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Health care and exposure to pesticides in periurban horticulture: the case of the Green Belt of the City of Cordoba, Argentina

Eandi Mariana Andrea B.Sc. in Nutrition. Doctoral research fellow in Health Science. Facultad de Ciencias Médicas (School of Medical Sciences). Universidad Nacional de Córdoba (National University of Cordoba). Cátedra de Epidemiología General y Nutricional (Department of General and Nutritional Epidemiology). School of Nutrition. Facultad de Ciencias Médicas (School of Medical Sciences). Universidad Nacional de Córdoba (National University of Cordoba), Argentina.
e-mail: marianaeandi@gmail.com
https://orcid.org/0000-0002-5952-7726

- Dezzotti Luciana. B.Sc. in Nutrition Cátedra de Epidemiología General y Nutricional (Department of General and Nutrition Epidemiology). School of Nutrition. Facultad de Ciencias Médicas (School of Medical Sciences). Universidad Nacional de Córdoba (National University of Cordoba), Argentina.
e-mail: Luciana.dezzotti@gmail.com
https://orcid.org/0000-0002-9765-7927

- Butinof Mariana. Medical Doctor. Cátedra de Epidemiología General y Nutricional (Department of General and Nutrition Epidemiology). School of Nutrition. Facultad de Ciencias Médicas (School of Medical Sciences). Universidad Nacional de Córdoba (National University of Cordoba), Argentina.
e-mail: mbutinof@fcm.unc.edu.ar
https://orcid.org/0000-0002-7228-5186


ABSTRACT
Objective: To analyze health care and exposure to pesticides within the context of productive and reproductive practices or the everyday life of horticulturists in the Green Belt of the City of Cordoba (GBCC), Argentina, from the individual, particular and general domains as the comprehensive framework of health determining processes. Material and Methods: An explanatory analytical study was implemented which included the use of mixed methodologies between 2013 and 2017. A triangulation analysis was carried out of the results of the quantitative and qualitative aspects. Results: It was observed that the dominant agricultural productive model has determined the deterioration of the productive conditions and exposure to pesticides of the horticultural population of the GBCC. Deficient systems for regulating land use, weak legislation and control from the State in accordance with the context impact on everyday life and block the horticulturists’ individual health protection practices.
Key words: social health determinants, pesticides, agricultural production, urban agriculture, ecological corridor.

RESUMO
Objetivo: Analisar a exposição a agrotóxicos e cuidados com a saúde, no contexto das práticas produtivas e reprodutivas do cotidiano de horticultores do Cinturão Verde de Córdoba (CVCC), na Argentina, a partir dos domínios individual, particular e geral como um quadro abrangente de os processos de determinação da saúde. Material e Métodos: Foi implementado um estudo analítico explicativo que incluiu o uso de metodologias mistas entre 2013 e 2017. Realizou-se uma análise de triangulação dos resultados dos aspectos quantitativos e qualitativos. Resultados: Observou-se que o Modelo Produtivo Agrícola Dominante determina a deterioração das condições produtivas e a exposição a agrotóxicos da população hortícola da CVCC. Os sistemas deficientes de regulação do uso da terra, legislação fraca e controle de acordo com o contexto por parte do Estado afetam o cotidiano e obstruem as práticas individuais que protegem a saúde dos horticultores.
Palavras-Chave: determinantes sociais da saúde, pesticidas, produção agrícola, horticultura urbana, cinturão verde.


INTRODUCTION
A country with centenarian farming traditions, Argentina has a wide range of geographical and territorial conditions for agricultural production which have encouraged differentiated processes of social construction within the sector. At present horticulture covers approximately 700,000 ha [1] and engages nearly 10 thousand workers a year, thus making it a highly valuable social activity [2]. The large urban centers – Buenos Aires, Mendoza and Cordoba – concentrate half of the total volume produced. The horticultural sector does not escape from the Dominant Agricultural Productive Model (DAPM), characterized by intensive primary exploitation as to factors relating to tilling the soil, work, capital and technology [3]. Compared with the remainder of the farming sector, it requires 30 times more labor in its entirety and 20 times more consumables per production unit, among them pesticides [4].
