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Education initiative for professionals launched 

Responding to a gap in health professional education and the public health risks posed by the widespread use of pesticides in the United States, the National Environmental Education and Training Foundation (NEETF) has launched a groundbreaking plan to integrate pesticides issues into primary health care education and practice. 

On June 12 NEETF publicly released the “National Strategies for Health Care Providers: Pesticides Initiative Implementation Plan,” developed by interdisciplinary teams of primary health care providers, medical and nursing school faculty, pesticide safety educators and public health professionals. 

“Environmental health risks are a leading cause of illness due, in part, to the widespread use of pesticides, and health care providers must be prepared to respond to the reality of patients’ and communities’ pesticide-related issues,” according to James R. Roberts, M.D., assistant professor of pediatrics, MUSC, and a contributor to the initiative. “Unfortunately, the average health professional receives minimal training in environmental health,” Roberts added.

NEETF has undertaken the initiative in partnership with the U.S. Environmental Protection Agency (EPA), and in collaboration with the U.S. Department of Health and Human Services, the U.S. Department of Agriculture, the U.S. Department of Labor, and a wide range of stakeholders. 

During the past decade, the Institute of Medicine and the American Medical Association have recommended improvements to primary health care providers’ education and training in the areas of environmental health and pesticides, respectively. 

“Primary health care providers are on the front lines of health care and play a key role in recognizing, managing and preventing potential pesticide poisonings and exposure,” said Andrea Lindell, dean of the College of Nursing, University of Cincinnati and one of the expert panelists who developed the Implementation Plan. “They are in the best position to identify the possible sentinel cases that signify the presence of a more widespread pesticide hazard,” she emphasized. 

The initiative calls for all primary health care providers—including physicians, nurses, nurse practitioners, physicians assistants, nurse midwives and community health workers—to acquire a basic knowledge of the health effects of pesticides and the treatments and preventive public health strategies to address them. The initiative will serve as a model for integrating other environmental health issues into medical and nursing education and practice. The goal is to change the way primary care providers assess and respond to potential pesticide exposure cases in their daily practice.

Pesticides in America
A pesticide is any substance or mixture of substances intended for preventing, destroying, repelling, or mitigating any pest, including insects, mice and other animals, unwanted plants (weeds), fungi, or microorganisms like bacteria and viruses. Examples of pesticide forms include disinfectants and cleaning products; cockroach sprays and baits; insect repellents for personal use; rat and other rodent poisons; flea and tick sprays, powders, and pet collars; some lawn and garden products, such as weed killers; and some swimming pool chemicals.

Agriculture accounts for 76 percent of the conventional pesticides used each year in the United States. More than four million farm workers and the million or more people who apply and handle pesticides appear to be at greatest risk for acute pesticide poisoning. Migrant and seasonal farm workers are especially at high risk since they often work and live in areas where pesticide exposures can be significant. EPA estimates there are approximately 250-500 physician-diagnosed cases of pesticide-related illness per 100,000 agricultural workers.

Pesticide exposure in the United States, however, extends well beyond agriculture. Americans living in rural, urban and suburban areas are potentially exposed to pesticides in the home, workplace, school and community, with 84 percent of American households using pesticides (most commonly insecticides). Additionally, control of a growing number of exotic and public health pests such as West Nile Virus, malaria-carrying mosquitoes and the Medfly, has increased the potential for pesticide exposure to the general public. 

Pesticides exposure can have a greater effect on children because of their physiology and behaviors.  Children eat more food, drink more fluids and breathe more air in proportion to their body weight than adults.  They also play close to the ground and put objects in their mouths.  As their bodily systems are still developing, they may be less able than adults to metabolize and excrete pollutants. 

National Environment Education and Training Foundation
Chartered by Congress in 1990, the National Environmental Education and Training Foundation (NEETF) is a private non-profit organization dedicated to advancing environmental education in its many forms.  Since it was established, it has become a leader in the development of new policies, grant-making approaches, and direct programming to advance environmental literacy in America. NEETF links environmental education to many of society’s core goals such as: better health, improved education, environmentally sound and profitable business and volunteerism in local communities.

Editor's note: MUSC's J. Rouitt Reigart, M.D., served on the Expert Panel that created the Initiative's Implementation Plan: James Roberts, M.D., is a member of the Initiative's September 2002 National Forum planning committee and a coauthor of National Competency and Practice Skills Guidelines for medicine and nursing. Roberts is also a spokesperson the for initiative.

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