though not necessarily permanent, to the cochlear nerve cells. Permanent damage
to hearing occurs when exposure to excessive noise levels continues and the
nerve cells are not given sufficient time to recover. There is no universal
agreement on recovery duration. There is ample evidence that the damage is
insidious, usually beginning at a young age, and in the long run, usually
severe enough to affect a person’s ability to hear and understand speech. Some
evidence suggests that chemicals such as solvents and pesticides can interact
with occupational noise exposure, resulting in a greater risk for hearing loss
than noise exposure alone. This mixture of exposures may be particularly
harmful for young farmworkers (Perry and May, 2005).
Stress
There is little doubt that farming is one of the
most stressful occupations in both developed and developing countries. Both
farm workers and farm family members are exposed to the economic pressures of
their family livelihood, the future of which remains precarious at best. The
influence of stress is manifested by psychological or emotional disturbance
such as alcohol abuse among family members, as well as by the creation of
insecure working conditions. Being unmarried, having negative life events
within the past year (legal problems, substantial income decline, and/or loss
of something of sentimental value), and lower perceived general health status
have been identified as significant risk factors for depressive symptoms among
male farmers in the United States.
Farm workers in general have high rates of depression.
Extreme poverty and hardship, the stress of job uncertainty and frequent moves,
and social stigmatization and isolation are contributing factors. This is true
for children and youth as well. Studies have also linked depression in workers
to long hours of work in high-intensity, low- skilled jobs, precisely the kind
of labor undertaken by farm workers.
Having one’s livelihood controlled by the uncertainty of
the weather and the agricultural market combined with the social isolation
often experienced by rural inhabitants increase the risk for psychological
distress. Rural areas of China and Sri Lanka, for example, have seen an increase
in suicides among subsistence farmers, many of whom are using toxic farm
chemicals to poison themselves. Identifying symptoms of psychosocial stress in
farmers requires history taking and consultation to determine current social
and economic conditions in the family. Depressive symptoms are expressed
differently in men and women. Knowing that adult farm owners and farm workers
are at higher risk for psychological disturbance should alert health-care
providers and public health practitioners to the need for outreach to these
high-risk groups. Because health-care providers are usually the first mental
health contact for rural residents, they play an important role in the early
identification of psychological distress in farmers, farm workers, and their
families.
Sanitation
Agricultural health clinicians have identified hygiene as
being key in preventing bacterial infections from animals and dermatoses caused
by chemical contamination. However, farmers themselves may forego the minimum
sanitation requirements when working in fields as a means of saving time and
effort or because water is simply not available. Regulations in the United
States illustrate how basic public health protections may not be in place for
agricultural workers. Access to clean drinking water, water for hand washing,
and toilet facilities are the minimum sanitation requirements imposed on farms
by the Occupational Safety and Health Administration (OSHA), the occupational
regulatory agency in the United States. Even these minimal requirements, however,
may be ignored by growers and by the farm labor contractors who bring in
workers. Furthermore, labor laws prohibit enforcement of these regulations on
farms with ten employees or less, essentially exempting small farms. An
estimated 95% of all U.S. farms fall under this exemption. Health-care
providers and public health practitioners should consider the multiple sources
of contamination in the farm
environment and consider hygiene as having a role in sources of infections,
especially of the skin.
Heat-related
illnesses can lead to death or brain damage and are an ever-present danger for
field workers. In the United States alone, there are approximately 400 deaths
annually from heat-related illnesses. Risk for heat stress during the growing
season is particularly acute, especially during haying and harvesting. It is
recommended that workers laboring under hot weather conditions drink a minimum
of 8 oz of water every half hour. Very high heat or humidity increases the
amount of recommended water, so that,
for example, a person working in 90 F heat under a full sun should drink 8 oz
of water every 15 min. Ensuring sources of fresh water are abundant is critical
to maintain workers’ hydration needs. Excessive sun exposure places farmers at
risk for future skin malignancies and must be prevented with proper head and
body covering, which can also increase the risk of heat stress from too much
clothing. Keeping farmers hydrated, protected from the sun, and ensuring a
minimum of 10 min of break time during each hour can reduce the risk of
illnesses from overexposure to heat and sun.
