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Health Emergency Assessment Report


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Report written for MSc Disaster Management & Sustainable Development (Northumbria University, 2010-11)

Report written for MSc Disaster Management & Sustainable Development (Northumbria University, 2010-11)

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  • 1. Health risk assessment and emergency health contingency plan (2500 words) w10025958Health Risk Assessment& Emergency HealthContingency Plan:Assessment of the health risks associatedwith pesticide application, the effectivenessof responses, and recommended strategiesPhysical & Mental Health in Disasters and Development (GE172)Northumbria UniversityW100259582500 words 1
  • 2. Health risk assessment and emergency health contingency plan (2500 words) w10025958IntroductionPesticides have long been used to protect crops grown for food and clothing, but over timethese pesticides have become synthetic, chemical products. There has also been anincreasing trend of the use of hazardous chemical pesticides shifting to developingcountries. They can affect human health and the environment in a number of ways, but thispaper will consider the health risks to people applying pesticides in an occupational setting,and their families and communities. The health risks will be described before examining theeffectiveness of response strategies. Finally, the paper will recommend strategies for action.Crop protection from pests has been practiced for thousands of years: one of the oldest andmost labour intensive methods is hand picking insects from crops. Sulphur compounds werebeing used as early as 2500 BC. Pesticide use on crops grown for food and clothing hasintensified from the 19th century onwards, to meet growing demands. Crop protection hasgone from natural methods to a vast choice of toxic, synthetic products (EJF 2002a).By 2000, global pesticide use was around 2.5 million tonnes with sales worth roughly $30billion annually. The production of pesticides has shifted to developing countries over time,but it is estimated that 30% of pesticides marketed in the developing world do not meetinternationally accepted standards and frequently contain banned or severely restrictedsubstances (EJF 2002a).This paper will examine the health risks to people applying pesticides, their families andcommunities. However, pesticides can affect human health in a number of other ways (EJF2009) such as:  People can be exposed to pesticide residues on food through their diet;  Industrial accidents can expose people through water contamination, inhalation or skin exposure;  Long range environmental transportation through the air, soil and water;  Bioaccumulation: they build up in fatty tissue as long as exposure continues;  And biomagnification up the food chain, so higher levels are in higher predators.Health risksThe WHO recognises exposure to highly hazardous pesticides as a major public healthconcern, but states that available data is too limited to make an accurate estimate of the 2
  • 3. Health risk assessment and emergency health contingency plan (2500 words) w10025958global health impacts (WHO 2010). Nevertheless, it is recognised that the handling, storageand disposal of pesticides can expose people to pesticides through (EJF 2009):  Inhalation;  Skin exposure;  Ingestion;  Across the placenta (Gilden et al. 2010).Families of pesticide workers are also at risk of exposure as workers bring pesticides into thehome on their clothes, shoes and bodies. Children are more vulnerable to pesticidepoisoning due to higher respiratory rates and more permeable skin than adults; and theyplay and crawl on the floor, where toxins accumulate (Lucas & Allen 2009).Acute exposure can lead to flu-like symptoms such as “headaches, dizziness, weakness,and nausea” (HECA:1). They often go unreported, as they considered minor and may notrecognise the connection to pesticide use. Symptoms are often attributed to malaria andtreated as such. More severe poisonings can cause: “excessive sweating, insomnia, skin rashes, difficulty breathing, diarrhoea, hand tremors, excessive salivation, staggering, narrowed pupils, irregular heartbeat and convulsions” (Dinham 2010:106)and “coma and death” (HECA:1). Jeyaratnam (1990) stated that, per year, an estimated 3%of agricultural workers in developing countries suffer an episode of acute pesticidepoisoning. At the time of writing, that would be approximately 25 million cases. It is currentlyestimated that there are 1-5 million poisonings per year, resulting in 20,000 deathsworldwide (HECA). In 1982 scientists in Sri Lanka believed acute poisoning was a moresignificant issue than communicable diseases (Jeyaratnam 1990).Much occupational exposure is chronic, and at low levels. This is also usually the case forfamilies and communities of workers. It can affect:“skin, eyes, nervous system, cardiovascular system, respiratory system, gastrointestinal tract and liver, kidneys, reproductive system and blood” (HECA:1).Many persistent organic pollutants (POPs) accumulate in fatty tissue and various healtheffects have been observed as a result. These include breast, prostate and testicular cancer,immune system suppression, and osteoporosis. Cardiovascular effects on blood pressureand heart rate variability, and metabolic disorders such as diabetes and obesity have also 3
