Since 2002, Santé publique France has undertaken various initiatives to expand knowledge of occupational and environmental risks associated with pesticide exposure and to improve the methods and tools related to this issue. Santé
publique France’s work focuses on three main areas:

• Monitoring pesticide exposure and its health consequences;

• Gaining a better understanding of exposure and health risks for certain at-risk population groups;

• Taking action to limit exposure and respond to emergency situations involving pesticide exposure.

Monitoring pesticide exposure and related health effects

Santé publique France has initiated various monitoring efforts regarding the population’s exposure to pesticides and health indicators suspected to be linked to pesticide exposure.

Several projects are currently underway:

Monitoring of pesticide exposure in the general French population 

To complement the results of the ENNS and Elfe studies, Santé publique France is currently conducting the Esteban study. This study will provide a picture of pesticide exposure among the general population in mainland France, and for the first time among children over the age of 6. The initial results will be available in 2020.

Monitoring of health indicators suspected to be linked to pesticide exposure

• Parkinson’s disease

A collaborative study conducted by Inserm and Santé publique France and funded under the Ecophyto plan examined the geographic distribution of Parkinson’s disease in metropolitan France between 2010 and 2012, and assessed the relationships, at the cantonal level, with various agricultural activities (13 crops, 5 livestock sectors). This study shows, on the one hand, an increase in the incidence of the disease in the most rural areas and, on the other hand, a 10% higher number of new cases in the cantons with the highest concentration of vineyards. While the results must be interpreted in light of the limitations noted by the authors in their article, the fact that viticulture is among the crops with the highest pesticide use suggests that environmental exposure to pesticides (via air, water, or soil) among residents of these cantons is a possible explanation for these findings.

This study continues with a more precise identification of the pesticides used in viticulture, notably using the vineyard crop-exposure matrix.

• Reproductive Health

Many pesticides are suspected of having endocrine-disrupting properties, and for some, their effects on reproductive health are known. Examples include DDT and Vinclozolin, which are now banned.
The surveillance system established by Santé publique France allows, among other things, for the analysis of spatial variations and causal hypotheses for certain selected conditions. Exposure to pesticides used in agriculture is one of the hypotheses being studied. Precocious puberty is one of the conditions being studied. The epidemiology of this condition (trends over time, geographic distribution, etc.) remains largely understudied, even at the international level. However, Santé publique France conducted a study that concluded the feasibility of epidemiological surveillance of precocious puberty in France, using data on drug reimbursements from the national health insurance system. The initial results of this nationwide surveillance were published in May 2017. The annual incidence rate of idiopathic central precocious puberty (with no identified or treated cause) is estimated at 2.68 per 10,000 among girls, or 1,173 new cases per year, and at 0.28 per 10,000 among boys, or 117 new cases per year (estimates based on 2011–2013 data).

Monitoring of workers exposed to pesticides: COSET-MSA cohort study

The COSET-MSA study involves monitoring the health status and working conditions of workers in the agricultural sector over several years; its objectives are to identify high-risk occupations and working conditions and to measure their impact on the population’s health in order to propose recommendations for prevention.

This study will be conducted in parallel in other occupational sectors.

It began with a pilot phase in February 2010 in the departments of Bouches-du-Rhône, Finistère, Pas-de-Calais, Pyrénées-Atlantiques, and Saône-et-Loire, involving a sample of volunteers selected by random draw.

In 2018, the cohort was expanded to cover all of France, including the overseas departments. Recruitment for the two cohorts—Coset-Indépendants and Coset-MSA—was completed in July 2018. The final counts were 20,361 and 27,044 respondents, respectively. The first results on the health status of the target populations of these studies will be available in 2020.

Epidemiological Surveillance of Agricultural Workers Exposed to Chlordecone in Martinique and Guadeloupe

• This initiative is being carried out as part of the Chlordecone Plan, in partnership with Inserm Unit 1085.

• The main objective is to retrospectively reconstruct a cohort of farm managers and agricultural workers who worked between 1973 and 1993 on a banana plantation in Martinique and Guadeloupe.

