Numerous classes of pesticides have been found to have significant acute and chronic consequences for the agricultural workers and their families who are exposed to them. Exposure comes in many forms: pesticide applicators may be exposed when mixing or applying pesticides; agricultural workers are exposed to residues of the chemicals when growing or harvesting; family members may be exposed from workers’ clothing or shoes; anyone in rural communities may be exposed to pesticide drift. Clinicians serving those at highest risk for exposure may find the following updates helpful.
Link Between Non-Hodgkin Lymphoma and Exposure to Glyphosate
Glyphosate, the active ingredient in the Monsanto-owned herbicide RoundUp™, is widely used in gardens and fields across the United States. While the Environmental Protection Agency as recently as 2020, determined that glyphosate poses no risk of concern to human health when used in accordance with labels, the World Health Organization has determined otherwise, listing glyphosate as “probably carcinogenic,” since 2015. Specifically, the WHO highlighted a positive association between glyphosate exposure and non-Hodgkin lymphoma.
A January 2023, study published in the Journal of the National Cancer Institute may provide some insight to the link. The study measured glyphosate levels in the urine of farmers and others at elevated risk of exposure and found that higher concentrations of the pesticide in urine were associated with higher biomarkers of oxidative stress, a key characteristic of carcinogens.
Worker advocates from the Legal Aid Justice Center, The Lawyers Committee for Civil Rights Under Law, and Public Citizen are informing agricultural workers, landscapers, and gardeners who have been exposed to RoundUp™ and developed non-Hodgkin lymphoma about their right to join a lawsuit to help them recoup medical costs. The coalition of advocates is currently suing Bayer, which acquired Monsanto in 2018, for excluding a non-United States citizen agricultural worker from its settlement program due to her citizenship status. Kathryn Youker, with the Lawyers’ Committee for Civil Rights, encourages clinicians to support patients with non-Hodgkin lymphoma by connecting them to legal resources.
“Farmworkers, landscapers, and gardeners are at high risk of exposure to this herbicide and often face myriad barriers to medical treatment and access to justice,” said Youker. “We hope that allies in the medical community will help patients overcome some of these barriers by discussing the possible link between NHL and environmental exposure in exam rooms and during community outreach and referring them to our non-profit coalition to learn about their rights.”
Access flyers in English and Spanish:
New Report Shows Pesticide Health Concerns Amplified Due to Climate Change
In January, the Pesticide Action Network of North America (PANNA) published, “Pesticides and Climate Change: A Vicious Cycle.” The report outlines the two-way relationship between pesticides and climate change.
“Climate change impacts us all,” noted Margaret Reeves, PhD, Senior Scientist of Environmental Health and Workers’ Rights at PANNA. “It affects us in many ways, including exacerbating the impacts of pesticides on workers. This report explains why we expect even worse health outcomes as climate change progresses.”
Pesticides contribute to climate change throughout their lifecycles. The report discusses the climate impacts at each step, through pesticide manufacturing, packaging, transportation, application, degradation after application, and disposal. Further, climate change is predicted to increase the use of pesticides, as the impacts of unpredictable weather, including increased pest and weed pressure, will likely lead to a heavier reliance on chemical agents to maintain crop production under the industrial model. For example, climate change is expected to increase soil temperatures, which precipitates faster degradation of herbicides, which may lead to an increased use of herbicides for weed control. This, in turn, raises the risk of exposure for the agricultural workers in those fields. Thus, the report displays an industrial agricultural system stuck in a “vicious cycle of ecosystem destruction.”
While the report focuses on the environmental impacts of pesticide use in a changing climate, several key predicted outcomes have significant impact on agricultural worker health. Agricultural workers and rural communities will face greater exposure to pesticides while also contending with longer and hotter heat waves, wildfire smoke, and other climate-related weather extremes and exposures. As climate change progresses and pesticide use increases, clinicians need to be aware of the compounding health impacts from these exposures. Indeed, agricultural pesticides are an air pollutant on their own; fumigant pesticides, and some non-fumigant pesticides, volatilize into gases that react with nitrogen oxides and UV rays to produce ozone, which can increase agricultural worker exposure to ozone, which presents a significant risk to agricultural worker health. (See “Why Agricultural Workers Are at Higher Risk of COVID,” in this issue, for more on the link between ozone and agricultural worker health.)
The report emphasizes the importance of the widespread implementation of agroecological farming methods that reduce or eliminate synthetic pesticide use while also leading to more climate-resilient soils and crops. Such adaptations, Reeves says, can benefit agricultural worker health in multiple ways. Many agricultural workers' families, for example, are unable to provide healthy meals for their families, despite their work in producing and harvesting the ingredients for healthy meals, like fruits and vegetables. Clinicians, she says, can promote healthy growing practices to reduce exposure to pesticides while increasing access to nutritious foods. “You see examples of farmworker communities [implementing] sustainable organic agroecology projects in their home gardens. They can produce their own food and do so without pesticides – and there are many health benefits,” she noted. Reeves pointed to the community gardens in the Farmworker Association of Florida’s Agroecology program as a model. “Farmworkers have the solutions, and they’re creating [them] in their own communities,” Reeves said.
Read the entire PANNA report:
Learn about Farmworker Association of Florida’s Agroecology program, which focuses on some of the solutions that the report outlines: https://floridafarmworkers.org/our-impact/agroecology/
Updated Cholinesterase Testing Protocols
Pesticide handlers have increased risk of exposure during mixing and application. Cholinesterase is a protein within the nervous system. Organophosphate and carbamate pesticides inhibit cholinesterase levels. To determine the level of exposure, cholinesterase monitoring is advised; indeed, it is required in several states. Because cholinesterase levels are highly individual, baseline readings are needed before exposure. Clinicians must also follow protocol on post-exposure testing, medical removal from handling, and return to handling. To guide clinicians through this process, Migrant Clinicians Network, National Farm Medicine Center, and AgriSafe Network have updated and re-released their Cholinesterase Testing Protocols for Healthcare Providers and Cholinesterase Testing Protocol Algorithm.
Access the updated cholinesterase testing protocol and algorithm in English and Spanish: https://www.migrantclinician.org/resource/cholinesterase-che-testing-protocols-and-algorithm-healthcare-providers.html
Consult the Pesticide Exposure Reporting and Workers’ Compensation Map, MCN’s popular pesticide comic books in Spanish, and additional pesticide clinical tools and resources on MCN’s Pesticide page: https://www.migrantclinician.org/explore-environmental-justice-and-worker-health/pesticides.html
Find MCN’s Pesticide Exposure Clinical Guidelines and Assessment Form, in English and Spanish: https://www.migrantclinician.org/resource/mcn-pesticide-exposure-clinical-guidelines-and-assessment-form.html
Access MCN’s Environmental/Occupational Health Screening Questions, in English and Spanish, and available in EHR format: https://www.migrantclinician.org/toolsource/resource/eoh-screening-questions-primary-care.html
MCN recommends EPA’s comprehensive manual for health care providers on toxicology, diagnosis, and pesticide treatment, Recognition and Management of Pesticide Poisonings Manual: 6th Edition: https://www.epa.gov/pesticide-worker-safety/recognition-and-management-pesticide-poisonings
Learn more about recognition and treatment of pesticide exposure on MCN’s archived webinar, “Pesticide Poisonings: Are You Prepared?”: https://www.migrantclinician.org/webinar/pesticide-poisonings-are-you-prepared-2017-04-20.html