  • 4. Health risk assessment and emergency health contingency plan (2500 words) w10025958been observed; as well as neurological effects on cognition, memory and attention span.Parkinson’s disease and Alzheimer’s are also believed to be effects. Women haveadditionally suffered reproductive effects and hypothyroidism. Children have suffered fromgrowth retardation and behavioural development, such as ADHD and learning disabilities(UNEP/AMAP 2011).Endosulfan is one example of a highly toxic pesticide, which has been banned by manycountries. It is absorbed through the skin and by the stomach and lungs. It inducesdizziness, vomiting, diarrhoea, convulsions, and can cause death. It is also an EndocrineDisrupting Chemical (EDC) and high exposure can cause mutagenic effects (EJF 2002b).Exposure to environmental contaminants can cause structural or functional defects tofoetuses if the exposure occurs at a ‘critical window of susceptibility’. Endocrine disruptingchemicals (EDCs) interfere with hormones and can result in effects such as genitalabnormalities, infertility, ectopic pregnancies and greater risk of cancer. They can also resultin fewer male offspring than expected. Other effects include: increased chemical sensitivity,impaired motor skills, social behavioural problems, and neurodevelopmental delays (Gildenet al. 2010).Despite all the research, there is some difficulty in accurately attributing effects to pesticideuse. Due to the ethical issues involved with intentionally exposing people to poisons, muchresearch around pesticides has to be extrapolated from animal research (Gilden et al. 2010).Existing preventative health and emergency response scenariosLegislation and strategies to improve knowledge and practices aim to promote the safe useand management of pesticides, in order to avoid negative effects on human health and theenvironment. In 1985 the FAO introduced the International Code of Conduct on theDistribution and Use of Pesticides: a non-legally binding instrument that provides guidanceon management of pesticides. It is agreed by FAO member states, the WHO, private sectorand NGOs (FAO). The Stockholm Convention of 2004 works towards restricting andeventually eliminating the production and use of POPs. It initially targeted 12 POPs,including nine pesticides. Following a review in 2009, nine new chemicals were targeted,including five pesticides (Secretariat of the Basel Convention [c]).In 1992 the Basel Convention became effective, concerning hazardous waste, in terms ofstorage, transport and disposal. Parties are expected to ensure that hazardous waste is 4
  • 5. Health risk assessment and emergency health contingency plan (2500 words) w10025958managed and disposed of in an environmentally sound manner (Secretariat of the BaselConvention [a]).The Rotterdam Convention promotes better management of hazardous chemicals through‘prior informed consent’ (PIC). A chemical is added to the PIC procedure when two or moreParties to the Convention plan to ban or severely restrict the chemical. A committee thenreviews information and makes a recommendation to the Conference of Parties aboutwhether the chemical should be listed (Secretariat of the Basel Convention [b]).Although international treaties are positive steps, it is still up to individual countries to enactand enforce legislation to deal with hazardous pesticides; and compliance varies, limitingtheir effectiveness. Better compliance exists in developed countries, which is one factorleading to the shift of use to developing countries (Lucas & Allen 2009).The conditions in developing countries make it almost impossible to guarantee appropriateuse of pesticides. Government policies and aggressive marketing by the pesticide industrymean that highly toxic chemicals are readily available (PAN 2007a). For example, in SouthAfrica the expansion of small scale farming is a key government strategy for economicgrowth; and ineffective pesticide surveillance may lead to inappropriate policy choices(London & Bailie, 2001).Personal protective equipment (PPE) is used in many developed countries, but people oftencannot afford it in developing countries. The weather conditions also provide a disincentiveto wearing PPE, as it is often hot and bulky (PAN 2007a).Manufacturers print labels and instructions for safely using pesticides, but illiteracy is abarrier. It is also common practice in Africa for pesticides to come from a neighbouringcountry, where they may speak a different language, and so the label will be in that language(PAN 2007a).The lack of information about the hazards involved and illiteracy mean people can accessthem but have no idea how to use them safely. There is a lack of understanding of thedangers of pesticides in many developing countries, which leads to their misuse. People donot use caution when transporting or handling pesticides, often making pesticide cocktailsand mixing by hand. They are also used inappropriately, for example, to catch fish. Oncecontainers are empty, they are re-used to store food or water (PAN 2007a). Some also 5