Hazardous
Organic and Inorganic Exposures
Potentially
harmful exposures exist in a variety of forms in the farm environment,
including solvents, pesticides, paints, welding and combustion fumes, plant
toxins, and animal bacteria and viruses. Their possible health effects vary
widely and can include acute intoxication, Parkinson’s disease, peripheral
neuritis, acute and chronic encephalopathy, various cancers, and reproductive problems.
Solvents
A
solvent is a liquid used to dissolve other substances. The most toxic solvents
are extracted or manufactured for chemical use. Most solvents are colorless
liquids at room temperature that volatilize easily and have strong odors. These
compounds may be referred to as volatile organic compounds (VOCs) in reference
to their physiochemical properties. Many commonly used solvents such as gasoline,
kerosene, and jet fuel are mixtures of solvents and other chemicals. They are
widely used for manufacturing, degreasing and other cleaning, and as carrying
agents in products ranging from insecticides to glues and paints. The most
common solvents and solvent mixtures found in the farm environment include
pesticides, fuels, paints, and metal degreasers. There is little information
from animal or human studies about the health effects of chronic low-dose
exposure. Solvents are most commonly inhaled in their volatilized form and
absorbed via the respiratory track.
Significant doses of solvents may occur
through skin exposure and absorption. Most solvents are lipid-soluble but some
are water-soluble.
Animal studies in the toxicology literature emphasize the role of solvents as
neurotoxins. The majority of solvents are central nervous system depressants
and some have long-term neuropsychological effects, including chronic toxic
encephalopathy. In adults, the following neurobehavioral problems resulting
from chronic solvent exposure have been recorded in the literature: memory
loss, decreased problem-solving ability, decreased attention span, impaired
dexterity and hand–eye coordination, altered reaction time, reduced psychomotor
function, and altered personality or mood. In addition to neurotoxic effects,
other documented health effects from solvent exposure in adults are pulmonary
sensitization, bradycardia, and ventricular fibrillation, defatting of the
dermis, chemical burns, and hearing loss.
Pesticides
Agriculture experienced a chemical
revolution after the Second World War with the broad-scale introduction of
pesticides to control unwanted pests and fertilizers to enhance soil
productivity. This revolution brought with it a series of unintended occupational
and environmental health consequences, and exposure to pesticides is a serious
risk to farmworkers worldwide. Data from the United States illustrate exposure
circumstances for people both working in and living in the agricultural
environment. The U.S. Environmental Protection Agency (EPA) estimates that as
many as 300 000 farmworkers suffer pesticide poisoning each year while the U.S.
Natural Resources Defense Council estimates as many as 40 000
physician-diagnosed poisonings occur each year (Natural Resources Defense
Council, NRDC, 1998). The International Labour Organization reports that
globally 70 000 agricultural workers die annually from exposures to pesticides.
Only a small percentage of pesticide-related illnesses are reported to government
or health officials.
Pesticides include herbicides to
control weeds, insecticides to control a range of insects, nematocides to
control worms, and fungicides to control molds, fungi, and other mycotoxins.
Exposures can happen when workers are mixing, loading, transporting, or
applying pesticides, and the three main routes of exposure are dermal,
inhalation, or ingestion. Risk of exposure can be compounded by lack of or
improper protective gear, leaking containers, illicit formulations, faulty labeling
of the chemical, improper application, and illiteracy. Workers may also be
exposed to pesticides if they drink from, wash their hands, or bathe in irrigation
canals or holding ponds, where pesticides can accumulate.
