Pesticides at Work: a PPE’s agricultural tale

#PesticidesAtWork is a collaborative project that investigates health consequences for farmers who use pesticides. The investigation is coordinated by Investigative Reporting Denmark and Le Monde. The Media partners are Tygodnik Powszechny (Poland), Ostro (Croatia and Slovenia), De Groene Amsterdammer (The Netherlands), Ippen Investigativ (Germany), TV2 (Denmark), Marcos Garcia Rey (Spain) and The Midwest Center for Investigative Reporting (United States). In Italy, Scomodo is in partnership with IrpiMedia. This article is also available in Italian.

The first scientific evidence emerged around twenty years ago: tumours, lymphomas and neurodegenerative diseases can be caused by exposure to fungicides, insecticides, herbicides and other chemicals used in agriculture.

To protect themselves from these substances, farmers must wear masks, gloves, coveralls and other Personal protection equipment (Ppe). However, it’s hard to tell if they always manage to do this, or if they do it in the right way. Part of the scientific community thinks that Ppe is not even sufficient to protect them from diseases. 

Millions of people pay the price for this ambiguity. The agricultural sector produces 1.3% of the gross domestic product of the European Union, has 10 million companies and 22 million employees.

An invisible phenomenon

In the 13th arrondissement of Paris, in the south of the city, is located the headquarter of Inserm, the National Institute of Health and Medical Research, one of the main French public institutions dealing with public health. This is one of the few scientific institutions in Europe to have conducted comprehensive studies on the consequences of pesticides on farmers’ health. 

The latest research dates back to June 2021 and is based on a review of 5,300 documents. “Considering the studies concerning professional figures who handle or are in frequent contact with pesticides” – the paper states – “and who are a priori the most exposed, the experts confirm the strong presumption of a link between pesticide exposure and six diseases: non-Hodgkin’s lymphoma (NHL), multiple myeloma, prostate cancer, Parkinson’s disease, cognitive disorders, as well as some respiratory system disorders”. 

No such studies exist in Italy. Even if it is not easy to find explicit data on the use of pesticides and their effect on the health of farmers, some clues come from the monitoring of the Higher Institute for Environmental Protection and Research (Ispra) that traces pesticides in water. 

“In Italy, 114,000 tons of pesticides are used every year, representing about 400 different substances,” Ispra writes in a report submitted to Parliament in December 2021. “In 2019, measured concentrations of pesticides exceeded regulatory limits in 25% of monitoring sites for surface water and 5% of those for groundwater.” 

The the overall picture is even more significant considering that “the contamination detected is still underestimated, due to technical and methodological difficulties, although over the years the effectiveness of monitoring is improving in relation to territorial coverage, the number of samples analysed and the substances sought.” 

Ispra is not the only institute to raise concerns about data underestimation. The National Institute for Insurance against Accidents at Work (Inail) is the only European institution that, together with its French counterpart, admits pathologies such as Parkinson’s disease as occupational diseases related to the use of chemicals in agriculture. 

Despite this, the institute has so far collected very little evidence. Between 2016 and 2020, only 20 farmers reported Parkinson’s disease and similar pathologies to Inail as a possible occupational disease. Of these, only ten cases were actually established as occupational diseases.

It is clear that these are irrelevant numbers for a country in which agricultural workers roam around 900,000 according to Eurostat data (excluding the illegal workers, not considered in these estimates).

The use of pesticides in Europe

Comparison between the European mean, Italy and other EU members. Data show the usage of pesticides per hectare [Kg/ha] on arable land between 1990 and 2019. 

Inail is aware of this underestimation in numbers of verified occupational diseases. A study conducted by Inail itself in 2016 concluded that "to a hypothesised prevalence of parkinsonian syndromes in subjects residing in rural and agricultural areas, does not yet correspond an adequate trend of requests to Inail for recognition as an occupational disease." 

(Almost) any attention

In France there is an association of victims of plant protection products, created in 2011. In Italy, an association like this doesn't exist. Between 2012 and 2020, "Phyto-Victimes" collected requests for help from more than 540 agricultural workers who feared they had fallen ill from pesticide exposure. In addition, Parkinson's disease has been included among occupational diseases, as in Italy. 

