ABSTRACT

This study aims to analyze exposure to pesticides and harm to the health of workers on sugarcane plantations in Pernambuco. This participatory research was conducted in rural territories of five municipalities with a strong presence in sugarcane-planted areas. The primary data were produced in workshops with rural workers to construct a participatory rural diagnosis, analyzed through condensation of meanings, and interpreted in light of the theoretical framework of Latin American critical epidemiology. The results are presented in three sections: i) Flowchart of work on sugarcane plantations; ii) Exposure to pesticides used on crops; iii) Harm to worker’s health. We conclude that permanent exposure to pesticides involves working on sugarcane plantations and emerges from a historical and socio-environmental construct in which the ways of life of the territories under the control of sugarcane agribusiness are subsumed. Public policies are recommended to promote family farming with diversification, flow, distribution of agroecological production, and strengthening primary health care and integrated epidemiological, health, environmental, and worker surveillance actions.

KEYWORDS
Saccharum; Rural workers; Agrochemicals; Rural health

Introduction

In Brazil, 720.87 thousand tons¹1 Instituto Brasileiro do Meio Ambiente e dos Recursos Naturais Renováveis. Relatório Comercialização de agrotóxicos. Brasília, DF: DILIQ; IBAMA; 2021. of pesticides were consumed in 2021 alone, which places the country among the world’s largest consumers of these agents. Soy, corn, cotton, and sugar cane monocultures comprise 85% of the total pesticides used²2 Pignati WA, Lima FANS, Lara SS, et al. Distribuição espacial do uso de agrotóxicos no Brasil: uma ferramenta para a Vigilância em Saúde. Ciênc. saúde coletiva. 2017; 10:3281-3293.. According to Bombardi³3 Bombardi LM. Geografia do Uso de Agrotóxicos no Brasil e Conexões com a União Europeia. São Paulo: FFLCH-USP; 2017., Brazil had 715 pesticides with authorized use in 2017, 177 of which had been prohibited for use in the European Union (EU)³3 Bombardi LM. Geografia do Uso de Agrotóxicos no Brasil e Conexões com a União Europeia. São Paulo: FFLCH-USP; 2017., which expresses a Brazilian situation permeated by conflicts of interest that directly interfere with the environmental and health regulation of the country. This situation has deteriorated in recent years with the authorization of use and the realization of2,807 new pesticide registrations between 2017 and the first half of 2022⁴4 Wendling GG, Bargos DC. Análise dos altos números de concessões de registro a agrotóxicos de 2017 a 2022 no Brasil e suas possíveis consequências. Bo-let. Paulist. Geog. 2023; 110:1-25..

Brazil has the most significant sugarcane production in the world. Pernambuco is the second-largest producer in the North and Northeast, with 134 thousand hectares of planted area and production of around 7 thousand tons/year⁵5 Companhia Nacional de Abastecimento. Acompanhamento da safra brasileira de cana-de-açúcar. Conab; 2020 [acesso em 2023 nov 10]; 7(3):1-117. Disponível em: https://www.conab.gov.br/info-agro/safras/graos/boletim-da-safra-de-graos.
https://www.conab.gov.br/info-agro/safra... . The state has the third-highest number of agricultural establishments using pesticides and the second-highest record of deaths related to exogenous poisoning³3 Bombardi LM. Geografia do Uso de Agrotóxicos no Brasil e Conexões com a União Europeia. São Paulo: FFLCH-USP; 2017..

Recent studies denounce the painfulness of human work, its exploitation by the sugar and alcohol sector, and the deteriorated health of sugarcane workers, who are daily exposed to the substandard, unsafe, and unhealthy conditions of the production process – besides the preserved historical and structural inequalities imposed to rural territories with direct implications for local epidemiological profiles⁶6 Silva CP, Guedes CA, Gurgel AM, et al. Condições de trabalho no cultivo da cana-de-açúcar no Brasil e repercussões sobre a saúde dos canavieiros. Rev Bras Saúde Ocup. 2021 [acesso em 2023 jan 3]; 46:e22. Disponível em: https://www.scielo.br/j/rbso/a/qx-ZQzVNs6P8GzZYrthN5VCH/#.
https://www.scielo.br/j/rbso/a/qx-ZQzVNs... , ⁷7 Leite MR, Zanetta DMT, Trevisan IB, et al. O trabalho no corte de cana-de-açúcar, riscos e efeitos na saúde: revisão da literatura. Rev Saude Publica. 2018 [acesso em 2022 dez 3]; 52:80. Disponível em: https://www.scielo.br/j/rsp/a/6jX8gDPr93FkHnCqnwqLsLf/?-format=pdf&lang=pt.
https://www.scielo.br/j/rsp/a/6jX8gDPr93... .

Conventional epidemiology understands the exposure category based on the assumptions of externality and eventuality, which govern the causal relationship of the organism exposed to the toxic substance. In contrast, the dialectical perspective of critical epidemiology broadens the spectrum of observation by considering the ecosocial history of exposure and distinguishes it as occasional, chronic, or permanent. The permanent exhibition refers to the imposed work and consumption patterns, invariable and intrinsic to the ways of life subsumed by the hegemonic productive logic⁸8 Breilh J. Epidemiologia crítica: ciência emancipadora e intercuturalidade. Rio de Janeiro: Editora Fiocruz; 2006..