• The reconstructed cohort includes 13,417 farm operators and employees who were active on a banana plantation between 1973 and 1993 (the period during which chlordecone was used) in Guadeloupe and Martinique. Information on the workers’ employment history during this period, their vital status, and causes of death was also collected. The collected data will be used to study cause-specific mortality among these workers and compare it to that of the general population. It will also be possible to determine these workers’ exposure to pesticides using the crop-exposure matrices developed as part of the Matphyto program and to analyze the cohort’s mortality according to exposure levels to chlordecone and other pesticides. Finally, a morbidity study can be conducted on this cohort by utilizing information from cancer registries or cross-referencing with data from medical-administrative databases to identify excess risks of certain chronic conditions (cancers, neurodegenerative diseases, etc.).

• The initial results, covering the period 2000–2015, show that mortality in the cohort is generally similar to that in the general Caribbean population. These preliminary data are likely to be refined as the analyses progress. These initial results were presented during a scientific symposium held in the Caribbean in October 2018.

Understanding Exposure and Health Risks Among At-Risk Population Groups

Characterizing pesticide exposure and cancer risk among residents living near agricultural crops

Santé publique France, in collaboration with ANSES and Inserm, is launching two studies aimed at addressing the question of links between pesticide exposure and the incidence of pediatric cancers in wine-growing regions.

• Géocap-Agri Study

Santé publique France and Inserm are currently conducting a national case-control study called Géocap-Agri. It aims to determine whether living near certain crops (vineyards, orchards, corn, etc.) increases the risk of certain cancers in children under 15 in mainland France (leukemias, brain tumors, embryonal tumors). This research program is part of the Géocap program established by Inserm in 2002 to study environmental risk factors for pediatric cancers

• Exposure Study Among Residents Living Near Agricultural Crops

This study, conducted by Santé publique France in collaboration with ANSES, aims to better understand pesticide exposure among people living near agricultural crops and the determinants of this exposure (diet, domestic use of plant protection products, drift of agricultural pesticides, etc.).
Exposure estimates will be based on complementary biological (urine, hair, and blood, if possible) and environmental (dust, indoor air, and, if possible, ambient air, food, and water) measurements. These measurements will help achieve the study’s main objectives, namely:

1. Describe the environmental contamination and exposure of residents living near agricultural crops to pesticides used in agriculture;

2. Identify potential overexposure of this population by comparing it with a population not living near agricultural crops;

3. Gain a better understanding of the determinants of exposure to aid in the implementation of management or prevention measures.

Characterize occupational exposure to pesticides and its consequences

• The Matgéné Program

Beyond pesticide use in the agricultural sector, there are many workers who handle pesticides on a daily basis and who, to varying degrees, are affected by exposure to these chemicals. Examples include:

• workers in parks, cemeteries, and gardens in the private sector or for local governments,

• road maintenance workers responsible for the upkeep of the road network,

• building sanitation workers (specialized work involving disinfection, pest control, or rodent extermination in buildings).

To date, no tool has been developed to assess occupational exposure to pesticides among the entire working population in France.

Occupational exposure matrices (OEMs) are, in this case, a useful tool for reconstructing current and past occupational exposures to pesticides.

The ongoing project aims to develop “multi-hazard” pesticide job-exposure matrices specifically tailored to the French workforce. This project is part of the MATGENE program, which has been conducted for over 10 years within Santé publique France.

The term “multi-hazard” is used to indicate that pesticide exposure will be assessed based on existing categories: fungicides, herbicides, and insecticides, as well as through the use of biocides and veterinary drugs.