The problem this work focuses on is located in the space immediately adjacent to the physical environment where cities are established, the productive, residential and service territory, the so-called periurban area [5]. In Argentina, this periurban space is called the “green belt” (GB) and is made up of family-run truck farms or market gardens, or others of more corporate characteristics. The multiple threats jeopardizing this space question public agendas as it constitutes the seat of these cities’ food replenishing systems [6]. The origin of periurban horticulture in the country was marked by its family nature and the migrant condition of the producer families: families originating from Italy, Portugal and Spain in the early 20th century and then from Bolivia at the end of the last and beginning of this century. Currently 60% of the GB in the country is sustained by Bolivian families [7]. Changes in the configuration of the exploitation were accompanied by transformations in the ownership and use of the land, where small and large landowners, lessees, sharecroppers and employees can all be identified [8]. Sharecropping is a figure in the agrarian sector (Law 13,246) in which the producer, the landowner, organizes the production process within his property using work force provided by way of direct access to resources for its production, accommodation, food, etc., an arrangement that enables, naturalizes and legitimates certain oppressive labor relations and precarious working conditions [9].
Among the particularities this horticultural sector acquires are the invisibility of the workers, legal loopholes in the sector, scarce knowledge of effective regulations, poor dissemination, discussion and nonperformance, low presence of unions and the State in its role as auditor, reasons which determine the existing job insecurity and facilitate exploitation [10]. Added to this, the imperceptibility that characterizes the activities in which family farming is prevalent [11]. The fact that they are migrants also increases the risk of diseases, environmental and occupational lesions, as well as health disparities typically associated with poverty [12].
The Green Belt of the City of Cordoba (GBCC) contributes 16% of the country’s production and is third in regard to the total volume produced, with a surface area covering some 5,500 ha of productive land. The unplanned urbanization model, established by the liberal economic model that proposed the elimination of export taxes, import duties on capital goods and a series of public agencies regulating the sector, along with the introduction of a modern biotechnological package, RR and glyphosate resistant soybean [13] has favored, among other things, a reduction to half of its size in less than 20 years. The advance of urban boundaries and the extensive farming of soybean, as well as the lack of water for irrigation on account of the reallocation of existing canals towards new gated communities, have been identified as the main reasons for the displacement of truck farms to nearby districts [14]. Most horticultural families (HF) live on the farm where the crops are located and where they lead their everyday lives [15], where the family members take part in different aspects of the production process [16]. Men, women and children work on the farm, where the work of the latter appears concealed under the label of “help” [17].
The workers’ and families’ exposure to pesticides must be considered with special attention given how the work is organized, as it brings together and intertwines productive and reproductive aspects [18] [19] with very little control from the horticulturists as to the safety conditions of their work [12]. The scenarios in which exposure to pesticides occurs depend largely on the favorable or negative conditions of the social and cultural situation in which they develop [20].
Epidemiological studies that have addressed the problem of exposure to pesticides in rural environments claim that the effects on human health are associated to a diversity of factors: the type of pesticide and its toxicity, the dose, the technology with which it is applied, the duration and the meteorological conditions during exposure, the channels through which it occurs, the characteristics of the subjects themselves, the use of measures of protection and the modes of organization of the labor environment [21] [22]. Hence it is claimed that the ailments and illnesses suffered by the horticulturists (handlers of pesticides) are a result of uncontrolled exposure to such substances, identified as risk factors that are preventable by implementing good farming practices. This epidemiological perspective, centered on identifying risk factors of an individual level, disregards the determination processes implicit in the productive structure. The reasoning conceals the restrictive frameworks faced by these people and communities in protecting themselves from destructive processes, that is to say, “in modifying their lifestyles.” These risk factors, resignified by the contribution of several authors from the field of collective health, could be considered links in the productive chain in the DAPM context [23] [24]. It is relevant here to incorporate the concept of comprehensiveness of care [25] as it allows us to reflect upon the sociocultural senses and practices that determine particular forms of caring for oneself, conceptions of health, risk, disease prevention and health promotion, among others. All of them come into play from the standpoint of health professionals and institutions, and in the communities themselves, facilitating or hindering such care practices. Thus exposure is no longer considered in an isolated manner or as a simple “contingency”: it is part of a pattern of intoxication which in turn acquires its form and epidemiological impact in the midst of a group lifestyle.