The contradictions arising from the relationship between health, environment, and work must be clarified in this context. Furthermore, this occurs through the production of data and scientific information with the active participation of affected populations and communities so that it becomes feasible to support strategic planning and political decision-making for reconfiguring health praxis and effective coping with the problems. This article analyzes the exposure to pesticides and harm to the health of sugarcane workers in Pernambuco, Brazil.

Material and methods

This participatory research⁹9 Brandão CR. Pesquisa participante. São Paulo: Editora brasiliense; 1983. with exploratory and qualitative analysis aimed to understand the subjects’ meanings, interactions, and behaviors in their experiences and circumstances¹⁰10 Minayo MCS. O desafio do conhecimento: pesquisa qualitativa em saúde. São Paulo: Hucitec; Rio de Janeiro: Abrasco; 2004.. It was developed in rural territories located in five municipalities with a strong expression in sugarcane planted areas, which are considered a priority for monitoring pesticide exposure in Pernambuco¹¹11 Pernambuco. Secretaria Estadual de Saúde. Plano de ações para Vigilância em Saúde de Populações Expostas a Agrotóxicos: Normas e Manuais Técnicos. 1. ed. Recife: SES; 2014. (Série A). [acesso em 2023 nov 10]. Disponível em: https://portal.saude.pe.gov.br/sites/portal.saude.pe.gov.br/files/plano_agrotoxicos_pe.pdf.
https://portal.saude.pe.gov.br/sites/por... : Água Preta and Sirinhaém, in Zona da Mata Sul; and Goiana, Itambé, and Aliança, located in Zona da Mata Norte.

Primary data was collected from January to August 2022 through workshops in exposed communities to build a Participatory Rural Diagnosis (PRD) on socioenvironmental vulnerabilities arising from the sugar-energy production process. The PRD promotes the direct acquisition of primary information through pedagogical tools that facilitate dialogue, the systematic assessment of problems, and solution opportunities, encouraging “self-analysis and self-determination of community groups”¹²12 Brasil. Ministério do Desenvolvimento Agrário, Secretaria da Agricultura Familiar. Diagnóstico rural participativo: guia prático DRP. Brasília, DF: MDA; 2010.⁽¹³⁾.

Coordination visits were conducted with community leaders in the territories to mobilize a workshop per municipality to build ‘work flowcharts’¹²12 Brasil. Ministério do Desenvolvimento Agrário, Secretaria da Agricultura Familiar. Diagnóstico rural participativo: guia prático DRP. Brasília, DF: MDA; 2010., ¹³13 Flores MG. Vulnerabilidade socioambiental e saúde da mulher em comunidades de pesca artesanal de Cabo de Santo de Agostinho e Ipojuca/Pernambuco. [dissertação]. Recife: Fundação Oswaldo Cruz; 2022. in the sugarcane fields. Each workshop lasted two hours and had an average of ten participants, selected over the age of 18, residents or sugarcane workers residing in the territory.

The first part of the workshop shared knowledge, memories, experiences, and practices that weave the historical and socioenvi-ronmental fabric of the communities’ ways of life. The narratives of work activities were described and sorted according to the participants’ daily workflow. Then, the activities were grouped into sequential steps related to the agricultural cycle and named on paper cards. Subsequently, the tool facilitated the debate on the historical and political context regarding the socio-health and environmental impacts resulting from the use of pesticides in the study territories. It enabled the characterization of exposure and harm to workers’ health.

The statements were analyzed from the condensed meanings¹⁴14 Kvale S. Interviews: an introduction to qualitative research interviewing. Thousand Oaks: Sage; 1996., which supported the identification and essential description of the central themes related to the study: i) Flowchart of work on sugarcane plantations; ii) Exposure to pesticides used on crops; iii) Harm to the worker’s health. Data interpretation was anchored in Latin American critical epidemiology and theoretical and methodological inputs to the social determination of health, whose dialectical observation of the epidemiological reality of health-disease processes involves the context of disputes in society and its inequalities, be they economic, cultural, political, social and health-related⁸8 Breilh J. Epidemiologia crítica: ciência emancipadora e intercuturalidade. Rio de Janeiro: Editora Fiocruz; 2006..

This study is nested in broader academic research conducted by the Health, Environment, and Work Laboratory of the Oswaldo Cruz Foundation. It was approved by the Research Ethics Committee of the Aggeu Magalhães Institute and aligns with the Resolution of the National Health Council/CNS Nº 466/2012, under CAAE: 73834317.2.0000.5190 and Opinion Nº 2.617.522. All participants signed the Informed Consent Form.

Results and discussion

Flowchart of work on sugar cane plantations

The sugar and alcohol production context is marked by the social division of labor, whose exploitation and spoliation affect the farmers of the extensive sugarcane fields. Payment for the production of manual agricultural work, which sustains the income of the plants, fluctuates with the abusive targets imposed on salaried workers, those settled with small plots of land, or migrants¹⁵15 Rosa LA, Navarro VL. Trabalho e trabalhadores dos canaviais: perfil dos cortadores de cana da região de Ribeirão Preto (SP). Cad Psic Social Trabalho. 2014; 17(1):143-60., ¹⁶16 Vilela RAG, Laat EF, Luz VG, et al. Pressão por produção e produção de riscos: a “maratona” perigosa do corte manual da cana-de-açúcar. Rev Bras Saúde Ocup. 2015; 40(131):30-48..

