Agricultural practices have significant health implications. Common practices and production inputs, used to maximize yields, negatively impact human health and environmental conditions. 

• Farmworkers and owners face a myriad of health risks, including chronic and acute exposure to pesticides, high risk of injury, and limited access to health care.
• Routine antibiotic use in animal agriculture contributes to antibiotic resistance, diminishing the effectiveness of these drugs for human use.
• Agricultural contaminants, including pesticides, nitrates, and phosphorus, impact ground and surface water quality, affecting both urban and rural communities.
• Synthetic fertilizers deplete soil health and require intensive use of fossil fuels to produce.
• Emissions and pollution resulting from all stages of agriculture, from production (pesticide drift and methane) to distribution (carbon dioxide) affect air quality and contribute to climate change.

While rural communities and farm owners and workers face the most immediate risks from these practices, the overall impact is far-reaching. Air and water pollution from agriculture affects communities over vast areas (rural and urban), and the impacts of antimicrobial resistance and climate change transcend geography.

Agricultural practices and environmental health risks

Large-scale, conventional farming focuses on intensive single crop production, mechanization, and depends on fossil fuels, pesticides, antibiotics, and synthetic fertilizers. While this system yields high production levels, it also contributes to climate change, pollutes air and water, and depletes soil fertility. The policies and practices underlying this system contribute to the epidemic of obesity and diet-related disease in the United States, and the health impacts of this system extend well-beyond diet. For instance, agriculture is a significant source of air pollution, which contributes to a range of respiratory and cardiovascular conditions. The industrial-scale, conventional system endangers farm workers and owners, who regularly face serious occupational hazards and limited access to health care.

Public health impacts of agricultural practices

Water pollution

Water pollution resulting from conventional agricultural practices is wide-reaching, affecting both surface and groundwater sources, in agricultural communities and those located downstream. Local water systems, which may be public or privately operated, are required to monitor and report on water quality to their states, which, in turn, report to the Environmental Protection Agency. Across the country, water systems, especially smaller ones, face staffing, technical, and funding challenges that interfere with their work to monitor and safeguard water quality. Water quality standards for agriculture-related pollution levels include microbial pathogens, nutrient pollution, and pesticides. 

While the public water sources are monitored regularly for certain pollutants, (including some, but not all pesticides), private wells, which are common in rural areas, are not. 

Despite regulation and monitoring, water quality issues persist. The United States Geological Survey has found high nitrates levels in shallow monitoring wells in both agricultural and urban areas, and a 2015 report found significant water violations in the United States, for both health safety standards and monitoring practices. The impacts of such contamination can be extensive. 

In 2014, an algae bloom in Lake Erie, attributed in large part to agriculture, rendered drinking water for Toledo residents unusable for several days. In Iowa, Des Moines Water Works is undertaking an effort to increase the size of its nitrate removal facility, which can currently treat ten million gallons of water daily, to ensure it can meet water quality standards and demand. The Environmental Protection Agency recognizes nitrates as a significant health risk because they inhibit oxygen transport in the blood. Exposure is particularly harmful to children because it is associated with developmental disorders and blue baby syndrome. Treating drinking water for nitrate contamination may result in increased costs for municipalities (and also for residents), particularly if treatment requires undertaking new processes. Reducing excessive fertilizer use and using proper application and storage practices are integral to addressing water contamination.

Air pollution

Agriculture is a significant source of air pollution. Nitrogen fertilizers and use of animal waste release ammonia. When airborne, ammonia combines with combustion emissions (from vehicles and industry) to form particulate matter. Agriculture is the major source of fine-particulate matter pollution in many areas of the United States. Particulate matter (dust, dirt, soot, smoke) can be coarse or fine, with fine matter being more harmful because it can enter the lungs and bloodstream. Particulate matter exposure is associated with a range of health effects, from coughing and shortness of breath to severe asthma and premature death from cardiovascular disease. Research indicates climate change will exacerbate air quality issues by increasing ozone and particulate matter levels, which will adversely influence respiratory issues and cardiovascular conditions.

