Agricultural Workers at Risk I have no conflicts of interest with - PDF document

Agricultural Workers at Risk I have no conflicts of interest with respect to the material ••••• included in this presentation. UCSF CE March 11, 2017 Marc Schenker M.D., M.P.H. mbschenker@ucdavis.edu University of California at Davis Grant Wood, American Gothic, 1930 1

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 Outline The agricultural labor transition continues to change in magnitude, Occupational health of immigrant workers direction and content……………… Health of immigrant workers in agriculture • Increase in undocumented immigrants – Injuries • Increased percentage of indigenous – Heat illness immigrant farmworkers – Pesticide toxicity • Decreased total farmworker immigration Summary and future directions • Longer term, older farmworkers • Impacts of increased deportations 2

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 Oaxacan working in 1 day in Mexico Oaxacan working in • 342 candidates for every 100 jobs in developing Mexico earns California earns = 1 hr in countries. (U.S.)$1.50/hr $9.00/hr California 3

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Occupation and Industry Injury and Occupational Health of Fatality Rates, ACS Immigrant Workers Variable Natives Immigrants Industry Injury 140.5 148.7 Rate* Occupational 108.8 139.7 Injury Rate* Industry Fatality 4.7 6.5 Rate + Occupational 5.9 7.5 Fatality Rate + *per 10,000 workers Orrenius. Demography. 46:535, 2009 +per 100,000 workers Agriculture 5

Occupational Health Problems Postville, Iowa Among Agricultural Workers May 12, 2008 “ 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 1091 157 (148 – 157) injury 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. 6

Non-Fatal Injuries Among Heat Stress in the Workplace – Farmworkers A Growing Occupational Hazard • 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 Percentage Increase in Heat- Sacramento Mean and Maximum Related Deaths in US Cities Temperatures, July, 1990 - 2085 www.Climatechip.org Int J Environ Res 7

Factors Associated with Heat 2006 California Heat Wave Impacts Wave-Related Deaths on All-Cause ED Visits A Meta-analysis • Excess in ED visits (all causes) (n=16,166) and Factor OR 95% CI hospitalizations (n=1,182) for all age groups Confined to bed 6.44 4.5 – 9.2 • Increase in ED visits for all race/ethnic groups Unable to care for oneself 2.97 1.8 – 4.8 • Increase in ED visits for all regions except SE Psychiatric illness 3.61 1.3 – 9.8 desert Cardiovascular disease 2.48 1.3 – 4.8 • Increase in cause-specific hospitalizations: heat Pulmonary disease 1.61 1.2 – 2.1 illness, electrolyte imbalance, acute renal failure, Air conditioning 0.23 0.1 – 0.6 nephritis. Increased social contacts 0.40 0.2 – 0.8 Knowlton, EHP 117:61, 2009 Bouchama, Arch Int Med 167, 2007 Heat Illness Fatalities in Agriculture, 2008 “ Exertional ” Heat-Related Illness Maria Isabel Jimenez Ramiro Rodriguez May 14, 2008 July 9, 2008 17 y.o. picking grapes 48 y.o. picking nectarines Jose Hernandez Jorge Herrera June 20, 2008 July 31, 2008 64 y.o. picking squash 37 y.o. loading grapes Maria Alvarez Abdon Garcia August 2, 2008 July 9, 2008 63 y.o. picking grapes Military Athletes Workers 46 y.o. loading grapes 8

CDC Analysis of Occupational Heat Stress Deaths by 5-year Periods, U.S. 1992 - 2006 Heat Fatalities in Agriculture, U.S. 1992 - 2006 • 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 Source: Centers for Disease workers Control and Prevention. (2008, MMWR, Vol. 57, MMWR 57 (24) : No. 24. 649-653, 2008 Age Distribution of Place of Death, Occupational Heat Fatalities Occupational Heat Fatalities in Agriculture, U.S. 1992 - 2006 in Agriculture, U.S. 1992 - 2006 Age N % Rate* State N % Rate* 20 - 34 16 24 .34 California 20 29 .49 35 - 54 37 54 .55 Florida 6 9 .74 N. Carolina 13 19 2.36 55+ 15 22 .33 Other 29 23 -- MMWR 57 (24) : * Per 100,000 649-653, 2008 MMWR 57 (24) : * Per 100,000 649-653, 2008 9

Acclimatization and Risk of Heat Related Illness: increased Heat Stress Illness susceptibility in farm workers In a study of 60 aluminum smelter workers: Extended period of working in direct sun with high Acclimatized Unacclimatized temperatures and humidity. (n = 50) (n = 8) Work pressure – Motivations to work beyond Tc > ACGIH 20 88 endurance, not take breaks, piece work pay, etc. Criterion (%)* Dehydration (restricted ability or failure to drink water, rest in shade). Minutes > Tc 28 46 (median) Lack of knowledge of symptoms and response needed. HR, Average* 107 118 Cultural beliefs (e.g. hot-cold syndrome) Poor nutritional habits, poverty and stress. *p < 0.01 Dang, JOEM, 56(3) 313, 2014 CHIPS Findings Among California Heat Illness California Farmworkers Prevention Study (CHIPS) Despite HRI prevention training, and provision of Marc S chenker water, 20 % of male and 4 % of female farm workers James Jones became dehydrated over a workshift. Debbie Bennett Dehydration was independently associated with Gail Wadsworth being male, and knowing how much water to drink. Dan Tancredi Most workers (72%) felt thirsty to extremely thirsty Diane Mitchell over the work day. Javier Castro Jose Gutierrez Knowledge is not translating into self-protective Carlos Piña actions Alondra Vega S ally Moyce 39 40 10

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. Toxicology, Diagnosis & Summary Management of Pesticide Illness by Functional Category 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. Insecticides Risk factors for HRI are multifactorial and require diverse Fumigants approaches addressing heat gain and cooling. Fungicides Metabolic heat gain may be a significant risk factor for HRI. Herbicides Approaches should include education, engineering and Disinfectants enforcement efforts, and address cultural beliefs and perceptions. Miscellaneous HRI is 100% preventable. 44 11

Fumigants Sulfur: Allergic Skin Reactions Halogenated hydrocarbons Positive patch test – Methyl bromide reactions to sulfur – Ethylene dibromide, DBCP in nursery workers Inorganic compounds applying sulfur US DOT – Sulfuryl fluoride Pro-fumigants Case reports – Metam sodium support sulfur- Metal phosphides induced allergy – Aluminum, Zinc, Magnesium 45 46 Case Summary Nursery Worker with Urticaria Immigrant farmworker face multidimensional health Itching and hives in problems redwood nursery worker – Poor working conditions Chlorothalonil patch test: – Numerous health and safety hazards – Local Type I – Precarious employment, especially for undocumented hypersensitivity – Agricultural exceptionalism 1% chlorothalonil open – Environmental hazards: housing, nutrition, stress, test discrimination – Systemic Type I reaction Attention needs to be focused on the unique health and safety needs of immigrant agricultural workers 47 12