During the PRD workshops, the debate surrounding working conditions underscored the exhausting nature of the working hours and work pace, with an overload of physical and mental effort, repetitive movements and work accidents, under high temperatures and substandard conditions of nutrition and hydration of workers, aligning with results from other studies¹⁷17 Rumin CR, Navarro VL, Perioto NW. Trabalho e saúde no agrobusiness paulista: estudo com colhedores manuais de cana-de-açúcar da região oeste do Estado de São Paulo. Cad Psic Social Trabalho. 2008;11(2):193-207., ¹⁸18 Abreu D, Moraes LA, Nascimento EN, et al. A produção da cana-de-açúcar no Brasil e a saúde do trabalhador rural. Rev Bras Medicina Trabalho. 2011;9(2):49-61., ¹⁹19 Borges LFS, Borges OP, Alves SS, et al. Impactos ambientais e sociais causados pela queima da cana-de-açúcar. Monumenta - Rev Cien Multidisciplinar. 2020; 1(1):73-83.. The work flowcharts were built by the communities emphasizing worker exposure to pesticides used during the sugarcane cultivation cycle stages. The work activities reported by the workers were grouped into work process stages and sorted per the narrative sequence of the community discourses produced (figure 1 and table 1).

As noted in the reports, pesticides mainly eliminate adjacent plants’ growth, which appear spontaneously and compete for nutrients in the soil with the cultivated sugarcane seedlings. The workers explain that the use of poison replaces the practice of manual clearing with a hoe during land preparation, planting, and cultivation, which allows them to concentrate more significant physical effort to meet the goals imposed in the subsequent stage of manual sugarcane cutting, converging with the results highlighted in a recent study carried out in Goiana, Pernambuco, Brazil²²22 Gurgel AM, Souto AS, Guedes CA, et al. Espelho sem reflexos: conflitos e vulnerabilidades socioambientais em uma região produtora de cana-de-açúcar. Ciênc. saúde coletiva. 2022; 27(3):1049-60.. Communities also point out the use of biocides during cultivation due to the proliferation of insects and other ‘pests’ that harm growth and the final concentration of sucrose in the sugarcane to be weighed and sold to the mills, aligned with the study of the same content²³23 Christofoletti CA, Souza CP, Guedes TA, et al. O emprego de agrotóxicos na cultura de cana-de-açúcar. In: Fontanetti CS, Bueno OC, organizadores. Cana-de-açúcar e seus impactos: uma visão acadêmica. Bauru: Canal 6; 2017. p. 51-61..

The statements revealed that the pesticides most used by workers are herbicides glyphosate (Roundup®) and 2,4-D, along with termite killer fipronil (Regent®), whose applications occur directly through manual knapsack spraying equipment coupled to the worker’s body and by aircraft that fly over the studied communities close to the harvest period, to combat the proliferation of leafhoppers in the sugarcane fields that surround the territories. In general, all communities realize that the incorporation of agribusiness technologies in the sugar and alcohol sector is motivated by increased productivity and the accumulation of wealth by the dominant agribusiness classes, a result also identified in another similar study¹⁵15 Rosa LA, Navarro VL. Trabalho e trabalhadores dos canaviais: perfil dos cortadores de cana da região de Ribeirão Preto (SP). Cad Psic Social Trabalho. 2014; 17(1):143-60..

The intensive use of pesticides in Pernambuco is immersed in a broader national situation since a 128.64% increase was recorded from the 2017-2022 period alone against the sum of the 2001-2016 period⁴4 Wendling GG, Bargos DC. Análise dos altos números de concessões de registro a agrotóxicos de 2017 a 2022 no Brasil e suas possíveis consequências. Bo-let. Paulist. Geog. 2023; 110:1-25.. This situation results from the dismantling of environmental and health protection mechanisms, legislative flexibility, scrapping of supervisory bodies³3 Bombardi LM. Geografia do Uso de Agrotóxicos no Brasil e Conexões com a União Europeia. São Paulo: FFLCH-USP; 2017., and consequent induction of an ‘economy of death’²⁴24 Breilh J. Entrevista: Jaime Breilh. Trabalho, Educação e Saúde. 2015; 13(2):533-40., given that the destruction of biodiversity and traditional ways of life were ‘authorized’ by public authorities, especially in the last five years. Glyphosate, for example, is the most sold poison throughout the country and is the most commonly used herbicide in sugarcane crops. Currently, the Maximum Residue Limit (MRL) for this product in sugar cane is 20 times higher than those established in the EU³3 Bombardi LM. Geografia do Uso de Agrotóxicos no Brasil e Conexões com a União Europeia. São Paulo: FFLCH-USP; 2017..

The manual cutting stage is preceded by the centuries-old practice of regular burning of extensive sugarcane fields, with the explanation of facilitating the cutting of sugarcane bundles by the machete blow performed by workers, whose labor rhythm is dictated by the imposed goals¹⁶16 Vilela RAG, Laat EF, Luz VG, et al. Pressão por produção e produção de riscos: a “maratona” perigosa do corte manual da cana-de-açúcar. Rev Bras Saúde Ocup. 2015; 40(131):30-48.. The gross collection of the harvested material is performed by machinery, and the residual remains are collected manually by workers. Then, the tons of sugarcane are transported by so-called ‘tremίnhões’ (large buckets for transporting sugarcane mounted on a traction vehicle) to the plant, where the production is weighed.

