Environmental and Occupational Health

PHOTO: Farmworker in cranberry field

Immigrant and migrant populations work in some of the riskiest industries in the country including agriculture, forestry, fishing and construction. Immigrants have higher rates of injury and fatality compared to workers in other sectors. In fact, foreign born workers are more likely to die on the job than those born in the U.S. MCN recognizes that migrant clinicians, like the majority of primary health care providers, lack expertise in recognizing and managing work-related injuries and illnesses. Given the competing demands and severe time constraints in primary care, clinicians struggle with ways to incorporate occupational medicine into their day-to-day efforts.

Since its inception, MCN has worked to eliminate health disparities among mobile populations, including farmworkers. Here, we present some common environmental and occupational health challenges for mobile populations.

Environmental and Occupational Illness and Injury

The cost of occupational injuries and illnesses is substantial. In fact, work-related injuries and illnesses cost the United States as much or more than cancer, in terms of medical costs and indirect costs (Leigh, 2011). Workers compensations covers only a small portion of these costs, and the remaining burden is shared across all members of society (Leigh, 2011).

In 2011, Latino workers had the highest fatal injury rates among workers. (Kesy & Pegula, 2011). Data from 2001 to 2011 reveals that 17% of fatal injuries in the workplace occurred to foreign-born workers (Kesy & Pegula, 2014). Across all industries, particular sectors tend to be more risky than others; agriculture and construction are two examples of industries with high rates of injuries and fatalities. In 2011, agriculture had the highest rate of fatal injuries across all industries (Kesy & Pegula, 2011).

In addition to the risks posed by machinery, livestock, and accidents, agricultural workers face additional health risks due to pesticide exposure. Studies have demonstrated that agricultural workers are exposed to various pesticides during the growing season, and they are typically exposed to these chemicals repeatedly over the course of one season (Arcury et al., 2009; Arcury et al., 2010). In addition to workplace exposures, families of agricultural workers are consistently exposed to pesticides in the home (Quiros-Alcalá, et al., 2011; Quandt et al., 2004). Multiple studies have demonstrated linkages between pesticide exposure and adverse birth outcomes, including decreased fetal growth and preterm birth (Eskenazi et al., 2013; Harley et al., 2011). Pesticides that affect the central nervous system have been linked with neurological effects in adults (Rahman et al., 2009), and neurodevelopmental abnormalties in children (Rosas & Eskenazi, 2008).

Sources

Arcury TA, et al. Variation across the agricultural season in organophosphorus pesticide urinary metabolite levels for Latino farmworkers in eastern North Carolina: Project design and descriptive results. Am J Ind Med. 2009; 52:539–550.
Arcury TA, Grzywacz JG, Talton JW, Chen H, Vallejos QM, Galván L, Barr DB, Quandt SA. Repeated pesticide exposure among North Carolina migrant and seasonal farmworkers. Am J Ind Med. 2010; 53:802–813
Eskenazi B, Chevrier SA, Kogut K, Harley KG, Johnson C, Trujillo C, Sjodin A, Bradman A. In utero and childhood polybrominated diphenyl ether (PBDE) exposures and neurodevelopment in the CHAMACOS study. Environ Health Perspect. 2011; 121.2 (2012): 257-262.
Harley, KG, et al. Association of organophosphate pesticide exposure and paraoxonase with birth outcome in Mexican-American women. PLoS One. 2011; 6.8: e23923.
Kesy L & Pegula S. Census of Fatal Occupational Injuries commemorates 20 years of occupational safety and health data. Beyond the Numbers. 2011; 3(23).
Leigh, JP. Economic burden of occupational injury and illness in the United States. The Milbank Quarterly. 2011; 89(4): 728-772.
Quandt SA, et al. Jackson DS. 2004. Agricultural and residential pesticides in wipe samples from farmworker family residences in North Carolina. Environ Health Perspect. 2004; 112:382–387.
Quirós-Alcalá, Lesliam, et al. Pesticides in house dust from urban and farmworker households in California: an observational measurement study. Environ Health. 2011; 10.19: 10-1186.
Rahman MM, Naidu R, Bhattacharya P. Arsenic contamination in groundwater in the Southeast Asia region. Environ Geochem Health. 2009; 31(1): 9-21.
Rosas LG & Eskenazi B. Pesticides and child neurodevelopment. Curr Opin Pediatr. 2008; 20(2): 191-197.