In understanding health as a complex and socially determined process [26], it has been posed that there is a dialectic movement between simple and complex, individual and collective dimensions [20], which may be identified. In this paper we adopt the proposal put forward by P.L. Castellanos [24] regarding three dimensions of analysis. The General Dimension (GD) which represents the expression of a society’s mode of life, its productive forces, economic and political organization, forms of relating with the environment, its culture and its history. The community’s life conditions, the Particular Dimension (PD), comprises 4 processes of social reproduction of everyday life: a) biological processes; b) those of relationships and ecological processes; c) those of the forms of awareness and conduct; d) those of economic relationships. The Singular Dimension (SD), meanwhile, is the expression of people’s individual ways of life and behaviors, family lifestyles and forms of existence [24]. Following this comprehensive model, the aim of this work was to analyze the determining processes of health care and exposure to pesticides within the context of productive and reproductive practices of the everyday lives of the horticulturists of the GBCC.
MATERIAL AND METHODS
An explanatory analytical study was implemented which included the use of mixed methodologies. To do so, a triangulation analysis was carried out of the results of the quantitative and qualitative aspects [27]. Using the quantitative approach, a survey of horticultural workers was conducted, adapted to the context of the GBCC in stages prior to this research [16]. A representative sample was drawn of the population of workers/producers in the GBCC with a confidence level of 95% (n=143). This stage was conducted between 2013 and 2017. The instrument applied has four modules, which address the following information: a) sociodemographic characteristics (age, educational attainment, marital status, type of family, nationality); b) production practices and work with pesticides (application techniques, number of hours a day devoted to work, use of personal protective equipment); c) everyday life (labor category, seniority in the job, size of the farm, number of hectares tilled, number of days per week devoted to work, participation of family members in farm labor, expressed as family work, place of residence); d) the worker and his family’s health conditions (associated symptomatology, medical consultations, accidents with pesticides). Variables from the first three modules were selected for this work. Descriptive analyses were made (average and SD for quantitative variables, description of frequency of categories of qualitative variables) and a logistical regression analysis.
The qualitative inquiry consisted of holding semi-structured interviews with key players (n=27) who were contacted following the “snowball” technique [28]: 17 members of HFs, 1 official from the Ministry of Agriculture, 2 phytosanitary advisors, 1 union contact person and 6 health professionals involved in the domain of the GBCC. Participant and non participant observation and field records were carried out in: farms, the city wholesale food market, meetings with horticulturists along with civil society and State agencies. After transcribing and reading the interviews, fragments were identified that made it possible to characterize the different dimensions of interest, resorting to the “grounded theory” to analyze the data [29]. By triangulating the data, an interpretative framework was built as from the categories described in Figure 1 (adapted from Castellanos [24]). This research was approved by the Ethics Committee of the School of Medical Sciences of the National University of Cordoba (148/12); the principles inherent to the declarations of Nuremberg, Helsinki and Tokyo were safeguarded. The data were preserved according to the principle of habeas data.
Figure 1
RESULTS
General Dimension as an expression of modes of life in the GBCC.