While acute pesticide health effects
have been well documented, epidemiological investigations continue to evaluate
chronic health effects. Toxicologic and epidemiologic data reviewed in this
section largely originate from adult animal and adult human studies. Infants
and children may be exceptionally vulnerable to health complications from
exposures due to their developing neurological, immunological, and reproductive
systems and due to differences in their ability to metabolize and excrete
toxicants
(Perry,
2003).
There is evidence that farm families
experience elevated levels of pesticide residues in their blood and urine. A
recent investigation from the U.S. Agricultural Health Study reported that
agricultural families could receive an absorbed dose of pesticides after
application by a member of the family. The report used indoor air sampling,
hand wipe sampling, serum, and urine monitoring to evaluate exposures to the
family of a single farm applicator. The farmer applied the carbamate
insecticidecarbaryl to pumpkins using a hand-cranked duster. His serum carbaryl
levels rose by 3 orders of magnitude following use of thepesticide, and the
carbaryl metabolite was detectable in his urine. Urine metabolite measurements
taken from his wife and twochildren showed a doubling of excretion of the
carbaryl metabolite following application of the pesticide. These results were
seen in the absence of a quantifiable increased carbaryl concentration in
indoor air or house dust (Shealy et al., 1997).
Additional preliminary results from the
Agricultural Health Study revealed that elevated blood serum pesticide levels
were detected in some farm families. The very potent organochlorine insecticide
dieldrin, which has been banned in the United States since 1987, was found at
significantly elevated levels in the blood of all members of one of the six
farm families sampled. Further investigation revealed persistently elevated
levels of this pesticide in food samples on the farm, although all legal food
uses of this pesticide
were canceled in 1974. Other persistent organochlorine pesticides identified in
the blood of farm families included chlordane and transnonachlor (Brock et al.,
1998).
Residents living near fields sprayed
with organophosphate pesticides had small reductions in plasma and whole blood
levels of the
neurotransmitter enzyme cholinesterase during the spraying season compared with
residents living farther from the fields and with
their own cholinesterase levels off-season. At the same time, infirmary records
indicated a significant increase in visits for certain symptoms on days when
organophosphate pesticides were sprayed. Symptoms included respiratory
problems, headache, and eye irritation (Richter et al., 1986). These data
suggested that exposures to organophosphate pesticide drift might result in quantifiable
cholinesterase inhibition and symptoms requiring medical treatment in residents
living nearby application fields.
In adults, acute pesticide exposures
resulting in poisoning symptoms have been well documented. The chronic health
effects
from
pesticide exposures that have been reported include neurobehavioral problems,
Parkinson’s symptoms, various cancers, and problems in reproduction including
sterility.
The problem of unintended consequences
of pesticide exposures globally is compounded by poor public health protections
for workers and a lack of comprehensive regulations focused on controlling
exposures for citizens. The World Health Organization (Dinham
and Malik, 2003) estimates that 20000 women, men, and children die of
accidental pesticide poisonings each year; three million are nonfatally
poisoned, and nearly three-fourths of a million new people each year experience
chronic effects from exposure. Some industrializing countries in Asia and
Africa are either importing pesticides that are banned elsewhere or are producing
them locally. Compounds known to have considerable toxicity and that are
environmentally or biologically persistent such as organochlorines remain in
use in over 20 different countries today, while the long-term ecological and
public health consequences of continued use remain unknown.
Microbes and Their Toxins
Grain
dusts, molds, and fungi are among several plant-based irritants that abound in
the agricultural environment and that cause a host of respiratory problems in
adult farmers. The clinical features of adult illnesses caused by these
irritants should be considered with regard to the potential for child exposures
as well. As with other chronic diseases, chronic respiratory diseases are
likely to originate during early exposures, with damage accumulating over time
until eventual clinical symptoms appear. Preventing suchexposures early may be
the key to reducing respiratory disease in adulthood.