The statements also describe the storage and disposal conditions of pesticide packaging, which highlights the opposite provisions of Law Nº 7.802 of 19 8 9²⁵25 Brasil. Lei nº 7802, de 11 de julho de 1989. Dispõe sobre a pesquisa, a experimentação, a produção, a embalagem e rotulagem, o transporte, o armazenamento, a comercialização, a propaganda comercial, a utilização, a importação, a exportação, o destino final dos resíduos e embalagens, o registro, a classificação, o controle, a inspeção e a fiscalização de agrotóxicos, seus componentes e afins, e dá outras providências. Diário Oficial da União. 11 Jul 1989. [acesso em 2022 nov 27]. Disponível em: https://www.planalto.gov.br/ccivil_03/leis/l7802.htm.
https://www.planalto.gov.br/ccivil_03/le... , which addresses the use of pesticides and establishes conditions for the storage and disposal of contaminated packaging, prohibiting their reuse for other purposes. Family exposure is highlighted by those who perceive the danger of accidents related to the storage of poisons in the domestic environment, aligned with the findings of Bombardi³3 Bombardi LM. Geografia do Uso de Agrotóxicos no Brasil e Conexões com a União Europeia. São Paulo: FFLCH-USP; 2017., who points out Pernambuco as the second-highest state in the country in the number of records of pesticide poisoning in children aged 0-14 in the country.

Exposure to pesticides used on crops

Table 2 clearly shows that the permanent pattern of exposure to pesticides is related to the production system, which seems to be a determinant of the lifestyles of the communities studied and prevents workers’ social mobility, which forces them to remain in that social structure that limits the reproduction of living conditions. However, the reality of work is hazardous and associated with insecurity, physical exhaustion, and unhealthy conditions¹⁶16 Vilela RAG, Laat EF, Luz VG, et al. Pressão por produção e produção de riscos: a “maratona” perigosa do corte manual da cana-de-açúcar. Rev Bras Saúde Ocup. 2015; 40(131):30-48..

In the municipalities surveyed, the economic monopoly of the sugar and alcohol sector was consolidated through the appropriation of territories and subsumption of peasant family work to the dependent chemical production process, and sugar cane cultivation was the only way of survival for most local populations. Recent studies have revealed that generating direct and seasonal jobs in this sector for less educated and people with low-income circulation in trade was perceived by local populations as a positive impact of the sugar-energy production chain²⁶26 Buhler HF, Hacon SS. Impactos da cadeia do etanol: subsídios para uma proposta integrada de vigilância ambiental e de saúde do trabalhador. Rev Bras Saude Ocup. 2022 [acesso em 2023 fev 10]; 47:e7., ²⁷27 Pessoa GS, Albuquerque PCC, Cotrim GS, et al. Uso de agrotóxicos e saúde de trabalhadores rurais em municípios de Pernambuco. Saúde debate. 2022; 46(esp2):102-21., which was the leading corporate, media, and even state argument used to justify the poisoning and permanent sacrifice of territories. As a result, the secular domination of territories by the sugarcane production process occurs by subordinating local people and ways of life to the reproduction of its predatory logic²⁸28 Pessoa VM, Rigotto RM. Agronegócio: geração de desigualdades sociais, impactos no modo de vida e novas necessidades de saúde nos trabalhadores rurais. Rev Bras Saúde Ocup. 2012; 37(125):65-77., ²⁹29 Silva GV, Santos JB, Santos AS, et al. Perfil socioeconómico de cortadores de cana-de-açúcar no município de Juripiranga (Paraíba – Brasil). Meio Amb. (Brasil). 2019; 1(2):09-17..

Mixing and spraying pesticides using backpack pumps were highlighted by the five communities in this study as the unhealthiest activities in the work flowchart. We observed the social division of labor in sugarcane already evidenced by the scientific literature⁶6 Silva CP, Guedes CA, Gurgel AM, et al. Condições de trabalho no cultivo da cana-de-açúcar no Brasil e repercussões sobre a saúde dos canavieiros. Rev Bras Saúde Ocup. 2021 [acesso em 2023 jan 3]; 46:e22. Disponível em: https://www.scielo.br/j/rbso/a/qx-ZQzVNs6P8GzZYrthN5VCH/#.
https://www.scielo.br/j/rbso/a/qx-ZQzVNs... , and the unequal distribution of risks and harm related to the occupation of jobs hazardous to the worker’s health, and poison applicators were the professional category most vulnerable to poisoning³⁰30 Preza DLC, Augusto LGS. Vulnerabilidades de trabalhadores rurais frente ao uso de agrotóxicos na produção de hortaliças em região do Nordeste do Brasil. Rev Bras Saúde Ocup. 2012 [acesso em 2023 jan 8]; 37:90-95. Disponível em: https://www.scielo.br/j/rbso/a/tBb4YhMVcDbX3PVHKKHHg7S/abstract/?lang=pt.
https://www.scielo.br/j/rbso/a/tBb4YhMVc... . The exposure burden increases depending on the types of equipment used during spraying. Lozier et al.³¹31 Lozier MJ, Montoya JF, Del Rosario A, et al. Personal air sampling and risks of inhalation exposure during atrazine application in Honduras. Int Arch Occup Environ Health. 2013; 86(4):479-88. found twice the concentration of atrazine in the personal air inhaled by sugarcane workers who use a conical spray nozzle compared to those who use a flat nozzle. Pesticide atrazine’s Active Ingredient (AI) was banned in the EU 20 years ago due to the evident harm to human and environmental health. However, local and national initiatives have been prohibiting the manufacture, use, and sale of this pesticide in Brazil³²32 Rio Grande do Sul. Projeto de Lei Estadual nº 421 de 11 de setembro de 2023. Proíbe fabricação, uso e comercialização do agrotóxico Atrazina no Estado do Rio Grande do Sul. Diário Oficial. 11 Set 2023. [acesso em 2022 nov 27]. Disponível em: http://proweb.procergs.com.br/consulta_proposicao.asp?SiglaTipo=PL%20&NroProposicao=421&AnoProposicao=2023.
http://proweb.procergs.com.br/consulta_p... , ³³33 Brasil. Ministério Público do Trabalho, Coordenadoria Nacional de Defesa do Meio Ambiente do Trabalho. Ação Civil Pública. Brasília, DF: MPT; 2023. [acesso em 2022 nov 27]. Disponível em: https://mpt.mp.br/pgt/noticias/acp-banimento-agrotoxicos-com-protocolo-judicial-3.pdf.
https://mpt.mp.br/pgt/noticias/acp-banim... only recently.