The GBCC is currently configured as a space of transition between the urban and the rural, where productive and reproductive activities of the HFs merge, with no demarcated geographical barriers. The scenery beyond the ring road, a fast circulation ring envisioned as a belt to limit the city’s growth [30], appears in Cordoba as a mixture of neighborhoods inserted in the areas with crops destined to horticulture, schools, companies and a variety of industries. Ancestral and community forms of agriculture connected with nature have been replaced by practices which respond to the DAPM: “(...) The important thing here is to produce more and more, we can’t take risks (...)” (Horticulturist, 50 years of age). The model is further pushed by companies that provide production consumables, seeds, fertilizers and pesticides, and which “invest” in training programs that promote their benefits. Precarious labor relations have been identified (unregistered temporary work, long working days, scarce hygiene and job security), phenomena which characterize the DAPM. “(...) I used to be an employee, now I’m a sharecropper, and for it to be worthwhile I have to work all day, (...) sometimes all my family have to come and lend a hand (...)” (Horticulturist, 39 years of age).
Within the context of an intense struggle for land use and access to irrigation, and faced with a lack of legislation to regulate the periurban area and protect horticultural zones, the horticulturists begin moving to neighboring districts or simply selling their farms: “(...) we’ve been in Rio Segundo for 6 years, but we were pushed out by the prices of productive land (...)” (Horticulturist, 32 years of age). A phenomenon that is appearing incipiently is the social pressure generated by the use of pesticides on land adjacent to urban centers; in view of this, agroecological production is emerging and establishing itself as a way of remaining in an area in the face of urban encroachment.
The use of pesticides in agriculture is regulated in Cordoba by Law 9,164; among the productive community of the GBCC there is little knowledge relating to its content and/or usefulness, even among farming professionals who by law are in charge of conducting phytosanitary prescriptions and advising on the use of pesticides: “(...) The law has to be interpreted, parts of it aren’t clear (...)” (Phytosanitary advisor, 30 years of age). Among some sectors there are also players who express the need to have a specific legal instrument for horticultural production on account of its characteristic differences with other agricultural exploitations for which the law in force was designed; health professionals see loopholes and regulatory inconsistencies related to the health needs of workers exposed to pesticides and those communities in the adjacencies. Thus regulatory loopholes and lack of control in current regulations restrict effective health care actions for the population.
Particular Dimension as an expression of everyday life in the GBCC.
The sociodemographic characteristics of the population of workers is shown in Table I. The average age is 43.6 years [SD 13.16], 69.23% are over 35 years of age, the majority have completed only the lower schooling levels (complete primary or less, 55.24%) and live with their families (74.82%). Interculturality is a particular characteristic that permeates these families’ daily lives, as 33.1% of the HFs are Bolivian. The Argentine families are children and grandchildren of Spaniards and Portuguese who arrived at the beginning of last century, inherited the land, the activity and their housing: “(...) I’ve done this all my life, my father and grandfather began with it (...)” (Horticulturist, 42); and on the other hand Bolivian families who migrated here during the last few decades: (...) first my husband came, then the rest of us, and we stayed (...)” (Horticulturist, 45 years of age). Some of the Bolivian HFs that arrived in the the GBCC to work as employees two decades ago today own the land they till. The family culture determines the differentiated forms of production, which reflect the allocation of roles to family members. The work done by Bolivian women on the farm is recognized. Among Argentine families, the woman’s participation in the productive tasks is dubbed “help,” thus rendering their economic contribution to the production process invisible. For all of them, work on the farm permeates their everyday life, determining the exposure to pesticides. “(...) the family works and the children come and go, sometimes curing, and the children follow their parents and hang around near them” (Horticulturist’s wife, who does not define herself as a horticulturist, 39 years of age). The spaces shared in marketing the products are also used for socialization and recreation, the horticulturists exchange vegetables cooperatively and gather around for meals. Bolivian families bond with each other and strengthen the recreational encounters outside of their production and sales locations. The Pasanaku strategy, described as a recreational game, makes it possible to purchase personal and immovable property cooperatively favoring growth and permanence in the sector.