• The Matphyto Program

Matphyto is a project dedicated to the assessment of occupational exposures. It involves the construction of crop-exposure matrices (CEMs) that describe the monitoring and trends in the use of plant protection products on major crops in France. The CEMs are designed to document, retrospectively (since the 1950s) and for metropolitan France, the use of arsenic-based products (viticulture, arboriculture, potato cultivation) and the various chemical families of insecticides, herbicides, and fungicides for the cultivation of straw cereals, potatoes, corn, and viticulture (currently under development). Thus, rather than a substance-based approach, the project prioritizes a crop-based approach to better understand exposure throughout a professional career—a necessary element for epidemiological surveillance, health monitoring, and the recognition of occupational diseases.

In the absence of a complete history of pesticide use on agricultural crops in France, the construction of crop-exposure matrices involves: 1) a literature review of parameters documenting the agricultural crop under study and the products used on it; 2) the compilation of data to quantify pesticide use; 3) the definition of periods and indices of use and, where applicable, different geographic areas, 4) the evaluation of indices of use by period and by area.

• Acta Index

To improve understanding of past occupational exposures, Santé Publique France collaborates with the Association de coordination technique agricole (Acta), which has published an annual phytosanitary index since 1961 describing all authorized agricultural uses for each available active ingredient.

The purpose of compiling these indexes is to identify the uses approved each year for each active substance and to track them continuously over the past 50 years. In this context, Santé publique France is responsible for interpreting, standardizing, and entering the data, enabling methodological work regarding the choice of groupings to be made between substances and/or periods, selection biases to be avoided or acknowledged, and compliance with technical requirements regarding the homogeneity of the data to be collected.

• Cipatox 

Conducted in 2016, this project aimed to add a toxicological component to the CIPA database (Compilation of Phytosanitary Indexes Acta) by documenting the effects of active substances listed by ACTA across 11 health effects:
carcinogenicity, mutagenicity, reproductive toxicity, respiratory effects, immunotoxicity, neurotoxicity, hepatotoxicity, nephrotoxicity, cardiotoxicity, hematotoxicity, endocrine disruption. A key rationale for this project was to facilitate the investigation of potential occupational causes of diseases with delayed onset. These effects were identified using several European databases (European lists of endocrine disruptors), based on VTRs from French (FURETOX) and American (IRIS, TOXNET) databases, or on potentially regulatory classifications (EU, IARC, US-EPA) for carcinogenic, mutagenic, or reprotoxic effects.

A more in-depth component of CipaTox on endocrine disruption was conducted in 2018.

Taking action to limit exposure and respond to emergency situations

Limiting exposure

Applying the precautionary principle to sensitive populations is justified to reduce pesticide exposure. As with other chemicals, Santé publique France’s recommendations for limiting exposure to air pollutants may apply. Similarly, the new dietary guidelines can be followed to reduce exposure to pesticides present in food.

On a personal level

• Pesticides must not be used around pregnant women throughout the entire pregnancy or in the presence of young children, who may be particularly exposed through playing on the ground and putting their hands in their mouths.

• The use of products in gardens (weed killers) or for indoor plants has been PROHIBITED since January 1, 2019.

In general, as with all household products, a few simple guidelines should be followed:

• DO NOT EXPOSE VULNERABLE PEOPLE to pesticides. Whenever possible, they should not be used by pregnant women throughout their pregnancy or in the presence of infants and young children. The same applies to people with asthma or allergies.

• LIMIT THE USE OF insecticides in the home and pest control products for pets as much as possible.

• When purchasing a pesticide, ask yourself the following questions: “Is this really necessary? Isn’t there another solution?”

• If use is unavoidable, it is important to FOLLOW THE USAGE AND STORAGE INSTRUCTIONS listed on the packaging to minimize human and environmental exposure to chemicals:

  • Store products out of children’s reach, in well-ventilated, unheated areas away from living spaces;

  • Do not mix products or use them simultaneously or in close proximity;

  • Never transfer products to a container other than the original one;

  • Do not use in the presence of children;

  • Do not remain in the room after using aerosols (ventilate before returning to the room);

  • Ventilate the room during and after use;

  • Wear protective gear such as gloves and a mask during application, as well as clothing that covers the body (boots, pants, long sleeves);

  • Handle with care and avoid inhaling the product directly (wear a mask if possible);

  • Follow the manufacturer’s recommended dosage (do not increase the amount);

  • Peel fruits and vegetables that can be peeled and wash the others thoroughly;

  • Wash your hands thoroughly after use and, if possible, take a shower;

  • For human or veterinary medications, strictly follow the instructions on the package insert.