The sociodemographic profile of pesticide applicators registered in Pernambuco shows that 97.4% of registrations correspond to male workers, 71.5% aged between 18 and 49, and 65% self-declared Black and brown people. Furthermore, 63.1% of poison applicators registered in the state are self-employed, casual, and temporary workers²⁷27 Pessoa GS, Albuquerque PCC, Cotrim GS, et al. Uso de agrotóxicos e saúde de trabalhadores rurais em municípios de Pernambuco. Saúde debate. 2022; 46(esp2):102-21.. The most dangerous jobs are delegated to poor Black men, a permanent pattern of reproducing historical class, gender, and race segregation structures preserved in the territories explored by the productive sugarcane agribusiness model.

The patterns of insecurity and unhealthy conditions underlying the use of pesticides were reported by communities as routine conditions intrinsic to the ways of life subsumed by the productive context. The potential harm of pesticides to human health shows the impossibility of safe use and total control of the risks associated with these agents. The bio-cumulative, interactive, additive, and synergistic effects of exposures must be considered while producing epidemiological data and information and analyzed through theoretical and methodological triangulations based on complex systems. Furthermore, it is necessary to consider the entire problem under the socioeconomic, political, and cultural context in which the exposure occurs, reducing biases³⁴34 Friedrich K, Gurgel AM, Sarpa M, et al. Toxicologia crítica aplicada aos agrotóxicos - perspectivas em defesa da vida. Saúde debate. 2022; 46(esp2):293-15..

Workers reported the misuse or non-use of Personal Protective Equipment (PPE) during the PRD workshops, and the reasons were anchored in the discomfort during work activities with great physical effort under high temperatures and the false impression of safety regarding pesticides. These results align with other authors³⁵35 Corcino CO, Teles RBA, Almeida JRGS, et al. Avaliação do efeito do uso de agrotóxicos sobre a saúde de trabalhadores rurais da fruticultura irrigada. Ciênc. saúde coletiva. 2019; 24(8):3117-28., ³⁶36 Bortolotto CC, Hirschmann R, Martins-Silva T, et al. Exposição a agrotóxicos: estudo de base populacional em zona rural do sul do Brasil. Rev Bras Epidemiol. 2020; 23:E200027.. The statement of a resident of Itambé-PE describes a pattern of collective belief, already pointed out by Fonseca et al.³⁷37 Fonseca MGU, Peres F, Firmo JOA, et al. Percepção de risco: maneiras de pensar e agir no manejo de agrotóxicos. Ciênc. saúde coletiva. 2007; 12(1):39-50., in which there is an association between odor and the substantial danger of the poison, which implies a tendency towards greater exposure of those workers who disbelieve in the toxicological potential of odorless pesticides and abdicate PPE use.

Pesticide use by rural workers was also marked in the study by Pessoa et al.²⁷27 Pessoa GS, Albuquerque PCC, Cotrim GS, et al. Uso de agrotóxicos e saúde de trabalhadores rurais em municípios de Pernambuco. Saúde debate. 2022; 46(esp2):102-21., mainly by the lack of training and non-use of PPE, even with a crucial weekly frequency of pesticide application using a manual knapsack sprayer. Authors highlight that obtaining information about pesticides occurs through social relationships between neighbors or television programs and only a tiny group from technical professionals. In contrast, another portion still needs reliable information about pesticides handled in everyday life³⁸38 Santana CM, Costa AR, Nunes RMP, et al. Exposição ocupacional de trabalhadores rurais a agrotóxicos. Cad Saúde Colet. 2016; 24(3):301-7..

The workers and residents of the communities analyzed identified the main routes of pesticide exposure, listed in table 3, in dialogue with the findings of Mattia and Ródio³⁹39 Mattia PI, Ródio GR. Variáveis associadas à intoxicação ocupacional por agrotóxicos agrícolas, na mesorregião oeste do Paraná, de 2010 a 2020. Res, Soc Development. 2022; 11(5):e33011528260. in Paraná, which express the multiple biological pathways that harm the sugarcane production process imposed on workers.