In 2012, data from Inrs - the French counterpart of Inail - show that 221 cases of occupational disease were recognized between 2012 and 2017: numbers that, though not very high, are much larger than those in Italy. Yet, according to Eurostat data, Italy has approximately 900.000 agricultural workers while France has 700.000. In Holland, the national association of Parkinson's disease patients has opened a telephone line for agriculture that has received about 130 reports in one year.

Parkinson's disease in agriculture

Number of cases of nervous system disorders (Parkinson's disease and similar) reported and verified as occupational diseases in agriculture in Italy. 

Italy's particularly low numbers, however, are not unique. The rest of the European countries show a deep-rooted inattention to this phenomenon. In Poland - where the agricultural sector employs 2.3 million people - the last cancer developed working in a field, according to official data, dates back to over ten years ago. Although there have never been chemical poisonings and the only consistently recognized injuries are from tick bites, which account for 80% of total compensation. 

In Germany some government documents obtained by our German colleagues of #PesticidesAtWork show how the agency that depends on the Ministry of Labor and that deliberates on occupational diseases, has been discussing for over twelve years whether to include Parkinson's disease among the diseases caused by pesticides. Without this decision, German workers have to go to court to get compensation. Since 2010, 61 German agricultural workers have registered with SVLFG, a specialised insurance association, to get Parkinson's recognized as an occupational disease. None have yet succeeded. 

In Denmark, the union 3F, which is specialised in agricultural work, says that it has never heard of any outbreaks of pesticide-related diseases. In Sweden, where compensation for occupational diseases in 2020 was about 35,000, pesticide-related illnesses were three in the last five years. Hence all of this can also be explained by legislation governing one of the key factors in pesticide use: Personal protective equipment.

True in theory, false in practice

To mitigate the environmental and health risk, for both those who live near the cultivated fields and the workers, the European legislation provides very stringent rules on how to use pesticides. Efsa, the European agency in charge of food safety, reviews together with the Commission and the Member States which list of pesticides should be introduced on the market and under which conditions. For workers handling pesticides, it is mandatory to use personal protective equipment (Ppe): overalls, masks with breathing filters, gloves, goggles, boots and  tractor cabs with special ventilation systems.

Theoretically, one should obtain a licence to use pesticides, purchase them only from authorised dealers, have specific documentation to show in case of controls, and use them only during specific periods of time. In practice, especially in Italy, there is a flourishing black market where forbidden products circulate. Indeed products are easily purchased online and controls are too few to effectively combat the phenomenon. 

"The fundamental problem is the use of protective equipment," comments Carlo Antellini, an Italian agronomist who trains farmers. As Tina Balì, Secretary of Flai Cgil nazionale, confirms to Scomodo, the union organisation is aware that most workers don't use Ppe during phytosanitary treatments.

Outside of greenhouses, pesticides are spread from March to October-November, which is the hottest period of the year. Thus when you wear certain devices that have the characteristic of being completely waterproof, "it becomes impossible to stay in them," Antellini reasons. This is confirmed by German, Spanish, Polish, French, Slovenian and Croatian farmers: personal protective equipment is often not used. "Many farmers recycle them, while I always recommend making them disposable," he adds.

In Poland, if a farmer is caught without Ppe, he risks losing his pension. The reason why complaints in the country are so low is that the risk is that the responsibility for the disease falls on the sick person, who, however, didn't wear the sanitary devices that, according to the workers themselves, are often unusable. 

This fact, concealed for years, has been corroborated by the Pestexpo - Pesticides exposure study. Begun 20 years ago in Normandy and the Bordeaux region, the study aimed to observe the effects of pesticide use on farmers in the field over time. It was the first study to verify farmers' actual exposure to pesticides through an observation of their activities, comparing them with exposure levels assumed by mathematical models used to approve plant protection products. As they explained to colleagues working on this investigation, the researchers quickly noticed the difference between theory and practice.

