Agriculture and Environmental Health in Central Europe:
Opportunities for Research and Intervention

Country Reports Summary

Poland—Agricultural Worker Health and Safety

The Polish delegation included participants from the Nofer Institute of Occupational Health, the Institute of Plant Protection, the Institute of Agricultural Medicine and the Agricultural Social Insurance Fund. Dr. Wojciech Hanke, Deputy Director for Research of the Nofer Institute presented their report.

Individual farmers and their families have owned a large percentage of Polish agricultural land since World War II. Individual farmers make up as much as 90% of all persons employed in agriculture, and 24% of the population employed in the national economy. They have so far not been covered by worker safety and hygiene legislation, nor provided with any occupational health services.

Summary of Research Issues

1. The rate of injuries is 3 times as high as in other industries.
2. There is a growing number of cases of occupational diseases, with respiratory diseases making up 80% of all registered cases.
3. It has been well documented that farmers are exposed to excessive noise. However, hearing impairments often go undiagnosed or are seldom referred to clinics with appropriate diagnostic equipment.
4. Farm workers are often sensitized to microbial aeroallergens. There is a need for further research on possible health implications.
5. Uncontrolled dumping of pesticides is a potential health risk for rural communities.

Interventions

A pilot program to test the feasibility of an occupational safety and health system to benefit private farmers was tested, based on the following principles:

• The present structures of public health centers and system of social insurance should be used.
• Farmers should not be charged for health services rendered.
• It should operate on well-defined operational principles and be an evidence-based approach.

Results showed that:

• Human and material resources of rural health units are adequate to provide prophylactic health care.
• Specialist training needs to be provided to medical and nursing personnel.
• Demand for prophylactic examinations among farm workers would be high.
• Prophylactic examinations could also include screening for diabetes and selected cancers (breast and prostrate).
• Implementation of comprehensive examinations of farmers requires new legal regulations.

Conclusions

1. There is a need to develop a system for recognition of occupational hazards in agriculture and the monitoring of farmers’ health, including better diagnostics.
2. There is a need to develop a more effective program for prevention of work-related injuries.
3. The environmental health aspect of pesticide exposure should be regarded as a priority area.

The Czech Republic—Protecting the Environment and Health of Food Consumers

Delegates from the Czech Republic represented the Institute of Hygiene and Epidemiology at Charles University, The Ministry of Agriculture, the Ministry of Health, the University of Veterinary and Pharmaceutical Sciences, and the Community Right to Know and Pollutant Release and Transfer Register Programs of the Environmental Partnership for Central Europe. Professor Vladimir Bencko of Charles University presented the report.

Protection of the food chain from agricultural chemicals in light of the necessity of their use for food production at this time is a major concern. Regulations focused on different areas have been prepared by the Ministry of Agriculture and are controlled and monitored by various offices. The report detailed how environmental issues, agricultural production issues, and consumer safety are well integrated and linked by supportive programs. For example, the Ministry of Agriculture supports research priorities with respect to the environment, such as:

• Multifunctional agricultural activities
• Soil protection and remediation
• Water management in agricultural catchments
• Plant/animal genetics and breeding
• Impact of xenobiotics on animal health

The Ministry of the Environment is concerned with the high proportion of cultivated land, inherited from a long period of intensive, large-area agriculture and heavy use of fertilizers and pesticides. The State Environmental Policy adopted by the Czech government in 1999 has the following requirements regarding agriculture:

• Establish optimum proportions of arable land, grasslands, pastures and forests in accordance with the principles of sustainable development and the carrying capacity of the local environment,
• Ensure food safety by minimizing the presence of xenobiotics in food chains,
• Limit non-point water pollution, especially by nitrates, ammonia and pesticides,
• Support environmentally sound practice and increase the proportion of arable land farmed organically to at least 2% by the year 2005,
• Support a decrease in the area of arable land by afforestation with tree species suitable for habitat in question, by grassing over or by creation of biocorridors,
• Promote environmentally sound management practices and create a code of good agricultural practice; connect subsidy programmes to the national agri-environment programme and regional policy.

Conclusions/Opportunities

1. There is a need for improved methods of risk assessment that can be carried forward to risk management.
2. Better coordination is needed of existing monitoring and surveillance and alert systems developed by the Ministries of Health, Agriculture and Environment to enable harmonized planning and priority setting.
3. In spite of many research initiatives being undertaken relative to agriculture and health, the present system lacks the flexibility to respond to late-breaking potential health problems. Universities and other research bodies (national and international) could play a role in increasing public awareness and knowledge.

The Slovak Republic—Rural Populations: Health Needs

The Slovak delegates represented the Institute of Preventive and Clinical Medicine, the Institute of Genetics and Reproduction, the Research Institute of Animal Production, the Slovensky Raj; and the Research Institute of Food Industry. Dr. Tomas Trnovec from the Institute of Preventive and Clinical Medicine presented the country report.

Collectivisation of farms in the former Czechoslovakia was almost 99%. After 1989, there was a shift from collective to individual farms that was very difficult and not very successful. Monetary investments were too great and many farmers didn’t have the necessary machinery. As a result, production of agricultural products decreased. Now there is another shift toward co-operative systems, but in a new form of market economy.

