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Toward the Creation of a Public Health Surveillance System For Toward the Creation of a Public Health Surveillance System for Pesticide Related Illness/Injury in Illinois Completed November 2018 ABOUT THIS REPORT In the summer of 2016, UIC School of Public Health received a contract from the National Institute for Occupational Safety and Health to report cases of Pesticide Related Illness occurring in Illinois. Under the guidance of Sherry Brandt- Rauf, JD, MPhil, Associate Professor, the students of Environmental and Occupational Health Policy (EOHS 480 and EOHS 580) conducted a policy analysis to inform the establishment of an active, high quality public health surveillance system for Pesticide Related Illness in the State of Illinois. Information was collected from online sources and interviews of key informants across the U.S. who are engaged in PRI surveillance in individual states between August, 2016 and May, 2017. Public health surveillance, specifically in the realm of PRI, is handled differently in each state. The goal of this project was to examine the array of policies and practices across the U.S. as a way to forge a policy initiative on PRI surveillance in Illinois. Published data sources are listed at the end of each section, comprehensive statewide data was most available for the year 2012. Published one year later, the status of the states may have changed since it was written. Authors take responsibility for any errors or misinformation in this report. Authors: Sherry I. Brandt-Rauf, JD, MPhil Linda Forst, MD, MPH Andrea A. Calahorrano, MPH candidate Blair D. Davis, MPH Martin Flores, MPH Elisha J. Friedman, MPH Sayuri Fujita, MPH Kinyell Gaston, MPH Obehi Ilenikhena, MPH Zainab S. Khomusi, MPH Amber E. Kofman, MPH Emmanuel Kyeremateng-Amoah, MBChB, MSPH Anitha Nimmagadda, MD Margot Schwamb,MPH Ivorie Stanley, MD, MPH Timothy J. Sutton, MD, MPH Siheen Amsalu Teshome, MPH Kimberly Vargas, MS Lanashia Wells, MD, MPH Illinois Occupational Surveillance Program | November 2018 1/54 EXECUTIVE SUMMARY Pesticide exposure, at work and at home, poses a significant risk to the health of people in Illinois. Every year, there are cases in which people become ill, even die, due to pesticide toxicity. Public Health Surveillance is the capture, analysis and dissemination of health information to focus preventive efforts. In the US, case ascertainment of Pesticide Related Illness/Injury (PRI) differs by state; the program in Illinois is extremely limited. The aim of this project was to investigate practices among the states to inform best practices and to align recommendations for an enhanced PRI Public Health Surveillance program aligned with Illinois statute. Recommendation Illinois should implement a PRI reporting system that incorporates the most effective practices of the states that require PRI reporting. Such a system would allow Illinois to target educational, regulatory, enforcement, and preventive services in the most effective and efficient manner, ensuring that the risks of pesticide use are minimized while maximizing the benefits. Specific recommendations: - Create a mandatory, well-publicized, simple mechanism for PRI reporting in Illinois. A mandatory reporting system that includes health care providers and fosters information sharing across state agencies, already in place in some states, is the most effective mechanism for capturing cases and assembling information that can be used for prevention. At minimum, current Illinois requirements for notification of PRI by applicators should be enforced. - Implement educational programming for health care providers so that they can more easily identify cases of PRI. Recognition, treatment, and appropriate documentation are skills needed by health care providers to prevent the devastating consequences of pesticide poisoning. [Once notified, the Illinois Poison Center, Toxikon, a few health care specialists, and other entities like the National Pesticide Information Center are able to handle acute interventions]. A number of states already have concise and easily accessible teaching modules for health care providers. (see Appendix B) - Institute a single portal reporting system for all cases of PRI whether structural or agricultural, occupational or non-occupational. The IDPH I-NEDSS system could be modified to include PRI reporting by health care providers. - Create a gatekeeper position for all pesticide-related inquiries. The gatekeeper should serve as the primary point of contact for PRI inquiries. The position should be filled by a member of one of the agencies involved in collecting or reporting PRI data. With an expert understanding of how pesticide related issues are handled within the state (who gets what information and where it goes to be aggregated, analyzed, and reported), the gatekeeper would be in a position to refer inquiries to the appropriate department, individual, or program. - Ensure that the flow of information within and among departments is seamless and efficient. The experience of other states reveals that the regulatory system is heavily dependent upon interagency coordination, which could be facilitated by the Illinois Interagency Committee on Pesticides and by the gatekeeper, who could serve as a strategic interagency liaison. - Emphasize and strengthen the requirements for reporting PRI in testing and training materials for applicators. Insure that the penalty structure for failure to report reflects the importance of reporting in cases of illness or injury. Illinois Occupational Surveillance Program | November 2018 2/54 - Incorporate PRI data into the decision-making process about whether to register or reregister pesticides in Illinois. With the availability of a more complete PRI database, the Director of the Illinois Department of Agriculture will more easily be able to rely on the data in evaluating the risks of pesticide use in making registration decisions. - Strengthen relationships with stakeholders. Relationships with stakeholders can help with education, outreach and research on PRI and can help advise their constituencies on how, when, and why to report PRI. - Fund PRI reporting through licensing fees, product registration fees, fines, and penalties. Raise fees if necessary so that the cost of pesticide poisoning and its reporting are incorporated in the cost of using pesticides in the state. Illinois Occupational Surveillance Program | November 2018 3/54 TABLE OF CONTENTS ABOUT THIS REPORT ..................................................................................................................................................1 EXECUTIVE SUMMARY ...............................................................................................................................................2 TABLE OF CONTENTS ..................................................................................................................................................4 I. INTRODUCTION TO PRI REPORTING ....................................................................................................................5 II. PESTICIDE REGULATION ......................................................................................................................................6 III. PUBLIC HEALTH SURVEILLANCE .......................................................................................................................7 IV. STATE REPORTS ..............................................................................................................................................9 A. SENSOR States ............................................................................................................................................................. 9 1. Iowa ............................................................................................................................................................................. 9 2. Michigan .................................................................................................................................................................... 15 3. Washington .............................................................................................................................................................. 18 4. Nebraska ................................................................................................................................................................... 22 5. Florida ....................................................................................................................................................................... 24 6. California ................................................................................................................................................................... 27 B. NON-SENSOR States ...................................................................................................................................................... 30 1. Missouri ..................................................................................................................................................................... 30 2. Minnesota ................................................................................................................................................................. 34 3. Ohio ........................................................................................................................................................................... 38 4. Illinois: Current Status and Goals .............................................................................................................................
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