Estudo sobre as condições de vida, trabalho e saúde de trabalhadores agrícolas no Brasil: uma análise dos dados da Pesquisa Nacional de Saúde, 2013

Introduction: Brazilian agriculture is an economic activity that generates revenues for Brazil in the order of billions of dollars performed by 15 million workers. However, the country occupies the first place in the world ranking of pesticide use with progressive increases in the last ten years associated with the increasing incidence of pesticide poisoning in the Brazilian population. Researchers have shown that this chemical-dependent agricultural model has generated environmental damages, illness of the agricultural population and negative social effects. Objectives: 1) to gather relevant scientific evidence on the main health problems associated with occupational exposure to pesticides; 2) to compare living and working conditions and access to health services between Brazilian agricultural and non-agricultural workers; 3) to compare the pattern of illness, lifestyle and oral health between Brazilian agricultural and non-agricultural workers. Methods: Three articles were developed. The first article consisted of a literature review of studies published between 2000 and 2017, in the bibliographic bases: Pubmed, Embase and Lilacs. Eligibility criteria were: a) observational studies; b) population of agricultural workers; c) occupational exposure to pesticides; d) outcome, defined as health problems; e) use of statistical tests to compare exposed with unexposed; f) English, Portuguese or Spanish languages. The second and third article were developed with data from the National Health Survey (NHS, 2013) from a representative sample of the Brazilian employed population, classified into agricultural (n=3755) and nonagricultural workers (n=33300) For the second article, variables on living and working conditions, socio-demographic, economic and access to health services were used. And for the third article, self-reported morbidities, lifestyles and oral health variables were analyzed. In both articles, statistical tests were used to compare the proportions among the agricultural and non-agricultural populations, considering the complex sampling design. In article three, the crude and age-standardized prevalence rates for NCDs and their CIs were calculated. Results: In the first article, 132 studies were identified (21 in EMBASE, 45 in LILACS and 66 in PUBMED). Of these, 54 publications were eligible and subsequently five studies were added totaling fifty-nine manuscripts (33 cross-sectional studies, 22 cohort studies and 04 casecontrols). The studies revealed significant associations between exposure to pesticides and subclinical conditions, chronic diseases, and signs and symptoms of poisoning in agricultural workers. In the second article, agricultural workers had worse living conditions, lower purchasing power, greater exposure to solar radiation and chemical agents and higher frequency and severity of occupational accidents compared to non-agricultural workers. The agricultural population had greater coverage of the FHS, sought medical care in SUS to treat diseases, while the non-agricultural, sought private medical care for preventive actions. The third article revealed that agricultural workers, compared to non-agricultural workers, had a higher prevalence of back problems and lower asthma / bronchitis. For the other NCDs there were no significant differences. The agricultural workers in relation to non-agricultural workers reported a higher proportion of non-good self-rated health (SRH), limitation of usual activities due to long-term chronic disease and reported a higher number of NCDs Relative to lifestyles, the agricultural workers showed higher prevalence of smoking and leisure-time physical inactivity, lower fruits and vegetables consumption, a high proportion of overweight and obesity, when compared to non-agricultural workers. Regarding oral health, there was a higher percentage of non-good oral SRH, lower frequency of tooth brushing and greater tooth loss in agricultural workers when compared to non-agricultural workers. Conclusion: The agricultural population is neglected in terms of actions to improve life, has worse working, but with a pattern of illness similar to that of non-agricultural populations. Such findings indicate the need to act on the determinations of the health-disease process in order to promote and protect the health of this group of workers. Equally important is to promote the health surveillance of the agricultural population through periodic surveys that collect information on exposure to pesticides, referred morbidity, in addition to laboratory tests for genotoxicity that can measure subclinical conditions.