This article is the third in a series of articles concerning children's environmental health published on the PRB website for "Children's Environmental Health II: A Global Forum for Action." The conference, held September 8–11, 2001 at Georgetown University in Washington, D.C., was sponsored by the Children's Environmental Health Network and the Canadian Institute of Child Health. For more information, e-mail email@example.com or visit the forum's website at www.cich.ca.
(September 2001) Pesticides pose a health threat to people of all ages, but children face the greatest danger of all. Not only does child behavior (hand-to-mouth movements, for example) increase their chance of exposure to these chemicals, their physiological development also creates unique health vulnerabilities after they have been exposed. And while children all over the world are menaced by these chemicals, nowhere is the threat more serious than in Central America.
A Region's Children at Risk
Central America uses more pesticides on a per capita basis — one and a half kilograms of pesticides per person per year — than any other region in the world, according to the Pan American Health Organization (PAHO). Imports of pesticides rose from 20 million kilograms per year in 1992 to nearly 50 million kilograms in 1998, an all-time high. And notably, some of the pesticides used in Central America have been judged dangerous enough to be banned in the United States and Europe. As a result, as many as 5 million agricultural workers in Central America — many of whom are children — are at risk of exposure to pesticides, according to UN figures.
While it is very difficult to quantify precisely the number of children at risk in Central America, rough estimates are possible. The International Labour Organization (ILO) estimated in 1998 that 17.5 million children between the ages of 5 and 14 in all of Latin America — one out of six children — were engaged in economic activities. If that total were distributed evenly throughout all of Latin America, Central America would have 4.6 million child workers. Since roughly 70 percent of all the child labor the ILO surveyed involved agriculture or forestry, Central America could have as many as 3.2 million children working in these sectors, both of which can involve working in close proximity to pesticides. Given Central America's heavy reliance on agriculture, the actual number of children at risk could be even higher.
The demography of Central America is suggestive as well. Altogether, 36 percent of the region's population is under the age of 15, suggesting a large potential supply of child workers (see Table 1). This figure stands in sharp contrast to the corresponding figure in more developed countries (18 percent) and even exceeds the average for less developed countries (33 percent).
Central America's Young Population
||Total Population — mid-2001
||% of Population Under 15
Source: PRB, 2001 World Population Data Sheet.
Of course, children do not have to work in the fields to come into contact with pesticides. Children have been known to become intoxicated after playing with pesticide containers or can be exposed to pesticides used in gardens or in agricultural areas located near their homes or schools. Pesticide use is also quite prevalent in the flower industry in Central America, usually inside greenhouses.
More dramatically, natural disasters can spread pesticides throughout entire regions, exposing thousands of children at once. In Honduras, floods caused by Hurricane Mitch in 1998 swept away storage sheds containing substantial quantities of pesticides. The resulting spillage affected a wide area near the mouths of the Choluteca and Nacaome rivers in the Gulf of Fonseca in the southern area of the country. A subsequent study by the World Health Organization (WHO) found that adolescents in the area had been exposed to a pesticide called parathion and noted that the exposure appeared to continue even after the hurricane. The study also found evidence of long-term exposure to another pesticide, dieldrin, even though it had been banned in Honduras since 1984. (See Table 2 below for the health effects of these and other pesticides.)
Data on Children Are Scarce and Troubling
Overall, PAHO reported that nearly 6,500 cases of acute (i.e., short-term) pesticide poisoning occurred in Central America in 1999, up from 1,500 in 1992. Of these, 60 percent were labor-related, while the rest were the result of accidents or suicide attempts. The actual numbers were probably much higher, however. Many instances of poisoning are believed to go unreported due to incorrect diagnoses, errors in medical records, and the inaccessibility of health facilities in rural areas. In Guatemala alone, where civil war and personnel shortages have crippled the official reporting system, some independent reports have estimated that 10,000 to 30,000 poisonings occur annually.
Again, numbers that are specific to children are scarce, but those that do exist are troubling. In 2000, PAHO's Project on Occupational and Environmental Aspects of Exposure to Pesticides in the Central American Isthmus (PLAGSALUD) documented 247 cases of children under the age of 15 suffering pesticide poisoning in El Salvador alone. PLAGSALUD also documented 142 child poisoning cases in Honduras that year, as well as 101 in Costa Rica and 60 in Guatemala. In 1998, the program documented 193 child poisonings in Nicaragua and Panama, with 16 of those cases ending in death. In 1997, the program reported 214 poisonings in those two countries, with 13 deaths. (See Box 1: "PAHO Takes On Pesticides" for more information.)
While children survive pesticide poisoning in most instances, their developmental physiology means that the exposure can still do serious, lasting damage. In the womb as well as during the first years after birth, a child's brain, endocrine system, reproductive organs, immune system, and respiratory organs are undergoing rapid development. If these processes are disrupted by chemicals such as pesticides, there is substantial risk of irreversible injury. According to the landmark 1993 U.S. National Academy of Sciences study, Pesticides in the Diet of Infants and Children, "exposure to neurotoxic compounds at levels believed to be safe for adults could result in permanent loss of brain function if it occurred during the prenatal and early childhood period of brain development." And even if long-term damage is avoided, the short-term effects of pesticide poisoning can be serious, ranging from dizziness and headaches to nausea or seizures (see Table 2).