A description of its context is shown in Table II. With respect to the labor condition according to their connection with the means of production, we find them as owners (42.14%) of the land and the production tools, lessees (40.71%) who rent the land and contribute the means of production, sharecroppers (8.57%) and employees (8.57%), to whom specific tasks such as sowing, harvesting, hoeing, etc. are allocated. In the sector, 70% of the farms are classified as small or medium sized. On farms of 10 hectares or less, several family members take part in the productive tasks: “(...) Unless we all work the land, it’s not worth it; the land is small and not enough to justify hiring employees... We are working in the greenhouse at the moment” (Horticulturist, 50 years of age). The landscape is uniform and indistinct between the places where: “we work” and “we live.” Women and children do activities on the farm. They often do farm work five days a week or more, and more than five hours a day on average, except when they apply pesticides: “I do everything except curing, which my husband always does. He says he knows about that... well, so do I, but he doesn’t let me...” (Horticulturist, 45 years of age). Some 89.09% of them work more than 5 days a week and when the family lives on the farm, women and children work as so-called “help” (48.15%). Everyday life revolves around intense, routine work with virtually no rest.
The members of the horticultural community interviewed generally define this kind of life and work environment as healthy: “I don’t think living here is bad for the health... Look, everything’s green, beautiful, and it was even more beautiful before (...)” (Horticulturist, 55). They perceive the use of pesticides in their everyday life as something dangerous or slightly dangerous and they consider that the products nowadays are “milder” than those their parents or grandparents used to use. The occurrence of serious health conditions among close family members, however, has generated changes in their perception of the risk.
The healthcare workers serving in the GBCC lack specific health records related to exposure.
Table 1
Table 2
Table III expresses the characterization variables of the practices with pesticides. The predominant pesticide application technique is using a manual backpack (80%) and 38.8% do it for more than 4 hours a day on the day the sprinkling is carried out. Most of the horticulturists do not wear Personal Protective Equipment (PPE) effectively to prevent exposure during application. The multidimensional approach selected in this study has made it possible to look beyond the immediate circumstances of the horticultural workers and their families. There is evidence of a relationship between the lifestyle and the particular forms of pesticide exposure, as well as connections between these forms of exposure and with the immediate events of their lives and working conditions. Table IV presents how the lack of care after pesticide application (p=0.039) and the fact of living on the farm (p=0.57) increase the chances of accidents. The jobs identified on the farm (sowing, curing or applying pesticides, a term in common usage in the sector, hoeing, harvesting, packaging) by the family members are defined according to how hazardous they are perceived. Those that represent the greatest “risk,” such as applying pesticides (“curing” is the term used by the horticulturists), are carried out by the man. The weight of the backpack and poisonous spills on the body are recognized as the greatest exposure situations. The former determines that health care is the worker’s individual responsibility, and is achieved exclusively by the use of PPE. Lack of time, discomfort and the cost of PPE are identified as impediments to their use: “But let’s get real, no one will use it (...) I’ll take you right away to all the farms there are in Villa Retiro (...).” (Horticulturist, 38 years of age). Triple washing of pesticide containers and adequately dispensing with them is hindered by the absence of any selective collection thereof. Burning and burying are habitual, even though these practices are forbidden by current legislation. Within the household, pesticide residue is circulated by way of the horticulturists’ footwear and working clothes and by drift from nearby crops, these being clear expressions of the invisibility of these spaces. Women moderate exposure by sustaining different healthcare practices: “Sometimes he changes there (in the farm) and others he comes in his working clothes (...); I’ve struggled against that... Him lying on the bed in his working clothes... it’s a struggle (...) (Horticulturist, 40 years of age). As for the role of the State as the guarantor of individual rights connected to health, a lack of information necessary for the correct handling of pesticides was evidenced by the subjects involved in using them. The workers fail to understand the existing regulations for their use as they consider they do not adapt to horticultural production conditions, thus resulting in an impediment for the healthcare of the horticulturists and their families. “(...) Those who work in these activities only come to consultations if the situation is serious and we don’t see them in the health center.” (Health professional).
