Information on Pesticide Illness Reporting Systems (Testimony,
03/13/2001, GAO/GAO-01-501T).

This testimony discusses findings from two GAO reports that relate to
Maryland's pending legislation on pesticide reporting. To determine how
the nation's information on pesticide illnesses could be improved, GAO
has worked with two federal agencies--the National Institute for
Occupational Safety and Health (NIOSH) and the National Center for
Environmental Health. These agencies told GAO 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 epidemics, clusters of diseases, emerging pesticide
problems, and populations at risk. Currently, about half of 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, they may wish to consider these important
recommendations made by experts from a number of federal agencies (1)
passing laws that make pesticide-related illness and injury conditions
that health care professionals are required to report, and (2) improving
the training of health care professionals in pesticide incident
handling.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  GAO-01-501T
     TITLE:  Information on Pesticide Illness Reporting Systems
      DATE:  03/13/2001
   SUBJECT:  Reporting requirements
	     Pesticides
	     Environmental monitoring
	     Occupational health standards
	     Health hazards
	     Agricultural industry
	     Occupational safety
	     Federal/state relations
	     State programs
	     Data collection
IDENTIFIER:  Maryland

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GAO-01-501T

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

1 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.

2 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

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

(GAO/ PEMD- 94- 6, Dec. 15, 1993).

3 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

4 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-

5 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. (360050)
*** End of document. ***