Selected Pesticides and Their Health Effects
||Symptoms of Exposure
||Headache, excitability, skin rash, disorientation, weakness, seizures
||Dizziness, vomiting, irritability, uncontrolled muscle movements, convulsions and kidney damage at high doses
||Sweating, abdominal pain, vomiting, blurred vision, flu-like symptoms
||Eye, skin, and upper respiratory tract irritation, vomiting and abdominal pain after ingestion
||Dizziness, blurred vision, headache, sweating, vomiting, skin rash, lack of coordination, abdominal cramps
Source: Weeks, James L., Barry S. Levy, and Gregory R, Wagner (eds.), Preventing Occupational Disease and Injury (Washington, D.C.: American Public Health Association, 1991): 480–481.
Governments Focus More on Pesticide Regulation Than Child Protection
To date, efforts to address the pesticides threat in Central America have focused more on regulating pesticides than taking on steps to protect children. In September 2000, for example, the Central American ministers of health unanimously agreed to restrict the use of 12 highly toxic pesticides at the Sixteenth Meeting of the Health Sector of Central America and the Dominican Republic held in Tegucigalpa, Honduras. The 12 chemicals selected were those responsible for the greatest number of poisonings and deaths in the region. In addition, the ministers called for initial steps toward the complete banning of 107 additional pesticides. This list included many chemicals that are prohibited in many countries outside Central America but generally remain legal within the region.
National governments are also tightening control over the use of pesticides within their own borders. In El Salvador, the government issued an executive decree in June 2000 prohibiting the use of 35 pesticides. In Belize, a new licensing program requires pesticide users to attend a one-day training workshop. Honduras has created a Pesticide Commission that is tightening enforcement of existing controls and coordinating work between the ministries of environment, agriculture and livestock, health, and labor on this issue.
But even though pesticides are clearly a health threat in Central America, bringing the problem under control in a region that uses these chemicals so heavily is no simple matter. Central American farmers started relying on pesticides in the 1960s to boost the production of export crops, particularly coffee, sugar, cotton, fruits, and vegetables. Once underway, heavy pesticide use often becomes difficult to reverse since the chemicals kill off the targeted pest's natural predators.
Pesticides are also used in many less developed countries to control the spread of diseases, particularly malaria. According to the WHO's World Health Report 2000, malaria kills more than 1 million people each year worldwide. DDT is used to control malarial mosquitoes, so simply banning it without an alternate means of controlling the disease could be exchanging one problem for another. South Africa and Sri Lanka have banned DDT in recent years only to see malaria rates soar.
One hopeful sign is greater use of organic farming methods in Central America. Although Costa Rica uses pesticides quite heavily, it has become a strong promoter of organic agriculture in the past few years. As a result, the country now has 135 organic producer associations, whose members cultivate more than 30 products using organic methods. To build on this progress, PAHO is working with Central American governments and NGOs through the PLAGSALUD program mentioned above to promote wider use of sustainable agriculture alternatives.
In the long run, since it will extremely difficult to eliminate pesticides completely, greater public education on the proper use of these chemicals is essential. While much work remains to be done in this area, there are signs of progress. Guatemala has created an educational program on pesticides for different indigenous groups in rural areas who are exposed to particularly high levels of pesticides. In Nicaragua, 55 groups called Local Inter-sectoral Pesticides Committees (CLIPs) train pesticides users and the general population on the safe use of pesticides, and include all sectors of society in environmental protection tasks. In the future, such public education campaigns should be expanded and make greater efforts to target the most vulnerable group of all: children.
César Chelala, M.D., is a medical consultant for several international organizations and the author of the Pan American Health Organization publication "Environmental Impact on Child Health."
PAHO Takes On Pesticides
Through PLAGSALUD — the Project on Occupational and Environmental Aspects of Exposure to Pesticides in the Central American Isthmus — PAHO is helping countries in the region to reduce pesticide poisoning, and promoting educational efforts and alternative agricultural methods. The goals of this project, initiated in 1994, include reducing pesticide-related disorders by 50 percent by 2005 and supporting the implementation of sustainable agriculture alternatives. Its activities include trying to ban pesticides that are not permitted in their countries of origin, promoting education for the proper use of chemical substances, and strengthening control and epidemiological follow up of poisoning episodes. To accomplish these goals, the PLAGSALUD project is working closely with the ministries of health, education, the environment, and labor as well as with community and nongovernmental organizations in all Central American countries. It is estimated that by mid-2001 the project and its counterparts will have invested almost US$11 million to reduce the problems caused by pesticides and to improve the health of the Central American population. One immediate result has been an increased awareness in Central American countries of the risks involved in the use of pesticides.