[PDF] - Agricultural Workers at Risk I have no conflicts of interest with PDF Document

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Marc Schenker M.D., M.P.H. mbschenker@ucdavis.edu University of California at Davis

Agricultural Workers at Risk

UCSF CE

March 11, 2017

I have no conflicts of interest with respect to the material included in this presentation.

Grant Wood, American Gothic, 1930

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Agriculture and Immigrant Labor

The majority of US farm work (~60%) is now done by immigrant workers, primarily Latino.

– In California, hired (immigrant workers) account for ~90% of farm work.

This phenomena exists around the world, with both transnational and internal migrant workers.

– Europe, Asia, South America, Australia

The agricultural labor transition continues to change in magnitude, direction and content………………

Increase in undocumented immigrants
Increased percentage of indigenous

immigrant farmworkers

Decreased total farmworker immigration
Longer term, older farmworkers
Impacts of increased deportations

Outline

Occupational health of immigrant workers Health of immigrant workers in agriculture

– Injuries – Heat illness – Pesticide toxicity

Summary and future directions

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Global Migration

232 million people live outside their country of birth

(46 million in the U.S.)

750 million transnational and internal migrants
Demographics will make increased migration

inevitable

Currently 142 young workers for 100 retirees in

developed countries.

In 2016 there was 87 entrants in workforce for 100

retirees.

Only immigrants can make up this gap
342 candidates for every 100 jobs in developing

countries.

Oaxacan working in Mexico earns (U.S.)$1.50/hr Oaxacan working in California earns $9.00/hr 1 day in Mexico = 1 hr in California

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4 Takeourjobs.org

February 25, 2017

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Occupational Health of Immigrant Workers

Occupation and Industry Injury and Fatality Rates, ACS

Variable Natives Immigrants

Industry Injury Rate* 140.5 148.7 Occupational Injury Rate* 108.8 139.7 Industry Fatality Rate+ 4.7 6.5 Occupational Fatality Rate+ 5.9 7.5

Orrenius. Demography. 46:535, 2009

*per 10,000 workers +per 100,000 workers

Agriculture

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6 Postville, Iowa May 12, 2008

Occupational Health Problems Among Agricultural Workers

“A textbook of occupational disease”

Injuries; acute and cumulative Respiratory disease Dermatologic disease Infectious disease Heat stress Cancer Adverse reproductive outcomes Mental illness Pesticide illness (acute, chronic) Neurologic disease Etc.

PMR External Causes, US Farmworkers, 24 States

Cause of Death Number PMR (95% CI) External Causes 3616 133 (129 – 137) All Injuries 2465 152 (146 – 158d) Motor vehicle injuries 1299 149 (141 – 158) Other unintentional injury 1091 157 (148 – 157) Unintentional poisoning 81 190 (145 – 244) Falls 72 117 (92 – 148) Suicide 480 80 (73 – 87) Homicide 807 142 (131 – 154) Firearms 721 99 (92 – 107)

Source: Colt, J.S. (2001). Am J of Ind Med, 40, 604-611.

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7 Non-Fatal Injuries Among Farmworkers

Non-fatal injury rate 3.8 – 13.0/100 FTE
This is 1.3 – 5+ x rate for all private employees
Rate higher:
Shuttle migrants
Southeast US
Recently employed
BLS estimates may undercount cases by 63 – 88%*
Greater undercount than other industries

Leigh, Ann Epi, 2014

Heat Stress in the Workplace – A Growing Occupational Hazard

Sacramento Mean and Maximum Temperatures, July, 1990 - 2085

www.Climatechip.org

Percentage Increase in Heat- Related Deaths in US Cities Int J Environ Res

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8 2006 California Heat Wave Impacts

n All-Cause ED Visits
Excess in ED visits (all causes) (n=16,166) and

hospitalizations (n=1,182) for all age groups

Increase in ED visits for all race/ethnic groups
Increase in ED visits for all regions except SE

desert

Increase in cause-specific hospitalizations: heat

illness, electrolyte imbalance, acute renal failure, nephritis.

Knowlton, EHP 117:61, 2009

Factors Associated with Heat Wave-Related Deaths A Meta-analysis

Factor OR 95% CI Confined to bed 6.44 4.5 – 9.2 Unable to care for oneself 2.97 1.8 – 4.8 Psychiatric illness 3.61 1.3 – 9.8 Cardiovascular disease 2.48 1.3 – 4.8 Pulmonary disease 1.61 1.2 – 2.1 Air conditioning 0.23 0.1 – 0.6 Increased social contacts 0.40 0.2 – 0.8

Bouchama, Arch Int Med 167, 2007

Military Athletes Workers

“Exertional” Heat-Related Illness

Heat Illness Fatalities in Agriculture, 2008

Maria Isabel Jimenez May 14, 2008 17 y.o. picking grapes Jose Hernandez June 20, 2008 64 y.o. picking squash Abdon Garcia July 9, 2008 46 y.o. loading grapes Ramiro Rodriguez July 9, 2008 48 y.o. picking nectarines Jorge Herrera July 31, 2008 37 y.o. loading grapes Maria Alvarez August 2, 2008 63 y.o. picking grapes

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CDC Analysis of Occupational Heat Fatalities in Agriculture, U.S. 1992 - 2006

MMWR 57 (24) : 649-653, 2008

423 deaths from occupational heat exposure
Rate of agricultural worker deaths 20x all

industry rate

76% agriculture deaths in crop production
Most (all?) agriculture deaths among immigrant

workers

Source: Centers for Disease Control and

Prevention. (2008,

MMWR, Vol. 57,

No. 24.