Exposure to pesticides through inhalation was reported in the five territories studied and noted in all stages of the work flowchart in the sugarcane fields. The condensed meanings from the statements revealed reports on sensory perceptions linked to the strong odor emanated by some pesticides in the management and mixing activities of the poison cocktail applied to the crops and aerosols dispersed in the atmosphere during soil spraying.

The volatility of pesticides was verified by Yera and Vasconcelos⁴⁰40 Yera AMB, Vasconcellos PC. Pesticides in the atmos-phere of urban sites with different characteristics. Process Sa-fety and Envir. Protec. 2021; 156:559-67., in which AI was found in samples of fine particulate matter collected in São Paulo’s urban and rural areas, and the atmospheric transport was an element of solid dispersion and ecosystem pollution. Another recent study⁴¹41 Msibi SS, Chen CY, Chang CP, et al. High pesticide inhalation exposure from multiple spraying sources amongst applicators in Eswatini, Southern Africa. Pest Manag Sci. 2021; 77(10):4303-12. in South Africa verified concentrations of four pesticides in the personal air inhaled by sugarcane workers during work, identifying agents such as 2,4-D, a poison widely cited by the communities in this research. Inhalation is also a route of exposure to polluting gases, particulate materials⁴²42 Vasconcellos PC, Souza DZ, Sanchez-Ccoyllo OS, et al. Determinação de compostos antrópicos e biogênicos em aerossóis atmosféricos coletados em áreas urbanas, queimadas de biomassa e florestas em São Paulo, Brasil. Ciênc Meio Amb Total. 2010; 408(23):5836-44., and other toxic elements, such as polycyclic aromatic hydrocarbons produced during biomass combustion⁴³43 Caruso MSF, Alaburda J. Hidrocarbonetos policíclicos aromáticos - benzo(a)pireno: uma revisão. Rev. Inst. Adolfo Lutz. 2008; 67(1):1-27. with atmospheric dispersion and burning before sugarcane harvesting in the municipalities studied.

Exposure through ingestion was reported by communities and related to daily agricultural work’s unhealthy practices, such as workers using their mouths to unclog the sprayer nozzle, mixing poisons with hands, chewing sugarcane lumps during painful working hours, and other practices. The chronic family intake of contaminated food and water is also noteworthy, aligning with the results by Oliveira et al.⁴⁴44 Oliveira EG, Ferreira ME, Araújo FM. Diagnóstico do uso da terra na região centro-oeste de Minas Gerais, Brasil: a renovação da paisagem pela cana-de-açúcar e seus impactos socioambientais. Soc e Natureza. 2012; 24(3):545-56. in their research on sugarcane agribusiness.

The Brazilian deregulation of the use of pesticides generally exposes the population to food and nutritional insecurity, specifically burdening the most vulnerable populations⁴⁵45 Gurgel AM, Guedes CA, Friedrich K. Flexibilização da regulação e agrotóxicos enquanto oportunidade para a (necro)política brasileira: avanços do agronegócio e retrocessos para a saúde e o ambiente. Desenv Meio Amb. 2021; 57:135-59.. Only glyphosate has an authorized MRL in Brazil, five thousand times higher in drinking water than international parameters³3 Bombardi LM. Geografia do Uso de Agrotóxicos no Brasil e Conexões com a União Europeia. São Paulo: FFLCH-USP; 2017.. The Dossier on water contamination in the Brazilian Cerrado, which denounced the disastrous scenario in all states that make up the biome, identified at least one AI in more than 70% of water collection points in seven communities in the region exploited by agribusiness. Furthermore, nine different AI pesticides were identified in a single water sample collected in Maranhão, indicating multiple exposures to concentrations up to 32 times higher than the parameters authorized in the EU⁴⁶46 Lopes HR, Gurgel AM, Melo LC. Vivendo em territórios contaminados [livro eletrônico]: um dossiê sobre agrotóxicos nas águas de Cerrado. In: Pontes M, Bonfim J, Santos PV, organizadoras. Palmas: APATO; 2023..

We should emphasize the fact that communities identify the ingestion of pesticides as the main route of exposure used in attempted or committed suicide among local populations. Other studies converge on these findings and endorse the discussion of a systematic reality still observed in different territories permanently exposed to pesticides⁴⁷47 Pires DX, Caldas ED, Recena MCP. Uso de agrotóxicos e suicídios no Estado do Mato Grosso do Sul, Brasil. Cad. Saúde Pública. 2005; 21(2):598-605., ⁴⁸48 Tavares DCG, Shinoda DT, Moreira SSC, et al. Utilização de agrotóxicos no brasil e sua correlação com intoxicações. Revista S&G. 2020; 15(1):2-10., ⁴⁹49 Torre E, Amarante P. Saúde mental, direitos humanos e justiça ambiental: a ‘quimicalização da vida’ como uma questão de violação de direitos humanos decorrente da intoxicação institucionalizada. Saúde debate. 2022; 46(esp2):327-44..

Exposure by dermal absorption was also reported by the communities analyzed, associated by workers with handling, mixing, and applying poisons to crops and direct contact between the worker’s skin and contaminated crops during the sugar cane manual cutting and harvesting. Dermal exposure to pesticides is the most common route associated with occupational poisoning, with the prevalence of symptoms significantly high (p-value = 0.032) in the group of workers who do not use waterproof clothing⁵⁰50 Silva AP, Camacho ACLF, Menezes HF, et al. Riscos à saúde do trabalhador rural exposto ao agrotóxico. Rev Saúde Colet. 2020; 10(52):2094-02..