Pierre Lebailly, one of the project coordinators, recalls an episode that struck him. "A guy had a degree in agricultural engineering and put his bare hands in the pesticide tank," he explains, talking about a farm worker in his 30s in Normandy. Beyond the individual case, the rules on Ppe require a level of attention only comparable to laboratories. Isabelle Baldi, also involved in the research, points this out. "People are working in shorts and t-shirts. It may not be a 'good agricultural practice,' but it's real life," Baldi says. According to her, the rules call for farmers to act "like surgeons who have both hands up so someone behind them can put on gloves, and it's fundamental that they don't touch anything. That's how it's done in a surgical unit, so it has to be done in a farm as well." 

According to French sociologist Jean-Noël Jouzel, a researcher at the French National Centre for Scientific Research (CNRS), the concept of "safe use" of protective equipment is an invention. "In theory, all pesticides are placed on the market with the idea that, if used according to the indications written on the label, they will not cause any undesirable effect," - explains the researcher - "But in reality, things do not work as it is written on the label." 

Crimes without guilt

Isabelle Baldi and Pierre Garrigou, her collaborator in the Pestexpo project, published a "note d'alerte", addressed to several French institutions in 2007. According to the results of the study, winegrowers who wear protective suits during "the treatment and cleaning phases," i.e., when preparing and applying phytosanitary products and when cleaning the suits of pesticide residues, "are overall more exposed to contamination than those who do not wear them" by two and three times, respectively. As counterintuitive as this conclusion may seem, it was also confirmed in a 2017 study of farm workers in California.

There are several reasons for this, and the first two are related on one hand to the reuse of Ppe, that is not always cleaned properly from traces of chemical agents, and on the other hand to the fact that the jet of water shot on the surface of the suit can flow inward, along with traces of chemical agents. 

Furthermore there is a third element: the chemical composition of pesticides allows them to penetrate any cell. The polyvinyl chloride (pvc) from which some aprons are made, for example, is perfectly waterproof, but not to pesticide filtration. 

The French Agency for Environmental and Occupational Health Safety (Affset) in January 2010 conducted its own study to independently verify the protective effectiveness of the suits. "Wearing a garment alone does not guarantee worker protection," the findings state. "The use of protective clothing should therefore not act as a substitute for, but as a complement to, collective protection and appropriate work organisation," the report continues. Finally, the report hints at what is still unknown: "The adequacy [of performance] of suits placed on the market to the substances or mixtures of substances used in real conditions remains a key issue since the products tested on the suits and indicated in the instruction manual differ from the products used in the industry, as well as since laboratory conditions do not reflect real conditions." 

While there was at least a stance in France, nothing happened in the rest of Europe. Ten years after the release of the study by the French ministerial agency, a group of researchers, including Baldi and Garrigou, have taken up the results of their research on personal protective equipment in a paper entitled "Critical review of the role of Ppe in preventing risks related to the use of pesticides in agriculture", published in the scientific journal Safety Science in 2019. 

"Some hazardous products," the researchers write, "have been licensed only because it is assumed that the use of Ppe limits exposure considerably. They conclude that "without this assumed protection, they would be banned". Ppe would then mainly play the role of lightning rod: they allow both producers and institutions to avoid any responsibility for the health of agricultural workers. 

CropLife Europe, a lobby representing at European level the producers of plant protection products and biotech companies, responded with a letter to Le Monde, the newspaper that coordinated the project #PesticidesAtWork. The organisation accused the researchers of having taken "an emotional position", without scientific basis, and of being "exaggerated at best, misleading at worst". 

CropLife Europe denied the newspaper interview but provided some written statements, "We did not feel that it presented a balanced view," it reads. The research "exaggerated the health risks for operators and overemphasised the importance assigned in the authorization phase [of pesticides] to protective factors". 

The Italian National Institute of Health, however, recognizes that agriculture is the working sector whose workers run the highest risk of developing Parkinson's disease. And this happens just because of the exposure to pesticides. Even if someone wants to reject the results of studies on the real degree of protection provided by Ppe, it is clear that the rules imposed on their use by workers are far from reality. All of this allows manufacturers and institutions to hold agricultural workers responsible for their own occupationally developed diseases. Jean-Noël Jouzel told our colleagues that "occupational diseases are crimes without guilt." As things stand, the risk is that are  the victims themselves who are held guilty.