Heat Stress Deaths by 5-year Periods, U.S. 1992 - 2006

Age Distribution of Occupational Heat Fatalities in Agriculture, U.S. 1992 - 2006

Age N % Rate* 20 - 34 16 24 .34 35 - 54 37 54 .55 55+ 15 22 .33 MMWR 57 (24) : 649-653, 2008 * Per 100,000

Place of Death, Occupational Heat Fatalities in Agriculture, U.S. 1992 - 2006

MMWR 57 (24) : 649-653, 2008

* Per 100,000

State N % Rate*

California 20 29 .49 Florida 6 9 .74

N. Carolina

13 19 2.36 Other 29 23

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Acclimatization and Risk of Heat Stress Illness

In a study of 60 aluminum smelter workers:

Acclimatized (n = 50) Unacclimatized (n = 8) Tc > ACGIH Criterion (%)* 20 88 Minutes > Tc (median) 28 46 HR, Average* 107 118

*p < 0.01 Dang, JOEM, 56(3) 313, 2014

Heat Related Illness: increased susceptibility in farm workers

Extended period of working in direct sun with high temperatures and humidity. Work pressure – Motivations to work beyond endurance, not take breaks, piece work pay, etc. Dehydration (restricted ability or failure to drink water, rest in shade). Lack of knowledge of symptoms and response needed. Cultural beliefs (e.g. hot-cold syndrome) Poor nutritional habits, poverty and stress. Marc S chenker James Jones Debbie Bennett Gail Wadsworth Dan Tancredi Diane Mitchell Javier Castro Jose Gutierrez Carlos Piña Alondra Vega S ally Moyce

California Heat Illness Prevention Study (CHIPS)

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CHIPS Findings Among California Farmworkers

Despite HRI prevention training, and provision of water, 20 % of male and 4 % of female farm workers became dehydrated over a workshift. Dehydration was independently associated with being male, and knowing how much water to drink. Most workers (72%) felt thirsty to extremely thirsty

ver the work day.

Knowledge is not translating into self-protective actions

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Beliefs, Behavior and Intervention: Hydration – Selected Findings

Beliefs about water temperature and consumption

shape, in part, participant choices:

to hydrate regularly
types of beverages consumed throughout the day
Beliefs about cause and effect between drinking water

and “sickness” may:

reduce frequency of water consumption
result in cognitive dissonance for workers about the

benefits of hydration.

Belief that shifting body temperatures too rapidly can be

dangerous and harmful to the body.

Summary

Heat illness (HRI) remains a risk of illness and death, especially for the most vulnerable outdoor workers. Climate change factors will increase risks in the future. Risk factors for HRI are multifactorial and require diverse approaches addressing heat gain and cooling. Metabolic heat gain may be a significant risk factor for HRI. Approaches should include education, engineering and enforcement efforts, and address cultural beliefs and perceptions. HRI is 100% preventable.

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Toxicology, Diagnosis & Management of Pesticide Illness by Functional Category

Insecticides Fumigants Fungicides Herbicides Disinfectants Miscellaneous

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Fumigants

Halogenated hydrocarbons

– Methyl bromide – Ethylene dibromide, DBCP

Inorganic compounds

– Sulfuryl fluoride

Pro-fumigants

– Metam sodium

Metal phosphides

– Aluminum, Zinc, Magnesium

US DOT

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Sulfur: Allergic Skin Reactions

Positive patch test reactions to sulfur in nursery workers applying sulfur Case reports support sulfur- induced allergy

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Case

Nursery Worker with Urticaria

Itching and hives in redwood nursery worker Chlorothalonil patch test:

– Local Type I hypersensitivity

1% chlorothalonil open test

– Systemic Type I reaction

Summary

Immigrant farmworker face multidimensional health problems

– Poor working conditions – Numerous health and safety hazards – Precarious employment, especially for undocumented – Agricultural exceptionalism – Environmental hazards: housing, nutrition, stress, discrimination

Attention needs to be focused on the unique health and safety needs of immigrant agricultural workers

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Which statement is NOT true with regard to immigrant agricultural workers?

A. Occupational fatality rate is several times the

rate for all industries combined.

B. Undocumented workers are at increased risk
f injury and illness.
C. There are more deaths among ag workers in

California from heat stress than from pesticide poisoning.

D. Injuries among agricultural workers are

reported with the same accuracy as in other industries.

Which statement is true with regard to heat stress among agricultural workers?

A. Men and women are equally affected.
B. Education alone is adequate to prevent most

heat stress among agricultural workers.

C. Risk of heat stress fatalies increase with

increased age.

D. Lack of acclimatization is a significant risk

factor of occupational heat illness.

Which statement is true with regard to immigrant agricultural workers?

A. Pesticides are the greatest occupational hazard

facing farmworkers in California.

B. The precariousness of many agricultural workers

is a significant risk factor for occupational illness and injury.

C. Net migration of agricultural workers to California

is likely to increase in the coming years.

D. US native born workers will supply an increasing