An investigation into the neurological and neurobehavioural effects of long-term agrichemical exposure among deciduous fruit farm workers in the Western Cape, South Africa

It is increasingly being recognised that agrichemical exposure may have adverse chronic health effects in humans, particularly on central nervous system function. However, much of this evidence sterns from studies relating to the effects of acute intoxications (i.e. short-term high dose exposures) and little data exist on the chronic effects of long-term low-dose exposures to agrichemicals in the absence of acute poisoning. Such a finding would have substantial public health implications for prevention and control of chronic morbidity and mortality. This is particularly important in South Africa, where a sizeable portion of the rural population are employed in agricultural work, often under extremely unhealthy living and working conditions, and where occupational agrichemical exposures appear to be substantial. To address this question, this study investigated the prevalence of neurological and neurobehavioural abnormalities amongst 247 fruit farm workers in the Kouebokkeveld in the Western Cape, of whom 163 were current agrichemical applicators. Outcomes measured included neurological symptoms, peripheral vibration sense, motor tremor, as well as performance on the World Health Organisation Neurobehavioural Core Test Battery (WHO NCTB) and a set of neurobehavioural tests based on the Information Processing model of cognitive psychology. These latter tests have been developed in South Africa for subjects of low educational levels and aim to by-pass the powerful effects of culture that complicate traditional neuropsychological testing, which may mask the smaller effects due to occupational chemical exposures. Cumulative, and average lifetime intensity of exposure to organophosphates were estimated using a job- exposure matrix based on a combination of secondary industry data, interview reports and farmer records. Confounders measured included age, education, smoking and alcohol habits, non-occupational exposure to agrichemicals and other potential neurotoxins, past medical history and usage of personal protective equipment. The study results confirmed low levels of education and high alcohol consumption amongst the sample of farm workers. Multiple logistic and linear regression were used to identify exposure-effect relationships and to control for confounding. Neurological symptoms were significantly associated with a history of previous pesticide poisoning, although this may have arisen as a result of reporting bias. Vibration sense and the neurobehavioural tests exhibited associations with established covariates, and regression modelling of the WHO NCTB tests was remarkably similar to findings in another study of solvent-exposed factory workers in South Africa. None of the vibration sense, tremor or neurobehavioural outcomes were associated with past agrichemical poisoning in the sample, and only two tests showed significant relationships with long-term occupational exposure. These included the Pursuit Aiming subtest of the WHO NCTB and one of the tests of long-term semantic memory in the Information Processing tests. However, the strength of these the associations were small (partial r²s less than 2%) and these findings may have occurred due to chance arising from multiple comparisons. The neurobehavioural tests based on the Information Processing model appeared to offer little improvement on the WHO NCTB in terms of being less sensitive to cultural effects, although some evidence was present that tests of semantic access were able to detect occupational effects and were less sensitive to education. The absence of a demonstrable and consistent long-term agrichemical exposure-effect relationship appears to suggest that long-term agrichemical exposure is not associated with adverse chronic nervous system effects, although the lack of organophosphate specificity in construction of exposure indices in the job-exposure matrix may partly contribute to this finding. Recommendations to improve the characterisation of agrichemical exposures at farming work place are made, as well as suggestions concerning the role of biological monitoring for agrichemicals, improving working and living conditions on South African farms, and methods of neurological and neurobehavioural assessment in occupational health

A case for integrating human rights in public health policy

In a global environment where human rights and well-being are coming under increasing threat, both from the spectre of terrorism and from the counter-reaction to it,1 and where international governance systems continue to pay lip service to poverty reduction while encouraging unbridled private accumulation of wealth resulting in huge inequalities between and within countries,2,3 the need to make human rights considerations an integral part of how public health policies are formulated cannot be overemphasised. Contestation over entitlements to socio-economic rights has troubled health care systems worldwide, from resource-poor settings in Africa, where questions have been raised as to whether human rights approaches are best suited to addressing the problem of AIDS in Africa,4,5 through to the over-consumptive USA where universal access to health care remains a policy objective doomed to unfulfilment under market-fixated economic systems.6,

Filling the gap : a learning network for health and human rights in the Western Cape, South Africa

We draw on the experience of a Learning Network for Health and Human Rights (LN) involving collaboration between academic institutions and civil society organizations in the Western Cape, South Africa, aimed at identifying and disseminating best practice related to the right to health. The LN’s work in materials development, participatory research, training and capacity-building for action, and advocacy for intervention illustrates important lessons for human rights practice. These include (i) the importance of active translation of knowledge and awareness into action for rights to be made real; (ii) the potential tension arising from civil society action, which might relieve the state of its obligations by delivering services that should be the state’s responsibility—and hence the importance of emphasizing civil society’s role in holding services accountable in terms of the right to health; (iii) the role of civil society organizations in filling a gap related to obligations to promote rights; (iv) the critical importance of networking and solidarity for building civil society capacity to act for health rights. Evidence from evaluation of the LN is presented to support the argument that civil society can play a key role in bridging a gap between formal state commitment to creating a human rights culture and realizing services and policies that enable the most vulnerable members of society to advance their health. Through access to information and the creation of spaces, both for participation and as a safe environment in which learning can be turned into practice, the agency of those most affected by rights violations can be redressed. We argue that civil society agency is critical to such action

Globalisation and health inequalities: can a human rights paradigm create space for civil society action?

