Incorporating health and ecologic costs into agricultural production.

Large-scale, resource-intensive enterprises, often based on a single crop, have come to represent the norm in modern farming. Such farms tend toward intensification (more production per unit area), reduction in biodiversity, dependence on inputs not found locally (e.g., fertilizers and pesticides), and production of wastes that cannot be absorbed easily by the local ecosystem or community. Such practices have their counterparts in meat production in the form of confined animal feeding operations and the routine use of antibiotics. Horrigan and colleagues at the Johns Hopkins University Center for a Livable Future refer to this type of production as “industrial agriculture” and contrast it with sustainable agriculture (2). They argue that industrial agriculture creates a wide range of negative health and ecologic consequences and that an agricultural production model based on the concept of sustainability provides a long-term alternative to current practices. This debate is a complex one, touching on social, economic, and ethical issues. A major criticism of conventional practices is that they fail to incorporate the true costs of production, treating human health and ecologic impacts as “externalities” within current economic models. This approach carries with it an implicit notion that producers are not responsible for such impacts and that entities such as government agencies will take on this burden. Such a view is fundamentally at odds with a public health model that attempts to incorporate the prevention of injury and illness into production processes. There is clearly a need to develop measures of sustainability that incorporate the so-called externalities of health and ecologic impacts, and to conduct comparisons across agricultural systems. A significant step in this direction was reported recently by researchers at Washington State University (3) who evaluated the sustainability of conventional, organic, and integrated (mixed organic–conventional) apple production. In this study, Reganold et al. (3) used quantitative indices of soil quality, horticultural performance, fruit firmness and taste, and environmental impact, including pesticide use, and found that “the organic system ranked first in environmental and economic sustainability, the integrated system second, and the conventional system last.” Unfortunately, analyses of this kind are the exception, but they point toward new directions for environmental health research. To the extent that we in the public health community ask producers to integrate health and safety into the production process, so too should we expand our own perspective to include the economic consequences of the policies we promote. Agricultural workers face a number of hazards in modern agricultural production, yet our knowledge of health effects for this population remains inadequate (4). These workers are at high risk for fatal and nonfatal injuries, and ergonomic risks are common to many jobs in agriculture. A summary of work in this area, with practical suggestions for ergonomic risk reduction, was recently published by the National Institute for Occupational Safety and Health (5 ). Pesticides are perhaps the most easily identified health hazard in the agricultural workplace. Current evidence indicates that acute intoxications are at what can be considered epidemic levels worldwide. Virtually no countries have national reporting systems, so incidence rates are difficult to determine, and long-term health effects are generally not being monitored. The Focus article in this issue of EHP examines the use of pesticides in floriculture in Colombia and other tropical countries (6). The intensive use of pesticides in greenhouse environments can lead to substantial exposures for workers; however, the diversity of pesticides used at these worksites presents a special challenge for epidemiologic research because it is often impossible to attribute symptoms or disease to particular chemical exposures. Substantial new documentation related to pesticide use, exposure, and resulting illnesses has been gathered in Central America over the past decade (7). Yet these regional data appear to have had little or no discernible impact on regulatory policies in these countries. This raises serious questions about the role of environmental research in risk management and deserves further examination. Finally, a recent study of cancer incidence in members of the United Farmworkers of America found that union members had elevated rates of leukemia, stomach cancer, and uterine cancers compared to the California Hispanic population (8 ). If it is determined that these cancers are related to workplace exposures or conditions, who will bear the costs associated with these illnesses? The Pew Hispanic Center estimates that 47% of the 2.5 million persons employed for wages on U.S. farms are undocumented (9 ). Because these workers are not enumerated and avoid contact with public agencies, characterization of health risks for this population is particularly challenging and will require special efforts to engage workers and communities in the design and implementation of epidemiologic and intervention studies. Industrial agriculture can also have significant impacts on communities. In an article in this issue of EHP, Steve Wing recounts his experiences with community-based research (10). He chronicles his investigations of air pollution, water pollution, and noxious odor production associated with industrial hog farming in North Carolina. His work sheds light on environmental justice aspects of such agricultural operations and explores the ethical issues that researchers face when working closely with a disenfranchised community. Community exposure to pesticides is the focus of another article in this issue (11); a study in Washington State’s tree fruit Incorporating Health and Ecologic Costs into Agricultural Production PERSPECTIVES Guest Editorial