  • 6. Health risk assessment and emergency health contingency plan (2500 words) w10025958believe that pesticides are only a hazard if they can be seen or smelled (Lucas & Allen2009).Training agricultural workers has led to some improvements, but it is not always appropriateor effective. Lucas & Allen (2009) found, in a study of immigrant Hispanic farm workers in theUS, that training was given in Spanish, which was a second language to many workers. Itwas also limited to them, and did not involve their families or communities. The training wasnot culturally appropriate: many Hispanic people would not immediately shower after work asthey do not believe in mixing metaphorical ‘cold’ and ‘hot’, i.e., water and the body. This canexacerbated by a lack of clean water, meaning people often are not able to wash after usingpesticides (PAN 2007a).Poverty and the lack of health facilities in rural areas are also factors that lead to pesticideuse posing a threat to food security, health and the environment (PAN 2007a). Healthprofessionals have limited training and knowledge of pesticides-related illnesses (HECA).Many people believe they will lose their job if they complain about conditions or makedemands about PPE (Lucas & Allen 2009).In summary, many steps are being taken to address the adverse effects of pesticides,includind legislation at international and national levels, and training down to more locallevels. Education programmes aim to modify behaviour of individuals. However, these arenot as effective as they could be, due to barriers such as illiteracy and cultural differences atlocal levels, and lack of enforcement of treaties and legislation and health centres.Additionally, government policy and industry marketing often encourage use of pesticideswithout regard for hazards.RecommendationsPesticide exposure is considered a major public health risk: a slow onset disaster in need ofa response. The measures above show that work is being done to address this. However,more can be done. Some strategies to avoid health risks are much easier to implement thanothers, involving just small changes in behaviour or practice. Others involve restrictingavailability and adopting a different agricultural approach. However, all would be necessaryto have the biggest impact.Firstly, greater effort should be made to avoid unsafe handling of pesticides. This shouldinvolve developing affordable, appropriate and effective PPE for tropical countries; and 6
  • 7. Health risk assessment and emergency health contingency plan (2500 words) w10025958requiring agrochemical companies to contribute to maintaining and repairing sprayequipment (Jeyaratnam 1990; Dinham 2010). It should also be a requirement foragrochemical industries to provide cheap, safe lockers to store pesticides; and ‘return tosupplier’ schemes should be promoted for empty containers, to avoid them being used forother purposes such as holding water (Dinham 2010).Jeyaratnam (1990) states that the WHO and ILO should continue to focus their efforts oneducation and training. These should be aimed at men, women and children: not just thoseapplying pesticides; and should be culturally appropriate (Dinham 2010). Individuals workingwith pesticides, and their families and communities need to understand the pathways ofexposure, health risks and protective measures (Lucas & Allen 2009). Community-basedmonitoring of pesticide impacts will also help raise awareness of their hazards. This is aparticipatory research method that enables communities to record effects on health and theenvironment. Not only does it raise awareness, it also empowers communities, can influencepolicy makers and contribute to implementing international conventions (PAN 2007a).Some work has been done on Integrated Pest Management (IPM) programmes. IPMstrategies can reduce reliance on pesticides by encouraging natural pest control systems,such as: encouraging bird species; crop rotation; refuge crops to provide habitat forbeneficial animals; considering the local ecology; and planting border crops as a barrier. The‘FAO-EU IPM Programme for Cotton in Asia’ involved raising awareness in six countries bydeveloping local IPM trainers to work directly with cotton farmers to develop appropriatestrategies. Over 100,000 farmers graduated under the scheme (EJF 2007).IPM limits the use of pesticides, but does still involve using narrow-spectrum pesticides (EJF2007). Some argue this does not go far enough, and that pest management must beconsidered in the context of sustainable farming systems that includes “nutrient cycling,regenerative technologies, soil fertility and water management” (PAN 2007b). Organicproducts remove the use of chemical pesticides altogether, by nurturing natural predators,and using strategies such as intercropping and crop rotation. Although organic cotton stillonly represents 0.15% of global production, there has been a five-fold increase in four years(EJF 2007).Whatever strategy is adopted, political commitment and good governance are required:legislation must be enforced as well as enacted (Jeyaratnam 1990). Governments shouldadopt a progressive ban on highly hazardous pesticides (HHPs), using PAN International’slist of HHPs. The ‘precautionary principle’ to pesticide regulation should be adopted. 7
