INFORMATION ON

PESTICIDE ILLNESS

REPORTING SYSTEMS

Statement of John B. Stephenson,

Director, Natural Resources and Environment

United States General Accounting Office

GAO Testimony

Before the Economic and

Environmental Affairs Committee,

the Senate of Maryland

For Release on Delivery

Expected at

1 p.m. EST

Tuesday

March 13, 2001

GAO-01-501T
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Mr. Chairman and Members of the Committee:

My name is John Stephenson, and I am a Director with the Natural Resources and

Environment team of the U.S. General Accounting Office (GAO). As you may know,

GAO conducts audits, evaluations, and investigations for the U.S. Congress. I am here

today at the request of U.S. Senator Barbara Mikulski and Maryland State Senator Paul

Pinsky to discuss findings from a recent GAO report that relate to the “Pesticides--

Education and Reporting” bill (S.B. 654) pending before this committee.

Our report, issued in March 2000, is entitled Pesticides: Improvements Needed to Ensure

the Safety of Farmworkers and Their Children (GAO/RCED-00-40). While our report

addressed a number of issues, I will focus on the sections that are most closely related to

the subject bill and that pertain not only to farmworkers, but to the general public. My

intention is not to comment on specific aspects of the proposed legislation, but rather to

provide information from our work that may be useful in your deliberations. As will be

evident from my testimony today, GAO has long supported federal and state efforts to

improve pesticide illness reporting systems.

Although pesticides play a significant role in increasing food production and eliminating

diseases, exposure to pesticides can be harmful to humans. The ill effects of pesticides

may follow from short- or long-term exposure through skin contact, inhalation, or

ingestion. Acute symptoms—those which may be tracked in a pesticide illness reporting

system—range from relatively mild symptoms, such as headaches, fatigue, nausea, skin

rashes, and eye irritation, to more serious symptoms, such as burns, paralysis, and even

death in extreme situations. In 1999, the U.S. Environmental Protection Agency (EPA)

estimated that, nationwide, there were 10,000 to 20,000 incidents of physician-diagnosed

pesticide illnesses and injuries per year in farm work alone. However, EPA recognized

that its estimate represents significant underreporting and that no comprehensive

national data are available on the extent of pesticide illnesses.
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About 1.2 billion pounds of pesticides are used annually in the United States. About

three-fourths of this amount is used in agriculture—the remainder is used in urban or

suburban settings such as homes, businesses, schools, parks, and other public places.

However, the human health risks associated with pesticide use involve numerous factors

other than the amount used. These factors include the extent and type of exposure, the

toxicity of the pesticides used, and the age and physical condition of affected people.

Because of the complexity involved in analyzing human health risks from pesticides,

monitoring pesticide illnesses is an essential step to providing an effective,

comprehensive public health response to pesticide risks.

In 1993, GAO reported that the existing sources of information on pesticide illnesses

were limited in coverage, comprehensiveness, and quality.1 In that report, we concluded

that without a valid system of monitoring pesticide illnesses, there was no way to

identify problems that may occur with the different uses of pesticides or to determine

whether practices intended to manage pesticide risks are effective in preventing

hazardous exposure incidents. In our March 2000 report, we found that little had

changed since 1993. While EPA uses four databases to provide some indication of the

extent of pesticide illnesses, each of these databases has serious limitations. The lack of

comprehensive nationwide data on pesticide illnesses remains largely unaddressed.

To determine how the nation’s information on pesticide illnesses could be improved, we

have worked with two agencies of the U.S. Government’s Centers for Disease Control

and Prevention (CDC)—the National Institute for Occupational Safety and Health

(NIOSH) and the National Center for Environmental Health (NCEH). Both of these

agencies have been working for years to improve pesticide illness reporting. These

agencies told us that establishing state pesticide illness reporting systems are key to

improving the national information on acute pesticide illnesses. For example, according

to NIOSH, state-based reporting systems are the best available data source for identifying

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See Pesticides on Farms: Limited Capability Exists to Monitor Occupational Illnesses and Injuries

(GAO/PEMD-94-6, Dec. 15, 1993).
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epidemics, clusters of diseases, emerging pesticide problems, and populations at risk.

Currently, about half the states have some requirement that pesticide incidents be

reported. However, only six states have a formal pesticide illness reporting and

investigation system, and another three states have more limited systems.