The exposure routes described in this section are observed in other analyses⁴¹41 Msibi SS, Chen CY, Chang CP, et al. High pesticide inhalation exposure from multiple spraying sources amongst applicators in Eswatini, Southern Africa. Pest Manag Sci. 2021; 77(10):4303-12., ⁵¹51 Souza GS, Costa LCA, Maciel AC, et al. Presença de agrotóxicos na atmosfera e risco à saúde humana: uma discussão para a Vigilância em Saúde Ambiental. Ciênc. saúde coletiva. 2017; 22(10):3269-80., ⁵²52 Marques JMG, Silva MV. Estimativa de ingestão crônica de resíduos de agrotóxicos por meio da dieta. Rev Saúde Pública. 2021; 55:36. and are related to several clinical outcomes in acute, chronic, and fatal forms described in table 4.

Harm to worker’s health

The statements evidence community perceptions about illness related to permanent exposure to pesticides and describe clinical manifestations with acute, chronic, and fatal progression. A recent study in the Northeast found that 74.6% of the rural population in Juazeiro and Petrolina reported having had some pesticide poisoning symptoms throughout their lives³⁵35 Corcino CO, Teles RBA, Almeida JRGS, et al. Avaliação do efeito do uso de agrotóxicos sobre a saúde de trabalhadores rurais da fruticultura irrigada. Ciênc. saúde coletiva. 2019; 24(8):3117-28..

Acute health harm was identified through reports referring to immediate signs and symptoms with localized clinical expression, such as headache, stomach pain, nausea, vomiting, diarrhea, and itching. Some also reported systemic manifestations, such as dizziness, fainting, convulsions, and severe respiratory failure, and requests for urgent medical intervention were common. Acute and immediate symptoms are often related to respiratory exposure through inhalation of pesticides during work in sugarcane fields⁶6 Silva CP, Guedes CA, Gurgel AM, et al. Condições de trabalho no cultivo da cana-de-açúcar no Brasil e repercussões sobre a saúde dos canavieiros. Rev Bras Saúde Ocup. 2021 [acesso em 2023 jan 3]; 46:e22. Disponível em: https://www.scielo.br/j/rbso/a/qx-ZQzVNs6P8GzZYrthN5VCH/#.
https://www.scielo.br/j/rbso/a/qx-ZQzVNs... .

Regarding chronic harm, the statements described later and typical clinical manifestations of endocrine, metabolic, hepatic, hematological, and oncological diseases. Some chronic harm reported by communities was diagnosed by medical professionals who associated the illness with permanent exposure to pesticides to which workers are subjected in their daily lives. When it occurs during critical periods of development, exposure can cause severe and potentially irreversible harm to future generations. For example, in early childhood behavioral neurodevelopment and fetal maturation, deleterious effects can permanently harm those exposed. Effects are observed in the fetal period, primarily in the first trimester of pregnancy, so that exposure to pesticides can be decisive in developing malformations and prematurity⁵³53 Lessuer C, Lesseura C, Pirrotteb P, et al. Maternal urinary levels of glyphosate during pregnancy and anogenital distance in newborns in a US multicenter pregnancy cohort. Environ Pollut. 2021; 280:117002., ⁵⁴54 Lesseur C, Pathak KV, Pirrotte P, et al. Urinary glyphosate concentration in pregnant women in relation to length of gestation. Environ Res. 2022; 203:111811., miscarriages, low birth weight, and other adverse outcomes⁵⁵55 Rahimi T, Rafati F, Sharifi H, et al. General and reproductive health outcomes among female greenhouse workers: a comparative study. BMC Women’s Health. 2020; 20(1):103..

Community reports also described fatal cases resulting from workplace accidents due to poisoning. They highlighted the sudden nature of the worker’s systemic collapse and the inability to reverse the sudden outcome, as some could not be transferred to an emergency unit in time. Other testimonies narrate the irreversibility of acute or chronic damage, even when there was guaranteed access to adequate services and care, and death was the outcome resulting from the illness process. These results converge with the findings observed by Tavares et al.⁴⁸48 Tavares DCG, Shinoda DT, Moreira SSC, et al. Utilização de agrotóxicos no brasil e sua correlação com intoxicações. Revista S&G. 2020; 15(1):2-10., in which higher rates of deaths due to pesticide poisoning in 2007-2017 are in Pernambuco and São Paulo.

This myriad of acute, chronic, and fatal outcomes is widely known in the scientific literature⁵¹51 Souza GS, Costa LCA, Maciel AC, et al. Presença de agrotóxicos na atmosfera e risco à saúde humana: uma discussão para a Vigilância em Saúde Ambiental. Ciênc. saúde coletiva. 2017; 22(10):3269-80., ⁵⁶56 Rigotto RM, Porto MFS, Folgado CAR, et al. Conhecimento científico e popular: construindo a ecologia de saberes. In: Associação Brasileira de Saúde Coletiva. Dossiê ABRASCO: um alerta sobre os impactos dos agrotóxicos na saúde. Rio de Janeiro: EPSJV; São Paulo: Expressão Popular; 2015., ⁵⁷57 Lopes CVA, Albuquerque GSC. Agrotóxicos e seus impactos na saúde humana e ambiental: uma revisão sistemática. Saúde debate. 2018; 42(117):518-34.. This health situation emerges from the chemical-dependent capitalist model in which agribusiness represents overload, demands, and costs for health services, showing the need to reorganize the health system towards precautionary, mitigation, and damage repair strategies, besides strengthening worker and environmental health surveillance actions.