Grain
dust is a complex substance composed of plant debris, insect parts, silica,
chemical residues, molds, fungi and bacteria and their metabolites, including
endotoxins. Approximately 40% of its particles are less than 5 mmin mean
diameter and representa respirable piece that can penetrate the terminal
bronchioles. Exposure to antigens from organic dusts may be responsible for hypersensitivity
pneumonitis, which has a reported prevalence of 0.1–15% among adult farmers.
Hypersensitivity pneumonitis is difficult to diagnose in adult farmers because
it has an insidious course and appears as recurrent influenza-like episodes or nonspecific
respiratory symptoms and may result in chronic respiratory problems that look
like pulmonary fibrosis.
The
organic-dust toxic syndrome is an acute response to inhaling organic dust,
usually characterized by a delayed onset of fever, malaise, and chest tightness
that does not evidence immunologic involvement and has an apparently benign
course without longterm respiratory impairment. Possible mechanisms include a
toxic reaction to endotoxins, mycotoxins, or proteinase enzymes of moldy plant
materials. It is related to dust level and can be reproduced in laboratory
subjects exposed to high concentrations of grain dust. Exposures responsible for
the related condition extrinsic allergic alveolitis (farmer’s lung) are
actinomycetes such as Micropolyspora faeni, fungi, and animal proteins present
in many agricultural environments.
Working
in confined spaces such as silos or manure pits can pose risks for exposure to
toxic gases such as nitrogen dioxide from fermented grain or methane gas
emitted from manure. Both of these gases can be fatal when inhaled, therefore
proper ventilation of enclosures is critical for mitigating acute exposures.
Carcinogens
While
the epidemiologic data are not conclusive enough to demonstrate causality for
any one agricultural exposure, a number of increased
cancer risks have been associated with either farming or specifically with
pesticide exposure, including non-Hodgkin’s lymphoma,
leukemia, multiple myeloma, soft tissue sarcoma, Hodgkin’s disease, and cancer
of the prostate, pancreas, ovary,
breast,
and testis. Currently only arsenic-containing insecticides are recognized as
known human carcinogens by the International Agency
for Research on Cancer, but many other pesticides are suspected. Agricultural
workers are also at excess risk for developing skin
cancer, which is most often caused by chronic exposure to ultraviolet radiation
from the sun.
Skin Irritants
Data from studies of adult farmers
indicate that skin irritation starts soon after employment commencement and
increases to involve more than 60% of workers after 4 years of employment in
the grain industry (Zejda et al., 1993). Skin cancers, dermatophyte infections,
and pesticide-related skin diseases are common in farmers.
The impact of microscopic fungi on
farmers’ health seems to be greater than originally understood. The infection
may be transmitted from infected humans, animals, plants, or soil. To date,
little epidemiological data on fungal skin disease in farmers are available.
Epidemiological studies from Poland suggest that mycoses are the most prevalent
skin diseases in farmers and may be present in over 20% of the population (Spiewak,
1998). Working conditions on farms directly contribute to the development of fungal
infections. Farmers may spend extended periods working in humid conditions and
long hours wearing rubber boots or gloves. Besides infection, fungi may also
cause noninvasive forms of skin disease, such as dermato-mycotoxicosis
professionalis or alternariosis. Most pesticide-related dermatoses are contact
dermatitis, both allergic and irritant. Rare clinical forms also occur, including
urticaria, erythema multiforme, ashy dermatosis, para- keratosis variegata,
porphyria cutanea tarda, chloracne, skin hypopigmentation, and nail and hair
disorders.
Reducing
Health Risks to Agricultural Workers
In a work environment such as
agriculture with an assortment of hazards, what is the best approach to
preventing injuries and disease? A useful way of thinking about prevention is
to adopt an integrated strategy that draws upon key aspects from public health,
industrial hygiene, and environmental leadership models. Occupational disease
and injury are caused by exposure to hazards on the job, and prevention
requires controlling exposures. Anticipation of hazardous exposures,
surveillance of hazards and health effects, analysis of health effects, and
ultimately hazard control are all critical parts of an integrated approach to prevention.