How can you protect yourself from exposure to sprayed products used to control mosquitoes (vector control)?

To reduce the population’s exposure to chemical risks (especially young children, pregnant women, and vulnerable individuals) during pest control campaigns conducted near homes, the following recommendations should be followed:

• stay indoors with doors and windows closed during spraying hours;

• wait 15 days before consuming fruits and vegetables that have been sprayed;

• Wash thoroughly and peel fruits and vegetables from gardens near the treated area;

• clean and remove roots outside the home to prevent soil from being brought inside;

• vary the sources of the fruits and vegetables you consume;

• Keep children away from the treated area; if this is not possible, ensure they engage in activities that limit skin contact with the treated soil and the ingestion of dust (reading, watching TV, indoor games, etc.);

• take all necessary measures to ensure good hygiene, especially for children:

  • clean shoes and change into clean ones upon entering the home

  • wash your hands and your children’s hands very regularly;

  • Keep nails short and brush them frequently;

  • Wipe down floors, furniture, window sills, and pavers near the house with a damp cloth while wearing gloves;

  • Wash children’s toys regularly.

Additional guidelines regarding insecticides or other biocides:

• Prefer insecticide-free lice treatments (ideally vegetable oils that suffocate lice, combined with meticulous combing using a suitable comb—with teeth spaced less than 0.3 mm apart—and washing of clothing and fabrics that come into prolonged contact with the head, such as seats or pillows).

• Against insects, parasites, rodents, etc.: use physical methods (mosquito nets, traps, fly swatters, sticky tape, etc.).

• Against bacteria, viruses, fungi, and mites: prioritize ventilating living spaces rather than using “sanitizing” sprays.

Guidelines regarding food:

• Peel and wash fruits and vegetables thoroughly before eating them (this recommendation also applies to organic products);

• Diversify your diet and food sources;

• Choose seasonal fruits and vegetables as well as local products;

• Consume organic products whenever possible. In the dietary guidelines for adults from the 2017–2021 National Nutrition and Health Program, the High Council for Public Health recommends prioritizing organic production methods, as they limit exposure to pesticides (with the exception of persistent contaminants such as dioxins, organophosphates, and mycotoxins). It also notes that a fatty and/or sugary organic product is not healthier simply because it is organic from a purely nutritional standpoint.

From a professional standpoint

Many workers—including farmers, horticulturists, workers in private parks and gardens, those maintaining green spaces not open to the public or sports fields, certain road maintenance crews, etc.—use pesticides frequently and extensively, which, as with any chemical product, can pose significant health risks.

As with any activity that may involve exposure to hazardous chemicals, the employer must conduct a risk assessment and is required to record the results in the Single Safety Document. They must also replace hazardous pesticides with less hazardous alternatives, limit their use to what is strictly necessary, adopt good occupational hygiene practices, train employees on these risks, and provide them with appropriate personal protective equipment (coveralls, gloves, boots, masks).

During the various stages of professional pesticide use, the most significant contamination occurs through skin contact. However, contamination via inhalation or ingestion (swallowing inhaled particles, contaminated hands brought to the mouth) should not be overlooked.

The Ecophyto Plan, launched in 2008, is the French implementation of the national action plan required of Member States by Directive 2009/128 to move toward the sustainable use of pesticides. It aims to reduce the risks and impacts of plant protection products on human health and the environment, and encourages the adoption of integrated pest management and alternative techniques to reduce dependence on pesticide use.

Since 2015, Certiphyto, an individual training certificate, has been mandatory for purchasing and applying pesticides for professional use. It helps raise awareness among agricultural workers about the health effects of pesticides and the safe practices they need to adopt to avoid exposure.