Despite the damages mentioned in this and other studies⁵¹51 Souza GS, Costa LCA, Maciel AC, et al. Presença de agrotóxicos na atmosfera e risco à saúde humana: uma discussão para a Vigilância em Saúde Ambiental. Ciênc. saúde coletiva. 2017; 22(10):3269-80., ⁵³53 Lessuer C, Lesseura C, Pirrotteb P, et al. Maternal urinary levels of glyphosate during pregnancy and anogenital distance in newborns in a US multicenter pregnancy cohort. Environ Pollut. 2021; 280:117002., ⁵⁴54 Lesseur C, Pathak KV, Pirrotte P, et al. Urinary glyphosate concentration in pregnant women in relation to length of gestation. Environ Res. 2022; 203:111811., ⁵⁵55 Rahimi T, Rafati F, Sharifi H, et al. General and reproductive health outcomes among female greenhouse workers: a comparative study. BMC Women’s Health. 2020; 20(1):103., ⁵⁶56 Rigotto RM, Porto MFS, Folgado CAR, et al. Conhecimento científico e popular: construindo a ecologia de saberes. In: Associação Brasileira de Saúde Coletiva. Dossiê ABRASCO: um alerta sobre os impactos dos agrotóxicos na saúde. Rio de Janeiro: EPSJV; São Paulo: Expressão Popular; 2015., ⁵⁷57 Lopes CVA, Albuquerque GSC. Agrotóxicos e seus impactos na saúde humana e ambiental: uma revisão sistemática. Saúde debate. 2018; 42(117):518-34., research highlights the troubling underreporting of poisoning cases in Brazil⁵⁸58 Malaspina FG, Zinilise ML, Bueno PC. Perfil epidemiológico das intoxicações por agrotóxicos no Brasil, no período de 1995 a 2010. Cad Saúde Colet. 2011; 19(4):425-34., ⁵⁹59 Albuquerque PCCC, Gurgel IGD, Gurgel AM. Health information systems and pesticide poisoning at Pernambuco. Rev. Bras. Epidemiol. 2015; 18(3):666-78.. Among the reported cases are different issues with records in health information systems, such as non-identification of chronic cases, incomplete and inadequate data, and information that cannot support planning actions and implementation of specific public policies to address priority problems⁵⁹59 Albuquerque PCCC, Gurgel IGD, Gurgel AM. Health information systems and pesticide poisoning at Pernambuco. Rev. Bras. Epidemiol. 2015; 18(3):666-78..

There are significant gaps in the scientific literature on the additive, interactive, synergistic effects of analyzing chronic and permanent exposure since the challenge of toxicological studies already produced is the difficulty of analyzing multiple simultaneous exposures to the combination of toxic substances⁵²52 Marques JMG, Silva MV. Estimativa de ingestão crônica de resíduos de agrotóxicos por meio da dieta. Rev Saúde Pública. 2021; 55:36., recommending the use of critical and contextualized toxicology for a broader understanding of the problem that considers the subjects based on their life experiences, problems, and health needs³⁴34 Friedrich K, Gurgel AM, Sarpa M, et al. Toxicologia crítica aplicada aos agrotóxicos - perspectivas em defesa da vida. Saúde debate. 2022; 46(esp2):293-15.. Strategies of this nature prevent these territories made vulnerable by agribusiness from becoming sacrificial zones imposed by this model of Brazilian development, in which nature and people are plundered to guarantee the accumulation of a few in an Ecocide process that is the racist, modern-colonialist product in the biome⁶⁰60 Egger DS, Rigotto RM, Lima FANS, et al. Ecocídio nos Cerrados: agronegócio, espoliação das águas e contaminação por agrotóxicos. Desenvolv. Meio Amb. 2021; 57(esp):16-54..

The limitations of this study are related to the nature of the methodology chosen for the production of primary research data, whose results represent, exclusively, the perception of the participating subjects involved during the PRD workshops held in the selected territories, and their representation cannot be extrapolated to the municipal level and others. Furthermore, the PRD provides a general analysis of priority problems and complementary data collection and analysis techniques and tools for a more in-depth understanding of the problems listed in this diagnosis.

Final considerations

We can see that sugarcane work patterns and characteristics have critical elements of the health-disease process that emerge from a historical and socio-environmental construct in which the epidemiological profile of the territories under the control of sugar and alcohol agribusiness is subsumed. Such results are relevant for the construction of Primary Health Care territorialization strategies, which include area diagnosis and mapping of areas most vulnerable to pesticide poisoning, supporting the planning of promotion, prevention, and monitoring actions for exposed populations, establishing referral and counter-referral flows for acute and chronic cases, besides strengthening local health, environmental, and occupational health surveillance strategies.

It is urgent and necessary to build public policies and socio-environmental legislation based on the involvement of exposed populations with active participation in all stages, from planning, implementation, and inspection of coping strategies to periodic monitoring and evaluation in epidemiological, health, environmental, and occupational surveillance. We recommend promoting family farming with diversification, flow, and distribution of agroecological production by strengthening community organization resources and forms, expanding access to rural credit, and continuous technical assistance based on worker safety.

References

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