While neoliberal globalisation is associated with increasing inequalities, global integration has simultaneously strengthened the dissemination of human rights discourse across the world. This paper explores the seeming contradiction that globalisation is conceived as disempowering nations states' ability to act in their population's interests, yet implementation of human rights obligations requires effective states to deliver socio-economic entitlements, such as health. Central to the actions required of the state to build a health system based on a human rights approach is the notion of accountability. Two case studies are used to explore the constraints on states meeting their human rights obligations regarding health, the first drawing on data from interviews with parliamentarians responsible for health in East and Southern Africa, and the second reflecting on the response to the HIV/AIDS epidemic in South Africa. The case studies illustrate the importance of a human rights paradigm in strengthening parliamentary oversight over the executive in ways that prioritise pro-poor protections and in increasing leverage for resources for the health sector within parliamentary processes. Further, a rights framework creates the space for civil society action to engage with the legislature to hold public officials accountable and confirms the importance of rights as enabling civil society mobilization, reinforcing community agency to advance health rights for poor communities. In this context, critical assessment of state incapacity to meet claims to health rights raises questions as to the diffusion of accountability rife under modern international aid systems. Such diffusion of accountability opens the door to 'cunning' states to deflect rights claims of their populations. We argue that human rights, as both a normative framework for legal challenges and as a means to create room for active civil society engagement provide a means to contest both the real and the purported constraints imposed by globalisation.Web of Scienc

Global occupational health: Current challenges and the need for urgent action

Background: Global occupational health and safety (OHS) is strictly linked to the dynamics of economic globalization. As the global market is increasing, the gap between developed and underdeveloped countries, occupational diseases, and injuries affect a vast number of workers worldwide. Global OHS issues also become local in developed countries due to many factors, including untrained migrant workers in the informal sector, construction, and agriculture. Objective: To identify the current status and challenges of global occupational health and safety and the needs for preventive action. Findings: Absence of OHS infrastructure amplifies the devastating consequences of infectious outbreaks like the Ebola pandemic and tuberculosis. Interventions in global OHS are urgently needed at various levels:1.  Increased governmental funding is needed for international organizations like the World Health Organization and the International Labor Organization to face the increasing demand for policies, guidance, and training. 2.Regulations to ban and control dangerous products are needed to avoid the transfer of hazardous production to developing countries. 3.The OHS community must address global OHS issues through advocacy, position papers, public statements, technical and ethical guidelines, and by encouraging access of OHS professionals from the developing countries to leadership positions in professional and academic societies. 4.Research, education, and training of OHS professionals, workers, unions and employers are needed to address global OHS issues and their local impact. 5.Consumers also can influence significantly the adoption of OHS practices by demanding the protection of workers who are producing he goods that are sold in the global market.. Conclusions: Following the equation of maximized profits prompted by the inhibition of OHS is an old practice that has proven to cause significant costs to societies in the developed world. It is now an urgent priority to stop this process and promote a harmonized global market where the health of workers is guaranteed in the global perspective

Health professionals should be speaking out about the victimisation of doctors in Bahrain

Doctors in Bahrain who treated people wounded during and after demonstrations have been arrested, tried by a military court and given sentences of up to 15 years’ imprisonment

Health and human rights: epistemological status and perspectives of development

The health and human rights movement (HHR) shows obvious signs of maturation both internally and externally. Yet there are still many questions to be addressed. These issues include the movement's epistemological status and its perspectives of development. This paper discusses critically the conditions of emergence of HHR, its identity, its dominant schools of thought, its epistemological postures and its methodological issues. Our analysis shows that: (a) the epistemological status of HHR is ambiguous; (b) its identity is uncertain in the absence of a validated definition: is it an action movement, an interdisciplinary field, a domain, an approach, a setting or a scientific discipline? (c) its main schools of thoughts are defined as "advocacists”, "ethicists”, "interventionists”, "normativists”; (d) the movement is in the maturation process as a discipline in which "interface”, "distance”, "interference” and "fusion” epistemological postures represent the fundamental steps; (e) parent disciplines (health sciences and law) competences, logics and cultures introduce duality and difficulties in knowledge production, validation and diffusion; (f) there is need to re-write the history of the HHR movement by inscribing it not only into the humanitarian or public health perspectives but also into the evolution of sciences and its social, political and economical conditions of emergence. The ambiguous epistemological status of this field, the need to re-write its history, the methodological duality in its research, the question of the competence of the knowledge validation, as well as the impact of HHR practice on national and international health governance are the challenges of its future development. To meet those challenges; we call for the creation and implementation of an international research agenda, the exploration of new research topics and the evaluation of the movement's contribution to the national and global public health and human rights governanc

The draft charter of the private and public health sectors of the Republic of South Africa: Health for all, or profits for few?

The central aim of the Department of Health’s recently released Draft Charter of the Public and Private Health Sectors (CPPHS) is to address the legacy of apartheid regarding access to health care for all South Africans. It commits the public and private sectors to create ‘a health care system that is coherent, cost effective and quality driven … for the benefit of the entire population’ and to work together ‘to improve the scope, accessibility and quality of care at all levels’. These are laudable goals and we express our wholehearted support for them. The CPPHS specifies four ‘key areas’ of transformation: access to health services, equity in health services, quality of health services, and black economic empowerment (BEE). Among these the first three – access to, equity in, and quality of health care services - are essential (though not sufficient) to meeting the goal of health for all in South Africa. The fourth, however, is problematic

The Draft Charter of the Private and Public Health Sectors of the Republic of South Africa : health for all, or profits for few?

No Abstract. South African Medical Journal Vol. 95(10) 2005: 742-74