In addition to ammonia, large animal feeding operations, in particular, are a source of hydrogen sulfide, particulate matter, and volatile organic compounds. Despite concern that emissions levels from large-scale operations are high enough to warrant regulation under the Clean Air Act, EPA has not finalized development of an estimation method capable of assessing if operations should be subject to requirements set forth under the act

Climate health and greenhouse gas emissions

Climate change influences social and environmental determinants of health, including air and water quality and food security. Agriculture and related activities contribute significantly to climate change through greenhouse gas (GHG) emissions. The total accumulated emissions associated with agriculture constitutes approximately one-third of GHG emissions worldwide. These emissions result directly from agricultural practices and indirectly from associated activities, including the manufacture of inputs (fertilizer production, which is highly energy intensive) and packaging and transportation. The main forms are agriculture-related emissions are: 

• Methane: released due to enteric fermentation (the digestive process) by livestock and certain practices, such as animal manure storage. Methane accounts for one-third of agriculture-related greenhouse gas emissions. 
• Nitrous oxide: released as a result of certain soil management practices, including fertilizer use and due to the breakdown of livestock manure. The global warming potential of nitrous oxide is around 300 times greater than that of carbon dioxide. 
• Carbon Dioxide: is released across the stages of agriculture, due to deforestation and land clearing for farmland and fossil fuel use. Soil management practices can intensify or mitigate carbon dioxide release. 

Antimicrobial resistance

Agriculture accounts for the majority of antimicrobial use in the United States, with approximately 70 percent of medically important antibiotics sold nationwide being used in this sector. Antimicrobial resistance in the environment is a significant public health concern, and full understanding of the impact of low levels of antibiotics in the environment and the spread of resistance does not exist. The transfer of resistant bacteria from animals to the environment (and humans) can occur when manure from animals treated with antibiotics is applied to crops or runoff from fields enters waterways.

Food system vulnerability

Common agricultural practices contribute to overall food system vulnerability. Pesticide use supports monocropping practices that increase crop vulnerability to pests, and pesticides harm wildlife and beneficial insects, such as pollinators, that are integral to food production. The use of chemical inputs affects soil acidity, which, in turn, affects productivity. Extreme weather events linked to climate change, such as heat waves, drought, and heavy rain, impact the quality and quantity of crop yields and damage agricultural lands as well as impact food distribution channels. In addition, research indicates higher levels of carbon dioxide in the atmosphere could adversely impact the nutrient levels, particularly for certain crops.
 

Health risks for agricultural workers

Farmworkers (both owners and hired labor) face significant occupational hazards due to agricultural practices, work conditions, and the challenges of farming. The risks faced by workers vary significantly based on the type of farm on which they work. Common risks faced by agricultural workers include: 

• Access to care: Both farmworkers and farm owners face barriers accessing health care, including insurance status, the high cost of care, and demanding work schedules that make it difficult to seek care. Unauthorized and migrant workers, in particular, often lack health insurance and may be hesitant to access care due to immigration issues. For instance, a survey of Vermont dairy workers found “fear of immigration enforcement was the greatest barrier to receiving care.” Another persistent issue for farmers and farmworkers is mental health, related to financial stress, injuries, and the inherent challenges of farming, such as unpredictable weather conditions.
• Pesticide exposure: In the United States, agriculture used 899 million pounds of pesticides in 2012. Farmworkers experience direct exposure through fieldwork. Pesticide exposure has short- and long-term health effects, including increased risk for certain cancers, birth defects, respiratory illnesses, and neurological disorders. Children of farmworkers are also affected as they experience indirect exposure through drift and residues carried into the home on shoes and clothing. Prenatal exposure to organophosphate pesticides has been associated with decreased mental development and increased risk of attention deficit disorder. Research has also found an association between exposure to certain pesticides and the likelihood of developing diabetes.
• Respiratory risks and pathogen exposure: Workers in livestock agriculture face additional respiratory risks and exposure to pathogens. Livestock workers are exposed to manure, dust, and bacteria, often in confined spaces. Workers who handle cattle have a higher risk of both latent and active tuberculosis, linked to exposure to bovine tuberculosis. Poultry workers have increased risk of respiratory conditions due to exposure to dust and chemicals.
• Heat-related illness: Working outdoors, often in high temperatures and wearing heavy clothing for protection purposes, puts farmworkers at risk for heat stress and injuries, including dehydration, electrolyte imbalance, and neurological issues.
• Gender discrimination: While farmworkers as a whole face serious discrimination and labor issues, women, who make up 28 percent of farmworkers, face particular risks. As field workers, women are exposed to chemicals that affect fertility and birth outcomes. When pregnant, these women often struggle to obtain appropriate prenatal care due to factors such as cost, work schedules, language barriers, and transportation. Women also regularly face sexual harassment at work, and migrant women may face pay discrimination.
   