Rural and agricultural population characteristics

• A large fraction of the population lives in villages with a population size of 1,000 - 5,000.
• The number of people employed in agriculture is estimated between 5-10%.
• Unemployment in Slovakia 20%. Many unemployed work for farmers on a day-to-day, cash basis. They don’t pay taxes, nor do they have insurance.
• People in the villages are primarily employed in factories, transport in the third sector, education, etc. To increase family income they have greenhouses.
• The people in this sector of the population work are exposed to pesticides and other unsafe conditions.
• A large sector of the urban population spends weekends in their (village) gardens to produce various agricultural products. Urban dwellers are also exposed to risks of agriculture.

Rural health issues needing attention

• Individual water supply (20% of population depends on local wells, and 80% of these water sources are contaminated by either biological or agricultural chemical contaminants)
• Problems with sewage water disposal and solid waste disposal
• Heating (using coal, exposure to sulphur oxide and lead leads to respiratory disease and blood lead levels in children)
• Cardiovascular disease is the main reason for premature mortality, and is a greater problem in rural than in urban populations
• Minority health issues – incidence of chronic degenerative diseases is higher in this population
  • Hungarian population in the South
  • Gypsy population in the Northeast in rural areas (about 10% of the population)

Hungary—Environmental Health Status

The Hungarian delegation represented the School of Public Health at the Debrecen University Medical School, the Department of Environmental Health of the Fodor Jozsef National Centre for Public Health, the Zala County Plant Health and Soil Conservation; the National Institute of Occupational Health of the Jozsef National Centre for Public Health, the Semmelweis Medical University, and the Ministry for Environment. Professor Roza Adany presented the country report.

Hungary is characterized by a large number of villages with a population of less than 1000 or even 500. Yet, general statistical data do not distinguish population centers and so “rural” data are not available except by indirect methods of standardization. In general, increased risk of mortality from alcoholic liver diseases and cirrhosis can be demonstrated among inhabitants of rural areas.

Air Pollution is considered one of the most important urban environmental problems. The most important emission sources are due to traffic, industry, and municipal heating. Environmental tobacco smoke is also important as a health-damaging factor. In villages, while ambient air quality is better, aero-allergens represent recently increasing problems contributing to increasing prevalence of asthma and allergy.

The majority of the population is supplied with good quality drinking water. The most common drinking water quality problem affecting larger population areas is the presence of nitrate in ground waters and subsurface waters.

A soil pollution monitoring system was introduced in 1992 for regular assay of the most important toxicants, and for measurement of pesticide contamination. The soil is considered generally good, however, point sources of contamination – pesticide depots, industrial pollution – should be assessed and evaluated. Traffic is considered to be a significant point source of soil pollution. There is no data dealing with the health status of the population with respect to living in polluted areas.

Management of an increasing amount of waste is a problem in Hungary. There is only one incinerator in the country for communal waste that has a capacity for 310,000 tons per year, one-half of the total amount generated in Budapest alone. Only 10% of sewage water is treated and 20% directed to communal drainage system. The major part of wastewater is drained into the soil without treatment.

In Hungary there are 150-200 deaths per year and 40 to 50 thousand injuries due to work accidents. About 1000 people are diagnosed with any kind of proven occupational disease, although the number of registered accidents is considered a low estimate. Due to the Hungarian economy, neither employees nor employers are motivated to report occupational injury or illness.

Food hygiene regulations are in agreement with European Union directives, however, problems still exist. The most important food contaminants are lead, cadmium, mercury, nitrate, radioactive materials, polycyclic aromatic carbohydrates, chlorinated chemicals, and pesticides. Although the concentration levels of well-known pollutants have been controlled, contamination may occur during technological processes and from environmental sources.

The Ukraine—Health Of Agricultural Workers And Health Services

The Ukrainian delegation represents the Institute for Occupational Health, the Department of Labor Protection at the National Agrarian University, the National Academy of Science, Institute for Economic Forecasting, and the Institute of Eco-hygiene and Toxicology. Professor Yuri Kundiev from the Institute for Occupational Health presented the country report.

The state of health in rural communities and agricultural workers in Ukraine reflects the socio-economic crisis. The turnaround in the situation must be among the strategic tasks with regard to the significance of this sector to the economy of country. A growing concern is based on inequality of health service for urban and rural populations, low efficiency of medical social and preventive measures, insufficient logistics of rural health care. Some countries are reforming their rural health services, often reducing the number of rural outpatient clinics, thus making the primary health care even less accessible. Reforms and rural health care improvement programmes ought to consider the existing variety of patterns of ownership in agriculture as well as new ones emerging. In rural areas the state health system is still serving as a basis. However, involvement of medical institutions other than state-run is envisioned. Ukraine has to base their efforts on a sustainable development concept. For agriculture this implies a reduction in use of harmful chemicals, a decrease in use of arable soil, afforestation, energy conservation and waste reduction, rational storage and processing of agricultural products. If implemented, the sustainable development concept will result in diminishing health risk factors for the workers.