Table 3
Tabel 4
DISCUSSION
The purpose of this work has been to shed light on the dialectic movement produced between the different health determination domains in the GBCC related to the prevalent productive model, health care and exposure to pesticides, which gain actuality in the individual and family health conditions of the people living and working within this context. The adoption of a multidimensional viewpoint and a comprehensive representation of the general, particular and individual processes makes it possible to visualize the health process as essentially contradictory, as all three of these dimensions are determined by negative phenomena that affect life and health patterns and by processes of protection and collective and individual support that promote health and prolong life [20].
The DAPM that promotes the current production context in the GBCC has triggered changes in the productive structure centered on corporate logic, determining alterations in the life patterns of horticultural families. The productive transformations which initiated over three decades ago in the GBCC, with an increase in the use of pesticides as the central aspect of the production process, have produced socioenvironmental impacts. Potential negative effects on human health are described in Argentina [16] [17] [31] [32] [33] [34], the dispossession of productive land [14] [35] [36] and the deterioration of productive conditions [37]; the loss of nutrients from the soil [38] and the reduction of local and regional dietary quality [39]. The effects on the workers’ health become visible in other Latin American contexts: health risks in Brazil are evidenced by rural workers in Soares and Porto, as well as the cost generated by intoxications [40], while Delgado and Paumgartten [41] reveal exposure to pesticides due to lack of individual protection while handling pesticides in 92% of workers. Existing evidence makes it possible to postulate that the social/economic costs associated to this productive model could be reduced by implementing public policies aimed at promoting other forms of production [42].
In agreement with Giarracca and Teubal [37] [43], the DAPM has determined the deterioration of the productive conditions and exposure to pesticides of the horticultural population of the GBCC. Growing dissemination of wage labor and loss of job stability in rural employment, deficient regulation, control, sanitation and education by the State with respect to the use of pesticides [44] [45] accompany this model, which impacts on the environmental, social and human spheres, resulting in an extremely vulnerable population with a high level of exposure to pesticides [46] [16] [17]. All this in a context where the provincial legislation admits legal loopholes that fail to guarantee health care.
The approach made to the particular dimension highlights the fact that the everyday practices displayed by horticulturists in the productive and reproductive environment in relation to exposure to pesticides respond to a socially construed signification of risk [20], which helps to understand how exposure conditions are reproduced in the most individual lifestyles: the individual dimension. As Foucault points out [47], the notion of self-care is incorporated by the relationship established not just with one’s own body but also with others and with the environment. Thus viewed, individual health facts such as the disorders and diseases that characterize horticultural workers and their families are part of collective health processes. Similarly, this dialectic movement gives way to aspects of protection, support and defenses that are closely related to the transformation of the health situation, which tends to reproduce itself in other collectives [24].
The current productive model constitutes a threat to the Argentine population’s safety and dietary sovereignty [48]. On one hand, we have the problem of sovereignty and on the other Argentina’s safety in guaranteeing food in sufficient quantity and diversity to meet the needs of its own population. Despite the hegemonic and excluding evolution of the DAPM, experiences have emerged that confront it and even dispute its prevalence. There are several tendencies within this paradigm that deserve to be identified even though they are often concealed. One of them is organic or ecological agriculture which is identified nowadays as a palliative and a potential improvement for environmental health. The analysis of exposure to pesticides and the care required in the context of the life and work of horticulturists, through the general, particular and individual categories, has made it possible to point to the fact that the DAPM modulates the everyday life of horticultural workers, their families and the communities they interact with, due either to the proximity of the farms or to being considered consumers of the production, generating a direct impact on health.
This form of production is considered irrational and, with respect to this, there are some technical solutions that deserve to be applied (Good Agricultural Practices, for example). Nevertheless, it is imperative to discuss the aims of the model, its reasonableness. In this sense, we present what Hardin [49] calls a problem with no technical solution. That is to say, it is perhaps harder but no less fruitless to admit the existence of a political and ethical problem and, as a result, seek solutions or, at least, advance in this sense beyond the technical solutions that fail to address the fundamental problem, the model’s (un)sustainability and its consequences in terms of caring for health and the environment.


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