  • 8. Health risk assessment and emergency health contingency plan (2500 words) w10025958Government policies should support the adoption of agroecological production systems(Dinham 2010). Institutional frameworks, such as policy and marketing incentives, should beenabled to foster alternatives, such as “organic, biodynamic, agroecological, permaculture,low external input and indigenous knowledge systems” (PAN 2007b). Manufacturers anddistributors should be liable for human health and ecosystem harm: a percentage of eachbottle sold could go towards biomonitoring. The food industry could also use their marketinfluence to phase out HHPs and promote organic production (Dinham 2010).Consumer awareness and consumption patterns that support alternative production shouldbe developed (PAN 2007b). The driving change of organic cotton production has beenconsumer demand in Western countries. Increasingly, major retailers are offering an organicselection. Consumers are able to make informed decisions due to better labelling (EJF2007).To conclude, the use of synthetic, chemical pesticides has many harmful effects on humanhealth and the environment. These can be chronic or acute, and are not limited to those indirect contact with pesticides. However, those who work with pesticides experience greaterexposure, as do their communities and families. The recommendations above are a holisticapproach to improving public health and the environment. Restricting access will also have aknock-on effect of reducing self-harm. Some are already taking place but need to beimproved, such as training being extended to families and communities. Some are low costand relatively easy to implement, such as community-based monitoring. Changes togovernment ad industry policy will require much more effort and commitment. 8
  • 9. Health risk assessment and emergency health contingency plan (2500 words) w10025958ReferencesDinham, B. (ed) (2010) Communities in Peril: Global report on health impacts of pesticideuse in agriculture, PAN Asia Pacific, Manila, Online: (Accessed 16/02/11)EJF (2002a) Death in Small Doses: Cambodia’s Pesticides Problems and Solutions,Environmental Justice Foundation, LondonEJF (2002b) End of the Road for Endosulfan: A Call for Action Against a DangerousPesticide, Environmental Justice Foundation, LondonEJF (2007) The Deadly Chemicals in Cotton, Environmental Justice Foundation incollaboration with Pesticide Action Network UK, LondonEJF(2009) End of the Road for Endosulfan: pushing for a global ban on a deadly pesticide,Environmental Justice Foundation, London, Second versionFAO (no date) Pesticides: Balancing Crop Protection and Responsible Use, FAO, Rome,Online: (Accessed 27/02/11)Gilden, R. C, Huffling, K. & Sattler, B. (2010) Pesticides and Health Risks, Journal ofObstetric, Gynecologic & Neonatal Nursing, 39, pp. 103-110Healthy Environments for Children Alliance (no date) Issue Brief Series: Pesticides, HECA,Online: (Accessed 5/04/11)Jeyaratnam, J. (1990) Acute Pesticide Poisoning: A Major Global Health Problem, WorldHealth Statistics Quarterly, 43.3, pp. 139-44London, L. & Bailie, R. (2001) Challenges for improving surveillance for pesticide poisoning;policy implications for developing countries, International Journal of Epidemiology, 30, pp.564-570Lucas, S. F. & Allen, P. J. (2009) Reducing the Risk of Pesticide Exposure among Childrenof Agricultural Workers: How Nurse Practitioners Can Address Pesticide Safety in thePrimary Care Setting, Pediatric Nursing, September-October 2009, 35.5, pp. 308-317Pesticide Action Network (2007a) Community Based Monitoring of Pesticide Impacts: A PANInternational Position Paper - Working Group 5, 7 June 2007, Online: (Accessed16/02/11)Pesticide Action Network (2007b) Alternatives to synthetic pesticides in agriculture: A PANInternational Position Paper - Working Group 4, 18 June 2007, Online: 16/02/11)Secretariat of the Basel Convention [a] (no date) At a Glance: Basel Convention, UNEP,Geneva, Online: (Accessed 27/02/11)Secretariat of the Basel Convention [b] (no date) At a Glance: Rotterdam Convention,UNEP, Geneva, Online: 27/02/11)Secretariat of the Basel Convention [c] (no date) At a Glance: Stockholm Convention, UNEP,Geneva, Online: (Accessed27/02/11)UNEP/AMAP (2011) Climate Change and POPs: Predicting the Impacts, Report of theUNEP/AMAP Expert Group, Secretariat of the Stockholm Convention, GenevaWorld Health Organisation (2010) Exposure to Highly Hazardous Pesticides: A Major PublicHealth Concern, Geneva, Online: 5/04/11) 9