Recommended practices for hospital community health engagement

The health impacts of agricultural practices are location specific. To fully understand the specific community impacts, hospitals should conduct an inventory of the direct and indirect ways agricultural policies and practices may affect health — from air and water quality issues to increasing community exposure to pathogens to contributing to the climate-related risks.

Water quality

To gain a deeper understanding of community water quality, hospitals should examine the water quality monitoring and oversight in the communities they serve. Water quality monitoring is carried out by a combination of federal, state, and local authorities. The EPA Safe Drinking Water Information System is the federal database with local data on water quality violation. Specific data potentially associated with agriculture include total coliform level and nitrate level. Water pollution associated with concentrated animal feeding operations, a significant concern in nearby communities, is subject to regulation under the National Pollutant Discharge Elimination System, part of the Clean Water Act. 

Air quality

Environmental Protection Agency sets standards regulating air quality and states monitor air quality and create implementation plans, approved by EPA, to control air pollution according to its standards. Among the core criteria, pollutants monitored are ground-level ozone, particulate matter, and nitrogen oxide. Hospitals should look to the state agencies charged with monitoring air quality to understand state regulations, which may be more stringent than federal standards, and to obtain community-specific data. For instance, California has the CalEnviroScreen tool, which identifies areas most affected by pollution and includes pesticide use as an exposure indicator. 

Farmworker and farm owner health

Hospitals in agricultural communities should consider the unique health needs of farmworkers, who face significant risks to their health and safety (such as acute pesticide poisoning), and who may lack access to care. Hospitals should examine how farmworkers’ access-to-care issues may differ from those of the larger community and look for opportunities to partner with community-based organizations to address specific local conditions and health needs. Hospitals can involve farmworker organizations in the community health needs assessment process by including them in key informant interviews or working with them to survey farmworkers about their health challenges and need

Partners 

Hospitals can look to outside sources to assist in assessing health risks from industrial-scale agriculture in their communities. Public health agencies and university programs can be valuable partners in this effort, sharing environmental health resources, data, and expertise, and recommending measures for hospitals to examine and strategies to employ in support of community health. Additionally, there are multiple large nonprofit organizations focused on agriculture, environmental health, and farmworker health that can be valuable sources of data and guidance. These include Food and Water Watch and National Center for Farmworker Health (see table below).

The table below outlines specific opportunities for hospitals to assess agriculture-related health issues in their communities.
 

Learn more

• Environmental Nutrition Approach: Redefining Healthy Food in the Health Care Sector is a brief from Health Care Without Harm that explains the concept of environmental nutrition, which looks at nutrition through the lens of individual, public, social, economic, and environmental health.
• The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment, a report from the U.S. Global Change Research Program, provides a comprehensive overview of health impacts of climate change, from air and water quality and vector-borne disease to food security and mental health and well-being.
• The Union of Concerned Scientists website includes a comprehensive section on industrial agriculture and the U.S. Public Interest Research Group report, Reaping What We Sow: How Practices of Industrial Agriculture Put Our Health and Environment at Risk, provides a thorough background on agriculture in the United States.
• Exposed and Ignored: How Pesticides are Endangering our Nation’s Farmworkers, released by Farmworker Justice, provides a detailed overview of the pesticide-associated health risks faced by farmworkers in the United States.
• The External Costs of Agricultural Production in the U.S. This 2004 study estimates the monetary impact of industrial-scale agricultural production. 
• The Journal of Environmental Quality produced a special on Antibiotics in Agroecosystems, discussing the public health issues associated with the use of antibiotics in agriculture.
• Institute of Medicine’s Exploring Health and Environmental Effects of Food provides extensive information on the health and environmental impacts of the U.S. food system, examining externalities of the food system and approaches for quantifying those costs.
• National Resource Defense Council’s report, Threats on the Tap, provides a comprehensive overview of the state of drinking water monitoring and quality in the United States.
• Redefining Protein: Adjusting Diets to Protect Public Health and Preserve Resources examines the various whole protein options, other than meat, that could be incorporated into menus and diets to optimize health, environmental, social justice, and animal welfare outcomes.