Four basic choices for controlling
hazards, in order of their preference, are agricultural production process
reengineering, work
environment
controls, administrative controls, and worker behavior controls, including personal
protective equipment and devices. Reengineering production agriculture means
rethinking the machinery, tools, equipment, and chemicals used to produce food
world-wide. In developed countries where farmers rely on machinery for sowing,
tilling, and cultivating crops, this can mean redesigning how workers must
interact directly with machinery or the ways machines operate. In developing
countries, productionprocess reengineering can mean introducing machinery to
reduce the amount of punishing physical labor farmers must endure. Another
example of production-process reengineering is transitioning to less chemically
intensive agricultural practices. Known as Integrated Pest Management (IPM),
this comprehensive approach relies on crop diversity and natural pest
resistance sources such as beneficial insects, reducing reliance on commercial
inputs such as fertilizers and pesticides. Integrated Pest Management programs
can be economically feasible, environmentally sustainable, and health promoting
by reducing harmful exposures to
workers
and their families.
Developing healthy agricultural work
environments can be as basic as ensuring adequate access to clean drinking
water or as multifaceted as diversifying tasks within farm cooperatives to
reduce psychological monotony and repetitive physical strain. Machine guarding
the power take off (PTOs) units on farm machines such as tractors, hay bailers,
and combines is a simple yet effective occupational safety intervention focused
on placing physical barriers between workers and hazards. Optimizing
administrative controls to reduce risks to workers’ health includes enforcement
of public health protections, from child labor restrictions
to
controls over pesticide manufacturing and distribution. It is preferable to
change the working environment rather than the worker; however, giving workers’
access to adequate information and training is a necessary part of promoting
healthy working environments. Adequate training in the health risks posed by
personal exposures to pesticides and strategies for protection is a good example
of targeting worker behavior controls to decrease hazardous exposures.
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Further Reading
Alavanja MCR, Hoppin J, and Kamel F (2004) Health effects of
chronic pesticide exposure: Cancer and neurotoxicity. Annual Reviews of Public
Health 25: 155–197.
Levy BS and Wegman DH (eds.) (2000) Occupational Health:
Recognizing and Preventing Work-Related Disease and Injury, 4th edn
Philadelphia, PA: Lippincott.
Schuman SH and Simpson WM (1997) AG-MED: The Rural Practitioner’s
Guide to Agromedicine. Kansas City, MO: American Academy of Family Physicians.
Stellman JM (ed.) Encyclopedia of Occupational Health and Safety .
(2011). Geneva, Switzerland: International Labour Office. online edn., ch. 64,
Agriculture and Natural Resources Based Industries. http://www.ilo.org/oshenc/.
United States, Department of Agriculture (USDA) (2000) National
Agricultural Statistics Service Agriculture Report 2000. Washington, DC: U.S.
Government Printing Office.
United States, Department of Labor (USDL) (2005) Findings from the
National Agricultural Workers Survey: 2001–2002. A Demographic and Employment
Profile of United States
Farmworkers. Report No. 9, Washington, DC: U.S. Government
Printing Office.
Relevant Websites
http://www.cehn.org – Children’s Environmental Health
Network.
http://osha.europa.eu/sector/agriculture – European
Agency for Safety and Health at Work.
http://www.fao.org – Food and Agriculture Organization
of The United Nations.
http://www.ilo.org/public/english/index.htm –
International Labour Organization.
http://www.ncfh.org – National Center for Farmworker
Health.
http://www.nagcat.org – North American Guidelines for
Children’s Agricultural Tasks (NAGCAT).
http://www.aghealth.org – U.S. Agricultural Health Study.
http://nasdonline.org/ – U.S. National Agricultural Safety
Database.
http://www.cdc.gov/niosh/docs/2004–146/ – Worker
Health, Chartbook.
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