If Maryland decides to develop a formal pesticide illness reporting system, you may wish

to consider some important recommendations made by experts from a number of federal

agencies. Specifically, both NIOSH and NCEH have identified steps that are

prerequisites to establishing effective state pesticide illness reporting systems, including

the following:

• Passing laws that make pesticide-related illness and injury conditions that health care

professionals are required to report.

• Improving the training of health care professionals in pesticide incident handling.

Acute pesticide incidents often go unreported because health care professionals

misdiagnose such incidents. Training is needed to help health care professionals

recognize, manage, and prevent acute pesticide illnesses and injuries.

Besides these steps, NIOSH, NCEH, and EPA support standardizing pesticide incident

definitions so that data can be compared and aggregated across states to assess trends,

determine magnitude, and identify emerging problems. Through this effort, several state

systems have begun to collect standardized information on occupational pesticide

incidents such as the location of the incident, the demographics of the victim, the

industry or occupation of the victim, the type of exposure that occurred, the chemicals

involved, and the health effects that occurred. After such data are collected and

tabulated, states then obtain additional information to confirm the pesticide incidents

and develop preventive interventions.

NCEH emphasizes that states need to design reporting systems that track not only

occupational illnesses, but also illnesses that affect non-working family members and the

general public. NCEH told us that the general public may be exposed to pesticides
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through drift from agricultural and forestry activities, through residues in food and

water, and through applications of pesticides in homes and gardens. NCEH also stated

that non-occupational pesticide illnesses and injuries outnumber those that are work

related. Consequently, NCEH has proposed establishing a pesticide illness reporting

system that would complement NIOSH’s occupational system. Such a system is being

piloted in Texas. As part of this pilot, the Texas Department of Health is required to

actively search existing data sources (such as poison control center data) for cases of

non-occupational pesticide incidents and to investigate those cases.

If Maryland’s pesticide education and reporting bill is enacted, and you decide to

implement a pesticide illness reporting system, federal agencies have developed tools

and resources that could assist the state in its efforts. Specifically:

• NIOSH has recently released a software database that states may use to enter data on

each individual pesticide incident. The software makes it possible for states to

collect, manage, and report in a standardized fashion all pertinent information needed

by NIOSH and EPA to conduct surveillance on acute pesticide illnesses.

• NIOSH is developing a “How To” manual for states that are considering implementing

a pesticide illness reporting system. The manual is currently in draft and is expected

to be published later this year.

• EPA has issued a fifth edition (March 1999) of its manual entitled “Recognition and

Management of Pesticide Poisonings.” This manual provides health professionals

with information on the health hazards of pesticides currently in use and

recommendations for the management of poisonings and injuries caused by them.

• EPA, in cooperation with several federal agencies, has undertaken an initiative to

give all primary care providers a basic knowledge of the health effects related to

pesticide exposures and an ability to treat such effects through clinical and

preventive strategies. A final version of the document summarizing the initiative—
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Pesticides and National Strategies for Health Care Providers: Draft Implementation

Plan”—is scheduled to be published this year.

In addition, several other states have experience with implementing pesticide illness

reporting systems. According to EPA, California, Florida, New York, Oregon, Texas, and

Washington have established formal reporting systems, while Arizona, Louisiana, and

New Mexico have more limited systems. These states have learned lessons in

establishing their pesticide illness reporting systems that may be useful to Maryland. For

example, Florida has found that it can strengthen its pesticide illness reporting system

through the cooperation of several state and local agencies. While the reporting system

in Florida is spearheaded by the department of health, other entities (including the State

Department of Agriculture, poison information centers, and county health departments)

have reported potential pesticide cases. Texas has found that closer cooperation

between the state health department and the state agriculture department resulted in

increased detection of pesticide incidents.

I will provide the committee with copies of the documents discussed in this testimony,

as well as federal and state contacts that may be helpful to you in your deliberations on

the proposed legislation. I hope that my testimony and this information will be helpful to

you. If Maryland decides to establish a state pesticide illness reporting system, the

information generated would be useful not only to the citizens of Maryland, but it would

also help to address the nationwide shortage of information on pesticide incidents.

I will be happy to address any questions that the members of the committee may have.

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