EPA’s Health Care Provider Initiative

Kevin Keaney, ChiefPesticide Worker Safety Programs

U. S. EPA2005

EPA’s Health Care Provider Initiative

EPA’s Health Care Provider Initiative

EPA’s Health Care Provider Initiative

EPA’s Health Care Provider Initiative

EPA’s Health Care Provider Initiative

Resources for Pesticide Competency & Practice Skills Government

-- Federal Government Agencies -- State Government Contacts and Resources

Resources and Publications-- Key Resources on the Web -- Handbooks, Databases, and Publications -- Software and Training -- Case Studies -- Journals

Background Papers -- A Pesticide Primer --Pesticide Laws and Regulations Glossary

Environmental History Taking Tool

EPA’s Health Care Provider Initiative2005 - 2010

EPA’s Health Care Provider InitiativePacific Northwest Agricultural Safety & Health Center

(PNASH)Established in 1996

One of nine Agricultural Safety & Health Centers created by NIOSH

Part of the Dept. of Environmental & Occupational Health Sciences at the University of Washington School of Public Health & Community Medicine.

Ranked as fourth best school of public health in the nation.

Goal: Reduce occupational disease and injury among those who work in

agriculture and their families.

Emphasizes partnerships and collaboration with a wide range of stakeholders, from employers to community organizations.

EPA’s Health Care Provider Initiative2005 - 2010

EPA’s Health Care Provider Initiative

Migrant Clinicians Network

A national, not-for-profit organization

Founded in 1984 by clinicians working in migrant health.

Nearly 2,000 members

The oldest and second largest clinical network serving the underserved

Goal:Improve health care of migrants and other mobile poor populations by providing support, technical assistance, and professional development services to clinicians.

Tracking Occupational Tracking Occupational Pesticide Incidents Pesticide Incidents

for Pesticide Worker Safetyfor Pesticide Worker Safety

..

Occupational Pesticide IncidentsOccupational Pesticide Incidents

Incidents: Incidents:

““health” = a well-documented exposure from health” = a well-documented exposure from pesticide use in an occupational context pesticide use in an occupational context resulting in adverse health effects. The resulting in adverse health effects. The source of the data must be credible, accurate source of the data must be credible, accurate and unbiased.and unbiased.

““enforcement” = a well documented regulatory enforcement” = a well documented regulatory agency’s pesticide enforcement action.agency’s pesticide enforcement action.

Problem and IntentProblem and Intent

Problem:Problem: Currently there is no national Currently there is no national program that collects accurate, unbiased program that collects accurate, unbiased pesticide incident data.pesticide incident data.

Statement of Intent:Statement of Intent: Collect, analyze and Collect, analyze and communicate accurate, unbiased communicate accurate, unbiased incident data in order to improve risk incident data in order to improve risk assessment, risk management and field assessment, risk management and field programs that affect occupational programs that affect occupational pesticide workers.pesticide workers.

GoalsGoals

Utilize incident data to:Utilize incident data to:

11. Improve field programs. Improve field programs

2.2. Improve risk assessmentImprove risk assessment

3.3. Improve risk managementImprove risk management

4.4. Enhance communications with Enhance communications with stakeholdersstakeholders

5.5. Evaluate program progressEvaluate program progress

Workers Exposed to Pesticides

Establish & CommunicateSafety Measures

Risk Management

Data Analysis Outcome Measures

Trend AnalysesFeedback to Data Selection

Data SelectionIdentify Evaluate

Select

Pesticide Worker SafetyPesticide Worker Safety

Communicate to the public

Data Selection: Incident Data Selection: Incident DatabasesDatabases

There are a number of databases which There are a number of databases which capture worker incident data. Specific capture worker incident data. Specific criteria will be used to evaluate and make criteria will be used to evaluate and make proposed decisions for our use of these proposed decisions for our use of these data bases.data bases.

Data SelectionData Selection

• Are the data valuable, acceptable, useful, Are the data valuable, acceptable, useful, and meaningful?and meaningful?

• Is the associated burden low – easy to Is the associated burden low – easy to collect, costs are acceptable, small collect, costs are acceptable, small number of measures, and user friendlynumber of measures, and user friendly

• Data that can be used nowData that can be used now

• Data that could be used, if modifiedData that could be used, if modified

Data Selection ListData Selection ListHealth Health

SENSORSENSOR

CA ProgramCA Program

Poison ControlPoison Control

FIFRA 6(a)2FIFRA 6(a)2

NPICNPIC

Worker’s CompWorker’s Comp

WA ChE WA ChE

EnforcementEnforcement

National Pesticide National Pesticide Field Data planField Data plan

Compliance Action Compliance Action Tracking Systems Tracking Systems

Support DataSupport Data

National National Agricultural Agricultural Workers SurveyWorkers Survey

Bureau of Labor Bureau of Labor StatisticsStatistics

Usage DataUsage Data

Cert. Applic. #sCert. Applic. #s

Data Collection Evaluation CriteriaData Collection Evaluation Criteria

ContentContent Occupational extractabilityOccupational extractabilityChemical type - active ingredientChemical type - active ingredientLevel of detail in case description, raw dataLevel of detail in case description, raw dataLink to enforcement - specific violations, investigations, independent Link to enforcement - specific violations, investigations, independent

verificationverificationClassification of probability - causality, confidence in pesticides being causeClassification of probability - causality, confidence in pesticides being causeSeverity index - how serious were symptomsSeverity index - how serious were symptoms

