Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
Received date: June 13, 2016; Accepted date: October 07, 2016; Published date: October 08, 2016
Citation: Moisés M (2016) Short Communication on "Reflections on and Contributions to the Ministry of Health's Integrated Plan on Health Surveillance Actions for People Exposed to Pesticides". Int J Pub Health Safe 1:113.
Copyright: © 2016 Moisés M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Environmental planning; Environmental health; Pesticides; Environmental exposure; Health surveillance; Worker’s health surveillance
The present essay is based on the author’s article  which was an important contribution to the thesis of the author’s PhD in Health Sciences . The analysis of the integrated plan for health surveillance of populations exposed to pesticides  of the Ministério da Saúde (the MS integrated plan) and its guidelines  made during research and compilation of this thesis had aimed to contribute in the discussion of the strategies of the integration process in Health Surveillance of Populations Exposed to Pesticides in Brazil from the performance of the various sectors of the Ministério da Saúde (“MS”) involved in its development. It is important to highlight that since 2012 many versions of the model of surveillance and comprehensive care of populations exposed to pesticides  were organized, made by the discussions and analysis of the Plan and its guidelines  that were published by the MS in 2016.
In its initial stage, the plan included the participation of MS members in order to constitute a stock harmonization strategy at the federal level of the Sistema Unificado de Saúde – (“SUS”). Throughout the construction process it was found internal problems related to equate and get articulate the agendas and proposals of the various representations. It became clear the lack of integration across sectors and institutions, but also the existence of overlapping activities of the technical areas of the MS. As a result, it was possible in 2012 only agreeing to the guidelines for health surveillance of populations exposed to pesticides.
The subject due to its complexity required actions that could include dialogues with various ministries such as the Ministry of Environment, the Ministry of Education, among others. Also the idea included interaction mechanisms with companies that manufacture and sell the pesticides because they must participate in the processes of discussion. The plan and its guidelines have provided broad participation of workers and social movements, that could ensure the inclusion of the theme of pesticides in the actions of the SUS management strategy and participatory policy with a view to strengthen social control.
The theme may be included in the content of continuing education for social control, representations of workers and also on the SUS ombudsman system with a view to build a stream for the complaints. Also, it defines more complex sustainability of actions and surveillance activities for health of the populations exposed to pesticides. Discussions were triggered on the subject with the participation of workers' representatives in various events organized throughout the country such as conferences, meetings, symposiums, forums, as well as documents and motions were developed as an explicit exposure from social movements that show the attentive to this issue.
It is important to organize educational processes that enhance the worker as a creative, critical and interpretative subject of the reality they experience in their routine work with stimulating the dissemination of information on alternative forms of food production and agricultural processes that do not need to use pesticides. And due to the risk in using these products, propose and ensure that pesticide applicators have a driver's license and obtain all the information, knowledge, technical support and materials needed to manipulate them.
It is essential to develop and publish educational and informational materials with questions that cover the general principles, guidelines, goals, skills as well as the health surveillance, considering interdisciplinary and cross-cutting strategies. Another important focus is the structuring of risk communication courses and education in environmental health, in-person and distance with strategies, methodologies, objectives and program content focused on the regional approach organized by experts, worker’s representatives of state departments and municipal health, education, environment activists and others. Also, an important suggestion is the disclosure of information with appropriate language and highlighting beliefs and traditions, ways of thinking, acting and living of the population to build programs involving all the actions that can be performed in an integrated way with professionals involved in rural extension.
Regarding the Information Systems, the proposal is to unify the systems with the valorization of the notifiable diseases information system, since the current situation is almost rounded by unfamiliarity related to the mortality profile caused by the exposure to pesticides. The information centers and toxicological assistance and worker health reference should develop capacity to act in this specific conformation area in occupational health and in toxicology.
In Brazil, it remains the need for staff training related to the clinical management of exogenous poisoning to even perform the notification of the case, and especially experts as toxicologists that are linked to SUS. There have been no concessions arising from the Federal Government from a programmatic point of view regarding the priority that the health surveillance theme to populations exposed to pesticides deserves. Thus, remains a question of the need to have a clear proposal of SUS for the population that is exposed to risks related to exposure to pesticides. It is essential to define what are the tasks, actions and tasks that will be triggered by each level of government, because the Plan and its Guidelines are primarily intended to become a political priority and will involve the effective participation of the three spheres of government.
It is essential that the issue become a political determination that ensures the implementation of the proposed plan and the guidelines of the MS restructured with the addition of the Operational Plan and with the participation of new members if necessary. Also, it is proposed the participation of primary care health as a privileged locus to contribute to the actions and activities in reference to its strengthening with emphasis on the family health strategy for the diagnosis, monitoring and tracking of the population exposed to pesticides.
It is also important to foster discussions on strengthening the legal instruments for actions of states and municipalities, as the increase in the forums already in place and others that may be created and legitimized through ordinances related to the use of pesticides banned in other countries that has caused serious damage to human health and the environment. Thus, it must be pointed out the importance to strengthen the implementation of the laboratory network, the harmonization of information the support for the installation of the national network critical that inputs storage for the control of endemic diseases, the mobilization of society and the State in relation to the importance of the theme, the information about the magnitude of the impacts on health and the environment, education and communication to promote healthy environments and alternative practices that reduce the risk, as well as the development and implementation of a study and research agenda in order to scientifically substantiate interventions and decision-making in the various fields of interest related to the topic. Knowledge gaps have been identified as the diagnosis of the state of the art knowledge about pesticides in Brazil and it is important that there is a definition as to the lines of research priorities for funding.
Another important proposal is implemented to foster and encourage the MS dialogue with the Ministry of Social Development and agrarian that articulates with the productive sectors of familiar agriculture and social movements, which could represent a strategy that will facilitate questions that address agricultural credit and other government incentives. Thus, it will become a strong political tool to be linked to major investments for the implementation of alternative methods in agricultural production, particularly for the agroecological credit.
It consigns, as well, the importance of an intersectional, interdisciplinary and integrated action of surveillance covering public policies and appropriate care that will lead to prevention and control of contamination by pesticides and contribute to the process of integration (especially with the health surveillance) if problems are overcome.
The appreciation of dialogic processes, also with more traditional sectors of MS, such as Endemic Diseases Control Program is fundamental to the promotion of these actions. It has become essential to structure a Vigilância em Saúde de Populações Expostas a Agrotóxicos (VSPEA), with national extension and integrated character and also consider that their construction, development and execution allows the MS and, consequently the SUS, to effectively monitor and control the risk situations to human health related to pesticides. This being said, invigorates the intention to propose to the states and municipalities to take ownership of the content set out in the plan, its guidelines that were published in 2016 and apply in accordance to their realities.
Before the facts cited in the exhibition of the work, it is evident the need for a more effective performance of the state through its governmental spheres. The strengthening of social control because the participation of workers and social movements, valuing them through educational programs, facilitating access to information, is shown to be essential for the control of risk situations involving pesticides. In addition, the implementation of the laboratory network and enhancement of notifiable diseases information system aimed at contributing to further study of the consequences of the use of pesticides and precision of mortality level refers to them. Also organize a study schedule to give scientific basis for interventions and decisionmaking on the proposed topic and expose the importance of Surveillance System in Health of Populations Exposed to Pesticides for states and municipalities suited fastest, monitoring and controlling possible risk situations.