Pesticides

Pesticides are essential tools in the production of the world’s food supply, in the protection of structures, in the prevention of illness transmission, and in the control of vector-borne diseases. As a group, however, pesticides contain some of the most toxic chemical products produced by modern chemistry. They are also unique among toxic environmental contaminants found in our environment for, like no other chemicals except war gases, pesticides are purposefully released into our environment with the intention of doing harm to living beings. In 1990, the date of the last attempted world estimate, the World Health Organization estimated there are 3 million poisonings and 200,000 deaths from pesticide exposure per year in the world and that this reflects only a fraction of the real problem. Learn more...

Lead

Lead Lead poisoning is a preventable disease. It causes behavioral and learning disorders in children. Migrant populations face unique dimensions of exposure that increase their risk of lead poisoning such as occupational exposures, neonatal exposures, cultural practices (folk remedies, food preparation, etc), migration, and substandard housing environments. Learn more...

Heat-Related Illness

Heat stress is a preventable illness brought on by prolonged overexposure to heat and the sun. Learn more...

Water & Sanitation

Water and Sanitation Despite advances in water supply and treatment, many farmworkers remain vulnerable to contaminated water supplies. Most of the water sources used to provide water to farmworkers in the fields or in the camps are private wells. This is of particular concern in agricultural areas where rain and irrigation water can carry pesticides, fertilizers, and human and animals wastes through the soil and into the underlying aquifer. Farmworkers may or may not be exposed to contaminated water via poorly maintained wells. Facilities for hand washing and properly maintained excreta disposal systems may or may be available to farmworkers. Knowing that enteric infection may be an issue for farmworkers has several implications for clinicians, outreach workers, and health educators. Learn more...

Migrant Children in Agriculture

The children of farmworkers are no less vulnerable to occupational and environmental risks. All children residing on or near farms as well as those working in agriculture face risks from injury and exposure both in their homes and at the worksite. While some farmworker parents report regular access to health care for their children, many lack continuity with regular providers and do not receive preventive care on standard schedules due to multiple access barriers.

According to a recent study, children ages 14 to 17 make up 5.5 percent of the hired crop farmworker labor force (Kandel, 2008). Many of these children are emancipated minors, who often work and reside in a different country or state than their parents; most farmworker children begin working on farms at 10 years old (Kandel, 2008). Children working in agriculture sustain high numbers of injuries and fatalities; agriculture accounted for 41 percent of fatal work injuries to youth from 1998 to 2002 (Windau and Meyer, 2005). For workers under the age of 16, agricultural production accounted for nearly 60 percent of deaths in this age group, with 79 percent of all work-related deaths for youths ages 10 or younger occurring in agriculture (Hard and Myers, 2006).

Young worker deaths in agriculture occur more frequently than in all other industries combined (Blueprint for Protecting Children in Agriculture, 2012). Despite the risky nature of agriculture, children who work in agriculture have been historically underprotected compared to children employed in other industries. Child labor laws do not protect children working in agriculture in the same way that children working in other industries are protected. For example, in agriculture, children who are 12 years old and older can work unlimited hours on a farm as long as they have parent permission (Blueprint for Protecting Children in Agriculture, 2012).

When farmworker parents do not have accessible and affordable childcare, they are more likely to bring their children to work with them. One study shows that seven percent of farmworker parents bring preschool-age children to work (Salazar et al, 2004). While these children are not part of the agricultural work force, they are still at risk for some of the same work-related dangers that their parents face. In fact, among the more than 1,800 injuries to children on farms in 2012, 75 percent of these injuries occurred to children who were not working (Blueprint for Protecting Children in Agriculture, 2012). MCN is dedicated to serving the needs of both working and nonworking children on farms, so that we can reduce injuries and improve health outcomes for all youth.

Links to EOH Resources

For further resources, click here.

The New York Center for Agricultural Medicine and Health has created a website linking clinicians and health care providers to information and resources to treat and manage farmworker patients. The site includes clinical and diagnostic tools, patient education materials, links to demographic data, and citations for regional research on farmworker health and safety.

Farmworker Clinical Care Resource for Occupational Health

For more information on MCN's response to environmental and occupational challenges in primary care, visit MCN's Environmental and Occupational Health Initiative webpage.

For questions about MCN's Environmental and Occupational Health Initiative, please contact Amy Liebman.

**MCN’s EOH efforts are largely supported through cooperative agreements with the US Environmental Protection Agency as part of their National Strategies for Health Care Providers: Pesticide Initiative. The conclusions and opinions expressed herein are those of MCN and do not necessarily reflect the positions and policies of the EPA.

MCN MAKES A DIFFERENCE IN 2020

Environmental and Occupational Health