RepresentativeRepresentativeData reliability - collection method; are incidents self-reported or do the data Data reliability - collection method; are incidents self-reported or do the data

originate from health care practitioner; is there follow-up on the casesoriginate from health care practitioner; is there follow-up on the casesBaseline availability - data longevity, depth and breadth of databaseBaseline availability - data longevity, depth and breadth of database

PresentationPresentation Accessibility - can we get the data, is it in a database, are the formats Accessibility - can we get the data, is it in a database, are the formats

consistent, cooperation of ownerconsistent, cooperation of owner

CostCost$, FTE$, FTE

Health Data Selection: EvaluationHealth Data Selection: Evaluation

Data Source

Chemical collected

Occupational exposure

Representative sample for nation

User-friendliness

Classification of probability

Severity index

Link with enforcement

Data reliability

Data accessibility

Level of detail

Baseline available

Cost

Proposed Decision

SENSOR

Y Y Y Y Y Y N H Y M Y M accept

PISP

Y Y N Y Y N Y H Y H Y L accept

PCC/TESS

Y Not well ? ? N Y N L Y M Y M acce

ptFIFRA 6(a)2

Y Notwell N N N Y N L N L Y L impr

oveNPIC

YNot well Y N Y Y N L N L Y H rejec

tWorkers Comp

N Y N N N Y N H N H N H reject

Enforcement DataEnforcement Data•Information on regulatory investigations linked to Information on regulatory investigations linked to specific incidents useful for:specific incidents useful for:

• Determining application specifics and why incident occurred,Determining application specifics and why incident occurred,• If a violation, which part of the regulatory scheme was not If a violation, which part of the regulatory scheme was not

followedfollowed• Tracking incident cause in order to formulate program Tracking incident cause in order to formulate program

improvementsimprovements

•OECA “5700” Forms summarize state inspection totals - OECA “5700” Forms summarize state inspection totals - includes totals by WP rule sectionsincludes totals by WP rule sections

•Most states only report federally funded inspections -Most states only report federally funded inspections -enforcement data is subset of state total enforcement data is subset of state total

National Pesticide Field Data – EnforcementNational Pesticide Field Data – Enforcement

• Database is a collection of closed pesticide Database is a collection of closed pesticide enforcement cases from several states enforcement cases from several states - - Severely limited in content for purposes of Severely limited in content for purposes of incident analysis, exact violation not collected incident analysis, exact violation not collected -- No quality control of the data - no plan for No quality control of the data - no plan for linkslinks

to incident datato incident data

Proposed action: enforcement and state liaisons Proposed action: enforcement and state liaisons should pursue development to improve should pursue development to improve usefulness for measures. In its current state, the usefulness for measures. In its current state, the data are not useful.data are not useful.

Compliance Action Tracking Systems - Compliance Action Tracking Systems - EnforcementEnforcement

• Systems were developed to help state lead agencies Systems were developed to help state lead agencies communicate their enforcement activities. Two communicate their enforcement activities. Two regions and several states outside those regions use regions and several states outside those regions use these tracking systems for their enforcement data.these tracking systems for their enforcement data.

+ Collects enforcement data + Collects enforcement data

- Unclear whether adequate detail is available - Unclear whether adequate detail is available

- Link to incident data seems absent- Link to incident data seems absent

Proposed Action: continue review and work with Proposed Action: continue review and work with enforcement and state liaisons on gathering enforcement and state liaisons on gathering enforcement dataenforcement data

Supporting DataSupporting Data

Information about pesticide use patterns, Information about pesticide use patterns, migrant worker demographics, worker migrant worker demographics, worker attributesattributes

Used to characterize exposed populations and Used to characterize exposed populations and develop incident rate estimates develop incident rate estimates

Important in understanding the context of Important in understanding the context of pesticide and agricultural worker issues.pesticide and agricultural worker issues.

Supporting DataSupporting Data

• National Agricultural Worker SurveyNational Agricultural Worker Survey

• Bureau of Labor StatisticsBureau of Labor Statistics

• Pesticide usage data – amount used on Pesticide usage data – amount used on

crops by state - includes USDA / NASS, crops by state - includes USDA / NASS, Doane, CA pesticide use reportingDoane, CA pesticide use reporting

• Certified applicator numbersCertified applicator numbers

Health Care Provider InitiativeHealth Care Provider Initiative&&

National Incidents ReportNational Incidents Report

ANY QUESTIONS ?ANY QUESTIONS ?